Comprehensive Community Services: Provider Resources

The Division of Care and Treatment Services (DCTS) supports community mental health and substance use programs. DCTS also operates seven facilities that offer services.

What DCTS does for CCS: The DCTS Bureau of Prevention Treatment and Recovery offers clarity and technical assistance with CCS structure and content. They also gather and review program data and outcomes. Contact DCTS if your tribal nation or county wants to be part of CCS.

Contact: DHSDCTSCCS@dhs.wisconsin.gov.

Memos

• DCTS Information Memo 2021-04—CCS for Individuals Enrolled in Medicaid Facing Homelessness (PDF)
• DCTS Action Memo 2020-10—Coordination of Services for Children Who are Dually Eligible for CCS and the Children’s Long-Term Support (CLTS) Waiver Programs (PDF)
• Frequently Asked Questions—Operational Guide: Children Dually Enrolled in the CCS and the CLTS Waiver Programs (PDF)

The Division of Medicaid Services (DMS) runs the Medicaid program. They support people with medical needs and low income.

What DMS does for CCS: DMS creates the ForwardHealth online handbook. It details what services CCS covers. The policy aligns with federal and state regulations but may describe requirements not found in Wis. Admin. Code ch. DHS 36.

Contact: VEDSCCSSupport@wisconsin.gov.

Memos

• DMS Administrator’s Memo 2021-03—CCS for Individuals Enrolled in Medicaid Facing Homelessness (PDF)
• DMS Numbered Memo 2020-01—Coordination of Services for Children Who are Dually Eligible for the CCS and the CLTS Waiver Programs (PDF)
• Frequently Asked Questions—Operational Guide: Children Dually Enrolled in the CCS and the CLTS Waiver Programs (PDF)

ForwardHealth Updates

• May 2018—New and Clarified Coverage Policy for Psychosocial Rehabilitation Programs (PDF)
• Dec. 2017—Increased Reimbursement and Changes to Claims Submission Requirements for Outpatient Behavioral Health Services (PDF)
• Aug. 2017—New and Clarified Telehealth Policy (PDF)
• May 2017—Coverage of Residential Substance Abuse Treatment by CCS Providers (PDF)
• June 2014—Changes to the CCS Benefit as a Result of the Wisconsin 2013-15 Biennial Budget (PDF)

The Division of Quality Assurance (DQA) regulates and licenses more than 40 types of programs, facilities, and caregivers. They focus on health and residential care.

What DQA does for CCS:

The DQA Behavioral Health Certification Section helps with CCS in these ways:

• Joins the review process for proposed regional CCS models
• Provides application materials for counties and tribal nations applying for certification
• Monitors compliance with CCS and other rules with on-site inspections and desk reviews
• Looks into complaints about CCS programs
• Offers limited guidance and technical help with any deficiencies from on-site visits
• Makes referrals to DCTS or other DHS experts
• Gives out certificates that define the period when a CCS program may work

Contact: DHSDQAMentalHealthAODA@dhs.wisconsin.gov.

The Office of the Inspector General (OIG) prevents and detects fraud, waste, and abuse of DHS public assistance programs.

What OIG does for CCS: OIG audits providers who are part of Medicaid. OIG makes sure the provider follows Medicaid rules and regulations. They also review, keep track of, and look into provider billing. This helps find any possible fraud, waste, or abuse.

Contact: DHSOIGAdmins@dhs.wisconsin.gov.

Last updated Jan. 2017

Note: These are only suggestions about how to correct documentation. You may need to correct documentation if there’s a discrepancy or if a document hasn’t been completed within CCS timeframes. You should document all factors related to the correction. Corrections can be reviewed on a case-by-case basis but don’t guarantee that the documentation won’t get a finding during an audit or survey.

You can’t correct past discrepancies retroactively

Past discrepancies are only considered correct from the date they’re fixed, going forward. This leaves tribal nations and counties at risk if another audit or survey, of any type, happens on dates before you correct the error(s).

How to correct files if you find a discrepancy

Here are the steps we recommend for amending a file if you find a discrepancy:

1. Add or adjust any missing or incomplete information to the document you’re fixing. The goal is to be fully compliant with all CCS rules and regulations. Make sure you note the date you’re making the changes.
2. Create documentation that explains why you made corrections. Note the date you made the changes.
3. Get signatures and dates (again) for the new document to be considered correct.

Examples of improper types of corrections:

• Back dating any signatures or documents.
• Filling in missing information without stating when and what additions you made.

Amending documents beyond the required timeframe

Wisconsin Admin. Code § DHS 36.16(2)(a) states that you must complete the assessment process and summary within 30 days of the receipt of an application for services. Wis. Admin. Code § DHS 36.17(2)(a) states that you must complete a written service plan within 30 days of a client’s application for services. Here are tips for what to do if you complete documents outside these timeframes:

• Complete documents as soon as you can.
• Document any and all reasons, when they happen, why you couldn’t complete the documents in the timeframe. With audits and surveys, this documentation can only be reviewed on a case-by-case basis to make sure it’s valid.

