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
The Recovery Navigator: Connecting ER Patients to Hope in Sumner County
Use Left/Right to seek, Home/End to jump to start or end. Hold shift to jump forward or backward.
You're listening to the Smart Policy Podcast, a production of the University of Tennessee's Institute for Public Service. When it comes to any large government program targeting health, social, and cultural issues, there are always concerns that the money won't be spent well. And the opioid settlements are no exception.
SPEAKER_05I was like, okay, there's this money, you know, how is this going to be used? And the first discussion or two, my fear was, oh, this is going to be squandered. But they really wanted to do something real. And after a couple of meetings, it was clear, hey, this is not going to just be spinning our wills and, you know, making some announcements. It was really going to help these people that I've seen throughout my career.
SPEAKER_06So when a program involves multiple community partners, a transparent and collaborative decision-making process, and is based on the local data, the rate of success tends to be far higher. This is what makes Sumner County's approach so remarkable.
SPEAKER_00There are five other counties in which we're receiving these funding, this funding for these programs. Sumner County is the only one that is so collaborative.
SPEAKER_01It's just making sure from the get-go and throughout the process that everybody's on the same page, communicating clearly, and it certainly helps that we all have the same end goal of we want to save lives and we want to help people.
SPEAKER_06After finding out that High Point Health Hospital alone received over 50% of all overdoses brought in by EMS, they hired a substance use and recovery navigator to join the emergency department and help connect overdose survivors with local resources and treatment. The program also includes funding to get people help at Volunteer Behavioral Health, located right across the street from the hospital, and a box of hope containing the lock zone, an up-to-date local recovery resource guide, and other tools provided by the Stumbler County Prevention Coalition. And this is just a part of the county's overall overdose response plan that they're funding with opioid settlement dollars.
SPEAKER_04Once you get into it, you can see that there's so many resources, but I think it's just the lack of knowledge for the individual who's actually going through it.
SPEAKER_06My guests this month are Justin Werlick, Substance Use and Recovery Navigator, Dr. Jeffrey Lifford, Chief Medical Officer of High Point Health, Haley McPherson Bush, VP of Operations in the Middle and West Regions for Volunteer Behavioral Health, Megan Griffith, Director of the Sumner County Prevention Coalition, Charlotte Hollis of the Sumner County Health Department, and Dr. Dustin Owens, Grant Accountant for the Sumner County Budget Committee. In this episode, we talk about how all of these vital partners were brought together, how concerns were addressed, including the fear of duplication or supplantation of existing services, and why they are working to make Naloxone more available to the community than ever before. We also discussed the larger barriers that people needing recovery face, including not only the lack of connection between existing resources, but the gaps in healthcare coverage that keep people from getting the help they need.
SPEAKER_00And realizing that that wasn't the case was difficult.
SPEAKER_04Hi, my name is Justin Roth. I am the recovery navigator over at High Point Health.
SPEAKER_05Hi, Dr. Jeff Lifford. I am an emergency physician and the chief medical officer with High Point Health.
SPEAKER_00My name is Haley McPherson Bush, and I am the senior VP of Operations for Volunteer Behavioral Health, and I cover uh the Middle Tennessee region.
SPEAKER_01I'm Megan Griffith, and I'm the director at the Sumner Prevention Coalition.
SPEAKER_02Hello, I'm Charlotte Hollis. I'm a health educator at the Department of Health.
SPEAKER_03Dr. Dustin Owens, Grant Accountant, Summer County Finance. I did not know you were a doctor, Dustin. I'm gonna have to call you Dr.
SPEAKER_06Owens for this.
SPEAKER_03That's only a rarity.
SPEAKER_06Gotcha. Uh all righty. Well, um, so yeah, I'd I'd like to dive into what is the overall project we're here talking about. What what is the shape of this project here in uh high point health? I know that's that's where a lot of it is centered, but it connects to so many other things.
SPEAKER_00To me, what this project is is several different community agencies and partnerships coming together to identify a need within this community and how we can all um really tap into our specialties and contribute to the solution.
SPEAKER_03So Sumner County received over $900,000 in restricted opioid abatement funds from the state of Tennessee. And in doing so, the Sumner County Opioid Abatement Committee decided to take $500,000 and set it aside for a larger scale project and offer $400,000 to not-for-profits to apply for. For the $500,000, we were looking at a project that would make a difference in the community that could be come long-term. And in doing so, we started looking for data, which the SMART team was part of. They were able to help me look at some of the data that we had on hand. EMS um early preliminary numbers showed that 51% of all EMS runs went to high point health.
SPEAKER_06Over 50% of all overdoses ended up involving high point health. Is that correct?
