Jefferson County Human Services Department 2020

JEFFERSON COUNTY HUMAN SERVICES DEPARTMENT

2020 ANNUAL REPORT

SERVING THE RESIDENTS OF JEFFERSON COUNTY TABLE OF CONTENTS LETTER FROM THE DIRECTOR ...... 2 MISSION & VISION STATEMENTS ...... 3 PERFORMANCE MANAGEMENT KEY OUTCOME INDICATORS ...... 3 BOARD & COMMITTEES ...... 5 ORGANIZATIONAL CHART ...... 6 ADMINISTRATION STAFF ...... 7 HUMAN SERVICES STAFF ...... 8 ADMINISTRATIVE SERVICES DIVISION ...... 9 Fiscal ...... 9 Financial Reports ...... 13 Maintenance Utility Usage Reports ...... 20 AGING & DISABILITY RESOURCE DIVISION ...... 27 Aging & Disability Resource Center ...... 29 Aging Programs ...... 33 BEHAVIORAL HEALTH DIVISION ...... 44 Emergency Mental Health Crisis Intervention Services ...... 46 Zero Suicide ...... 49 Mental Health and Alcohol and Drug Outpatient Clinics ...... 53 Detoxification Services ...... 57 Comprehensive Community Services ...... 58 Community Support Program ...... 69 Community Recovery Services ...... 73 CHILD & FAMILY DIVISION ...... 74 Birth to Three ...... 76 Busy Bees Preschool ...... 90 Child Alternate Care ...... 94 Children in Need of Protection and Services ...... 101 Children’s Long Term Support ...... 107 Coordinated Service Team/Wraparound ...... 114 Incredible Years Parenting Program ...... 120 Intake ...... 124 Youth Justice Services ...... 130 ECONOMIC SUPPORT DIVISION ...... 140 INFORMATION & ACKNOWLEDGEMENTS ...... 149

JEFFERSON COUNTY HUMAN SERVICES DEPARTMENT Serving the Residents of Jefferson County 1541 Annex Rd, Jefferson, WI 53549-9803 Ph: 920-674-3105 Fax: 920-674-6113

April, 2021 Dear County Board Chair, Members of the Jefferson County Board of Supervisors and the Jefferson County Human Services Board, Jefferson County citizens and other interested parties,

RE: Letter from the Director I am pleased to bring to you Jefferson County Human Service’s 2020 Annual Report. As you well know, 2020 brought us all a global pandemic. We learned new skills, transformed every service we provide, and practiced a new vocabulary that included words such as “unprecedented”, and phrases such as “you are frozen”, and “we can’t hear you”. The Co-Vid 19 pandemic affected our Department and the people we serve in a myriad of ways. We transformed mental health and substance use services to a telehealth platform. Nutrition meals sites had to be closed resulting in frozen and fresh meals having to be delivered. Supervised visits had to occur, at least for a time, either outside with people in personal protective equipment, or in a virtual manner. Vehicles and transportation services had to be adapted to prevent spreading the virus. At every turn, new policy and practices had to be developed and implemented. I am very gratified to be able to report that we met these challenges with resiliency and responsiveness. All services were maintained, and some even increased, over the year. We were very fortunate to have great assistance from all of our County Departments and County leadership. For the current year, the Department will address the presenting needs of Jefferson County residents while meeting all of our statutory mandates. In 2021:  Our Administrative Services Division will continue all fiduciary duties while enhancing all foundational services such as contracting, billing, maintenance and vehicles.  The Aging and Disability Resource Division will augment services for people over the age of sixty and for people with disabilities through the Aging & Disability Resource Center, Adult Protective Services, Benefit Specialist, Transportation and Senior Dining programs.  The Behavioral Health Division will expand the delivery of evidence-based treatment in a person- centered manner for any person who resides in Jefferson County.  The Child and Family Division will amplify the well-being of children, from birth to adolescence, while remaining family based and assuring safety and permanence.  The Income Maintenance Division, in partnership with the Southern Income Maintenance Consortium, will facilitate access to public benefits and provide access to needed resources. In the following pages are detailed reports on each division and team. We hope it increases your understanding of our services and community. I welcome your questions and feedback. In this year like no other, I sincerely thank our County Board Supervisors, the members of our Human Services Board, and our County Administrator, for continuing support and leadership. I offer the utmost gratitude to every employee for their resiliency, commitment, and benevolence.

Respectfully submitted,

Kathi Cauley Director

Mission Statement To enhance the quality of life for individuals and families living in Jefferson County by addressing their needs in a respectful manner and enabling citizens receiving services to function as independently as possible while acknowledging their cultural differences. Vision Statement All citizens have the opportunity to access effective and comprehensive human services in an integrated and efficient manner.

Program Title Program Description Mandates and/or Key Outcome Indicator References ADMINISTRATION

Fiscal Accurately complete all county, State and Federal 100% compliance with state, and federal reports and budget acts reporting requirements as billing Numerous Compliance laws denoted on work chart All Medicaid and Medicare requirements

Maintenance Maintain buildings and grounds 46 100% of capital projects while planning for future completed on time and within budget

AGING & DISABILITY RESOURCE CENTER (ADRC) ADRC A one-stop shop providing 46.283, DHS 10 100% compliance with the State accurate, unbiased information contract on all aspects of life related to aging or living with a disability; and serves as the access point for publicly-funded long-term care.

Adult Protective Vulnerable adults, aged 18+ are 46.283, 46.90, 51, and 55 100% of referrals are Services and aware of and have access to responded to within the time Elder Abuse Adult Protective Services 24/7 frames contained in the statute, and case notation and legal time frames are met in 100% of cases referred.

Senior Dining Serve & deliver, without Older American’s Act (OAA) 95% of qualifying individuals Program interruption, well-balanced who request home-delivered meals to seniors who request meals receive them them in our service area, and to those who have the greatest economic or social need

Provides medical transportation 100% of qualifying individuals Transportation 85.21 who request a ride receive one. to seniors and persons with disabilities and rides to department appointments.

Program Title Program Description Mandates and/or Key Outcome Indicator References BEHAVIORAL HEALTH DIVISION Community Support Integrated services for people 51 72% of all treatment plan goals Program with severe and persistent AR 63 are met mental illness

Community Recovery Residential services for people 51 100% compliance with CRS Services with mental health and rules substance abuse

Comprehensive Recovery based community, Supports 51 services 72% of all treatment plan goals Community Services mental health, and substance AR 36 are met abuse services

Emergency Mental 24/7 mobile response to all 51 Considering lethality and acuity, Health crisis calls maintain diversion rate to a least restrictive setting

Outpatient Alcohol Treatment services for substance 75 Decrease Brief Alcohol and Other Drugs use including opioid addictions Monitoring Scores Clinic

Outpatient Mental Provide mental health 51 PHQ 9 scores will improve by Health Clinic counseling AR 35 2%

CHILD & FAMILY DIVISION Supporting Families in 46 and 51 The Birth to Three Program will promoting the growth and AR 910 be issued a notification of 100% Birth to Three development of their children. compliance with our Federal Indicators by DHS based on the annual data review.

