Health care reporting for Montanans

Montana Free Press will provide in-depth, ongoing coverage of health and health policy issues. These stories will be published for free on the Montana Free Press website and in collaboration with over 100 partnering news outlets across the state. Reporting will ensure that public health experts, policymakers, leaders, and Montana residents alike are aware of the policy debates and decisions made by their elected representatives and have access to the information they need to make informed decisions for their health and the health of their communities. Funding will support reporting and editorial staff positions. Partners include print and online news sites and radio stations across the state that re-publish Montana Free Press reporting.

Transgender Community Support and Wellness Project

This planning grant will support the development of a statewide network focused on reducing isolation and increasing resilience through engaging transgender and non-binary people across Montana. The Montana Gender Alliance (MGA) – a fiscally-sponsored organization of the Montana Human Rights Network – provides community support and resources to transgender and nonbinary Montanans, as well as public education and training. MGA will complete a community assessment focused on eliminating barriers to participation for rural community members, such as lack of reliable access to high-speed internet. Funds will support hiring a project coordinator, travel expenses to carry out meetings as part of the community assessment component of the project, and marketing and advertising to promote support groups through social media. Partners include Shodair Children's Hospital, the Montana Primary Care Association, Bridgercare, Montana Legal Services Association, the Montana Chapter of the American Academy of Pediatrics, and the Montana Medical Association.

Strategic Planning of Additional Hospital-Based Medical-Legal Partnerships

This grant will support the Montana Legal Services Association (MLSA) in developing hospital-based medical-legal partnerships that address health-harming legal needs and achieve better health outcomes for low-income patients. MLSA is a nonprofit law firm that empowers low-income people by providing free legal information, advice, and other services. Over the past six years, MLSA has developed innovative, successful medical-legal partnerships that serve a network of federally qualified health centers and Providence St. Patrick Hospital in Missoula. Through this grant, MLSA will extend this model to other communities by building a sustainable hospital-based medical-legal partnership structure, identifying interested hospitals, nurturing relationships with those hospitals, building needed data sets, and finalizing memoranda of agreement. Grant funds will primarily be used for staff salaries, consultant fees, and travel. MLSA will identify and develop three primary partnerships with Montana hospitals as part of the project's outreach phase.

Montana Professional Health and Wellbeing Program

The Montana Medical Association Foundation is joining with other health care coalition members to protect public safety by establishing a Montana program run by Montana health care professionals to assist and rehabilitate licensed Montana health care professionals who are found to be physically or mentally impaired. This coalition intends to establish a non-profit to provide these services to licensed Montana healthcare professionals and offer educational sessions with respect to recognition and treatment of alcohol dependency, and chemical dependency. The goal will be achieved through the committed work of a coalition of Montana healthcare stakeholders who will identify and bring the resources needed together for the creation of the organization and establishment of the medical assistance program. The funding will support MMA to develop a business and operations plan and establish a new organization. Partners include MHA, Montana Nurses Association, Montana Dental Association, and BHAM: broad buy-in from these organizations will be essential to successfully re-establishing services. The partners include the Montana Medical Association, the Montana Hospital Association, the Montana Nurses Association, the Montana Dental Association, and the Behavioral Health Alliance of Montana.

Indigenous Foundations in Systems of Education: Shifting the Academic, Holistic Health, And Behavioral School Supports Provided to Montana’s American Indian Students

The Montana Office of Public Instruction (OPI) will work to improve American Indian student academic and wellness outcomes by adjusting its support for academics, holistic health, and behavioral health. OPI serves as the state education authority in Montana and acts as the state-level governmental organization for education. OPI has incorporated Native American knowledge within its Tribal Relations and Resiliency Unit. Through this project, OPI will contract with the Elder and Cultural Wisdom Council to provide training to additional units within the organization. The units include American Indian Student Achievement, Coordinated School Health, and Indian Education for All. Each team will update its strategic plans and implement policies and practices to create necessary changes in the services offered to districts. Grant funds will support the consultant, cover the strategic planning efforts, and travel for meetings.

Partnering to Provide Equitable Care to Unhoused Individuals Impacted by Opioid Use Disorder

The Montana State University College of Nursing (MSU CON) will use this grant to plan an innovative program to deliver medication-assisted treatment (MAT) for opioid use disorders to people living on the streets. Unhoused individuals encounter many barriers to accessing this life-saving treatment. MSU CON will take a three-pronged approach to develop a street-based treatment model. 1) Seek insight and guidance from unhoused individuals with opioid use disorders. 2) Design a coordinated response by partnering with organizations already serving this population. 3) Engage interdisciplinary health profession students in this street-based model of care to build a pipeline of nursing, medical, and behavioral health clinicians capable of implementing the model. Grant funds will be used for staffing, supplies, and participant costs. Project partners include Partnership Health Center, Open Aid Alliance, and All Nations Health Center.

