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Comprehensive Community Services: Provider Resources

Are you a provider for the Comprehensive Community Services (CCS) program? If so, this page has helpful resources to support you. 

Laws and administrative codes

CCS programs adhere to these Wisconsin rules and regulations:

Division and office contacts

Three divisions and one office manage CCS. Expand each section to learn more about their role, helpful updates, and how to contact them. 

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.



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


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.


Trainings and guidance

Find options for training and development:

Expand these sections to find guidance on a topic:

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. Wisconsin 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 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 March 2020.

DCTS, DMS, and DQA worked together on this guidance for providing substance use treatment.

The CCS program serves people with mental health, substance use disorders, or both. It provides psychosocial rehabilitation and treatment services. These include substance use treatment service category 13 in ForwardHealth Update 2014-42—Changes to the CCS Benefit as a Result of the Wisconsin 2013–15 Biennial Budget (PDF) .

CCS programs can offer substance use treatment to people with substance use disorder in two ways:

  • They can hire or contract a staff person that’s on the roster to work directly in the CCS program.
    • The need for substance use treatment must be identified and services must be in the CCS service plan.
    • The staff person must fit qualifications of a substance use professional:
      • Wisconsin Admin. Code § DHS 36.10(2)(g): 1, 2 (with knowledge of addiction treatment), 4 (with knowledge of psychopharmacology and addiction treatment), 16 (certified alcohol and drug use counselors or substance use professionals)
      • Wisconsin Admin. Code § DHS 75.02(84) , either a certified substance use counselor, substance use counselor, substance use counselor in training, marriage and family therapy, professional counseling, or Social Worker Examining Board (MPSW) 1.09 specialty
      • Licensed/certified and acting within their scope of practice

  • They can contract with a certified Wis. Admin. Code § DHS 75.12 day treatment service and/or certified Wis. Admin. Code § DHS 75.13 outpatient treatment service.

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:

Evidence-based practices

The yearly CCS Program Survey asks each program to report on the evidence-based practices (EBPs) they offered. It also asks how many people received them during the past year. Any EBP that you report should match the description in the EBP toolkits. We link to these below. 

Programs should report whether, during a specific year, an EBP was either:

  • Fully implemented—Meets all critical elements (in the toolkit and listed below).
  • Partially implemented—Meets some critical elements.
  • Not offered—Not implemented. 

Some survey questions also ask if the program tracked the fidelity of each EBP they used. Refer to the tools and methods (below) and the toolkits to see if fidelity is monitored for an EBP. 

EBPs for adult participants

Expand each section to learn more about the EBP.

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.

View the Family Psychoeducation EBP Kit.

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. 

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.

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.

IDDTs 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.

View MedTEAM EBP Kit

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.

MI 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. Behavioural 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.

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 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).

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:

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.

EBPs for youth participants

Expand each section to learn more about the EBP.

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 Evidence-Based and Promising Practices—Interventions or Disruptive Behavior Disorders (PDF), pages 107–112.

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.

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 Evidence-Based and Promising Practices—Interventions for Disruptive Behavior Disorders (PDF), pages 95–106.

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.

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

View Evidence-Based and Promising Practices—Interventions for Disruptive Behavior Disorders (PDF), pages 61–65.

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 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.

View Evidence-Based and Promising Practices—Interventions for Disruptive Behavior Disorders (PDF), pages 113–118.

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.

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.

Core features 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:

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

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.

Enrollment reports

See how many participants were served, admitted, and discharged from CCS. Expand a section to find reports from each quarter.

Participant satisfaction surveys

We use data from participant surveys to measure how satisfied CCS participants are with public mental health and substance use services.

Below, you can find links to the survey and sample cover letters to send with surveys.

Related topics

Last revised March 23, 2023