Three counties in Montana, Silver Bow, Lewis and Clark, and Gallatin, have recently implemented jail diversion programs. These programs provide treatment for those with mental illnesses pre-arrest, during incarceration, and after release.
The programs are producing impressive results. In Gallatin County, for example, after implementing the program recidivism rates dropped to 9% for the group participating in the jail diversion program (for comparison, the statewide rate is 41.9%). Although each county’s program was initially funded primarily with grants, diversion is proving so successful that now primary funding of the programs is out of its corrections budget. Referring to Montana as a whole, Representative Margie MacDonald, chair of the legislature’s Law and Justice Interim Committee said, “If we reduce recidivism rates, we have the potential to save literally tens of millions of dollars. Incarceration is one of the most expensive things the state of Montana does”.
With positive results in each county, the Montana Association of Counties is now planning an initiative to help corrections departments around Montana implement similar programs, in hopes of not only improving mental health outcomes but reducing recidivism and related correction costs as well.
In the past year the critical access hospitals in Ennis and Deer Lodge have implemented clinical care coordinator programs. The programs are internally funded by the hospitals and are run by experienced nurses who understand the challenges of an increasingly complex healthcare system, the challenges to health that come up in people’s daily lives. These programs seek to improve patient care, reduce hospital re-admissions, improve chronic disease outcomes, and provide a consistent point person for patients throughout their treatment.
Even though both programs are still in their first year of implementation, there are already signs of improvement. The Madison Valley Medical Center for example, has seen a reduction of readmission rates from 7.4% to 2.6%, and patients have expressed tremendous appreciation for the follow up calls and additional support during their illness and recovery. Another benefit of these programs is that they help people referred out of the community for specialty care to return home sooner, more safely, and without any breaks in their care. The Deer Lodge Medical Center, for example, observed that patients appear to recover more quickly when they have a consistent point person throughout their treatment, and help transitioning from tertiary hospitals back into their communities.
Evidence from around the U.S. suggests that care coordination via nurse care navigator programs, community health workers, and collaboration between public health departments and hospitals can improve health outcomes and reduce costs. These two programs show that such efforts are feasible in Montana, and can yield substantial rewards for patients and the hospitals and clinics that serve them.
Partnerships and Collaboration: Richland Health Network
In 2000, the Richland County Health Department and the Sidney Health Center partnered to form the Richland Health Network in an effort to improve health and quality of life in the community. This longstanding partnership has achieved notable outcomes that would have been difficult for either organization alone.
The Network’s initial goal was to decrease hospital re-admissions among older adults by providing outreach, care coordination and assistance with daily needs, such as taking medications correctly and eating well. Together the Health Department and Health Center applied for and received a federal grant for the project. The collaboration was not only successful in reducing re-admissions, but also in enabling the Network to expand their focus to include the growing needs of people with diabetes in the county.
Over the course of the partnership, the Richland Health Network implemented a variety of programs, such as training diabetes ambassadors and creating a Senior Health Coalition to provide outreach to vulnerable seniors in their homes. The project also led to the creation of a new diabetes center housed at the Sidney Health Center, which offers patients tools and support for managing their illness; and the Health Department continues to facilitate collaboration between agencies and organizations while identifying and securing resources to address other chronic disease issues.
One of the most important roles that county health departments can play is providing strategic leadership and bringing people together to address important health issues. As part of the community health improvement process that local health departments carry out periodically, the Richland County Health Department completed a health assessment, in collaboration with stakeholders, to identify the most important health-related issues facing the county. The Health Department then built a steering committee to address these issues, with members from all areas of the county including representatives from the Health Department and other leadership groups such as the City-County Planning Board and the Chamber of Commerce. Some of the other partners include the faith-based community, Transportation Director, County Commissioners, County and City Public Works Director, Park and Recreation board members, the hospital, and the library.
Action groups made up of steering committee members took ownership for implementing various aspects of the strategic plan. Their accomplishments to date are impressive. One action group focused on physical activity to reduce the risks of diabetes and obesity, advocating successfully for a “complete streets” policy and new walking paths to local schools. To provide social support, opportunities for learning, and physical activity for vulnerable kids, another action group created the Richland County Boys and Girls Club, raising approximately $2 million to house the club. Some other notable accomplishments of the steering committee’s working groups include:
- Creating a community foundation.
- Establishing a family resources center, providing parenting classes and a “Parent Café” for the Sidney Schools.
- Holding Mental Health First Aid trainings – evidence-based interventions helping community members identify, understand, and respond to signs of mental illnesses and substance use disorders in friends, co-workers, and students. Mental Health First Aid is not a common training used in communities throughout Montana, and the mental health action group that started the training was the first in the state to do so.
- Assembling a large coalition of local organizations, businesses, and individuals to address emergency response for the many RV parks created in Richland County during the recent increase oil production.