Rimrock Foundation

Rimrock Program for Assertive Community Treatment (PACT)

Rimrock will implement a new Program for Assertive Community Treatment (PACT) team that serves Yellowstone, Musselshell, Big Horn, Carbon, Stillwater, Golden Valley, and Wheatland counties. PACT is the core service of a tiered delivery system that targets people with severe disabling mental illness who require long-term ongoing 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 build this new PACT program's capacity through technical assistance by the National Council for Behavioral Health and bridge funding to help offset the cost of hiring and training new staff. Project partners include the Southcentral Montana Mental Health Center, Billings Clinic Behavioral Health Service, and the Montana State Hospital. This project aims to stabilize 196 clients with severe disabling mental illness and reduce admission to inpatient psychiatric hospitals.

Grant Amount

$197,148

Term

12 month

2020

Rimrock Foundation

Substance Abuse CONNECT Crisis Diversion Project

This project will support Substance Abuse Connect (CONNECT) to redesign the crisis system in Yellowstone County. There are multiple crisis services available in Yellowstone County (peer support, inpatient behavioral health, and homeless outreach, for example), but there is a need for strategic alignment among services. With the help of a local coalition known as CONNECT, Rimrock will lead the project, using grant funds to hire an executive director who will work to align the efforts of the current crisis service providers. Partners that make up CONNECT include leadership from the local hospitals (Billings Clinic, St. Vincent Healthcare, RiverStone Health), School District 2, the Indian Health Service, Yellowstone County, the City of Billings, the U.S. Department of Justice, the Yellowstone County Continuum of Care Coalition, and the Behavioral Health Alliance of Montana.Sub-committees of this group lead work on specific tasks in the strategic framework. The project aims to decrease emergency department utilization and criminal justice recidivism in Yellowstone County by developing a sustainable behavioral health crisis system.

Grant Amount

$150,000

Term

24 month

2021

Rimrock Foundation

Elm House: Residential Treatment for Pregnant American Indian Women

This grant helped Rimrock Foundation establish Elm House, a residential treatment program that incorporates perinatal care with addiction treatment throughout pregnancy to support long-term sobriety for mothers and improved health outcomes for babies. By partnering with St. Vincent Healthcare's midwifery program, Rimrock was able to ensure pregnant women struggling with addiction receive adequate prenatal care along with treatment services. Case management is provided to help women transition to a safe, sober living environment after delivery. Rimrock was also able to identify specific gaps in care and develop services to fill those gaps, including Parent-Child Interaction Therapy, Circle of Security, Helping Women Recover Beyond Trauma, health coaching, and peer support. Elm House served 10 pregnant women during the reporting period, with five completing the full residential treatment program, one currently in treatment, and four leaving treatment against medical advice. Rimrock built a strong relationship with the Montana Obstetrics & Maternal Support (MOMS) program at the Billings Clinic and was awarded a SAMHSA grant through the State of Montana to serve outpatient pregnant women.

Grant Amount

$63,000

Term

24 month

2017

RiverStone Health

Expanding Integrated Behavioral Health Care and Training in Primary Care

For this project, RiverStone Health successfully completed a business feasibility plan for expanding its scope of service to provide integrated psychiatric services. The feasibility plan also examined opportunities for RiverStone to serve as an integrated behavioral health rotation site for students in psychiatric nurse practitioner training programs, psychiatry residency programs, and Master of Social Worker students. As a result of the planning, the project was able to successfully formalize an integrated behavioral health training program. Additionally, a community coalition of behavioral health providers was established in Billings and continues to meet to network and share critical information among programs.

Grant Amount

$50,000

Term

12 month

2016

RiverStone Health

Integrated Clinical Pharmacy Services Best Practices

This project focused on supporting clinical pharmacist and primary care integration to improve health outcomes. Important achievements included working with DPHHS to develop administrative rules for Medicaid reimbursement for clinical pharmacist practitioners. The grantee will continue to work on establishing standard outcomes measures across the state that will be used to demonstrate the value of clinical pharmacy services. Ongoing planning and educational sessions will also occur to assist pharmacists who are interested in establishing clinical pharmacy services in a physician practice.

Grant Amount

$25,000

Term

12 month

2016

RiverStone Health

PAX: Good Behavior Game and Trauma-Informed Schools on the Southside of Billings

This grant provided funding for a pilot project in three elementary schools on the Southside of Billings (Newman, Orchard, and Ponderosa), where students often experience multiple health inequities and other societal challenges that impact their well-being and their ability to succeed in school and adult life. The project implemented the PAX Good Behavior Game (PAX:GBG) model. PAX:GBG is a trauma-informed approach that helps students learn effective self-management skills shown to increase student success through increasing graduation rates, decreasing costs of special education, and lower rates of suicide, incarceration, and substance abuse. The model helps create a more equitable school culture which enhances student success and creates a healthy trajectory for children as they become adults. As part of the model, parents also receive coaching to ensure students’ self-management skills are translated into the home. The success of PAX:GBG in these three schools helped inform the planning and disbursement of a $2.1 million opioid block grant, leading to the model being used in all 22 elementary schools in Billings, as well as many elementary schools across the state. The pilot project also led to five GBG trainers working in Montana to train and mentor teachers throughout Montana and the development of a working group to advance GBG statewide.

Grant Amount

$75,000

Term

24 month

2017

RiverStone Health

SBIRT Screening and Treatment at School Based Health Center

This project helped RiverStone Health develop a curriculum and training to implement screening, brief intervention, and referral to treatment (SBIRT) to identify and treat substance use disorders (SUDs) in adolescent patients. RiverStone established a standardized and universal SBIRT process to identify, reduce, and prevent problematic use, misuse, and dependence on alcohol and illicit drugs at its two school-based health centers—an elementary and middle school. RiverStone developed a standardized SBIRT workflow for its school-based health clinics, trained school-based health center staff in SBIRT, and worked with school and health partners to implement the process. In total, 270 youth were screened for SUDs. SBIRT reporting is now integrated into RiverStone's quality metrics and will continue as an expectation for school-based health centers. 

