Integrated Behavioral Health Expansion at Butte Native Wellness Center

Butte Native Wellness Center (BNWC) is the Urban Indian Organization providing primary care, behavioral health, nutrition, and cultural services in Butte-Silver Bow, Anaconda-Deer Lodge, Madison, Beaverhead, and Powell counties since 2022. This grant will support BNWC in implementing culturally responsive team-based primary care that integrates behavioral health services. BNWC will expand its behavioral health team by hiring a second licensed addiction counselor (LAC), an IBH clinician, and an IBH care manager. Through this project, BNWC will offer brief, same-day, and short-term behavioral health interventions, longer-term therapy, and care coordination that bridges medical, behavioral, and cultural care. Grant funds will support a portion of salaries and fringe benefits for three new positions. The multidisciplinary team will bring a strong foundation of collaboration, cultural expertise, and clinical experience to ensure the timely and effective implementation of IBH services. Project partners include Montana universities, Billings Area IHS, local psychiatric providers, Southwest Montana Community Health Center, the local pre-release program, Montana Chemical Dependency Treatment Center, Butte Rescue Mission, Butte-Silver Bow City-County, and the Montana Consortium of Urban Indian Health (MCUIH).

Providing Access to Total Health

Granite County Medical Center (GCMC) is a 25-bed critical access hospital that serves the rural communities of Philipsburg and Drummond with a total population of 3300 residents. This project aims to implement integrated behavioral health in GCMC’s two rural health clinics. GCMC will contract with Roots & Resilience, a nonprofit community mental health agency, for an on-site clinician one day/week and access to on-call providers as needed. The work plan includes training providers and staff on integrated care and universal screening, updating the electronic health record (EHR) with data collection templates, and updating billing processes with appropriate behavioral health codes. Grant funds will support a portion of project staff salaries, a contract for Roots & Resilience, a contract for data collection and EHR optimization, and equipment/supplies. Project partners are Roots & Resilience for clinical services, Health Equity Solutions for EHR optimization and billing technical assistance, and the Healthy Granite County Network for referrals to community resources.

Behavioral Health Service line- Chester Montana

Logan Health Chester is a 25-bed critical access hospital serving the rural communities of Liberty, Hill, and Toole Counties on the Hi-Line in northcentral MT. This project will add integrated behavioral health (IBH) to the rural health clinic’s primary care practice. Logan Health Chester will hire a full-time behavioral health provider to offer a hybrid model of brief interventions and traditional therapy. The IBH program will be supervised by Logan Health’s Hi-Line behavioral health manager, who oversees behavioral health staff for hospitals in Conrad, Cut Bank, and Shelby, facilitates education and connections with local schools and community providers, and oversees marketing and outreach for IBH. Grant funds will support the salary of the new behavioral health provider and a portion of the Hi-Line behavioral health manager’s salary, as well as supplies and equipment. The other Hi-Line critical access hospitals in the Logan Health system are project partners. Logan Health Cut Bank will offer all previous materials, policies and procedures, and budgetary tools to help Logan Health Chester mirror its successful IBH service line. Partners include the Chester school district and community social service agencies.

Integrated Behavioral Health in Primary Care

The Montana Chapter of the American Academy of Pediatrics (MTAAP) is the state professional association for Montana pediatricians. The MTAAP IBH Initiative in Primary Care project will support three-to-five independent pediatric primary care clinics to implement the integrated behavioral health (IBH) model. MTAAP will contract an IBH program manager to assist clinics with planning implementation and identifying and overcoming implementation challenges; provide tailored assistance to design a tailored IBH model of care for each clinic; and train and support clinic managers on IBH business models and quality improvement. MTAAP will also create a peer-led working group to support ongoing IBH education and training for pediatricians, practice managers, and staff. Finally, MTAAP will provide continuing medical education (CME) sessions at the annual Pediatric Roundup conference each fall and scholarships for mental health trainings for clinical staff at the REACH Institute. Grant funds will support a contracted part-time IBH program manager, a portion of MTAAP staff salaries, physician leadership stipends, CMEs for the IBH sessions at Pediatric Roundup, and scholarships for REACH Institute training.