Improving Mountain Home’s Continuum of Care for Indigenous Women and Children

With this planning grant, Mountain Home Montana will work with All Nations Health Center and Kauffman & Associates to improve their care continuum and access to services for indigenous women and children. Mountain Home Montana’s mission is to provide a safe home and nurturing community where young mothers discover their strengths and their children thrive. Mountain Home offers shelter for young mothers who need a place to live and a network of support as they create their own safe, stable, and nurturing homes. They aim to increase the percentage of Native women in their residential services from 16% to 30%. Through their justice, equity, diversity, and inclusion initiative, Mountain Home will work with project partners to review programs and spaces through an Indigenous lens and address identified health inequities. Funds will support completing a quality improvement assessment, creating a new referral coordinator position, and recruiting more Native staff across the organization. In addition to All Nations Health Center, primary partners include Montana Pediatrics and the Missoula City-County Health Department.

Four Bands Workforce & Professional Development

NACDC Financial Services, a community development financial institution (CDFI) located in Browning, will create the infrastructure to incubate businesses and train community members as part of the Mountain|Plains Native CDFI Coalition’s Native finance industry project. This project will address the health consequences of poverty, unemployment, and lack of economic opportunity by placing candidates in quality jobs in the region's Native economies. NACDC will design and implement a skills development program for Native CDFI staff, including a regional recruitment strategy and workforce training program, and will leverage partnerships to explore workforce wrap-around services. Funding will be used as sub-award grants to the other Montana-based Native CDFIs to pilot workforce and professional development innovation.

Integrated Behavioral Health 2.0

The Billings Urban Indian Health and Wellness Center (BUIHWC) will implement a cohesive, collaborative, and culturally appropriate approach to patient care by integrating behavioral health into its primary care clinic. As one of the five urban Indian health centers in Montana, BUIHWC serves Native American people living in Billings and Yellowstone County. This project will hire a project manager to help the organization implement the integrated behavioral health program and collaborate with community health partners. Anticipated results of this program include improved patient outcomes, lower operations costs, and reduced stigma surrounding mental health. Funding will support the project manager position and additional technical assistance. Project partners include community health programs associated with the Native American Development Corporation.

Baatz Block Apartments Technical Assistance

NeighborWorks Great Falls has partnered with Homeword Development to rehabilitate the historic, abandoned Baatz building in downtown Great Falls into 24 permanent supportive housing units. Permanent supportive housing combines affordable housing with support services to improve health and social outcomes for people experiencing chronic homelessness in addition to complex, chronic physical and behavioral conditions. The services are designed to build independent living and tenancy skills and connect people with community-based health care, treatment, case management, employment assistance, and other services. The project is the community’s first purpose-built permanent supportive housing. The team has secured $10 million in tax credits and other funding from state and local sources to construct the project. This grant was used to fund technical assistance and support provided by BeauxSimone Consulting (BSC), including engagement of a design team and community partners, coordination of regular service planning meetings, conducting focus groups that included both experts and those with lived experiences, and the development of MOUs between service providers and property owners. While the project has experienced delays due to construction market conditions, its strong financial standing will most likely result in a successfully completed supportive housing building by the summer of 2025. The project expects to sustain the Baatz Block Apartments through partnerships and grants.

Northern Cheyenne Healthy Housing Needs Assessment

The Northern Cheyenne Tribal Housing Authority will conduct an in-depth housing needs assessment for the Northern Cheyenne Nation. The assessment will focus on housing needs and incorporate health, education, employment, economic development, and social services related to housing. Funding from the U.S. Department of Housing and Urban Development Office of Native American Program Training and Technical Assistance will support a consultant to conduct the assessment. Montana Healthcare Foundation funding will support the direct expenses incurred through local data collection activities, including field staff labor, equipment, mileage, and respondent incentives. Project partners include Northern Cheyenne Tribal Health, the Tribal Board of Health, and the Tribal Health Improvement Program.