Grant Amount

$15,000

Term

12 month

2019

Rocky Boy Health Board

Centralized Coding, Billing, and Revenue Maximization Project

The goal of this project was to develop a sound administration and stable revenue base, which would allow the tribe to design and run effective, tribally-led health programs. During the course of the project, eight tribal health employees completed a coding course through Stone Child College, one patient registration clerk and two benefits coordinators were hired, three staff completed Indian Health Service third-party billing and account management training, and two staff members attended the National Indian Health Service patient registration. One year after the completion of the grant, the grantee reported an overall increase of third-party revenue of over $2 million (52.74%). 

Grant Amount

$99,608

Term

24 month

2015

Rocky Mountain College

SBIRT Curriculum and Training Development

This grant supported Rocky Mountain College to develop and implement a curriculum to train physician assistant (PA) students in screening, brief intervention, and referral to treatment (SBIRT) for substance use disorders (SUDs). The training was provided to 72 PA students, many of whom will practice in Montana. Students learned the adolescent SBIRT screening and other screening modalities; intervention, referral, and treatment; and appropriate follow-up procedures. Students demonstrated significant gains in confidence, readiness, and competence in the implementation of SBIRT. Two faculty members have been trained as SBIRT trainers, and the SBIRT curriculum is now part of the PA required curriculum, ensuring the sustainability of SBIRT training and curriculum for future PA classes.  

Grant Amount

$4,138

Term

12 month

2019

Rocky Mountain Development Council, Inc's Retired Senior Volunteer Program

Tri-County RSVP Keeping You Home Project

This project’s goal was to reduce the risk of hospital re-admission for high-risk seniors and disabled individuals. This pilot project successfully recruited 13 RSVP (retired senior volunteer program) volunteers to work with 47 discharged patients from St. Peters Hospital in Helena and four other rural hospitals. A care coordination training toolkit was developed and agreements for accessing patients’ health records were secured. Only two of the patients who took part in the program were re-admitted to St. Peters (which was well below the 20 percent re-admission rate that the hospital had experienced prior). Local health care providers found the program to be useful in reducing hospital re-admissions and plan to support it moving forward. 

Grant Amount

$25,000

Term

12 month

2015

Rocky Mountain Tribal Epidemiology Center

From Plans to Action: Prevention and Support for Pregnant Blackfeet Women Using Opioids on Blackfeet

In 2016, MHCF supported the Rocky Mountain Tribal Epidemiology Center and their Boston University-based partners to work with the Blackfeet Tribe and the Indian Health Service Blackfeet Community Hospital on early-stage planning work to address opioid use by pregnant women. The funds supported a conference hosted at the Blackfeet Community College, a detailed report and feedback, an inspirational Blackfeet visit to the Lummi tribe’s opioid maintenance program, and the formation of a new, multi-partner opioid prevention task force on Blackfeet. This project continued this work through task force strengthening and capacity-building, focus groups/key informant interviews with clinicians and substance-using pregnant women, the production of a “gap analysis” to determine treatment shortfalls for substance-using pregnant women on Blackfeet, and the production of a feasibility analysis and business plan for developing services to address perinatal drug use. Ultimately, the project resulted in the coordination and development of a medication-assisted treatment (MAT) clinic for pregnant women and families on the Blackfeet Reservation. The grantee was also able to successfully secure additional funding to support further development of the project through the State of Montana STR grant and a Tribal Opioid Response grant which will supplement the services offered through the MAT clinic. A building on the Blackfeet Reservation was secured for the MAT clinic and a partnership was establish with Community Medical Services. Community Medical Services provides the induction and medication management services and Blackfeet Tribal Health provides the care coordination and behavioral health services for the women and families.

Grant Amount

$75,000

Term

12 month

2017

Rocky Mountain Tribal Epidemiology Center

Feasibility of Maintenance Therapy in Pregnancy Among Opioid Users in Trubal Communities

This planning grant investigated the feasibility of providing medication-assisted treatment for women on the Blackfeet Reservation who are using opioids during pregnancy. This treatment is recommended by the American College of Obstetricians and Gynecologists as an evidence-based standard of care because it can prevent maternal and fetal complications of opioid use and withdrawal, encourage prenatal care and drug treatment, and reduce social complications and criminal activity associated with addiction. The grantee organized a conference on Blackfeet that was attended by more than 90 people. Speakers included clinicians from the Blackfeet Community Hospital, members of the Lummi Tribe, and a neonatologist from Kalispell Regional Medical Center. The conference and feedback from participants were used to generate a final report: Addressing Opioid Use in Pregnancy: Conversations and Next Steps in Blackfeet. Following the conference, members of the Blackfeet Tribe visited the Lummi Opioid Prevention and Treatment Center in WA and were inspired to consider creating a similar program on Blackfeet. They formed an opioid prevention task force which includes employees of the Blackfeet Community Hospital, Silent Warriors, Blackfeet Tribal Health, Blackfeet Community College, and other stakeholders. This task force and their opioid prevention work will continue in 2017 with new foundation funding.

Grant Amount

$25,000

Term

12 month

2016

Rocky Mountain Tribal Leaders Council

Supporting the RMTLC Health Sub-Committee with a Health Policy Analyst / Indian Health Care Advisor

The Rocky Mountain Tribal Leaders Council (RMTLC) will hire a full-time health policy analyst to support the RMTLC Health Subcommittee. The new employee will coordinate the subcommittee's quarterly meetings and provide analysis, technical assistance, and training to support the Tribal leaders' health advocacy efforts. Primary partners include the Indian Tribes of Montana and Wyoming and the Urban Indian Health Programs in Montana. Grant funds will supplement the RMTLC's resources to support the position. The goal for this position is to provide internal support so that the RMTLC Health Subcommittee can better support tribal health policy and participate on national advisory committees.

