Ongoing Assessment Activities - Data Collection and Analysis:

 

State Health Improvement Plan

 

The Family and Community Health Bureau (FCHB) programs contributed to the 2019-2023 Montana State Health Improvement Plan (SHIP) and the 2020 SHIP Update Report, published in February 2021.  The 2020 SHIP Update Report highlights the state’s progress aimed at improving the health of Montanans in these priority areas:

 

• Behavioral Health;
• Chronic Disease Prevention and Self-Management;
• Motor Vehicle Crashes; and,
• Healthy Mothers, Babies, and Youth/Adverse Childhood Experiences.

 

The SHIP identified objectives for monitoring improvement over time; and proposed prevention and health promotion, clinical, policy, and health equity strategies for driving improvement.  It also identified each priority area’s Workgroup Members, which included individuals from organizations representing: Department of Public Health & Human Services (DPHHS) and other state of Montana programs; non-profits; County and Tribal Health Departments; coalitions; healthcare providers; and clinical and social service organizations.

 

Throughout 2020, the Workgroups hosted 12 topic-specific, virtual meetings (three meetings per priority) and a combined virtual meeting in December 2020.  From December 2019 to 2020, interest in the SHIP increased (see Table 1). The number of unique organizations also increased from 89 in 2019, to 102 in 2020.

 

 

The SHIP and the Update Report are included with the supporting documents, and can also be found at: https://dphhs.mt.gov/ahealthiermontana.

 

Family & Community Health Bureau Needs Assessments

 

The Title V MCHBG is housed in the FCHB.  Since the completion of the MCHBG 5-Year Statewide Needs Assessment (NA), the following two FCHB programs have released results of their NAs: the Primary Care Office (PCO) and Healthy Montana Families Home Visiting (HMF/HV).  This narrative includes summaries of the findings from these NAs pertinent to serving the MCHBG population and highlights of smaller-scale assessments by other programs.

 

Montana Primary Care Office 2021 Needs Assessment

 

In January 2020, under the direction of Montana’s (MT’s) Title V Director, the PCO contracted with the University of MT Rural Institute for Inclusive Communities (RIIC) to assist with the PCO 2021 NA. The RIIC evaluation team worked with MT PCO epidemiologists and the Program Specialist to: determine sources of data; clarify information; and, learn more about initiatives, strategies, and partnerships relevant to primary care services in MT.  A copy of the complete report is included with the supporting documents for this submission.

 

The purpose of the statewide PCO NA was to:

• Describe the health status of MT’s residents, specifically underserved and vulnerable populations;
• Describe MT’s primary health care system, including factors associated with the delivery, access, and utilization of primary health care in MT; and,
• Identify community-based programs and partners that implement activities to reduce barriers to healthcare.

 

The assessment utilized analysis of secondary data to present a picture of MT’s vulnerable populations, health care needs, health disparities, social determinants of health, and health workforce. The RIIC evaluation team compiled data from local, state, and federally recognized agencies, such as the U.S. Census Bureau, and several data sources within DPHHS (e.g., Vital Statistics, Behavioral Risk Factor Surveillance Survey).  For health indicators and social determinants of health (SDOH), the most recent single-year data was captured and presented when appropriate for comparisons to national rates or averages. When single-year data was unavailable or unreliable, multi-year estimates were used.

 

In addition to secondary data collection, RIIC completed eight key informant interviews with stakeholders in MT’s primary care system, including healthcare consumers and healthcare providers. Health care consumers were asked about their access to primary health care services, and health care providers were asked about the strengths and challenges of the state’s primary care system. COVID-19 put increased pressure on MT’s healthcare systems, limiting the providers’ capacity to participate. Two key stakeholder groups were invited to review preliminary drafts of the report: MT Disability and Health Program; and the MT Healthcare Workforce Advisory Committee. They provided feedback on content, methods, and recommendations for the next steps.

 

The NA reviewed the following factors related to the access and utilization of primary care:

 

• SDOH, including: unemployment, poverty, food and housing insecurity, and educational attainment
• Health insurance coverage and affordability
• Preventative services such as immunizations and routine dental and medical check-ups
• Health professional workforce and shortage areas
• Medical education programs
• Primary Care Health Centers
• Partner Programs

 

Population to Provider Ratios

 

For purposes of the NA, the population-to-provider ratios for MT primary care were calculated using the total population of the county to the total Full-Time Equivalent (FTE) number of providers serving that geographic area, where 40 hours/week equal 1 FTE.  The population to primary care physician FTE ratio in MT was 2231:1 as of June 2020. This ratio does not include physicians in active practice with Indian Health Services, Tribal Health, Veterans Affairs, Military Bases, Student Health, or State Agencies. The population to dentist FTE ratio was 2753:1, and the population to psychiatrist FTE ratio was 28513:1.  Population to primary care provider FTE for tribal reservations ranged from 428 to 1 to 1116 to 1, which are lower than other areas of the state.

 

While the data show there may be a sufficient overall supply of primary care providers in MT, the supply is unevenly distributed. Some counties have a relatively wide population to provider FTE ratios or no providers identified in the service area. There are 13 MT counties that do not have primary care physicians and ten counties without dentists. There are 46 counties without psychiatrists. Health professional shortages or an uneven distribution of health care providers can create barriers to accessing healthcare, among other issues.

 

Geographic Disparities & Access to Care Barriers

 

For the 13 counties without primary care physicians, there is a transportation burden for county residents. Using county seats as a centralized metric, the drive time to reach the nearest physicians ranges from approximately 27 minutes for Wibaux County residents to reach Glendive, MT to well over an hour for residents in Garfield County to reach either Glendive, MT or Miles City, MT. While counties are a crude metric for assessing distance to services, they illustrate the geographic barriers to accessing services experienced by rural Montanans.

 

Geographic barriers to services can also be complicated by the distance to the nearest primary care providers accepting Medicaid patients. For example, drive-times from the population centers of counties without a dentist to the nearest dentist accepting new Medicaid patients is greater than for those utilizing other payment methods. For these adults, the average drive-time from Eastern MT is 85 minutes, and 51 minutes from Central MT. For children, the average drive-times are 54 and 38 minutes, respectively.

 

Geographic barriers to service may be reduced for some populations, given the rapid expansion of telehealth due to the COVID-19 pandemic. However, these opportunities are limited to those with reliable internet access, capable devices, and affordable data plans.

 

Distance can also have an impact on recruiting and employing primary care providers in rural and frontier areas. These areas struggle to compete with metropolitan areas with regards to wages, work flexibility, social opportunities, education opportunities, and other local services. Clinics and hospitals in Montana’s rural and frontier areas rely heavily on programs to recruit and retain primary care providers.

 

MIECHV Needs Assessment – Published September 2020

 

MT’s MIECHV Program is also a part of the FCHB, and works closely with the Title V MCHBG.  The MIECHV Statewide NA was finished approximately six months after the Title V MCHBG’s. It includes unique data and insights which have provided additional information and understanding for MCHBG programming, especially in regard to at-risk counties.  A copy of the full report is included with the supporting documents for this submission.

 

Key Findings

 

• Thirty-two counties in MT were identified as at-risk. In agreement with findings from the Title V MCHBG NA, the Child Abuse and Neglect Prevention Strategic Plan, and other recent statewide NAs, the most significant risk factors MT families experience include: substance use disorders (SUD); mental health concerns; a lack of mental health providers; and, increasing rates of child maltreatment. Rural and tribal communities have the largest concentration of risk factors.

 

• SUD and child maltreatment are growing problems for MT families, evidenced by higher rates of SUD for alcohol use (57.3%), marijuana use (19.8%), methamphetamine use (0.97%), and opioid misuse (4.03%) compared to national rates (51.2% alcohol use, 15% marijuana use, 0.7% methamphetamine, and 3.6% opioid misuse) and the increasing number of children taken into foster care due in part to parent SUD. In 2018, 65% of cases where children were taken into care were SUD-related.

 

• Seventy-two agencies and organizations provide home visiting services in 36 counties, including 23 MIECHV-funded agencies (Lead Implementing Agencies) serving 19 counties. In FFY 19, MIECHV-funded agencies served 1,444 households and reached 32.9% of the population estimated to need home visiting services in their counties.

 

• MIECHV-funded agencies support rural and tribal communities. Of the four smaller counties (populations of less than 10,000 residents) served by MIECHV-funded agencies, 61% of the estimated in-need population received home visiting services. Additionally, 14% of MIECHV home visiting clients are American Indian (American Indians comprise 6.6% of the state’s population). Sustained service to rural and tribal communities will provide needed support for these populations.

 

• Mirroring national trends in the characteristics of the home visiting workforce and state demographics, home visitors in MT tend to be non-Hispanic, White, and female. Increasing the gender and racial diversity of home visiting staff may help to reach subgroups with unique cultural and language needs such as single fathers, American Indians, migrant workers, and Spanish-speakers.

 

• Home visitors reported feeling motivated by working with families and having supportive teams/colleagues. Notable barriers to providing services include client retention and lack of knowledge of home visiting services. Continuing or increasing outreach and other efforts to destigmatize home visiting may serve to reduce these barriers.

 

• Substance use disorder treatment capacity in the state is limited by a lack of mental health providers and limited outpatient and residential services. Additional barriers are faced by those in rural/frontier areas as many services are primarily available in urban centers. Various local and state initiatives are striving to remove barriers that previously blocked people from getting needed help.

 

• There is a lack of infrastructure in MT to support new mothers, particularly those with current or past substance use. Home visitors report not being fully prepared to recognize or address SUD issues. Home visitors may benefit from professional development around recognizing the signs of SUD and using trauma-informed, destigmatizing approaches to reduce staff burnout and turnover.

 

At-Risk Counties

 

Thirty-two of MT’s fifty-six counties were identified as at-risk (57%). Of those counties, the most frequently identified domains of risk were SUD (16 counties), Mental Health (12 counties), Child Maltreatment (11 counties), and Crime (11 counties). SUD, mental health concerns, and child maltreatment have been identified in other recent NAs as known issues in the state. A map is provided on the next page (Figure 1.).

