Billings Clinic 2024

Expanding Empaths: Implementing Collaborative Care in the Perinatal Care 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. This project will expand and transition Billings Clinic's current reproductive behavioral health care program to an integrated behavioral health model. Billings Clinic will implement Collaborative Care services in its OB/GYN clinic to provide routine screening, care management, peer support, and therapeutic and psychiatric services for perinatal women. Grant funds will support a full-time behavioral health care manager and a portion of the project director's salary. Billings Clinic actively partners with One Health, which provides a recovery doula to OB/GYN patients.

Grant Amount

$150,000

Term

24 month

2024

Benefis Health System Foundation 2023

Meadowlark Initiative – Benefis Hospitals

Benefis Hospital will continue participating in The Meadowlark Initiative, expanding the mental health services and care coordination it provides to pregnant women in Great Falls and the surrounding areas. Benefis will use this grant mainly to hire an additional licensed behavioral health provider. The new provider will allow the site to treat more patients and shorten wait times for counseling services. Benefis will sustain the position through billing insurance. Partners include Great Falls OB/GYN Associates, Cascade City-County Health Department, and DPHHS Child and Family Services.

Grant Amount

$100,000

Term

24 month

2023

Blackfeet Tribal Health 2023

Blackfeet Meadowlark Initiative

The Blackfeet Tribal Health Department will continue participating in The Meadowlark Initiative and expand integrated, team-based care to pregnant women on the Blackfeet Reservation. Through a partnership with the Women's Clinic at the Indian Health Service (IHS) Blackfeet Community Hospital, Blackfeet Tribal Health will provide behavioral health services to women with mental health issues or substance use disorders. Grant funds will support a care coordinator who will help women access community-based resources to address their social needs. Care will be coordinated with Logan Health in Kalispell and Benefis Health System in Great Falls when appropriate. Partners include IHS, Blackfeet Child Protective Services, and many programs under Blackfeet Tribal Health.

Grant Amount

$100,000

Term

24 month

2023

Northeast Montana Health Services 2023

Northeast Montana Health Services Meadowlark 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 The Meadowlark Initiative® in their two primary care clinics in Wolf Point and Poplar. NEMHS will implement a team-based approach to care for pregnant women, including universal health screening, embedded behavioral health and care coordination supports, robust community partnerships, and defined referral pathways to higher-level treatment when necessary. MHCF contractors and staff will provide technical assistance on the clinical model, and JG Research and Evaluation will provide data collection and analysis support. Grant funds will hire a care coordination and behavioral health provider. 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.

Grant Amount

$150,000

Term

36 month

2023

Rocky Boy Health Board 2023

Nurturing Healthy Moms for Bright Futures

Rocky Boy Health Center (RBHC) is a tribally-led system that provides health care services to the community on the Rocky Boy Reservation in Montana. RBHC offers a full suite of health care and services for over 4,000 people with over 180 employees. The project will establish a model of care that efficiently and effectively tracks and supports high-risk prenatal patients, guiding them through the health care system and other essential support programs. Funding will deploy a specialized RN care coordinator to provide personalized care, collaborating seamlessly with RBHC and external partners, including Northern Montana Hospital, Benefis Hospital, and OB/GYN specialists who provide prenatal services, behavioral health providers, and various tribal programs. By joining The Meadowlark Initiative®, RBHC aspires to measurably improve outcomes for prenatal patients, forging a healthier and more empowered community.

Grant Amount

$150,000

Term

24 month

2023

Bozeman Health Foundation 2022

Perinatal Substance Abuse in Southwest Montana: An Integrated Model

Bozeman Health will support pregnant women with behavioral health issues by expanding and strengthening The Meadowlark Initiative model of care in its Women’s Specialty Clinic. The Meadowlark Initiative provides routine screening in prenatal care for mental health issues and substance use disorders and prompt access to treatment and additional community support if needed. Building on a previous grant, this project will focus on implementing collaborative care and building partnerships with community organizations that serve pregnant women and families. Grant funds will support staff salaries and a consultant who will help Bozeman Health implement the Meadowlark Initiative model of care. Community and organization partnerships will be developed throughout the course of the project.

Grant Amount

$100,000

Term

24 month

2022

Kalispell Regional Medical Center Inc. dba Logan Health Medical Center 2022

LHMC Meadowlark Phase 3

Logan Health will expand its Meadowlark Initiative from its midwifery clinic into its maternal-fetal medicine clinic and its newly acquired obstetrics practice, Logan Health OB/GYN. This project will implement Meadowlark’s collaborative care model by adding a full-time counselor and a part-time care coordinator to Logan Health’s staff to support women and families across its clinics. Funding will support the project staff and a consultant to provide technical assistance on Meadowlark’s collaborative care model. This is the third Meadowlark project supported at Logan Health since 2017. Over the years, the hospital has developed extensive partnerships with community coalitions and organizations that provide social support to pregnant women and their families. A few identified collaborators on this project include the Early Childhood Coalition of Flathead Valley and the Flathead Valley Perinatal Mental Health Coalition.