Progress notes and functional documents

All counties and tribal nations have their own internal policies that govern when they must complete items, such as progress notes.

• Progress notes—These aren’t given a finding on an audit if you complete them in a sensible timeframe and are fully compliant with all CCS and Medicaid rules and regulations. The time starts from the date of service.
• Functional documents—These include the assessment or written service plan. They aren’t given a finding on an audit if you complete them within the timeframes defined in CCS rules and regulations.

Last updated Jan. 2024

If a CCS program wishes to count training provided prior to their staff's employment toward orientation, the CCS program must clearly establish policies and procedures, per Wis. Admin. Code § DHS 36.07(5)(i), that demonstrates how that training meets the duration requirements set forth in Wis. Admin. Code § DHS 36.12(1)(a) and the content requirements set forth in Wis. Admin Code § DHS 36.12(1)(b).

Last updated June 2023

Wisconsin Stat. 49.46(2).(b)6.Lm states that psychosocial services are prescribed or ordered by a provider acting within the scope of the provider's practice under statutes, rules, or regulations that govern the provider's practice.

ForwardHealth Online Handbook Topic #3726 states that Wisconsin Medicaid requires a prescription or order from a physician or other health care provider prior to initiating community-based mental health services.

To determine if the provider meets these eligibility requirements to prescribe or order CCS supports, the following should be considered:

• Does the provider have prescribing or ordering privileges, such as a physician, advanced practice nurse prescriber, or physician assistant?
• Is it within the provider's scope of practice to write a prescription for psychosocial services?
• Is the provider's practice in adherence with their professional-specific rules and statutes?

Last updated May 2023

The Division of Care and Treatment Services (DCTS), Division of Medicaid Services (DMS), and Division of Quality Assurance (DQA) collaborated on the following guidance regarding the provision of psychotherapy within CCS.

CCS serves people across the lifespan with mental health, substance use disorders, or both and provides psychosocial rehabilitation and treatment services, including Psychotherapy Service Category number 12 in the ForwardHealth Online Handbook Topic #17137. The need for psychotherapy must be identified in the CCS assessment, and services to be provided must be on the CCS service plan.

Outpatient psychotherapy, including outpatient psychotherapy services for children provided in the home, must be provided through the CCS program and cannot be reimbursed separately under any other Medicaid or BadgerCare Plus benefit per Wis. Admin. Code § DHS 107.13(7).

CCS programs can provide psychotherapy in the following three ways. All associated elements listed must occur.

1. The CCS program can hire or contract a licensed/certified mental health professional to provide psychotherapy.
   • The staff member must meet the qualifications as identified under Allowable Provider Types for the Psychotherapy Service Category in ForwardHealth Online Handbook Topic #17137. All providers are required to be licensed/certified and acting within their scope of practice.
   • The staff member must be included on the CCS staff roster and work in the CCS program to provide psychotherapy directly to CCS individuals.
   • The CCS program must ensure that the staff member follows all Wis. Admin. Code ch. DHS 36 rules.
2. The CCS program can contract with a certified Wis. Admin. Code ch. DHS 35 outpatient mental health clinic to provide psychotherapy to CCS participants, herein after referred to as a “DHS 35 certified clinic:”
   • The staff member must meet the qualifications as identified under Allowable Provider Types for the Psychotherapy Service Category in ForwardHealth Online Handbook Topic #17137. All providers are required to be licensed/certified and acting within their scope of practice
   • The staff member's time must be split rostered in both the DHS 35 certified clinic and CCS program.
     • The DHS 35 certified clinic must roster their staff to reflect the amount of time the staff provides psychotherapy within the certified DHS 35 clinic only. The DHS 35 certified clinic does not need to roster the amount of time their staff provides psychotherapy to CCS participants.
     • The CCS program must roster the DHS 35 certified clinic staff to reflect the amount of time the staff provides psychotherapy to CCS participants only.
   • The CCS program must ensure that the contracted DHS 35 certified clinic follows all Wis. Admin. Code ch. DHS 36 rules.
   • The DHS 35 certified clinic must share with the CCS program the required Wis. Admin. Code ch. DHS 36 service documentation that will be filed in the CCS file. CCS participants served by the DHS 35 certified clinic do not need to have a duplicate DHS 35 file.
3. The CCS program can contract with a certified Wis. Admin. Code § DHS 75.50 outpatient integrated behavioral health treatment service to provide psychotherapy to CCS individuals, herein after referred to as a “DHS 75.50 certified program:”
   • The staff member must meet the qualifications as identified under Allowable Provider Types for the Psychotherapy Service Category in ForwardHealth Online Handbook Topic #17137. All providers are required to be licensed/certified and acting within their scope of practice.
   • The staff member's time must be split rostered in both the DHS 75.50 certified program and CCS program.
     • The DHS 75.50 certified program must roster their staff to reflect the amount of time the staff provides psychotherapy within the certified DHS 75.50 program only. The DHS 75.50 certified program does not need to roster the amount of time their staff provides psychotherapy to CCS participants.
     • The CCS program must roster the DHS 75.50 certified program staff to reflect the amount of time the staff provides psychotherapy to CCS participants only.
   • The CCS program must ensure that the contracted DHS 75.50 certified program follows all Wis. Admin. Code ch. DHS 36 rules.
   • The DHS 75.50 certified program must share with the CCS program the required Wis. Admin. Code ch. DHS 36 service documentation that will be filed in the CCS file. CCS participants served by the DHS 75.50 certified program do not need to have a duplicate DHS 75.50 file.

