MT Discretionary Funding Fiscal Year 2020

The BT has an enrolled Tribal membership of 17,321 members (Source: Blackfeet Enrollment 2020) with ancestral ties reaching as far as Canada and throughout the United States and has been in existence for more than 10,000 years. Over half of all tribal members still reside on the Blackfeet Indian Reservation (BFIR), which has a land base of 1.463 million acres and which is considered our homelands. The largest town on the reservation is Browning (population 1,026) which has served as the headquarters of the Blackfeet Tribal government since 1894. Browning is considered the gateway to Glacier National Park and is also the principal center of commerce on the reservation. As per the US Census Bureau, our geographic area is considered a rural community because our population is less than 50,000 residents. In 2017, the BTHD conducted a Community Health Assessment (CHA) which is a needs assessment that identified the health needs of the Tribe via systematic data collection and analytic techniques. The CHA contains information and data about healthcare within the Blackfeet Nation. Featured community health priorities include mental health, substance abuse, access to primary health care, EMS services, violence and public safety, and maternal/infant health. One of the findings in the report indicated that the BT lacked a sufficient number of trained and licensed Tribal members in all healthcare professions, including EMT and Paramedic positions. In 2015, the EMS department had 1,851 calls for service and in 2019 we had 2,546 calls for service. Thus, between 2015 and 2019 we had a 38% increase in calls for service (Source: 2020 Blackfeet EMS Department statistics). Further, on many occasions, our response team is required to transport a patient to hospitals in either Great Falls (252 miles R/T) or Kalispell (200 miles R/T) for more advanced medical care that our local clinics are not qualified to handle. The Primary Goal of our project is: “To increase the number of enrolled Tribal members who will become State and Nationally Certified and Licensed Paramedics.” Our Major Objective is: “During the 12-month project period, the BTHD, in partnership with FVCC and BCC, will recruit and provide tuition, fees, and travel expenses to six (unduplicated number) Tribal members (current EMTs) who will eventually receive an AAS Degree in Paramedicine as measured by records of course completion, travel records, National Register of Emergency Medical Technicians (NREMT) certification, and State of Montana Medical Examiners Certification.”

Focusing on combining virtual and face-to-face direct services, this Healthy Spirit Happy Heart seeks to promote better life for the tribal people of the Flathead Reservation by using evidence-based practices and cultural traditions to assist those with SMI, SUD or other presentments such as grief, trauma, depression or anxiety linked to the COVID-19 pandemic. Goals include increasing capacity on the Flathead Reservation for responding to those dealing with substance use disorders and serious mental illness through improve interagency collaboration and better use of technology, providing more direct services by Mental Health Therapists and Addiction Specialists and cultivating better health outcomes for those impacted by the COVID-19 pandemic with support services, outreach, and assistance. By August 1st, 2020 uses telehealth technology with all outlying communities, enhancing direct SUD services for at least 400 clients, establishing new therapy sites for direct services to 200 clients with SUD in 5 outlying communities. To increase access to recovery services, partnering with 3 agencies to assist at least 200 clients beginning August, 2020. By October 30th, 2020 coordinate ASAM training for at least 35 providers. By August 1st, 2020 use telehealth technology with all outlying communities, improving direct SMI services for at least 300 clients. By August 1st, 2020 establish new therapy sites for direct services to 200 clients with SMI. Deliver 3 trainings by the Native Wellness Institute to at least 40 health care staff by February 1st, 2021. To expand capacity and improve direct services by having 5 behavioral health team members complete the EMDR certification March 2021. To offer referral services, advocacy, follow-up assistance, and other case management supports to 100% of those who have a positive screen for a mental health presentment or a positive screen for a substance use disorder. By January of 2021, consult with Head Start Centers. BY January 0f 2021 and quarterly thereafter, host a screening day for children in childcare. By November 1st, 2020, once a week consulting services, to all primary care providers. To provide two culturally informed, family focused experiences to at least 300 participants by May, 2021. BY June, 2021 host a series of culturally informed Community Connections Camps for at least 400 participants. Host Compassion Fatigue Workshops for at least 100 health care providers by April, 2021. Beginning in November of 2020 and quarterly thereafter, provide a "Ask The Therapist" virtual activity for educators. By October 1st, 2020 and monthly thereafter, host virtual Healthy Spirit Board meeting with at least 20 members. To provide an Awareness Campaign showcasing services and resources for SMI, SUD and other levels of behavioral health presentments, connecting to at least 10,000. Over the duration of the project, direct services are forecasted being present to more than 2,899 individuals, training to more than 400 individuals and education to over 500 individuals.