Busy Bee Supporting Families in 46 and 51 Busy Bees Pre-School will Pre-School promoting the growth and AR 910 maintain a 4-star rating from development of their children. the YoungStar Program. Monitor safety, well-being, and 48 All out-of-home placements will permanence for all children be formally screened for Children in Need of found to need protection or permanency options at nine (9) Protective Services services by the courts. months of continued placement in out-of-home care.

CST Multi-disciplinary approach to 46 90% of all children will remain building community-based MA- in their home with the use of Wraparound funded programing for youth. CST services

Support children and youth who Federally authorized under CLTS program will meet Children’s Long live at home or in the community 1915(c) of the Social enrollment timeframes (DHS Term Support and have substantial limitations. Security Act Activity Timeline) 95% of the time.

Intake Provides a single access point for 48, 938 100% of all State and Federal all children, juvenile, and family timelines will be met service needs.

Program Title Program Description Mandates and/or Key Outcome Indicator References 80% of the youth who are Youth Justice Provide evidence based 938 placed in out-of-home care will treatment and supervision to all reside in a family setting, and of court ordered youth. those placed in a family setting, at least 50% will be placed with their own family or like kin ECONOMIC SUPPORT DIVISION Child Care- Provides financial assistance for 46 and 49 Meet mandated performance Wisconsin Shares child care expenses to those who standards including 100% meet income guidelines. timely processing and accuracy Energy Assistance Provides financial assistance to 46 and 49 Meet mandated performance those who have a heating standards including 100% expense and meet income timely processing and accuracy guidelines. FoodShare- Provides financial assistance to 46 and 49 Meet mandated performance Food Stamps purchase food for those who standards including 100% meet income guidelines. timely processing and accuracy Medical Assistance Provides Health Insurance 46, 49 and PPACA Meet mandated performance and MarketPlace benefits for those who meet standards including 100% exchanges income guidelines. timely processing and accuracy.

HUMAN SERVICES NUTRITION PROJECT COUNCIL BOARD OF DIRECTORS Carol O’Neil, Chair Richard Jones, Chair Audrey Postel, Vice Chair Russell Kutz, Vice Chair Carol Battenberg, Secretary James Schultz, Secretary Carol Ellingson Michael Wineke Patricia Rabay Sira Nsibirwa Barbara Schmitt Kirk Lund Nancy Boos Leslie Golden resigned 08/2020 Cynthia Crouse resigned 12/2020 Augie Tietz resigned 02/2021

AGING AND DISABILITY RESOURCE CENTER ADVISORY COMMITTEE Russell Kutz, Chairperson Jeanne Tyler, Vice Chair ReBecca Schmidt, Staff Janet Sayre Hoeft, Secretary Kimberly Swanson, Staff Ruth Fiegi Dominic Wondolkowski, Staff Frankie Fuller Ellen Sawyers Sharon Olson resigned 01/2021 LaRae Schultz

ADMINISTRATION

Director, Kathi Cauley Deputy Director, Brent Ruehlow

Administrative Services Division Manager, Brian Bellford Accounting Supervisor, Mary Jurczyk Office Manager, Kelly Witucki Senior Accounting Supervisor, Cathy Swenson

Aging & Disability Resource Division Manager, ReBecca Schmidt Aging & Disability Resource Center, Dominic Wondolkowski Senior Dining Nutrition Program Supervisor, Kimberly Swanson

Behavioral Health Division, Kathi Cauley Community Support Program, Marj Thorman Compliance Officer, Kevin Reilly Comprehensive Community Services, Tiffany Congdon Emergency Mental Health, Kim Propp Lueder Haus, Terri Jurczyk Medical Director, Mel Haggart, M.D. – (Contracted) Mental Health/AODA, Holly Pagel

Child & Family Division, Brent Ruehlow Birth to Three, Busy Bees Preschool, Beth Boucher Child Welfare/Coordinated Service Team, Erica Lowrey Children’s Long Term Waiver Support, Barb Gang Parents Supporting Parents Coordinator, Andrea Szwec Foster Care Coordinator, Katie Schickowski Intake, Laura Wagner Youth Justice Integrated Services, Jessica Godek

Economic Support Division Manager, Jill Johnson Supervisor, Sandy Torgerson

TEAMS & STAFF (as of April 1, 2021)

ADMINISTRATION … continued … continued … cont. Mental Health & Intake Brian Bellford, Manager Penny Klement Lori Brummond AODA Laura Wagner, Administrative Kassie Kluge Rebecca Burda Emily Stout Supervisor Kelly Witucki, Office JaNae Kreul Kasey Elmer Jamie Tegt Jenifer Eilert Manager Alyssa Kulpa Cassie Hohlstein Jennifer Wendt Cherilyn Emond Marcia Doubek Karla Nava Leah Hibl CHILD & FAMILY DIVISION Kelly Ganzow Jennifer Hoppenrath Mary Parizek Jeremy Higgins Brent Ruehlow, Deputy Heidi Gerth Mary Klein Wendy Petitt Brittany Kislow Director Katie Mannix Rick Pfeifer Betsy Lane John Mock Alyson Schmidt Birth to Three Kevin Purcell Jessica Lawrence Autumn Risch Suzanne Smith Elizabeth Boucher, Julie Schultz Dane Luebke Bridget Schwantes Becca Snyder Supervisor Dale Schweitzer Ashley Neis Elizabeth Shropshire Fiscal Tonya Buskager Gary Schweitzer Gwendolyn Olson Ashley Timmerman Mary Jurczyk, Accounting Carolina Drayna Michael Solovey Stacey Palermo Adrianna Zickert Supervisor Steffani Evans Shelly Theder Shawna Reiter Cathy Swenson, Senior Jennifer Hoppenrath Youth Justice Jean Thiede Christine Richards-Pagel Accounting Supervisor Leah Riemer Jessica Godek, Shelly Wangerin Sirina Shepherd Supervisor Lynnell Austin Child Welfare & Jacquelyn Ward Dawn Shilts Dominic Alvarez Holly Broedlow Wraparound Charles Wedl Kenny Strege Jessica Breezer Kristie Dorn Erica Lowrey, Supervisor Sara Zwieg Jessica Taylor Rebecca Brown Mary Klein Audra Bakalars BEHAVIORAL HEALTH Brandie Veronikas Leann Cornell Barb Mottl Carissa Davis DIVISION Brian Weber Christina Czappa Mary Ostrander Nichole Doornek Kathi Cauley, Director Brianna White Lyndsey Dallman Alyson Schmidt Kayla DuBois Dr. Mel Haggart, MD Bao Yang Amy Junker Dawn Shilts Jillian Endl Crisis & Lueder Haus Codi Papcke Jessica Tucker Community Support Lindsay Fanelli-Huettl Kim Propp, Supervisor Lindsey Slatter Mary Welter Program Kelly Ganster Terri Jurczyk, Supervisor L.H. Darci Wubben Compliance Marj Thorman, Supervisor Alyssa Koch Maureen Browning Kevin Reilly, Supervisor Andy Barnhill Brittany Krumbeck ECONOMIC SUPPORT Lori Brummond Nicole Lieblang Anna Bedford Maggie Messler DIVISION Chris Blakey Casey Crandall Jill Johnson, Manager Maintenance Nancy Mielke Austin Bourdo Megan Freund Sandy Torgerson, Todd Pooler Jacob Morris Jessica Cornwell Sandra Gaber Supervisor Paul Vogel Hannah Riedl Cindy Crouse Rebecca Gregg Emma Borck Robert Orval Andrea Szwec Kasey Elmer Susan Hoehn Kathy Busler Jon Welke Bridgette Unger Jennifer Fortune Steven Keeling Lisa Degrandt Richard Zeidler Jenny Witt Carol Herold Art Leavens Dana Dietschweiler Children’s Long Term ADRC DIVISION Julie Johnson Gabriella Lopez Rose Engelhart Services ReBecca Schmidt, Grace Kanzenbach Larissa Miles Carrie Fischer Barb Gang, Supervisor Manager Daniel Lawton Kimberly Miller Lea Flores Andrea Bauer Dominic Wondolkowski, Gino Racanelli Jennifer Rhodes Lindsay Gonzalez Mary Behm-Spiegler Supervisor Amanda Ruechel Tonya Runyard Kathy Green Kristine Feggestad Kimberly Swanson, Courtney Schmidt Kirstin Steines Meghan Harris Paul Gephart Supervisor Sarah Vincent Dunham Mental Health & AODA Susan Hoenecke Jennifer Bannister Mary Lenz Comprehensive Holly Pagel, Supervisor Julie Ihlenfeld Erin Bleck Tara Montoya Community Services Heather Bellford Melissa Jung Joy Clark Abigail Porter Tiffany Congdon, Terry Bolger Michael Last Richard Crosby Lindy Schrader Supervisor Krista Doerr Nova Marin Alan Danielson Darci Wubben Anna Falci, Supervisor Lisa Dunham Kaity Schmear Sharon Endl Parents Supporting Parents Lisa Dunham, Supervisor Heather Hegge Jessica Schultze Clifford Fleischmann Andrea Szwec, Supervisor David Fischer, Supervisor Alex James Moises Sequeira Randall Frohmader Alyssa Hake Brittney Long, Supervisor Cory Krueger Mary Springer Michael Hansen Jessica Manogue Britt Asbach Llana Majeres Jan Timm Kimberly Herman Hadassah Meyer Pamela Abrahamsen Kelly North Mary Wendt Patti Hills Sean Arient Amy Porter Foster Care Coordinator Erika Holmes Laura Bambrough Michelle Rushton Katie Schickowski Heather Janes Katie Schultz Lola Klatt Sirina Shepherd

