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Integrating prenatal and behavioral health to measurably improve maternal and neonatal outcomes.

The Meadowlark Initiative brings together clinical and community teams to provide the right care at the right time for patients and their families; improve maternal outcomes, reduce newborn drug exposure, neonatal abstinence syndrome, and perinatal complications; and keep families together and children out of foster care.

Substance use disorders (SUDs) and mental illnesses such as depression and anxiety affect thousands of pregnant women and their babies in Montana each year. These illnesses cross all demographics and often go unnoticed and untreated. Unfortunately, the problem is on the rise and contributes to poor outcomes for many Montana families.

  • Between 2011 and 2016, the number of Montana children in foster care more than doubled; in 2016, 64% were removed from the home because of parental substance abuse.
  • Many delivering hospitals report increasing numbers of drug and alcohol-exposed newborns.
  • In a 2015 survey, 42% of Montana moms reported symptoms of post-partum depression.
  • At the beginning of this initiative in a 2017, only 6% of Montana’s state-licensed SUDs treatment programs serve pregnant women.
  • Screening and treatment for prevalent mental illnesses are not yet routine in prenatal and post-partum care.

Based on research and examples from other states, implementing a supportive, team-based approach to prenatal and postpartum care along with better coordination between health care providers and social service agencies offers a powerful way to improve these outcomes.

The Meadowlark Initiative provides funding and technical assistance to allow medical practices that provide prenatal and postpartum care to implement a coordinated, team-based approach that improves outcomes for women with SUDs and mental illness. The initiative will support at least one prenatal practice in each Montana community that has a hospital that delivers babies. The Meadowlark Initiative is funded and supported through a partnership between the Montana Healthcare Foundation and the Montana Department of Public Health and Human Services.

The Meadowlark Initiative System of Care

A simple team-based system of prenatal care can improve perinatal outcomes and strengthen families. In the Meadowlark Initiative System of Care, a Clinical Team and Community Team collaborate to provide integrated prenatal and behavioral health care, and to coordinate community-based supports and services that families need. This simple system has been shown to reduce newborn drug exposure, improve maternal and neonatal outcomes, and reduce the need for foster care placement.

The Clinical Team

Mothers and their families receive care from prenatal and behavioral health providers with support from a care coordinator. These three make up the core of the Clinical Team.

  • The Prenatal Care Provider screens all incoming prenatal patients for SUDs and mental illness using a validated written or verbal screening tool. Patients who screen positive receive a same visit “warm hand-off” to the behavioral health provider for evaluation.
  • The Behavioral Health Provider (LCSW, LAC/LCSW, or LCPC) assesses the patient and provides a brief counseling intervention, outpatient therapy, or an appropriate referral to higher-level care.
  • The Care Coordinator works with each patient to ensure they receive the right care at the right time by coordinating services and referrals and tracking clinical outcomes. The care coordinator also works with patients to identify social factors that may impede their treatment (like insecure or unsafe housing, lack of transportation, or food insecurity) and helps navigate the patient and family toward community resources that can help address those factors.

The Community Team

The Community Team consists of a group of agencies and organizations that can provide critically needed support for pregnant and postpartum women and their families. The Community Team may include social service providers, home visiting programs, child protective services, public health departments, and housing and other agencies. The Care Coordinator helps build and coordinate the Community Team.

The Clinical Team and Community Team work collaboratively to form a support system for the patient and their family.

2021 Grant Funding Opportunity

The Meadowlark Initiative will support at least one prenatal practice in each Montana community that has a hospital that delivers babies. Grant funding and technical assistance is currently available for practices in those communities that would like to participate in the initiative. Prenatal care providers that see Medicaid patients (including family practitioners, obstetricians, midwives, and rural hospitals) are encouraged to apply.

  • For 2021, we will be awarding grants of up to $150,000 for two-year projects. Supplemental funds may be available to help practices with full implementation of care coordination and outcome tracking, or for implementation across a larger network of providers.
  • The grant application opens on Nov 16, 2020. All applications are due by Jan 15, 2021. Funded projects will start on Mar 1, 2021. 
  • Grant decisions will be based on our selection criteria.

