Governor's Wisconsin Works (W-2) and  Alcohol and Other Drug Abuse (AODA) Task Force Recommendations

March 2000

The Governor's W-2 & AODA Task Force members agreed upon these recommendations as effective strategies identifying and/or working with the W-2/AODA participant. They are recommendations not requirements. These recommendations are not intended to replace existing valuable resources, such as the W-2 Case Management Resource Guide, existing screening tools currently being used at a W-2 agency, existing relationships with AODA treatment providers, or any of the Enhanced Case Management Training Courses. The recommendations are intended to supplement these existing informational sources.

The recommendations for W-2 agencies are:

1. Use a self-administered screening tool that identifies psychological stressors for all W-2 applicants.

Early detection, referral, and treatment will aid the Financial and Employment Planner (FEP) and the participant in the development of an Employability Plan (EP) that concurrently addresses substance abuse treatment and work related activities. Due to the time-limited function of W-2, early engagement in treatment activities will maximize the effective use of the participant's time for those who are willing to address their chemical dependency as a barrier to employment. Therefore, the recommendation is the utilization of a screening tool, self-administered upon application for W-2 services, at EP review, or as needed. Based on that screen's outcome, the administration of a comprehensive clinical assessment may be necessary. The Task Force has recommended the use of the Mini OQ™-10.2 or the Rosenberg Self-Esteem Scale as the screening tools. These tools identify psychological stressors (depression, anxiety, coping strategies, and low self-esteem) that interfere with a person's ability to obtain and/or maintain employment.

1. All new W-2 applicants should be given either the Mini OQ™-10.2, Rosenberg Self-Esteem Scale, or similar tool as determined by the W-2 agency, for self-administration upon application for W-2 services.
2. The Governor may wish to modify the statutes to require W-2 agencies to administer a screening tool for all new W-2 applicants, and for those who are assessed with substance abuse problems after a comprehensive clinical assessment, require and arrange for treatment for the participant.
3. The screening tool should be re-administered at EP review or as needed.
   
   
2. Use the revised DES-10779 R. 12/99, form Authorization for Disclosure of Confidential Information.
1. The revised form meets federal and state requirements for the confidential release of AODA or AODA/Mental Health information.
2. It ensures that communication between the treatment provider and the W-2 agency will occur, and allows for better coordination of activities, development/revision of the Employability Plan, and to receive progress summaries.
3. A Bureau of Work Support Programs' Operations Memo will be distributed to all W-2 and Economic Support agencies that identifies the confidentiality laws for participants with AODA and/or mental health issues and provides all agencies with a copy of the form.
3. Develop written agreements with HMO behavioral health providers covering the following items:
1. Procedures for point of entry and initial assessment.
2. Authorization for Disclosure of Confidential Information is signed by the participant for communication of basic information and follow-up, when referred to their provider.
3. Identifying the Medicaid advocate and EDS ombudsmen for each HMO and having procedures in place for contacting them if there are problems.
4. Training participants on accessing and contacting, their HMO/Medicaid advocate.
5. Having procedures to work with HMO Behavioral Health care managers in getting the participant referred to their provider of choice. HMO's pay for treatment not supportive services. There are resources for Targeted Case Management for specific populations (i.e. Families with children at risk, asthma, AODA.) Keep in mind that, if available, participants are allowed to switch providers once per year.
6. Further defining the role of the Supportive Services Planner (SSP) to assist the participant in verbalizing behavioral health care needs to the HMO manager. The goal is a good provider match for the member.
7. Having the ability to request referrals to providers with bundled services. Bundled services are services beyond the scope of medical care and can include: advocacy and referral, in-home assessments, social services, safety services, and life-skills management activities.
4. Use flexibility when working with the W-2/AODA family, and coordinating referrals and appointments with work requirements.
1. Too often appointments are scheduled that conflict with required work and work-related activities.
5. Use inter-systems collaboration for participants involved in multiple systems.
1. The recommendations and procedures outlined in the example Memorandum of Understanding (MOU), developed by the Milwaukee Inter-systems Collaborative, may be used as a template for developing an overall plan (see attached example on page 5.)
2. Using the comprehensive case management approach would provide consistent and seamless delivery information and services to the participant and her family from all agencies involved. W-2 FEPs should coordinate the participant's Employability Plan (EP) with service plans from other systems.
3. Multi-disciplinary team progress and planning meetings should occur with all agencies/systems represented for the duration of the participant's involvement in W-2.
4. The participant confidentiality requirements will be upheld. DES-10779 will be obtained and signed by the primary person in the case on an as-needed basis to coordinate communication, ensure confidence of sensitive information, coordinate inter-agency meetings, service plans, and establish protocol for crisis or emergency situations.
6. Document all AODA treatment hours, appointments, and related services on Part 3 of the participant's Employability Plan.
1. Participants will be made aware of the consequences and held accountable for non-participation. All applicable sanctions for non-participation will occur.
7. Participate in a training module developed by the Division of Economic Support Training Section on appropriate documentation of confidential case comments.
1. Require all FEPs and other agency staff who have the responsibility for documentation of case comments to attend this type of training. DES will also distribute a separate document on case comments that can be used as a desk aid.
2. Require all experienced IM workers to take at least one annual training course in Enhanced Case Management special needs areas of: substance abuse, domestic violence, and/or physical or mental disabilities. The training recommendations are made on an annual basis by the DES Division Administrator, and will have no financial impact on the W-2 contracts since two Enhanced Case Management modules are required for experienced IM workers. The training requirements are based on operational need as well as Administrative Rule DWD 17.
8. Coordinate all current TANF Funding sources (W-2 contracts, WtW, and Community Reinvestment) for possible use for non-medical AODA services.
1. Agencies should make every effort to coordinate this funding with the new SAPT/TANF funded substance abuse grants and work cooperatively with collaborating agencies to maximize the financial resources available to the W-2/AODA participant.

The recommendations for the Department of Health and Family Services are:

9. Consider applying for more federal and foundation grants to supplement current treatment dollars.
1. The current federal Center for Substance Abuse Treatment (CSAT) allocation of $24 million per year does not meet the statewide treatment need for women's services.
2. Of that allocation, only $1,340,000 FED per year is used for treatment programs targeted for women. That allocation is currently divided between 5 women's treatment providers statewide.
3. Identify grants and offer technical assistance on grant applications for treatment providers that seek additional federal and foundation grants.
10. Consider providing financial incentives to treatment providers that administer innovative outpatient treatment models that are gender specific, culturally relevant, integrate recovery and work, and are outcome based.
1. The outpatient treatment "programs" identified in the Best Practices section of the Making it Work publication guide are not covered by Title XIX HMO funding. Title XIX funding covers "medically necessary" therapy sessions, not programs. The Department of Health and Family Services may wish to consider offering a financial incentive to treatment providers that provide holistic programming driven services that are outcome based and utilize inter-systems collaboration.