The Central Montana CCBHC Improvement and Advancement Project - Abstract The Central Montana Certified Community Behavioral Health Clinic Improvement and Advancement (CCBHC-I-A) Grant will allow Many Rivers Whole Health (MRWH) to focus on improving and advancing service and program development, including expanding care coordination services which were developed under our CCBHC-E grant award, closing 2/14/2023. Our populations of focus for this grant will include all clients in our catchment area with any mental health or substance use disorder diagnosis in Cascade and Lewis and Clark counties in North Central Montana. We will also work to expand our CCBHC service reach to our surrounding rural counties with expansion of care coordination, access to care point personnel and crisis services. MRWH has more than 4 ½ decades of experience providing behavioral health services, serving the 15 counties in our region. Nine of the thirteen counties served are classified as “Frontier” with fewer than 7 people per square mile. Since the beginning of the CCBHC-E grant project 2/15/2021, MRWH has provided 135,813 services, of which 2,787 unduplicated clients were served. Our goals and measurable objectives for this project are: Goal 1: Expand access and improve the range of CCBHC services within our service region through increased screening, referrals, and tracking to ensure whole person care. Objective 1.1: By the end of Year 1, increase to 90% the number of clients screened, referred, and tracked for primary healthcare issues. Objective 1.2: By the end of Year 1, provide screening, referral and tracking to 90% of the individuals with co-occurring opioid, alcohol, or tobacco use disorders receiving Medication Assisted Treatment and/or behavior modification counseling. Objective 1.3: By the end of Year 1, increase to 90% the number of clients receiving screening, referrals and tracking for peer support, housing, and/or vocational services. Objective 1.4: By end of Year 2, work with local school district and community partners to advance and improve utilization of screening, referral, and tracking for whole person care services for at least 90% of youth who are enrolled in MRWH behavioral health school programming. Goal 2: Expand MRWH’s ability to link clients to the full continuum of community-based care and recovery/social support services. Objective 2.1: By end of Year 1, expand our capacity for care coordination to include the hiring and training of an additional 3 Care Coordinators. Objective 2.2: By the end of Year 1, establish point of contact personnel for all rural counties regarding crisis referrals, behavioral health resources, access to care points and behavioral health consultative services. Objective 2.3: By the end of Year 4, establish Memoranda of Understanding and have referral systems in place for crisis stabilization and/or receiving facility beds/services in all served counties. Goal 3: Increase cultural competency of our employee team through evidence-based training and with the input of our clients, family members and community partners. Improve clinical outcomes by development of a culturally competent approach to whole person care. Objective 3.1: By end of Year 1, identify, develop, and implement specific evidence based cultural competency, diversity, and inclusion curriculum(s), both on the macro agency level and on the micro personnel level for specific training needs by position. Curriculum is based upon target population of American Indians; however, will also include: LGBQT+, elderly, minority races and youth. Objective 3.2: By end of Year 1, complete CCBHC Community Needs Assessments in Cascade and Lewis and Clark Counties. By the end of Year 2, complete CCBHC Community Needs Assessment in all other counties. Objective 3.3: By end of Year 2, complete of evidence-based training curriculum for all employees to include refresher training as part of annual training schedule