Integrated Behavioral Health Initiative Implementation at Northern Montana Hospital

Northern Montana Hospital (Northern), based in Havre, will implement integrated behavioral health throughout its health system to universally screen primary care patients for behavioral health conditions and improve health outcomes. Northern will hire a care coordinator and two therapists who will work with the primary care teams to implement integrated behavioral health throughout the Northern health system. Funding will support staffing, project oversight, and updates to the electronic health record to support population health and data analytics. Northern will receive technical assistance from the Montana Healthcare Foundation's technical assistance team and data collection and analysis assistance from JG Research and Evaluation. Throughout the project, Northern will work with the local federally qualified health center, mental health center, Rocky Boy Reservation, and Northern Montana College.

Meadowlark Initiative Implementation at Northern Montana Hospital

Northern Montana Hospital (Northern) will implement The Meadowlark Initiative to decrease drug use in pregnancy, reduce child removals, identify individual needs for each patient and their family, and build a safe team-based approach to support better perinatal outcomes. Northern will coordinate OB/GYN, family practice, and behavioral health providers and provide care coordination to identify and connect resources from the community to patients when needs are identified. Funding will support a care coordinator and licensed addiction counselor, and the project will also draw on Northern's behavioral health team. Project partners include Rocky Boy Health Center and Sweet Home Medical Center.

Strategic Alliance for Improved Behavioral Health

This grant will support the Strategic Alliance for Improved Behavioral Health to decrease the number of behavioral health crises resulting from incarceration or hospitalization by implementing the Crisis Now Model. The Strategic Alliance for Improved Behavioral Health (Alliance) is a coalition that includes critical stakeholders in Missoula County, including Providence St. Patrick Hospital, Community Medical Center, Partnership Health Center, Western Montana Mental Health Center, All Nations Health Center, the Missoula City-County Health Department, and the City Council and County Commission. This grant will support implementation of a crisis line (988), expand the community's mobile crisis team, and create a crisis receiving facility as a more effective alternative to hospitalization or incarceration for people in crisis. More broadly, the Alliance will also continue to plan and support implementation of a more complete continuum of behavioral health services -- from prevention to early diagnosis and treatment -- for the region. The Alliance will utilize the grant funds for a coordinator to oversee the project and a consultant for updating the resource mapping and strategic planning.

Crisis Coalition Formation, Improvement, and Sustainability

Pioneer Medical Center will plan and develop a crisis system for Sweetgrass County based on the Crisis Now Model. With this grant, Pioneer Medical Center will create a coalition, hire a coordinator, map the current behavioral health crisis system, and develop a strategic plan. The Crisis Now Model includes a crisis line (988), a mobile crisis team, and a crisis-receiving facility and provides a more effective alternative to hospitalization or incarceration for people in crisis. Funding will support a coordinator to oversee the project, mapping, program design, and convenings. Through this grant, Pioneer Medical Center will also engage neighboring counties, including Park, Wheatland, Meagher, Golden Valley, and Stillwater counties, in discussions on a regional crisis framework. Project partners include Sweet Grass County, Sweet Grass County EMS, Billings Clinic, and Billings Clinic Integrated Behavioral Health Program.

Crow Nation Innovation Center

The Crow Nation Innovation Center will develop a facility to support community development for the Crow Reservation and surrounding area. Through this project, a signature space in the Crow community will be created to spur innovation and entrepreneurial development as well as local income and jobs. This grant will serve as a match for federal funding secured from the U.S. Economic Development Administration (EDA). Partners include The Steele Reese Foundation, First Interstate Bank Foundation, and the Northwest Area Foundation.

Richland County Rural Housing Planning Grant

The Richland County Housing Authority (RCHA) will develop a community action plan focusing on Richland County’s homeless and housing insecure populations and coordinating housing and supportive services for this population. RCHA will contract with the Corporation for Supportive Housing to identify housing insecure individuals who frequently use community systems. It will also build partnerships with community service providers that can provide tenancy support and care coordination. The Richland County Health Department has identified housing as a critical health issue. It has partnered with the RCHA to convene stakeholders and develop a community plan to address housing access and service support for vulnerable populations. Funds will support the technical assistance contractor, project management, and convening. Partners engaged in preliminary steering committee discussions include the Richland County Health Department, Sidney Community Health Center, Eastern Montana Community Mental Health Center, law enforcement, and Prairie Hills Recovery center.

Postpartum Doula Project

The Postpartum Doula Project, a program of Roots Family Collaborative, will provide free or sliding-scale postpartum doula services in Gallatin and surrounding counties for families in the critical developmental stage following birth. Roots Family Collaborative's mission is to connect all families to the support they need from pregnancy to parenthood. This planning grant will support a year-long process during which the organization will examine and build program staff capacity, identify new and existing strategic partnerships, develop an advisory council, identify and overcome barriers to creating long-term sustainability for the program, and develop a handbook for program implementation.