Last updated Feb. 2015

View CCS—Residential Rate Setting Guidance (PDF). It explains:

• Moving CCS residential billing from a per diem rate to a per-unit rate.
• Criteria for billing for CCS residential services costs.
• Setting up an individual and group billing rate.
• Correctly documenting individual and group residential services.

Last updated May 2023

The Division of Care and Treatment Services (DCTS), Division of Medicaid Services (DMS), and Division of Quality Assurance (DQA) collaborated on the following guidance regarding the provision of substance use treatment within CCS.

CCS serves people across the lifespan with mental health, substance use disorders, or both and provides psychosocial rehabilitation and treatment services, including Substance Abuse Treatment Service Category number 13 in the ForwardHealth Online Handbook Topic #17137. The need for substance use treatment must be identified in the CCS assessment, and services to be provided must be on the CCS service plan.

CCS programs can provide substance use treatment in the following two ways. All associated elements listed must occur.

Option 1

The CCS program can hire or contract a licensed/certified substance use professional to provide substance use treatment services.

• The staff member must meet the qualifications as identified under Allowable Provider Types for the Substance Abuse Treatment Service Category in ForwardHealth Online Handbook Topic #17137. All providers are required to be licensed/certified and acting within their scope of practice.
• The staff member must be included on the CCS staff roster and work in the CCS program to provide substance use treatment directly to CCS individuals.
• The CCS program must ensure that the staff member follows all Wis. Admin. Code ch. DHS 36 rules.

Option 2

The CCS program can contract with the following levels of care certified under Wis. Admin. Code ch. DHS 75 to provide substance use treatment to CCS participants, herein after referred to as a “DHS 75 certified program:”

• Wis. Admin. Code § DHS 75.49 - Outpatient substance use treatment service
• Wis. Admin. Code § DHS 75.50 - Outpatient integrated behavioral health treatment service
• Wis. Admin. Code § DHS 75.51 - Intensive outpatient treatment service
• Wis. Admin. Code § DHS 75.52 - Day treatment or partial hospitalization treatment service
• Wis. Admin. Code § DHS 75.53 - Transitional residential treatment service
• Wis. Admin. Code § DHS 75.54 - Medically monitored residential treatment service

The staff member must meet the qualifications as identified under Allowable Provider Types for the Substance Abuse Treatment Service Category in ForwardHealth Online Handbook Topic #17137. All providers are required to be licensed/certified and acting within their scope of practice.

The staff member’s time must be split rostered in both the DHS 75 certified program and CCS program.

• The DHS 75 certified program must roster their staff to reflect the amount of time the staff provides substance use treatment within the DHS 75 certified program only. The DHS 75 certified program does not need to roster the amount of time their staff provides substance use treatment to CCS participants.
• The CCS program must roster the DHS 75 certified program staff to reflect the amount of time the staff provides substance use treatment to CCS participants only.

The CCS program must ensure that the contracted DHS 75 certified program staff follows all Wis. Admin. Code ch. DHS 36 rules.

The DHS 75 certified program must share with the CCS program the required Wis. Admin. Code ch. DHS 36 service documentation that will be filed in the CCS file. CCS participants served by the DHS 75 certified program do not need to have a duplicate DHS 75 file.

Last updated Oct. 2016

In the past, tribal nation providers who are part of the CCS program have been required to submit two cost reports each year:

• A CCS cost report.
• A Federally Qualified Health Center cost report.

Cost reports for each program ensure that tribal nations get reimbursed for 100% of the cost of providing services.

To simplify the process, tribal nations no longer must submit the CCS cost report. Now, they can include CCS costs on the Federally Qualified Health Center report. They should:

• Keep billing interim claims for CCS under procedure codes H2017 and 99199. These claims will be paid at the interim state rate like they are today.
• Keep following all requirements from ForwardHealth Update 2014-42—Changes to the CCS Benefit as a Result of the Wisconsin 2013–15 Biennial Budget (PDF).

