SMART Policy Podcast
Podcast by the UT SMART Initiative. Host Jeremy Kourvelas speaks with experts from across the recovery ecosystem - representing healthcare, prevention, law enforcement and more - about local, state and federal drug policy to find out what is and isn't working to make this fight against addiction a little easier.
SMART Policy Podcast
Equipping Communities for Recovery: Inside Tennessee’s Lifeline Peer Project
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You're listening to the Smart Policy Podcast, a production of the University of Tennessee's Institute for Public Service. In our last episode, we heard from Uplift Appalachia that churches and communities want to help with recovery, but most don't feel equipped to take on the challenge. And there's also the persistent fear that they might get things wrong.
SPEAKER_03I haven't met a single congregation that doesn't want to help. But I've met so many who don't know how to, and because they don't know how to, they do nothing.
SPEAKER_00We can't give up if we are met with resistance because there's going to be a day when a person's ready to actually have the conversation, and we want to be there to be able to support them in that conversation.
SPEAKER_01The Tennessee Lifeline Peer Project, a statewide effort by the Tennessee Department of Mental Health and Substance Abuse Services Office of Faith-Based Initiatives, is making a massive impact in providing that vital information, training, and connection to resources. Through their team of 20 coordinators across the state, they have had a significant impact on reducing stigma and strengthening local support.
SPEAKER_03Since the inception of the program, I believe we have set up over 925 support groups throughout the state of Tennessee.
SPEAKER_00For every educational event that we do, on our last report, there was a 98% reduction in personal stigma.
SPEAKER_01My guests this month are Jessica Youngbloom, Director of Strategic Initiatives, and Jamie Harper, Director of Faith-Based Initiatives. In this conversation, we talk about why the Lifeliners are having such a huge impact.
SPEAKER_03So to go into events and hear someone from the community share their story of where they've been and where they are. It makes it personal for the community and allows them to see, okay, this isn't just those people, this is us two.
SPEAKER_00Each one of our coordinators are individuals of long-term recovery from either substance use or mental health or both.
SPEAKER_01The challenges faced by the communities they serve. How little things can make huge differences for people in recovery.
SPEAKER_03It's easy to look at a food pantry being something for the community, but that's a piece of recovery capital.
SPEAKER_01And how the long-term outcomes from this work can last deep into the future.
SPEAKER_03We will not live to be able to see the full impact. And I love that.
SPEAKER_00My name is Jessica Youngbloom, and I have the pleasure of serving as the Director of Strategic Initiatives for the Department of Mental Health and Substance Abuse Services. I oversee various community-based programs, including our Office of Faith-Based Initiatives with Jamie. I oversee our Tennessee Recovery Navigator Program, along with other items such as medication assisted treatment in emergency departments and our Pathway Scholarship Initiative. There are much more. I like to say that my position is a jack of all trades, but really it's a position that affords me the opportunity to help our department and our state identify areas and needs that aren't being met and piloting programs that may meet those needs.
SPEAKER_03I'm Jamie Harper. I'm the director of the Office of Faith-Based Initiatives through Tennessee Department of Mental Health and Substance Abuse Services. Oversee the Lifeline Peer Project coordinators, hybrid lifeline coordinators, faith-based coordinators, and collegiate recovery initiatives.
SPEAKER_00Between our mission and vision, it's like our biggest thing is we want to make sure that people who have mental health or substance use issues that they're able to thrive in their communities.
SPEAKER_01So we're here today to talk specifically about uh the Lifeline Peer Project. I think people in the space have become familiar with y'all. Uh, but for those in my audience who are not, uh just a brief overview and we'll go from there.