Grant Amount

$100,000

Term

24 month

2022

Northern Montana Health Care 2022

Meadowlark Initiative Implementation at Northern Montana Hospital

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

Grant Amount

$175,000

Term

24 month

2022

St. Luke Community Healthcare Foundation 2022

Meadowlark Initiative

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

Grant Amount

$100,000

Term

24 month

2022

St. Peter's Health Foundation 2022

Parental Mental Health Support Program Expansion

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

Grant Amount

$100,000

Term

24 month

2022

Healthy Mothers, Healthy Babies - The Montana Coalition 2021

Building Bridges for Better Births

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

Grant Amount

$74,601

Term

24 month

2021

Holy Rosary Healthcare Foundation 2021

Eastern Montana Perinatal Behavioral Health

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

Grant Amount

$148,360

Term

24 month

2021

One Health 2021

Sacred Families Rosebud County

The Sacred Families Team at One Health Ashland will partner with health care providers in the region to reach pregnant women and families experiencing substance use disorders or mental health issues. It will provide screening, interventions, services and create a referral network under The Meadowlark Initiative®. A county health and social service provider coalition will design a community-wide, structured approach to funnel families identified through regular screenings to a care coordinator. The care coordinator will oversee services in five clinical care sites in Ashland, Lewistown, Chinook, Harlem, and Miles City. The care coordinator will travel among the sites 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. One Health will continue its partnerships with Indian Health Services, 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. Grant funding will support care coordination management across all five One Health sites. Partners include Indian Health Service Lame Deer Unit, Northern Cheyenne Recovery, Tribal Social Services, Rosebud Best Beginnings, and the Boys and Girls Club.

Grant Amount

$150,000

Term

24 month

2021

One Health 2021

Sacred Families Fergus County

The Sacred Families Team at One Health Lewistown will partner with health care providers in the region to reach pregnant women and families experiencing substance use disorders or mental health issues. It will provide screening, interventions, services and create a referral network under The Meadowlark Initiative. A county health and social service provider coalition will design a community-wide, structured approach to funnel families identified through regular screenings 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. One Health will continue its partnership with Central Montana Medical Center to create a structured process for providing continuity of care for families as they move between clinic-based prenatal care, delivery, and the community. Funds will be used for staffing of the care coordinator and peer support positions. Partners include Central Montana Coalition for Family Health, Central Montana Medical Center, and One Health.

Grant Amount

$135,200

Term

24 month

2021

One Health 2021

Sacred Families Blaine County

One Health - Chinook/Harlem is a federally qualified health center that serves the communities of Blaine County. Through this grant, One Health will join The Meadowlark Initiative and provide routine screening and treatment for substance use disorders as part of prenatal and postpartum care. The Sacred Families Team at One Health will partner with health care providers in the region to provide screening, outpatient care, referrals for specialty care when needed. They will also coordinate community services for pregnant patients with mental health and substance use disorders at One Health and clinics that offer prenatal care in the region. The team will develop a coalition of county health and social service providers to design a community-wide structured approach to screen and provide care coordination to address the social needs of women and families. A care coordinator hired through this grant will travel across the county to connect expecting families seen in other practices for prenatal care with a peer support specialist and behavioral health provider, creating a bridge to a new and expanded, coordinated community of care. Funding will support the peer support specialist and care coordinator positions to successfully implement the project work plan, data reporting, and offer evidence-based patient services. Partners include Blaine County Public Health, WIC, and SPROUTS.

Grant Amount

$135,200

Term

24 month

2021

Providence Montana Health Foundation 2021

Providence St. Joseph Medical Center’s Journey of Hope

Providence St. Joseph Medical Center (SJMC) is a critical access hospital with a rural health clinic and an assisted living center located in Polson within the Flathead Indian reservation, serving Lake County residents. SJMC provides prenatal and postpartum care in a coordinated, team-based approach and delivers approximately 175-200 babies per year by two board-certified OB-GYN physicians. SJMC's Journey of Hope project will integrate existing initiatives (Wrapped in Hope, Bridge to Hope, and Medication Assisted Treatment) within The Meadowlark Initiative® model. The overall goal is to address pregnant and postpartum women's substance use disorder and behavioral health needs, providing non-judgmental, quality health care, recovery support, resources, and referrals. Journey of Hope will focus on building and strengthening the bonds between a mother and infant; building trust with providers and the health care system; building healthy support systems to allow for infants to stay in the custody of their biological parents; and referrals to community resources for patients to address the social determinants of health. Grant funds will support behavioral health and care coordination staffing costs to successfully implement the project work plan, data reporting, and offer evidence-based patient services. Project staff will work closely with the wide range of agencies and organizations that serve impacted families, including Tribal Child Protective Services, Montana Department of Public Health and Human Services Child and Family Services, Drug Endangered Children Task Force, Drug Court, Confederated Salish and Kootenai Tribal Health Services, and Lake County Public Health.

