Western Montana Mental Health Center

RESTORING COMMUNITY MENTAL HEALTH IN MONTANA - RESTORING COMMUNITY MENTAL HEALTH IN MONTANA WILL INCREASE MONTANANS ACCESS TO EVIDENCE-BASED, PERSON- AND FAMILY-CENTERED INTEGRATED BEHAVIORAL HEALTHCARE AND IMPROVE THE QUALITY OF COMMUNITY MENTAL HEALTH AND SUBSTANCE USE DISORDER TREATMENT SERVICES IN WESTERN MONTANA. THE FOCUS OF THIS PROJECT IS TO IMPROVE CRISIS SYSTEM CAPACITY THROUGHOUT THE WMMHC SERVICE AREA AND TO IMPROVE CARE COORDINATION FOR INDIVIDUALS ENTERING SERVICES THROUGH THE MENTAL HEALTH CRISIS SYSTEM, ENSURING ACCESS TO COMPREHENSIVE, INTEGRATED BEHAVIORAL HEALTH SERVICES FOR INDIVIDUALS WITH SERIOUS MENTAL ILLNESS (SMI), SUBSTANCE USE DISORDERS (SUD), CO-OCCURRING MENTAL AND SUBSTANCE USE DISORDERS (COD), AS WELL AS YOUTH AND ADOLESCENTS WITH SERIOUS EMOTIONAL DISTURBANCES (SED).

WESTERN MONTANA CCBHC IMPROVEMENT AND ADVANCEMENT PROJECT - WESTERN MONTANA MENTAL HEALTH CENTER (WMMHC), A CERTIFIED COMMUNITY BEHAVIORAL HEALTH CLINIC (CCBHC) "IMPROVING INTEGRATION AND ADVANCING ACCESS PROJECT", WILL UTILIZE GRANT FUNDS TO STRENGTHEN AND EXPAND THE NINE CORE CCBHC SERVICES TO CONTINUE TO PROVIDE COMPREHENSIVE AND COORDINATED BEHAVIORAL HEALTHCARE TO ADULTS WITH SERIOUS MENTAL ILLNESS, CHILDREN AND YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE, AND PEOPLE WITH SUBSTANCE USE DISORDERS OR CO-OCCURRING DISORDERS, MOST MOST OF WHOM COME FROM LOW INCOME HOUSEHOLDS. THE GEOGRAPHIC CATCHMENT AREA WHERE SERVICES WILL BE DELIVERED INCLUDES MISSOULA COUNTY (POPULATION 121,630), WHICH IS THE SITE OF WMMHC'S EXISTING CBHC CLINIC. WMMHC WILL EXPAND PRIMARY CARE SCREENING AND MONITORING, AND SERVICES TO THE BUTTE CLINIC IN SILVER BOW COUNTY (POPULATION 35,180) DURING THE GRANT PERIOD. WMMHC IS IDENTIFYING TWO SERVICE AREAS FOR IMPROVEMENT AND ADVANCEMENT:(1) PRIMARY CARE SCREENING AND MONITORING AND CARE COORDINATION FOR INDIVIDUALS WITH CHRONIC DISEASES SUCH AS DIABETES AND HYPERTENSION AND THOSE WITH RISK FACTORS FOR HEALTH PROBLEMS AND DEATH FROM ILLNESSES SUCH AS HEART DISEASE OR CANCER (E.G. PRE-DIABETES, OBESITY, TOBACCO USE), AND (2) RAPID ACCESS TO MENTAL HEALTH THERAPY FOR CLIENTS SERVED BY WMMHC. WMMHC IS ALSO IDENTIFYING TWO SUBPOPULATIONS FOR WHICH WE PLAN TO ADDRESS BEHAVIORAL HEALTH DISPARITIES: NATIVE AMERICANS AND INDIVIDUALS IDENTIFYING AS HISPANIC OR LATINO. AT THE END OF YEAR 1 OF THE EXPANSION GRANT, DATA SHOWED THAT 49% OF WMMHC'S ADULT MALE CCBHC ENROLLEES HAD WAIST CIRCUMFERENCE MEASUREMENTS THAT PUT THEM AT A GREATER RISK FOR HEALTH PROBLEMS AND DEATH FROM ILLNESSES SUCH AS HEART DISEASE AND CANCER, AND 65% OF ADULT FEMALE ENROLLEES HAD AT-RISK MEASUREMENTS. 