 

The risks Montanans face are elevated in rural and frontier regions where services are limited or sparse. Except for Deer Lodge County, counties with the highest concentrations of risk (highest number of at-risk domains) are those where tribal reservations are located. Tribal reservations, which have Sovereign Domain governmental status, face significant health disparities and greater concentrations of risk.

 

                      Figure 1.

 

Family & Community Health Bureau: Additional Program Assessments

 

Children’s Special Health Services

 

Children’s Special Health Services (CSHS) is assessing the status of the CSHS stakeholders advisory group and the role of the Title V Family Delegate. CSHS intends to increase parent voice through improved engagement of parents in the stakeholders advisory group and build capacity within the Title V Family Delegate role. Assessment of partnering with the Part C of the IDEA Family Support Advisory Council, focused on children with developmental delays and disabilities 0-3 years of age is also planned.  CSHS is working with the University of MT RIIC to append the Pediatric Mental Healthcare Access (PMHCA) NA to target behavioral health considerations for special populations that include: LGBTQI youth; youth who experience homelessness; and, American Indian youth. This will include a literature review, focus groups and the creation of population-specific care guides.

 

Family Planning

 

The Title X Family Planning Program conducted a NA to determine community need for family planning services, which will be used to determine potential new clinic locations.  In addition, the Title X program collects clinical data from each family planning clinic to conduct internal medical audits to improve clinical service provision.  As of June 2021, Title X is in the process of building a new database for more efficient and effective data collection and analysis.  Title X has also expanded to include telehealth services to reach underserved communities.  In addition, Title X is enhancing fertility awareness based method services to provide broader support of family planning preferences by individuals served. 

 

The Rape Prevention and Education Program (RPE) conducts an annual program evaluation to examine actual and potential reach of activities, capacity of partnerships to implement community level strategies, and demonstrate the use of indicator data to track outcomes.  The information from the current evaluation will be used to improve RPE’s sexual violence prevention strategies and reduce sexual violence and victimization rates in Montana.

 

Oral Health Program

 

The Oral Health Program (OHP) conducts routine surveillance on the oral health status of children in Head Start, kindergarten, and 3rd grade utilizing the Basic Screening Survey (BSS).  The BSS is an open-mouth survey that collects data on untreated decay, history of decay, and sealant prevalence.  The OHP attempted to conduct the BSS of the Head Start population in the 2020/2021 academic year, but was limited, largely due to barriers presented by the COVID-19 pandemic.  The surveillance was rescheduled for both the Head Start and kindergarten population in the 2021/2022 academic year.  This data will provide valuable insight into the oral health status of children in MT.

 

Supplemental Nutrition for Women, Infant, & Children (WIC)

 

Starting the summer of 2020, WIC State staff completed a NA of the MT WIC program. This assessment was focused on nutrition and breastfeeding services and is intended to identify gaps and barriers to care and opportunities for improvement, expansion, and re-engagement. The results of the NA will be used by the State staff and local WIC staff, particularly by the WIC Workgroup from September 2021-August 2022. The WIC Workgroup is a stakeholder group consisting of local WIC staff from small, medium, large, and tribal WIC clinics and State WIC staff, with the goal of completing quality improvement projects.

 

Regarding agency capacity and systems of care; WIC clinics were able to provide remote services during the pandemic because of federal waivers.  State WIC staff tracked local WIC clinic capacity and remote versus in-person status via a monthly survey. This short survey allowed WIC to direct time, energy, staff, and resources towards clinics struggling due to sickness, staff time (many WIC staff were pulled for COVID-19 response at various times throughout the year), and local public health lockdowns/quarantines.

 

MCHBG-Participating County Public Health Departments (CPHDs)

 

Each June, CPHDs complete a Pre-Contract Survey (PCS) and submit data on: contact information and staff responsibilities; administrative details; services provided; FICMMR information and processes; MCHBG information and processes; and feedback on FCHB support. The survey results provide a picture of CPHD resources across the state.  The survey also captures the choice of performance measure for the upcoming federal fiscal year, along with intended evidence-based or informed activities and evaluation plans.

 

The following graph (Figure 2.) shows the broad categories of injury-prevention activities as first planned last year, before it became clear how much COVID-19 would continue to dominate time and resources.  In terms of the targeted population domains, with some overlap, we see that: infants are covered by car seat safety and safe sleep for a total of 19 activities; adolescents (and to some extent older children) are covered by: suicide prevention, distracted driving, ATV safety, vaping prevention, seat belt usage, gun safety, and bicycle safety for a total of 21 activities; and adults or PH staff are covered by trainings for: mental health support, ACES, parenting education, maternal mental health, and CPR for a total of nine activities.

 

         Figure 2.

 

The next graph (Figure 3.) reflects one of the challenges for counties with limited resources.  22% of CPHDs responding to the survey are open fewer than 40 hours a week.

 

         Figure 3.

 

 

Changes in Health Status and Needs Statistic Update

 

Pregnant Women, Mothers and Infants

 

A snapshot of the health status of MT’s pregnant women, mothers, and infants may be seen from the following common health indicators.  Data-source references are in the endnotes.

 

The health status data of 1) pregnant women, 2) mothers and infants, and 3) women of child-bearing age serves as an indicator of how well programs are addressing respective needs of each group. In 2019 there were 11,080 resident births, of which 1,280 (11. 6%) were to American Indian (AI) mothers; 804 (7.3%)  births were infants weighing less than 2,500 grams; 1,065 (9.6%) were infants less than 37 weeks gestation;  8,302 (74.9%) infant’s mothers received prenatal care beginning in the first trimester; 1,468 (13.2%) of infant’s mothers used tobacco during pregnancy; and 3,150 (28.5%) of infants were born via cesarean section[i]. Of those infants born in 2019, 93.3% (95% CI: 91.3% - 94.8%) were ever breastfed[ii].

 

 As noted above, births to American Indian mothers comprise 11.6% of Montana’s resident births; however, race is correlated for the following MCH outcomes:   

• The number of infants born to women who received prenatal care beginning in the first trimester was 585 AI (45.7%) and 7,512 White (78.6%). 1
• The number of mothers who used tobacco during pregnancy was 344 AI (26.9%) and 1,099 White (11.5%);
• The infant mortality rate was 10.9 per 1,000 live births for AI and 4.1 per 1,000 for White[iii].

 

A preliminary review of the 2013-2019 CDR data, indicates that sleep-related circumstances

strongly correlate to infant deaths.  Of the 120 sleep-related deaths of infants, 72 were White, 42 were American Indian or Alaskan Native, 9 Hispanic/Latino (any race), and 6 were Multi-Racial.  AI citizens make up 6.7% of the total population, but constitute 35% of all sleep-related infant deaths.

 

Children and Adolescents

 

In 2019, there were 216,929 children ages 1-17 years in MT, and of this total, 27,027 (12.5%) are AI.  MT’s childhood mortality rate for this age group was greater than the U.S. rate: 27.2 deaths per 100,000 children compared to 19.8, respectively.1,5

 

Young drivers involved in fatal crashes continue to be a serious problem in MT. From 2015-2019, MT’s motor vehicle (MV) mortality rate for children age 1-17 years was greater than the U.S. rate with 3.2 deaths per 100,000 children compared to 1.1 deaths per 100,000 children, respectively. 

 

The 2019 National Survey of Children’s Health reported the following statistics for MT:

• 17.1% of children aged 0-17 years lived in households where someone smoked[iv];
• 53.3% of children age 0-17 years without special health care needs had a medical home[v];
• 79.0% of children age 12-17 years had one or more preventive medical care visits[vi];
• 65.6% of children aged 0-17 years were adequately insured[vii];
• 7.0% of children aged 1-17 years had oral health problems in the past 12 months[viii];
• 80.5% of children age 1-17 years had one or more preventive dental visits.7[ix]

 

The rate of birth to adolescents aged 15-17 years, was 6.1 per 1,000 in 2019.1 MT’s 2017-2019 suicide rate among teens (15-17) is twice that of the national rate (19.3 compared to 9.5 per 100,000 teens).5

 

Changes in Title V Program Capacity or MCH Systems of Care: MCH-Related COVID-19 Assessment

 

The largest impact of COVID-19 on the MCH population in the state has been the tremendous strain it put on the overall public health system, consuming staff time and resources usually devoted to MCHBG performance measure activities – especially at CPHDs. These were largely redirected to: contact tracing; quarantine support; public education; and, vaccinations.

 

Epidemiologists located in the DPHHS Public Health & Safety Division released an interim analysis of COVID-19 cases in MT near the beginning of every month.  To provide a snapshot, most of the information in this section pulls from the report on June 4, 2021, with a focus on the maternal and child population.  The whole report is included with the supporting documents for this submission.  408,908 Montanans were fully immunized as of June 11, 2021 (approximately 38% of the total population). 

 

Age and Demographic Distribution

 

As of July 30, 2021, there were 116,535 reported COVID-19 cases in MT. This is approximately 11% of the total population.  As of June 4, 2021, persons between 20-29 years of age accounted for 19% of the cases. The next most common age group wa 30-39 years (16%), followed by 40-49 (13%) and 50-59 years (13%). The median age for all cases was 39 years of age (range: <1-108 years). Fifty-two percent of cases were between 24-58 years of age.

 

                    Figure 4.

 

Most cases are reported in more populous counties. Yellowstone County and Gallatin County are the most impacted to-date, reporting 16% and 13% of all reported cases, respectively. Flathead (11%), Cascade (8%), Missoula (8%), and Lewis & Clark (6%) counties report more than 6,000 cases each.

 

Congregate Settings

 

A congregate setting is an environment where a number of people reside, meet, or gather in close proximity for either a limited or extended period of time. Examples include homeless shelters, group homes, prisons, detention centers, schools, and workplaces. There are 878 congregate settings in MT which experienced a COVID-19 outbreak. Most outbreaks occurred in schools, assisted living facilities, and long-term care facilities, but outbreaks in correctional facilities, group homes, and mental health facilities, have also been reported (see Figure 5.).