Grant Amount

$50,000

Term

12 month

2020

Rocky Mountain Tribal Leaders Council

Supporting the RMTLC Health Sub-Committee with a Health Policy Analyst / Indian Health Care Advisor

This grant helped the Rocky Mountain Tribal Leader's Council (RMTLC) re-establish a health sub-committee composed of representatives from each Tribe and an Urban Indian Health Center representative. The sub-committee meets quarterly to provide tribes and key partners a forum to discuss health policy directly impacting tribal members and to make recommendations to the RMTLC regarding Indian Health Services and other health services, including Montana Medicaid, the Tribal Health Improvement Program, and other medical services accessed by tribal members. The sub-committee chairperson will bring the sub-committee’s recommendations to the quarterly RMTLC board of directors meeting for action. Funding was used to hire a health policy analyst to provide support, leadership, and guidance to the sub-committee. Responsibilities of the analyst include coordinating quarterly meetings, communicating with committee members, providing expert policy analysis, and developing policy papers and recommendations. The analyst also serves as a liaison to the American Indian Health Leaders group, facilitating collaboration and coordination between RMTLC and the Tribal and urban Indian health center directors. 

Grant Amount

$75,000

Term

12 month

2019

Salish and Kootenai Housing Authority

Staff Training and Support

The Salish and Kootenai Housing Authority (SKHA) provides high-quality, affordable housing to the people of the Flathead Reservation. In early 2021, SKHA established Morning Star Apartments, the Flathead Reservation's first permanent supportive housing project. With this grant, SKHA will contract with Beau Simone Consulting to provide training and technical assistance for the staff who are managing the 14-unit Morning Star Apartments. Beau Simone Consulting will provide a weeklong onsite training for Morning Star staff on the Housing First model, trauma-informed care, conflict resolution, and developing and maintaining a sustainable, supportive housing site. Funding will support consulting fees and travel costs. This project is a collaboration among the Confederated Salish and Kootenai Tribes, the Salish and Kootenai Housing Authority, and the Tribal Defenders Office.

Grant Amount

$9,950

Term

12 month

2021

Salish and Kootenai Housing Authority

Flathead Indian Reservation Housing Needs Assessment and Homelessness Study

The Salish and Kootenai Housing Authority (SKHA) works to provide the highest quality affordable housing to the people of the Flathead Reservation. This project will facilitate a survey of the housing needs in the community and will help SKHA plan, finance, and develop housing resources to meet the community's needs. The assessment will gather quantitative and qualitative data using a mixed-method approach involving a household survey, focus groups, community meetings, and interviews with knowledgeable sources. Funding will be used to hire a consultant who will help develop and implement the survey. Partners include the Polson and Ronan municipalities. Other municipalities in the surrounding area will be invited to participate as well.

Grant Amount

$50,000

Term

12 month

2021

Salish Kootenai College

Four-Year Bachelor of Science in Nursing Degree to Increase Native American Nurses in Montana

This project will develop a four-year Bachelor of Science Degree in Nursing (BSN) at Salish Kootenai College (SKC). SKC’s mission is to provide quality education for Native American students so they can improve the lives of their families and the communities in which they live. The Indian Health Service (which only hires only BSN graduates), has hospitals and clinics on every reservation in Montana which means that BSN graduates will have a much better chance of finding employment opportunities in their own communities. Funding will be used to fund the staff time needed for development and implementation of the BSN program. The goal of this project is to graduate BSN students, particularly Native Americans, who can return to their home communities and reservations to decrease health disparities through the provision of culturally congruent care.

Grant Amount

$100,000

Term

24 month

2019

Salish Kootenai College

Type 2 Diabetes Intervention: At Risk Children of the Pend Orielle, Salish, and Kootenai Tribes

Salish Kootenai College staff taught CSKT members about diabetes prevention during community events and increased the college’s capacity to teach students about chronic disease prevention. As part of the project, the college strengthened its relationship with the CSKT Tribal Health Department. For example, during the Women 4 Women Wellness Health Fair, college staff screened 77 women for diabetes, and they referred the 21% who screened positive to the CSKT Tribal Health Department for a follow-up. The college also used its grant funds to help promote its new Health Promotion Practices Program. This program trains students in chronic disease management and health promotion and will help build a pipeline of community health professionals in the tribe. Since the program started in 2019, eight students have enrolled and will graduate with an associate’s degree.

Grant Amount

$75,000

Term

24 month

2017

Sapphire Community Health, Inc

Ravalli County School Wellness Program

Sapphire Community Health is a Federally Qualified Health Center that provides medical and behavioral health services to the underserved population in Ravalli County. This implementation project will open a school-based health center in two school districts, Hamilton and Victor. Sapphire will provide behavioral health and medical services on designated days of the week at each district. They will provide behavioral health services onsite and medical services in their mobile unit. Funding will support the behavioral health provider/school-based health services coordinator, a nurse, and startup costs and supplies. This project is a close collaboration among Sapphire Community Health, Victor School District, and Hamilton School District.

Grant Amount

$263,273

Term

24 month

2021

Sapphire Community Health, Inc.

Sapphire’s School Wellnes Project

Sapphire Community Health (SCH) will undergo a planning process to implement school-based health services in three school districts in Ravalli County. The school districts include Victor School (a school designated as “comprehensive”), Stevensville Alternative High School, and Hamilton Alternative School. As part of the planning process, SCH will pursue formalized relationships and collaborate with the school districts. Grant funds cover staff costs related to relationship building and planning the implementation of school-based services. Ultimately, SCH intends to use a newly acquired mobile unit to provide medical and behavioral health services to students in these rural communities and in turn, to improve students’ ability to learn and succeed in school.