45% OF ENROLLEES HAD HIGH SYSTOLIC BLOOD PRESSURE (>130 MMHG) AND 64% OF ENROLLEES HAD HIGH DIASTOLIC BLOOD PRESSURE (>85 MM HG). NATIVE AMERICANS AND HISPANIC/LATINOS EXPERIENCE HIGHER RATES OF DIABETES AND OBESITY IN MISSOULA AND SILVER BOW COUNTIES THAN WHITE, NON-HISPANICS. SELF-REPORTED RATES OF TOBACCO USE WERE HIGHER AMONG CCBHC ENROLLEES THAN THE ESTIMATED RATES AMONG ALL ADULT MONTANA RESIDENTS STATEWIDE (60% OF ENROLLEES VERSUS 30% STATEWIDE). GOAL 1: IMPROVE AND ADVANCE RAPID ACCESS TO MENTAL HEALTH THERAPY FOR CLIENTS, WHILE SUPPORTING PRODUCTIVITY OF CLINICIANS. OBJECTIVES: (1) IMPLEMENT A CONTINUOUS QUALITY IMPROVEMENT PLAN FOR INCREASING RAPID ACCESS TO THERAPY FOR CLIENTS WITH ACUTE NEEDS. DEVELOP PLAN BY MONTH 6 OF GRANT. IMPLEMENT BY END OF YEAR 1. SET GOALS FOR YEARS 2-4. (2) DECREASE CLINICIAN CASELOADS BY 5% BY IDENTIFYING AND DISCHARGING CLIENTS WHO HAVE EITHER (A) NOT BEEN ENGAGED IN THERAPY FOR 90+ DAYS OR (B) NO LONGER NEED THERAPY AND MAY BENEFIT FROM OTHER SUPPORTS. (3) INCREASE RAPID ACCESS TO THERAPY FOR CLIENTS WITH ACUTE NEEDS, AS EVIDENCED BY A 25% DECREASE IN WAIT TIMES. (4) DEVELOP A PLAN TO TRAIN THERAPISTS IN BRIEF EVIDENCE-BASED INTERVENTIONS. DEVELOP PLAN BY END OF YEAR 1. IMPLEMENT IN YEAR 2. GOAL 2: IMPROVE PROVISION OF AND ADVANCE ACCESS TO SELF-MANAGEMENT OF CHRONIC HEALTH CONDITIONS THROUGH ENHANCED PRIMARY CARE SCREENING AND MONITORING, HEALTH AND WELLNESS SERVICES, AND DELIVERY OF CARE COORDINATION. OBJECTIVES: (1) FOR EACH QUARTER, 50% OF INDIVIDUALS WITH CHRONIC HEALTH CONDITIONS WILL COMPLETE REFERRALS TO SPECIALTY CARE AND OTHER COMMUNITY RESOURCES FOR SUPPORTIVE SERVICES AS PART OF THEIR CARE COORDINATION PLAN, AS DOCUMENTED BY STAFF SERVICE LOGS AND WMMHC'S ELECTRONIC HEALTH RECORD. (2) 70% OF CLIENTS REPORTING DAILY TOBACCO USE WILL RECEIVE ONE OR MORE TOBACCO CESSATION SUPPORTS. (3) 40% OF CLIENTS REPORTING DAILY TOBACCO USE WILL REDUCE TOBACCO USE AFTER 2 MONTHS OF ACTIVE ENGAGEMENT IN TOBACCO CESSATION PROGRAM. (4) 50% OF CLIENTS WITH CHRONIC DISEASES AN/OR THOSE WITH RISK FACTORS FOR HEALTH PROBLEMS AND DEATH FROM ILLNESSES SUCH AS HEART DISEASE OR CANCER WILL BE ENGAGED IN AN EVIDENCE-BASED WE

