Action Inc

Butte Housing is Health Care Data Coordination Project

Action, Inc. is the nonprofit community action agency for the six-county region around Butte and works to develop pathways out of poverty for area residents. This grant will support Action, Inc. to create a database that allows the Butte Housing is Health Care Initiative partners to track and coordinate housing units and supportive services. It will begin by working with partners – including the Butte Housing Authority, St. James Healthcare, and Southwest Montana Community Health Center – to assess the data systems they currently use to track homeless individuals and their interactions with health, justice, and social service systems. Then, the team will agree to a set of data elements that will allow partners to track and more effectively manage outcomes for these individuals and build them into the new data tracking platform. Funding will support project coordination staffing, consultation, and data system access. The new shared data system will enable the partners to align housing units with supportive services, creating a more effective permanent supportive housing program for the region.

Grant Amount

$42,896

Term

24 month

2021

Addictive and Mental Disorders Division

Communities that Care Training Expansion

The Montana Department of Public Health and Human Services (DPHHS), Addictive and Mental Disorder Division (AMDD) will hire two Communities that Care (CTC) coaches to help implement the CTC program in six counties (Lake, Flathead, Silver Bow, Toole, Lewis and Cark, and Pondera). CTC is a sustainable, evidence-based program designed to promote healthy youth development, improve health and social outcomes, and reduce problem behaviors. With a previous MHCF grant, AMDD hired a CTC program coordinator and contracted with the University of Washington to provide intensive training and technical support to help ten communities implement the program. This grant will support hiring two additional coaches to help expand the program into six counties. The project's primary partner is the DPHHS Public Health and Safety Division, which leads the state's public health efforts and coordinates services to local and Tribal public health agencies. AMDD's goal is to implement CTC in every county in Montana, and it has committed to continuing to scale the program by using internal resources to sustain these positions after our grant is done, and to support additional coordinators.

Grant Amount

$178,824

Term

24 month

2020

Addictive and Mental Disorders Division

Improving Health Through Collaborations

The Addictive Mental Health Disorders Division (AMDD) partnered with the Montana Department of Public Health and Human Services (DPHHS) Public Health and Safety Division (PHSD) to implement the Communities That Care (CTC) model in 11 counties across Montana. The goal was to establish a new, coordinated, public health-led initiative to prevent substance use disorders and mental illness statewide. The project entailed hiring a program manager who facilitated the technical assistance to support communities to build the capacity and readiness for future implementation of the CTC program. The program manager's tasks included identifying key partners, aligning and combining coalitions to address behavioral health issues, and coaching communities through the CTC process. Both AMDD and PHSD committed to funding personnel to continue training and implementing the CTC model in more communities across Montana. They established a strong working relationship with the University of Washington, which provides ongoing technical assistance, training, and support to the AMDD coach and contracted coaches to ensure the CTC model and phases are implemented strategically in each community. Two additional CTC coaches have been brought on under contracts with AMDD to support the expansion of CTC in Montana. 

Grant Amount

$162,587

Term

24 months

2018

All Nations Health Center

Walking Well with Traditional Healing

This project successfully increased the health center’s capacity to provide culturally adapted, evidence-based, and trauma-informed awareness to the over 500 active clients they see each year. Project accomplishments include providing historical trauma education sessions and Community Resiliency Model workshops to the Missoula community. Mending Broken Hearts, a grief support series, was provided to clients who reported a deeper understanding of historical and inter-generational trauma and were able to begin addressing the impact on their own lives. Finally, a trauma-informed organizational assessment was completed, and trauma-informed practices were incorporated into the diabetes prevention education series offered to teens and adults.

Grant Amount

$50,000

Term

24 month

2018

All Nations Health Center

Qua Qui Connection: The Circle of Good Medicine & Holistic Care

This grant supported the All Nations Health Center (the urban Indian health center in Missoula) to provide integrated, comprehensive, culturally appropriate care for one of the largest urban Indian populations in the state. This underserved population has suffered disproportionately from diabetes, high-blood pressure, cardiovascular disease, and obesity—conditions that are both preventable and treatable with appropriate primary care services. Over the course of the grant, the All Nations Health Center hired a full-time family nurse practitioner to provide primary medical care; created organization-wide policies and procedures that guide and support the integration of medical and behavioral services; trained all clinical, support, and administrative staff on integrated health care models; obtained a medication assisted treatment (MAT) certification for the nurse practitioner, allowing them to treat those struggling with opioid use issues; helped the community better understand the structure and importance of integrated health care; and transitioned to an electronic health records (EHR) system that supports full integration of care. With the addition of primary care services, the All Nations Health Center was able to be recognized by Medicaid and Medicare as an urban FQHC, giving it access to a more favorable rate of reimbursement, which will help ensure its sustainability into the future.

Grant Amount

$150,000

Term

24 month

2017

All Nations Health Center

Strengthening the Circle: Increased Capacity for Increased Health

All Nations Health Center's Strengthening the Circle project was designed to increase the center's capacity to provide high-quality, integrated health care services to American Indians living in and around Missoula. The project implemented a holistic care model that improves coordination and collaboration within and between care teams. This included allocating staff time to design and execute the model, providing training to clinical and non-clinical support staff, and delivering high-quality technical assistance to support the successful implementation of the model. All staff were trained to use the electronic health record system, case conferencing, and co-location to provide patients with holistic rather than siloed care. Population health data and analysis are used to inform planning efforts. By providing integrated patient care that is reimbursable under Medicaid and Medicare, the health center is on track to increase annual revenue by at least 75%. All Nations' partnership with Greenway Health, a health information technology services company, will provide ongoing resources and support to maintain the progress that has been made and identify future opportunities for improvement.