Grant Amount

$50,000

Term

12 month

2020

Shodair Children's Hospital

Shodair Children’s Hospital Integrated Behavioral Health Planning Project

This project helped enhance Shodair’s current services by allowing them to develop a plan to integrate primary care and substance use disorder treatment to their current inpatient services and develop a plan to provide pediatric psychiatric consultation in their primary care clinics. In addition, Shodair opened an outpatient behavioral health program, which helps expand the continuum of care that was limited to inpatient. They also integrated substance use disorder treatment as part of their care by hiring and incorporating a licensed addiction counselor into their programming. Finally, they developed a psychiatric consultation service that is available to pediatricians throughout the state; this helps ensure access to remote areas and helps prevent unnecessary admissions and facilitates successful discharges back to the community.

Grant Amount

$50,000

Term

12 month

2017

Sidney Health Center

Bakken Behavioral Health Integration

Sidney Health Center will join the Meadowlark Initiative to expand its current integrated behavioral health program from the primary care clinic into the OB/GYN clinic. The project will support the implementation of standardized screenings for all patients entering the OB clinic. It will also develop a home-visiting program in collaboration with community entities, create protocols for analysis of data analysis, develop a behavioral health team for same-day consults, and create a stepped-care process for patients. Sidney Health Center will develop stronger partnerships with public health, substance use facilities, mental health facilities, and the organizations in Wolf Point, where a cohort of their patients live. Expanding behavioral health and care coordination services into the OB/GYN clinic will allow for a more streamlined and coordinated effort of care across the Sidney Health Center continuum and throughout the community serving those who suffer from substance use disorders and mental health issues. Grant funds will be used to initially support the integrated health therapist position and the start-up costs for implementing this program, such as a telepsychiatry contract.

Grant Amount

$150,000

Term

24 month

2020

Sidney Health Center

Bakken Behavioral Health Project

The project enhanced integration of behavioral health into Sydney’s rural health clinic. The National Council for Behavioral Health provided technical assistance and training for the project. The project developed universal depression screening and referral procedures, provided support for the licensed clinical social worker working within the clinic to become credentialed, and ultimately enabled the clinic to implement a more sustainable business model by establishing reimbursable services. By the end of the grant, the project was functioning in a sustainable model where revenues exceeded expenses.

Grant Amount

$20,414

2015

Smiles Across Montana

Expanding Smiles Across Montana Services

Smiles Across Montana will expand the reach of their mobile dental clinic to serve rural and tribal communities across the state. The program will focus on providing dental hygiene services and oral hygiene education to children and Medicaid recipients. Funds will be used to support networking, planning, and implementing the mobile dental clinic’s services into new facilities and communities. As part of the project, Smiles Across Montana will prioritize developing strong partnerships which will help them increase access to preventative oral health services in rural Montana and make referrals to higher level of dental care as needed. The project’s goal is to bring equitable oral health to all Montanans and to work together with other programs to improve the overall health of Montana’s most vulnerable populations.

Grant Amount

$100,000

Term

24 month

2019

Southern Peigan School Health

Behavioral Health Services for At-Risk Youth Served by Southern Peigan School Health (SPSH)

Through this project, the Southern Peigan school-based health center began offering substance use disorder services as part of an integrated behavioral health model of care. Standardized screening for substance use has been implemented, and providers have been trained in SBIRT (screening, brief intervention, and referral to treatment). Grant funds were used to hire a licensed addiction counselor to provide treatment services within the existing school-based health center. The National Council for Behavioral Health provided training and technical assistance. The health center’s services are sustainable through third-party billing from licensed providers, and they plan to expand their services and hire additional staff.   

Grant Amount

$75,000

Term

12 month

2017

Southwest Montana Community Health Center

Kennedy Elementary School-Based Clinic

Southwest Montana Community Health Center (SMCHC) is a federally qualified health center with clinics and pharmacies in Madison, Silver-Bow, Anaconda-Deer Lodge, and Beaverhead counties. This project will develop a school-based health center in Kennedy Elementary School, a school in which nearly 100% of students qualify for free and reduced-price meals and in which many students have low attendance rates. The health center will help improve the students' health, which will support their attendance and education. The health center will provide on-site medical and behavioral health services to students and their families. It will also offer other services like dental screenings, care management, pharmacy, and insurance assistance. Funding will support health center staff and IT services. Kennedy Elementary School (School District No. 1) is the project's primary partner along with other community groups like the local health department and Action Inc.

Grant Amount

$125,000

Term

24 month

2021

Special Olympics Montana

Insurance Enrollment, Health Screenings, Follow-Up Care for Special Olympics Athletes

For this project, Special Olympics Montana (SOMT) partnered with the Confederated Salish and Kootenai Tribal (CSKT) Health Department, and the Montana Department of Public Health and Human Services to work towards improving health for those with intellectual disability on the Flathead Reservation. Grant funds allowed for outreach, enrollment, and engagement by SOMT with the CSKT Health Department and other tribal communities. A SOMT tribal outreach director worked in the CSKT Health Department to identify potential CSKT Special Olympics athletes, involve them in SOMT, and facilitate participation in SOMT-required health screenings. CSKT Health Department staff will assisted with insurance enrollment, billed insurance for care received, and ensured robust coordination of care among all each individual’s health providers. The project successfully established relationships among the partners, and outreach and events to identify and engage potential Special Olympic athletes will continue as a result of this project.

