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HMA Evaluation of Montana’s Tribal Systems of Care Grant

Editor’s Note: This post was authored by Principal Rebecca Kellenberg.

Montana Office of Public Instruction (OPI) contracted with HMA to serve as the independent evaluator of the Tribal Systems of Care grant from the Substance Abuse and Mental Health Services Administration (SAMHSA). In this four-year role, HMA will assist in reporting on project evaluation data to show progress in meeting the goals and objectives of the grant as well as the fidelity, implementation, and impact of the project in the participating tribal communities.

A System of Care (SoC) is a spectrum of effective, community-based services and supports for children and youth with or at risk for mental health or other challenges and their families. Organized into a coordinated network, a SoC builds meaningful partnerships with families and youth, and addresses their cultural and linguistic needs, in order to help them function better at home, in school, in the community, and throughout life.[1] The Montana OPI Tribal SoC grant supports the ongoing operation of high fidelity wraparound services for tribal students (and their families) in 6th through 12th grade on five Indian Reservations:

  • Fort Peck
  • Blackfeet
  • Fort Belknap
  • Crow
  • Northern Cheyenne

What is High Fidelity Wraparound?

The wraparound concept has continuously evolved since the term originated in the 1980s. Today, wraparound is considered a process of intensive, individualized care planning and coordination of care for children with, or at risk of, Serious Emotional Disturbance (SED) or Severe Mental Illness (SMI). The wraparound process relies on a blended team of professional relationships and natural support relationships brought together to support the child and family. High Fidelity simply means the practitioners have been trained to appropriately follow the wraparound process, which employs a strength-based approach, active partnership with youth and families, and honoring their voices in decision-making for their life.[2]

Goals of the Tribal SOC Grant

In addition to implementing wraparound, the grant goals include:

  • Increasing knowledge and skills for school staff, community partners, and community members in trauma informed care; and increasing cultural knowledge and skills for all school staff.
  • Promoting the vision, goals, and activities of the OPI SoC Project, and increasing access to services and tools for wellness for the entire population (29,066) through a communications plan and improved service database.
  • Using a pilot project approach to increase the number of youth with early onset of SED/SMI or those who are at high risk who are systemically identified and connected to services early.
  • Strengthening local and state governance systems to sustain and scale wraparound.

HMA’s Role as Evaluator

HMA evaluation staff will participate in monthly meetings with a Family/Youth Advisory Council on each reservation. At these gatherings, families and youth will give input to all key aspects of the SoC work. We will also create and administer an annual family/youth survey, to learn from families about their experience with the SoC. Families/youth will be given the opportunity to participate in trauma informed care training and provide input for the communications and sustainability plans. Additionally, families, youth, and consumer organizations will determine for themselves how they want to be represented at the Local Advisory Team and State Advisory Team.

Throughout the evaluation, HMA is employing a collaborative, communicative, and partnership-based evaluation approach. Drawing on our experience working with tribes and tribal organizations, we work with the OPI SoC grant team and participating organizations in a culturally appropriate manner that is consistent with member organizations’ expectations and traditions. Our approach to the evaluation is built around a commitment to a consensus-based, community-driven participatory approach that recognizes community partners and participants as “experts in their own lives” and as critical sources of insights and data to successfully meet the goals of the evaluation.

To meet the overall goal of conducting a Local Performance Assessment of the SoC grant, HMA is also providing proactive oversight and technical assistance to project staff in designing data collection instruments and protocols; managing a database; assuring data quality and integrity; analyzing data; and reporting on SoC performance. Our team of evaluation experts is not only providing in-depth evaluation guidance and oversight, but we are also creating the requisite data collection tools and database in a participatory manner with the project staff, State Advisory Team and Local Advisory Teams. We are building the data collection system using Tableau software, which is a sophisticated data visualization and analytics tool capable of retrieving and combining many different datasets and types together to create one, unified dataset and report.

HMA’s Experience Working with Native American Tribal Organizations

Since its inception in 1985, HMA has been at the forefront of healthcare reform with a special emphasis placed on safety net healthcare systems across the country. HMA has extensive experience working with community stakeholders to address long-standing healthcare access, quality, outcomes, evaluation, and cost challenges. We have helped build models of care that are truly integrated and meet the needs of the populations in those communities. Our work spans a wide variety of communities, including Native American populations that rely on a combination of public and private resources to provide a healthcare safety net for their community. HMA has helped these communities and others establish collaboratives of key stakeholders – hospitals, Federally Qualified Health Centers, physician groups, mental health providers, oral health providers and others – to address the healthcare needs of the community and to help reshape the safety net into a coherent, value-based, integrated, accountable system of care.

In addition to our state and local health policy expertise, HMA staff have worked on several direct healthcare projects for and with American Indian and Alaska Native Tribes. Our team understands the diverse nature of Tribal 638 and traditional Indian Health Service (IHS) clinics and the multitude of chronic physical and behavioral health disorders that tribal members confront daily. We also can provide expertise in development of both administrative and clinical systems. This support includes:

  • Policy Development: HMA can provide policy expertise on the regulatory and programmatic issues relevant to IHS and tribal healthcare, federal financing of purchased and referred care, behavioral health needs assessments, and more. We can facilitate conversations with Medicaid agencies and tribal health facilities to explore options and identify opportunities.
  • Operational Planning: HMA has worked directly with and can leverage our knowledge of healthcare operations in rural and urban settings to support infrastructure needs such as data management, information technology, staffing, policies and procedures, and eligibility and enrollment processes.
  • Cultural Competence: HMA understands the importance of working with American Indian and Alaska Native populations in a way that respects their unique values and approaches to improving health and healthcare. We can provide tribes with resources and expertise on healthcare issues that impact American Indian and Alaska Native populations, including the array of health disparities, substance abuse, historical trauma, lack of public health infrastructure, housing and education on reservations, and the importance of addressing these issues through American Indian and Alaska Native leadership and engagement that is culturally sensitive and respectful.
  • Stakeholder Engagement and Partnership Development: Having worked directly with tribes and with other governmental entities in states with significant tribal populations, HMA is well positioned to assist tribes and Urban Indian Health Centers in their relationships with IHS, other government health leaders, and other providers. HMA has experience facilitating conversations that develop trust and support discussions focused on key operational and policy decisions. Depending on the state and/or tribe, HMA can facilitate conversations with Medicaid agencies, healthcare leaders, IHS, and other community-based organizations and foundations that have trusted relationships with tribes.
  • Implementation: HMA colleagues have built and operated managed care programs and have implemented provider system changes at all levels of the healthcare system, including state-wide programs and clinic-level work with tribal partners.

Want to learn more? Please contact Rebecca Kellenberg at [email protected].


[1] Updating the System of Care Concept and Philosophy, Beth A. Stroul, ME; Gary M. Blau, PhD; and Robert Friedman, PhD (2010, p.6)

[2] “High-Fidelity Wraparound in Tribal Communities: Fact Sheet” National Indian Child Welfare Association. August 2015