ADMINISTRATION SERVICES DIVISION ~Providing fiscal and maintenance oversight for the Department~

he Administrative Services Division provides fiscal, administrative, and maintenance oversight for the department. These teams are overseen by a Division Manager. The Division underwent staffing and T reorganizational changes in 2020 and will undergo more in 2021. The Fiscal team consisted of ten full-time employees and a part-time employee in 2020. The team ensures that all accounting, billing for client insurance, client financial ability to pay reviews, data entry, and analysis, financial reporting, office management, payroll processing, protective payee payments, system, and technical analysis, and voucher payments are accomplished for the department. All members of the Fiscal team report to the Division Manager. The Maintenance team consisted of a supervisor, four other full-time employees, and one part-time employee. They ensure that the vehicles, buildings, and grounds are in working order, and capital projects are completed within budgetary guidelines.

The Administrative team is overseen by the Office Manager. Four full-time employees report to the Office Manager. They oversee the front desk, reception, medical records and file, schedule appointments, and provide administrative support and assistance to our psychiatrist.

FISCAL TEAM ~ Ensuring fiscal responsibility to the citizens of Jefferson County~

Fiscal Statement Summary December Final, 2020 (Unaudited) We had a positive fund balance of $4,180,820 at the end of 2020. This included $324,888 of prepaid expenses. Of the remaining $3,885,932 of spendable fund balance, $2,662,730 lapsed to the general fund, and $1,193,202 was approved to be carried over into 2021. Our year-end fund balance of $1,964,685 was $3,582,339 more than what was budgeted for the year. Major Classifications that Impacted the Favorable 2020 Balance Summary of Variances: Federal/State & Operating Revenue: Overall, revenues were favorable by $998,619. Expenditures: Overall, expenditures were favorable by $2,583,720. CCS revenues were $3,626,053. They increased significantly toward the end of the year because of increased hours/staff, more billable hours per staff, and a higher billing rate. CLTS revenues were over budget by $462,640. Conversely, CLTS expenses were over budget by $375,856. We have begun serving more kids and providing additional services. We added two new positions in 2020 to continue this expansion. We added another position in 2021. WIMCR revenue collections were more than budgeted. We received $1,101,116 from WIMCR, compared to $996,008 last year and $910,053 in 2018. In 2020, we budgeted $980,000.

We received an enhanced income maintenance payment of $184,487 in December 2020, and additional Random Moment Sampling (RMS) funding of $41,516 in March 2020. This was $126,003 more than budgeted. Type 2020 2019 2018 2017 RMS $41,516 $195,583 - - Enhanced $184,487 $186,653 $186,172 $162,832 Total $226,003 $382,236 $186,172 $162,832 Children's Alternate Care expenditures were under budget by $923,343. This includes Foster Care, Group Homes, Alternate Care, Child Caring Institutions, Detentions, and Shelter Care. More children were placed in a lower cost of care, such as foster homes or kinship care. We also had very few detention costs. Hospital/Detox was favorable on a net basis by $339,432: 2019 Actual 2020 Actual 2020 Budget Revenue $356,518 $387,932 $356,635 Expenditures $1,268,890 $963,089 $1,271,224 Net $(912,372) $(575,157) $(914,589) Total hospital costs increased $280,455 or 28.4% from 2018. Operating Costs were over budget by $44,626. This includes Employee Travel, which was under budget by $74,045, Employee Training, which was under budget by $43,611, and Capital Outlay, which was under budget by $83,808. This was offset by Other Operating and Space Costs, which included: insurance settlements, liability claims, and COVID costs. We had approximately $210,610 in total COVID-related costs. We did not spend any of our $650,000 Operating Reserve in 2020. In 2019, the County Board created an Operating Reserve for the Human Services fund. This reserve was $650,000. To date, we have not spent any of this reserve. The Outpatient Clinic and Emergency Mental Health billing were $200,524 more than budgeted. Outpatient mental health billing has increased significantly over the past few years, because of many factors, such as increased demand for services, new positions, Open Access, Billing Mgmt., additional billing oversight, telehealth rules, and insurance initiatives. Description 2021 Budget 2020 2019 2018 2017 2016 Total Revenue $465,514 $466,153 $308,853 $274,618 $230,774 $207,667

Total 2020 expendiures are shown in the chart below.

Dollar Percent In 2020, expenditures decreased $54,452 or (0.22%) from Community Care 20,705,172 83.4% 2019. Child alternate care and hospitalization Child Alternate Care 1,313,987 5.3% (net) expenses decreased 24.6% and 37.0%, respectively. Institution Services (net) 575,157 2.3% Community care and financial assistance expenses Financial Assistance 2,229,061 9.0% increased 3.5% and 0.9%, respectively. TOTAL 24,823,377 100.00%

* Does not include depreciation and county indirect costs. Depreciation was $350,191 and County indirect costs were $682,692.