Grant Amount

$75,000

Term

12 month

2019

All Nations Health Center

All Nations Housing Feasibility Study

All Nations Health Center is an urban Indian health center located in Missoula; it serves over 4,000 Native American people. This project will help the center conduct a feasibility study for a new facility incorporating housing and an integrated care clinic. Homeward, a local affordable-housing developer, will conduct the study, including housing development costs and available funding resources for financing. MASS Architecture Design will finish a preliminary architecture report detailing the logistics of an integrated care clinic. The Native American Development Corporation will support organizing finance options for the new building. Funding will support the contractors to complete the feasibility study, housing development costs, building design, and finance options.

Grant Amount

$74,250

Term

12 month

2021

Alliance for Youth, Inc.

Development of Recovery Support Services Funding Model and Peer Support Capacity Building, Implementation, Evaluation and Integration Into Crisis Intervention Program

Alliance for Youth is a nonprofit organization that advances healthy youth development through a collaborative approach to substance use disorder education, prevention, intervention, and treatment. Sober Life is a program within Alliance for Youth that provides peer and recovery support services. With this grant, Alliance for Youth will partner with Alluvion Health to provide peer support services for Alluvion's Crisis Intervention Program. The Crisis Intervention Program decreases relapse rates among people struggling with substance use disorders and diverts people in crisis away from emergency rooms and jails. This partnership will help develop a sustainable funding model for peer support and expand services in Great Falls and North Central Montana. Funding will support staff salaries and contracts for billing and clinical supervision for peer support. Partners include Alluvion Health and the local Crisis Intervention Program organizations.

Grant Amount

$75,000

Term

24 month

2021

Alluvion Health

Community Health Care Center Integrated Behavioral Health Program Development Project

The goal of this project was to strengthen the existing integration of primary care and behavioral health services within the Cascade County Community Care Center. To achieve this goal, the health center hired a psychiatric nurse practitioner to join their team of medical providers, licensed clinical social workers, and care managers to help move their program from partial to full behavioral health integration. The National Council for Behavioral Health provided technical assistance, training, and learning communities for this project. Key project outcomes included: strengthening the continuum of care with Benefis Hospital by ensuring that patients discharged from the hospital’s behavioral health unit would receive appropriate and timely care from the health center’s behavioral health team; adjusting behavioral health therapist schedules to ensure availability for “warm handoffs” and consults with primary care providers; coordinating with a dedicated biller/coder to ensure sustainable third-party billing and collections. Through this grant, the health center determined that the addition of the psychiatric nurse practitioner provided a more comprehensive model of care for the center and that the position would be sustainable moving forward through third-party billing.

Grant Amount

$35,000

Term

12 month

2016

Alluvion Health

Health Wealth Service Partnership Pilot Program

This pilot program assessed, tracked, and analyzed the link between mental, physical, and financial health by working to establish a financial planning service for Cascade County Community Health Center clients with large receivables balances. The project made progress with the branding and establishing a workplan for their approach and began to engage patients with financial coaching. There was a delay in the project when the financial consulting partner, Rural Dynamics, was sold to a national firm. However, they did find a new partner: MOFI, a regional community development corporation that has a financial literacy component. As part of the project, four case managers were trained and began working with patients, they are also working with a bank system to establish short-term credit instrument for patients who are participating in the program. The goal of this project was to develop a health care model that included financial health and could definitively prove the impact of financial instability on physical and mental health. While this ambitious goal was not fully realized during the grant, the health center is committed to continuing the project and to tracking its outcomes.

Grant Amount

$50,000

Term

12 month

2018

Alluvion Health

Crisis Intervention System

The Great Falls Community will redesign the behavioral health crisis system to reduce emergency department admissions and criminal justice encounters and recidivism. Alluvion Health will serve as the “backbone” organization, providing project oversight and partnership coordination. This project will bring together new and existing partners through a formal charter that establishes project goals and expectations and outlines commitments. The primary objectives are to collect data and analyze the existing behavioral health crisis system and resource allocation, research best practices, develop a plan for prevention and intervention strategies, and implement new strategies. The project will use funds to employ a care coordinator to assist with navigating individuals throughout the system, a clinician to assist with clinical oversight and intervention, and a project lead to coordinate partners and activities. Primary partners include leadership from Alluvion Health System, Benefis Health System, Gateway, the Center for Mental Health, Cascade County Sheriff, Great Falls Chief of Police, Cascade County Commissioner, and emergency services. Ultimately, the project will redesign the crisis system by utilizing existing resources differently and by developing a sustainable and robust framework for the future.

Grant Amount

$100,485

Term

24 month

2019

Alluvion Health

Alluvion Health Vaugh Schools

Alluvion Health will implement school-based health services, including medical, dental, and behavioral health, in Vaughn Public School. Vaughn Public School is a K-8 school located 15 miles from Great Falls. Alluvion will use a newly acquired mobile unit to provide dental services and provide medical and behavioral health services within the school. Grant funds will cover startup costs including salaries for the staff providing services. The project’s goal is to offer health services to the students and staff members of Vaughn Public School and the surrounding communities of Sun River, Fort Shaw, and Simms and in turn, to improve students’ ability to learn and succeed in school.

