Pamela Ponich - Peer Recovery Doulas in Montana

Episode Description:

In this episode of the LIFTS Podcast, host Emily Freeman talks with Pam Ponich, Perinatal Program Manager for One Health, about an innovative program changing the face of perinatal support in Montana — the Peer Recovery Doula certification.

Pam, a longtime psychotherapist and program developer, helped create this dual certification for Certified Behavioral Health Peer Support Specialists and Full Spectrum Doulas. The program recognizes the powerful overlap between peer support and birth work — both rooted in trust, lived experience, and standing beside rather than above the person being served.

Together, Emily and Pam discuss how this work helps fill critical workforce gaps in rural and frontier areas, reduces stigma, and offers a more compassionate, coordinated approach to supporting families — especially those navigating recovery, trauma, or behavioral health challenges during pregnancy and postpartum.

Topics in this episode include:

• What peer support specialists and recovery doulas do
• How lived experience strengthens behavioral health and birth work
• Addressing trauma and stigma in perinatal care
• How the Meadowlark Initiative and other statewide efforts are reshaping systems of care
• Pathways for becoming a certified Peer Recovery Doula in Montana
• How Medicaid reimbursement and certification are evolving for doulas

Resources mentioned:

• LIFTS Online Resource Guide: hmhb-lifts.org 
• The Meadowlark Initiative: https://mthf.org/priority/the-meadowlark-initiative/ 
• One Health Recovery Doula Program Information: https://www.ruralhealthinfo.org/project-examples/1123
• Montana Free Press Recovery Doula Article: https://montanafreepress.org/2023/10/16/montana-recovery-doulas-bridge-gaps-for-pregnant-people-struggling-with-addiction/
  
  

Contact:
For more information about upcoming Peer Recovery Doula trainings, email Pam Ponich at Pam.Ponich@onechc.org.

Enjoying the podcast? We’d love your feedback and ideas for future episodes! Take our LIFTS Podcast Listener Survey at hmhb-mt.org/survey.

Connect with Healthy Mothers, Healthy Babies

• Website
• Facebook
• Instagram 

For statewide resources to support Montana families in the 0-3 years of parenting, check out the LIFTS online resource guide at
https://hmhb-lifts.org/

Transcript

Emily Freeman, HMHB-MT: 0:04

Welcome to season five of the LIFTS podcast, where we connect with parents, caregivers, providers, and advocates for Montana families in the early years of parenting. Through personal stories of lived experience and expert insights, we highlight the people and programs that are helping families thrive. I'm Emily Freeman and this is The LIFTS Podcast, A project of Healthy Mothers Healthy Babies, the Montana Coalition.

Pam: 0:31

My name is Pam Ponich. I'm the Perinatal Program manager for One Health, which is A-F-Q-H-C, federally Qualified Health Center, that has community health centers in 16 counties in eastern Montana and a couple in Wyoming. Mostly Eastern Montana, but I live in Helena, so I mostly work virtually, but my passion really, I am a psychotherapist in LCPC. Have been for a few decades now, doing a lot of different things. But I really love to develop programs and people and in my current role I've been, just fortunate and honored to be part of a pretty innovative project. Which was creating a certification around, what we call peer recovery doulas. And that's a piece of what I do. What we learned is that there's huge value in having people with their own lived experiences, right in their own behavioral health journeys, their own parenting journeys. This work is kind of specific to the perinatal period, right? So pregnancy, birth, and beyond. But, but people with their own lived experience, they have a magical way of building trust and connection and supporting folks in their own journeys. I was brought on to One Health several years ago to develop our peer support specialist program. And within that, really looking at this perinatal time and realizing there's very little access to a lot of resources and services, especially in rural eastern Montana, but across Montana in general, in a lot of ways. And, we just really saw a workforce need, to get people with their own lived experiences into the workforce, but trained not only as certified behavioral health peer support specialists, which is a state certification has been for the last several years in Montana. But then to really get them cross-trained as well as full spectrum doulas. So working with birthing persons in pregnancy and birth and beyond, made sense to kinda marry those two roles because the roles themselves look very similar anyway. It's about nonclinical, nonmedical, support and advocacy being, to the side of a person in their journey as opposed to on the other side of a desk or a clipboard. It makes a lot of sense in both the peer world and the doula world.