RVMC Integrated Behavioral Health

Ruby Valley Medical Center (RVMC) will integrate behavioral health services into its primary care practice. RVMC is a critical access hospital in Sheridan serving seven rural communities in western Madison County and southern Jefferson County. This project will help RVMC identify a champion to lead the project and provide team training for its providers to enhance the organization’s standard way of delivering care. Funding will support staff training on the integrated behavioral health model, developing organizational workflows to support the model, and integrating a counselor into the primary care office.

Improving PACT Client Outcomes through Medication Optimization and Care Coordination

The South-Central Montana Regional Mental Health Center (SCMRMHC) will explore the feasibility of improving its Program of Assertive Community Treatment (PACT) teams by adding another provider type – a clinical pharmacist – to the team. PACT allows people with longstanding, severe, or disabling mental illnesses to live and function safely in their homes and communities rather than being hospitalized. Traditional PACT teams consist of a supervisor, program assistant, psychiatrist, peer specialist, and mental health professionals. This project will explore the feasibility of adding a clinical pharmacist to the team to provide medication management which is proven effective in complex populations. Funds will be used for care coordination and supporting a consultant to help determine the feasibility of integrating a clinical pharmacist into the PACT team and recommending a successful finding to the state.

West Elementary School-Based Clinic

The Southwest Montana Community Health Center (SWMTCHC) will expand school-based health services to the students of West Elementary in the Butte school district, the second school in which they will offer health services. The health center will help improve the students' health, which, in turn, will support their attendance and education. SWMTCHC will provide the medical and behavioral staff needed to offer services to students on-site at West Elementary. Funding will support a part-time behavioral health provider. Project partners include West Elementary School and the Butte School District.

St. John’s United Workplace Integrative Behavioral Health Initiative

This project will develop on-site primary care with integrated behavioral health services for residents and employees of St. John’s United (SJU) senior living facilities. SJU is a significant provider of senior living opportunities, with campuses in Billings, Laurel, Red Lodge, and Hamilton. Its services include transitional inpatient rehabilitative care, skilled nursing, memory care, assisted and independent living, permanent supportive housing for older adults, home health, hospice, outpatient rehabilitation, and home and community-based services. The project goals include lower turnover, lower insurance premiums, higher work satisfaction for staff, and fewer hospital admissions and falls. They hope to achieve reduced rates of anxiety and depression and improved quality of life for both employees and residents. SJU’s work plan includes gathering initial health assessment data to develop implementation and service delivery targets. Funds will support the salaries of the team developing the project as well as consultation fees from mental health professionals. SJU will establish a new partnership with South Central Regional Mental Health Center for consulting services and future contracts with mental health providers.

Meadowlark Initiative

St. Luke Community Healthcare will continue participating in The Meadowlark Initiative and enhance the behavioral health services it provides to women and families on the Flathead Reservation. This project will develop a patient registry to improve St. Luke’s data collection and analysis capacity, strengthen care coordination for pregnant women and families, and build a self-sustaining Meadowlark Initiative program. Funding will support care coordination and staff training on the electronic medical record. Partners include the Confederated Salish and Kootenai Tribes Tribal Health Department and St. Joseph Healthcare.

Integrated Behavioral Health Support Program Expansion

St. Peter's Health (SPH) will expand and strengthen its established integrated behavioral health program. This project will increase the evidence-based screening cadence and enhance team-based care by expanding specialized support services. SPH will hire a licensed addiction counselor and behavioral health navigator and embed these positions into the ambulatory clinics to provide outpatient substance abuse services. The addition of the licensed addiction counselor position will allow SPH's addiction medicine and behavioral health providers to work to the top of their licensure, and the behavioral health navigator will assist in identifying social needs, connecting patients to the appropriate level of care, facilitating referrals, and ensuring continuity of care. Grant funds will support the licensed addiction counselor's salary and a stipend for a Carroll College Master of Social Work Program intern. Over the past several years, SPH has formed strong relationships with community partners, including other health care providers, mental health providers, DPHHS Child and Family Services, Lewis & Clark County Home Visiting Program, and many community-based organizations which will help support the effectiveness of this project.