Grant Amount

$100,000

Term

24 month

2020

Alluvion Health

Implementation of an Innovative Alternative Payment Model for Direct Primary Care

As is the case in communities throughout the country, small businesses in Great Falls are often unable to provide health care coverage to their employees. Alluvion Health, a Federally Qualified Health Center (FQHC) in Great Falls, used this grant to create a monthly fixed-rate health care plan intended to provide affordable and easy access to primary care, behavioral health, and dental care services to uninsured and underinsured members of the community. Alluvion learned about the program’s financial model and membership structure; developed policies, procedures, and protocols; and created a plan to evaluate the program. It developed a communications and outreach campaign to educate small employers, self-employed individuals, and others about the program, using written materials, luncheons, presentations, and digital advertising. This project built on the already strong relationships Alluvion had with local and regional employers. While demand for the program was not as high as expected, partly due to the pandemic, Alluvion made strides in educating patients, staff, and providers about the program. It also learned more about the community’s needs and how to improve and adjust the program so that it better serves patients’ health care requirements.

Grant Amount

$32,750

Term

12 month

2019

Alluvion Health

Partnering for the Health of Our Community

Great Falls Clinic will integrate behavioral health into their two primary care clinics and one specialty clinic, with Alluvion Health providing technical assistance and training. This project establishes a new partnership between Great Falls Clinic and Alluvion Health and leverages each organization’s strengths and resources. Alluvion’s experience with implementing the integrated behavioral health model positions them as a robust technical assistance partner. Funding will be used for Alluvion to hire a care coordinator and a behavioral health clinician and will assist with project oversight by organizational leadership. The project will also support consultation by the National Council for Behavioral Health. Ultimately, the project hopes to establish a sustainable integrated behavioral health model in the Great Falls Clinic and create a new successful partnership that will help improve patient health and reduce costs to the health system.

Grant Amount

$125,000

Term

24 month

2019

Arlee Community Development Corporation

The Community Dining Project

The Community Dining Project of the Arlee Community Development Corporation (CDC) was designed to increase family health and happiness by providing skills and encouragement to cook and eat healthy meals and develop better family communication and play skills. The project built on the organization's current programming, which includes hosting community dinners; providing nutrition, meal planning, and cooking classes; and developing garden boxes and a community farmers market. The project relied on many community partners to help access food and supplies, distribute food boxes, host community dinners and cooking classes, and other activities, including Arlee Schools, CSKT Tribal Health, Montana No Kid Hungry, HOPA Mountain, and Salish Kootenai College Extension Office. While the project achieved some of its original goals, the COVID-19 pandemic required a significant shift in direction. At the outset of the pandemic, Arlee's existing food pantry became overwhelmed by increased demand and a shortage of volunteers. In response, the Arlee CDC requested and received permission from MHCF to redirect portions of this grant to purchase food for area families. The Arlee CDC and its partners were able to help address the growing food insecurity in the community, and they continue to work together to submit grant applications, expand partnerships, and create programs to further help families in need.

Grant Amount

$51,000

Term

24 month

2018

Arlee Community Development Corporation

Pivoting from Emergency Food Response to Food Sovereignty (FSC) Programming with Healthy Local Foods

The Arlee Community Development Corporation will establish a walk-in, choice-based food pantry and a food resource center for the Jocko Valley (comprised of Lake, Sanders, and Missoula Counties), providing more local, healthy food options for the community. This project will help create local partnerships and reorganize food distribution models to connect local producers with local communities. The resource center aims for less dependence on low-quality staple foods and instead emphasizes locally grown, more nutrient-dense food options. Partners include Confederated Salish and Kootenai (CSKT) Tribal Health, CSKT Food Sovereignty Initiative, Mission Mountain Food Enterprise, and Montana Growers Cooperative. Funding will support project personnel and a consultant who will help with project development and travel expenses.

Grant Amount

$60,000

Term

12 month

2021

Association of Montana Public Health Officials

Higher Logic Community Sharing Platform

The Association of Montana Public Health Officials will use the Higher Logic web platform to create a cloud-based application that enables Local and Tribal Health Departments to share resources and discuss and provide each other with technical assistance on specific public health questions. The Higher Logic platform has been used by the Association of State and Territorial Health Officials (ASTHO), NNPHI, and other public health organizations. During the COVID-19 pandemic, the need for this resource has become more pressing. With limited staff and funding, county and tribal health departments face an overwhelming range of new tasks, such as issuing isolation and quarantine orders, creating spreadsheets for contact tracing and monitoring quarantine, developing fact sheets for a wide range of audiences (such as daycares, first responders, shelters, and law enforcement), drafting letters to businesses not following public health directives, and issuing press releases and public statements that are informative but comply with all privacy laws. This investment will create a critically needed platform for counties and tribes to share templates and offer and receive advice and assistance as questions related to COVID-19 arise, and beyond the pandemic as well.

Grant Amount

$42,500

Term

24 month

2020

Aware Inc.

AWARE PACT Service Expansion-Region 4

AWARE Inc. will expand its existing Program for Assertive Community Treatment (PACT) team in central Montana. The counties it will serve include Lewis and Clark, Jefferson, Broadwater, and Meagher. PACT is the core service of a tiered delivery system that targets people with severe disabling mental illness who require long-term, intensive support that exceeds traditional outpatient services. The goal of the service is to rehabilitate each client to their highest level of functioning. PACT teams are mobile and deliver services in community locations to meet clients where they are. Grant funds will provide technical assistance from the National Council for Behavioral Health and support for part of the startup costs of expanding PACT services. AWARE has already established partnerships with many of the health and social service organizations that work in the region including, St. Peter’s Hospital, PureView, and the Helena Housing Authority, among others. Through this project, AWARE will deepen its current partnerships and develop new ones with the local health departments, clinics, housing authorities, shelters, and other entities as they expand into other counties. The project aims to stabilize 196 clients with severe disabling mental illness and reduce inpatient admissions.