NORTHWEST MONTANA INTEGRATED CARE PROJECT - THE WESTERN MONTANA MENTAL HEALTH CENTER (WMMHC) CCBHC PLANNING, DEVELOPMENT, AND IMPLEMENTATION PROJECT WILL ESTABLISH A CERTIFIED COMMUNITY BEHAVIORAL HEALTH CLINIC PROVIDING INTEGRATED BEHAVIORAL HEALTHCARE AT ITS FLATHEAD COUNTY CAMPUS LOCATED IN KALISPELL, MONTANA. COMBINED WITH WMMHC'S FOUR OTHER CAMPUS LOCATIONS, THIS NEW CCBHC SITE WILL SERVE INDIVIDUALS WITH SERIOUS MENTAL ILLNESS (SMI), SUBSTANCE USE DISORDER (SUD), CO-OCCURRING MENTAL AND SUBSTANCE USE DISORDERS (COD), AS WELL AS CHILDREN AND ADOLESCENTS WITH SERIOUS EMOTIONAL DISTURBANCE (SED) IN FIVE (5) WESTERN MONTANA COUNTIES. VETERANS, AMERICAN INDIANS, AND LOW INCOME HOUSEHOLDS ARE INCLUDED IN THE POPULATION OF FOCUS. ALL COUNTIES IN MONTANA ARE HEALTH PROFESSIONAL SHORTAGE AREAS (HPSA'S). LOW POPULATION DENSITY ACROSS AN EXPANSIVE LAND AREA MAKES MONTANA ONE OF THE MOST RURAL STATES IN THE UNITED STATES (US) AND CREATES COMMUNITIES THAT ARE ISOLATED FROM THE HEALTH SERVICES THAT DO EXIST. MONTANA IS A POOR STATE WITH A MEDIAN HOUSEHOLD INCOME 12.8% LESS THAN THE NATIONAL MEDIAN. AMERICAN INDIANS, WHO EXPERIENCE A DISPARATE INCIDENCE OF POVERTY, LOWER LIFE EXPECTANCY, SUICIDE, SUBSTANCE ABUSE, AND ACCESS TO QUALITY MENTAL HEALTHCARE, COMPRISE THE LARGEST RACIAL MINORITY AT 6.6% (1.3% US). 8% OF MONTANA ADULTS ARE VETERANS (5.7% US). MONTANA IS CONSISTENTLY RANKED IN THE TOP TEN STATES FOR RISK FACTORS RELATED TO ALCOHOL USE AMONG 18-25-YEAR OLD ADULTS, AND HAS RANKED IN THE TOP FIVE STATES FOR SUICIDE RATES FOR EACH OF THE PAST 30 YEARS. SMI, SUD, COD, AND SED EXIST IN MONTANA AT RATES HIGHER THAN NATIONAL AVERAGES AND COMMUNITIES CONSISTENTLY REPORT IN NEEDS ASSESSMENTS BARRIERS TO ACCESS AND ISOLATION FROM SERVICES. FLATHEAD COUNTY IS EXPERIENCING RAPID POPULATION GROWTH OUTPACING BEHAVIORAL HEALTHCARE AVAILABILITY AND RESOURCES. WMMHC'S GOALS ARE TO ESTABLISH A CCBHC IN FLATHEAD COUNTY, INCREASE ACCESS TO EVIDENCE-BASED PERSON- AND FAMILY-CENTERED INTEGRATED BEHAVIORAL HEALTHCARE, AND TO IMPROVE THE QUALITY OF COMMUNITY BEHAVIORAL HEALTH SERVICES FOR 800 NEW CLIENTS. OBJECTIVES AND STRATEGIES INCLUDE GAINING LICENSURE FOR PRIMARY CARE, HIRING PRIMARY CARE STAFF, TRAINING CLINICAL STAFF COLLABORATIVE CARE AND INTEGRATING CARE WITHIN FOUR MONTHS OF AWARD. ADDITIONALLY, WMMHC WILL INCREASE ACCESS BY EXPANDING TELE-HEALTH AND SAME DAY ACCESS TO SERVICES, EXPAND TARGETED CASE MANAGEMENT AND MOBILE CRISIS SERVICES, AND IMPLEMENT CULTURALLY AND LINGUISTICALLY APPROPRIATE TRANSLATION SERVICES. FINALLY, WMMHC WILL IMPROVE THE QUALITY OF CARE BY RECRUITING AND MAINTAINING LICENSED PERSONNEL WITH PROFESSIONAL DEVELOPMENT TRAINING AND BY WORKING WITH REGIONAL EDUCATIONAL INSTITUTIONS TO PROVIDE RESIDENCY, FELLOWSHIP, AND INTERNSHIP OPPORTUNITIES.