Parental Mental Health Support Program Expansion

St. Peter's Health (SPH) will expand and strengthen its established Meadowlark Initiative program. This project will increase evidence-based screening cadence and access to services and enhance team-based care by expanding specialized support services. SPH will hire a licensed addiction counselor and behavioral health navigator and embed these positions into the obstetrics clinic to provide outpatient substance use and mental health services. The addition of the licensed addiction counselor position will allow SPH's addiction medicine and behavioral health providers to work to the top of their licensure, and the behavioral health navigator will assist in identifying social needs, connecting patients to the appropriate level of care, facilitating referrals, and ensuring continuity of care. Grant funds will support the behavioral health navigator's salary. Over the past several years, SPH has formed strong relationships with community partners, including other health care providers, mental health providers, DPHHS Child and Family Services, Lewis & Clark County Home Visiting Program, and many community-based organizations which will help support the effectiveness of this project.

Helena Coordinated Entry System Data Coordination

St. Peters Hospital (SPH) will expand its data system to include the Coordinated Entry System, which identifies the most appropriate housing resources for homeless individuals. Currently, SPH’s system tracks data points of frequent users of jails, shelters, hospitals, and crisis public services (known as “Frequent User System Engagement” or “FUSE” clients). By enhancing its current data dashboard and expanding it to partner with the Coordinated Entry System, SPH will improve the community's capacity to monitor outcomes and keep clients housed. The new system will also help SPH and partners track and coordinate the supportive services needed to keep clients housed. Grant funds will support staffing costs for building and managing the upgraded data system. Our partners include the Helena Housing Authority, United Way, PureView Health Center, God’s Love, Good Samaritan Ministries, Lewis and Clark County Jail, and other organizations within the Coordinated Entry System.

Butte-Silver Bow Behavioral Health Systems Improvements and Sustainability Project

The Butte-Silverbow City-County Health Department will implement the Crisis Now Model to decrease the number of behavioral health crises resulting in emergency room visits, hospitalization, and incarceration. The Crisis Now Model includes a crisis line (988), a mobile crisis team, and a crisis-receiving facility, and provides a more effective alternative to hospitalization or incarceration for people in crisis. Funding will support a coordinator to oversee the project, the expansion of the mobile crisis team, and planning for the crisis-receiving facility. Project partners include members of the Butte-Silver Bow Strategic Alliance, including St. James Healthcare; Action Inc; Southwest Montana Community Health Center; Western Montana Mental Health Center; and Community, Counseling, and Correctional Services, Inc.

Engaging Private Sector Building Industry Professionals in Partnerships to Develop Permanently Affordable Homes for Montanans

Trust Montana will implement a replicable model for partnership between community land trusts and private sector building industry professionals as an innovative way to create more affordable housing. Trust Montana is located in Missoula and works to increase the number of permanently affordable homes in the state. This project will accelerate affordable home development by leveraging private developer construction financing, nonprofit grant acquisition expertise, land donations, related charitable tax benefits, and community land trusts' growing public and government support. Funds will support current staff in developing a tool kit and outreach plan and assisting rural communities across the state. Partners include WGM and Blueline Development, Inc.

Building Support to Advocate Effectively for Public Health at the State Level and Nationally

The Network for Public Health Law used this grant to commission a feasibility study to identify barriers, challenges, and opportunities to strengthen public health advocacy at the local, state, and national levels. The goal of this project is to address the chronic lack of funding for public health, which has resulted in county, tribal, state, and federal agencies being unable to carry out the core activities needed to protect and promote health effectively. The seven-page report that was written identified six key opportunities for action: 1) develop and advocate for pro-health policies, 2) cultivate friends of public health, 3) build and strengthen state-level advocacy organizations, 4) develop and disseminate effective, consistent messaging, 5) train the current and future workforce, and 6) unlock funding. The report was disseminated to study participants and partners in the public health field and posted on the Network’s website. The next steps are to convene advocacy and legal experts, funders, and key leaders to react to report findings and discuss actions to strengthen and align public health advocacy efforts at the local, state, and national levels, and to assess the existing capacity for public health advocacy at the state and national levels. The Network has received funding from the CDC Foundation and de Beaumont Foundation for $250,000 each, as well as in-kind support from the American Heart Association. In November, the study’s authors presented the results at the APHA Advocacy for Leaders annual workshop, and they submitted abstracts for several related conferences in 2023.

Montana PAX Sustainability Initiative

The Economic Impact of a Montana Law Income Housing Tax Credit Program

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.

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.

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.