 

                    Figure 5.

 

Emerging Public Health Issues

 

Directly related to COVID-19, foregone healthcare has increased as an emerging public health issue.  With access to healthcare already a challenge for much of the state, hesitation to seek medical attention (especially preventive) was increased.  CPHD staff were also unable to provide many of their regular services, with offices being closed to in-person interactions for almost a year.  A significant number of staff at the state or local level involved with COVID-19 vaccination are still redirected from normal duties.

 

In addition, there has been about a 20% turnover of CPHD staff responsible for MCHBG implementation during FFY 2020, largely impacted by the COVID-19 environment.  State-level Title V MCHBG and FICMMR staff offered communications and networking support, and flexibility for deliverables from April 2020 to the present time.  The option to formally request redirection of MCHBG funding towards COVID-19 response efforts was offered in the CPHD FFY 2021 Task Orders (contracts). Many of the programs within the public health system felt impacts of COVID and have required a shift in tasks or efforts to support CPHDs during this difficult time. 

 

As noted in the Home Visiting NA key findings section, Substance Abuse Disorder (SUD) and child maltreatment have been growing problems for MT families. The increasing number of children taken into foster care has been due, in part, to parent SUD. Various local and state initiatives are striving to remove barriers that previously blocked people from getting needed help.  These include the Meadowlark Initiative, which is a collaboration between the MT Healthcare Foundation, the MT Obstetric Maternal Support (MOMS) Program, and the Strengthening Families Initiative, housed in the Addictive and Mental Health Disorders Division and supported by the SAMSHA Pregnant and Postpartum Women grant.  These projects support evidence-based interventions for pregnant people with SUD and mental illness (https://mthcf.org/the-meadowlark-initiative/).  Additionally, Montana’s current Governor has included the Healing and Ending Addiction through Recovery and Treatment (HEART) initiative as an integral part of his agenda, with intent to inform an 1115 demonstration waiver for Medicaid. 

 

Together, MT’s Title V Director and CYSHCN Director oversee two telehealth programs that are working to alleviate ongoing access to care issues in the state:

 

• MAPP-net: The MT Access to Pediatric Psychiatry Network (MAPP-Net) grant strives to support primary care providers and behavioral health specialists in serving children and youth in their communities with mental healthcare needs through education and consultation.  Two activities help meet this goal:

• Project ECHO is a hub-and-spoke model out of the University of New Mexico. Billings Clinic is the contracted “hub” for this program and began Project ECHO Pediatric Mental Health sessions in March 2019. An expert hub team consisting of a Child and Adolescent Psychiatrist, Psychiatric Pharmacist, Psychotherapist and Resource Specialist meets twice per month with primary care providers across the state utilizing an online platform. A member of the hub team delivers a 25-minute didactic. Then, participants can present de-identified cases to review. The hub panel and spoke sites offer feedback and suggestions on the presented cases. This collaboration among peers helps support the presenter’s care for their pediatric patients with mental health care needs and provides an opportunity for increased knowledge for everyone listening. ECHO clinics are grant-funded, and there is no cost to participate.
• A toll-free access line (1-844-922-6277) was established in 2019 for primary care providers to call and consult with a Child and Adolescent Psychiatrist during daytime business hours. Consultations are with Billings Clinic Child and Adolescent Psychiatrists. In 2021, the access line was expanded to support mental health providers across the state.  This is a provider-to-provider call, and patients do not participate. There is no cost for primary care providers to participate in this service.

 

• The MT Obstetrics & Maternal Support (MOMS) program was created to connect rural providers to obstetrical/gynecological, perinatal, mental health and substance abuse specialists, to build competency and consistency across perinatal providers.  The MOMS program guides the multidisciplinary collaboration of maternal and perinatal health providers, programs, resources, and initiatives to deliver training, resources and support to rural healthcare providers in MT as they care for their perinatal patients. Using Project ECHO (Extension for Community Healthcare Outcomes), urban-based experts are linked to rural providers to share their expertise via mentoring, guidance, feedback and didactic education. MOMS leverages existing telemedicine efforts to disperse evidence-based practices to rural providers in efforts to address shortages in OB/GYN specialists and mid-level providers of maternal healthcare across rural MT.

 

[i] MT Office of Vital Records (OVR), 2019 Resident Births. Retrieved from: http://ibis.mt.gov/query/result/birth/BirthBirthCnty/Count.html.

[ii] MT Pregnancy Risk Assessment Monitoring System (PRAMS), 2019.

[iii] MT OVR, 2019 Resident Deaths. Retrieved from: http://ibis.mt.gov/query/result/mort/MortCnty/Count.html

[iv] Maternal and Child Health Bureau of the Health Resources and Services Administration (MCHB), 2019 National Survey of Children's Health (NSCH). Retrieved from: https://www.childhealthdata.org/browse/survey/results?q=8411&r=28

[v] MCHB, 2019 NSCH. Retrieved from: https://www.childhealthdata.org/browse/survey/results?q=8407&r=28

[vi] MHCB, 2019 NSCH. Retrieved from: https://www.childhealthdata.org/browse/survey/results?q=8406&r=28

[vii] MCHB, 2019 NSCH. Retrieved from: https://www.childhealthdata.org/browse/survey/results?q=8412&r=28

[viii] MCHB, 2019 NSCH. Retrieved from: https://www.childhealthdata.org/browse/survey/results?q=8413&r=28

[ix] MHCB, 2019 NSCH. Retrieved from: https://www.childhealthdata.org/browse/survey/results?q=8410&r=28

Ongoing Assessment Activities – Data Collection and Analysis:

 

The Title V MCHBG is housed in the Maternal and Child Health Coordination (MCHC) Section which also includes the HRSA funded Maternal Health Innovation Grant, known as the Montana Obstetrics and Maternal Support (MOMS) Program. The MCHC, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), and Children’s Special Health Services (CSHS) are sections in the Family & Community Health Bureau (FCHB). MOMS, WIC, and CSHS engaged in needs assessment activities during this reporting period.

 

WIC Needs Assessment Highlights

 

Introduction

 

WIC released the results of their 2021 Needs Assessment in January 2022, which was conducted from summer 2020 to summer 2021 by the WIC program in conjunction with Yarrow, LLC,  a contracted public health consulting organization. Data for this assessment were sourced from both primary and secondary data sets at the national, state, and local levels. The direction and scope of the Needs Assessment were shaped by: the WIC Nutrition Services Standards; the Montana WIC Program Director/Section Supervisor; and key Montana WIC staff.   The WIC Needs Assessment was conducted to better understand the needs and resources of the WIC program; its participants and services; and to be used as a guide to WIC’s comprehensive statewide nutrition services plan.  A copy of the full report is available at: https://dphhs.mt.gov/assets/ecfsd/WIC/WICNeedsAssessment.pdf

 

As of 2021, Montana had 29 local agencies and 84 clinics, noted on the following map. Satellite clinics are operated by WIC staff who travel out to a location to provide services in a smaller community at regular intervals, depending on size and need.

Needs Assessment Findings

Findings from the WIC Needs Assessment Survey 2021 suggest that the major barriers to care for the WIC population, as perceived by WIC staff, are the time required of participants to take off work or school or other commitments in order to attend appointments, transportation barriers, and that WIC participants may not find enough value or interest in the nutrition education services provided. Additional findings include:  

 

Program Participation

When looking at participation trends in the Montana WIC Program from 2016 to 2021, overall participation in the Montana WIC program decreased by 22%. The largest drop in participation was seen among women (pregnant, breastfeeding, and postpartum), with a 32.9% decrease from 2016 to 2021. Total children participants exhibited the smallest participation decrease: 13% from 2016 to 2021 (figure 1).

Participant Depression Screening

In 2017, the Montana WIC Program began training staff and implementing the Patient Health Questionnaire (PHQ)-2, which asks two questions to screen for whether a person has experienced a depressed mood over the past two weeks, which may warrant further assessment and follow-up care. By 2018, all women being certified in any category were asked the PHQ-2 questions at the time of certification, including at mid-certification for breastfeeding women. Over the three-year period from 2018 to 2020, more than a quarter of women screened positive for potential depression at least once.

 

Breastfeeding Peer Counselor Programs

Peer counseling programs have found great success in many areas, including breastfeeding. 78.2% of WIC participants have access to Breastfeeding Peer Counselor Programs (BPCP).  BPCP significantly increases the rate of breastfeeding among MT WIC participants. Additionally, MT WIC staff clearly indicated in the MT WIC Needs Assessment Survey 2021 that Breastfeeding Peer Counseling was an area of WIC programming that needed improvement.

With the known benefits of breastfeeding for mother and baby, expansion of BCPC across Montana was identified as a priority area.  The WIC NA identified a need for BCPC targeted expansion to agencies identified as small, located in Northeast Montana, and Tribal or agencies serving Tribal communities.  Currently, very few small agencies, no agencies in Northeastern Montana, and just two Tribal communities have access to BPCPs. WIC Staff are focusing on efforts to expand BPCP to more local agencies. Additionally, heightened emphasis will be placed on ensuring all necessary staff are appropriately trained as certified lactation counselors (CLCs). The following map shows the location of the Montana WIC Program’s Breastfeeding Peer Counselors and Service Areas.

Food Security

Underutilization of services like WIC is a contributing factor to food insecurity alongside larger, more systemic issues in Montana such as food deserts, insufficient living wages, and high medical and childcare costs. Close to one in five participants self-identify as “food insecure” or “sometimes food insecure” when first entering the Montana WIC Program.

 

WIC staff used the USDA’s Economic Research Service’s (ERS) interactive mapping tool, to identify food deserts across Montana. The areas of green in the following map show places in the state where people meet the ERS definition of low-income Census tracts and live more than 1 mile from a grocery store in urban areas or more than 10 miles from a grocery store in areas considered to be rural. Six of the eight Montana counties without Montana Food Bank Network services or partners lie in areas that were determined to be food deserts.