Emily Freeman, HMHB-MT: 3:19

Would you mind defining what a peer support specialist is And tell us a little bit about what that process is to become one and then what that work looks like once someone is in it.

Pam: 3:29

Good question because peer support specialists in Montana and really across the country- kind of a new workforce. We've had them in Montana and with a mechanism to get certified and reimbursed through Medicaid now for, I think maybe seven years. But still fairly new. So people that are eligible to become behavioral health, peer support specialists are those with their own lived experiences. Again, in recovery also very vague, right? Because recovery journeys look very different for different people.

Emily: 4:07

So is this recovery specifically substance abuse?

Pam: 4:10

No, it's not. Both substance abuse or substance use, and or mental health challenges. We're kind of switching in the field. When we say behavioral health, it captures both of those things. Not everyone knows that or uses that. Certified Behavioral Health Peer Support Specialist is a full title mouthful acronym but covers both substance use and mental health challenges. And in this work, I am particularly interested in increasing the support too with perinatal, behavioral health issues, right, that maybe haven't been there prior to the perinatal period. Because we know more and more what a vulnerable time that is and how often, especially mental health issues might come up in that period.

Emily: 5:00

It's heartening that there is that increased awareness over time that behavioral health and substance use are not separate. As far as some of these issues coming up in the perinatal period, is that due to just the stress of that situation of being pregnant? Or do you see connections to the hormonal changes that might trigger something?

Pam: 5:22

It's a great question because there has been a lot of newer but great research into really looking at this and identifying how prevalent perinatal mood and anxiety disorders. PMADS is kind of what that's been called for a while. But, it's not just mood disorders. It can definitely be psychosis and other issues that come up And yes to your question. There's hormonal changes clearly and influences that can trigger that. If there's any kind of history with depression or anxiety or anything like that, this is a definitely a vulnerable period where that can absolutely get really triggered and manifest in a bigger way. We know that, and, again, as a therapist myself, underneath all of that behavioral health for the most part is trauma, right? That's the other leg that is so, so much a part of, and underneath so much of all of that. And trauma can really be triggered within this period for a lot of different reasons. Bodies are changing. Sense of self, sense of identity, relationships. You know, all the things. The perinatal period itself can be traumatizing for people and birth. Some birth situations are very traumatic and one thing that we know, for example, if there's a history of sexual abuse, this is a very vulnerable time for one's body, you know, then, and trauma really lives there. So the awareness of what might come up for birthing professionals like doulas is, is really important to, to be aware of. To look for signs to get a sense of what might be going on. Really get a history of behavioral health and trauma, and know what you're dealing with. And also just to how best to then support that person going forward with that awareness, because not surprisingly, right, these issues are very under-reported. They're very underdiagnosed. And they're very undertreated because of stigma and shame and the realities of our systems. Where, oh my gosh, if I tell my provider, my OB person that I am using substances, my children are gonna be taken away. There'll be a report. CPS will get involved, kids are will be removed. And that has happened historically. We're working on it really hard on a systems level. But, that's another reason why it's so important we thought to develop professionals or paraprofessionals, you know, people in this birthing, this perinatal space to be able to also work as kind of care coordinators and across systems and help their clients to develop a family Plan of Safe Care. That's just a standard document that we help in case anyone does have concerns. It's all in one place saying, no, look, here's what I have in place. Here are the supports. I have a recovery doula, I have a therapist, or whatever. Just proactively to keep families together. We haven't been great as a system of child protection to think before we act always. And that's no one's fault. There's been a history of just removing babies from their mamas right after birth, and that's a huge, huge issue. Some of this work has also come out of the Meadowlark initiative work that a lot of people know about.

Emily Freeman, HMHB-MT: 9:01

And I will, I'll link to that in the show notes for listeners who aren't familiar with it. Maybe just quickly define the Meadowlark Initiative. Then my question for you related to that is as you've been in this work for years, have you seen a decrease in stigma on the part of providers of these issues? And is there more of a sense of, let's be proactive so that we're not in reactive crisis mode when we could have taken steps ahead of time to set mom on a better path?