Cognitive behavioral therapy (CBT) is a short-term therapy that focuses on the relationships between thoughts, feelings, and behaviors, and helps clients build skills to change their unwanted moods and behaviors. CBT uses “Socratic questions” and “cognitive restructuring” to help identify and change cognitive distortions that lead to unwanted emotions. CBT also focuses on changing behavioral patterns that contribute to unwanted emotions. CBT involves between-session practice or homework of the skills learned in therapy.

Critical elements of CBT include:

• Structured sessions with psychoeducation and skill building.
• Exploring automatic thoughts, cognitive distortions, and underlying beliefs to identify and restructure unhelpful thoughts that contribute to unwanted emotions.
• Identifying and modifying patterns of behavior that contribute to unwanted emotions.
• Between session homework assignments focused on building and practicing skills learned in session.

Dialectical behavioral therapy (DBT) is a comprehensive treatment that includes many aspects of other cognitive-behavioral approaches. DBT teaches skills to help control harmful and impulsive behaviors such as self-harm, substance use, and binge eating; to reduce suicidal thoughts and behaviors; and to improve symptoms of posttraumatic stress disorder, depression, and borderline personality disorder. DBT can also help clients build and maintain healthy relationships, and may be particularly well-suited for people who experience significant conflict in relationships with frequent ups and downs.

DBT is a longer-term comprehensive program that includes weekly individual therapy sessions; weekly group skills training sessions; and therapist consultation team meetings.

Critical elements of DBT include:

• Dialectical philosophy, which helps therapist and client balance and synthesize acceptance and change-oriented strategies.
• Focus on emotional regulation, including through acceptance and mindfulness practice.
• Five other key aspects of treatment include:
  • Enhancing capabilities through emotional regulation, mindfulness, interpersonal effectiveness, and distress tolerance skills.
  • Generalizing capabilities through homework assignments designed to practice and improve skills outside therapy sessions.
  • Improving motivation and reducing dysfunctional behaviors, which includes completion of a “diary card” used to track treatment targets, with priority given to life threatening behaviors, therapy interfering behaviors, and behaviors that interfere with client’s quality of life.
  • Enhancing and maintaining therapist capabilities and motivation, through a weekly consultation meeting with colleagues.
  • Structuring the environment, to support emotional regulation.

Eye movement desensitization and reprocessing (EMDR) has been shown to reduce symptoms of trauma and has also been used to address a wider range of situations such as phobias and pain. This treatment pairs a client’s eye movements with their processing of traumatic memories. The client pays attention to a back-and-forth movement (or sound) while they recall a traumatic memory until the distress associated with that memory decreases; eventually, the client focuses on a positive belief or feeling while they hold the traumatic memory in their mind.

EMDR requires specialized training, and certification is available.

Critical elements of EMDR include:

• Client history and treatment planning. The targets for treatment are identified and prioritized for sequential processing.
• Preparation. The therapeutic relationship is developed, and the therapist explains how trauma is processed.
• Assessment. The client and the therapist identify the target memory for the specific session.
• Desensitization. The trauma-related sensory experiences and associations are addressed by having the client attend to both the target image and eye movement (or tones/tapping) simultaneously.
• Installation. The strength of a positive cognition is increased to replace the negative one.
• Body scan. The client scans their body for signs of residual tension, which are then addressed through further processing.
• Closure. Grounding techniques are used at the end of a session when reprocessing is not complete.
• Reevaluation. The work is reviewed to determine if optimal treatment has been reached, or to identify additional targets.

Family psychoeducation is offered as part of an overall clinical treatment plan. It’s meant to help people with mental illness achieve the best possible outcomes. This happens through active involvement of the family in treatment and management. Families also get support in their efforts to aid the recovery of their loved one. This program may be either multi-family or single-family focused.

Core features of family psychoeducation programs include:

• Education.
• Emotional support.
• Problem-solving skills.
• Resources during times of crisis.

Critical elements of family psychoeducation include:

• Using a structured curriculum.
• Including psychoeducation as part of clinical treatment. The EBP of Family Psychoeducation must involve a clinician as part of clinical treatment. This sets this EBP apart from others like it.

Illness self-management and recovery (IMR), also called Illness management or wellness management, is a set of rehabilitation methods. The goal is to teach people with mental illness effective strategies for working actively with professionals to manage their illness. This helps:

• Improve social support.
• Lower risk of relapse and going back to the hospital.
• Lower severity and distress from symptoms.

IMR is different from advice that relates to self-care. It’s a comprehensive, systematic approach to helping a person be an agent for their own recovery.

View the Illness Management and Recovery EBP Kit.

Critical elements of IMR include:

• Coping skills.
• Medicines.
• Mental illness facts.
• Recovery strategies.
• Stress management.

More specific EBRs that fall under IMR include:

• “Behavioral tailoring” to help people fit taking medicine into their daily routine.
• Cognitive-behavior therapy for psychosis.
• Psychoeducation about the nature of mental illness and its treatment.
• Relapse prevention planning.
• Social skills training.
• Teaching of coping strategies to manage distressing, lasting symptoms.