 

Referrals

Referrals are an important aspect of WIC Program recruitment and services. The Montana WIC Program both receives and sends referrals from and to a variety of organizations to better meet the wide range of participants’ needs. As part of the wider network of social services available to residents in Montana, the Montana WIC Program must maintain relationships with a variety of organization across the state. 

 

The State of Montana has recognized the importance of interagency referrals and the need to increase efficient referrals across the State. To this end, the State supported the development of an electronic referral system named CONNECT in 2009, with a significant refurbishment and roll out in 2019. WIC began utilizing CONNECT in 2020 and is in the process of increasing the utilization of the system across all local agencies.

 

WIC Participant Survey 2021

Every year during the summer, from July to September, the Montana WIC State Office conducts a survey of Montana WIC Participants. This is to ensure that the State Office is adequately meeting the needs of families and addressing any issues or concerns. The information from the survey is used to inform quality improvement efforts and strategic planning.  It is also shared with other programs in the FCHB which could benefit from the insights it provides, including the Title V MCHBG.

This survey was provided to participants in 2021 via text with a link to a Qualtrics survey to be collected electronically. It was also available through a link on the Montana WIC Shopper Application, and in paper form available from local WIC agencies.  The following highlights help provide useful insights into a population which is also served by many Title V MCHBG programs, and undermines many negative stereotypes:

• Only 9% of participants do not have at least a High School diploma or GED;
• Only 11% have more than two children;
• Only 1% are younger than 18;
• 61% find the breastfeeding information WIC provides to be somewhat or very important;
• 89% find learning about or connection to community resources (referrals) to be somewhat or very important

Children’s Special Health Services: New & Upcoming Needs Assessments

The Children’s Special Health Services Section (CSHS) is preparing to launch three separate needs assessments, beginning in June 2022.

 

Cleft Clinic & Specialty Care Needs Assessment

 

This needs assessment is designed to obtain parent, patient, and provider input on the condition of specialty care in Montana and includes three steps.   The assessment phase will lead into the development of a comprehensive plan with goals, strategies, and action steps for implementation of identified improvements.

 

The first step will entail a historical review of CSHS’s provision and coordination of specialty pediatric care.  This will provide historical context and background information.  This, in turn, will provide a deeper understanding of the current situation. 

 

The second step will be to gather information on the current state of pediatric specialty clinic services and outreach.  Current providers will be surveyed to determine: 1) current services and alignment with CYSHCN; 2) Strengths, Weaknesses, Opportunities, and Threats (SWOT) of cleft, metabolic, and Cystic Fibrosis clinics; and 3) coordination of care for patients between clinics.

 

Additional activities in step 2 include:

• As necessary based on survey, conduct interviews with current providers and others as directed by CSHS to understand current specialty clinic services and outreach;
• Develop focus group/key informant questions for current families and consumers of specialty care clinics to determine 1) experience; 2) access and, 3) coordination of care for patients in between clinic visit; 4) other needs or concerns;
• Conduct focus groups/interviews with current families and consumers to determine 1) experience; 2) access and, 3) coordination of care for patients in between clinic visit; 4) other needs or concerns;
• Gather statewide clinic locations, services, outreach efforts and contact info: Examples include: endocrinology, gastroenterology, nephrology, neurology, neurosurgery, orthopedic, orthopedic spine, pulmonary, rheumatology, urology, developmental behavioral health, cystic fibrosis, hemophilia, muscular dystrophy;
• Gather clinic data points, i.e.: number of attendees; discharge services; return rate; types of providers; costs; and patient outcomes;
• Gap analysis between best practices and current state of specialty care against CYSHCN Standards of Care.

 

A third step in the assessment process focuses on finances; with a review of the financing and operational structure of clinics.  This includes: a comparison to two to four similar states; and review of Medicaid financing options.  Additionally, analysis will cover: optimal clinic structure for the best and more comprehensive care; sustainable funding options; care coordination between visits; and recommendations for sustaining specialty care from a MCHBG perspective.

 

Behavioral Health Access Line Assessment

 

Prior to receiving the Montana Access to Pediatric Psychiatry Network (MAPP-Net) funding, a MAPP-Net Utilization Needs Assessment was conducted, and it indicated that providers would support and utilize a consultation line.  However, the actual utilization data indicates an underutilization of the MAPP-Net Consolation Access Line.  To determine why and how to improve usage, CSHS has contracted with the University of Montana Rural Institute for Inclusive Communities (UMRI) Research Services Team to oversee a Behavioral Health Access Line Assessment.

 

The Behavioral Health Access Line Assessment is composed of three key informant interview cohorts: 1) the 52 providers who indicated in the initial Utilization Needs Assessment their support and use of an Access Line but have underutilized or never used it; 2) providers, not among the 52, who have utilized the Access Line; and 3) providers enrolled in the MAPP-Net Program but have not utilized Access Line. 

 

UM RII will conduct Zoom or telephone interviews with all key informant cohorts, which have been identified by the MAPP-Net Program Specialist and CSHS Title V/Section Supervisor.  UM Rural III will analyze the key informant interview results.  CSHS intends to use the results to identify both the reasons for the lack of calls to the consultation line and what changes could be considered to increase the MAPP-Net Consultation Line utilization; and to understand the gap between the support and actual utilization for program improvement next steps.

 

Diversity, Equity, and Inclusion Evaluation for MAPP-Net

 

In a separate evaluation of the MAPP-Net Program, CSHS is working to gather and report data about the mental and behavioral health needs of three groups of youth in Montana: LGBTQ, Native American, and Homeless. This analysis, with a timeline of June – December 2022, will identify existing resources in Montana for mental and behavioral health services specific to the three populations.

 Activities:

1. Review of literature related to the specific groups of interest;
2. Key informant interviews;
3. Resource mapping.

 Deliverables:

1. Needs assessment supplemental report. This will be appended to the October 2019 Montana Access to Pediatric Psychiatry Network: Statewide Needs Assessment Final Report along with other subsequent needs data gathered since October 2019;
2. List of Montana-based and other relevant resources to improve behavioral health services for the three groups;
3. Care guides that address issues specific to each group.

 

MOMS Program Needs Assessment Contributions

 

The MOMS Program began working with the University of Montana Rural Institute for Inclusive Communities (UMRII) on a maternal health system needs assessment in March 2021. This needs assessment gathers information on Montana's maternal health system and services to identify areas of strength and need. The assessment focuses on the health system capacity, delivery of services, and the experiences of the patient population. The needs assessment utilizes the World Health Organization (WHO) Strengthening Health Systems to Improve Health Outcomes framework, which outlines the essential elements and activities that make up a strong health system.

 

To date the UM/MOMS maternal health system needs assessment activities have focused primarily on the healthcare delivery system, emphasizing obstetric care.  As appropriate, the results have been used by the MCHBG Program Coordinator and CPHDs.    The next phases of the UM/MOMS needs assessment tasks will help inform 2025 to 2030 MCH Needs Assessment and selection of priority areas and national/state performance measure to address the population domains. Discussions have begun to operationalize a partnership with UM and the Title V program’s specific priority areas for Title V. In FFY 2023, UM will be focused on data collection for: service delivery (primary care and patient experiences), healthcare workforce (clinical and non-clinical settings), and health information systems (data systems, health system performance, and health status).

 

A copy of the MOMS Severe Maternal Morbidity in Montana Report, released in September 2021, is available at: https://www.mtmoms.org/wp-content/uploads/2021/10/SevereMaternalMorbidityMontanaReport_final-1.pdf

 

The MOMS Maternal Health in Montana Full Report, released in May 2022, is available at:  https://www.mtmoms.org/wp-content/uploads/2022/07/MOMS_MaternalHealthMT_Final-5.25.2022-1.pdf

 

County Public Health Department’s Pre-Contract Survey Highlights

 

Each June, CPHDs complete a Pre-Contract Survey (PCS) and submit data on: contact information and staff responsibilities; administrative details; services provided; FICMMR and MCHBG information and processes; and feedback on FCHB support. The survey results provide a picture of CPHD resources across the state.  The PCS also captures the choice of performance measure for the upcoming federal fiscal year, along with the CPHD’s evidence-based or informed activities and evaluation plans.

 

The following graph shows the hours open per week.  Eleven CPHDs, or 22%, are open less than 40 hours per week, and two are open less than 20 hours per week.  This speaks to the capacity of frontier-level population counties to provide access to public health services.

 

 

 

This following graph shows the number of full-time equivalent staff, illustrating the capacity challenge in terms of available personnel.

 

 

 

While motor vehicle traffic deaths in Montana have been trending downward over the last 20 years, they still remain significantly higher than the in the U.S. overall. The following graph shows a comparison by child age groups from 2011 to 2020.

 

 

 

 

The next graph is from the Title V Information System.  It shows National Outcome Measure 16.2, for the adolescent motor vehicle mortality rate: for ages 15 – 19; per 100K; from 2007 to 2019.  Montana’s trend line is on top in the yellow, compared to the U.S. rate in blue.

 

 

In FFY 2021, 15 CPHDs had motor vehicle-related injury-prevention activities: 11 for car-seat safety; and 4 for distracted driving and seatbelt usage. The following chart shows the number of certified car-seat technicians at CPHDs across the state, which is another indicator of limited capacity.  Twenty-five of the responding counties had no certified car-seat technicians affiliated with their CPHD.

 

 

Changes in Health Status and Needs Statistic Update

 

Pregnant Women, Mothers and Infants

 

A snapshot of the health status of MT’s pregnant women, mothers, and infants may be seen from the following common health indicators.

 

The health status data of 1) pregnant women, 2) mothers and infants, and 3) women of child-bearing age serves as an indicator of how well programs are addressing respective needs of each group. The Montana Office of Vital Statistics (OVS) supplied the following data: In 2020 there were 10,870 resident births, of which 1,072 (9.9%) were to American Indian (AI) mothers; 831 (7.6%)  births were infants weighing less than 2,500 grams; 1,059 (9.7%) were infants less than 37 weeks gestation;  8,169 (75.2%) infant’s mothers received prenatal care beginning in the first trimester; 1,278 (11.7%) of infant’s mothers smoked during pregnancy; and 2,975 (27.4%) of infants were born via cesarean section . Of those infants born in 2020, 92.2% were ever breastfed (PRAMS).

