TMG has been involved in major changes in Wisconsin’s behavioral health system as it moved toward a recovery-based model grounded in evidence-based practices and effective coordination between mental health and substance abuse treatment, as well as between those two areas and primary and acute health care. Increasingly, emphasis is on reducing institutionalization and improving community-based care options. TMG has worked closely with the Wisconsin Department of Health Services and counties to facilitate mental health redesign efforts and evaluate cost effective options in the new system.


  • Single Coordinated Care Plan Initiative for Milwaukee County – Under contract with the Milwaukee County Division of Behavioral Health, TMG developed and pilot tested a single coordinated care plan (SCCP) and care planning process for clients who are receiving substance abuse services and who are also involved in multiple other systems, such as W-2, corrections and child welfare. Similar to the family teaming process, this is a strength-based, family-focused approach for achieving outcomes for individuals and families with complex needs. TMG led an advisory committee that included representatives of the Bureau of Milwaukee Child Welfare, Milwaukee Division of Behavioral Health, Wisconsin Department of Corrections, Wisconsin Department of Workforce Development, and W-2, child welfare, and AODA services contract agencies, and people. TMG worked closely with the Bureau of Milwaukee Child Welfare to coordinate SCCP with the Coordinated Service Team (CST) process.


  • Mental Health Expenditure Project – Under contract with the former DHFS Bureau of Mental Health and Substance Abuse Services, TMG developed Mental Health Client Expenditure Profiles for persons receiving mental health services in the redesign counties (Forest, Vilas, Oneida, La Crosse, Kenosha and Dane). The profiles depicted state and county Medicaid mental health expenditures in a way that had never previously been seen. TMG analyzed program expenditures for individual Medicaid recipients, showing the breakdown of county and state fiscal responsibilities for specific service utilization (inpatient hospital, counseling, prescription drugs, etc.). With this data, the mental health redesign counties were able to view per member/per month, aggregated data by service category as well as individual claims data. Program managers could begin to assess service utilization including analysis of emergency room visits, inpatient hospital stays and prescription drug costs, and alter client managed care as appropriate to better coordinate care and improve cost effectiveness.


  • ROSA Pilot Project – TMG assisted in the planning and piloted the implementation of the Recovery-Oriented Systems Assessment (ROSA) consumer outcomes tool in La Crosse, Dane, Kenosha, Brown and Forest/Vilas/Oneida counties. Over 200 consumer interviews and subsequent care manager interviews were conducted in these counties, and counties initiated quality improvement projects based on findings from ROSA and other county data sources. The tool has been modified according to county, consumer, interviewer and other stakeholder input.


  • SSI Managed Care Design – TMG provided facilitation, data analysis and planning assistance for design of county-based SSI managed care systems in Dane and La Crosse counties that focus on integrating mental health/substance abuse services with acute and primary care services.


  • Mental Health Transformation Systems Grant – TMG provided assistance to the former Division of Disability and Elder Services to develop Wisconsin’s proposal and $5 million funding request for the Mental Health Transformation Systems Improvement grant application. This major federal grant opportunity proposed a comprehensive, multi-year, recovery-focused transformation of Wisconsin’s mental health and substance abuse programs.


  • Mental Health Quality Improvement Project – In collaboration with the Department of Health Services and the three counties (Brown, Kenosha and Marathon) awarded state quality improvement grants, TMG developed a toolkit to be used by counties throughout the state to guide local quality improvement efforts for Comprehensive Community Services (CCS) and Community Support Programs (CSPs). Specific components of the Quality Improvement Toolkit developed by TMG include:

The application of a quality system framework for mental health/substance abuse programs, involving the key elements of discovery, remediation and improvement.

The use of the ROSA (Recovery-Oriented System Assessment) tool and the recovery principles on which it is based to enhance the recovery orientation and consumer focus of the day-to-day operations and major processes (i.e., intake, assessment and recovery planning) of local MH/SA programs.

The development of a framework for using quality indicators, development of specific indicators, and use of available state data to benchmark the outcomes of local programs and to identify potential local quality improvement projects.

The development of summary information on SAMHSA’s Evidence-based Practices (EBPs), and the development of a resource document highlighting EBPs, best practices and other resources available to help guide the design and implementation of recovery-oriented MH/SA systems.


  • Wisconsin Public Mental Health and Substance Abuse Infrastructure Study – In 2009, in conjunction with the Wisconsin Department of Health Services (DHS), Division of Mental Health and Substance Abuse Services (DMHSAS), TMG began a comprehensive effort to review the current system of financing and provision of publicly funded mental health and substance abuse services, as well as alternative funding and delivery systems. The Phase I study resulted in a report which was presented and discussed at a statewide summit that was attended by more than 230 system stakeholders in December 2009.

Based on feedback from the summit, TMG began the second phase of the study project in the spring of 2010. Phase II involved bringing together a broader group of system stakeholders representing consumers, counties, providers, advocates and state staff to develop specific actionable recommendations for advancing improvements to the public MH/SA service system to be considered during the state’s biennial budget process. Again based on feedback from the December summit and the lessons learned from other state reform efforts, the continuing study effort focused on two areas: the identification of core benefits for the MH/SA system and the development of shared service/regional pilot initiatives. To accomplish the Phase II work, TMG worked with an expanded MH/SA Infrastructure Study Committee made up of over 70 system stakeholders and facilitated two work groups, one to address each of the identified areas for improvement – core benefits and shared service/regional pilots.