Grant Amount

$165,000

Term

12 month

2020

Awe Kualawaache Care Center

Infection Control Training

This grant will provide infection control training for the Awe Kualawaache Care Center staff. The Care Center provides long-term care to the Crow Tribe and the surrounding community; its mission is to preserve culture between the elderly and youth. Funding will be used to purchase software to track infections and help the staff member who is leading this work enroll in an infection control certificate program.

Grant Amount

$3,000

Term

12 month

2020

Barrett Hospital Foundation

Southwestern Montana Rural Accountable Care

This goal of this project was to support Barrett Hospital’s participation in Montana’s first Rural Accountable Care Organization (RACO). The RACO consists of 12 critical access hospitals in Montana, Idaho, and Wyoming that collectively serve more than 9,000 Medicare patients. Barret Hospital’s project developed an evaluation and measurement process for key health outcomes and implemented case management and patient discharge care plans. Highlights include: more than 63 percent of Medicare patients received annual wellness visits (the Centers for Medicare and Medicaid’s goal is 50 percent); a multidisciplinary team was developed to do a monthly review of all patients (reducing the cost of sub-acute care by 15 percent over 6 months); several reports were designed and implemented, giving providers the ability to focus on and follow up with chronic disease patients. The hospital plans to continue working with the RACO workgroup and a consultant and will sustain this project through internal funds. 

Grant Amount

$50,000

Term

24 month

2015

Barrett Hospital Foundation

Barrett Hospital & HealthCare Integrated Behavioral Health Collaborative

Barrett Hospital & HealthCare in Dillon will integrate behavioral health services throughout their health care system. They will bring together a multi-disciplinary team to increase access to behavioral health services, decrease emergency and inpatient utilization, improve patient and population outcomes, and support community activities promoting behavioral health. Barrett currently has a single therapist co-located with primary care. This project will support integration of primary care and behavioral health services and implement integrated care in other parts of the system such as the inpatient and emergency room settings. Grant funding will be used to hire a second behavioral health clinician and support the clinical and administrative staff time required to implement team-based care. Partners include the local advisory council for mental health and the local community health center. The project also seeks to contribute to a more robust behavioral health continuum of care in the region.

Grant Amount

$100,000

Term

24 month

2019

Beaverhead County Public Health

Integrating Behavioral and Physical Health in Rural Southwest Montana

For this project, Beaverhead County’s local advisory council on mental health oversaw a community-wide coalition which leads work plan development and implementation of integrated behavioral health in their county. Other coalition accomplishments include: establishing criminal justice, crisis response, ACE (project materials: ACE Task Force Mission and Goals, ACE Task Force Pamphlet), universal screening, and mental health task forces; implementing universal screenings for depression at the University of Montana-Western Student Health Center; and successfully hosting a two-day behavioral health summit which was facilitated by the National Council for Behavioral Health and will continue as an annual event. 

Grant Amount

$22,100

Term

18 months

2015

Behavioral Health Alliance of Montana

Advocacy for Behavioral Health Prevention, Treatment, and Recovery

This grant provided organizational support to the Behavioral Health Alliance of Montana (BHAM), a consortium of mental health and addiction treatment providers serving adults and children statewide. The purpose of BHAM is to strengthen the behavioral health prevention and treatment system in Montana by coordinating the efforts of providers, guiding state policy, implementing new initiatives, and promoting and supporting the adoption of best practices. By bringing together addiction, mental health, and tribal behavioral health providers, BHAM has helped address the fragmentation of Montana's behavioral health system. Grant funds were used to develop internal capacity, facilitate outreach efforts, cultivate membership, and secure ongoing financial support. BHAM developed bylaws and a policy manual; created clear branding and marketing messages to expand membership and engage providers; and established an annual membership meeting to elect officers and board members, renew memberships, and provide networking and educational opportunities. With solid financials, a strong membership, and continued growth, BHAM has emerged as a state leader in behavioral health and a powerful tool to strengthen services for mental health and substance use disorder (SUD) providers. It has helped improve state policies in several areas, including the SUD intensive outpatient program, children's case management, home support services, adult mental health group homes, and comprehensive school and community treatment.

Grant Amount

$150,000

Term

36 months

2017

Benefis Health System Foundation

Integrated Behavioral Health for Primary Care Patients in Great Falls and North Central Montana

This project’s initial goal was for the Benefis Medical Group to plan for the integration of behavioral health into their primary care practice and support the broader implementation of integrated behavioral health by regional partners in Cascade County and north-central Montana. However, the project experienced unexpected challenges which led to an adjustment in scope. Despite challenges, the project did succeed in implementing a pilot program with a provider in a primary care clinic to screen individuals for depression. More than 150 individuals were screened, 40 of whom reported high depression scores. Through this pilot project, Benefis was able to fine-tune an algorithm for identifying individuals with depression and/or suicidal ideation, develop plans for the ongoing integration of behavioral health in clinic operations, and identify ways to improve and consolidate their electronic health records system and incorporate behavioral health modules into primary care clinic workflows.