Individual Placement and Support (IPS) refers to the EBP of supported employment. This helps people living with behavioral health conditions work regular jobs they choose. IPS is based on the principle that work promotes recovery and wellness. IPS is not prevocational training, sheltered work, or employment in enclaves. Instead, it:

• Focuses on each person’s strengths.
• Customizes services that last as long as the person needs and wants them.
• Uses a team approach with different experts. Includes practitioners and state vocational rehabilitation counselors.

View the Supported Employment Fidelity Review Manual (PDF).

Critical elements of IPS include:

• Benefits planning—Helps people get correct information about their Social Security, Medicaid, and other government benefits. Information is personalized and easy to understand.
• Competitive employment—Finds opportunities for job seekers that are inclusive. These are jobs that anyone can apply for. They also pay at least minimum wage or the same pay as coworkers with similar duties. They don’t have artificial time limits set by a social service agency.
• Integration services—Is part of mental health and substance use treatment programs. Employment specialists work with a job seeker’s treatment team to support the job seeker’s goals.
• Rapid job search—Doesn’t require assessments, training, or counseling before looking for a job. The first face-to-face contact between a job seeker and business happens within 30 days.
• Systematic job development—Has IPS employment specialists regularly visit businesses to learn about their needs and who they’re looking to hire. This is based on the job seeker’s interests.
• Time-unlimited supports—Keeps up services as long as each person served wants and needs support.
• Worker preferences—Focuses on each job seeker’s goals and wishes.
• Zero exclusion—Helps all job seekers who get services for mental health and substance use disorders.

Integrated treatment for co-occurring mental health and substance use disorders/integrated dual disorders treatment (IDDT) mix mental health and substance use interventions at the clinical level. This means the same clinicians or team of clinicians, in the same setting, provide the right mental health and substance use interventions all at once. For the patient, this makes services appear seamless. There’s a consistent approach, philosophy, and recommendations. IDDT removes the need to negotiate with separate teams or programs. The goal of IDDT is to help the patient recover from two illnesses. It differs from coordination of clinical services across provider agencies.

View Integrated Treatment for Co-Occurring Disorders EBP Kit

View Clinical Guide for IDDT

Critical elements of IDDT include:

• A complete team—Offers a team of clinical professionals working in one setting. They provide and coordinate mental health and substance use interventions.
• Stagewise interventions—Give treatment that fits with each patient’s stage of recovery (engagement, motivation, action, or relapse prevention).

There’s not an explicit definition of medication management. It’s different than medication prescription administration that happens without the minimum critical elements (outlined below). Core features include:

• Objective measures of outcomes.
• Shared decision-making between consumers and providers.
• Thorough and clear documentation.
• Use of a systematic plan to manage medicines.

MedTEAM is one example of an EBP for medication management.

Critical elements of medication management include:

• A treatment plan that denotes an outcome for each medicine.
• Tracked desired outcomes. Tracking method must use standard instruments to inform treatment decisions.
• Sequencing of antipsychotic medicine. Changes must be based on clinical guidelines.

Motivational interviewing is a “collaborative, goal-oriented style of communication with particular attention to the language of change. It is designed to strengthen personal motivation for and commitment to a specific goal by eliciting and exploring the person’s own reasons for change within an atmosphere of acceptance and compassion.” MI differs from stages of change, a manipulative way of tricking people into change, and client-centered therapy.

Fidelity is measured through the direct coding of practice samples. It’s defined in terms of basic and advanced standards for skills measures. These include:

• Percent of open questions (out of total questions).
• Percent of complex reflection (out of total reflection).
• Ratio of reflections to questions.
• Percent of MI-adherent behaviors (out of total behaviors).

There also are global measures to look at overall MI practice.

MI resources include:

• Miller, W. R., & Rollnick, S. (2013, p. 29, p. 400). Motivational interviewing: Helping people change (3rd ed.). New York: Guilford Press.
• Miller, W. R., & Rollnick, S. (2009). Ten things that motivational interviewing is not. Behavioral and Cognitive Psychotherapy, 37(2), 129-140.

Critical elements of MI include:

• A spirit or way of being with people that is collaborative and compassionate. You must be accepting and respectful of a person’s autonomy.
• Core skills, which include:
  • Asking open-ended questions.
  • Looking for strengths and affirming them.
  • Listening and reflecting carefully.
  • Summarizing.
  • Providing information using the “elicit-provide-elicit” procedure.
• Core skills that are applied within four processes:
  1. Engaging the person and building the relational foundation.
  2. Focusing on an agenda that’s developed as a team to talk about with a listed specific “target behavior.”
  3. Exploring the person’s ideas and motivations for change. The practitioner listens for change talk, draws it out, and responds to it to enhance motivation.
  4. Planning and creating a goal and support plan as a team.

