A training program developed by Montana State University’s Montana Office of Rural Health and Area Health Education Center (MORH/AHEC) has reached more than 1,500 health care workers and students in its first year. The program, called Caring for Indigenous Montanans, aims to improve health care for Native Americans across the state.
The initiative was created in response to longstanding distrust among some Native Americans toward health care institutions, a result of historical experiences. Grace Behrens, project coordinator with MORH/AHEC, noted that this distrust can have significant effects. Research from MSU shows that Indigenous people in Montana have a life expectancy 19 years shorter than white residents and face higher rates of chronic illnesses such as diabetes, heart disease, high blood pressure, as well as worse maternal and infant health outcomes.
“That’s why creating resources that build understanding and respect is so important,” Behrens said. “It’s directly tied to health outcomes. We know that sometimes people delay or avoid care when they don’t feel like they’re being treated well in the health care system.”
Funded by the Montana Department of Health and Human Services (DPHHS), the free online text and video trainings are open to anyone working in health care fields.
Since launching in August 2024, the course has received positive feedback from both Native Americans and providers who completed it.
“Trust is at the heart of effective health care. By centering Native perspectives, we can strengthen connections between Montana’s current and future health care workforce and the communities they serve,” said Kailyn Mock, director of MORH/AHEC.
Behrens added: “What we’re hearing is a lot of appreciation that there’s a resource out there that reflects different Native communities and how they want to be seen.”
The curriculum includes eight separate trainings tailored to each tribal government in Montana. Behrens explained that most existing resources group all tribes together rather than recognizing their unique identities. She recommends providers take courses relevant to the communities where they practice.
The project began in 2023 under Stephanie Iron Shooter, director of DPHHS’s Office of American Indian Health. Iron Shooter emphasized this was DPHHS’s first time creating comprehensive resources specific to each reservation. Tribal governments were consulted for permission on the project; leaders and cultural knowledge keepers helped shape content for cultural relevance.
Tribal members also shared personal stories through interviews conducted during visits to every reservation in Montana by Behrens and Iron Shooter in summer 2023. Lex Harold, an MSU graduate student from the School of Film and Photography, filmed these interviews.
“Storytelling has been a traditional way of expression for many Indigenous people for centuries. We took the voices of Montana tribal members and incorporated them into every piece of this training,” Iron Shooter said.
Each module features interviews with community members alongside context provided by Joseph Gone—an anthropology professor at Harvard University who previously held an endowed chair at MSU.
Health practitioners who complete the course receive practical advice on caring for Indigenous patients—such as making time for patient storytelling or respecting generational healing practices.
“That was one thing we heard a lot, was folks wanting their traditional ways of being healthy to be just as respected,” Behrens said.
Video modules also cover historical topics including buffalo extermination and government-run boarding schools’ impact on Native communities.
Iron Shooter encouraged providers not only to take part in these trainings but also visit local clinics on reservations or attend cultural events: “Come and get to know us as a people, as cultural keepers of our way of life. Come and get to know us so that we can work together to build trust,” she said.
Simple gestures—like displaying photos or flags representing nearby tribes—can help create welcoming spaces within clinics or hospitals according to Iron Shooter.
Organizers are now collecting feedback about possible improvements while keeping expansion options open moving forward.
“This was a really unique partnership between the state health department, the university and all eight tribal governments,” Behrens said. “It just really shows the impact we can make when we all work together.”
The free trainings remain available online at https://healthinfo.montana.edu/cfim/index.html.