Grant Amount

$35,000

Term

12 month

2016

Benefis Health System Foundation

Addressing Perinatal Substance Use Disorders in Cascade County and Montana Northern Tribes

Benefis Hospital, together with community agencies, will work to reduce the adverse outcomes of perinatal drug and alcohol use for newborns and their families through supportive, team-based care and better coordination between health care providers and social service agencies. Benefis will implement SBIRT (screening, brief intervention, and referral to care) as a routine part of perinatal care and develop a system of care coordination for pregnant women who are identified through routine screening. The hospital will invite and engage outside providers to implement a similar model of team-based care throughout the community, and partnerships with outside social service agencies and neighboring tribes will be established throughout the course of the project. Grants funding will be used to support the project coordinator position.

Grant Amount

$150,000

Term

24 month

2018

Billings Clinic

Establishing a Montana Psychiatric Residency Training Track

The goal of this planning grant was to create a blueprint for the establishment of a psychiatric residency training track at Billings Clinic. The University of Washington agreed to be the academic partner in the residency program’s design and launch. As part of the planning process, the project disseminated a survey that estimated costs of Montana’s psychiatry shortage at $3 million annually, which helped reinforce the need for psychiatric residency in the state. The project resulted in the Montana State Legislature allocating an increase of $400,000 annually to graduate medical education funding in the Office of the Commission of Higher Education’s budget. These funds will be crucial for the implementation of the psychiatric residency training track, will ensure the stability of Montana’s primary care and psychiatric physician workforce, and will enhance residency training overall in the state. With the inclusion of federal match dollars, this MHCF investment resulted in an increase of approximately $4.3 million annually for Montana’s residencies.

Grant Amount

$50,000

Term

24 month

2015

Billings Clinic

Transforming Primary Care to Meet the Needs of Alzheimer’s Patients and Caregivers

This project developed and implemented a clinical care pathway to screen for and improve outcomes among Alzheimer’s patients at Billings Clinic and two rural healthcare facilities: Glendive Medical Center and Lewistown’s Central Montana Medical Center. As part of the project, patients over the age of 65 were screened appropriately for Alzheimer’s dementia and related dementias (ADRD) and that those diagnosed with ADRD and their caregivers received high-quality care and support. A detailed clinical care pathway and set of tools that address clinical care, support services, operations, and billing issues, with the goal of transforming and standardizing dementia care were also put into place. The project produced a robust framework, and the sites will continue to work on implementing the clinical pathways and will collect data and outcome measures over the next 12 to 24 months. Billings Clinic is interested in sharing the success of this project and their specific approach with other clinics across the state.

Grant Amount

$150,000

Term

24 month

2016

Billings Clinic

American Indian Healthcare Advocate Program

This project provided outreach, information, and health insurance enrollment assistance to American Indian people residing on the Crow and Northern Cheyenne Reservations and the urban American Indian population residing in Billings. Through the American Indian Healthcare Advocate Program, outreach events, presentations, and informational materials were distributed to over 700 individuals with questions about Montana’s Medicaid expansion and how obtaining health insurance could increase their access to quality health care. Twenty-six people were directly enrolled in a health insurance product for which they were eligible but not yet enrolled and 177 people were assisted in the enrollment process. Additionally, a qualitative research project was initiated to gain insight into American Indian perceptions of health insurance and health care.

Grant Amount

$46,820

Term

12 month

2016

Billings Clinic

Integrated Behavioral Health Expansion Project

This project allowed the Billings Clinic to improve and expand an existing integrated behavioral health (IBH) pilot program in one of its locations to all three of its primary care sites, ensuring that all patients have access to timely screening, diagnosis, and treatment for mental health conditions. The Billings Clinic now has seven full-time therapists and case managers and two consulting psychiatrists, which has allowed for approximately 94% of all patients to receive behavioral health screening and has led to significant improvement in outcomes for those receiving treatment for depression. While screening for substance use has been challenging, primary care providers and residents in internal and family medicine are receiving training in early identification and intervention for patients with alcohol and drug use. Additionally, an on-site training on medication assisted treatment (MAT) is scheduled for 2021, which will allow providers to obtain the certification required to provide this service. The grantee established a data registry to track and improve care for IBH patients. The registry project was challenging due to issues of electronic health record compatibility, but the grantee is now beta testing this feature. Now that IBH has become standard operating procedure in all Billings primary care clinics, the Billings Clinic is working to expand IBH to all regional affiliates.

Grant Amount

$150,000

Term

24 month

2017

Billings Clinic

Regional Integrated Behavioral Health Integration Project

Billings Clinic is a health care system that serves the state of Montana through a network of regional affiliate hospitals. For this project, nine critical access hospitals (which began implementing integrated care through a prior grant) will continue the process of transforming their primary care practices to a high-quality integrated behavioral health model, and up to five additional sites will join the network and begin implementing integrated care. The project aims to promote a deep understanding of integrated care practice and benefits, support long-term, sustainable engagement at rural sites, and promote integrated care conformity across the Billings Clinic affiliate network's Montana sites. Billings Clinic will continue network development activities and data sharing, with close collaboration and support of the Billings Clinic Regional Services team and the Montana Healthcare Foundation's technical assistance providers. Funding will support startup costs for additional care managers for the region (located in a rural affiliate site) and remotely support the rest of the facilities.

