For Missoula resident Tami Burlingame, finding the right services for her son, diagnosed with ADHD and bipolar disorder, was an exhausting battle.
“It just felt like you’re out there on this island with no support,” she said. “We didn’t know where to go, who to ask for help.”
Burlingame’s son, now 24, struggled while in public schools, where his illness was not properly recognized or accommodated, she said. The school district has since made changes for the better, Burlingame said. Her son had periods of stability and help from doctors and psychiatrists, but when he was in middle school, his mental illness worsened, leading to anxiety, aggression and long nights in the hospital emergency room, Burlingame said.
After her son’s psychiatrist recommended more intensive inpatient care, Burlingame struggled to figure out how to pay for it, racking up $200,000 in debt to Shodair Children’s Hospital in Helena before insurance coverage kicked in. Burlingame said her son did well in the structured environments at Shodair and at youth group homes but struggled after returning home.
“It was very frustrating because we could see what he needed but couldn’t provide it for him,” she said. “As a parent, that’s the hardest thing ever, to sit back and know what your kiddo needs and you can’t help. You just don’t have the tools to give them what they need.”
After seven months of living in a group home as an adult, Burlingame’s son is now doing well, she said. While the mental health care system has seen some improvements since her son was a child, Burlingame said more work is needed to reduce stigma, catch issues when children are younger and better serve area families.
“I always use the comparison of if a child is diabetic, you don’t think twice about providing them insulin,” she said. “Mental illness should be thought of and supported the same way.”
A group of Missoula organizations is using new federal grant funding to address many of the challenges Burlingame’s family faced, the Montana Free Press reports.
In September, the Substance Abuse and Mental Health Services Administration, a branch of the U.S. Department of Health and Human Services, awarded Missoula County a Systems of Care grant, administered by Partnership Health Center. The four-year grant provides nearly $1 million per year for PHC, Providence, Youth Homes Montana and AWARE to expand and coordinate mental health and supportive services for youth and their families.
Systems of Care is a nationwide approach to providing comprehensive and coordinated services for youth and families while also offering more flexibility than other funding sources, said Amy Krzyzek, a project director with PHC.
“People are really attracted to the idea of pooling resources and collaborating better so that it’s not just this feeling of scarcity all the time that we’re all kind of feeling in this moment,” she said.
The goals of the Missoula project include improving collaboration among providers to better center families, helping youth transition between services with less waiting time, keeping kids in the community, engaging youth and families in plans for care, and decreasing crises and hospitalizations, Krzyzek said.
Missoula’s Strategic Alliance for Improved Behavioral Health, a group of providers and local government officials, identified improvements to youth crisis care services as a priority several years ago, as more children were ending up in the hospital or justice system, Krzyzek said.
The state Legislature’s cuts to the health department and Medicaid reimbursement rates in 2017 greatly affected home and community-based support for Montana youth, Krzyzek said. The increased cost of living has further stretched agencies and families who don’t know how to navigate the system, she said.
“If services are really fragmented, that just means a mental health condition can get worse as they figure out what is the right next step,” Krzyzek said. “And so what would be more supportive is just having more connections and official agreements across agencies.”
In the first year, PHC will receive about $117,300 to administer the grant, and $150,000 will go toward a contract with TriWest Group, an expert in System of Care work, to collect data and evaluate the grant’s effectiveness.
AWARE, a statewide nonprofit offering community-based mental health support, will receive about $153,000 annually to provide outreach, system navigation and advocacy support for caregivers.
About $340,500 will go toward expanding Providence St. Patrick Hospital’s youth mobile crisis unit to provide more services in the community and at schools.
Missoula County Youth Court partnered with Providence Montana and worked with the school district to create a mobile crisis response unit to better prevent students from entering the juvenile justice system and connect them to help.
The crisis team, started in early 2023, has expanded to seven people — three clinicians working in schools, one full-time and one part-time social worker responding in the community, a case manager and an assessment and referral coordinator.
Kate Wiltfong, the manager of social work at St. Patrick Hospital, said the team was designed to respond to crises in the moment but has been doing more prevention work. As the therapists built relationships with schools and students, they had less time to efficiently respond to crises, she said. Two of the new social workers have taken on the immediate crisis response work, which includes emergency evaluations that previously had to be done at the hospital, Wiltfong said.