The Montana Emergency COVID-19 project will strengthen the capacity of nine counties and four tribal behavioral health programs to provide mental health and substance use services, including crisis services, during COVID-19 pandemic to individuals with serious emotional disturbance (SED) for youth, serious mental illness (SMI) for adults, and substance use disorder (SUD) for youth and adults. Funding will also be utilized to support healthcare workers and others with less severe mental disorders who are impacted by the COVID-19 pandemic. Our state strategy involves contracting with nine counties who work through their existing partnership networks to fund licensed / state approved mental health and substance abuse treatment programs who will provide direct services identified most critical and needed in their community. The nine counties who will participate in this initiative are: Yellowstone, Missoula, Gallatin, Sanders, Ravalli, Silver Bow, Flathead, Lake, and Lewis and Clark. Collectively, these counties represent 62% of Montana's overall population and are home to an estimated 178,000 adults in the target population. As of April 8,2020, 78% of the COVID-19 cases in Montana were in one of these 9 counties. Our second strategy involves funding four tribally operated state approved substance abuse treatment facilities, located in four American Indian Reservations. White Sky Hope on the Rocky Boy Reservation, Spotted Bull on the Fort Peck Reservation, Fort Belknap Chemical Dependency Program on the Fort Belknap Reservation, and Crystal Creek on the Blackfeet Reservation. American Indians compromise the largest racial minority in Montana with 6.4% of residents identifying as American Indian / Alaska Native. American Indians in Montana are disproportionately impacted by behavioral health issues including substance misuse and abuse. The goal of this project is to increase Montana's capacity to provide behavioral health crisis services, including telehealth services, along with assessment, treatment and recovery support services to individuals impacted by COVID-19 pandemic. Our measurable objectives include documenting behavioral health crisis service provision to at least 1,000 individuals in Montana supported by this funding over the course of the project period and document behavioral health assessment, treatment and recovery service provision supported by the funding to at least 400 individuals over the course of this project period. We anticipate at least 1000 individuals will be served in the first year of the project and 1,400 will be served over the course of the project period.

The Powder River First Responders (PRFR) Emergency Medical Services Training Project will increase the capacity of the emergency medical system in the greater Powder River region through increased EMT and paramedic training and enhanced life-saving equipment. PRFR serves residents, visitors, and people traveling through an area of almost 4,000 square miles in the rural southeastern portion of the Montana. PRFR is a community-based, non-governmental organization, which serves the greater Powder River County region with emergency medical services (EMS). The resident population is approximately 1,700 for roughly six months of the year but swells to 50,000 during the six months of summer and fall with hundreds of thousands of motorists traveling through annually (400,000 motorcyclists during the Sturgis Rally on top of an average of 3,000 vehicles through the area each day). Thirty-seven percent of PRFR’s call volume is for visitors to the area. All of these individuals, both resident and tourists, are included in the population of focus and will benefit from proposed emergency response training and purchase of life-saving equipment. PRFR’s service area is removed by over 85 miles from the nearest medical facility. On calls to the extreme edge of PRFR’s service area, it can take responders over 1.5 hours to arrive on the scene and over 3 hours to transport to the nearest emergency department. Powder River County residents experience increased incidence of multiple health factors (rate per 100,000) compared to Montana as a whole, including ischemic heart disease, diabetes, urogenital, blood, and endocrine disease mortality, and transport injuries. Specifically, the grant will: • Recruit 20 students in two Basic EMT training classes, with the goal of graduating 16 trainees as Basic EMTs. • Conduct two upkeep classes to support licensure maintenance and expansion for all existing and new registered PRFR EMTs. • Complete two upgrade classes for Advanced EMT (AEMT) endorsement for three students each class. • Support two AEMTs to obtain paramedic certification. • Purchase a cardiac monitor/defibrillator and two Automatic Chest Compression devices, and train all current and newly trained EMS staff to use equipment. • Continue to purchase and train EMS personnel on the use of the opioid overdose antidote, naloxone. • Increase the ability of EMS personnel to respond effectively to behavioral health needs in emergency situations.

The Rocky Boy Health Center (RBHC) Emergency COVID-19 Project will serve American Indian persons with a Serious Mental Illness (SMI), Substance Use Disorder (SUD), and/or a co-occurring SMI and SUD on the Rocky Boy's Indian Reservation. The community faces a high prevalence of serious mental illness, substance abuse, suicide and chronic poverty. This project, when implemented, will provide crisis recovery support services for children and adults impacted by the COVID-19 pandemic. The goal of the RBHC Emergency COVID-19 Project is "to address the needs of individuals with serious mental illness, substance use disorders, or co-occurring serious mental illness and substance use disorders impacted by the COVID-19 pandemic." To achieve this goal, we will incorporate the following strategies contained within our measurable objectives: Objective 1: By the end of month four, RBHC will develop and implement one (1) comprehensive plan of evidence-based mental and substance use disorder treatment services for individuals on the Rocky Boy's Indian Reservation impacted by the COVID-19 pandemic. Objective 2: During the 16 month project period, RBHC will establish four (4) telehealth outreach centers for the purposes of providing screening and assessment and culturally appropriate evidence-based treatment services to individuals on the Rocky Boy's Indian Reservation impacted by the COVID-19 pandemic. Objective 3: During the 16 month project period, RBHC will establish one (1) mobile mental health crisis response team for the purpose of providing 24-hour mobile crisis services to individuals on the Rocky Boy's Indian Reservation impacted by the COVID-19 pandemic.