Grant Amount

$300,000

Term

36 months

2021

Billings Clinic

Montana Integrated SBIRT Training for Healthcare Professionals

This project created a screening, brief intervention, and referral to treatment (SBIRT) training curriculum for residents at the Billings Clinic to enable them to identify and provide effective initial treatment for people with undiagnosed substance use disorders. Residents in the internal medicine, family medicine, psychiatry, nursing, and pharmacy programs, as well as providers who are currently treating patients, receive SBIRT training. Trainers from the Montana Primary Care Association use role-playing exercises in virtual workshops and Grand Rounds, which are weekly professional development and networking events that attract a large local audience and are broadcast on the Eastern Montana Telemedicine Network. Billings Clinic also integrated the SBIRT curriculum into its existing clinical pathways. Billings Clinic will continue to support SBIRT in its various residency programs and integrate it into service lines throughout its system.

Grant Amount

$15,000

Term

12 month

2019

Billings Clinic

Initiation of a Licensed Addiction Counselor into the Broadwater Health Center Integrated Care Team

This grant was designed to help the Broadwater Health Center (BHC) enhance its existing integrated behavioral health program by adding substance use disorder (SUD) services, which are in high demand within the community. BHC secured state approval as a SUD provider, implemented universal screening for SUDs, and hired a licensed addiction counselor (LAC). State approval as a SUD provider allowed for the reimbursement of addiction services and access to the state’s SUD block grant for prevention activities. This project faced many challenges, including the departure of BHC's CEO and other staff members, opposition from medical providers, and the hiring of an LAC who did not adapt his approach to BHC's model of brief, focused counseling and referral to stepped care. The LAC left the organization, which halted SUD treatment, but therapy continued for depression, anxiety, and other mental health conditions. BHC was later acquired by the Billings Clinic, giving it access to the Billings Clinic Regional Services and the IBH Expansion Project, which is also supported by the Montana Healthcare Foundation. The organization is now in a rebuilding phase with new medical providers, but it will likely have improved infrastructure and support going forward. 

Grant Amount

$40,000

Term

12 month

2018

Billings Clinic

Regional Integrated Behavioral Health Expansion Program

The goal of the Billings Clinic Regional Integrated Behavioral Health (IBH) Expansion Program was to bring together a network of nine independent hospitals and clinics to offer integrated behavioral health services based on a standardized approach to collaborative care. By hiring a project coordinator, the Billings Clinic achieved the critical task of relationship building between network sites and continuously engaging them as part of a group effort. The project also brought increased awareness of the importance of data collection and use to improve treatment, and it enabled each site to access the Cerner EMR for standardized screening, data collection, and reporting clinical measures. Another major accomplishment was connecting primary care providers in rural areas to psychiatrists at the Billings Clinic for IBH consultation and general peer support. The number of consultation sessions about specific cases increased measurably, and this peer-to-peer support helped increase satisfaction among rural providers, decrease burnout, and improve the overall patient experience. By the end of the project, three of the nine facilities had embedded behavioral health providers in their primary care practices, enabling greater access to services for their patients. Billings Clinic will continue to pursue the implementation of collaborative care across its affiliate network system, including any new affiliates acquired in the future. This may be sustained through budget support by Billings Clinic and the rural affiliates, as well as grants from governmental sources and private donors.

Grant Amount

$262,739

Term

12 month

2018

Bitterroot CASA, Inc.

Bitterroot CASA Advocacy Training & Sustaining

Bitterroot Court Appointed Special Advocates (BCASA) will provide well trained and supported advocate volunteers to connect with and speak for the best interests of children under the jurisdiction of 21st District Court. BCASA currently represents 81 children removed from their homes due to abuse and neglect, and the number of children they serve has more than doubled over the past 18 months. BCASA will strengthen its program and partnerships to meet the advocacy and permanency needs of every abused and neglected child in Ravalli County. The funding will provide an increase in the program director hours, increasing the director’s capacity to recruit, train, and manage advocate volunteers. Through the active partnerships with the 21st District Court, Family Social Services, and the National CASA program, they will provide in-service training and support volunteer advocates as they care for children and navigate the complex issues and multiple causes of child maltreatment. Bitterroot CASA will facilitate 12 presentations in 7 communities to recruit at least 20 new advocates. The overall goal of the project is to increase awareness of abuse and neglect to decrease the number of incidences in Ravalli County.

Grant Amount

$55,826

Term

24 month

2020

Blackfeet Community College

Trauma Informed Planning Grant

This two-part project will begin to create a trauma-informed campus on the Blackfeet Community College and disseminate a culturally-based, trauma-informed toolkit to other agencies on the reservation, and develop a feasibility and business plan for an integrated behavioral health student health center on campus. To create a trauma-informed campus, this project will train trainers in a culturally-based historical trauma curriculum, provide professional development in integrated care models, strengthen campus and community referral resources, create an action team, and provide support to students. The National Council for Behavioral Health will assist in creating a detailed strategic plan for implementing integrated behavioral health into the student health center. The goals for the student health center are for it to not only provide students with primary and behavioral healthcare screenings but also with space for behavioral health and nursing students to practice trauma-informed integrated health.

Grant Amount

$75,000

Term

12 month

2017

Blackfeet Tribal Health

School and Community Based Health Services for Blackfeet Youth

This grant allowed Blackfeet Tribal Health to plan for and establish a school-based clinic to serve students in Browning. During the grant, the tribe formed a successful collaboration with the school district, secured and renovated a building to house the clinic, and hired staff. In the fall of 2016, the new clinic (named the Southern Piegan School Health and Wellness Program) began seeing students. As of late 2017, the clinic had provided care to more than 1,500 students and was preparing to implement a new integrated behavioral health program. The clinic is fully self-sustaining through revenue from insurance billing and will not require grant support to maintain operations.