Costs by major service categories are shown below.

Total revenue resources were $27,395,166 in 2020. This is a $1,815,294 or 7.1% increase from 2019. Revenues by Funding Source are shown below.

Total expenditures were $24,823,377 in 2020, as shown below. This is a $54,452 or 0.2% increase from 2019. Personnel and Operating cost increased by $819,838 or 4.7%, because of several new staff positions to provide need services and carry out new programs and mandates. Hospitalizations are reported on a net basis (i.e. revenue received offsets the expenditures) and decreased significantly from 2019. Depreciation and County indirect costs are not included in the totals below. These costs are reportable to the State but are not recorded on the Human Services Ledgers.

FINANCIAL REPORTS The Financial Reports that follow summarize the Department’s resources and expenditures by source and type, target group, and service type. Total resources for 2020, including the County tax levy, were $27,395,166. We also carried forward $1,609,031 in non-lapsing funds from 2019. Total expenditures were $24,823,377.

We ended 2020 with a net surplus of $4,108,820 or 15.24% of total budgeted expenditures. Of this surplus, $2,662,730 lapsed to the general fund and the rest was carried forward in 2021.

The table below summarizes amounts lapsed at year-end for the past ten years.

The chart below summarizes all donations and community grants the Department received in 2020. It includes various community fundraisers and donations from private individuals and corporations. DONATIONS AND GRANTS RECEIVED IN 2020 DONATIONS Amount Program Various Fundraisers $ 4,206.13 Child Abuse Prevention Paddy Coughlin's $ 223.00 Child Abuse Prevention Private Donation $ 110.00 Child Abuse Prevention Private Donation $ 5.00 Child Abuse Prevention Private Donation $ 1,000.00 Rental Assistance Various Fundraisers $ 285.31 Juvenile Justice Private Donation $ 250.00 CCS Ball Corporation $ 30,000.00 Home Delivered Meals Private Donation $ 39.15 HOPE Program Private Donation $ 200.00 HOPE Program Private Donation $ 100.00 HOPE Program Private Donation $ 25.00 HOPE Program Private Donation $ 50.00 HOPE Program Private Donation $ 200.00 HOPE Program Private Donation $ 250.00 HOPE Program Kwik Trip $ 300.00 HOPE Program Various Fundraisers $ 3,691.84 Mental Health Recovery Pack the Parlor Toy Drive $ 300.00 Child Abuse Prevention Fort Health Care $ 230.00 Zero Suicide Culvers Scoopie Night $ 19.26 Zero Suicide Total Donations $ 41,484.69

GRANTS Amount Program United Way of Jefferson & Walworth Counties $ 1,500.00 Incredible Years Watertown Area United Way $ 2,500.00 Incredible Years Watertown Area United Way $ 750.00 Early Intervention Greater Watertown Community Health Foundation $ 1,000.00 Talk Read Play Private Donation $ 150.00 Talk Read Play Greater Watertown Community Health Foundation $ 69,500.00 Community Reponse Greater Watertown Community Health Foundation $ 20,000.00 Trauma Informed Care Greater Watertown Community Health Foundation $ 2,783.02 COVID-19: TIC Greater Watertown Community Health Foundation $ 8,945.00 Birth to 3: Parents as Teachers Total Grants $ 107,128.02 Total Donations & Grants $ 148,612.71

Review of Staff Mileage and Vehicle Expenses Since 2009, we have endeavored to reduce staff mileage costs by adding additional fleet vehicles for staff use. The chart below summarizes this data with 2009 as the base year, because Department vehicles were only available on a limited basis then. The cost savings were significant in 2020 for several reasons. First, the COVID- 19 pandemic is limited to travel, reducing mileage and gas costs. Secondly, the County has undertaken a fleet management program for its vehicles. The internal service fund handles the purchases of and maintenance of these new cars. This helped reduce the automobile costs and the parts/repairs cost. The goal is to replace vehicles every other year to provide cost savings and ensure County staff have safe and enough vehicles.

Review of 2020 Goals: 1. Accurately and timely complete all State and Federal reports and billing. The State and Federal governments require the Department to submit numerous budgets and reports as a condition of receiving program funding. We must be compliant with all Medicaid and Medicare requirements. Reporting and billing work charts are maintained to ensure compliance with reporting requirements. GOAL: We complied with reporting requirements, as denoted on work charts for the fiscal team. We were compliant with timely reporting. All billing was done in early 2021. This was exceptionally complicated in 2020 because we had to implement a new clearinghouse, which put major stress on MIS and our billing staff. We had to delay billing for several months, and we still managed to get it done timely. 2. Complete the 2020 capital projects for Human Services on time and under budget. Our 2020 budget called for a significant number of capital projects. The County Board approved issuing bonds to complete these projects. GOAL: We completed the planned capital projects. The original plan for projects had to be adjusted for the COVID-19 pandemic. 3. Successfully expand the use of the new county purchased vehicles. The County is working to create an internal service fund that will support the purchase, use, and sale of County vehicles. A portion of our lapse to the General Fund is intended to purchase several new vehicles for Human Services. We hope to replace old vehicles, expand our fleet, and reduce mileage costs. GOAL: This was accomplished this year. We replaced eight vehicles from our fleet with 14 new ones. We plan to get 14 more in 2021. The savings from these replacements were seen immediately. 4. Implement the new CLTS initiatives. The federal Centers for Medicare & Medicaid Services (CMS) have directed the State of Wisconsin to create a uniform rate-setting methodology for most CLTS waiver services as per the home and community-based service (HCBS) 1915(c) regulations. This directive requires many changes to the CLTS process, including new contracts, a new authorization process, and more tracking and reporting. We will have to revise all of our 2020 CLTS contracts, developed new modifiers and codes, and test that the new authorizations can be sent to the third-party administrator.

GOAL: We successfully implemented the CLTS initiatives. A new contract process was developed in 2019 and implemented in 2020. Authorizations and billing were adjusted to comply with the new rate schedule. We provided services to significantly more children and worked with many new vendors. 5. Work with outside vendors to expand our services and enhance our revenue. We want to work with contractors in 2020 to enhance our outpatient billing process. We also want to contract with additional prescribers and therapists during the year. GOAL: The transition to a new vendor for outpatient billing was a major success in 2020. We saw a major increase in outpatient billing for many reasons. As we continue to work with the vendor, the process has become more streamlined and effective. We did not contract with any new prescribers during the year. 6. Expand child welfare services. The Child Welfare contract from the State DCF increased our child welfare allocation for 2020. We budgeted using this increase in several ways: new child welfare positions, continuing to fund other grant-funded positions, additional legal services, more placement costs. GOAL: We were able to add a new position on the child welfare team and successfully use and report the additional legal services. We saw a decrease in placement costs in 2020. 7. Provide technological, billing, and financial support to other teams as they begin using telehealth. GOAL: This was an incredible success during 2020. We continued services during a generational pandemic with many staff working remotely. We were able to deploy the technology to the most needed areas, allowing for staff to continue providing services. The increase of services and the expansion of telehealth was a major contributor to our increased mental health billing revenue surplus this year. 8. Continue to use priority-based budgeting. The priority-based budgeting initiative was implemented in 2019 for the 2020 budget. We should continue to use it for the 2021 budget. It will help set priorities, analyze programs, and ensure dollars are put to the most efficient use. GOAL: We successfully used priority-based budgeting again during the preparation of the 2021 budget. Because of the uncertainty created by the pandemic, we had to prepare three different budget scenarios. The priority-based budgeting model was helpful in this process. 2021 Goals: 1. Accurately and timely complete all County, State, and Federal reports and billing. The State and Federal governments require the Department to submit numerous budgets and reports as a condition of receiving program funding. We must be compliant with all Medicaid and Medicare requirements. Reporting and billing work charts are maintained to ensure compliance with reporting requirements. As we seek more funding opportunities, more reports are required. Reports have become more involved and complex, as we continue to serve more consumers and teams. 2. Transition duties to new supervisors and team members. The 2021 budget created a new Account Specialist position on the Fiscal Team. Additionally, two new Accounting Supervisor positions were created through the elimination of other Accounting positions. As the Fiscal workload has increased tremendously, these positions were needed. In 2021, these new positions will effectively streamline and organize our workload.

