Tennessee

Recovery Navigators
FY20 Annual Report
Tennessee Department of Mental Health & Substance Abuse Services

July 2020
Department Introduction
Department Mission
Creating collaborative pathways to resiliency, recovery, and independence for Tennesseans living
with mental illness and substance use disorders.

Department Vision
A state of resiliency, recovery, and independence in which Tennesseans living with mental illness
and substance use disorders thrive.

Program Overview
Tennessee Recovery Navigators (“Navigators”) are individuals in long-term recovery who are
responsible for meeting patients in the hospital when they present due to an overdose, are
experiencing active withdrawal, or present with a primary substance use disorder, to connect
them with treatment and recovery resources. Navigators are also responsible for following up
with each patient they meet at 72 hours and 30 days to ensure that patients have connected to
the resources, are doing well, and do not need any additional community referrals.

This program is executed through partnerships with community treatment providers who
employ the Navigators. Navigators are Certified Peer Recovery Specialists 1, who function as a
resource with lived experience for patients as well as hospital staff. Navigators are not
clinicians, law enforcement, counselors, or sponsors for patents they meet in the hospital.

History & Background

The TN Recovery Navigator program began in June 2018 through funding allocated to the
Tennessee Department of Mental Health & Substance Abuse Services (TDMHSAS) from the
TNTogether Initiative (TNTogether). TNTogether was based on recommendations, feedback
and ideas culled through a work group former Governor Bill Haslam convened and was hosted
by the Commissioners of TDMHSAS and Health. Understanding executive branch priorities,
legislative ideas and feedback, as well as recommendations from the judicial system,
TNTogether was created, and the General Assembly passed a funding and legislative package in
the spring of 2018.

1
https://www.tn.gov/behavioral-health/mental-health-services/cprs/peer-recovery-
services/certified-peer-recovery-specialist-program.html

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TN Together included priorities across three primary areas:

• Prevention
• Treatment
• Law Enforcement

Public Chapters 1039 and 1040 of 2018 carried the legislative changes, and the funding was
provided for in the Governor’s Budget that year – to include the seed funding of the “Enhanced
Lifeline” for $750,000.

The program was first called “Enhanced Lifeline” because it was thought of as an expansion of
the Lifeline Peer Project, run by the Director of Faith-Based Initiatives. However, in June of 2018,
the program was officially renamed to be the “Tennessee Recovery Navigators.”

Patient Testimonial
Treatment has helped me in ways that can’t be explained. From the beginning I reached out to
my Recovery Navigator for help and he has been there since day one. Since I have been sober,
treatment has given me some accountability and has allowed me to share my experience,
strength and hope with others addicts who suffer like I do. It has made me want to help others
more and more. I understand now how helping another addict will help me in my walk-in
sobriety. Without this experience, I don’t think that would have been possible.

Expanding in 2019
Through a partnership with the Department of Finance & Administration (F&A) and the Office of
Criminal Justice Programs (OCJP), TDMHSAS received $500,000 annually for three years to
expand the Navigator program.

The funding for the expansion came through Victims of Crime Act (VOCA) dollars. In
order to receive the funding, several documents and commitments to serve a
population with a history of victimization was made.

Fiscal Year (FY) 2020 Program Highlights

• 38 Hospitals in 21 Counties are officially being served by the Navigators.
• 2,905 individuals were served from July 2019 through June 2020.
• Of the 2,905 individuals served, 2,241 were placed in treatment; this is a 77% placement
rate.

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 • The Navigators were able to continue to serve individuals when the Coronavirus
Pandemic hit by telephone and through the utilization of telehealth.
• Of the 2,905 individuals served, 996 individuals reported some type of victimization to
the Navigators; this information is reported quarterly to OCJP.

Current Tennessee Recovery Navigator Providers

The following providers are currently facilitating the Navigator Program across the state of
Tennessee.

Provider Location
Cocaine and Alcohol Awareness
Shelby County
Program (CAAP)

Pathways Madison County and Surrounding Areas

Buffalo Valley, Inc. Davidson County and Surrounding Areas

Volunteer Behavioral Health Putnam County

Council for Alcohol and Drug Abuse

Hamilton County
Services (CADAS)

Cherokee Health Knox County and Surrounding Areas

Helen Ross McNabb Center Hamblen County and Surrounding Areas

Frontier Health Tri-Cities

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Spotlight on Navigator Data
Patient Interactions
The Navigators’ reach across the state of Tennessee has increased from Year 1 871
Year 1 to Year 2. In Year 1, the Navigators served 871 individuals. In Year individuals were
2, the Navigators were able to serve 2,905 individuals.
served, Year 2
2,905 individuals
The increase in patient interactions in the second year can partially be
attributed to the foundation that was built in the first year. Another
were served.
factor in the increase is the continued addition of participating hospitals to the Navigator
program.