Permanent supportive housing (PSH) includes services to help people find and keep suitable housing. This EBP was founded on the idea that some people can live by themselves in the community only if they have support staff for monitoring or helping with residential responsibilities. Staff help clients find, get, and keep safe, decent, affordable housing. At the same time, they keep clients linked to other essential services in the community. PSH differs from residential treatment services and a component of case management.

PSH is a specific program model. The client lives in a house, apartment, or similar setting, alone or with others. They are in charge of most residential maintenance, but they get regular visits from mental health staff or family. These visits help monitor and/or help with residential responsibilities.

View PSH EBP Kit.

Critical elements of PSH include:

• Target population—Focuses on people who wouldn’t have practical housing arrangements without this service.
• Staff assigned—Assigns specific staff to give supported housing services.
• Integrated housing—Provides supported housing in settings that are also available to people who don’t have mental illness.
• Consumer right to tenure—Makes ownership or lease documents in the name of the client.
• Affordability—Assures that housing is affordable. Clients pay no more than 30–40% of their income on rent and utilities through rent subsidies and other services.

Mental health supported employment (SE) promotes rehabilitation and a return to productive employment for people with serious mental illnesses. SE programs use a team approach for treatment. Employment specialists carry out all vocational services, from intake through follow-along. SE differs from prevocational training, sheltered work, and employment in enclaves.

Job placements are:

• Community-based (not sheltered workshops or on-site at SE or other treatment agency offices).
• Competitive and open to the public.
• In normal settings.
• Used with more than one employer.

The SE team has a small client to staff ratio. SE contacts happen in the home, at the job site, or in the community. The SE team is assertive in engaging and keeping clients in treatment, especially with face-to-face visits instead of contact by phone or mail. They work with family and others when needed. Services are often coordinated with vocational rehabilitation benefits.

View SE EBP Kit

Critical elements of SE include:

• Competitive employment—Provide job options that have a permanent status instead of temporary or time-limited. Possible applicants include people in the general population.
• Integration with treatment—Have shared decision-making between employment specialists and mental health treatment teams. Employment specialists attend treatment team meetings and have regular contact with the treatment team members.
• Rapid job search—Offer fast job search after program entry.
• Eligibility based on consumer choice (not client characteristics)—Does not have requirements, such as job readiness, lack of substance use, no history of violent behavior, minimal intellectual functions, or mild symptoms.
• Follow-along support—Provides personal follow-along supports to employer and client without time limits. Employer supports may include education and guidance. Client supports may include crisis intervention, job coaching, job counseling, job support groups, transportation, treatment changes (medicine), and network supports (family/friends).

The Tobacco Cessation Bucket Approach (TCBA) was developed at University of Wisconsin Center for Tobacco Research and Intervention with the National Alliance on Mental Illness Wisconsin. It’s a set of tobacco reduction interventions tailored to how willing the client is to move towards quitting. TCBA is an interventional approach based on the established stages of change model. It can help people with mental illness make progress and stop using tobacco.

Each client who currently uses tobacco products (cigarettes, cigars, pipes, snuff, chew, snus, and e-cigarettes) is assigned to only one bucket. The bucket is based on their stage of change defined at the end of the survey year:

• Quit—Client quit using tobacco and stayed quit during the survey year. Don’t assign this category if the client says they’ve quit, but there’s clear evidence they haven’t.
• Quit Now—Client is actively trying to quit fully.
• Talk and Prepare—Client is not trying to quit fully but is making efforts towards their goal. For example, reducing, practicing quit attempts, using cessation medicines, or recording smoking.
• Just Talk—Client isn’t willing to make efforts towards quitting, but they are willing to talk about their tobacco use.
• Not Right Now—Client isn’t willing to talk about their tobacco use at this time.

Each client who has never used tobacco or quit previously is assigned to one of these categories:

• Never Used Tobacco—Client never smoked or used any tobacco products.
• Ex-Users of Tobacco—Client stopped using tobacco before involvement in CSP or CCS, or before the current survey year.
• Other Smoking—Client smoked other chemicals that aren’t tobacco products during the survey year. For example, marijuana, crack, cocaine, heroin, or methamphetamine. You can assign this category with other categories.

TCBA resources include:

• UW-CTRI’s “Bucket Approach” to Help Patients with Severe Mental Illness Quit Smoking
• Addressing Tobacco Dependence in the Behavioral Health System: Training in the “Bucket Approach”

Critical elements of TCBA include:

• Inquiry and assessment of each client’s readiness for change based on the Bucket Approach.
• Proper application of interventions that fit with each client’s bucket.
• Systematic tracking of outcomes using standard definitions to measure progress.
• Treatment and recovery plans that identify a person’s assessed need for specific interventions. Includes designed outcomes in line with the client’s bucket assignment.
• Use of a systematic plan for program-wide implementation of the Bucket Approach.