SPEAKER_03That is correct. 51% of all EMS runs went to high point health. And so with that number, we went um to Mr. Hawkerroad as well as Dr. Lilith and was able to sit down and come up with the plan. And in doing so, we reached out to our community partners who at first did not want to participate with us. And so um High Point Health was right there with us, ready to participate, but we had to find our own advocate. And in this case, it was Charlotte Hollis with the Summer County Health Department who was able to help bridge those connections to bring those two entities on board.
SPEAKER_06Charlotte, I definitely want to learn more about that process. But uh, if I could quickly start with uh Dr. Lifford, if you could talk a bit about what the hospital was experiencing in terms of all those EMS calls and and what the public may not understand about the volume.
SPEAKER_05Sure. Well, you know, as you can imagine, this is obviously not a local issue or a Tennessee issue. I mean, the opioid epidemic is uh, you know, nationwide a big, big deal. And it's something that we've been struggling with for years. And prior to my uh assuming this role as the chief medical officer, I worked in the emergence department and uh would routinely see overdoses or other uh issues not just opioid abuse, but you know, alcohol and drug abuse in general. And it's it's a very serious public health issue. Uh and uh so I was excited when we were approached, and although I'll have to say it's a little bit skeptical, I was like, okay, there's this money, you know, how is this going to be used? And the first discussion or two, my fear was oh, this is gonna be squandered. It's not going to be something that is really gonna help the patients. Uh and, you know, and I've, you know, again, not to be too cynical, but I've seen other, you know, government projects and things that they're not done in a thoughtful way. But I was really impressed with the uh the uh Sumner County folks, Dustin and his team and everybody. Like you said, they really were looking at the data that you know, we were receiving by a slight number, the majority of the overdoses in Sumner County, that the other hospitals, they get plenty of them too. Uh, but they really wanted to do something real. And after a couple of meetings, it was clear, hey, this is not gonna just be spinning our wills and you know making some announcements. It was really gonna help these people that I've seen throughout my career. People coming in with uh overdoses and and uh again, a tangible way that this was gonna make a difference. And so uh, and that's what we've done. It's uh it's been very excited to be a part of it, and it looks like it's it's launched and working and and I think really making a difference, which is really cool.
SPEAKER_06Excellent. Uh Charlotte, what what were some of the difficulties you were experiencing with uh uh bringing people on?
SPEAKER_02So um again, just working closely with both of those entities in this community, I was like, they would be on board 100%. So when Dustin came back to me and said, Oh, they are not, I was like, wait, what? Hold on, let me go talk to them and translate.
SPEAKER_06It that is surprising. Uh, what what were some of their fears and concerns?
SPEAKER_02I think it really necessarily wasn't me. I think it was honestly Dustin. He had this amazing idea, but wasn't necessarily able to translate uh in a way that was understood by all parties. Um, in fact, I was just joking both with Volunteer Behavioral Health and with the Prevention Coalition, if I remember distinctly, both at the end of those meetings, and they go, We have no idea what just happened, but we don't want to be a part of it. And uh so part of my role was I work closely with both of those entities because of what I do for the state. And so I got back with them individually and I said, guys, this is really what he's after. He's really trying to establish um essentially a recovery navigator that can connect people who say, come into the hospital, who need that help or are interested in recovery, but then don't have anywhere to go, which is partly how this project came about was we realized so many times people do end up in the hospital or in the ER, for instance, and they have overdose or they are ready for recovery or both, but don't have any resources or don't have any readily available. And so they would get discharged. And so we didn't want that. We wanted them to be able to be connected to whichever resource it is that they needed.
SPEAKER_01For us at the very beginning, it was sort of being billed as a uh it kept being called a one-stop shop, and we were not really on the same page as what that looked like. To us, it seemed like a duplication of a lot of services that were already provided in the county, and it seemed like do we need to put up funding towards this project when there's already individual entities dealing with different aspects of this same project? It eventually came back around to us and was verbalized in a much different manner than we were immediately on board and like absolutely tell us what we can do to help. This sounds great. It is, I think, impressive that we meet regularly to make sure we all continue to be on the same page, offer suggestions for what could possibly be done to improve it or needs we're seeing. But so it's just making sure from the get-go and throughout the process that everybody's on the same page, communicating clearly and really understanding what needs to be done. And it certainly helps that we all have the same end goal of we want to save lives and we want to help people.
SPEAKER_06All right. Justin, you are this navigator uh and uh welcome aboard. Glad you're doing this work. Uh how would you describe what your role is?
SPEAKER_04Uh my role is within the hospital and based here, but it's really for the community as a whole. Um, it's really just like Charlotte said, to help people get connected with recovery resources, harm reduction materials, just to kind of be, you know, a friendly face for them to help throughout their recovery journey, as recovery is different for everyone, just to get a good start. And it helps the people who come to the hospital, especially for the overdose when they might not know the resources, they don't even know where to begin, might be scared as well. So it's just a great, you know, resource to have for them.