Pam: 9:30

You know, I actually do. I do see it changing I do feel hopeful. I've been around a long time doing similar work in the behavioral health field and seeing some great initiatives come and go with grant funding and energy. And then, sometimes they stick around. A lot of times it kind of fades away. But the Meadowlark project that was started with the state D-P-H-H-S and through the Healthcare Foundation several years ago. I was kind of at the beginning of that work too, but that's really propelled this perinatal awareness, behavioral health awareness, really strongly across the state. And, their goal was to get sites, Meadowlark sites in every birthing hospital. They're very close to that. Um, and then there are sites in other community-based centers like the one that I work at. 

Emily: 10:26

And when you say Meadowlark sites, what does that mean?

Pam: 10:29

A Meadowlark team is comprised of a care coordinator, right? Someone who is coordinating care for the perinatal person. The medical provider, behavioral health provider, if there is one, should be a peer if there is one. Not often is that available. Unfortunately, they cannot, for an example, hospitals can't bill for peer support specialists under Medicaid. So that's an obstacle and a challenge. But recovery doulas would also be and are also a very important part of that team. And CPS too. right? Child Protective Services to get them in proactively going. There could be some, you know, risk factors here, but this is what we're gonna put in place.

And, of course there's varying levels of what that looks like. And probably the success of that across different sites. But, along with that, there's been an annual conference every year now that's well attended. And I think more and more providers are coming to that because the medical providers are a big piece of that. And also people have been trained, you know, your mandatory reporters and if you have any concerns at all, you better get Child Protective Services in here. And, just being an attachment therapist myself for a long time had huge, huge concerns about the trauma of that. I think we are working, we're getting a lot better at knowing okay, for one thing, let's really work on the stigma and shame. These are people with brain disorders. They are not choosing drugs over their babies. We have a long ways to go, of course, in our society with stigma and shame, but I do think we're making headway. We've got some really good, um, initiatives going on statewide that we're right in the middle of to pull more of the right people together.

To, to really look at this issue across the state. I'm also, just as a side, I'm also on the Montana Maternal Mortality Review Committee. So we look at maternal deaths in Montana, and the top two major ways of mortality for mamas is suicide and overdose. And that's so that is really driving some of this energy too, right? This is real. People are dying and we can do better.

Emily: 12:55

For someone listening who either is interested in finding out more about how they can maybe become professionalized in this space, or someone who's maybe pregnant or thinking of becoming pregnant and recognizing like, wow, that would be really valuable for me. How would you go about either becoming a recovery doula or getting a recovery doula to be a part of your, your team? How do we find out more?

Pam: 13:19

Great question. So this has been, this work has been grant funded. Kind of a pilot project for the last several years. And, one of our challenges frankly has been finding the right folks to come to the table to get certified because it is a bit of a niche. You know, having a real interest in birth work, but also, you know, that lived experience, or at least real interest and passion around helping and supporting people with behavioral health. You don't have to have lived experience. It's kind of been our focus, but we've also trained others anyway. Just drive people to me. We work closely with Billings Clinic too, and so we have some folks over there that are helping to coordinate the work. We have an application process when we are starting a new cohort. The training is mostly all online. We did switch to that intentionally a couple years ago, partially because there's people from all across from Montana, but also people from other states that are very interested and this work because it's really new.

Emily Freeman, HMHB-MT: 14:30

Is the training free or is there a cost associated?

Pam: 14:33

At this point it has been able to be funded by our grant. Obviously that's not gonna be forever. But it's still in place currently. It was just so thrilling that we were also written into another grant that MSU did where we can now provide really generous stipends to people for completing the full certification and also paid internships, apprenticeships, in the workforce after they're certified.

Emily: 15:04

Please reach out to Pam for more information and she can help connect you to a training, connect you to a recovery doula.

Pam: 15:11

We're really are just getting to the point of getting a good group of folks that are certified and so we just need to make sure they're on the Healthy Mothers, Healthy Babies LIFTS. We'll just make that a part of our training in what next steps, right? How do you get the word out there that you are trained and that's gonna be our primary place.