WESTERN MONTANA MENTAL HEALTH CENTER'S CCBHC EXPANSION PROJECT - WESTERN MONTANA MENTAL HEALTH CENTER (WMMHC) CCBHC EXPANSION PROJECT WILL ESTABLISH THE FIRST CERTIFIED COMMUNITY BEHAVIORAL HEALTH CLINIC IN THE STATE OF MONTANA AT ITS MISSOULA COUNTY CAMPUS. COMBINED WITH WMMHC'S FOUR OTHER CAMPUSES, THIS NEW CCBHC CAN SERVE INDIVIDUALS WITH SERIOUS MENTAL ILLNESS (SMI), SUBSTANCE USE DISORDERS (SUD) AND CO-OCCURRING MENTAL AND SUBSTANCE USE DISORDERS (COD), AS WELL AS CHILDREN AND ADOLESCENTS WITH SERIOUS EMOTIONAL DISTURBANCE (SED) IN NINETEEN WESTERN MONTANA COUNTIES. VETERANS, AMERICAN INDIANS AND LOW-INCOME HOUSEHOLDS ARE INCLUDED IN THE POPULATIONS TO BE SERVED. ALL COUNTIES IN MONTANA ARE HEALTH PROFESSIONAL SHORTAGE AREAS (HPSA). LOW POPULATION DENSITY ACROSS AN EXPANSIVE LAND AREA MAKES MONTANA ONE OF THE MOST RURAL STATES IN THE UNITED STATES (US) AND CREATES COMMUNITIES ISOLATED FROM HEALTH SERVICES THAT DO EXIST. MONTANA IS A POOR STATE WITH A MEDIAN HOUSEHOLD INCOME 12.8% LESS THAN THE NATIONAL MEDIAN. AMERICAN INDIANS - WHO EXPERIENCE A DISPARATE INCIDENCE OF POVERTY, LOWER LIFE EXPECTANCY, SUICIDE, SUBSTANCE ABUSE AND ACCESS TO QUALITY MENTAL HEALTH CARE - COMPRISE THE LARGEST RACIAL MINORITY AT 6.6% (1.3% US). EIGHT PERCENT OF MONTANA ADULTS ARE VETERANS (5.7% US). MONTANA IS CONSISTENTLY RANKED IN THE TOP TEN STATES IN TERMS OF RISK FACTORS FOR ALCOHOL USE AMONG 18 TO 25-YEAR OLD ADULTS, AND FOR THE PAST THIRTY YEARS, MONTANA HAS RANKED IN THE TOP FIVE FOR SUICIDE RATES IN THE NATION FOR ALL AGE GROUPS. SMI, SUD, COD, AND SED EXIST IN MONTANA AT RATES HIGHER THAN NATIONAL AVERAGES AND COMMUNITIES CONSISTENTLY REPORT BARRIERS TO ACCESS AND ISOLATION FROM SERVICES IN NEEDS ASSESSMENTS. THREE COUNTIES IN WESTERN MONTANA ARE EXPERIENCING RAPID POPULATION GROWTH OUTPACING HEALTH SERVICES AVAILABILITY. WMMHC'S GOALS ARE TO ESTABLISH THE FIRST CCBHC IN MONTANA; INCREASE ACCESS TO EVIDENCE-BASED, PERSON- AND FAMILY-CENTERED INTEGRATED BEHAVIORAL HEALTHCARE; AND IMPROVE THE QUALITY OF COMMUNITY MENTAL HEALTH AND SUBSTANCE USE DISORDER TREATMENT SERVICES FOR 1000 NEW CLIENTS IN ITS FIRST YEAR AND 1500 IN ITS SECOND YEAR FOR A TOTAL OF 2500 NEW CLIENTS. OBJECTIVES AND STRATEGIES INCLUDE GAINING LICENSURE FOR PRIMARY CARE, HIRING PRIMARY CARE STAFF, AND TRAINING