Grant Amount

$20,000

Term

24 month

2016

Sprout Oral Health

School Nurse Fluoride Varnish Programs in Montana Elementary Schools

Sprout Oral Health developed and implemented a sustainable School Nurse Fluoride Varnish Program (SNFVP) that can be replicated in schools and Head Start programs throughout the state. When implementing this program, Sprout Oral Health targeted low-income Head Start and elementary aged students as fluoride varnish can significantly reduce tooth decay, a chronic disease which disproportionally impacts children of low socio-economic status. Eighteen schools participated in the program with an average federal Free and Reduced Lunch rate of 70%. From these schools, 121 children received no-cost fluoride varnish. The School Nurse Fluoride Varnish Program Manual and Reimbursement Toolkit has been disseminated through existing and new partnerships, such as Montana Association of School Nurses. The School Nurse Fluoride Varnish Program has now been integrated into the package of community-based dental programs Sprout Oral Health maintains and implements across rural and frontier Montana.

Grant Amount

$50,000

Term

24 month

2016

St. James Healthcare Foundation

A Relational Model for Reducing Perinatal Substance Use Disorders in Southwest Montana

For this project, Saint James Healthcare (SJH), in partnership with a network of community partners, will work to prevent perinatal substance abuse and improve care and access for pregnant women struggling with substance use in Southwest Montana. The multidisciplinary community team includes SJH, Montana Chemical Dependency Center, Southwest Montana Community Health Center, the Butte-Silver Bow Health Department, the Southwest Region Child & Family Services, and the Butte Community Action Team. This program a relational model of care and education inclusive of behavioral health, consistent prenatal care, and care coordination to address social factors impeding treatment. As a key component, the program engages the father or significant partner within the sphere of care, treatment, and social support. The program seeks to reduce occurrences of substance use in pregnancy and specifically encourages a path to long-term recovery through early detection and intervention, accessible treatment, and increasing community awareness. SJH will create a clinical team consisting of a social worker/care coordinator, a licensed behavioral health provider and family medicine physicians and an obstetric provider. Grant funds will be used primarily to support personnel and facilitate travel.

Grant Amount

$150,000

Term

24 month

2018

St. James Healthcare Foundation

Increasing Access to Integrated Behavioral Health in Silver Bow County

This grant helped the Integrated Behavioral Health (IBH) project at St. James Healthcare expand behavioral health services into the organization's primary care and obstetrical practices. In response to the tremendous need for these services in the Butte community, the project worked to develop strategies to provide the full continuum of care for patients with mental illness and substance use disorders and thoroughly train and integrate the clinical teams. St. James hired two clinicians to provide behavioral health care, trained staff and providers on team-based care and the core elements of IBH, implemented universal screening for behavioral health conditions, and added behavioral health screening and warm hand-off data to its clinical quality dashboards. By elevating behavioral health data to the same level as traditional physical health measures, St. James helped legitimize and normalize this model of care for patients, new staff, and providers. The project achieved a score of 7.75 out of 9 on the National Council for Behavioral Health's Integration Tracker, up from a score of less than 5, and improved from a 2 to a 5 (out of 6) on the Integrated Practice Assessment Tool (IPAT). Nearly 70% of all patients were screened for behavioral health conditions at least once, and 98% of patients with thoughts of suicide completed a suicide risk assessment. The program adopted telehealth to increase access to care during the pandemic and achieved sustainability with patient revenue.

Grant Amount

$130,000

Term

24 month

2018

St. James Healthcare Foundation

BSB FUSE: Butte-Silver Bow Supportive Housing Development Project

The goal of the Butte housing project was to create permanent supportive housing for people with complex medical needs who are experiencing chronic homelessness. Participants would be provided with housing and mental health case management, as well as comprehensive health and mental health services to improve their health outcomes and reduce the costs of providing medical, corrections, and other services to this population. The project partners, which included a variety of health care, housing, and community organizations, discovered that the most important and challenging aspect was the creation of wraparound support services to help individuals remain in housing, rather than the housing itself. The grantee created a five-person team of community health workers who offer supportive services, including entry into medical and behavioral health care, case management, and coordination with other service providers. These community health workers attend weekly meetings and update the partners on the services available to meet participants’ needs. The project also created a partnership with the county to identify funding and complete a preliminary architectural report to find potential sites for 16 integrated permanent supportive housing units. In 2021, 15 people were housed and received supportive services. Emergency department use for one of the residents fell from 37 visits the year prior to the grant to one visit in 2021. This program was initially funded by St. James Healthcare to house the support team at the local Community Health Center. The health center now sustains the team through internal funding.

Grant Amount

$100,000

Term

24 month

2019

St. James Healthcare Foundation

Butte-Silver Bow Strategic Alliance for Improved Mental Health and Wellbeing

The Butte-Silver Bow Community will develop a plan to redesign its behavioral health crisis system to reduce emergency department admission and criminal justice encounters and recidivism. Too often, people in crisis end up in the emergency department or in encounters with law enforcement, rather than receiving behavioral health care that could de-escalate the crisis, improve outcomes, and reduce the need for higher-cost emergency and law enforcement interventions. St. James Healthcare will serve as the “backbone” organization, providing project oversight and partner coordination. This project brings together new and existing partners including St. James Healthcare, the Southwest Montana Community Health Center, the Butte-Silver Bow Sherriff, Butte-Silver Bow Health Department, Action Inc., and the Western Montana Mental Health Center. The partners have established a formal charter that outlines goals and expectations and each organization’s commitments. The project will collect data and analyze the existing behavioral health crisis system and resource allocation, research best practices, and develop a plan for prevention and intervention strategies. Funding will be used to employ a facilitator for sequential intercept mapping, as well as meeting and travel expenses. Ultimately, the project will create a plan to redesign the crisis system by using existing resources differently and identifying key implementation activities.