SPEAKER_03Well, brief overview, and this is really of the Office of Faith-based initiatives, which includes the Lifeline Peer Project. The initiative itself began uh in 2014, in August of 2014. It was under the vision of the Deputy Commissioner Marie Williams at that time and Commissioner Doug Barney. Now, it was a couple of years that they were talking about an opportunity to really leverage the faith community in the state to be able to provide services to individuals struggling with substance use disorder. And then Commissioner Barney believed that the faith community could and really should be at the front line of combating substance use disorders, especially with a rise in opioid misuse and overdoses. So Commissioner Barney, Deputy Commissioner Williams went out, they were heard this guy was supposed to be speaking and they need to go listen to him. They saw Dr. Monty Burke speak about his personal path to recovery, as well as the role of the faith community and how they played in the process. And they're just like, okay, that's the guy. So since then, and at that time, the Department of Mental Health created the first director of faith-based initiatives. His responsibility was really to reach out to local communities, congregations, and engage them in discussion of what it means to support individuals who struggle with substance use disorders. Now, the result is there's been a huge increase of awareness around mental health challenges as well as substance misuse as behavioral health challenges. And that way it really increases the opportunities for partnership and collaboration. So since its inception in 2014, I believe they started with four lifeline peer project coordinators. Now we have 10 lifeline peer project coordinators, 10 hybrid lifeline coordinators, seven faith-based coordinators, and one collegiate recovery director. So we're really operating in a lot of different areas of the community and able to encompass in one way or another all 12 sectors of each community with specific focus on the faith community.
SPEAKER_01It's a lot of coordination and effort. Why is this so important and impactful to coordinate like this?
SPEAKER_03Well, coordinated piece is extremely important. And it almost seems as if the more individuals we have involved in the coordination of events, the more of the community that actually attends. And so being able to reach out and to actually learn the formula of reaching out to the faith community, providing a safe place for everybody to come together and to talk about behavioral health and how to meet the needs of the community. It's it can be tricky sometimes, especially as you get into some of the more rural areas. But I don't think that we have had a single county that has caused any problems. Really being able to go in and provide access to education, access to resources is something that everyone needs. A lot of the problem is getting through to the community that, okay, this community actually has a problem. And so, even with a coordinated effort of that, it's bringing in city leaders, county leaders to be able to say this is what we're seeing. Bringing in the different partners within the community so they can say, and this is what we're already doing, and we can show how we're supporting their work. If it can't come from the community itself, it's not going to be impactful.
SPEAKER_01That is certainly true. So a quick observation. When we do needs assessments of the strength of a given recovery ecosystem, we frequently hear just across the state in different places that stigma is an issue, that that the problem's there, but nobody's talking about it. That, or even if they're aware of it, they they say, Oh, we'd love to do something, and then they don't. Uh, a lot of inaction. So it sounds like that is kind of an sounds like that's a pretty huge impact that this program is having.
SPEAKER_03It is well, would say community changing, could say life changing, but the reality is it's generational change that is created within each community because of the work that is being done. So I guess going back in my 15 years of working in the space, not necessarily in this position, but in the space, what you see is typically three to four generations of dysfunction, which includes trauma and addiction that can be passed down from generation to generation. Typically, after that third to fourth generation, somebody gets tired of it and have that determination look, this has got to stop with me.
SPEAKER_01Yeah.
SPEAKER_03At a conference that I attended not too long ago, it was reported that some new research had come out that showed the effects of that one person wanting to create that change for themselves. But to see that that influence that they have takes that three to four generations of dysfunction and creates seven generations of healing. So it's uh it's pretty profound being able to understand that the work that we do on a regular basis, even with individuals, we will not live to be able to see the full impact. And I love that.
SPEAKER_00The other thing I would add too is with our programs for every educational event that we do, we do a pre and post-survey to kind of see what knowledge has been gained and what personal beliefs have changed. And in speaking of stigma, on our last report, there was a 98% reduction in personal stigma because of the event or training. So that's like one of our key goals with our programs is that through our education and providing, you know, the tools needed to learn about these different, you know, topics, that people will start to see, oh, you know, it's not a choice. It is possible for people to recover and it will help break down that stigma. Um, and so I think that's one, you know, concrete example. I think another thing that we do well that helps break down that stigma across communities is each one of our coordinators or individuals of long-term recovery from either substance use or mental health or both. And so it is a very clear depiction to those people in the community that here's this person presenting this information to me that I may not know nothing about, may know some about. And they're telling me that they were this person out on the street, they were this person in our hospitals. You can't tell me that. Like that's crazy, right? So I've seen it in our hospital settings where, you know, nurses and um physicians who see, you know, individuals coming in due to overdoses or what have you, they it's exhausting to watch, you know, someone go through that, but to see individuals in long-term recovery do the work and see that they could also help others who are in that situation, I think that really is the stigma breaker. Yeah, is showing showcasing that you know, these people are just like us. They just unfortunately had a wrong turn at some point and they needed a little extra help to get out of it.