SPEAKER_06Could you potentially walk me through a typical presentation? Uh like what does your role look like if someone is presenting to the emergency room having survived an overdose?
SPEAKER_04Yeah, definitely. Um, so if someone would come into the emergency room, say post-overdose, then I would I normally check with the nurse and everything just to make sure everything's okay, but then I'll go into touch base with them, use some motivational interviewing just to see where they are and their stage of change, and then kind of formulate a game plan, whether if that's scheduling an appointment for them, if that's linking them with voluntary behavioral help to go to a detox. If not, I make sure that they have some treatment resources or at least some harm reduction, like some Narcan. We have a great box of hope that has some basic resources and everything. Just if they're not willing or able to make the change right now, it at least gives them hope for the future for the you know, the box of hope. And then I'll schedule appointments for them, make follow-up appointments as well, you know, kind of anything that they need, anything that they want, I just help navigate that for them.
SPEAKER_06Dr. Lifford, if before I we get into the box of hope, could I get you to contrast what it might look like if we didn't have a navigator position? Uh how what what kind of barriers might be faced?
SPEAKER_05Absolutely. So, you know, again, the opioid epidemic has been the last 15, 20 years. And when uh overdoses would come in or people that were you know struggling with substance abuse, you know, myself, the the case managers, the social workers, ER nurses would all try to fill in this gap, you know. But you can imagine in a busy emergency department, sometimes unfortunately, it was hey, you know, sir, you know, it looks like you have a serious issue with opioids, you just survived an overdose. Here's the list of you know, 12-step meetings in the area. Good luck and godspeed. And not to be crap. I mean, but you know, and now sometimes, you know, we had some time, the the social worker was available, they could talk through it, but uh it was you know limited. And also a lot of these folks, when you get to the point that you're having overdoses, you're advanced in your addiction, you don't have resources. Uh, and so it wasn't like, hey, just you know, call your insurance to get into a treatment program because a lot of them have lost insurance. I mean lost family and things like that. And so uh again, it was it was very frustrating as a provider recognizing this is someone that's in a you know precarious situation. Uh, they don't need to come to the hospital, but they need to get hooked into outpatient resources. But we didn't have someone like Justin that had the time. And now, you know, with with some of this grant money, it's you know, options for treatment and outpatient treatment and things like that. So, so that's what it looked like previously. It was we'd counsel them, uh, you know, I might discharge them with Narcan or encourage them to go get Narcan for another overdose, but it wasn't set up the whole system that we have with Justin and and you know what we have right now. It's a lot of different people coming together, you know, the the county, and and that's those are big pieces of it as well. So it's it's nice to, you know, Justin, of course, can talk with them, he can spend more time with them, he can, you know, direct them to these outpatient resources, but the outpatient resources is you know being available obviously is a key piece of it as well.
SPEAKER_06Sounds like a pretty noticeable difference then. So, Charlotte, what is this box of hope? It's it's a it's a great title. And and I believe was this created by the Sumner County Prevention Coalition?
SPEAKER_02That's correct. Um, again, I brought them into this partnership or tried to get them in because of that. They had created another box and another project I'd work with them. And I thought it would be a perfect way that for those who came into the ER, for instance, or who were admitted, um, but just weren't ready to take that next step, we hated to send them home empty-handed.
SPEAKER_06Uh Megan, what is the prevention coalition's part of this project?
SPEAKER_01So we are partnering to provide the box of hope, which is given out by Justin and others at High Point Health to people that come in for really any substance misuse issue. But it's got a resource magnet that's got information on it, resource the keychain, and the keychain links to the uh has a QR code that links to a resource guide that is pretty inclusive of all Sumner County resources, not just mental health and substance abuse services, but clothing needs, housing needs, food needs, pretty much everything you could think of. Um, we update that pretty regularly because we try to keep everyone included and we don't want people calling for resources that are no longer available. We have a printed version of that that just includes the mental health and substance abuse services that's included in that box, wallet cards for red line, quit line, 988, uh suicide crisis line, and then also a box of naloxone. So those are sent with individuals and it doesn't. We've also sent some not just through the hospital, but to some other agencies or given them out at other events, but they're mostly distributed by Justin at the hospital when he sees individuals. He thinks, hey, maybe they're not ready for help right this second, but let's send them home with this so they have the resources once they decide they are.
SPEAKER_06And for those that are ready for treatment, I believe they're sent on to volunteer behavioral health. So what is y'all's end of this project?