Grant Amount

$34,200

Term

12 month

2019

St. James Healthcare Foundation

A Relational Model for Reducing Perinatal Substance Use Disorders in Southwest Montana

For this project, Saint James Healthcare (SJH), in partnership with a network of community partners, will work to prevent perinatal substance abuse and improve care and access for pregnant women struggling with substance use in Southwest Montana. The multidisciplinary community team includes SJH, Montana Chemical Dependency Center, Southwest Montana Community Health Center, the Butte-Silver Bow Health Department, the Southwest Region Child & Family Services, and the Butte Community Action Team. This program a relational model of care and education inclusive of behavioral health, consistent prenatal care, and care coordination to address social factors impeding treatment. As a key component, the program engages the father or significant partner within the sphere of care, treatment, and social support. The program seeks to reduce occurrences of substance use in pregnancy and specifically encourages a path to long-term recovery through early detection and intervention, accessible treatment, and increasing community awareness. SJH will create a clinical team consisting of a social worker/care coordinator, a licensed behavioral health provider and family medicine physicians and an obstetric provider. Grant funds will be used primarily to support personnel and facilitate travel.

Grant Amount

$150,000

Term

24 month

2018

St. James Healthcare Foundation

Increasing Access to Integrated Behavioral Health in Silver Bow County

This grant helped the Integrated Behavioral Health (IBH) project at St. James Healthcare expand behavioral health services into the organization's primary care and obstetrical practices. In response to the tremendous need for these services in the Butte community, the project worked to develop strategies to provide the full continuum of care for patients with mental illness and substance use disorders and thoroughly train and integrate the clinical teams. St. James hired two clinicians to provide behavioral health care, trained staff and providers on team-based care and the core elements of IBH, implemented universal screening for behavioral health conditions, and added behavioral health screening and warm hand-off data to its clinical quality dashboards. By elevating behavioral health data to the same level as traditional physical health measures, St. James helped legitimize and normalize this model of care for patients, new staff, and providers. The project achieved a score of 7.75 out of 9 on the National Council for Behavioral Health's Integration Tracker, up from a score of less than 5, and improved from a 2 to a 5 (out of 6) on the Integrated Practice Assessment Tool (IPAT). Nearly 70% of all patients were screened for behavioral health conditions at least once, and 98% of patients with thoughts of suicide completed a suicide risk assessment. The program adopted telehealth to increase access to care during the pandemic and achieved sustainability with patient revenue.

Grant Amount

$130,000

Term

24 month

2018

St. James Healthcare Foundation

Butte Supportive Housing Collaborative

For this project, Saint James Healthcare, in partnership with Action, Inc. and with the guidance of the Corporation for Supportive Housing, developed a plan that uses data integration and hospital analysis along with community resources and program coordination to drive investments in supportive housing. Supportive housing was designed to serve the population that is most likely to be homeless or near homeless, and who face health obstacles including mental illness and substance use disorders. The project’s goal was to give community service providers guidance in identifying cost-effective ways to improve outcomes for vulnerable people by providing supportive services and secure housing. Throughout the course of the grant, the project accomplished several significant milestones including: 1) identifying and bringing together stakeholders to address chronic homelessness, 2) developing collaborative needs assessments among stakeholders to define the scope of the problem of chronic homelessness in Butte, 3) identifying 19 unique individuals in the Butte area who are frequent users of existing public safety resources and who could benefit most from the project’s supportive housing services, 4) compiling economic data on the costs of chronic homelessness and frequent systems utilizers in Butte, and 5) and partnering with the Corporation for Supportive Housing to finalize a plan to implement a new strategy to address chronic homelessness in Butte.

Grant Amount

$60,000

Term

12 month

St. James Healthcare Foundation

Emergency Medical Response in Jefferson County: Feasibility Study and Planning

St. James Healthcare will partner with the City of Boulder, Jefferson Valley Ambulance District, and other stakeholders in Jefferson County to address the need for improved access to sustainable, effective emergency medical services in the county. The county is sparsely populated, with fewer than seven people per square mile; residents are older and chronic diseases are prevalent. The project will assess the feasibility of creating a county-wide ambulance district to ensure the delivery of high-quality emergency medical services throughout the county, with a particular emphasis on rural and underserved communities. A steering committee of local stakeholders will work with a consultant to gather, review, and analyze local data. The study will take place over 12 months, resulting in a final report with recommendations for stakeholders on whether to pursue the special district and considerations for improving emergency medical response in Jefferson County.

Grant Amount

$25,000

Term

12 month

2021

St. James Healthcare Foundation

Butte-Silver Bow Strategic Alliance for Improved Mental Health and Wellbeing

The Butte-Silver Bow Community will develop a plan to redesign its behavioral health crisis system to reduce emergency department admission and criminal justice encounters and recidivism. Too often, people in crisis end up in the emergency department or in encounters with law enforcement, rather than receiving behavioral health care that could de-escalate the crisis, improve outcomes, and reduce the need for higher-cost emergency and law enforcement interventions. St. James Healthcare will serve as the “backbone” organization, providing project oversight and partner coordination. This project brings together new and existing partners including St. James Healthcare, the Southwest Montana Community Health Center, the Butte-Silver Bow Sherriff, Butte-Silver Bow Health Department, Action Inc., and the Western Montana Mental Health Center. The partners have established a formal charter that outlines goals and expectations and each organization’s commitments. The project will collect data and analyze the existing behavioral health crisis system and resource allocation, research best practices, and develop a plan for prevention and intervention strategies. Funding will be used to employ a facilitator for sequential intercept mapping, as well as meeting and travel expenses. Ultimately, the project will create a plan to redesign the crisis system by using existing resources differently and identifying key implementation activities.