SPEAKER_02Right.
SPEAKER_01That's incredible results. Uh that people are reporting a personal reduction. Um, it it it's what kind of audiences are receiving this education? Because the the the need for education is frequently cited as something people uh across the state are hungry for.
SPEAKER_03The events that we provide are really for the whole community. So anyone could come. This really is to be able to change the understanding and reduce the stigma community-wide so that individuals who need help have a better opportunity to ask for it, to know that they're gonna get it without being judged. But not only that, it allows them an opportunity with the reduction of stigma within each community to come back home and to be such an instigator of change for good for the community. So to go into events and hear someone from the community share their story of where they've been but where they are, it makes it personal for the community. Yeah, allows them to see okay, this isn't just those people, this is us two.
SPEAKER_01Might I ask, and you you can remove place names or any identifying into information if you'd like, but is there a particular illustration uh that comes to mind when you think about some of these impacts?
SPEAKER_03Anything that really stuck out in your mind is that a trick question. No, every single day we see something. So on our reports, we actually have a section in there for victories. What have you seen? Either of yourself, one of your clients, one of your co-workers, that is just you've got to share the information. And what we see more than not is and here's a personal experience that I sat there and watched happen. I went to an event in a rural community, was going to present with a few of the coordinators, and one of the coordinators leaned over and was just like, Hey, see that guy in the back?
SPEAKER_02It's like, Yeah, that was my dealer back in the day.
SPEAKER_03Well, as a result of that event, the individual was able to go into treatment and now has two years in recovery. And this is just something we see on a regular basis. I mean, that's not a special story that happens so much. Also taken into consideration, even from our own coordinators. I think we have four of our coordinators who called one of the lifeline coordinators whenever they were in active use, was able to find recovery, and now they're serving as a coordinator. And so individuals who have used the system are becoming a part of the system to help others.
SPEAKER_01That's really talking, that is an impact right there, is that it seems to be almost self-sustaining in terms of its workforce.
SPEAKER_03It is amazing. And to be able to look at different communities and to physically watch during the presentation, their jaws drop and their perception change. Because we do a little bit of questioning in that pre and post to be able to see where their mindset is before and to see where it is afterwards. And so whenever she's talking about that 90% 98% of respondents report or reduction in stigma, this is a direct result of the education that they're getting from someone who has been there. That way we're actually able to share not what the community believes, not what people have said, but this is what I have experienced. And it's a game changer. Yeah.
SPEAKER_00I think the other thing that's important to mention too is that these events occur continually. It's not a, oh, we did an event here in this county and we're never going back.
SPEAKER_02Right.
SPEAKER_00We're there constantly. And I think that's important because sometimes it takes hearing the same message four or five times before the light bulb goes off. And we've seen that in these communities. Like we've had coordinators tell us, you know, I've said the same information over and over again, but today, you know, this person came up to me and told me today it made a difference. And so I think that's the other important thing is that we can't give up if we are met with resistance, because there's going to be a day when a person's ready to actually have the conversation and we want to be there to be able to support them in that conversation.
SPEAKER_01You know, I think that sentiment is uh going to land well in the ears of every parent out there because I think they know what that feels like. Uh, but uh it in a way, I love I love that point because that is a best practice for for actually having an impact. You can't just do a one-off series of billboards and you know, clap your hands and say job well done. You've got to keep pushing for sure, because that is just the nature of human learning.
SPEAKER_00Um other pieces bringing the successes back, right? So, you know, showing you know the difference that's being made, the partnerships that have been created, because then it makes people go, oh, this is actually working. How do we get involved? So I think that's the other piece, you know, latching onto that competitive nature of us as humans.