SPEAKER_00So we are the treatment component. So we provide um mental health and substance use co-occurring treatment to those in the Medicaid population, to the uninsured population, the underinsured population who don't really have the resources to access treatment. We have an outpatient facility that is right across the street from High Point Health. We were also provided the funding for a Narcan vending machine, which will be revealed on August 29th at our event. So that's going to be at our outpatient campus. And then that is where you have your outpatient therapy, intensive outpatient program, um, medication management, and then case management. And then at our Murfreesboro facility, um, we have a crisis stabilization unit and detox facility. And what's really special about that is they don't have to worry about a bill whenever they leave. So Justin is able to call me and say, hey, I've got someone here. They've decided they want to go to treatment, they don't have any insurance, and I'm able to call them an Uber there within 15, 20 minutes to pick them up, and they're driven straight to our detox facility and then provided that treatment.
SPEAKER_06That's incredible. So I'm gonna ask you the same question that I did uh to Dr. Lifford earlier about what uh is the difference between what you have now through this program and what might have existed before without a navigator position in terms of an overdose presenting to the emergency room? What would it look like from volunteer behavioral health standpoint?
SPEAKER_00We wouldn't be dispatched crisis-wise unless it was a suicide attempt. Um so we don't typically get those reports, but if they were combined or if um there were there was drug use um previously that they reported and would like outpatient help for, um, then they would reach out to us. But it was it wasn't very common, I will say that. But now I can say that we have a very warm handoff. There is no point in time in which the client is kind of left suspended. Um, you know, they come into the ER, they're they meet with the doctor who refers to Justin or the other social worker who immediately reaches out to me and then they're dropped off at our front door and welcomed. So it it's a very thorough process. And I mean, even people who have to come back through the program and talk about how they're just uh taken care of from start to finish. So I think that's something that is extremely significant.
SPEAKER_06What misunderstandings do you encounter the most when it relates to responding to people in crisis?
SPEAKER_05You know, the um I think uh the understanding that you know addiction, opioid addiction is a disease. Um I think that's a tough one. People outside of healthcare or people that are not familiar with addiction and recovery don't get. Um, and I think that's a a common misperception. It is, you know, why should we help this person? They did this to them. And uh, you know, in in medicine, there's all sorts of things that, you know, people. I've got an uncle that eats a slab of bacon every morning and he had a heart attack, you know, or he, you know, he's smoked for 20 years. I can go on and on, you know, they don't exercise enough. There's a lot of things that just, you know, because of the imperfect human condition, that's how we end up with medical problems. And uh, you know, and so it's and we don't deny those people health care, you know, we still help them. And uh for whatever reason, I think with alcohol and drug addiction, people seem to see that differently. But it is it is very much a brain disease. Once people get addicted, it's not just you know, moral weakness or bad judgment, it's a it's a disease process. And and I mean, if if people just needed to, you know, wisen up and stop doing it, we wouldn't have alcohol and drug problems because you know it's and so uh people understanding that the you know the disease model of addiction and that I I think that's lost on a lot of people. And I'm uh you know, I'm glad that with this money, you know, that that's uh again that that uh there's enough wisdom in the you know the county government and understanding that we really do need to treat it like a disease and try to help these people.
SPEAKER_06Very well said. Justin, amongst the people that you have helped. What are some of the most common barriers that they're facing? Uh uh obviously they they come into the ER, they get treated, but then after that, uh uh that's gotta be the biggest problem, right? That's where pr I'd imagine most of the issues are.
SPEAKER_04Yeah, I think the the most common issue is just uh just the the lack of like knowledge around it, um, and just not the lack of resources, but just the lack of resources at the time for the person. Like there's so many resources in Sumner County, especially with all the good work that like the health department and the county and the prevention coalition is doing. Like, once you get into it, you can see that there's so many resources, but I think it's just the the lack of knowledge for the individual who's actually going through it. There's been so many times where they're like, I don't have insurance, I don't have any money, I don't have this. And I'm just like, Well, we partner with volunteer behavioral health, they have a grant we can get you into treatment right now today. You know, you won't have to pay anything. And they're like, Wow, I didn't even know that was something that was available. I didn't know that I could get into treatment and get help and everything and get over there today if I wanted it. It's just like, yeah, we can make that happen and get you over. But I think that's the biggest barrier is just the the lack of knowledge by all these individuals who, you know, have the substance use or misuse.
SPEAKER_06So this program is fairly all-encompassing. Uh, people are presenting to the ER, they get connected with Justin, who talks with them, levels with them, connects them to outpatient treatment or a detox, or uh at minimum gives them a box of hope, uh, which includes lists of resources, um, a whole lot of excellent things as you've listed here. Uh one thing though about the naloxone in there, and I understand that there are other projects in Sumner County that are expanding access to naloxone, including a vending machine and so on. But this strategy is not without its controversy. Do you have any thoughts for those who fear that providing naloxone encourages more drug use?