Hospital Testimonial
Holston Valley Medical Center (Kingsport, TN)
Melody Huber, ER Behavioral Health Technician
Our Navigator is amazing! It’s always such a joy to see her come into the ER. The patients
respond well to her and are very comfortable opening up to her about their mental health and
life struggles. She does an excellent job of providing patients with multiple resources that will
better their future and help support their recovery! She always has a positive attitude and
would go the extra mile for any one of them to enjoy a healthy, addiction-free lifestyle!

The Navigators capture demographic information on all the individuals they serve. This
information includes gender identification, race, and age. As the program continues, we are
always looking at ways to outreach to at-risk and underserved populations.

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 Gender Race Age
1.90%
1.70% 2%

14% 9% 9%

18%
31% 82% 36%

69%
26%

18-24 25-34
White Black
35-44 45-54
Male
Other Unwilling to Disclose 55-64 65 and Up
Female

Figure 1. Demographic Data of Clients Served

Patient Placements
In FY20 the Navigators were able to place 2,241 individuals The placement rate has
in treatment – this is a 77% placement rate. In FY19 the
increased from FY19 to
Navigators were able to place 642 individuals in treatment,
a 74% placement rate. The treatment type and the
FY20.
recommended level of care varies from person to person. When the Navigators meet with the
individuals in the hospitals, they recommend levels of care that best fits the person’s needs,
wants, and insurance type. The Navigators always try to find an available resource for the
individual. Figure 2 shows the recommended levels of care for patients in FY20, and Figure 3
shows the top placement locations.

Primary Recommended Levels of Care

Medication Assisted Treatment (MAT)
Intensive Outpatient (IOP)
Residential Treatment
Residential Detox
Outpatient Treatment
Outpatient Detox

0 500 1000 1500 2000 2500

# Recommended

Figure 2. Primary Recommended Levels of Care

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 Patient Testimonial
For one, the program helped me get back into control of my life and my Navigator even pointed out
things I needed to work on and things that I have worked on that he helped me with. He showed me
what I needed to work on when I thought I didn't need to work on. He showed me that I should ask my
fiancé what she wanted to do instead of always doing what I wanted to do, I had a problem and I
needed to fix it. He has helped me with my anger instead of just blowing up I need to realize what I was
mad about. The program has helped me not just get off drugs but to show me I'm a better person
without it. The program has helped me get closer to my family rather than running and hiding from
them. Patient Insurance Type

The Navigators will serve any person who is seen at the hospitals
89% of the
if they were admitted due to an overdose, are currently
experiencing active withdrawal, or have been identified as having
individuals served by
a substance use disorder. The type of insurance a person has the Navigators were
helps the Navigators find treatment options best suited for the uninsured or noted
individual. Figure 3 shows that most of the individuals served are
having TennCare.
those who are uninsured or covered by TennCare.

Insurance Type
2500

2000

1500

1000

500

0
Medicare Private Insurance Self-Pay TennCare Uninsured

Insurance Type

Figure 3. Patient Insurance Type

Top Substance of Use

The Navigators capture the primary, secondary, and tertiary substance of choice for each
individual they serve. This helps the Navigator identify the most appropriate treatment type.

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Figure 4 shows the top 5 overall substance choice for the individuals served through the
navigator program in FY20.

Top Substance of Use

Marijuana

Other Opiates and Synthetics (Excluding

Buprenorphine)

Heroin

Methamphetamine

Alcohol

0 200 400 600 800 1000 1200 1400 1600

Number Reported

Figure 4. Top Substance of Use

This information coupled with other program data collected by The Department of Mental
Health and Substance Abuse Services helps identify the areas of need across Tennessee. This
data allows TDMHSAS to ensure that the programs being funded by the department are
efficient and serving the most vulnerable Tennesseans.