MAINTENANCE ~Updating Capital for Long-Term Sustainability~ In 2020, the County undertook a major renovation of capital projects at the Human Services buildings. These projects included replacing HVAC components at the Main Building, replacing the generators at the Main and Workforce buildings, replacing the HVAC rooftop unit on the main building, exterior improvements (siding, windows, roof, insulations), adding parking lot lights at the Main and Hillside buildings, replacing the sewer line, replacing the air conditioning at the Workforce building, upgrading the duress button system, replacing the uninterrupted power supply (UPS), and adding several new door strike readers. We have several capital projects planned for 2021, as well. In addition to the capital projects mentioned above, the County began a fleet management program for staff vehicles at Human Services. In 2020, we replaced nine vehicles and acquired 14 new vehicles. In 2021, we plan to replace 14 more vehicles. This will ensure staff has access to vehicles at most times when needed, improve safety in the vehicles, and reduce maintenance and gas costs on the vehicles. Both the pandemic and the changes noted above affected utility usage and staff mileage reimbursements throughout the year. 2020 UTILITY USAGE FOR HEALTH & HUMAN SERVICES BUILDINGS

2020 UTILITY USAGE FOR HILLSIDE BUILDING

2020 UTILITY USAGE FOR LUEDER HAUS

2020 UTILITY USAGE FOR WORKFORCE DEVELOPMENT CENTER

2020 UTILITY USAGE FOR MAINTENANCE SHED

CAPITAL IMPROVEMENTS SUMMARY OF BUILDINGS, EQUIPMENT, AND PHYSICAL PLANT Hillside House Built in 1938 Wttn. Dehumidification 2019 Head Start renovation 1987 Stairway fire door 2019 Electrical upgrade early 1990’s File room door 2019 Added entry door access control 2013 Siding on the maintenance shed 2019 Replaced roof, added insulation 2013 New copier lease 2019 Replaced office lighting to T8 2013 Foster parent storage shed 2020 Replaced 7 A/C units with air handlers 2014 Electronic door strikes (2) added 2020 Replaced sidewalks 2014 Replaced UPS 2020 Replaced two entry doors 2014 Replaced roof, gutters, membrane, and insulation Replaced sewer line in floor 2014 2020 Remodeled bathroom into two offices 2015 Removed reznor units on rooftop and replaced Installed Automated Logic 2016 train unit 2020 Installed security cameras 2016 Health/Human Building Built in 1995 Replaced windows 2016 Replaced flooring in Health lab and exam rooms Replaced sidewalks 2017 2008 Installed Fire Alarm System 2017 Remodeled Intake area 2010 Replaced door 2 2018 Seal coat re-stripe parking lot 2010 Remodeled CCS conference room 2018 Added access control 2013 Remodeled kitchen 2019 Replaced A/C coil and compressor 2013 New copier lease 2019 Replaced three boilers with some DD Control 2013 Replaced boiler 2020 Remodeled Health Department conf room 2013 Added radiators, pipes, and hot water system 2020 Replaced damaged heating coil 2014 Health/Human Building Built in 1980 Added BR Glass at ADRC & Health Reception 2014 Remodeled basement 1989 Added LED lighting 2014 Replaced roof membrane/gutters 2003 Added BR Glass in Health Dept 2015 Replaced rooftop HVAC unit 2007 Installed Automated Logic 2016 Replaced four rooftop unit heaters 2009 Installed security cameras 2016 Remodel TPR room 2010 Parking lot addition at south lot 2018 Added door access control 2013 Started installation of AC units 2018 Replaced flooring 2013 Intake area remodel 2018 Remodel Viewing room 2013 Completed AC installation 2019 Replaced office lighting with T8 2013 Front vestibule flooring 2019 Remodeled three work regions 2014 Stairway treads and landings 2019 Added BR Glass at main reception 2014 HVAC controls continuation 2019 Replaced two entry doors 2014 Electronic door access at public entries 2019 Replaced sidewalks 2014 New copier lease 2019 Added LED lighting 2014 Electronic door strikes (3) added 2020 Replaced vestibule unit heater 2014 Roof replaced 2020 Installed Automated Logic 2016 New siding, windows, insulation 2020 Installed security cameras 2016 New generator 2020 Replaced sidewalks 2017 New HVAC and controls 2020 Replaced Fire Alarm System 2017 19 additional parking lot lights 2020 Remodeled Watertown Conference 2018 New sewer line 2020 Remodeled Aztalan Conference 2018 WIC lobby remodeled 2020 Replaced door 8 2018 WDC/UWX Building Built in 1999 Installed data room AC 2018 Remodeled call center 2013 Wttn. Smartboard system 2019 Replaced flooring 2014

Added LED lighting 2014 Added LED outside lighting 2013 Installed Automated Logic 2016 Modified deck 2013 Installed security cameras 2016 Painting 2013 Installed new carpet at WDC 2016 Replaced all flooring 2014 Replaced sidewalks 2017 Completed backup generator 2015 Replaced Fire Alarm System 2017 Installed new furnace 2016 Installed new carpet 2017 Installed security cameras 2016 Installed new boilers 2019 Installed new roof shingles 2016 HVAC controls continuation 2019 Reconstructed rear entry 2016 Return fan VFD 2019 Replaced sidewalks 2017 Public entry doors 2019 Replaced Fire Alarm System 2017 Electronic door access at public entries 2019 Started rebuild of retaining wall 2018 New copier lease 2019 Completed retaining wall 2019 Parking lot improvements 2020 Graded and started asphalt 2019 Replaced generator 2020 Rear concrete sidewalk 2019 Replaced air conditioning 2020 Lower level entry door 2019 Electronic door strikes (1) added 2020 Lueder Haus/CSP Built in 1996 Replaced bolts and joists on deck 202 Remodeled/Added CSP offices 2004 - 2010 Replaced A/C condensing unit 2012

Review of 2020 Goals: All goals were met. Key Outcome Indicator: Capital projects completed on time and within budget. It was decided not to do some projects because of the COVID-19 pandemic. 2021 Goals: Key Outcome Indicator: Complete all capital projects on time and under budget 1. Complete capital projects 2. Continue to use the fleet management program to expand and improve our fleet.