SPEAKER_01I'll speak on just my personal viewpoints on that. People that are in addiction are going to be using the naloxone is not going to encourage them to use more. They're going to use regardless. So let's give them a factor, a protective factor that if they use it, this is some harm reduction, that maybe today they weren't ready to get help, but let's save their life with this naloxone right now. And quite frankly, in my opinion, as many times as we need to. If it takes them having to be receiving naloxone five, six times before they're ready to get help. In my opinion, it's worth it. That is saving a life until somebody makes the decision that they're ready to get help and get out of this lifestyle. Um, people that I've talked to that have had issues with it, I just ask them if it was a family member or friend of theirs that was in this situation, what would they want to do?
SPEAKER_06That's very well said.
SPEAKER_00I agree. And and to kind of piggyback off of that, I feel like at the end of the day, um, it's no different than becoming CPR certified. Um, saving a life is saving a life at the end of the day. And if you had a choice, um if someone was dying in front of you from an overdose, um, I'd I'd be surprised if you truly chose to just let that person die because you feel they deserved it, um, or that you think that they're just going to waste this opportunity um by going out and using again. I just feel like at the end of the day, as a human being, if we have the ability to save a life, then we should take that opportunity.
SPEAKER_06I don't know if this was a coincidence or not, Megan, but your your mention of five or six times, I believe the average is five to six times of attempting recovery before long-term recovery is sustained. Now, admittedly, that that's a mean or a median. I I can't recall. Uh, but uh, you know, so we're we're looking at wide variability between some people, it's it's that first time they try, they're ready, others take many times. But at the end of the day, yeah, it's it's like any other chronic condition. You're gonna want to try to provide the tools to keep them alive. I is is that is that what I'm hearing?
SPEAKER_01Yes, exactly.
SPEAKER_06So one of the concerns that were mentioned in the initial stages of this program and getting it together and getting everyone on board was the concern that this might be a duplication of services. It is reminiscent to me of the concern that opioid settlement funding might be used to replace existing funding for services in this space. Uh that's a scary conversation because the entire purpose of these opioid settlements, in the stated in the documents themselves, is to enhance our uh treatment and recovery support and prevention responses. Uh so that's certainly an interesting and important concern to consider.
SPEAKER_00I can jump in here as well. Um, and this, you know, from my perspective, in addition to Sumner County, my role at Volunteer Behavioral Health, um, any kind of agreement that we have or funding that we receive from the opioid abatement settlement settlement funds that are county specific in the Middle Tennessee region, I am also over those programs as well. So there are five other counties in which we're receiving these funding, this funding for these programs. And I think you brought up a really good point and something that um, you know, this is my first time supervising a grant project and kind of creating something along the lines of that. And I will say that Sumner County is the only one that is so collaborative for this specific project. Um, I think that we kind of just sat down and determined where each of our strengths were and how we were able to provide the resources and the creativity and procedure on how to how to achieve this goal. And I think it was important to emphasize, especially in the project creation, that this is not a replacement of funding for another position. Anything that we have is in addition to. Um, now we're able to help pay for co-pays and access to treatment for those who are above that federal poverty guideline, but are stuck in that benefit gap where you can't afford to have health care, but you make too much money to get on any kind of specific grant and you're stuck and you just can't afford it. So it's been really, really amazing to see how it's impacted those who have been previously told no.
SPEAKER_06So this has come up multiple times, this conversation, that this program is finally a lifeline to people that otherwise might not have known or more importantly, been able to afford treatment. Uh, how substantial an issue is this?
SPEAKER_00Oh my gosh. Um, I will, I can definitely speak on it on a certain grant. We are, there's a uh grant that we use for the uninsured population, and um, it covers all of their uh mental health services, so medication, therapy, and case management. However, the income guidelines are set right now at the federal poverty guideline, which for one person is about $21,000. And right now, you know, when when this grant came out, we had a lot of people with the ability to be covered because when they went and worked at McDonald's, they were only making $725. But now you're getting hired at McDonald's full time at you know, $13, $14, $15 an hour. And even working part-time at that rate knocks you out of eligibility. And if you don't have dependents and or anything that would, you know, allow a little wiggle room on your income, um, you're getting kicked out. And that's that's what a lot of places use for income guidelines. And um not adjusting those has significantly has has been difficult, especially if it's not adjusted per county. You know, there are certain counties where that guideline may still very well be accurate. Um but here in the higher, higher earning counties, I have people working a full-time job at twenty twenty dollars an hour that still live in their car.
SPEAKER_06Yeah.
SPEAKER_00So it it that that has been a significant challenge.
SPEAKER_06That gap in coverage is uh a demonstrable problem, especially in a state like Tennessee. Uh our Medicaid system, TenCare, does not cover a lot of uh working age males, which are also the demographic dying of the highest rate of overdose.