 

As noted above, births to American Indian mothers comprise 9.9% of Montana’s resident births; however, race is correlated for the following MCH outcomes:   

• The number of infants born to women who received prenatal care beginning in the first trimester was 569 AI (47.3%) and 7,399 White (79.5%).
• The number of mothers who smoked during pregnancy was 321 AI (26.7%) and 931 White (10%);
• The infant mortality rate for 2016 through 2020 was 11.9 per 1,000 live births for AI and 4.3 per 1,000 for White.

 

A preliminary review of the 2016-2020 CDR data, indicates that sleep-related circumstances

strongly correlate to infant deaths (<18 months age).  Of the 87 sleep-related deaths of infants, 56 were White, 26 were American Indian or Alaskan Native, 5 Hispanic/Latino (any race), and 5 were Multi-Racial.  AI citizens make up 6.7% of the total population, but constitute 30% of all sleep-related infant deaths.

 

Children and Adolescents

 

In 2020, there were 218,318 children ages 1-17 years in MT, and of this total, 26,576 (12.2%) are AI (OVS).  MT’s childhood mortality rate for this age group was greater than the U.S. rate: 32.5 deaths per 100,000 children compared to 21, respectively.

 

Young people involved in fatal crashes continue to be a serious problem in MT. From 2016-2020, MT’s motor vehicle traffic (MVT) crude mortality rate for children aged 0-17 years was greater than the U.S. rate with 6.2 deaths per 100,000 children in MT compared to 3.0 deaths per 100,000 children nationwide (Source: WISQARS, unintentional MV-T deaths, Age 0-17, crude rates MT vs US.) 

 

The 2019-2020 National Survey of Children’s Health (NSCH) reported the following statistics for MT:

• 18.0% of children aged 0-17 years lived in households where someone smoked; 
• 53.7% of children aged 0-17 years without special health care needs had a medical home;
• 79.0% of children aged 12-17 years had one or more preventive medical care visits;
• 65.9% of children aged 0-17 years were adequately insured;
• 9.1% of children aged 1-17 years had oral health problems in the past 12 months;
• 80.4% of children aged 1-17 years had one or more preventive dental visits. 

 

MT’s rate of birth to adolescents, aged 15-17 years, was 4.8 per 1,000 in 2020, and MT’s 2018-2020 suicide rate per 100,000 teens, aged 15-17, was 22.6 (OVS).  The suicide rate is almost three times that of the U.S. rate of 8.6 per 100,000 teens.

 

Changes in Title V Program Capacity or MCH Systems of Care

 

Title X Family Planning Grant Awardee Change

 

On March 30, 2022, DPHHS was notified that the FCHB’s Title X/Family Planning Program was not awarded the Title X Grant beginning on April 1, 2022.  DPHHS had been the sole awardee for the past 50 years. The grant was instead awarded to Bridgercare, a non-profit reproductive and sexual healthcare clinic, founded in 1972, located in Bozeman, Montana.

 

DPHHS received a no-cost extension of current grant funding until September 30, 2022 and is working closely with Bridgercare to transition Title X Family Planning Clinics from their existing contracts with DPHHS, to being subrecipients of Bridgercare. The phased transition plan ensures there will be no break in services.  As of October 1, 2022, all Title X Family Planning Clinics will be subrecipients of Bridgercare, and DPHHS will begin final closeout and reporting activities.

 

Montana Maternal Mortality Review and Prevention Program

 

Montana recently received a CDC grant award for Enhancing Reviews and Surveillance to Eliminate Maternal Mortality (ERASE MM), which is housed in the Maternal and Child Health Coordination Section (MCHC).  The Nurse Abstractor/Grant Manager is supervised by the Title V Director/MCHC Supervisor, who also supervises staff administering federal grants focused on maternal health:  Montana Obstetrics and Maternal Support (MOMS); Fetal, Infant, Child, and Maternal Mortality Review/Prevention (FICMMR); and the Title V/Maternal and Child Health Block Grant programs.

 

This funding directly supports the work of the Montana Maternal Mortality Review & Prevention (MMRP) committee; to identify, review, and characterize maternal deaths; and identify prevention opportunities. Goals include: 1) facilitate an understanding of the drivers of maternal mortality and complications of pregnancy and better understand the associated disparities; 2) determine what interventions at patient, provider, facility, system, and community levels will have the most effect; and, 3) inform the implementation of initiatives in the right places for families and communities who need them most.

 

The MMRP Program hired a Nurse Abstractor/Grant Manager, whose duties include but are not limited to: data abstraction from the local FICMMR teams serving the 56 local health departments and seven reservations; supporting the Montana Maternal Mortality Review Committee (MMRC); data entry into the CDC MMRIA; fulfill CDC reporting requirements; and providing technical assistance and reports to the state FICMMR Coordinator, FICMMR teams, MOMS Maternal Health Leadership Council (MHLC) and Montana Perinatal Quality Collaborative (MPQC) related to implementing prevention recommendations.   Due to a family move, the Nurse Abstractor/Grant Manager’s last day was July 1, 2022, and the position is being advertised.  

 

Changes in Organizational Structure and Leadership

 

Montana’s Title V Program is housed within the Early Childhood & Family Support Division (ECFSD) of the Department of Public Health & Human Services (DPHHS).  Jamie Palagi has been the Division Administrator since its inception in January 2020. Ms. Palagi resigned effective June 17, 2022.  A new Division Administrator, Tracy Moseman, is set to begin work on August 13, 2022.  Ms. Moseman has been the Faith and Community Based Services Coordinator, in the DPHHS Director’s office.  In this role, she has brought community partners together to offer innovative solutions for accessing services. Ms. Moseman holds a bachelor’s degree in Sociology-Criminal Justice, and a master’s degree in Public Administration. Her previous roles over the course of 21 years of public service include: leading health and safety initiatives in public schools through various positions at the Office of Public Instruction; improving community and school-based prevention services; and supporting public safety and offender success during her tenure at the Montana Department of Corrections.

 

Following the loss of the Title X federal award, two Title X Family Planning program staff and the Family Planning & Adolescent Health Section Supervisor have left their positions for new opportunities.  The two remaining Adolescent Health program staff will temporarily report to the FCH Bureau Chief.  Due to the recent change in funding to the Family Planning & Adolescent Health Section, the FCHB will undergo strategic visioning and planning to determine the future organizational structure of the bureau. This will begin in August 2022.

 

Emerging Public Health Issues

 

DPHHS and the Montana Department of Justice, in conjunction with local law enforcement, have identified an alarming number of fatal opioid overdoses across the state. Seizures of fentanyl by law enforcement have increased dramatically in Montana; more fentanyl was seized in the first 3 months of 2022 than in the previous four years combined.

 

Further, there was a 112% increase in fentanyl-related cases from 2020 to 2021. In 2020, there were 41-fentanyl related deaths, and in 2021 that number rose to 87. The number of opioid overdose-related 911 responses increased by approximately 35% in 2021 compared to 2020.

In 2021, there were 836 opioid overdose-related 911 responses by ground transporting EMS agencies.

Maternal & Child Health Partner Programs: FFY 2022 Needs Assessments

 

For ongoing needs assessment work in the interim years between Title V MCHBG 5-Year Statewide Needs Assessments, Montana’s program benefits from partnerships with other maternal and child health programs housed in the Family and Community Health Bureau (FCHB).  This narrative begins with brief summaries of several needs assessments completed in FFY 2022.

 

Children’s Special Health Services Section (CSHS): Cleft Clinic Needs Assessment 2022

 

The current system of state-funded Cleft Clinics (Clinics) was established many decades ago, and the landscape of healthcare and available providers has changed significantly since then. In recent years, several trends have emerged that prompted the need for this assessment. These concerns include a lack of consistent state-based funding, a burdensome administrative system, decreasing ability for providers to volunteer their services at the Clinics, and a decreasing number of participants attending the Clinics.

 

Today, the Clinics still provide a convenient way for 150 patients each year to see approximately 8-10 providers in a single day, receive basic evaluations from each, and then receive a plan of care for Cleft Lip and Palate (CL/P) or other craniofacial conditions, based on the team of providers seen. Within MT there are approximately 800-850 people aged 0-17 years old with CL/P who would benefit from annual team-based care planning. While ACPA still recommends team-based care as best practice, there are alternative and improved ways to achieve an interdisciplinary approach to CL/P that would better fit the existing healthcare landscape.

 

Montana now has: greater access to pediatric specialists across the state; improved access to specialists outside of Clinics; increasing telehealth capacity; and larger, more complex medical systems forming networks across the state for coordinating and maintaining care. Together, all these factors improve patient CL/P care and access. When considering a redesign of the Clinics statewide, however, numerous differences across communities and healthcare systems make it unlikely that one model would be the best option across all communities in MT.

 

The Cleft Clinic Needs Assessment identified the following general opportunities for improvements:

 

Increase Access

• Consider telehealth options for access to Clinics in rural areas.
• Investigate low-cost ways to establish Clinics in population centers that currently lack Clinics (Helena, Kalispell, Bozeman).
• Provide additional support to American Indian / Alaska Native communities to narrow racial disparities in CL/P access and specialized care.

 

Establish Strategic Partners

• Study establishing a connection or partnership with MT State University College of Nursing to support a Bozeman-based Clinic or statewide care coordination center.
• Determine whether MT School for the Deaf and Blind (Great Falls) could provide the necessary screenings and evaluations at the Clinics at little or no charge.
• Intermountain Healthcare, based in Salt Lake City, has recently merged with St. Vincent’s Healthcare in Billings, MT. They provide ACPA-standard CL/P care and may be able to make this CL/P care available to patients in the Billings area.
• Shriners Hospital for Children provides CL/P nationally and internationally. It may be possible to establish MT-based access through a combination of telemedicine and financial support.
• Work with Office of Public Instruction and local school districts to ensure that they understand how to support patients in using the Clinics, and that individualized education plans and legal implications of Section 504 of the Rehabilitation Act of 1973 are applied equitably to people with CL/P.