• Consumer-Operated Services EBP Kit
• Texas Medication Algorithm Project Procedural Manual—Schizophrenia Treatment Algorithms (PDF)
• Treatment of Depression in Older Adults EBP Kit

Cognitive behavioral therapy (CBT) is a short-term therapy that focuses on the relationships between thoughts, feelings, and behaviors, and helps clients build skills to change their unwanted moods and behaviors. CBT uses “Socratic questions” and “cognitive restructuring” to help identify and change cognitive distortions that lead to unwanted emotions. CBT also focuses on changing behavioral patterns that contribute to unwanted emotions. CBT involves between-session practice or homework of the skills learned in therapy.

Critical elements of CBT include:

• Structured sessions with psychoeducation and skill building.
• Exploring automatic thoughts, cognitive distortions, and underlying beliefs to identify and restructure unhelpful thoughts that contribute to unwanted emotions.
• Identifying and modifying patterns of behavior that contribute to unwanted emotions.
• Between session homework assignments focused on building and practicing skills learned in session.

Dialectical behavioral therapy (DBT) is a comprehensive treatment that includes many aspects of other cognitive-behavioral approaches. DBT teaches skills to help control harmful and impulsive behaviors such as self-harm, substance use, and binge eating; to reduce suicidal thoughts and behaviors; and to improve symptoms of posttraumatic stress disorder, depression, and borderline personality disorder. DBT can also help clients build and maintain healthy relationships, and may be particularly well-suited for people who experience significant conflict in relationships with frequent ups and downs.

DBT is a longer-term comprehensive program that includes weekly individual therapy sessions; weekly group skills training sessions; and therapist consultation team meetings.

Critical elements of DBT include:

• Dialectical philosophy, which helps therapist and client balance and synthesize acceptance and change-oriented strategies.
• Focus on emotional regulation, including through acceptance and mindfulness practice.
• Five other key aspects of treatment include:
  • Enhancing capabilities through emotional regulation, mindfulness, interpersonal effectiveness, and distress tolerance skills.
  • Generalizing capabilities through homework assignments designed to practice and improve skills outside therapy sessions.
  • Improving motivation and reducing dysfunctional behaviors, which includes completion of a “diary card” used to track treatment targets, with priority given to life threatening behaviors, therapy interfering behaviors, and behaviors that interfere with client’s quality of life.
  • Enhancing and maintaining therapist capabilities and motivation, through a weekly consultation meeting with colleagues.
  • Structuring the environment, to support emotional regulation.

Family Centered Treatment (FCT) is a home-based treatment, although it can also be provided in other treatment and community settings such as school. FCT is designed for families that are at risk for out-of-home placements; have histories of trauma exposure; have histories of delinquent behavior; or are working toward reunification. During treatment, FCT aims to help families identify their core emotional issues, identify functions of behaviors in family systems, change the emotional tone and interaction patterns among family members, and strengthen attachment.

Critical elements of FCT include:

• The joining and assessment phase. The practitioner establishes trust with the family, and works with the family to establish therapeutic objectives by identifying needed changes in family functioning skills.
• The restructuring phase. The practitioner works with family to identify and practice new patterns of interacting in accordance with their goals.
• The valuing changes phase. The practitioner helps the family internalize new patterns to advance the family toward value integration rather than compliance;
• The generalization phase. The family evaluates their changes, plans for future challenges, and ends their treatment.

Functional Family Therapy (FFT) is a prevention and intervention program that’s driven by outcomes. It’s for youth who have shown the entire range of maladaptive, acting out behaviors and related syndromes. Treatment occurs in phases, with both the youth and their family. Each step builds on another to enhance protective factors and reduce risk. Phases include:

• Engagement
• Motivation
• Assessment
• Behavior change
• Generalization

View FFT Training

Critical elements of FFT include:

• Services in phases (noted above).
• Services that are short-term, ranging from 8–26 hours of direct service time.
• Flexible service delivery by one- and two-person teams. Takes place at the client’s home, the clinic, juvenile court, or at time of re-entry from institutional placement.

Multisystemic Therapy (MST) is an intensive family- and community-based treatment. It looks at the many causes of serious antisocial behavior. MST views people within their complex network of connected systems that include:

• Individual factors.
• Family factors.
• Outside of family factors—peer, school, neighborhood.

The client may need intervention in any one or more of these systems. The goal is to help with change in the natural environment to promote individual change. Caregivers are key to long-term outcomes.

View MST from the California Evidence-based Clearinghouse for Child Welfare.

Critical elements of MST include services that:

• Account for the life situation and environment of the youth.
• Involve peers, school staff, parents, and others as needed.
• Are specific to the youth.
• Are given by MST therapists or master’s level professionals.
• Are time limited.
• Are offered 24/7.