SPEAKER_01Definitely, definitely. Now, in in terms of using these services, what what does it actually look like? Say, say I'm someone who needs recovery. What does an interaction with the lifeliners look like?
SPEAKER_03Uh it depends on what you need, really. So there's a couple of ways to be able to get in contact with this. One of the main ways to get in contact with Lifeline is the Tennessee Red Line. So the Tennessee Red Line is a service that has been set up through the state. So calling into the red line, they'll go through, talk to the individual, see what would be a good fit for them, provide them some resources as well as the number for the lifeliner in their region. That way, if they have some trouble with some of the resources that have been provided, Lifeline can go through, walk with them through the process after finding, you know, big thing is being able to work with the individual from where they are, meet them where they are, find out where they want to be, go through our extensive knowledge of the different programs that are out there in order to match them up with a good program that would be suitable for the individual, whether they have insurance or not. The vast majority of the individuals we serve do not have insurance or the ability to pay. Okay. Well, are you ready? So, right, you know, depending on the needs as well as depending on availability of space within the facilities is going to determine how long it takes, but we still have some other resources to help the individual, even during that time. So, what they do is they make a call either to the red line or to the coordinator. The coordinator is going to ask them what's going on, do a baseline assessment, see what is needed in order to get the individual help. Sometimes it may be long-term services, but they could also need that inpatient there at the beginning. Yeah. It may be that they need detox before they go into inpatient. And these are all things that we can help set up for the individual. So we can work with them to get into a detox, be transferred out of there to go to a 28-day inpatient treatment, unless that is attached to the detox. And then after that 28-day period or 90-day period, however long it is, we can work with the individual to get them into long-term recovery housing, which can provide access to a lot of different services to increase the recovery capital so the individual has a much better opportunity for the long-term recovery.
SPEAKER_01Quickly, what is recovery capital?
SPEAKER_03Recovery capital really boils down to connections that you have within the community, access to resources that can help you further in life. So, Harvard actually did a study a few years ago over a 40-year period of what uh the recovery process looks like. And you look at that 40-year uh graph that they have, and it's just like, okay, you get into recovery and you just start doing good.
SPEAKER_01Right.
SPEAKER_03Yeah, okay. And they knew that. And so they went back and they they said, Okay, well, let's see what the first two years looks like.
SPEAKER_01Right.
SPEAKER_03And what they showed on that is what we know is that the good thing about recovery is you can get your feelings back. And the bad thing about recovery is you get your feelings back. So it can be difficult sometimes, but whenever we're getting our feelings back, having to deal with the things that we've been going through that we've been Running from numbing ourselves from because a lot of people don't understand, even for those who say that addiction is a choice. Okay, what's the choice? Yeah, my choice wasn't to use whenever I started using at 11 years old. My choice was to stop hurting.
SPEAKER_02Yeah.
SPEAKER_03And I chose what was presented to me, and it worked until it didn't. Until I went from alcohol and Virginia Slim Cigarettes through the gamut up to being addicted to crack cocaine and everything in between. What started off as me trying to kill the pain from childhood trauma ended up in active addiction. It's easy for a community to say that, well, marijuana is the gateway drug. Weed ain't the gateway drug, trauma is the gateway. Yeah. And that's what we're trying to get away from is the pain. And that's not something that is unique to us. That is something that we are taught innately, everyone. We don't want to hurt. Some of us have better coping mechanisms as well as access to healthier ways of dealing with stuff than others. I grew up in a pretty decent home, but I still had no community. The recovery capital shows that within that community, even though during that first piece of recovery, the psychological distress increases, even though our emotional state decreases, even though there are so many negative connotations in that first piece of recovery, because now we got our feelings back and we got to feel it. We got to work through some stuff, which means we have to learn that process.
SPEAKER_01Yeah, absolutely. On our last episode, we had on Uplift Appalachia. Are you all familiar with that? Okay, great. Uh so one of the things that Tanner Clements said, the director, that really stuck with me is uh the purpose of what they're trying to do with training and empowering churches to step up and and and provide community to people in recovery, starting with giving someone a ride, helping them find some food, you know, the basic, basic needs of a person, right? In the act of doing that, you end up creating a community that, in his words, wraps around the individual. So you're not just connecting to wrap around services, you're wrapping around the individual uh themselves, which is a beautiful commentary on what the purpose of community is. So you have that network and that connection. Is the Lifeline Project doing something similar?