Collaborative Care Management & Chronic Care Management Implementation

PureView Health Center is a federally qualified health center that serves Helena and neighboring communities. With this grant, PureView will expand its integrated behavioral health program to include chronic care management (CCM), transitional care management, and collaborative care management (CoCM) services. PureView has provided integrated services for over 10 years, but patients’ needs exceed the available resources. CCM/CoCM offers the team a population-level approach to managing behavioral health and chronic medical conditions. Grant funds will support the upfront investment in staffing, infrastructure, and workflow integration. Primary project partners include Big Sky Psychiatry, Helena Indian Alliance, and St. Peter's Health.

Professional Leadership Project

Rocky Boy Health Center (RBHC) is a non-profit, tribally led facility serving the Chippewa Cree community on the Rocky Boy Reservation in northcentral Montana. Through its Professional Leadership Project, RBHC will integrate an award-winning integrated behavioral health model -- the Alaska Southcentral Foundation's Nuka System of Care -- while building a system of care that integrates the Chippewa Cree Tribe’s principles and traditions. RBHC aims to improve patient care and staff efficiency, enhance workplace culture, increase professionalism, define roles, and advance operational procedures that support quality of care and quality improvement efforts. Grant funds will support consultation with experts for structured training, coaching, and mentorship to the medical director and healthcare staff. Leadership and administrative staff will visit the Southcentral Foundation in year one and the Seattle Indian Health Board in year two to gain knowledge and insight into the Nuka and other integrated care models. Primary project partners on this project include SouthCentral Foundation and Mountain-Pacific Quality Health.

Rural Health Center Integrated Behavioral Health Project

Big Sandy Medical Center (BSMC) is a 25-bed critical access hospital with a rural health clinic that has served northcentral Montana since 1965. The clinic cares for 2700 patients annually from the Big Sandy community and surrounding rural areas, including the Rocky Boy’s reservation and Hutterite colonies. This project aims to integrate behavioral health services into the standard care provided at BSMC, enhancing its ability to address the community's mental health needs. BSMC will recruit and onboard a part-time mental health professional (LCPC/LCSW) to improve outcomes for patients with identified mental health conditions or those at risk for such conditions. It will also employ an RN as a care coordinator to optimize care for patients identified as ‘at risk’ of mental health concern development or crisis. Grant funds will support a portion of the salary for a part-time behavioral health provider and RN care coordinator, staff training, the development of mental health screening protocols, and the establishment of a sustainable framework for ongoing mental health care within the facility. Primary partners are the Chouteau County Health Department and Big Sandy Public Schools. BSMC also partners with AWARE's medical director for supervision of its psychiatric mental health nurse practitioner.

Expanding Empaths: Implementing Integrated Behavioral Health and the Collaborative Care Model in the Pediatric Setting.

Billings Clinic is a not-for-profit, community-owned and governed, multi-specialty group practice serving multiple regions throughout southeast and south-central Montana, including Crow and Northern Cheyenne Tribal Members. Billings Clinic will implement Integrated Behavioral Health (IBH) within the pediatric primary care department using the Collaborative Care (CoCM) model to serve vulnerable patients' needs better. The goal of this project is to routinely screen all patients ages 11-18 for mental health conditions, social determinants needs, and substance use concerns. Billings Clinic will implement a team-based approach as a best practice model of care. The funding provided by MTHF will support personnel dedicated to the project, including an additional 1.0 FTE behavioral health care manager and a portion of the project director's salary. Many of the partners for this project include internal Billings Clinic departments that will be cross-trained to work with the perinatal and pediatric departments and the psychiatry residency program to provide psychiatric consultation for the CoCM implementation. Billings Clinic will also partner with graduate social work and/or counseling programs to host practicum students, generating further revenue to support program sustainability.