If you are interested in learning more or participating in the Meadowlark Initiative, please contact our office.

Required Project Elements

In order to participate in the Meadowlark Initiative, all grantees must work towards the following required project elements:

  • Establishing a clinical team: Establish a care team that includes a medical provider, behavioral health provider, and care coordinator. The team provides prenatal and postpartum care with care coordination and “warm hand-offs” to the behavioral health clinician as needed.
  • Building a community-wide reach: Develop partnerships and a defined referral pattern with other practices in the community so that most prenatal patients in the community are screened for substance use disorders and mental illness, and those that would benefit from integrated care are referred to the Clinical Team.
  • Establishing multidisciplinary collaboration: Develop collaborations among the clinical team, child protective services, public health and home visiting programs, criminal justice, and other agencies as appropriate.
  • Addressing unmet social needs: Using a standardized screening tool and care coordination and collaboration with local organizations, help address common needs such as transportation, housing, and food insecurity.
  • Changing culture and communications: Develop and promote (both in the hospital and community) a supportive approach that engages women and increases participation in prenatal care and substance use disorder treatment.
  • Implementing SBIRT: Implement screening, brief intervention, and referral to treatment for pregnant women.
  • Collaborating with tribes or urban Indian health centers: Develop a strong collaboration with the appropriate tribal or urban Indian health centers if caring for a substantial number of American Indian families.

Selection Criteria for Grant Funding

Invited grant applications for this initiative will be evaluated according to the following criteria:

  • Importance of perinatal behavioral health issues in your community: The volume of prenatal and postpartum care provided in your practice or hospital, and the prevalence of perinatal behavioral health issues in the population you serve.
  • Need: The grant will fill a need that cannot be met by other resources available in the community(ies) served.
  • Sustainability: A short-term grant investment will catalyze improvements that endure long after the grant funding runs out. When funding will be used to establish or support new programming, the strongest proposals will demonstrate a clear, feasible plan to sustain the programming through third-party reimbursement or shared savings within the health care system.
  • Creating partnerships: The proposed project will create or advance new and substantive partnerships that result in more efficient and effective use of resources, and collaboration between organizations that may not typically work together, such as health care providers (hospitals, clinics, behavioral health treatment centers), public health (local or tribal health departments), and other organizations (such as community developers, county sheriffs, or schools). The strongest proposals will include specific plans for the involvement of and collaboration with and among the major health resources in the community.
  • Focus on at-risk populations and health disparities: The proposed project will serve a region or population of high need, as measured by the existence of health disparities, poor access to health care, health professional staffing shortages, geographic remoteness, or other factors clearly described in the proposal. Health disparities are defined as the higher rates of illness experienced by certain populations, including socially or economically disadvantaged families, racial and ethnic minorities, children, and older adults. In all our initiatives, we seek to decrease health disparities and to improve health and well-being among those at greatest risk.
  • Solutions exist: Effective, evidence-based interventions exist to address the problem but are not already being implemented.
  • Workable in Montana and culturally appropriate: Infrastructure, community support, and strong partners exist to implement the intervention; the intervention is tailored to work well within the community(ies) that will be served.
  • Feasibility and scale: There is a high probability that this MHCF investment will lead to success. The strongest proposals will also have a high potential for being replicated successfully in other communities. The dollar amount of the proposed project budget is appropriate to the scale and complexity of the project.
  • Contribution to a diverse grantee portfolio: We seek to support a range of projects across Montana. We recognize that preparing a high-quality grant application may be more difficult for smaller communities that lack staff and resources. We may give preference to proposals based on their contribution to the overall diversity and balance of our portfolio, and to proposals from regions with the greatest demonstrated need.
  • Involving stakeholders and community members: The proposed project includes a strong plan to ensure that community members and other stakeholders are engaged and included in the work.
  • Collaboration with tribal leadership: Projects that involve a substantial focus on American Indian populations must demonstrate collaboration with the appropriate tribal health authorities, such as the relevant tribal council(s), the health directors of the relevant tribes, or the relevant urban Indian health centers.