Patient Testimonial
Since I have started group, my entire life has changed for the better. I temporarily lost custody
of my kids and had a restraining order, so I wasn’t allowed to see them unless I was
supervised. At the time I started treatment, I weighed 95 pounds. My Navigator has a lot in
common due to our past, to know that people weren’t judging me, and I wasn’t judging them,
and we could talk about our past and not worry about keeping anything back. After 6 months
of having DCS in my life and Plateau [Mental Health Center,] I can say it has helped a lot. I’ve
gained 35 pounds from being clean, and I am almost ready to come off of my suboxone. I
haven’t done any meth which was my drug of choice since November 30th. I’m so happy to
wake up every day in reality, forgiving the people who hurt me in the past, and loving that I’m
not trying to find someone to get me my fix. I get to be with my kids every other week full-time,
and it’s a blessing. I noticed the change in my kids because their lives are different now, and it’s

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 great. Thank you to my Navigator and all the hard workers from Plateau that helped me get to
where I am today. I won’t ever be able to thank you guys enough.

Participating Hospitals
The following 38 hospitals have partnered with the Navigator Program. As always, we are
looking for new hospitals to introduce the Navigators too.

 Blount Memorial Hospital  Jackson-Madison County General

 Sycamore Shoals Hospital Hospital
 HCA, TriStar Skyline  Cookeville Regional Medical Center
 HCA, TriStar Centennial  Ascension, St. Thomas Rutherford
 Ascension, St. Thomas Midtown  LeConte Medical Center
 Ascension, St. Thomas West  Methodist North
 WTH Dyersburg Hospital  Methodist South
 Milan General Hospital  Methodist University
 Greeneville Community Hospital  Regional One
East  St. Francis
 Greeneville Community Hospital  Holston Valley Medical Center
West  Indian Path Medical Center
 Morristown/Hamblen County  Bristol Regional Medical Center
Medical Center  Sumner Regional Medical Center
 CHI Memorial  Unicoi County Memorial Hospital
 CHI Memorial – Hixson  Creekside Behavioral Health
 Erlanger Baroness  Franklin Woods Community Hospital
 Erlanger East  Johnson City Medical Center
 Erlanger North  Woodridge Psychiatric Hospital
 Hancock County hospital  WTH Volunteer Hospital
 UT Medical Center

Hospital Testimonial
Indian Path Community Hospital (Kingsport, TN)
Sarah Lane, Charge Nurse of the Emergency Department
We have many patients with addiction problems who come through to this hospital for help. I
have witnessed our Recovery Navigator give her all into helping others recover from their
addiction. She spends a lot of time with the patients, so she can figure out what is best for

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 them. She continues to keep in contact with these patients once they complete their treatment;
therefore, she provides the continuum of care that these patients require. Without her, many
of these patients would relapse without her existential support.

Tennessee Recovery Navigator Expansion Pilot

In December of 2019, TDMHSAS partnered with the Tennessee Department of Health on a pilot
that will expand the scope of the Navigator program.

TDH received a grant from the Centers for Disease Control and Prevention (CDC) enabling the
expansion of the Navigator program. The expanded scope includes implementing Medication
Assisted Treatment (MAT) in the emergency department. The pilot will be for three years with
the targeted goal of development through middle Tennessee and an end result of statewide
expansion.

Rutherford County has been identified as the starting point for this pilot project due to
experiencing the 4th highest rate of nonfatal overdoses in Tennessee as reported in 2017. St.
Thomas Rutherford was chosen as a potential pilot site due to an already established TRN
Program Memorandum of Understanding with Buffalo Valley and TDMHSAS.

Goals of the Pilot:

To design a more comprehensive overdose and opioid withdrawal protocol with the hospital
and emergency department administrations. The partnership will explore implementation of:
o Targeted and universal screening;
o Initiation of Medication Assisted Treatment for eligible patients;
o Access to naloxone;
o Continued facilitated referrals and peer recovery services to the Recovery
Navigators.

Final Thoughts
The Tennessee Recovery Navigator program has been able to reach individuals in their most
vulnerable state. With the Navigators being both peers and located in the hospitals, it provides
a new way of outreaching to individuals and connecting with them on their road to recovery.
We are always looking for ways to expand the program and expand our reach to different
hospitals throughout Tennessee.

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If you would like to learn more about the Navigator program please visit
www.tn.gov/recoverynavigators. If you have any further questions or if you would like your
hospital to start participating in the Navigator program, please reach out to Jessica Ivey at
[email protected].

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