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

The Arlee Community Development Corporation (CDC) sought to establish a walk-in, choice-based food pantry and resource center that provides access to more local nutritious food and food education to communities in the Jocko Valley. By collaborating with a range of partners, including Confederated Salish and Kootenai (CSKT) Tribal Health, CSKT Food Sovereignty Initiative, Mission Mountain Food Enterprise, and Montana Growers Cooperative, Arlee CDC was able to serve more hard-to-reach populations with a variety of food options, services, and educational programs. Patrons of the food pantry were educated about SNAP benefits and received assistance with SNAP applications. Arlee CDC accessed food from local growers and producers, provided meal kits to families, offered cooking and food preservation classes, educated about ancestral food preparation, and provided garden boxes to encourage families to grow their own food. Arlee CDC received a $15,000 grant from Hopa Mountain, got access to $15,000 - $20,000 in federal Emergency Food Assistance Program funding, and obtained other in-kind and financial donations from partners.

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.

Butte SPIRIT Home, Scaling up Staffing to Support SUD Recovery Home Sustainability

The Butte Spirit Center, which operates the Butte SPIRIT Home, a transitional housing and addiction recovery home for adult males, used this grant to attain approval as a substance use disorder (SUD) treatment program from the state of Montana. The goal was to enable the home to access Medicaid and other private insurance revenue to sustain its current operational model. The home was successful at getting approval as a Montana Medicaid biller and is licensed to provide care as a clinically managed low-intensity residential service provider (ASAM Level 3.1). In addition to the executive director, the home hired a clinical director, residence manager, and assistant residence manager. Staff retention has been excellent, with staff finding the Butte SPIRIT Home to be a good workplace offering a competitive benefits package. The home has served 26 men overall and has graduated five residents, all of whom remain in contact with the home to ensure their success in recovery. Based on an internal evaluation and feedback from partner organizations, the Butte SPIRIT Home provides a quality sober living environment that is helping people in early recovery to succeed. Working with a third-party biller, the home has attained reimbursement for services through Medicaid. Current reimbursement levels indicate that the Butte SPIRIT Home could be 100% sustained by the billable services that the home is already providing.

Expansion of Behavioral Health Programs in Missoula

This grant enabled Cancer Support Community Montana (CSCMT), which provides support, education, and hope to improve the quality of life of those impacted by cancer, to open a Missoula Chapter in in the former Cold Springs Elementary School building. The goal was to bring a new resource to Western Montana that could transform the cancer experience, increase access to care, and address depression and anxiety for patients and their families. CSCMT’s Missoula Chapter is now fully functioning, with a full-time executive director, a full-time program director, and a full-time development and operations manager. It offers a comprehensive program of support for people with cancer and their caregivers, including monthly support groups, weekly new participant orientations, education programs, mind/body classes, behavioral health services, and wigs and other supplies. The program director is providing one-on-one mental health counseling and developing a community so people have the support they need during their time of difficulty. The Missoula Chapter has successfully localized services in the community in a warm home-like environment that is patient-centered and free of charge. It has built relationships with local cancer centers, other support groups, and community members; recruited a Chapter Board; started building its donor network of individuals and businesses; and executed several successful fundraising campaigns, which will help it continue to provide all services at no cost to community members.

Increasing Capacity and Food Quality to Create a Healthy Culturally Based Reservation Food System

Center Pole is a 23-year-old grassroots, Native-led organization on the Crow Indian Reservation in southeastern Montana. Its food security project aims to improve its capacity to procure, produce, store, and distribute healthy foods to people on the reservation and in the surrounding areas. Despite the challenges of decreased food supplies and higher food prices, Center Pole achieved several of its objectives. It completed improvements to its warehouse, expanded its mostly indigenous food network, received a wide variety of local food donations, and trained 42 community food interns in food safety, distribution, and preparation. Center Pole is working with community elders to learn about the edible wild plants in the area and how they can be used by local populations. It is also focusing on requesting healthier foods from its sources, including the Montana Food Bank Network.

Rocky Boy Food Sovereignty Project

Rocky Boy's Indian Reservation is in the remote Bear Paws mountains of North Central Montana. The remote location has contributed to a food desert on the Reservation, with the nearest grocery store selling fresh foods over 30 miles away. The Chippewa-Cree Tribe's Rocky Boy Food Sovereignty Project will develop a food chain of healthy products grown and produced on the Reservation. The project will help plant gardens, develop and market new value-added food products such as flour and pasta, and establish food handling laws. Locally grown and raised food products will be branded and made available to the community. Funding will help the purchase tools to support the food packaging and support a project coordinator who will develop and implement the program and build toward financial sustainability. Partners include the Stone Child College, the Rocky Boy Diabetes Program, Rocky Boy Public Schools, and the Chippewa Cree Agriculture and Sustainability Program team, which will serve as a board oversight for the project.