Maintenance and Expansion of Integrated Behavioral Health

Bitterroot Health is a critical access hospital in Hamilton with 24 acute care beds, more than 90 medical providers, and 14 associated primary and specialty clinics. Since 1931, its mission has been to provide quality, accessible, and personalized healthcare to Bitterroot Valley residents. This grant will enable Bitterroot Health to expand its integrated behavioral health project from two to five rural health clinics in Ravalli County. It will hire a behavioral health care manager in the first year of the grant and two more in the second year. It will also establish new partnerships for psychiatric consultation and clinical supervision to support its program objectives, community needs, and patient volumes. Grant funds will primarily support the behavioral health staff positions, with a portion used for developing and sustaining integrated care in Bitterroot Health's clinics.

Implementation of Integrated Behavioral Health in Pediatrics at Western Montana Clinic

Western Montana Clinic (WMC) is a multispecialty health care organization located in Missoula, providing primary and subspecialty care. WMC’s two pediatric primary care clinics serve 10,000 children from birth through 21 years of age. WMC will recruit and on-board a mental health professional to help implement additional primary care behavioral health screening, provide crisis intervention, community referrals, parenting support, brief intervention, counseling, and follow-up. Grant funds will primarily support the behavioral health staff position, with a portion used for developing and sustaining integrated care in WMC’s clinics. Project partners include Partnership Health Center, The Children’s Clinic of Billings, Community Medical Center, Providence St. Patrick Hospital, and the Montana Chapter of the American Academy of Pediatrics. WMC is also building creative partnerships with Missoula County Public Schools as professionals unfold new plans to support students struggling with behavioral health challenges in schools.

CFVH Medicine Network Behavioral Health Expansion for Long-Term Sustainability

Clark Fork Valley Hospital (CFVH) will improve and expand its integrated behavioral health program (now in its ninth year) by hiring and training new staff to replace a retiring therapist and by increasing addiction counseling and case management services. Over the next two years, CFVH will hire, train, and establish supervision and networking for new team members. Contracting with licensed professionals to supervise pre-licensure clinicians will create a workforce pipeline for its three family medicine clinics. Grant funding will support two full-time staff, including a licensed behavioral health provider or candidate with addiction counseling credentials and a social work care coordinator. Project partners include the Sanders County Commissioners, a local therapist to provide clinical supervision if needed, Western Montana Mental Health Center, AWARE, the Sanders County Council on Aging, and the Sanders County Local Advisory Council.

Northeast Montana Health Services IBH Initiative

Northeast Montana Health Services (NEMHS) is a seven-facility health system, including two critical access hospitals, two primary care clinics, two retail pharmacies, and a long-term care facility, serving Roosevelt County and the Fort Peck Reservation in Northeast Montana. Through this project, NEMHS will implement integrated behavioral health in their two primary care clinics in Wolf Point and Poplar. NEMHS will utilize updated universal screening protocols and increase access to behavioral health care by hiring a care manager, a licensed behavioral health consultant, and a psychiatric nurse practitioner. Funding will support staffing and project oversight. NEHMS will receive technical assistance from the Montana Healthcare Foundation's technical assistance team and data collection and analysis assistance from JG Research and Evaluation. Partnerships for this project include Roosevelt County Health Department, Fort Peck Tribal Health Department, Eastern Montana Community Mental Health Center, Indian Health Services, Spotted Bull Treatment Center, the Fort Peck Tribes Health Promotion Disease Prevention Program, and Red Bird Women's Shelter.

Behavioral Health Consolidation Grant

Barrett Hospital & HealthCare is an 18-bed Critical Access Hospital located in Dillon, serving several rural communities in southwest Montana. This consolidation grant will build on Barrett’s previous successful integrated behavioral health implementation grant. It will allow Barrett to develop consistent screening protocols, pathways, and processes for anxiety and suicide risk; build psychiatric collaborative care management services; drive practice change through ongoing data analysis; optimize technology and electronic medical record tools to facilitate and deliver behavioral health care. Barrett will also implement social determinants of health (SDOH) screening to allow them to identify unmet needs like housing or transportation that impact health and well-being, and they will develop a referral system to connect patients to available community resources to address those needs. Barrett will also increase access to behavioral health services by adding another licensed clinical social worker or coordinated care staff member to its primary care team and pursuing a contract with existing partners for psychiatric consultation. Funding will support an additional full-time team member, consultation services for collaborative care, and direct expenses, including education, electronic medical record tools, and marketing. Barrett will complete the project in close collaboration with current partners, including social services and mental health agencies serving low-income community members and families struggling with food and housing insecurity, drug and alcohol use, suicidal ideation, and other needs.