Project Name: Confederated Salish and Kootenai Tribes Circle of Care Project Population to be Served: Individuals of all ages who have unaddressed substance abuse and mental health needs who are enrolled members of the Confederated Salish and Kootenai Tribes, descendants, or members of other American Indian/Alaska Native Tribes residing on the Flathead Indian Reservation. Strategies/Interventions/Objectives: The Confederated Salish and Kootenai Tribes' Department of Human Resource Development, Health Department, and Early Childhood Services Department will collaborate to implement the Circle of Care Project. Strategies/Interventions will include convening a task force toto guide the project; providing staff development training in the systems of care approach; using a community-based process that includes cultural activities and actively engages community members, key stakeholders, youth, elders, and tribal leaders in program development; conducing community outreach/education to sectors such as schools, the faith community, the housing community, and the justice system, in addition to healthcare systems; provide network development and collaboration activities; implement a community-base system of care model that is holistic, community-based, culturally competent, family-driven, and youth-guided across multiple agencies; and implement a pilot project to provide mental health consulting to professions/families, assess 100 individuals from the population of focus during the grant award period for substance abuse and mental health unmet needs and facilitate expedited services t meet these needs in collaboration with partner agencies. Project Goal: The Circle of Care Project will increase the capacity and effectiveness of the mental health service delivery system by implementing a holistic, evidence and community-based , coordinated system of care, thereby reducing the gap between the need for substance abuse/mental health services and the availability of such services for enrolled members of the Confederated Salish and Kootenai Tribes, descendants, or members of other American Indian/Alaska Native Tribes residing on the Flathead Indian Reservation. Number of People Served: Yr 1: 20 individuals provided with direct services; 30 individuals provided with training, network development , collaboration, consensus development, or other outreach/educational activities. Yr 2: 40 individuals provided with direct services; 50 individuals provided with training, network development, collaboration, consensus development, or other outreach/educational activities. Yr 3: 40 individuals provided with direct services; 50 individuals provided with training, network development, collaboration, consensus development, or other outreach/educational activities. Other the Entire Project Period: 230 will be served.

Two Eagle River School (TERS), the BIE funded high school of the Confederated Salish & Kootenai Tribes )CSKT) proposes to improve the mental health of American Indian students by implementing an evidence-based, culturally relevant, comprehensive mental health program. The name of the project is Nkwusm-A'klukpukamnam Native Connections. The Nkwusm-A'klukpukamnam Native Connections Project will serve 121 TERS students in grades 8-12, 25 youth ages 6-12 years old, and approximately 200 family members each year on the Flathead Reservation in Northwest Montana for a total of over 600 TERS students, 125 youth ages 6-12, and 1,000 family members over the five-year period of the project. Nkwusm is the Salish word for "one family or one fire." A'klukpukamnam is the Kootenai word for "we are all family" as it provides a conceptual framework for the project's vision, mission, and guiding principles. The Nkwusm-A'klukpukamnam Native Connections Project's goals, objectives, and activities are based upon the mental health priorities of TERS using school and community data from the past four years. The mental health priorities of suicide and substance abuse prevention, healing from grief, and reduction of violence were aligned with the Tribal Behavioral Health Grant Program criteria and requirements. The overall goal of the project is to create pathways of support using evidence-based practices made culturally relevant for TERS students and families to be mentally healthy and overcome the challenges they face. The goals of the Nkwusm-A'klukpukamnam Native Connections Project are: Goal 1: The TERS Native Connections Project will increase the capacity of the school and community to reduce high-risk behaviors of students that may contribute to substance abuse and/or other risk factors that keep them from being successful in school and life. Goal 2: The TERS Native Connections Project will increase the capacity of the school and community to utilize traditional values and practices that support students' and families' ability to be mentally and physically healthy. Goal 3: The TERS Native Connections Project will increase the capacity of the school to create a safe learning environment for students and staff and to reduce the incidences of and referrals for violent offenses, school suspensions/expulsions, arrests for assault and weapons charges, and other crimes. TERS will partner with CSKT Tribal Law and Order and the Boys and Girls Club of the Flathead Reservation and Lake County. These partnerships will provide opportunities for TERS to collaborate on professional development, to create a safe and supportive and school environment, and to create opportunities for TERS students to mentor younger students. The project hopes that its work will serve local students, families and community, as well as informing other professionals on the knowledge gained from the project.