Community Medical Center’s Consolidation Grant

Community Medical Center (CMC) is a large hospital in Missoula that serves the surrounding region. This project will expand CMC's capacity to provide the entire continuum of care for patients with mental illness and substance use disorders by fully integrating behavioral health into its primary care clinics, expanding services through telehealth to specialty and walk-in clinics, and thoroughly training and integrating its clinical teams. Funding will support a social worker to serve as a centralized behavioral health care manager for the project. This person will provide the personnel, psychiatric consultation, and clinical supervision needed to implement the project. Partners include the University of Montana's Behavioral Health Workforce Education and Training Program, Walla Walla University's Masters in Social Work Program, Andy Laue, LCSW, who provides group clinical supervision for the behavioral health providers, and other community behavioral health providers who offer individual clinical supervision and psychiatric consultation to the team.

Aaniiih/Nakoda Food Sovereignty on the Fort Belknap Indian Reservation

The Day Eagle Hope Project, a Native nonprofit on the Fort Belknap Indian Reservation that addresses health and wellness issues, used this grant to provide fresh fruits, vegetables, and protein to all four communities on the reservation and to demonstrate healthy living and cooking for every home. Partners included the Fort Belknap Tribe, Fort Belknap Public Health, Indian Health Service, and Aaniiih Nakoda College. The project identified American Indian farmers and ranchers from Fort Belknap and the Chippewa Cree Tribe to supply high-quality, ranch-raised beef—including Bear Paw Livestock Yards and Bear Paw Meats—and oversaw every stage of the process, from production to processing to distribution. The Fort Belknap Tribe donated eight buffalo for meat distribution on a yearly basis, and the Peoples Partners for Economic Development provided a mobile processing unit to come on site for the kill. The project partnered with the Turner Hutterite Colony to supply locally grown vegetables and sponsored a youth event where young people received education on healthy living and a large bag of fresh produce. This project will be sustained through tribal support, local support, and possibly USDA funding.

Sustaining Food Security with MNT Service Delivery

FAST Blackfeet used this grant to develop a sustainable method of funding for its Food Pharmacy Program (FPP), which provides medical nutrition therapy (MNT), group nutrition classes, fruit and vegetable vouchers, and specialized food pantry food boxes to participants who are referred by their health care provider for a nutrition-related chronic disease or food insecurity. The goal was to establish a method of third-party billing so FAST Blackfeet could receive reimbursement for its MNT services. FAST Blackfeet hired consultants to provide technical assistance to help create the new billing system and coordinate the effort with the Blackfeet Tribe, Blackfeet Tribal Health, Blackfeet THIP, and Montana Medicaid. The Blackfeet Tribal Business Council signed a contract, to be administered by Blackfeet Tribal Health, that allows the FAST registered dietitian to provide MNT to patients at the Southern Piegan Health Center (SPHC). Services will be billed at the tribe’s all-inclusive Medicaid reimbursement rate, and the revenue generated will be shared between SPHC, Centralized Billing, and FAST Blackfeet (15/5/80). Because MNT visits for adults 21 and older are not covered by Medicaid, the consultants submitted a proposal to Montana Medicaid to expand coverage to that age group. Medicaid has requested time to review the proposal before making a decision. The consultants also helped create systems for evaluating the FPP. While FAST Blackfeet has not yet seen any revenue from this project, the systems are in place to generate revenue. Additionally, as the community becomes more familiar with MNT services, there will be more opportunities for revenue through Medicaid billing.

Working Toward a Healthy, Food Secure Blackfeet Nation

FAST (Food Access and Sustainability Team) Blackfeet used this grant to reduce food insecurity, increase food access, and improve nutrition intake and knowledge in the Blackfeet Nation. Due to the pandemic, the FAST Blackfeet O’yo’p’ Food Pantry saw a 3.6-fold increase in its participant numbers, requiring it to expand its operations to meet the demand. With the help of this grant, FAST Blackfeet was able to continue distributing food five days a week year-round, both in the food pantry in Browning and through its O’yo’p’ on Wheels Mobile Food Pantry, which serves eight outlying communities located within reservation boundaries. Under the direction of its new executive director, visitors to the pantry are now able to choose, handle, and load their own food, which has resulted in greater satisfaction among participants. FAST Blackfeet has strengthened its partnerships, including with the Montana Food Bank Network, which provides food, helps procure equipment, and assists in obtaining small and large grants. The Montana Food Bank Network helped FAST Blackfeet conduct its annual survey, which led to modifications in the pantry’s food offerings, delivery logistics, and public communications. FAST Blackfeet was able to resume its in-person nutrition workshops and dietician services, which are well-regarded within the community and help empower participants to make healthy food choices.