Grant Amount

$150,000

Term

24 month

2021

Logan Health 2020

Integrated Behavioral Health for High Risk Pregnant Women Phase II

Logan Health Medical Center used this grant to bring integrated behavioral health (IBH) services into its obstetrics clinic in order to better serve at-risk mothers in Flathead County, the Flathead and Blackfeet reservations, and the surrounding area. Logan Health implemented The Meadowlark Initiative® team-based care model into its services. The clinic now universally screens all prenatal patients for depression, anxiety, and substance use, and patients who screen positive are referred to the care coordinator. Staff members forged a relationship with Child and Family Services and are developing a bi-directional referral agreement to improve the implementation of the Family Plan of Safe Care. Hiring behavioral health professionals has been a challenge, but Logan Health is working hard to recruit candidates through hiring bonuses, incentives, and networking channels. The care coordinator participates in two state-level coalitions to further the reach of The Meadowlark Initiative® and improve patient care locally and statewide. Logan Health is committed to continuing to provide excellent patient care and bolstering its care coordination across the organization.

Grant Amount

$50,000

Term

24 month

2020

One Health 2020

Sacred Families of Big Horn County

With the support of The Meadowlark Initiative, One Health in Hardin strengthened its team to provide supportive care to pregnant women in Bighorn County who have substance use and mental health disorders. The goals of the project were 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 children out of the foster care system. The One Health Meadowlark community team collaborated with the One Health clinical team to train all staff on screening, brief intervention, and referral to treatment (SBIRT). They implemented structures and processes to ensure prenatal patients were routinely screened for substance use, depression, and anxiety throughout their pregnancy and were referred to the Meadowlark team if they were at risk. One Health expanded its outreach and target population to include offering support and resources to the patient’s family members as well. One Health created a Peer Support Team to help reach mothers and bring them to their prenatal and postnatal appointments; enroll them in the medication-assisted treatment program; and provide support programs such as parenting classes, recovery groups, and assistance with insurance. One Health collaborated with other clinics and providers in the area to ensure patients’ care was well coordinated throughout their pregnancy and the postpartum period. The project also worked closely with state, tribal, and social service organizations. The One Health team is continuing to explore ways to generate revenue to ensure the project is sustainable.

Grant Amount

$150,000

Term

24 month

2020

Sidney Health Center 2020

Bakken Behavioral Health Integration

Sidney Health Center, a nonprofit community-based medical center serving Eastern Montana, used this grant to join The Meadowlark Initiative and expand its current integrated behavioral health program from its primary care clinic into its OB/GYN clinic. The goal was to improve its support for perinatal patients who have substance use or mental health issues. Sidney Health Center implemented universal screening for substance use, depression, and anxiety in prenatal and postnatal care, and all providers refer women to behavioral health as needed. Key partners include Eastern Montana Mental Health Services and other community-based resources serving women and families. Sidney Health Center is committed to growing and expanding its behavioral health services and is considering adding care coordination to its current services.

Grant Amount

$150,000

Term

24 month

2020

St. Luke Community Healthcare Foundation 2020

Wrapped In Hope

St Luke Healthcare successfully implemented team-based, coordinated care to better support perinatal patients at its critical access hospital in Ronan on the Flathead Indian Reservation as well as its four clinics. The goals of the project were to improve access to behavioral health services, 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 infants. St. Luke implemented universal screening for substance use, depression, and anxiety in prenatal and postnatal care. It added a care navigator to the team to serve as a conduit between primary care providers, behavioral health clinicians, patients, and psychiatric services, as well as to help connect women and their families to community resources. St. Luke established a medication-assisted treatment program for patients and implemented the Eat, Sleep, Console program to teach mothers how to manage the symptoms of infants with neonatal abstinence syndrome. Staff were trained on health equity, implicit bias, and cultural humility to better serve the diverse population in the community. St. Luke has strengthened its relationship with Child and Family Services as it begins to use the Family Plan of Safe Care to better address the needs of families. St Luke Healthcare is committed to sustaining the Meadowlark model and is seeking additional funding to support its programs.

Grant Amount

$130,000

Term

24 month

2020