Milwaukee County WIser Choice Access to Recovery Project ... - NIATx

Milwaukee County WIser Choice Access to Recovery Project: Building a
Recovery­oriented System of Care
In 2007, the state of Wisconsin was awarded a three‐year
Access to Recovery (ATR) grant of 4.83 million per year—the
highest ATR grant awarded nationally. The award, the second
for Wisconsin, was allocated to the Milwaukee County
Behavioral Health Division (BHD), to support its efforts to
develop a continuum of services that support the recovery of
persons with substance use and/or co‐occurring mental health disorders.
“We have been very fortunate that the ATR dollars have specifically come to
Milwaukee County for two ATR cycles to support the redesigned Milwaukee County
substance abuse treatment system,” says Janet Fleege, WIser Choice Coordinator.
“The Milwaukee County Behavioral Health Division was in the midst of a redesign
upon receipt of the first ATR award, so it was perfect timing.’
The redesign aims to create a recovery‐oriented system of care in Milwaukee
County. As the Substance Abuse and Mental Health Systems Administration states,
“Recovery‐oriented systems of care include all sectors of society working together
to support recovery for an individual and for members of that person’s family. “
Access to Recovery (ATR) is a three‐year competitive discretionary grant program
funded by the Substance Abuse and Mental Health Services Administration, Center
for Substance Abuse Treatment. This presidential initiative provides vouchers to
clients for purchase of substance abuse clinical treatment and recovery support
services. The goals of the program are to expand capacity, support client choice, and
increase the array of faith‐based and community based providers for clinical
treatment and recovery support services. The Milwaukee County WIser Choice ATR
funding ends in September 2010.
The grant along with other funding sources comprises the total amount of money
available for treatment and ancillary services in the Alcohol and Other Drug Abuse
(AODA) voucher system in Milwaukee County, commonly referred to as WIser
Choice.
The WIser Choice network includes nearly 100 sites operated by approximately 75
organizations. Services provided by the network include residential, day treatment
and outpatient AODA clinical treatment as well as non‐clinical services supporting
recovery such as transportation, childcare, pre‐employment education/training,
parenting assistance, life skills training and housing.

Fifteen Milwaukee county providers are participating in the project.
The State of Wisconsin/Milwaukee County BHD application for the grant included a
narrative description and budget line to work with NIATx.
“We knew that the NIATx focus on the customer and on improving systems was a
good fit for our system,” comments Fleege. “We specifically wanted to work with a
NIATx coach to examine the multiple hand‐offs between levels of care as well as
from provider to provider.”
NIATx process improvement model helps organizations minimize the work that
results from multiple hand‐offs, with a goal of creating seamless transitions between
levels of care. This simultaneously maximizes the resources available within each of
the provider agencies.
The key goals of the Milwaukee County Wiser Choice ATR project are to:
• Meet or exceed the target of serving 7,626 clients over the three‐year grant
period; and
• Collect Government Performance and Results Act (GPRA) information on
each client enrolled in the system, with a goal of gathering data on 80 percent
of clients for six months after intake.
Milwaukee County WIser Choice serves a highly mobile population, explains Fleege.
“After discharge, some clients do not want to be contacted, for a variety of reasons.”
Fleege and colleagues formed a change team and set about examining the processes
in the ATR system that needed improvement. Guided by NIATx coach Tom
Mosgaller, “We mapped out a process flow for what a typical client experiences from
intake and assessment through the assignment of a Recovery Support Counselor,
selection of a treatment approach, to discharge and follow up.” The team also
developed a diagram of barriers in the process that impede the ability to track a
client six months following intake.
These activities helped the team identify early engagement as a key to a client’s
successful journey to recovery through the WIserChoice system. “We recognized
that if we engage a client early in the process, we’re more likely to develop a
relationship that will allow tracking six months after intake.” The change projects
the teams began to work on in June 2008 focused on implementing strategies to
improve the first handoff from intake to treatment.
Fleege’s team then developed a set of solutions to be piloted by each agency
participating
in the pilot, with an emphasis on early interactions that promote

engagement. “We felt that the emphasis on optimizing the whole experience would
result in improved relationships and the ability to track clients more successfully.”
The participating providers meet with Fleege’s team every six weeks to share
progress, refine their rapid‐cycle testing projects, and share next steps.
At a report‐out meeting in January 2009, the Milwaukee County WIser Choice ATR
project identified the following improvements:
• An increase in the number of clients provided access or assured contact
within 24 to 48 hours of first contact
• Clear plans for each client scheduled within seven days of first meeting
• Paperwork shortened to one page at initial intake
“We also feel that we have a greater focus on the client as a result of ATR and our
work with NIATx,” adds Fleege. “Communications improved between the Central
Intake Units and the Recovery Support Coordinators, which also helped improve
hand‐offs.” In addition, the group noted improved collaboration between providers
and Recovery Support Coordinators.
The project has maintained a 62 percent follow‐up rate and continues to work on
meeting the 80 percent goal. “We have set up focus groups with Recovery Support
Coordinators to find out how we can improve given the current process for the
collection of the follow up data,” says Fleege.
Goals for the coming year include working on ways to diffuse the lessons learned
from the initial 2008 pilot providers to other providers in the WIser Choice system.
“This project is allowing Milwaukee County to integrate recovery support
coordination into substance abuse treatment,” concludes Fleege. “We now have a
better
opportunity to become a recovery‐oriented system of care.”