Spotted Bull Recovery Resource Center Behavioral Health Capacity Building Project

Spotted Bull Resource Recovery Center (SBRRC) is the primary addiction treatment service provider in Fort Peck, offering chemical dependency services and inpatient treatment to the Fort Peck Indian Reservation and surrounding community. With this grant, SBRRC will add mental health services to the care it offers people with substance use disorders. To accomplish this, SBRRC will provide training to its staff to help them develop the necessary clinical competencies, contract with a mental health provider for therapeutic services, implement culturally relevant healing practices, and develop a third-party billing system. Funding will support the contract with a mental health consultant and behavioral health telehealth providers. It will also support the project's evaluation and travel for site visits. The project will be completed through established partnerships with the Indian Health Service, Volunteers of America, and Our Home, Inc.

Tribal-County Crisis Coalition Launch (Blackfeet – Glacier)

The Blackfeet Nation and Glacier County Health Department will launch a "Tribal-County Crisis Coalition" (Coalition) that aligns resources from law enforcement, behavioral health, and medical services across the Blackfeet Nation and Glacier County. The Coalition will conduct sequential intercept mapping (SIM) to understand how people in crisis currently interact with law enforcement, emergency medical services, and behavioral health, and use the results of this mapping to outline a more effective model for crisis response. The project will also develop a sustainable implementation plan. The project will be led by the Glacier County Health Department and the Piikani Lodge Health Institute staff. Loveland and Associates will support mapping, data analysis, and strategic planning. Funding will support the coordination efforts, consultation, travel, and convening expenses. Partners include law enforcement, the Blackfeet Tribe's Culture and Hope Program, and Blackfeet Tribal Health.

Building Bridges for Better Births

Building Bridges for Better Births aims to improve community-based support systems for families through pregnancy and after birth by facilitating relationships between prenatal care providers and family support providers. The program will support the development of community teams, a critical component of The Meadowlark Initiative® model of care. Community teams are made up of social service providers, peer recovery coaches, and related caregivers who all play an essential role in supporting pregnant and postpartum women and their families. This project is a continuation of Healthy Mothers Healthy Babies'work to support The Meadowlark Initiative® in previous years.

Feather Woman Healing Lodge Business Plan

Heart Butte Public Schools, located on the Blackfeet Reservation, hired RJS & Associates to develop a business plan for creating the Feather Woman Healing Lodge, a new facility that would serve students who are homeless or experiencing a mental health crisis. The school district has already purchased two modular homes that will be able to shelter up to 12 students—six girls and six boys—at a time. Through this project, RJS completed a business plan that outlines staffing needs, operation and maintenance costs, insurance costs, risk management, potential funding sources, and other operational infrastructure needed for the facility, as well as the next steps required to advance the project. The project was delayed due to difficulties in securing a partnership with Blackfeet Tribal Health programs (which have been impacted by COVID and leadership changes), but Heart Butte Public Schools is actively developing that partnership.

New Clinic Addition/Design

Helena Indian Alliance (HIA), an urban Indian health center based in Helena and serving the surrounding counties, used this grant to support the redesign of its clinic so it could expand and improve its integrated physical, behavioral, and dental health care services. HIA contracted with SMA Architecture to complete the design phase of the project, which included the creation of a schematic design; structural, civil, mechanical, plumbing, electrical, and architectural scopes; project specifications; and construction and bid documents. This project builds on two prior grants that involved developing a master plan and a structural assessment of the current building. With the plans and design in place, HIA was able to secure funds for the construction costs, estimated at roughly $1.1 million; receive approval from the Billings Area Indian Health Services to move forward; and select a contractor.

Eastern Montana Perinatal Behavioral Health

Holy Rosary Healthcare will join the Meadowlark Initiative and improve access to mental health and substance use disorder care for pregnant women in Miles City and Eastern Montana. The project will integrate behavioral health services into Holy Rosary’s obstetrics clinic. As part of this project, Holy Rosary Healthcare will hire a care coordinator to work directly with patients and foster connections with social service organizations in the community. In addition to hiring a new staff person, grant funding will help establish telepsychiatry services and support coaching from the National Council for Behavioral Health to ensure the project’s success and sustainability. Partners include the Montana Health Network, the Eastern Montana Community Mental Health Center, and Rimrock Foundation.