Resources

The Meadowlark Initiative One-Pager

Care Coordinator Position Training Manual

The Family Plan of Safe Care

Meadowlark Initiative Sites & CFSD Contacts

News & Updates

The Meadowlark Initiative Grantees

Saint Luke Community Healthcare Foundation

Wrapped in Hope

Project Term: 24 months; 2020-2022
Grant Amount: $130,000

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.

Kalispell Regional Medical Center, Inc.

IBH for High-Risk Pregnant Women Phase II: Meadowlark Initiative

Project Term: 24 months; 2020-2022
Grant Amount: $50,000

Kalispell Regional Medical Center (KRMC) will build on its successful 2017-2019 MHCF-funded project to bring integrated behavioral health services into the obstetrics (OB) setting, serving at-risk mothers in Flathead County, the Flathead, Blackfoot Reservation, and surrounding areas. This grant will enable KRMC’s Pathways Behavioral Health program to join the Meadowlark initiative, continue to fine-tune the clinical model, and continue data collection and reporting as a Meadowlark site. The clinical manager for KRMC’s three OB practices will provide project management for this grant. Grant funds will cover a portion of staffing expenses over the next two years to ensure program continuity. The project will also strengthen care coordination services and enable KRMC to screen for and address social determinants of health needs for at-risk mothers and families.

Bighorn Valley Health Center

Sacred Families of Big Horn County-Community-Wide Support for Expecting Families Affected by Substance Use Disorders

Project Term: 24 months; 2020-2022
Grant Amount: $150,000

The Sacred Families team at Bighorn Valley Health Center will partner with health care providers in the region to reach substance use-exposed, expecting families, providing screening, interventions, services, and referral networks under the Meadowlark Initiative. A coalition of county and tribal health and social service providers will design a community-wide, structured approach, funneling families identified through regular screening to a care coordinator. The care coordinator will travel across the county to connect expecting families with a community-based peer support specialist and a behavioral health care provider, creating a bridge to a new, expanded community of care. Funds will primarily be used for care coordination and peer support salaries and travel and outreach/education. Partners include Indian Health Service Crow Service Unit, Crow Wellness, Crow Recovery, Bighorn County Sheriffs Victims Services, Crow Human Services Legislative Chair, Bighorn Hospital Emergency Department, Safe Care, YWCA of Hardin, Tribal Social Services, Billings Urban Indian Health Center, Crow ICWA Advocate, and Bighorn County Public Health. Together IHS and BVHC will pursue partnerships with Billings Clinic, St. Vincent’s Healthcare, and Riverstone Health Center to create a structured process for providing continuity of care for families as they move between local prenatal care and delivery in Billings. Project goals are to provide comprehensive, compassionate care to families, improve maternal and family outcomes; reduce newborn drug exposure, neonatal abstinence syndrome, and perinatal complications; and keep families together and out of the foster care system.

 

Saint Vincent's Healthcare Foundation

Look Closer: Addressing Perinatal Behavioral Health in Eastern Montana

Project Term: 24 months; 2019-2020
Grant Amount: $150,000

This project will help St. Vincent Healthcare increase access to mental health and substance use disorder care for pregnant women in Eastern Montana. The project will do this by developing an integrated prenatal care program and expanding it to four additional OB sites affiliated with St. Vincent Healthcare and Riverstone Health Center. Grant funds will primarily be used for hiring a prenatal services liaison who will provide coordination to women in all participating sites. Partners include Rimrock Treatment Center and associated prenatal care providers in Eastern Montana (Billings OB/GYN Associates, St. Vincent’s West Grand Family Medicine, St. Vincent Maternal Fetal Medicine, St. Vincent’s Midwifery and Women’s Health, and RiverStone Health). The project’s overall goals are to increase the rates of women who receive prenatal care and substance use disorder screening, intervention, and treatment, and to reduce the rate of infants who are substance-exposed before birth.  

Saint Peter's Health Foundation

The Reducing Adverse Outcomes of Perinatal Mental Illness and Substance Use Disorders in the Greater Lewis and Clark County Area Project

Project Term: 24 months; 2019-2021
Grant Amount: $150,000

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.

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