 

Ensure Stable Funding for SFY 2027 and Beyond

• Work with MT Medicaid to increase reimbursement rates billed for HCPCS T1025 and T1024.
• Increase the number of private insurers that cover the HCPCS T1025 and T1024.
• Understand all of the possible procedures that could be conducted at the Clinics by each participating provider type and provide education to providers.
• Improve and ensure adequacy of MT Medicaid reimbursement rates for those specific procedures that could be conducted and billed at Clinics (if billing by individual provider and procedure).
• Consider applying for grants that could contribute to “baseline” funding for Clinics starting in SFY 2027.
• Engage in continuous research and conversation with healthcare partners to identify long-term or consistently sustainable financial structures for Clinics.

 

Improve Quality in Clinics

• Use an Electronic Health Record system.
• Research and replace the CHRIS system with one that better suited to the needs of the Clinics. Consider a system that will allow each provider to electronically chart in real time and access the charts between Clinics. Review providers note templates and work with providers to improve and modernize these.
• Further investigate the lack of participation from orthodontic specialists and support changes to incentivize their involvement.
• Advocate for the presence of mental health professionals on the Clinic team.
• Encourage the inclusion of pediatricians on the Clinic team.
• Promote CL/P continuing education opportunities for all providers who participate in Clinics.
• Consider creating a Community of Learning (COL) or other quality improvement collaborative to bring Clinic site Coordinators and teams together to collaborate on QI projects across sites.
• Develop and use a robust patient registry that can follow patients from infancy to adulthood.

 

Increase Public Knowledge

• Update the Department of Public Health & Human Services (DPHHS) website with additional information, including: how the Clinics are administered; what is covered by insurance; and the providers that families will have access to through the Clinics.
• Consider regular press releases or other media stories that promote CL/P general knowledge and Clinic awareness specifically.
• Provide suggested information and wording to participating Clinic sites for their websites and patient materials.

 

MT Access to Pediatric Psychiatry Network Access Line: 2022 Needs Assessment

 

The purpose of the MT Access to Pediatric Psychiatry Network (MAPP-Net) 2022 Needs Assessment was to update the 2019 MAPP-Net Needs Assessment, with a specific focus on the MAPP-Net Access Line. Since its implementation in 2019, the MAPP-Net Access Line has been under-utilized in MT, despite the broad support and enthusiasm indicated by participants in the 2019 Needs Assessment. The information in the 2022 Needs Assessment was intended to identify the reasons for underutilization and to inform programmatic changes. 

 

To gather and report data on the under-utilization of the MAPP-Net Access Line, the University of MT Rural Institute for Inclusive Communities (UMRIIC) Evaluation Team developed and implemented evaluation activities, including a statewide survey of MAPP-Net enrollees and MAPP-Net Project ECHO participants. They also conducted 12 key informant interviews with stakeholders identified in collaboration with MT DPHHS and the coordinating organization. 

 

The UMRIIC Evaluation Team sent the Access Line Survey to 107 MAPP-Net enrollees and 256 Project ECHO participants between October 3, 2022 and October 21, 2022. In total, there were 65 responses. Of those, 24 (37%) were MAPP-Net enrollees and 41 (63%) were Project ECHO participants.

 

Drawing on the data collected in this evaluation of the MAPP-Net Access Line, the UMRIIC Evaluation Team made the following recommendations for the MAPP-Net Program with the objective of improving utilization of the Access Line.

1. Increase awareness of the MAPP-Net Access Line and work to build trust within the community of mental/behavior healthcare providers.  Strategies for improving awareness of the program may include expanding outreach to wider-audiences, developing audience-specific messaging, and collecting and sharing success stories from providers who utilize the Access Line.
2. Designate a program champion. This person should be a Child and Adolescent Psychiatrist or a Primary Care Physician who serves as the face of the program, helps staff the Access Line, and assists with outreach efforts across the state.
3. Improve the efficiency of the enrollment process for utilizing the Access Line. Improvements to the call service process should take into consideration the following:

• All requests submitted online are directed to the Child and Adolescent Psychiatrist staffing the line.
• When providers submit an online request, provide an opportunity for the provider to schedule a time to speak with the Child and Adolescent Psychiatrist directly.
• For providers phoning into the Access Line, prioritize the shortest call back time possible.

 

4. Maintain an Advisory Board consisting of diverse group of key stakeholders (mental/behavioral health care providers, physicians, pediatricians, parents, and youth) to guide MAPP-Net decision-making and inform program strategies.

 

Montana Obstetrics & Maternal Support (MOMS) Program

 

The MOMS Program supported the MCHBG with several studies aimed at informing challenges and nuances related to NPM1: Well-Woman Visit, with the ultimate aim to elevate maternal health as a priority health issue in Montana.

 

The MOMS Program contracted with the University of Montana Rural Institute for Inclusive Communities (UMRIIC) for data collection and analysis, evaluation, and research services. Their staff launched several research projects to gather more information on maternal health, focusing on the experiences of pregnant people and providers within the health system:

 

• A provider survey: Understanding and Improving Barriers to Treatment and Care of Postpartum Depression aimed to identify provider bias related to the treatment and care of pregnant women with substance use disorder.

 

• A study: Facilitators and Barriers to Seeking Postpartum Care aimed to identify risk and protective factors associated with seeking care for postpartum depression symptoms among Montana women who use substances.

 

• A patient survey: Maternal Health Care Experiences gathered information on patient experiences interacting with the healthcare system before, during, and after pregnancy to identify unmet needs.  The information from these surveys was used for Year-4 MOMS Strategic Planning in June 2022, which included staff representing Billings Clinic, UMRIIC, the MOMS Program Coordinator, and the Title V Director/MCHC Supervisor.  Additionally, the results are being considered as a part of ongoing Title V MCHBG needs assessment data collection.

 

Maternal & Child Health Partner Programs: Current Needs Assessment Activities

 

This portion of the narrative details several needs assessment activities by partner programs which are currently underway.

 

Adolescent Health Needs Assessment

 

Work on the Adolescent Health Needs Assessment began in earnest in January 2023, with partial funding support from the MCHBG. To begin, Adolescent Health Program staff created, modified, and edited a list of health indicators to guide the assessment. The list has been organized based on a social-ecological model to ensure a holistic approach. Substantial secondary data has been collected from several sources, including Youth Risk Behavior Surveillance System; Behavioral Risk Factor Surveillance System; and Prevention Needs Assessment Youth Survey.  To help shape and inform the focus group questions, seven key informant interviews were conducted.

 

Institutional Review Board (IRB) approval for statewide adolescent focus groups was obtained from the University of Montana IRB. Only one focus group has been conducted, although significant efforts continue to be made to recruit adolescents from across the state for these groups. Individual IRB applications were also written and submitted to seven tribal college IRBs. Conversations with tribal leaders (with additional approvals needed at the tribal level) are being conducted on behalf of the team by the DPHHS American Indian Health Director.

 

Finally, two surveys were created and sent out to collect additional primary data. The first survey, Sex Education in Montana Schools, was sent out to all public and private middle and high school principals or superintendents listed in the OPI Directory of Montana Schools.  To-date, 44 responses have been received. The second survey titled Montana Adolescent Health Survey for Educators, Healthcare Professionals, and Community Members, was also initially sent to all public and private high school and middle school principals. The email asked those recipients to please forward the email/survey on to anyone in their school district, healthcare system, or clubs/groups/organizations in their community that routinely interact with adolescents. To date, 86 responses from this second survey have been received.

 

By late September 2023, it is expected that primary data collection will be complete, and a preliminary report provided for review.  A final report will be completed in November 2023, and dissemination to stakeholders will occur in December.  All Tribal data collected on tribal lands will be given to those individual tribal nations.

Oral Health Program (OHP)

 

The OHP began work on the 2024 Oral Health Workforce Assessment with WIM, LLC in March 2023, during an OH Partner’s Stakeholder meeting attended by 40+ individuals and organizations all with a vested interest in improving access to oral health services.  These stakeholders included: advocates and families for adults and children with disabilities and special healthcare needs; dentists; dental hygienists; university systems; and tribal public health. 

 

The 2024 Oral Health Workforce Assessment aims to provide additional insight to trends in the oral health workforce in Montana, and the impact of COVID-19 on the field. The OHP will use the 2024 Assessment as a guide for future workforce development projects, which includes targeting the areas and populations most in need of oral health providers.

 

Title V MCHBG: Current Needs Assessment Activities

 

Statewide 5-Year 2025 Needs Assessment: Phase 1 and 2 Activities and Purpose

 

In January 2023, Montana’s Title V MCHBG Program began discussion with UMRIIC on Phase 1 of work for the Statewide 5-Year 2025 Needs Assessment.  The purpose of Phase 1 is to help prepare and lay the groundwork for Phase 2, which has an overall purpose to collect primary data from key groups (parents/caregivers, maternal health stakeholders, and tribal communities) on maternal and child health in Montana through a statewide survey and qualitative interviews. It is also to improve the representation and inclusion of service recipients in the MCHBG needs assessment process.

 

As part of Phase 2 activities, UMRIIC will conduct a statewide survey with parents/caregivers to collect information on the health needs of families across Montana. UMRIIC created a draft survey based on the Minnesota Department of Health and Human Services Discovery Survey.  Phase 1 covers continued survey development, with UMRIIC hosting listening sessions to engage parents/caregivers in further designing the survey questions and recruitment plan. UMRIIC will integrate their feedback into a revised version. They will be sharing the updated materials with the Title V Needs Assessment Team for discussion at a meeting on August 8th.  This team includes the American Indian Health Director for Montana’s Department of Public Health & Human Services.  The feedback from the parents/caregivers and needs assessment team will shape the final survey for the beginning of Phase 2 implementation in the fall of 2023.