Advancing Integrated Behavioral Health in North Central Montana

Benefis Health System in Great Falls will integrate behavioral health and primary care. This project will improve behavioral health access, care delivery, patient outcomes, and patient and provider experience in Benefis' women's health, pediatrics, and family medicine clinics. The project will move forward in four phases: laying the foundation, planning for clinical practice change, building clinical skills, and fully implementing the integrated model. Funding will support project staff – including a coordinator, data manager, counselor, and case manager – and education for leadership, providers, and patients. Benefis will also partner with Benefis Teton Medical Center, a critical access hospital and rural health clinic in Choteau, to implement integrated care there.

Expanding Behavioral Health Services for Children’s Clinic’s 12,000+ Pediatric Patients

The Children's Clinic of Billings will expand its primary care to include integrated behavioral health services. The Children’s Clinic is a physician-owned, independent outpatient pediatrics practice that serves more than 12,000 patients at two locations in Billings, Montana. Through this grant, the Children’s Clinic will hire a pediatric social worker and implement new care pathways and workflows to integrate that position into the clinic. The new pediatric social worker will enhance current mental health screening and provide brief interventions and a bridge to care for patients who need to be connected to counselors in the community. The project will also offer clinical supervision for the clinic’s recently hired psychiatric mental health nurse practitioner. Funding will support startup costs for the social worker and nurse practitioner positions while the clinic gains the expertise to bill for their services and sustain the project independently. Primary project partners include Shodair Children’s Hospital, the Behavioral Health Integration Collaborative, and Youth Dynamics.

Integrated Behavioral Health

IFHC IBH: Hope, Healing & Health

The Indian Family Health Clinic (IFHC), which serves more than 9,000 patients in Great Falls and the surrounding area, used this grant to expand its previous integrated behavioral health project, providing accessible, culturally informed behavioral and physical health services. The grantee developed shared care plans to improve collaboration among teams and enhance wraparound services, resulting in better patient outcomes and stronger connections between behavioral health and primary care. Among its many achievements, IFHC remodeled the behavioral health unit to implement pod-based care, which helped improve team communication and collaboration; trained all providers and staff in screening, brief intervention, and referral to treatment, and other evidence-based practices; improved the tracking of patient data and data-driven decision-making processes; implemented safety planning protocols for suicide prevention; created key performance indicators to measure progress; and improved patient outcomes and increased patient satisfaction. This grant has enabled IFHC to secure additional financial support and enhance its financial sustainability. The implementation of third-party billing services, a new electronic health record system, and the increase in patient encounters have all bolstered revenue, helping IFHC secure a more sustainable financial future and ensuring the ongoing success of its integrated care initiatives.

MCH Integrated Behavioral Health

Mineral Community Hospital (MCH) will integrate behavioral health services into its primary care clinic to improve access to behavioral health for community members with complex social needs and patients experiencing crises. MCH is a 25-bed critical access hospital serving rural western Montana in Superior. The hospital plans to recruit a new behavioral health staff position for the primary care clinic, contract or recruit a psychiatrist to provide program oversight, and update its electronic medical records system to facilitate new screening workflows and data monitoring. Funding will support the new staff position, psychiatric consultation, and direct expenses like training, travel, and marketing. MCH works closely with the Mineral County Health Department and will collaborate on identifying community needs and expanding services.

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.

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.

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.

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.

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.

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.