Grant Amount

$34,200

Term

12 month

2019

St. James Healthcare Foundation

BSB FUSE: Butte-Silver Bow Supportive Housing Development Project

The goal of the Butte housing project was to create permanent supportive housing for people with complex medical needs who are experiencing chronic homelessness. Participants would be provided with housing and mental health case management, as well as comprehensive health and mental health services to improve their health outcomes and reduce the costs of providing medical, corrections, and other services to this population. The project partners, which included a variety of health care, housing, and community organizations, discovered that the most important and challenging aspect was the creation of wraparound support services to help individuals remain in housing, rather than the housing itself. The grantee created a five-person team of community health workers who offer supportive services, including entry into medical and behavioral health care, case management, and coordination with other service providers. These community health workers attend weekly meetings and update the partners on the services available to meet participants’ needs. The project also created a partnership with the county to identify funding and complete a preliminary architectural report to find potential sites for 16 integrated permanent supportive housing units. In 2021, 15 people were housed and received supportive services. Emergency department use for one of the residents fell from 37 visits the year prior to the grant to one visit in 2021. This program was initially funded by St. James Healthcare to house the support team at the local Community Health Center. The health center now sustains the team through internal funding.

Grant Amount

$100,000

Term

24 month

2019

St. James Healthcare Foundation

Butte Supportive Housing Collaborative

For this project, Saint James Healthcare, in partnership with Action, Inc. and with the guidance of the Corporation for Supportive Housing, developed a plan that uses data integration and hospital analysis along with community resources and program coordination to drive investments in supportive housing. Supportive housing was designed to serve the population that is most likely to be homeless or near homeless, and who face health obstacles including mental illness and substance use disorders. The project’s goal was to give community service providers guidance in identifying cost-effective ways to improve outcomes for vulnerable people by providing supportive services and secure housing. Throughout the course of the grant, the project accomplished several significant milestones including: 1) identifying and bringing together stakeholders to address chronic homelessness, 2) developing collaborative needs assessments among stakeholders to define the scope of the problem of chronic homelessness in Butte, 3) identifying 19 unique individuals in the Butte area who are frequent users of existing public safety resources and who could benefit most from the project’s supportive housing services, 4) compiling economic data on the costs of chronic homelessness and frequent systems utilizers in Butte, and 5) and partnering with the Corporation for Supportive Housing to finalize a plan to implement a new strategy to address chronic homelessness in Butte.

Grant Amount

$60,000

Term

12 month

2017

St. James Healthcare Foundation

Emergency Medical Response in Jefferson County: Feasibility Study and Planning

St. James Healthcare will partner with the City of Boulder, Jefferson Valley Ambulance District, and other stakeholders in Jefferson County to address the need for improved access to sustainable, effective emergency medical services in the county. The county is sparsely populated, with fewer than seven people per square mile; residents are older and chronic diseases are prevalent. The project will assess the feasibility of creating a county-wide ambulance district to ensure the delivery of high-quality emergency medical services throughout the county, with a particular emphasis on rural and underserved communities. A steering committee of local stakeholders will work with a consultant to gather, review, and analyze local data. The study will take place over 12 months, resulting in a final report with recommendations for stakeholders on whether to pursue the special district and considerations for improving emergency medical response in Jefferson County.

Grant Amount

$25,000

Term

12 month

2021

St. Luke Community Healthcare Foundation

Integrated Behavioral Health Consolidation Grant

St. Luke Community Healthcare will implement integrated behavioral health in their critical access hospital and rural health clinic. As part of this project, they will develop a patient registry, adopt collaborative care billing, incorporate crisis management systems into integrated behavioral health, fully implement SBIRT (screening, brief intervention, and referral to treatment), and initiate medication-assisted treatment. The project will use funds to staff a care coordinator position, establish psychiatric consultation, including training and consultation from the National Council for Behavioral Health, and provide enhancements to their patient registry. Through this project, St. Luke’s hopes to improve health outcomes and reduce costs by fully implementing their integrated behavioral health model. Additionally, they will make more formal efforts to partner with the Confederated Salish and Kootenai Tribes to ensure effective alignment of resources and services for the Native American population. 

Grant Amount

$75,000

Term

24 month

2019

St. Luke Community Healthcare Foundation

Wrapped In Hope

This project will create a seamless continuum of care for all pregnant women and their families. Specifically, it will implement team-based, coordinated care for all perinatal patients through each of St. Luke’s four clinics and the hospital. Clinical care pathways for each prenatal patient will be determined based on initial screenings, diagnosis, and recommended treatments. Grant funds will initially support a care navigator position, which will primarily serve as the conduit between primary care providers, behavioral health clinicians, the patient, and psychiatric services. The care navigator will also be the patient’s lifeline to community resources. Through this project, the grantee will actively engage and inform patients about the program, create partnerships with other organizations (tribal and non-tribal), and solicit feedback from consumers. Ultimately the project will improve access to behavioral health services and improve outcomes for women who screen positive for substance use disorder or mental health issues and reduce the instances of out of home placements for their infants.

Grant Amount

$130,000

Term

24 month

2020

St. Luke Community Healthcare Foundation

Integrated Behavioral Health

This project developed a plan to enhance St. Luke’s current integrated behavioral health model so that they could provide more evidence-based and financially sustainable services throughout their health care system. St. Luke’s successfully optimized scheduling and stratification of patient needs and reduced no shows for behavioral health appointments by 50%. They also received approval for rural health clinic status so that they can now assist with the delivery of integrated care and ensure its financial sustainability. Finally, they added a second licensed clinical social worker so that they could offer more comprehensive behavioral health coverage throughout their health system.

Grant Amount

$50,000

Term

12 month

2017

St. Peter's Health Foundation

Integrating Behavioral Health into St. Peter’s Health Medical Group

St. Peter's Health (SPH) used this grant to implement integrated behavioral health (IBH) in its nine primary care clinics to improve the overall health and well-being of its patients and the community. SPH started with minimal IBH in its primary care clinics but is now implementing the model throughout its network. SPH has expanded its IBH team from three to five members; began offering team-based IBH care to all primary care patients; worked to identify patients in need of a higher level of support; provided screening, brief intervention, and referral to treatment (SBIRT) training to all team members and providers; and established universal screening protocols for depression and suicide. SPH is tracking its progress with the help of a population health data scientist. Additionally, SPH has taken on a leadership position in Helena's larger mental health community by joining various mental health-related organizations and sponsoring local suicide prevention and mental health activities.