SPEAKER_03So that's where the faith-based coordinators come in working with the congregations to be able to set up, provide education, access to resources for them so that the congregations can become recovery-friendly and in turn uh educate the community at the same time because all the community is invited, but now we have the faith community who is there to be able to be that wrap around service to wrap around the individual. So it's not just all right, we'll help you, and that's where it stops. It's okay, we'll help you. We'd love to see you come back. And what happens there is the faith community allows an opportunity for individuals to get the help that they need and then to come back and really to be a champion for that congregation and community to help other individuals who are where that person needs to be. So it's not just wrapping around, it's allowing opportunity for the individual to find their purpose and place in community.
SPEAKER_00I think the other thing, too, that the lifeline coordinators do is you have your faith-based coordinators that are, you know, educating our congregations and our organizations of faith. Our lifeline coordinators aren't just connecting the individuals to treatment, they're educating the larger community.
SPEAKER_02Right.
SPEAKER_00So they're working with the chambers of commerce, they're working with other entities in the community, just the typical, you know, individual that's walking down the street and has an interest in this. They're educating the community at large. And I think that's an important factor of it all because our communities feed into our places of faith. And our places of faith send our individuals out into the community to do the things that they need to do. And so those two bodies come together to really create that recovery capital that Jamie was talking about.
SPEAKER_03And then in addition to that, the hybrid lifeliners that are working in the distressed counties who have access to different uh services that are available through DHS. And so there's opportunity for access to SNAP, TANF, other different types of resources that are available through DHS, including what we already have as well. So being able to work with the faith community is a piece of it. We're working with the general community, specific with the distressed communities and counties across the state, as well as within our collegiate recovery initiative, working on college campuses, university campuses, so that students, admin, faculty, and teachers all have access to the different resources, as well as opportunity to set up support groups. Since the inception of the program, I believe we have set up over 925 support groups throughout the state of Tennessee. It's pretty legit. And this isn't us going in and saying this is what we want you to do. It's working with the community to find out what they need and helping them get that right.
SPEAKER_00And it kind of goes back to your original question, Jeremy, of why is it necessary for all these different players to kind of why it's important for us to collaborate? And it's because we can't do this by ourselves, right? We need all these facets to work together to really create an avenue for individuals to be able to access the services more easily, to be able to stay in the services, to be able to jump back into services if they decide right now it's not for me, and to have that support network that comes around them so that they can succeed. So I think that kind of goes back to your original question and how this all started is we have to leverage the resources we have so that we A, don't duplicate something that's already so hard to obtain, but B, so that we can make sure that we're doing our best to create a system that can be navigated and a person can thrive in.
SPEAKER_01Yeah, that's an excellent point. And uh an even better way of describing a recovery ecosystem than I did earlier. Uh, so truly impactful and helpful, thinking long-term, planting trees, building cathedrals. These are metaphors that popped into my head uh throughout this conversation, such as when Jamie, you said we won't see the full impact of this, we won't live long enough. Uh it's it's a good way to think about how we get out of this because this didn't just start in the 2010s, this goes back a long time. What are some of the most common problems that communities face? What are, you know, when lifeline project coordinators and the other programs uh in the department are are working on improvement. What are some of the most common problems? I mean, obviously something like there's not enough recovery housing or or or not enough open beds or something like that.
SPEAKER_03There's never enough resources. And then we have an opportunity to talk with them about all the resources that actually are available. There are so many resources that very few people know about. So the most common challenge we have is finding the opportunity to go in and to let them know what they actually do have access to.
SPEAKER_01Right.