AGING & DISABILITY RESOURCE DIVISION ~An inclusive community where older adults and people with disabilities are respected, healthy, and productive. ~

ur vision to contribute to an inclusive community where older adults and people with disabilities are O respected, healthy, and productive. Our mission is to advocate for and help people achieve their goals by providing them with comprehensive information, assistance, and opportunities to engage in the public policy process so that each person can make informed decisions and remain in charge of their lives. The Aging & Disability Resources Division of Jefferson County Human Services encompasses many programs and funding streams that provide services and supports to the elderly, adults with disabilities, children with disabilities as they transition into adulthood, and persons with Alzheimer’s disease or another dementia and their caregivers. Services and supports are intended to help people live with a high degree of independence in their own homes and communities for as long as they desire. We adhere to the spirit and principles of motivational interviewing to help people achieve their best possible outcomes. The Aging Programs are funded with federal and state dollars, county tax levy, and private donations. Federal funding comes from the Older American’s Act or OAA. The Older Americans Act (OAA) specifies that these funds should be directed to individuals with the greatest economic and social need “with particular attention to low-income older individuals, including low-income minority individuals, older individuals with limited English proficiency, and older individuals residing in rural areas.” The growth of the aging populations in Jefferson County in the coming decades will create opportunities and challenges for our long-term supports and services. Between now and 2040, the proportion of the population age 65 and over will increase significantly. Strategic planning of program services is needed at this time to meet the demand of future consumers. Jefferson county is projected to have a slightly higher than average percentage of community members over the age of 65 in the years to come. The OAA provides the framework under which the Division’s two oversight committees exist and operate. Aging & Disability Resource Center Advisory Committee ADRC Advisory Committee Members are ambassadors of the ADRC. These committee members act as a conduit between the ADRC and the community members it serves. The committee members help to “spread the word” about the ADRC and about the services the ADRC provides, as well as to bring identified needs from the community to the ADRC for consideration. This committee is actively involved in oversight and planning efforts on behalf of the division’s constituents and is responsible for advising the Human Services Board about programs, policies, and unmet community needs. Nutrition Project Council This council is responsible for advising the Nutrition Program Director on all matters relating to the delivery of nutrition and nutrition supportive services, including making recommendations regarding days and hours of meal site operations and site locations, setting the annual “suggested donation,” and making recommendations regarding meal site furnishings with regards to persons with disabilities. In an effort to remain a customer-driven organization, we challenge ourselves to envision the future, reinvent how we do business, push through barriers and advocate for system changes that will make a positive difference for our community. With the population shift, we are expecting as the Baby Boomer generation navigates the later years of their lives, we will need to listen to our aging community members and their caregivers to learn how we can best meet their unique needs.

We have a responsibility to our community consumers to provide meaningful services, while also upholding our responsibility to be good stewards of tax-payer dollars. Through intentional listening sessions and comprehensive surveys, the ADRC consults with community partners and citizens to learn about the unmet needs of individuals who are aging or living with a disability in our community. It’s important that we understand not only what the needs are but also the delivery methods most desirable to and effective for the consumers. To maximize our effectiveness, we need to consider new and creative ways to provide supports and services to our community. Successfully achieving these goals while also efficiently utilizing the funds generously available to us, defines our core purpose at the Aging and ADRC of Jefferson County. The table below reflects the overview of the entire budget of this division.

AGING AND DISABILITY RESOURCE CENTER “Answers and Solutions Start Here” Aging and Disability Resource Center (ADRC): The Aging and Disability Resource Center of Jefferson County is a welcoming and accessible place where older adults, people with disabilities, transitioning youth, families, caregivers, and professionals alike can receive unbiased, reliable information and guidance on a wide variety of topics and programs. The ADRC promotes individual choice, supports informed decision-making, and makes every effort to minimize confusion and streamline access to needed services and resources. By empowering people to find resources in their local communities and make informed decisions about long-term care, the ADRC helps people conserve their personal resources, maintain self-sufficiency and dignity, and delay or prevent the need for potentially, expensive long-term care. The ADRC of Jefferson County serves as the single access point for publicly-funded long-term care, providing eligibility determination and enrollment counseling for the state’s managed long-term care programs (Family Care and Partnership) and self-directed supports waiver programs (IRIS). ADRC staff also provides options counseling, short-term case management, and advocacy support to ensure that our consumers remain as independent as possible. ADRC services are always free, confidential and if desired, anonymous. Staff is available in person, through the office and home visits, by virtual conferencing, by telephone, text, and email, whichever is preferred. The ADRC operations were funded by state contract general purpose revenue (GPR) and match federal funds only in 2020. This past year the ADRC had a small positive balance for all allocations (ADRC balance = $4.401, Dementia Care Specialist balance = $7, 356 and Nursing Home Relocation balance = $14, 816 for a total positive balance of $26,573.62). The ADRC’s 2020 year-end federal reimbursement rate is 36.73%. Each year, the surplus is insufficient to add ADRC staff. The concern moving forward is with a large aging baby boomers’ population, many may go underserved without an increase in staff to accommodate the need. The Bureau of Aging and Disability Resources (BADR) recognizes that the current formula creates an inequitable distribution of funding among ADRC’s, as the current formula does not consider elements associated with health and social inequity; does not adjust for the need for ADRC services; does not account for the needed cost of living adjustments. To address this, in December 2017, the ADRC Reallocation Stakeholder Advisory Group was formed to develop and implement a consistent, accurate, and equitable method for allocating state general purpose revenue (GPR) to aging and disability resource centers (ADRCs). The Committee concluded that an additional $27, 410, 000 of general-purpose revenue (GPR) in funding to our state’s ADRC’s is needed to keep pace with providing quality services to the aging and disabled populations of Wisconsin. In December 2020, the Jefferson County Board of Supervisors submitted a resolution supporting increased funding for ADRCs to Governor Tony Evers, DOA Secretary Joel Brennan, DHS Secretary -designee Andrea Palm, the Wisconsin Counties Association, and all area legislators. The ADRC of Jefferson County has been a busy place. In 2020, the ADRC engaged in 9,069 unduplicated contacts with 2,269 unduplicated callers to provide information and assistance. This was an increase in contacts for two consecutive years (see chart below). Moving forward in 2021, the ADRC is fully staffed. ADRC 2018-2020 Contacts Summary

Month Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec Totals Total Calls 2018 551 541 518 519 569 646 507 623 522 656 615 515 6782 Total Calls 2019 631 541 627 743 600 792 619 721 640 863 677 492 7946 Total Calls 2020 623 602 800 1166 1050 1335 785 533 677 626 470 402 9069 Public benefits for long-term care (LTC) programs are the most common conversation ADRC staff has with our callers (the topic was documented 3,892 times in 2020). Many of those conversations are preliminary in

29 nature, while for others, the need is more immediate. Resource Specialist staff assist customers with financial (Medicaid) and functional screen eligibility followed by enrollment counseling. In 2020, the ADRC enrolled 195 individuals into Family Care, Partnership, or IRIS (I Respect, I Self Direct) programs compared to 204 enrollments in 2019. To assist customers in making a more well-informed enrollment choice. ORCD has Manage Care Organization (MCO) and IRIS Consultant Agencies (ICA) scorecards that provide star ratings in several categories including customer service and satisfaction. Updated scorecards have been released for the calendar year 2021.