Emily: 15:33

So a mom who's listening who wants to get a recovery doula, who's found the contact information, is it like with other doulas where it's a range of cost or not? Billable or not? 

Pam: 15:47

So one of the reasons that we also decided to do the cross training is that when we started we know that there's really cool, exciting news about this now, but when we started, there was no mechanism for people with Medicaid to access doula care, right? However, we peer support specialists can be billed through Medicaid by certain entities.

Hospitals cannot. Several hospitals though, have gotten peers on board just through grant funds. So, but you know, with the exciting work that we did together, with Healthy Mothers, Healthy Babies, really driving that bus is, we got that bill in the legislature passed to pave the way to state certification for doulas and therefore Medicaid reimbursement. What has happened with doula care in Montana thus far is that it's been a pretty expensive, but always out of pocket expense. So it's basically. People that have several thousand dollars to get a doula on board. And the families that we really wanted to reach with this generally are, that's not at all accessible to them. And so being able to bill Medicaid is gonna be huge. It's ha it's not in place yet. We're hoping next year, 2026 that that will be a thing.

And then, recovery doulas can work in a variety of settings. They can set up their own shop. They're gonna have to figure out all the billing, all the Medicaid if they want to go that route. And that's just some more of the process and learning and education that we'll all be learning and be a part of as we create this system and this workforce. But they could potentially work for hospitals. Hospitals are excited that now doulas are gonna be certified and reimbursable. That will really help to open up birthing spaces like hospitals and birthing centers and to, and obs to, to get recovery doulas on board because there's actually a mechanism for reimbursement. Right now there's, there's two if peer support is also billable, depending, again where that person is. Right now, peer supporters can't be just out on their own.

They have to be connected to either a mental health center, a state approved, substance use, facility, an FQHC, or Indian Health Services. Part of the work is the oversight, is the support. They're expected, they have to have two hours of clinical supervision a week because that certification goes through the board of behavioral health. And they oversee that. So it's, it's regulated and so will this doula work.

Emily: 18:33

And it's valuable too, in the sense of providing a community of support for the person who's providing support to someone else to have that community to come back to and say, Hey, I ran into this. I'm struggling. How would you have dealt with it, whatever that looks like when you return to the fold of your peers in that professional space.

Pam: 18:51

Exactly. And since this is such a brand new professional opportunity developing this workforce from the ground up. We're being very intentional at building a community of recovery doulas across the state where they do know each other, can connect with one another and have that community as well outside of an agency, because it's very specific and hard and potentially, you mentioned secondary trauma. Absolutely. There's a need for a lot of support and they deserve that. And so, for example, in our next training, we're intentionally bringing former graduates for a meet and greet section. We do do a two day in-person kickoff for a training, which is hybrid. Some people are, you know, out of state or whatever and can't do that. But really trying to connect people into this community so that they will know each other and can reach out to one another and celebrate and grow this forever. Let's hope. Yay.

Emily: 19:53

Well, cool. Thank you so much for your time today. 

Pam: 19:57

My pleasure. I loved obviously love to talk about this work. I'm very passionate about it. It's very worthwhile and we need it. And we're seeing some really, really good successes and amazing work that's coming from these folks that have gone through this certification are out there in the field. And we're new, but we're mighty and we're definitely wanna get the right people to the work. So please give me a call. Email me anytime. Alright.

Emily: 20:24

I'm gonna put your contact info in the show notes. I hope people reach out to you after they hear this.

Pam: 20:28

Yeah. Wonderful.

Emily Freeman: 20:33

The LIFTS Podcast is a project of Healthy Mothers, Healthy Babies The Montana Coalition, a nonprofit dedicated to improving the health, safety, and wellbeing of Montana families in the zero to three years of parenting. Visit us at hmhb-mt.org to learn more about who we are and what we do. Views and opinions expressed in these interviews do not necessarily represent HMHB as an organization. If you have feedback on the podcast or an idea for a future guest or episode, we'd love to hear from you. Take our LIFTS podcast listener survey at hmhb-mt.org/survey or email us at stories@hmbmt.org. Thanks for listening.