Grant Amount

$20,000

Term

24 month

2015

Blackfeet Tribal Health

Blackfeet Emergency Medical Services program

The Blackfeet EMS Program trained and certified three paramedics from Blackfeet Tribal Health’s emergency medical technician staff. With the advanced certifications, the Blackfeet EMS Program is now able to bill at a higher rate and will continue to expand its program. The revenue allowed the tribe to purchase three new ambulances with advanced equipment, which is helping the program to provide a higher level of service. By certifying their paramedic staff, the Blackfeet Tribe is addressing their workforce challenges and providing improved emergency response to the community. The program is sustainable through revenue generated from billing services.  

Grant Amount

$75,136

Term

24 month

2017

Blackfeet Tribal Health

Tribal Health Improvement Program

This project provided funding for a project coordinator position to help design and implement the Blackfeet Tribal Health’s Tribal Health Improvement Program (T-HIP). T-HIP is Montana’s innovative new Medicaid waiver program that provides per capita funding for tribes to address factors that contribute to health disparities in the American Indian population residing on the reservation. Our grant funded the project coordinator position for six months and allowed the tribe to develop and execute a task order with the State of Montana to begin implementing Tier 1 of the T-HIP program. Tier 1 of the T-HIP program addresses high utilizers of health care on the Blackfeet reservation and provides care coordination and outreach to this population. The tribe is now providing care management, health education and transportation to the Blackfeet community, and the program is entirely self-sustaining; they are now planning for Tier 2 of the T-HIP program.

Grant Amount

$42,000

Term

12 month

2017

Blackfeet Tribal Health

T-HIP Tier 1 Daphne Software Support

This project helped support the Blackfeet Tribe’s start-up costs for implementing the Tribal Health Improvement Program (T-HIP). The grant helped the tribe to purchase a software system (Daphne) designed to track T-HIP care management reporting measures. The grant also helped set up and staff the T-HIP office, develop their services, and sign a task order to begin Tier 1 services. Daphne is computer software for recording and reporting care management information for T-HIP and other care management initiatives. Now that the primary elements of the system are in place, the tribe will begin providing care management services to high–risk Medicaid recipients on the Blackfeet Reservation to improve health outcomes and reduce their reliance on high-cost emergency and hospital services. The program is sustainable through Medicaid T-HIP payments. 

Grant Amount

$12,000

2018

Blackfeet Tribal Health

Blackfeet Tribal Health 638 of the Community Health Education Program

The Blackfeet Tribal Health Department will work to assume management of its Community Health Education Program from the Indian Health Service (IHS) under Public Law 93-638 (this is often called the “638 process.”) This grant will help the health department complete a feasibility study and plan for assuming the Community Health Education Program; funds will help the Tribe hire a contractor to help with the 638 process. Adding the Community Health Education Program into the health department will help it achieve accreditation through the Public Health Accreditation Board and coordinate a more robust portfolio of community health-related activities.

Grant Amount

$19,877

Term

12 month

2020

Blackfeet Tribal Health

Addressing Perinatal Behavioral Health on the Blackfeet Reservation

Blackfeet Tribal Health will partner with the Indian Health Service (IHS) Blackfeet Community Hospital to create a community-wide system of care to address substance use and mental illness for pregnant women and their families. Addressing perinatal substance use is a top community health priority for Blackfeet with a high fraction of babies born screening positive for substances. Grant funds will be used to hire a care coordinator and behavioral health specialist to work with the Blackfeet IHS OB Department and the Blackfeet Medication-Assistant Treatment Program to serve all perinatal patients. This project will bring together many of the tribal social service agencies together to collaborate and ensure services are provided to address social issues the families are facing.

Grant Amount

$150,000

Term

24 month

2019

Blackfeet Tribe

Centralized Third Party Billing System

The Blackfeet Tribe created a centralized third-party billing office for their health system. The billing office allows the tribe to maximize revenue from the health services they provide and improve the financial management of revenue from third-party billing. The project hired a benefits coordinator and patient accounts coordinator to assess their current programs and identify billable services. The billing office collected over $2.5 million in revenue and provided referral services for Blackfeet Tribal Medicaid recipients for denture and brace services. The billing office is helping the tribe improve and expand health services to serve the needs of their community better and create a more fiscally stable, and sustainable structure for existing health programs. The office is sustainable through the revenue generated from billing services. 

Grant Amount

$100,000

Term

24 month

2016

Blackfeet Tribe

Blackfeet Partnership for Food Sovereignty Strategic Plan

The Blackfeet Agriculture Resource Management Plan (ARMP) completed a comprehensive, five-year food sovereignty strategic plan and began implementation. The project’s long-term goal is to work towards ending food insecurity and many of the problems implicit in disconnecting from traditional food sources. Objectives for the planning process included coordination of food production and delivery systems on the Blackfeet Indian Reservation, creation of a Blackfeet food code, and development of measurement tools to track potential health changes due to interventions in the food and health system. As part of this project, the ARMP team began implementing a feasibility study for a Blackfeet Beef/Bison Processing Plant. They also received a five–year, $1 million grant from the Foundation for Food and Agriculture Research that will underwrite all the research objectives outlined in the food sovereignty strategic plan. Key partners include the Blackfeet Tribe, community partners, and the MSU Native Land Project.   

Grant Amount

$50,000

Term

12 month

2018

Boys & Girls Club of Lewistown

Central Montana Mental Health Alliance

This project will help the Boys and Girls Club work towards providing behavioral health services to youth and their families in Lewistown and the surrounding rural communities. In partnership with Central Montana Head Start and the Lewistown School District #1, this project will either hire or contract with a mental health provider to provide services at each facility. Grant funding will support staff time and a consultant who will design an optimal service model and develop plans for funding and implementation.