Grant Amount

$130,000

Term

24 month

2018

St. Peter's Health Foundation

Helena Regional Housing is Healthcare Initiative

This project will develop a cross-systems data sharing between health care, homeless services, housing, criminal justice, child welfare, and emergency service systems to identify high-utilizers of these community service systems who are homeless or unstably housed. The data sharing effort will begin with an inclusive effort to include as many key stakeholders as possible and resolve barriers to data sharing to allow for meaningful system coordination. The grantee will identify people and families that demonstrate the greatest need and cost burden and examine root causes contributing to their homelessness and high utilization of system resources. The project will also utilize the data sharing efforts to study patterns of systems utilization related to existing affordable housing locations and resources particularly among vulnerable populations of seniors, persons with disabilities, and families with children. Through this process, broader system-wide solutions will be proposed in a Helena Regional Supportive Housing and Services Intervention Plan. The plan will identify possible funding sources to implement supportive housing and services, new housing and services partnerships, and improved cross-systems data sharing and coordination.

Grant Amount

$60,000

Term

12 month

2018

St. Peter's Health Foundation

Reducing Adverse Outcomes of Perinatal Mental Illness and Substance Use Disorders

This project will help St. Peter’s Health (SPH) work to reduce the adverse outcomes of perinatal mental illness and substance use disorders. The project will do this through implementing screening, treatment, and referral protocols; expanding integrated behavioral health services within SPH OB provider clinics and the inpatient women and children’s unit; expanding nurse care coordination staff and support resources in the Helena community; and developing applicable data management and reporting capabilities. Grant funds will be used primarily for hiring a behavioral health specialist and a care coordinator to help implement and support the project. Partnerships include Helena OB/GYN who will work with SPH to develop a community wide approach including outreach and development of partnership with the Women’s Clinic of Helena and Helena pediatric clinics. The project’s overall goal is to reduce substance abuse and stabilize mental health disorders in the perinatal and postpartum populations and reduce the necessity of Child Protective Services intervention and foster care removals.

Grant Amount

$150,000

Term

24 month

2019

St. Peter's Health Foundation

Integrating Behavioral Health into St. Peter’s Medical Group’s Primary Care Practice

This planning project sought to establish clinical work flows, data analytics, and revenue cycle needed to develop a successful integrated behavioral health model in St. Peter’s two primary clinics. The project successfully created a multidisciplinary team of primary care and behavioral health professionals who worked together to create standardized screening assessments and clinical pathways for the medical groups. Care team education, standardized tools, and clinical pathways were all developed and implemented to support best practice clinical care and integrated behavioral health workflows. As a result of this project, St. Peter’s realized a 9.4% reduction in emergency room visits and a 5.1% reduction in inpatient stays for behavioral health patients. The behavioral health professionals continue to increase the number of warm hand-offs and follow-up patient appointments to help increase the access to behavioral health services in their community. With this robust planning process and beginning implementation steps, St. Peter’s is positioned to take the next steps to fully implement integrated behavioral health into their primary care clinics.

Grant Amount

$50,000

Term

12 month

2017

St. Peter's Health Foundation

Helena Regional Housing is Health Care Initiative Implementation

The Helena Regional Housing is Health Care development project will provide access to permanent supportive housing for people in the Helena area who are homeless and have complex medical issues requiring frequent hospital care. To do this, the project will 1) provide high-quality training on permanent supportive housing to improve existing programs and improve housing and service system integration overall; 2) explore onsite health care and other support services at key housing sites; 3) develop community-level data sharing agreements to identify the most vulnerable persons who are homeless or unstably housed; 4) improve referral systems to better serve vulnerable populations (persons with disabilities, elderly, and families and children in child welfare systems; 5) develop additional services where needed to address unmet needs that drive high costs; 6) review housing policies to better serve high need persons in coordination with health care and other services; and 7) explore the development of additional permanent supportive housing resources, vouchers, and new facilities in conjunction with Helena Housing Authority’s redevelopment efforts. Key partners include Helena Housing Authority, Pureview Health Center, Saint Peter's Health, United Way, Center for Mental Health, and AWARE. Grant funds will support a new dedicated Community-Based Services Manager to lead program implementation.

Grant Amount

$100,000

Term

24 month

2021

St. Vincent Healthcare Foundation

MSCA Website Establishment

The Montana Spiritual Care Association (MSCA), an affiliated society of the Montana Hospital Association, supports spiritual care providers in health care and behavioral health settings. This project will support the development of a new website for MSCA to provide information, membership maintenance, resource sharing, and continuing education for its membership. Funding will support the website design and initial maintenance. By making its information more readily available, MCSA plans to increase its membership and better support the spiritual care providers who look to it for support.

Grant Amount

$3,950

Term

12 month

2021

St. Vincent Healthcare Foundation

Clinical Supervision for Integrated Behavioral Health Quality and Sustainability

SCL Health Montana Medical Group (SCL Health) provides primary and specialty care through 14 clinics across Montana. This project will create and staff a clinical supervisor position at SCL Health to provide coaching, quality improvement, and safety support for integrated behavioral health services across the organization's primary care clinics. The clinical supervisor will improve clinical the quality of care and fidelity to the integrated care model in primary care clinics while also increasing engagement and retention for behavioral health specialists working in the clinics. Funding will support the clinical supervisor position and provide report writing capacity for the clinics to develop data monitoring reports and dashboards to improve outcomes. This project will utilize the internal partnerships it has established with each of its participating sites. Each integrated care clinic will utilize its partnerships for care coordination and referral for specialty care to meet each patient's needs.

Grant Amount

$150,000

Term

24 month

2021