SPEAKER_00Yes, it it it is very difficult that um, you know, a homeless man with a plethora of physical health issues um cannot get on Medicaid. And they can't it's been very difficult. I started as a case manager and that was one of the biggest eye-opening moments was I was under the impression that if you had zero income, then you would be able to get on some some sort of Medicaid. And um realizing that that wasn't the case was difficult. And then the disability system it's it just goes around and around. And right now we have this um issue of um commercial insurance companies that are basically going into the hospitals. And if they don't have insurance, um the health departments and the hospitals sign people up for certain insurance coverages that will basically get them covered physical health-wise, but their deductible sometimes is so high that they can't even afford to go to the doctor to start working on it. And sometimes the grant coverage they were previously on is better suited for them than having medical coverage at all.
SPEAKER_06So that that's astounding. So in many ways, it's sort of trapping people in a poverty sense. So back to the program. What does the future of this look like? Should it continue to be successful? And and we've seen some of your preliminary data showing that the referrals are rapidly increasing, that uh the the program is working. But of course, if you do want to talk to that to some extent, I'd be happy to hear more.
SPEAKER_04I'll I'll hop in a little bit just from my my standpoint, uh from how I see it on my end, the the future of the program is to kind of continue that same relationship that we have with volunteer behavioral health, but to extend that to other community partners to try to kind of grow this and keep it going. That way the connections are made with the community. That way, not only do we have a great detox facility and outpatient, but we also have a great residential, and we also have that bond so that when anyone comes in for any type of like substance use, mental health, or anything that we have the ability to be like, okay, we'll sit with you, we'll you know, we'll do a little assessment to figure out what you need, but we'll be able to get you those services if that's what you want. Of course, it's a great program, it works. Get involved. You know, substance use isn't something to be scared of, it's not something to be taboo, but it's more of something that can turn into an open conversation, just like everything else, that we can eventually discuss and figure out ways to kind of treat and just have it be a normal conversation you have with someone, not of oh, that's substance abuse, that's addiction. Like we can't talk about that. Like hush, hush, hush, hush. That's what I would really like for it. That's my soapbox thing to you know make sure that everyone has care and just can talk about it freely, because sometimes just being able to talk about addiction in general helps more than people think as well.
SPEAKER_06Megan, I was wondering if you could jump onto some of those points. Justin, thank you for that. I thought I thought that was very well said, uh, that there's so much we can do to change the conversation that would have a long-term impact on this. What would you say to that?
SPEAKER_01Yeah, I agree. Reducing the stigma is very impactful and something we're still daily struggling with, even with the box of hope. They don't know where on the outside of the box does it say anything about what they are just because we don't want people feeling uncomfortable carrying them or like they're being judged just for having it. So the outside of the box has nothing, but once you open it, you get all the information and resources you need. Um, it would be great if we get to the point where people don't feel like this is something they have to hide. Overdose happens. Let's talk about it. Let's help people understand it's not just one or two people it's happening to, it's not just a certain type of person it's happening to. It is across the board, all people, all families. Addiction affects them in some way, whether it's friends, families, coworkers. For some reason, we're just uncomfortable talking about it as a whole. And the more we can reduce that stigma, like Justin said, that helps so much more people who are willing to come forward and say, hey, I do need help and not feel like they're going to get judged for it. So yeah, the more open conversations we can have surrounding addiction and overdose and mental health issues, it's only going to help those issues.
SPEAKER_06So, what policies should we be considering? And this could be at the federal, state, or local level uh to make these efforts better, not just stigma, but the efforts like this program in Sumner County, this recovery navigator, uh, multi-partner collaboration.
SPEAKER_03From a financial standpoint, is making sure that the funds are there to continue such programs. I mean, we have a great upgrade abatement council. They are looking at partnerships and funding partnerships. This past year, out of all the grant awards that were given, uh, or the contracts would be issued for January 1st. Only 25% of those awarded were partnerships. So we would encourage the state and federal officials that are looking at funding programs when they say we want partnerships, is to find a way to bring those partnerships up. That is not just one entity or one entity and they're not for profit that helps sponsor them, but it is different people coming to the table together to work on an issue at hand. And so looking at what our state and federal officials need to do is when they talk about partnerships and they're wanting it to happen, they need to find ways to encourage it and to promote it up to the top and actually put the money where their mouth is because 25% out of all those that are awarded is a little bit too low. They should be looking at 50% or 75% funding through partnerships that can make a difference, like Summer County has.