ADRC 2020 Contacts Summary

Initiatives: 2020 was a unique year, as we found ourselves in a global pandemic with COVID-19. This created many challenges for us and how we safely continued business for both our consumers as well as our staff. The ADRC of Jefferson County closely followed CDC guidelines as information transpired throughout the year. Several changes were made to reduce contact, promote social distancing and yet maintain the high service standards we are known for. ADRC staff transitioned to working remotely, requiring innovation in technology and communication. The staff was equipped with cell phones, laptops, and scanners so they could complete their job duties from the safety of their own homes. Staff learned to utilize virtual meeting resources such as ZOOM to continue offering “face-to-face” interactions with consumers. Visits were reduced to only necessary visits and limited in duration. The office and reception area were closed to walk in’s and consumers were recommended to call in to meet with staff. Our offices remained open to staff during this time. Staff was required to wear face masks whenever in common areas, meetings transitioned to virtual mediums, staff followed social distancing recommendations while present in the building, and shared office supplies were removed to reduce cross- contamination. Through this time of significant change, our staff put forth great effort to maintain the highest quality of customer service possible. Recognizing the vulnerability of many of our Home Delivered Meal Recipients (who may experience social isolation, food shortages, or have other concerns) ADRC staff provided wellbeing phone calls, on the days when meals were not delivered, from March 26 – July 9. The ADRC provided approximately 2,500 wellbeing calls during the indicated period. The ADRC was also involved with two other initiatives with DHS. In April, we were 1 of 5 counties involved in an Outcome Measurement Focus Group The project is part of the No Wrong Door Return on Investment grant DHS received to study the benefits of options counseling and to develop a measurement tool ADRC staff would use to determine if options counseling is the best course of action and customer outcomes are achieved. The second initiative involves our lead screen liaison who participates in the “pilot” Continuing Skills Test program with an examination in January 2021. Review of 2020 ADRC Goals: Key Outcome Indicator (Jan-Mar. 2020): 100% of initial home visit requests shall be conducted within ten (10) business days following the customer’s request or at another time preferred by the customer. Due to the pandemic, this goal was measured Jan-Mar. 2020 only and compliance is 62 out of 63 home visits. This goal was nearly met (98.4%). Key Outcome Indicator (June-Dec. 2020): Within 10-business days from the date the customer is determined functionally and financially eligible for publicly funded long-term care, ADRC staff shall provide enrollment counseling During these seven months, 103 out of 104 customers were provided enrollment counseling per the KOI guidelines. This goal was nearly met (99%). Additional 2020 Goals: 1. 100% compliance with the State Contract. Compliance was monitored through regular case reviews, data analysis, and staff training. This goal was met. 2. The ADRC will translate to Spanish agency created brochures and printed materials, budget permitting. The DCS brochure was translated to Spanish by ADRC staff-Karla Nava but not until March 2021 due to circumstances related to COVID. The goal was partially met. 3. Continue to promote the ADRC and raise awareness of programs and issues relating to aging and people with a disability especially to our underserved Hispanic population. The goal will be to provide one or more community outreach events aimed at educating the Hispanic population. On 1-19-20, the ADRC’s Dementia Care Specialist provided dementia training and resources (Hispanic outreach) to 40 individuals at St. John the Baptist Catholic Church. Due to the pandemic, no other outreach events occurred. This goal was met.

4. In 2020, the ADRC complete at least one Quality Improvement (QI) project. Although initially required per the 2020 Scope of Services, due to the pandemic, the Office of Resource Development waived the requirement for ADRC’s to complete one Quality Improvement (QI) project. The goal was not met. 2021 ADRC Goals: Key Outcome Indicator: 100% of initial home visit requests shall be conducted within five (5) business days following the customer’s request. Additional 2021 Goals: 1. 100% compliance with the State Contract. Compliance Plan- There are limited changes in the 2021 contract between the DHS/ORCD and ADRC’s. One change in response time is noted in the 2021 Key Outcome Indicator. The thirteen core services remain as priorities. The ADRC is also required in 2021 to completed two Options Counseling Record Review Tools and one Supervisor Observation Tool submission per staff by 12-31-21 with one submission each per staff to ORCD. 2. The goal will be to provide one or more community outreach events aimed at educating the Hispanic population. Continue to promote the ADRC and raise awareness of programs and issues relating to aging and people with a disability especially to our underserved Hispanic population. 3. The ADRC will complete one Quality Improvement (QI) project. For 2021, the Office of Resource Development waived the requirement in the Scope of Services. Nonetheless, the ADRC will have at least one project for quality improvement purposes. Disability Benefit Specialist Program The Disability Benefit Specialist (DBS) program helps adults with disabilities who are encountering problems with private or government benefit programs. DBS staff is highly knowledgeable in the following areas: Medicare, Food Share, Social Security Disability, Supplemental Security Income (SSI), and Medical Assistance. Disability Benefit Specialists are trained and guided by attorneys who specialize in disability benefits law. In 2020, 232 individuals were assisted directly with 408 case issues. Several other individuals were assisted with telephone or mail contact. Through applications and appeals, the tracked economic outcomes for Jefferson County residents totaled $1,938,519 in federal dollars compared to $304, 191 in State, and $2,740 in “other” dollars for a total of $2,245,450. Review 2020 DBS Goals for: 1. During the 12-months of 2020, the Disability Benefit Specialist programs will continue to serve all individuals requesting help without imposing a waitlist. No waitlists were needed for 2020. This goal was met. 2. DBS staff will develop and enhance information on the DBS portion of the ADRC website. The goal was to have only relevant resources that are easily accessible from our webpage. At least one DBS staff will attend the ADRC website change project sustainability team meetings as one means to meet the goal. Due to the COVID pandemic, this goal was not met. We will continue this goal for 2021. This goal was not met. 3. DBS staff will co-present with EBS staff at four or more “Welcome to Medicare” Workshops. Due to the COVID pandemic, these types of training were not possible in 2020. We will continue this goal for 2021. This goal was not met. 2021 DBS Goals: Key Outcome Indicator: DBS staff will co-present with EBS staff at four or more “Welcome to Medicare” Workshops. Additional 2021 Goals: 1. DBS staff will develop and enhance information on the DBS portion of the ADRC website. The goal was to have only relevant resources that are easily accessible from our webpage. At least one DBS staff will attend the ADRC website change project sustainability team meetings as one means to meet the goal. Due to the COVID pandemic, this goal was not met. We will continue this goal for 2021. 2. DBS Staff will work together to make a standardized procedure for different aspects of the program.