Integrated Behavioral Health

Madison Valley Medical Center in Ennis used this grant to integrate behavioral health into its primary care services. Building upon a successful integrated behavioral health (IBH) planning grant that was driven by the local advisory council on mental health, this project aimed to provide early identification and more effective treatment of depression and substance use disorders, increase revenue from integrated care, and reduce emergency room visits related to behavioral health conditions. The Madison Valley team received technical assistance from the National Council for Mental Wellbeing and the Montana Healthcare Foundation. The team was able to recruit a therapist, educate staff about IBH, establish consistent screening protocols, and track behavioral screenings and referrals. Having to input, track, and report data manually posed a challenge, but the team is working to build a new electronic medical record system with more data capabilities. The Madison Valley team will continue its IBH journey through a consolidation grant and will work with the Montana Healthcare Foundation’s IBH technical assistance team.

Eastern Montana Integrated Behavioral Health Project

Montana Health Network (MHN) used this grant for its Eastern Montana Integrated Behavioral Health Project, designed to support behavioral health integration into primary care at seven rural primary care practices that serve a large area of the state. The project aimed to implement routine screening and early intervention for behavioral health and substance use issues in primary care, improve care coordination between treating facilities, and develop a sustainable integrated behavioral health model for existing and new facilities. MHN provided clinical, operational, and financial support, information, and insights to the teams. It conducted regular monthly meetings with the seven facilities and MTHF staff, where participants shared their progress, challenges, and opportunities, networked with their peers, and learned from experts on behavioral health and integrated behavioral health. MHN provided mini-grants to each site to offset planning and implementation costs. Through this grant, four out of seven sites were able to bring mental health providers from within their organization or community into the primary care setting to implement IBH. All facilities and representatives from MHN and MTHF will continue with the monthly networking and information-sharing calls. To continue support for IBH, MHN also secured a one-year HRSA grant of $100,000.

Providence Montana IBH Continuation and Specialty Clinic Expansion

Providence Montana Medical Group (Providence) is a network of 46 clinics in Missoula, offering the entire spectrum of primary and specialty medical and behavioral health care. This project will allow Providence to expand its capacity to provide the full continuum of behavioral health care and care coordination across its outpatient platform. This project builds on two successful prior grants that supported behavioral health integration into Providence's primary care clinics. With this consolidation project, Providence will begin screening patients for substance use disorders and social determinants of health needs, expand integrated care into its specialty clinics, and enhance its ability to provide care coordination. Funding will support the addition of licensed clinical social workers who will work with health care teams to manage patients' mental health and chronic medical conditions. Project partners include Providence's primary care and specialty clinic practice managers, physicians, providers, and Providence Medical Group leadership.

Providence St. Joseph Medical Center IBH Consolidation Grant

Providence St. Joseph Medical Center (SJMC) is a critical access hospital serving over 30,000 residents on the Flathead Indian Reservation. This project will increase patient access to evidence-based, culturally relevant behavioral health services by building upon and improving SJMC's existing integrated care program across its primary care clinics. The project will provide behavioral health staff with training in cultural competence and evidence-based interventions to build resiliency when working with a patient population that has experienced substantial historical and interpersonal trauma. Funding will support additional behavioral health personnel in primary care and provide education, training, and supervision for existing staff. Project partners include the Confederated Salish and Kootenai Tribes, tribal health leaders, and other local health and community organizations.

Clinical Supervision for Integrated Behavioral Health Quality and Sustainability

The Intermountain Healthcare system used this grant to hire a clinical supervisor to support a team of nine behavioral health providers across the state at St. Vincent Hospital in Billings, Holy Rosary Hospital in Miles City, and St. James Hospital in Butte. The goal was to improve the quality of care and fidelity to the integrated behavioral health (IBH) model in primary care clinics, while also increasing engagement and retention for behavioral health specialists working in the clinics. The clinical supervisor provided direct supervision, coaching, and training to the team of behaviorists; developed quality and safety data monitoring systems; and executed strategic and sustainability plans. She attended professional development trainings to improve her work and has passed that knowledge on to those she supervises. As a result of this grant, Intermountain was able to improve retention among its behavioral health staff. Additionally, having a dedicated clinical supervisor experienced in IBH on board has led to at least three team members completing their post-graduate training hours and obtaining licensure. This increase in licensed clinicians opens billing opportunities and contributes to the long-term sustainability of IBH services. The team in Montana is currently assisting Intermountain Health's behavioral health teams in Colorado and Utah to replicate this model.