SPEAKER_05Again, I start as you know, there's a lot of government programs that maybe start with a good idea, but that you know the money is wasted. Um and uh the uh yeah, so that's one thing. I guess the other is maybe the county commission, local folks looking and saying, hey, are there ways locally that we could continue this if we lose some of that funding? Because I would I would hate to lose it. I mean, when you look at kind of different interventions in healthcare, you know, saving the life of a 21 or 25-year-old addict, you know, the number of uh life years you've saved, uh, you know, that's huge. The impact is is really, really big. Yeah. And so uh, you know, prioritizing that, recognizing that's a lot of bang for your buck. And and again, directing it towards programs that are really directly helping the people that need it.
SPEAKER_00I feel like I could go on for several hours on this part, but you know, and this kind of ties into um the topic we were just on, you know, keeping the resources updated and being on the community mental health side, part of that is the fact that we can't always guarantee that grant funding uh for certain populations is going to be available that next year. So those consistently have to be updated. Um, you know, insurance, commercial insurance providers adjust their reimbursement rates very frequently as well. And so sometimes as a nonprofit, we have to get to a point to where we don't we just don't accept that that insurance any longer because it's so difficult uh to maintain a nonprofit clinic when the salaries that we have to pay for these services and we're getting reimbursed, you know, $10 for 45 minutes. And so um, you know, I I think as far as policy updates, we definitely need to expand Medicaid coverage. Um and I think that we definitely need to look at a policy directed at, you know, insurance cannot determine the amount of times somebody can go to detox or the amount of times somebody can go to a residential treatment facility, or the amount of times they need to be in an intensive outpatient program. Um, there shouldn't be time limits on that because no one is in recovery the exact same way. And it may take you to go the AA path and then the celebrate recovery path and then the evidence-based path and then the mat path before you find a path that works for you. And that might take several detox days or several residential stays to find what works for you. Um, and the only thing that's important is that you do find something that works for you. And um, I think when it comes to treatment like that, that there should be no bounds. Um, I know that's very far-fetched. Um, but that that would definitely be my dream or you know, something that is geared towards improving the overall access to care, um, adding more nonprofits, making making it easier for nonprofits to accept certain certain funding resources and giving them a promise that this is going to continue. Um, but of course, we have to have our politicians on our side with that as well.
SPEAKER_01I would agree with Haley. It's mostly funding surrounding treatment, recovery services, even housing. I know it's um to get in any sort of short or long-term recovery housing. There are just not nearly enough houses available. Um entities don't that do those houses, don't have the funds to continue to build them or find the land to be able to build them. So we know a few in our county that would like to add houses and help more looking for recovery housing, but that's just not an option because they can't get the funding they need for that.
SPEAKER_06Any uh final thoughts?
SPEAKER_01Yeah, so Sumner County Recovery Fest will be taking place September 21st from 2 to 5 p.m. at Triple Creek Park in Gallatin. And we'll have multiple resource vendors there, some live music, free shirts and food, while supplies, last games for the kids. It'll be a fun time just celebrating those in recovery, another another way we can try to reduce the stigma surrounding addiction.
SPEAKER_06I love music. Nice.
SPEAKER_00Um, I don't have an event, but I did just want to mention that um the Gallatin Office for Volunteer Behavioral Health at 510 East Main Street in Gallatin, right across the street from Food Line beside High Point. Um, we do accept walk-ins Monday through Friday, 8 to 5 for intakes, and you get an intake and um a medication visit and prescription done same day. You can also call our intake line and get your intake done on demand as well. Um, and that's 1877-567-6051. Um, you can do it in person by phone, um, same day access for everything that you need.
SPEAKER_02So I'd like to add something, Jeremy. Um, I really think it's important that you have these partnerships. And even if you're not the one who knows who to reach out to, maybe trying to figure out who that is. So for instance, I I got connected to Dustin through my boss. Um, I wasn't roped into the original meetings, he had sat down, so he's the director of the um health departments here. And so my boss realized he's like, I don't really have those connections, but he said, My health educator does. You know, she's out and about, she works with these individuals, she teaches classes with them, helps hold events and seminars. So she's probably the best one to connect to. So I think sometimes if another county, for instance, is trying to do this in their own, finding those people who can be your champions, who can be those bridges, as Dustin called it earlier. Uh, we Joe can say a lot of times on the liaison, um, you know, between a lot of different partners. But I think too building that partnership. So we're really grateful to have Justin, who is so kind and easy to work with, that we can connect with him and even give him more resources maybe than what's in the box, for instance. Him and I have talked a couple of times about potentially adding to that, for instance. So I think just maintaining, you know, for future too, you know, not just monetarily, but you know, maintaining those strong bonds so that you can make this a unified project and one that continues into the future.