“The hope is to meet the client where they’re at and do what we need to do to keep them in the environment they’re in,” said Serene Cusack, the team’s assessment and referral coordinator. “We’re still trying to limit the emergency room visits to those who need to be in the emergency room, versus when families feel like there’s no other option but the emergency room.”
In the first three months of 2025, the team has served nearly 200 different individuals, Cusack said. Their work is free for area youth and families.
Working with children in crisis is different from adults because they have a whole system around them that is affected, Cusack said. The program defines a crisis as an event or experience that a family is not able to manage with the coping skills or resources they already have, she said. That can be a child with thoughts of suicide or not enough food to eat, Wiltfong said. The team often acts as a bridge to other support services and is supposed to be short-term, Cusack said.
“But when a family’s been kicked off of Medicaid or they don’t have the ability to get their insurance back, or those huge system problems we can’t address, then what’s happening is we’re seeing repeat clients coming back to us,” she said. “The family constantly feels in crisis because we don’t have anywhere to bridge to, so we’re elongating our time with them.”
The grant’s flexibility and focus on collaboration allow for a smoother transition between services, and the Providence team can check on placements or referrals, Cusack said.
“We’re making sure it happens instead of just assuming that these people, whose needs are not being met in general, are making those connections,” she said.
Officials from Providence and the other participating organizations said the grant allows them to serve youth and families without worrying about their insurance status.
“It’s going to be a gamechanger for us because it provides those pathways,” said Amy Schaer, CEO of Youth Homes Montana. “And not just pathways, but also the funding behind it to create these easy bridges between one another.”
With $238,000 in grant funds, Youth Homes is creating a crisis care team and providing a crisis stabilization bed. The organization runs youth group homes, including four in Missoula, shelter programs in Helena and Kalispell, and a family care program.
The crisis care team will include a crisis specialist and therapist to provide in-home assessment, placement and case management services. The team will work closely with the Providence crisis response unit, Schaer said.
“Home-based care is powerful because it stabilizes kids and supports parents and caregivers in the environment they know best,” she said. “It’s a service that comes alongside families and youth where they are at.”
By the end of the first year, Youth Homes expects the team to support at least 25 youth in crisis, and three times that annually in the following years, Schaer said.
The crisis stabilization bed is located in the organization’s Tom Roy Youth Guidance Home. While the group home focuses on giving 16- and 17-year-olds aging out of foster care independent living skills, the crisis bed is not restricted to those requirements, Schaer said.
“For some young people, a safe place to stabilize can prevent a hospital visit or worse,” she said. “This is currently a gap in crisis services for youth and makes it possible for youth to have access to critical safety net care in Missoula.”
Since October, five youth have used the crisis bed for two weeks each, the maximum length of stay, Schaer said.
One girl stayed there while her living situation was worked out after leaving the hospital’s adolescent inpatient unit, Schaer said. Another teenager in state care used the bed after he was abruptly moved from an out-of-state facility back to Missoula, Schaer said. While that situation is an anomaly, the crisis bed provided a place for someone with nowhere else to go, she said.
Youth Homes is planning for an entire group home for youth in crisis as it adjusts to an uptick in the number of children struggling with anxiety, depression, suicidal ideation and self-harming behaviors, Schaer said. Youth often end up in crisis when families can’t get the care they need early on, something the grant-funded work aims to address, she said.
“Ultimately, this grant is about building a seamless continuum of care, building a system that doesn’t just respond to crisis but prevents it,” Schaer said. “It’s an investment in the future of Missoula’s youth and in a healthier, more resilient community. That long-term vision of the grant helps fill in cracks and creates stronger infrastructure through capacity, services and pathways that make it a better place for Missoula youth.”
Burlingame, the mom who struggled to navigate the system years ago, said while services like crisis teams responding to the schools and community and crisis training for law enforcement have made a difference, Missoula still lacks so much for people dealing with mental illness.
It’s important to let families know what support is available and that it’s OK to ask for help, Burlingame said.
“My dream would be for every family to have a case manager to help walk them through and help decide what might be the best avenue for this particular child,” she said.
This story was originally published by Montana Free Press at montanafreepress.org.