Parent-Child Interaction Therapy (PCIT) is a treatment program for young kids, 2–7 years of age, with disruptive behavior disorders. It emphasizes improving the quality of the parent-child relationship and changing parent-child interaction patterns. With PCIT, parents are taught skills to set up or strengthen a nurturing and secure relationship with the child. They’re also taught how to encourage prosocial behavior and discourage negative behavior. Treatment has two phases:

1. Child-directed interaction
2. Parent-directed interaction

Professionals: What is PCIT?

Critical elements of PCIT include:

• Staff getting initial and ongoing training in PCIT. Training helps them provide proper, sensitive coaching.
• Using PCIT to meet the child’s needs for nurturance and limits.

With Therapeutic Foster Care (TFC), kids are placed with foster parents. The foster parents are trained to work with kids with special needs. Often, each foster home takes one child at a time. For agencies that oversee the program, their caseloads stay small.

TFC foster parents get a higher stipend than typical foster parents. They also get full pre-service training and in-service supervision and support. Case managers or care coordinators stay in contact with the treatment family. They offer more resources and mental health services as needed. TFC differs from an enhanced version of regular foster care.

Critical elements of TFC include:

• An explicit focus on treatment.
• An explicit program to train and supervise treatment foster parents.
• Placement in the individual family home.

Trauma-Focused Cognitive Behavior Therapy (TF-CBT) is a psychosocial treatment model. It’s designed to treat posttraumatic stress and related emotional and behavioral problems in kids and teens. TF-CBT was first developed to address the psychological trauma from sexual abuse. Over time, the model has been adapted to use with kids who have a range of traumatic experiences, which include:

• Domestic violence.
• Traumatic loss.
• Many psychological traumas that kids often experience before foster care placement.

TF-CBT is designed for trained therapists to give treatment. They first have parallel, individual sessions with kids and their parents/caregivers. Then, they include family sessions during the course of treatment.

Critical elements of TF-CBT include:

• Affect expression and regulation skills.
• Cognitive coping skills and processing.
• Conjoint parent-child sessions.
• Enhancement of safety and future development.
• In vivo exposure (when needed).
• Psychoeducation and parenting skills.
• Relaxation skills.
• Trauma narrative.

TF-CBT often has 12–16 sessions of individual and parent-child therapy. It can also be offered in the context of a longer-term treatment process or in a group therapy format.

View TF-CBT Implementation Resources.

View TF-CBT Brief Practice Fidelity Checklist.

Other resources include:

• Certification Process and Criteria
• Treating Trauma and Traumatic Grief in Children and Adolescents

A critical element of TF-CBT includes training given through a learning collaborative model. Training takes 12 months with national trainers as consultants.

Trauma-Informed Child-Parent Psychotherapy (TI-CPP) is a parent-child therapeutic treatment. It’s for kids from birth to age 6 who have had trauma. As a result, they’re living with emotional, behavioral, attachment, and/or mental health problems.

Traumatic events may include:

• Maltreatment.
• Sudden or traumatic death of someone close.
• A serious accident.
• Sexual abuse.
• Exposure to domestic violence.

The main goal of TI-CPP is to support and strengthen the relationship between the child and their parent/caregiver. This is used to restore a child’s sense of safety, attachment, and appropriate affect and then improve cognitive, behavioral, and social functions.

View TI-CPP Training Manuals.

View TI-CPP Fidelity.

A critical element of TI-CPP is training that’s happens through learning collaboratives. These last 18 months with national trainers as consultants.

Select the link to access the survey in English, Hmong, Khmer, Laotian, Nepali, Somali, and Spanish.

• MHSIP Adult Satisfaction Survey, F-01389
• MHSIP Youth Satisfaction Survey, F-01389A
• MHSIP Family Satisfaction Survey, F-01389B

Select the link to download a cover letter template. Send the cover letter with the survey.

Adult cover letter

• English—Sample Adult Cover Letter (Word)
• Spanish—Sample Adult Cover Letter (Word)
• Hmong—Sample Adult Cover Letter (Word)
• Khmer—Sample Adult Cover Letter (Word)
• Laotian—Sample Adult Cover Letter (Word)
• Nepali—Sample Adult Cover Letter (Word)
• Somali—Sample Adult Cover Letter (Word)

Youth cover letter

• English—Sample Youth Cover Letter (Word)
• Spanish—Sample Youth Cover Letter (Word)
• Hmong—Sample Youth Cover Letter (Word)
• Khmer—Sample Youth Cover Letter (Word)
• Laotian —Sample Youth Cover Letter (Word)
• Nepali—Sample Youth Cover Letter (Word)
• Somali—Sample Youth Cover Letter (Word)

Family cover letter

• English—Sample Family Cover Letter (Word)
• Spanish—Sample Family Cover Letter (Word)
• Hmong—Sample Family Cover Letter (Word)
• Khmer—Sample Family Cover Letter (Word)
• Laotian—Sample Family Cover Letter (Word)
• Nepali—Sample Family Cover Letter (Word)
• Somali —Sample Family Cover Letter (Word)