SPEAKER_06Beautifully put, thank you. Charlotte, this is neither here nor there, but I I'd be curious to know what challenges you face as a health educator in the 21st century. Uh uh, because I this this could be I actually this question, I I I would say broadly speaking, uh, I'd open it up to everybody here, but uh in particular, I know this is a shifting technological landscape. Uh probably targeting, I imagining, the most high-risk individuals who need to hear the information the most can be very difficult. But I'd be curious to hear from you on that.
SPEAKER_02You are correct. In fact, a lot of the people that we feel like we need to reach with the information we would like to get out is actually incredibly hard to get to. For instance, right now we teach a lot in schools and we're asked a lot of times to talk about the harms of nicotine, the harms of tobacco. Of course, that ropes in as well, vaping. And right now we have a large problem with marijuana use as well. So a lot of times when we talk to the kids, we try to not talk at them, we try to talk with them and ask questions and get them to think critically. Why did they start using the product to begin with? And sadly, a lot of times the answer is that their parents gave it to them or their older sibling. And a lot of times it's because they feel like the parent feels it's safer for them to vape than to smoke, or they would rather them, you know, do it in a controlled way by using a vape product versus using a cigarette or a cigar or both. So again, now we have the kids and we're telling them one thing of don't do this. It's you know dangerous to your brain health and to your growth and to your development, but they keep saying, well, my parent says it's safe. So who will they believe at the end of the day? So we've tried to work with the school systems, for instance, to try to host uh parent seminars to educate them as well to understand that it is a dangerous product. And that's just one example.
unknownRight.
SPEAKER_02Um, I do have quite a few because again, I'm the health department, so it's an overarching, you know, health field. So we do um talk about nutrition a lot that we fight a lot with Google. Uh Google is definitely the no-it-all compared to us. And so that's always kind of interesting to break down those barriers. Exercise is the same way, physical activity, and I could go on and on, but you kind of get the gist. It can be a challenge, and it's also a challenge as well because of the technology use today, uh, trying to engage students, especially in learning about the correct information and not the misinformation that's online.
unknownDr.
SPEAKER_06Lutford, I noticed a couple of facial expressions that uh seem to resonate. I I just have to ask if uh any of that resonated with you.
SPEAKER_05Oh, the fighting against Google, the story of an ER doctor's life, you know. Um, that made me laugh. But I totally uh agree. I mean, we're you know, we're talking about uh opioid addiction, but uh, you know, marijuana and THC analogs, there's a lot of substances out there that are are doing harm to our public health. And uh uh yes, that's uh it's a big public health issue as well. And I'm I'm glad that uh you know that we're talking about that as well.
SPEAKER_06Uh Justin, uh any of your thoughts as well? There is is there any misinformation that that you encounter amongst your uh the people you serve?
SPEAKER_04Uh yeah, there's there's definitely a lot of misinformation, especially with uh opioid use specifically. I know a lot of people um there's the kratom which is you know becoming a big thing, and there's a lot of misinformation about that amongst people that you know it it's not addictive, you know, I could do this and use it, and then unfortunately it you know, low doses has the same properties depending on how much you use and all those things, and uh doctor, but you know, has the same properties as opiates with heroin and fentanyl. And I think that there's definitely misinformation about that, and also a lot of misinformation about THC and cannabinoids and that, and just again, I think just the overarching theme of the lack of education around everything, which definitely hinders people's ability to make you know educated choices about anything. But I think that definitely needs to be more education and awareness. I'm big on harm reduction, so more about you know getting people information and helping them where they are, you know, to make better choices.
SPEAKER_06Well, thank you all for working on this problem. And uh uh Charlotte, it sounds like your work's cut out for you. I'm glad you're already working with schools uh and that there are other uh uh folks like you doing this kind of work uh as well. Because I the the more folks like you uh get your job done, the less the burden falls on folks like uh Justin and Dr. Lifford, I imagine, right?
SPEAKER_02Yes, sir. Thank you for that. I don't know how you wanted to end it, but honestly, I think a great way to end this today would be to hear a success story from Justin. He had a couple of good ones that he presented to us the other day.
SPEAKER_06That's a wonderful idea. I would love to hear one, uh, for sure.
SPEAKER_04So um a patient came to the ER with an opioid overdose. Uh we were able to connect that patient with inpatient treatment at a regional detox facility. After inpatient treatment, uh, the patient followed up with residential care and as a result was able to reconnect with family members and has been sober for months. So it was really great to see that happen.
SPEAKER_06Okay, wonderful. Well, hey, thank you all so very much for joining me on the Spark Policy Podcast. I do really appreciate it.
SPEAKER_02Thank you so much. Thank you.
SPEAKER_06Thank you.
SPEAKER_02Thank you for having us.
SPEAKER_06Thanks, Jeremy. Thank you. For 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.tenessee.edu. I'm Jeremy Corvellis. Thank you for listening and see you next month.