Grant Amount

$15,000

Term

12 month

2018

Boys & Girls Clubs of Yellowstone County

Joint-Service Behavioral Health Model Pilot for the Lockwood Clubhouse

The Boys and Girls Club of Yellowstone County, Yellowstone Boys and Girls Ranch, Tumbleweed, and Lockwood Schools partnered to provide behavioral health services to youth attending Boys and Girls Club activities at Lockwood Schools. While a new, valuable partnership was formed among these entities, the goal of providing sustainable behavioral health services to Lockwood youth was not achieved. Though Lockwood school is a school-wide Title 1 school, the number of youths who attended the Boys and Girls Club who were on Medicaid or eligible for Medicaid was significantly lower than anticipated at the start of this project. Additionally, of the youth who had third-party health insurance, the majority had plans that would not cover the type of behavioral health therapy being offered through this project. This resulted in an inability to bill for services which made this model unsustainable. While this project did not yield the desired results, the three organizations remain in contact and are continuing to explore other ways to provide behavioral health services to the youth participating in Boys and Girls Club after-school activities. Staff will continue to engage the Yellowstone Boys and Girls Club as conversations with the Lockwood School District, St. Vincent hospital, and the Yellowstone Boys and Girls Ranch around school-based health services take place.

Grant Amount

$50,000

Term

12 month

2018

Bozeman Health Foundation

Integrating Behavioral Health into an Internal Medicine Team

The goal of this project was to develop a plan to integrate behavioral health care into a Bozeman Health internal medicine team. The project resulted in the hiring of a psychiatrist who worked with the internal medicine team and a women’s specialist to establish the integrated behavioral health (IBH) program. The National Council for Behavioral Health met with providers and staff to provide guidance on implementing IBH workflows, policies, procedures, and protocols. Bozeman Health integrated IBH into one “pod” of providers and then expanded to the rest of the group once workflows were ironed out. The staggered roll-out allowed refinement and improvement of processes prior to full implementation. Because of this thorough planning process, Bozeman Health positioned themselves to fully implement IBH throughout their primary care and pediatric practices.

Grant Amount

$32,700

Term

12 month

2016

Bozeman Health Foundation

Behavioral Health Symposium, Work Groups, and Summit

For this project, Bozeman Health partnered with leaders from the Gallatin City-County Health Department, the mental health Local Advisory Committee, Gallatin Mental Health Center, United Way of Gallatin County, and MSU’s Student Health Services to host a behavioral health planning symposium in the fall of 2017, working groups through the winter, and a behavioral health summit in the spring of 2018. The project’s goal was to bring together community partners to re-imagine a behavioral health vision and develop a behavioral health strategy for Bozeman Health. Elevating Behavioral Health (EBH) successfully brought a broad cross-section of community leaders together to understand challenges, identify early and long-term solutions and to form new and strengthened partnerships focused on a common behavioral health vision. The EBH steering committee continues to meet, to advance early solutions, and to rally collaborative efforts toward a now agreed upon set of key community outcomes in improving behavioral health. The effort also enabled Bozeman Health to identify how and where it can best support behavioral health throughout its service region. This new clarity informed a Bozeman Health board endorsed Behavioral Health Care System plan and a budget that passed in November 2018.

Grant Amount

$25,000

Term

12 month

2017

Bozeman Health Foundation

Community Crisis Response

The Bozeman community will develop a crisis diversion program by redesigning behavioral health crisis services in Gallatin County. The project will begin with an analysis of the existing behavioral health crisis system and the current use of behavioral health, emergency department, and corrections resources. Based on this analysis, the partners will develop a plan for crisis diversion that aims to de-escalate crises and thereby reduce reliance on high-cost emergency care and corrections system resources. Grant funds will be used to employ a care coordinator/clinician to oversee crisis admissions and discharges at Bozeman Health. Bozeman Health will serve as the lead organization for this project, working through a formal charter with the Gallatin County Health Department, Gallatin County Sheriff’s Department, and Western Montana Mental Health. The goals of the project are to reduce emergency department admissions, criminal justice encounters, and recidivism.

Grant Amount

$100,000

Term

24 month

2019

Bozeman Health Foundation

Implementation of Integrated Behavioral Health

This project will build upon the work of a planning grant to fully implement integrated behavior health throughout Bozeman Health’s primary care system. Bozeman Health will also continue integrating its OB/GYN and pediatrics practices through psychiatric consultation, shared learning, and training by the National Council for Behavioral Health. Grant funding will be used to cover the initial costs of employing licensed clinical social workers in the respective practices.

Grant Amount

$150,000

Term

24 month

2018

Bozeman Health Foundation

Perinatal Substance Abuse in Southwest Montana: An Integrated Model

This project will allow Bozeman Health to develop and implement an effective model of care for OB/GYN patients who have behavioral health needs. Through this project, Bozeman Health will integrate behavioral health provides into their current care teams and expand the model of team-based care to partners in the community. Grant funds will be used to add additional behavioral health providers, who will be available for warm hand-offs and same day visits, into existing care teams who care for pregnant women. Partners include Gallatin County Health Department and Roots Family Cooperative who will assist in addressing social needs of women and families. The project’s overall goal is to improve timely access to effective evidenced based care to help serve women and families that are affected by drug and alcohol use or mental health issues during the most crucial time of development.

Grant Amount

$110,000

Term

24 month

2019