CLINICAL STAFF IN COLLABORATIVE CARE AND INTEGRATED CARE TO QUALIFY AS A CCBHC WITHIN FOUR MONTHS OF THE GRANT AWARD. ADDITIONALLY, WMMHC WILL INCREASE ACCESS BY IMPLEMENTING TELEHEALTH AND SAME-DAY ACCESS, ESTABLISHING A CALL CENTER, UTILIZING AN APPOINTMENT REMINDER SYSTEM, EXPANDING TARGETED CASE MANAGEMENT AND MOBILE CRISIS SERVICES, AND IMPLEMENTING CULTURALLY AND LINGUISTICALLY SENSITIVE TRANSLATION SERVICES. FINALLY, WMMHC WILL IMPROVE THE QUALITY OF CARE BY RECRUITING AND MAINTAINING LICENSED PERSONNEL WITH PROFESSIONAL DEVELOPMENT TRAINING; ENGAGING REGIONAL EDUCATIONAL INSTITUTIONS TO PROVIDE RESIDENCY, FELLOWSHIP OR INTERNSHIP OPPORTUNITIES; HIRING ONE FTE PSYCHIATRIST; AND UPGRADING ITS ELECTRONIC HEALTH RECORD.

WESTERN MONTANA 988 CRISIS CENTER FOLLOW-UP PROJECT - WESTERN MONTANA MENTAL HEALTH CENTER (WESTERN) IS THE 988 CRISIS LIFELINE PROVIDER FOR MISSOULA, FLATHEAD, RAVALLI, LINCOLN, MINERAL, AND SANDERS COUNTIES IN WESTERN MONTANA. WESTERN WILL USE GRANT FUNDING TO IMPROVE FOLLOW-UP CARE AND COORDINATION AFTER CRISIS SERVICES, REDUCE SUICIDES AND ATTEMPTED SUICIDES, AND DECREASE LAW ENFORCEMENT INVOLVEMENT FOR THE SEVEN COUNTIES COVERED BY ITS 988 CALL CENTER. IN 2022, ITS FIRST FULL YEAR OF OPERATION, THE CALL CENTER HAD 1025 ANSWERED LIFELINE CALLS; 740 OF THESE WERE REPEAT CALLERS, INDICATING A SIGNIFICANT NEED FOR IMPROVED FOLLOW-UP CARE. THROUGH THE GRANT, WESTERN WILL ANSWER 1200 CALLS ANNUALLY AND 3600 CALLS OVER THE LIFETIME OF THE PROJECT. THE INFRASTRUCTURE DEVELOPMENT SUPPORTED BY THIS GRANT WILL IMPACT ALL RESIDENTS WHO ACCESS 988/CRISIS/EMERGENCY SERVICES FOR THEMSELVES, ON BEHALF OF OTHERS, AS WELL AS SERVICE PROVIDERS; 20% ARE UNDER 18, 59% ARE BETWEEN AGES 18 AND 64, AND 21% ARE 65 AND OLDER. HALF ARE MALE, HALF ARE FEMALE. APPROXIMATELY 7% IDENTIFY AS LGBTQ+. EIGHTY-EIGHT PERCENT IDENTIFY AS NON-HISPANIC WHITE, 4% AS NATIVE AMERICAN/ALASKA NATIVE, AND 4% AS HISPANIC/LATINO AND 12% OF RESIDENTS LIVE UNDER THE FEDERAL POVERTY LEVEL. THE PERCENTAGE OF VETERANS IN MONTANA (8%) EXCEEDS THE NATIONAL RATE (5.7%). THE OVERALL SUICIDE RATE IN THE SERVICE AREA (28.2/100,000) IS TWICE THE NATIONAL RATE (14.5). SUICIDE RATES AMONG NATIVE AMERICANS/ALASKA NATIVES IN THE SERVICE ARE ARE HIGHER THAN THAT OF THE NON-NATIVE POPULATION. LGBTQ+ YOUTH ARE MORE