 

Health Status and Needs of Montana’s Title V MCHBG Population

 

Results from the ongoing Needs Assessments previously detailed in this narrative offer insights regarding the priorities identified in the Statewide 5-Year 2020 Needs Assessment.  These priorities continue to remain pertinent: Access to Public Health Services; Bullying Prevention; Family Support & Health Education; Infant Safe Sleep; Medical Home; Children’s Oral Health; and Women’s Preventive Healthcare. 

 

In Montana, County Public Health Departments (CPHDs) are the primary providers of Title V MCHBG services to their residents. Information gathered from the CPHDs also indicate that Access to Public Health Services and Family Support & Health Education remain priorities.  On the FFY 2024 CPHD Pre-Contract Survey, 31 counties choose SPM 1: Access to Public Health Services for their performance measure, and 12 choose SPM 2: Family Support & Health Education, which addresses social determinants of health.

 

The FCHB and its MCH programs were key contributors to the 2019-2023 Montana State Health Improvement Plan. FCHB staff continue to be key partners for addressing the objectives found in the Priority Area 4: Healthy Mothers, Babies, and Youth section, and the Priority Area 5: Adverse Childhood Experiences section.  The 2020 Montana State Health Improvement Plan report offered a snapshot of the MCH population’s health status on these key objectives: infant mortality rate for all Montanans; sleep-related infant deaths; births from unintended pregnancy; prenatal care for pregnant women; breastfeeding for WIC-participating infants; and postpartum depression screening. Even though improvement is being met, ongoing needs continue in the areas of: infant safe sleep; women’s preventive healthcare; access to public health services; family social services support; and health education for families. 

 

Capacity Changes in Title V MCHBG Programs and Systems of Care, Especially for CSHCN, and Impact on Service Delivery

 

Staff turnover has been a challenge for both the Children’s Special Health Service (CSHS) Section, and the Maternal & Child Health Coordination (MCHC) Section.  CSHS is currently conducting a third round of interviews to try and fill the Nurse Consultant position.  Previously, CSHS had a Program Assistant position; however, the position will not be refilled.

 

Both the MCHBG and FICMMR programs rely on contracts with the CPHDs for implementation of population-level services.  These local departments are still experiencing staffing shortages related to fallout from COVID-19 stresses, and difficulty with recruitment for relatively low-paying positions for nurses. From 2020-2022 there was a thirty percent turnover rate in CPHD staff tasked with implementing the programs at the local level, which impacts the CPHDs’ ability to provide services in a consistent manner.

 

Montana’s Title V MCHBG Partnerships and Collaborations with other Federal, State, Local, and Tribal Entities

 

As detailed in the narratives for: the National/State Performance Measures; Health Care Delivery Public & Private Partnerships; Family Partnership; and Public Input; collaborations are extensive and extend beyond the state borders.  Many of these are long standing partnerships which have evolved with the changing composition of Montana’s population, such as: the University of Washington School of Dentistry; Montana School for the Deaf and Blind; Comprehensive Statewide Cancer-Control Coalition; Montana Chapter of the American College of Obstetricians and Gynecologists; the Montana Breastfeeding Coalition; and Healthy Mothers Healthy Babies,  These partnerships and collaborations are pivotal to address the health care needs of the MCH population.

 

The value of working within the realm of state government is significant for all FCHB programs’ ability to connect with the eight American Indian Nations, each recognized as their own sovereign government.   As noted in the AH Needs Assessment summary, the American Indian Health Director is key to involving Tribal input.  Also, the Tribal Relations Manager’s expertise is valued when establishing tribal government contracts, such as the home visiting contracts with the Blackfeet, Fort Peck, and Northern Cheyenne tribes. 

 

In the last several months, the Title V MCHBG Director, FCHB Bureau Chief, MOMS Program Specialist, and the Maternal Mortality Review/Prevention Program Specialists have contributed to a workgroup aimed at addressing how to address the increase in the syphilis rate, especially congenital syphilis.  Co-led by the State Medical Officer and the STD/HIV/Hep C Supervisor, over 350 healthcare professionals and local and tribal health department staff were made aware of the emerging health care crisis and CDC recommended protocols to decrease the rate. 

 

Changes in Organizational & Structure and Leadership

 

The ECFSD has witnessed several changes in the past year.  In August 2022, Tracy Moseman transitioned from her role as the Director’s Office of Faith and Community Based Services Coordinator to the ECFSD Division Administrator. The ECFSD recently underwent an organizational structure analysis, and with the recent addition of the Preschool Development Birth through Five Grant, is undergoing reorganization.

 

Within the DPHHS Director’s Office, David Gerard began as Director Charlie Brereton’s Deputy Director in April 2023.

Title V MCHBG: Current Needs Assessment Activities

 

County Public Health Departments: Ongoing MCHBG Assessment Activities

 

In Montana, County Public Health Departments (CPHDs) are the primary providers of Title V MCHBG services to their residents. Every year, the CPHDs complete an extensive MCHBG Pre-Contract Survey. The survey gathers information on:

• Department and program capacity;
• MCH services provided;
• Staff changes;
• Priorities needs for MCHBG funding and activities; and,
• Feedback on the quality of services and support from state MCHBG staff

 

Information gathered from the CPHDs on the FFY 2024 CPHD Pre-Contract Survey indicated the on-going priorities of access to public health services, family support, and health education. Thirty-one counties choose SPM 1: Access to Public Health Services for their performance measure, and 12 choose SPM 2: Family Support & Health Education, which addresses social determinants of health.

 

The following graphs illustrate results on “Hours Per Week Open to the Public” and “Total Number of Employees:”

 

  

 

The CPHDs also provide qualitative information on their MCHBG activities on two semi-annual narrative reports.  These reports ask for a description of any activities or planning efforts undertaken during the six-month timeframe, pertaining to the county's chosen performance measure. This might include progress or challenges pertaining to activity goals, using the evaluation strategies described on their Pre-Contract Survey, and any collaborative efforts with other organizations.

 

The MCHBG Program Specialist conducts in-person site visits to CPHDs on a rotating three-year basis. This schedule equates to approximately 17 visits a year.  These visits are an opportunity to conduct key informant interviews, solicit individual feedback, and conduct personalized performance monitoring and assessment.

 

One of the MCHBG contract requirements for CPHDs is that they conduct their own client satisfaction surveys, and report a summary of the results to the state program.  Examples of the  information CPHDs collect include: demographics; preferred methods of communication; how to improve services; sources of information on health topics; client experience with staff, and suggestions for improvement, including hours open to the public.

 

Medicaid Data Query: Women’s Annual Preventive Healthcare Visit

 

Objective: The objective of this analysis was to find the percent of Montana adult (18+) women who were covered by Medicaid and received a preventative healthcare visit during the calendar year of 2022.

 

Methods: Through the Medicaid claims database, all adult women (sex coded as female) who were 18+ for at least one day in the 2022 calendar year were identified. Additionally, county of residence, race, and iCD-10 codes were also obtained.

 

For the women who met these criteria, they also had to have at least one paid claim with a well-woman visit CPT code. These CPT codes not only encompassed preventative medicine services, but also substance use visits, mental health, blood pressure, diabetes, healthy diet, domestic violence, lipid, obesity, tobacco use, STI, HIV, Hepatitis, cancer, and bacteriuria screenings, as well as other preventative care such as contraceptive care, folic acid supplementation, breastfeeding services, Rh(D) blood typing, and immunizations, which all have unique CPT codes beyond the standard preventative medicine services. All claims with CPT codes pulled were finalized claims.  All statistical evaluations were performed in SAS 9.4.

 

Results: In 2022, there were 91,894 adult (18+) women enrolled in Montana Medicaid. This number was derived from the 279,401 people enrolled in Medicaid, 148,217 (53%) were women, and 172,697 (62%) of Medicaid enrollees were adults. These percentages were used to calculate the number of adult female Medicaid enrollees. Of these women, 46,577 (51%) received some form of preventative care.

 

These 46,577 women were then divided into six healthcare regions. County-level data was not available due to low counts in some counties. The percentage of Medicaid recipients with well-woman visits as divided into healthcare regions is shown in Table 1 below.

 

Table 1: Percentage and Rate per 1,000 of Adult Medicaid Recipients with a Well Woman Visit, Montana Medicaid, 2022

 

 

Regions 3, 4, and 5 all had the highest percentage of well-woman visits, all of which are over 50%. Regions 1, 2, and 6 were the lowest with 41%, 47%, and 43%. However, the range between the lowest region (Region 1, 41%) and the highest (Region 4, 53%) was only 12%.

 

 

 

The women were also divided into race by American Indian/Alaskan Native and other races. These categories were chosen due to the enrollment categories available on the Montana Medicaid website. The percentage of American/Indian Alaskan Native Medicaid recipients was 14% lower than the other Medicaid recipients, at 58% compared to 72% (Table 2).

 

 

 

 

 

Table 2: Percentage and Rate per 1,000 of Adult Medicaid Recipients with a Well Woman Visit by Race, Montana Medicaid, 2022

 

 

The Medicaid recipients were also divided into three age categories: late teens (19 – 20 years old), adults (21 – 64), and elderly (65+). Like the racial categories, the age groups were chosen based on available data on the Montana Medicaid website. While the adult and elderly populations had about the same percentage of recipients with well-woman visits (53% and 51%, respectively), the late teenagers had about a 10% reduction in visits at 42% (Table 3).

 

Table 3: Percentage and Rate per 1,000 of Adult Medicaid Recipients with a Well Woman Visit by Age Group, Montana Medicaid, 2022

 

 

Discussion:  While the percentage of Medicaid recipients with well-woman visits across the six regions varies from 41% - 53%, it does show that only about half of women with Medicaid are receiving preventative healthcare. Additionally, as Tables 2 and 3 show, American Indians and Alaskan Native women are receiving less preventative care than other races, and women in their late teens receive less than adult or elderly women.