SPEAKER_03And you know, going back to what was said a few minutes ago about being able to maybe use a church van, that that Uber that only gets to be used one day a week. Well, why don't we see if we can put that in service a few more days a week and allow that to be some transportation to meetings, to treatment, to work, to whatever may be needed for that individual. There's so many resources out there that each congregation and each faith community has access to. Just as well as a clothing closet. Well, that's recovery capital too. Recovery is much wider, much broader than substance use and mental health. We all need recovery in one way or another. We all struggle with something in one way or another, and it's not new to us, it's always been that way. I think one of the biggest things that communities face is the challenge of being able to say that we had that problem here. Interesting. I haven't met a single congregation that doesn't want to help. But I've met so many who don't know how to, and because they don't know how to, they do nothing. So what we can do is empower them with the education to see how to work with individuals, how to ask the right questions, instead of saying, Hey, how you doing? Oh, I'm doing good, how you doing? Just letting that be it. Following that up with the how are you really? Yeah, what's going on? And sitting down and having a conversation, that is what allows change because that invites connection and relationship. We have to have that, but not everybody knows how to get that. That's to me, that is one of our main goals, is to allow people the ability to have those hard discussions and know that they don't have to be the expert. All they need to know is to how to listen and where the resources are.
SPEAKER_01And that's what we teach. So in making decisions going forward, we're doing a lot of great work across the state. We're seeing a lot of a lot of really exciting things in Tennessee. The people I've had on the show over the past year, for example, covers the private, the public sector. Um our overdose rate is coming down in Tennessee faster than it is in the national average, uh, which is tremendous. Uh that that says that we're doing a lot of good good work here. Um, what should we be thinking about? What do people not understand about recovery? Uh, that they may they may think they get or or that they've just never considered before. When thinking about recovery, what what is it that that helps it thrive?
SPEAKER_00One thing is that it doesn't look the same for every person and that it's not linear. And so I think, you know, it's very easy for us as people to really be black and white. And with this, it is a day-to-day adventure. And so I think we have to be ready for that. And for, you know, the family that's, you know, working with a family member that's going through this or the treatment agency or whatever, we all, you know, we have to be fully prepared that things may look really good for three days, but there may be a day where things go a little bit backwards and that's okay. And we have to be okay with that and still provide the support because we all make mistakes in our lives and we shouldn't be tossed as the side because of that mistake if we're trying. And so I think that's the biggest thing is it doesn't look the same for everybody and it's not linear.
SPEAKER_03And following that up, in one of our trainings that we do, it's the trauma-informed care training that we provide. There's a quote on one of the slides, and what it says is we don't see things how they are. We see things how we are. To be able to get into a space where I'm not I don't have sympathy for you, I have empathy for you. Sympathy essentially is I feel for you. I don't need you, Kitty, I got enough of that for myself. Instead of feeling for me, feel with me. Walk with me. The community can provide that, the faith community can provide that. If you don't know how, we can help you. Beautifully said.
SPEAKER_00And I think the other thing I will add, because Jeremy you mentioned how our numbers have continued to decline. I know our department really focuses on outcomes and what we're doing and ensuring that the programs that we're implementing are working and if they're not pivoting so that they do work. I would say one of the other things that I feel very privileged to be able to work for this department is that we see each individual person we serve as that a person and not a member. So though we are looking at numbers, we know that our day-to-day is focused on serving the individual for who they are as a human and not a member.
SPEAKER_01Well, I uh feel very comforted by the uh mission and attitude that I have her today. Um and I'm I'm not gonna lie, I'm very proud of my state right now.
SPEAKER_00I will say really the work that we do and the the vision that we have is because of our leadership. So, Commissioner Margaret Williams, like she drives the way that our department works, and it's because she cares so deeply because of the work she's done. And I'd be reminiscent to say that we've had an amazing governor and legislature that has supported the work that we've done, and our budget shows that. And if it wasn't for them, we wouldn't have the budget to do the work that we do.
SPEAKER_01All right, just some excellent thoughts here. Um, Jessica Youngbloom, Jamie Harper, I thank you so much for joining me on the Smart Policy Podcast. I really appreciate it.
SPEAKER_02Thank you, Jamie.
SPEAKER_01For more episodes on in-depth discussions on Tennessee policies related to substance use disorder by a range of local experts. Please subscribe to us wherever you get podcasts and visit our website at smart.tennessee.edu. I'm Jeremy Corvillis. Thank you for listening and see you next month.