THAN FOUR TIMES AS LIKELY TO ATTEMPT SUICIDE COMPARED TO THEIR PEERS. GOAL 1: IMPROVE CONNECTION TO FOLLOW-UP CARE FOR 988 CALLERS TO PREVENT CYCLING BACK INTO CRISIS, PREVENT SUICIDE ATTEMPTS AND COMPLETIONS, AND PROMOTE RECOVERY. (1.1) BY END OF Y1, DEVELOP A PLAN TO CONFIRM WHICH CALLS WITH A DISPOSITION OF "RESOURCES GIVEN" RESULT IN CALLERS MAKING ACTUAL CONNECTIONS TO RESOURCES. BY END OF Y2, REPORT BASELINE PERCENTAGE OF "RESOURCES GIVEN" CALLS RESULTING IN CONNECTION; BY END OF Y3, DEMONSTRATE A 15% INCREASE IN CONNECTION TO SERVICES OVER Y2 BASELINE. (1.2) BY END OF Y1, RESEARCH BEST PRACTICES FOR PEER SPECIALISTS IN CRISIS SERVICES; BY END OF Y2, DEVELOP A PLAN TO INCORPORATE PEER SPECIALISTS IN FOLLOW-UP CARE FOR 988 CALLERS; BY END OF Y3, HIRE AT LEAST ONE PEER SPECIALIST TO SUPPORT CONNECTION TO FOLLOW-UP CARE. GOAL 2: IMPROVE COORDINATION OF SERVICES, ESPECIALLY FOR HIGH-RISK SUBPOPULATIONS, TO FACILITATE RAPID CONNECTION TO APPROPRIATE AND CULTURALLY RESPONSIVE CARE. (2.1) DEVELOP FOUR MOUS WITH ORGANIZATIONS WITHIN LOCAL CRISIS CONTINUUM EACH YEAR WITH AT LEAST ONE MOU IN EACH OF THE SEVEN COUNTIES. (2.2) TRAIN ALL 988 CALL CENTER STAFF, WESTERN CRISIS SERVICES STAFF, AND MOU PARTNERS IN CULTURAL SENSITIVITY TO IDENTIFIED HIGH-RISK SUBPOPULATIONS BY END OF GRANT PERIOD. GOAL 3: DIVERT INDIVIDUALS EXPERIENCING BEHAVIORAL HEALTH CRISES FROM LAW ENFORCEMENT INVOLVEMENT TO MORE APPROPRIATE CRISIS SERVICES BY CLOSING SERVICE GAPS. (3.1) BY END OF Y1, COMPLETE CRISIS RECEIVING CENTER IN MISSOULA; BY END OF Y2, DETERMINE BASELINE USE, INCLUDING DROP-OFF TYPE; BY END OF Y3, REDUCE NUMBER OF OF LAW ENFORCEMENT DROP-OFFS BY 15% FROM BASELINE AND INCREASE DIRECT USE BY 15%. (3.2) BY END OF YEAR 1, COORDINATE WITH COMMUNITY PARTNERS TO DEFINE WESTERN'S ROLE IN THE DEVELOPMENT AND IMPLEMENTATION OF A CRISIS RECEIVING CENTER IN FLATHEAD COUNTY; BY END OF Y2, COMPLETE CRISIS RECEIVING CENTER; BY END OF Y3, CAPTURE BASELINE USE AND SET GOAL FOR REDUCTION OF LAW ENFORCEMENT DROP-OFFS. (3.3) BY END OF Y1, DEVELOP CRISIS SERVICE PLAN FOR EACH COMMUNITY. BY END OF Y2, COMPLETE IMPLEMENTATION OF PLANS THROUGH OUTREACH, SERVICE INTEGRATION AND TRAINING. BY END OF Y3, CAPTURE BASELINE MEASUREMENTS FOR CALL DISPOSITIONS AND SET GOALS FOR NEXT LEVEL DIVERSION.

TELEMEDICINE GRANT