 

However, there are limitations to using Medicaid claims for analysis purposes. Medicaid claims are used for billing purposes, so they are coded as such and are not coded for research or public health purposes. Additionally, these claims are limited to the CPT codes used to pull the data. If a CPT code was overlooked or missing from the claim, it was not included. Finally, Medicaid can be used with other insurances such as Medicare, private insurance, or Indian Health Service (IHS) insurance. The other insurances could be used to pay for preventative healthcare, as Medicaid is a payor of last resort.

 

Even with these limitations, it is clear that women are not receiving necessary preventative care. Steps such as advertising preventative services, physicians sending reminders, and providing education on the important of screenings are all common recommendations to improve preventative care rates.

 

Statewide 5-Year 2025 Needs Assessment: Activities and Purpose

 

In January 2023, Montana’s Title V MCHBG Program began discussion with the University of Montana Rural Institute for Inclusive Communities (UMRIIC) on Phase 1 of work for the Statewide 5-Year 2025 Needs Assessment.  The purpose of Phase 1 was to collect primary data from parents and caregivers on maternal and child health in Montana through a statewide survey. It is also to helped improve the representation and inclusion of service recipients in the MCHBG needs assessment process.

 

UMRIIC created a draft survey based on the Minnesota Department of Health and Human Services Discovery Survey. In May 2023, UMRIIC hosted listening sessions to engage parents/caregivers in further designing the survey questions and recruitment plan. UMRIIC and MCHBG staff then integrated the feedback into a revised version. This team included the American Indian Health Director for Montana’s Department of Public Health & Human Services.  The Parent/Caregiver Survey data collection occurred from October through December 2023, with 558 participants.

 

Phase II of work on the needs assessment began in October 2023, and will continue through September 2024.  It’s emphasis is on primary data collection from key groups such as maternal and child health stakeholders and tribal communities. The main methods are surveys and qualitative key informant interviews. Federal Fiscal Year (FFY) 2024 is also the main timeframe for quantitative data analysis. 

 

Phase III begins in FFY25, with the following workplan:

• 10/1/24 – 12/21/24: Complete data analysis from surveys and interviews. Review findings with the needs assessment team to clarify key issues and priority concerns.
• 1/1/25 – 3/31/25: State staff will finalize performance measure choices for FFY 2026, with consideration for federal requirements and capacity.
• 4/1/25 – 7/15/25: Complete Needs Assessment Summary Report and submit to HRSA.

 

Family & Community Health Bureau-Affiliated Programs: Needs Assessment Activities

 

Healthy Montana Families Home Visiting: Ongoing Risks Identification

 

Montana’s Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program is called Healthy Montana Families (HMF).  HMF is currently contracting with 18 Local Implementing Agencies (LIAs).  In FFY 2023, the LIAs served 1,837 participants, in 931 households, with 11,805 home visits.  In 2023, the LIAs were asked to identify ongoing risks.  By far, the top three were: Housing (n=18), Behavioral Health (n=14), and Transportation (n=14).

 

HMF’s Demographic Service Utilization FFY 2023 Report presented the following statistics on LIA households served (percentages based on the total of 931):

• 51.8% were low-income;
• 43.9% had a history of child abuse or neglect, or had interactions with child welfare services;
• 37.4% included a member who used tobacco products in the home;
• 32.7% included a member with low student achievement or has a child with low student achievement;
• 31.5% had a history of substance abuse or had a member who needed substance abuse treatment;
• 21.8% included a child with developmental delays or disabilities;
• 10.1% included a member who was serving or had formerly served in the U.S. Armed Forces.
• 2.6% included an enrolled participant who was pregnant and under age 21;

Oral Health Program

 

During 2023, the Montana Oral Health Program conducted an assessment of the oral health workforce. The goal of the 2023 Oral Health Workforce Assessment was to examine the distribution, workforce capacity, and demographic characteristics of the current dental workforce in Montana. This examination is a platform to increase access for populations that experience disparities, and identify opportunities and challenges for health equity in dental care.

 

Stakeholder input was collected during three stakeholder meetings that included representation from: the dental health workforce; those in education settings; and representatives of Montana communities that experience oral health disparities. Kick-off and mid-point meetings were used to: formulate assessment needs and data sources; identify key informants; set partner expectations; and inform future involvement in the assessment.

 

Surveys were developed and disseminated to dentist and dental hygiene professional networks, and a key informant survey was conducted to collect qualitative data. Analysis of survey data was used in combination with other workforce data sets, and dental care utilization data, to create a comprehensive view of the oral health workforce in Montana.  Here are the key findings of the assessment:

 

Understanding the Workforce:

• Montana authorizes the practice of dental health aides (DHA) and dental health aide therapists (DHATs) within tribal health, Indian Health Services and Urban Indian Health Centers. However, performing dental extractions or invasive procedures to teeth and gums is prohibited. Although authorized by law, the functions of a DHAT in Montana do not align with what is nationally recognized in dental therapy.
• Dental hygienists provide care under general supervision with the intent and knowledge of the supervising dentist, which does not require the dentist to be on the premises. Dental hygienists practicing with a limited access permit (LAP) may practice under public health supervision in specific public health settings.

 

Supply and Demand:

• In 2023, 1,055 dental hygienists held a professional license; 914 of those license holders had a Montana address on file.
• In 2022, Montana Occupational Employment Statistics estimated 1,420 dental assistants to be working in Montana.
• Dentist survey respondents reported employing an average of 2.5 dental hygienists yet reported needing an average of 3.1 dental hygienists. Similarly, dentists reported a need for more dental assistants, with an average of 3.9 currently employed and a need for 4.2. Results indicate dental clinics across Montana are understaffed.
• The American Dental Association Health Policy Institute estimates there are 640 active dentists in the State or 56.5 dentists per 100,000 population. This is below the national average of 60.4 per 100,000 population, ranking Montana 30th in the nation.

 

Recruitment and Retention:

• Employers in Western and South Central Montana report more difficulty recruiting dental hygienists compared to Eastern and North Central Montana.
• Dentists in North Central Montana reported 7-9% lower hourly pay for dental hygienists compared to those in Western, South Central, and Eastern Montana.
• Benefits are important to dental hygienists; 87% rated them as either extremely or very important.
• On average, dentists who participate in the National Health Service Corp within rural Montana intend to continue in rural practice for 18.6 years.

 

Educational Pipeline:

• 66% of Montana dental hygienists reported they obtained their high school diploma or GED in Montana.
• Many of Montana’s current dental hygienists reported starting their career as a dental assistant.
• 47% of Montana dentist survey respondents reported graduating from high school in Montana; 34% were trained through either the University of Washington School of Dentistry, Oregon Health and Science University School of Dentistry, or the University of Minnesota School of Dentistry.
• Many dentists, 50%, decide to become a dentist before going to college.
• Career interest among high school students is low; 5% of students in healthcare pipeline programs report an interest in pursuing a dental career.
• 15-25% of Carroll College Pre-Dental Pathway students matriculate to dental school.
• 42.2% of WICHE Dental Exchange Program graduates are estimated to be working in Montana.
• 44.6% of Minnesota Dental Exchange Program graduates are estimated to be working in Montana.
• Great Falls College Dental Hygienist Program estimates 89% of their 2022 graduates are employed in Montana.
• Salish Kootenai College Dental Assisting Program staff reported 100% of graduates work in Montana.
• Both the Great Falls College and Salish Kootenai College Dental Assisting Programs have experienced a decline in enrollment in recent years.

 

Underserved Populations:

• Barriers to care for historically underserved populations include financial constraints, geographical limitations, healthcare system complexities, and specific population challenges.
• In 2022, 77.5% of general and pediatric dentists served Medicaid-enrolled Montanans; 13% of dentists accounted for 63% of Medicaid services billed.
• Just 36% of Montana dentist survey respondents reported they are accepting new adult Medicaid patients and 57% reported they are accepting new child Medicaid patients.
• In 2023, 103 hygienists held a LAP, which is 9.8% of all dental hygiene license holders.
• HRSA estimates 33.5 dentists are needed to meet the needs of Montana’s underserved communities. Missoula, Cascade, Ravalli, and Gallatin counties have the greatest needs.
• Workforce needs reported by Montana's Indian Health Services and Tribal Health Clinics in the fall of 2023 included 11 dentists, 4 dental hygienists, and 17 dental assistants.
• In 2022, 4,264 nontraumatic dental care visits were made to an emergency room in Montana.

 

Innovative Initiatives:

• 22% of dentists surveyed report they utilize teledentistry.
• Montana promotes the use of primary care medical providers who are trained in preventive oral healthcare such as risk assessment, referral to dental care, and fluoride varnish application.

 

Early Childhood & Family Support Division: Bright Futures Birth-5 Grant, Early Childhood Needs Assessment

 

Montana had 57,646 children under the age of five in 2022, according to the U.S. Census. Getting the best start in these years has life-long impacts on everything from educational outcomes to life expectancy. Each child and family has a unique mix of needs and assets. In Montana, services to help children and families thrive are delivered through many coalitions, organizations, businesses, programs, agencies, and individual professionals. Together, families and these organizations make up the early childhood system.

 

The system-level needs assessment was designed to do three things:

• Characterize the current state of young children and their families and the services that support their needs and goals
• Identify opportunities and challenges within the early childhood system
• Provide system-level recommendations that will help inform strategic planning to address challenges and build on successes 

 

The needs assessment drew on public data sources, 50 family and service provider interviews, and a family and service provider survey that was answered by 1,734 total respondents including 990 families from every county in Montana.

 

Preliminary results show gaps in service capacity, provision, and access. Gaps in data, communication, coordination, and state-local early childhood system governance also show needed areas for further improvement. Additionally, there is widespread recognition of the need to work as a system. It was also noted, however, that there have been significant advancements since 2019.  These advances include: consolidation of early childhood functions in state government; and increased coordination and recognition of the valuable functions that early childhood coalitions and other organizations provide in Montana.  A final report will be released in August of 2024.