Helena Indian Alliance Native Connections Project Population(s) to be served (demographics and clinical characteristics): Native American youth up to age 24 in the Helena Indian Alliance's catchment area (Lewis and Clark County, Broadwater County, and Jefferson County) Strategies/interventions: Tier One - Universal Prevention Strategies; Tier Two - Selective Prevention and Intervention Strategies; and Tier Three - Indicated Prevention and Intervention Strategies Project goals and measurable objectives: The goal of the HIA Native Connections Project is to prevent and reduce suicidal behavior and substance abuse, reduce the impact of trauma, and promote behavioral health among American Indian youth (ages 24 or younger) within the HIA catchment area. To achieve this goal, we have developed the following measurable objectives: Objective 1: By the end of Year 1, HIA will conduct one (1) Community System Analysis; one (1) Community Needs Assessment; and, one (1) Community Readiness Assessment; and will develop one (1) Community Resource/Asset Map focused on addressing suicide prevention, substance abuse prevention, and behavioral health disorders in the HIA catchment area. Objective 2: By the end of Year 1, HIA will develop one (1) set of community-driven suicide prevention policies and procedures; one (1) set of protocols; and one (1) set of postvention protocols designed to address the standards of care for youth at risk of suicide. Objective 3: The HIA will develop (year one) and implement (years two through five) one (1) community-driven Action Plan that will address the three (3) tiers of prevention and intervention strategies: Universal Prevention Strategies, Selective Prevention and Intervention Strategies, and Indicated Prevention and Intervention Strategies. Objective 4: During the project period, the HIA will recruit and implement a school and community-based behavioral health youth and/or peer led group that will meet at least monthly (throughout the school year) to assist in developing and implementing a suicide prevention plan for native youth located within the catchment area, as measured by Youth Advisory Committee (YAC) roster, meeting minutes, sign in sheets, and external evaluation results. The number of people to be served annually and throughout the lifetime of the project: At least 125 (tier one, unduplicated count) per year; 625 (tier one, duplicated count) over the life of the project; 100 (tier two, unduplicated count) per year; 500 (tier two) over the life the project; 75 (tier three, unduplicated count) per year; 375 (tier three) over the life of the project.

The Montana Project AWARE Initiative will develop state infrastructure at Montana’s Office of Public Instruction (SEA) and Children’s Mental Health Bureau (CMHB) to support school districts across Montana in developing Multi-Tiered Systems of Support for mental health promotion and response. This grant will also fund three Local Education Agencies (LEAs) in Montana to implement evidence-based and culturally competent school mental health practices. The participating LEAs include Montana’s largest district, a rural district in the Southwestern corner of the state and a tribal school district on the Rocky Boy Indian Reservation. The first LEA to be funded is the largest district in Montana, Billings Public Schools. Project AWARE funds will support the 11,533 students in the Elementary (K-8) Billings Public School District in Montana’s largest city (population 109,550). The second LEA to be funded is the Dillon Public Schools K-8 Elementary District #10, located in Beaverhead County a rural county in Southwest MT with a population of 9,453 residents. Dillon is the largest community in Beaverhead County (population 4,261) and a K-8 District enrollment is 727. The final LEA to be funded is the Rocky Boy Public School Districts Elementary (K-8) and High School (HS) which serve the Rocky Boy Indian Reservation in Northcentral Montana near the Canadian border, enrollment is 574. The reservation provides a home for about 2,500 members of the Chippewa-Cree tribe. Goal 1: Increase the awareness and capacity of Montana school systems and staff to prevent and respond to mental health issues using the Multi-Tiered Systems Framework: Objective 1: By the end of Year 5, the percent of middle and HS students demonstrating prosocial behaviors and mental health literacy will increase by 15% from baseline: Objective 2: By the end of Year 5, at least 3,500 individuals will receive training in mental health prevention and promotion in mental health related practices/activities: Objective 3: By the end of Year 5, 8 state or local policy changes will be documented that improve systems for responding to mental health issues in schools Goal 2: Increase the capacity of three Local Education Agencies in Montana to connect youth who have behavioral health issues and their families to needed services: Objective 1: By the end of Year 5, increase by 2,800 the number individuals referred to Tier 2 or Tier 3 mental health or related service: Objective 2: By the end of year 5, 100% of students in grades K-8 and Rocky Boy 9-12 will be receiving Tier 1 universals, 15% of students will be receiving Tier 2 interventions, and 1-5% of students will be receiving Tier 3 interventions in LEAs.

This project will seek to implement a community-informed, culturally appropriate, comprehensive approach to youth suicide prevention and substance misuse, reduce the impact of trauma, and promote mental health among AI youth through the age of 24 years. This approach will be used initially in the Billings urban area, but be designed to be replicable in other urban areas across Montana.