AGING PROGRAMS ~Providing community-based services to support older adults in their own homes~ Dementia Care Specialist (DCS) The Dementia Care Specialist position supports individuals in Jefferson County who are living with Dementia, their caregivers, and the Jefferson County Community in creating safe and welcoming public spaces for individuals living with Dementia. This is accomplished through educational programming for caregivers and community businesses, offering supports and social connections for caregivers, as well as offering tools and programs developed to enhance the quality of life for individuals with Dementia. Jefferson County has employed a Dementia Care Specialist since January of 2013. Funding for the position comes from state GPR dollars and federal Medicaid matching funds of $80,000 via the ADRC contract between the county and the Department of Health Services. In 2020, 218 individual consumers were served through dementia consultation, support, resources, and education coordinated by the Dementia Care Specialist. In 2020, the Dementia Care Specialist offered programs mostly virtually due to the COVID-19 pandemic. Programs included but were not limited to: Memory Screenings Monday Morning Caregiver Coffee Hours Dementia Friends Quarterly Caregiver Newsletter Dementia Basics presentation DCS Statewide Book Club Dementia Friendly Business Training Poetry Calls Powerful Tools for Caregivers Music and Memory Brain Health Presentations Grandpa and Lucy Program Initiated Living with Dementia JCHS training; dementia basics and brain health Celebrated National Caregiver Month Alzheimer’s Dementia and Driving Crisis Training for Law Enforcement Radio interviews WI Advocacy Days at the state capitol Review of 2020 Goals: Key Outcome Indicator: The Dementia Friendly Community Initiatives will be sustained and grow by 5 new members. The following Jefferson County businesses were trained during 2020: Hometown Pharmacy of Fort Atkinson, County City Credit Union of Jefferson, Optimal Physical Therapy of Lake Mills. Only 3 organizations completed in the training due to the COVID-19 pandemic. The goal was not met for 2020 due to the pandemic. Additional 2020 annual goals: 1. Increase participation at the Caregiver Conference to 20 participants. The 2020 Caregiver Conferenced was modified in 2020 due to COVID-19. Rather than meeting in person, the Dementia Care Specialist invited caregivers to provide advice and support for one another. This advice was then shared in the quarterly Caregiver Newsletter. Eight caregivers participated in this activity. The goal for 2020 was not met due to the pandemic. 2. Open 1 Memory Café in 2020. Memory cafés were put on hold or moved to a virtual setting in 2020. The goal for 2020 was not met due to the pandemic. 3. Creation of Sensory Kits. Consumers shared that they enjoy receiving the gift and the caregivers are happy with having a “tool” to offer in the middle of moments of agitation, fear, or confusion. Sensory kits are provided to local physician offices, emergency departments, police departments as well as to families participating in the dementia care programs. The goal for 2020 was met. 4. Provide memory screenings. Memory screening efforts were less in 2020, as meeting in person was not an option due to the COVID pandemic. 26 memory screens were completed throughout 2020. The goal for 2020 was met. 5. Facilitate Dementia Live Program at least 5 times in 2020. The Dementia Live Program was not offered in 2020 due to the COVID pandemic. The goal for 2020 was not met due to the pandemic.

2021 Goals: Key Outcome Indicator: Increase community participation by 10% through DCS programming. The DCS worked with 218 consumers throughout 2020, the goal is to increase this number by 22 members in 2021. Additional 2021 annual goals: 1. Initiate Rotating Memory Café amongst Jefferson County Libraries in 2021. 2. Reach 5-10 new minority community members. 3. Continue to offer all current ongoing programming through 2021. 4. Host Teepa Snow presentation (s) for National Caregiver Month in November 5. Increase the number of Dementia Friendly Community trained organizations by 3 in 2021

Caregiver Support Programs The caregiver Support Specialist position is designed to coordinate and facilitate the AFCSP, NFCSP, and Support Services programs. The table below the average number of caregiving hours provided each week to a loved one, buy a loved one in 2020. It is clear from this table that as people age their caregiving responsibilities tend to increase significantly. Supporting these caregivers is a vital to assist aging individuals to remain in their homes as long as possible.

Alzheimer’s Family Caregiver Support (AFCSP) The Alzheimer’s Family and Caregiver Support Program or AFCSP was a program created by the Wisconsin legislature in 1985 in response to the stress and service needs of families caring at home for someone with irreversible dementia. To be eligible, a person must have a diagnosis of Alzheimer’s disease or a related disorder, and be financially eligible. Funding allocated for 2021 is $35,502, and can be used to cover in-home help, medical equipment, prescriptions medications, respite care, adult daycare, assistive devices, and transportation. National Family Caregiver Support (NFCSP) The National Family Caregiver Support Program was created by the Administration on Aging in October 2000. The funding allocation for 2021 is was $37,329; the county cash match for this budget is $13,695 allowing a total budget of $51,024. The program helps families sustain their efforts to care for older relatives by providing them with the following services/supports:  Information in the form of outreach and education about resources to help families in their caregiver roles  Assistance to families in learning about and locating services  Caregiver Support in the form of counseling, training, and support groups

 Respite Care to provide caregivers a temporary break from their responsibilities  Supplemental Services including items or services designed to help “fill the gap” when there is a need. Supportive Services Program Supportive services are intended to help people remain in their homes, with the help that they need, to meet their activities of daily living or access community services. Supportive Services is the second-largest funding category under Older American’s Act (OAA). The Title 3 B Supportive Services budget is funded at $76,431 (2021) with a county match of $11,718. The match includes an estimated $29,000 of unspent 2020 funding. Review of 2020 Goals: 1. Key Outcome Indicator: 100% of caregivers surveyed indicate that they were linked to helpful, appropriate services. Due to the pandemic, no survey was completed for 2020. This goal was not met. 2. Starting in 2020, a new part-time Family Caregiver Support Specialist will be hired to offer support groups and work with the Caregivers to offer support and services through the NFCSP as well as the Alzheimer’s Family Caregiver Support. This goal was met. 2021 Goals: Key Outcome Indicator: Increase overall participation in Caregiver Support Programs by 10%.

Elderly Nutrition Program The Elderly Nutrition Program, enacted by Congress in 1972, provides grants to support nutrition services to older adults throughout the country. The goals of this program are to improve the dietary intake of participants, provide nutrition education, and offer participants opportunities to form new friendships and informal support networks. The Elderly Nutrition Program consists of the Senior Dining Program and the Home Delivered Meal Program. The Senior Dining Program offers meals, nutrition education, and the opportunity to socialize with others at six congregate meal sites throughout Jefferson County. In 2020, the Jefferson County Senior Dining Program served 2,055 meals to 293 people at six congregate meal sites. These six sites have been closed for public dining since the week of March 16, 2020, due to the global coronavirus pandemic. The Home Delivered Meal Program provides a well-being check, nutrition education, and a nutritious meal delivered to a participant’s home. In 2020, the Jefferson County Home Delivered Meal Program served 27,369 meals to 415 people. Below is a 2019 and 2020 comparison of Congregate Meals and Home Delivered Meals.

2019 to 2020 Comparison 35,000 28,87729,424 30,000 27,369 25,000 19,345 20,000 15,000 9,532 10,000 5,000 2,055 0 Home Delivered Meals Congregate Meals Total Meals

2019 Total 2020 Totals

Due to the closure of congregate sites, we offered contactless, curbside, carry-out meals beginning in July. The number of carry-out meals is included in the 2020 Home Delivered Meals and 2020 Total Meals represented in the graph above. The graph below represents only the number of carryout meals served in 2020 and the number of unreplicated participants per month.

500 454 439 450 389 400 350 300 250 215 200 175 150 87 69 71 67 100 49 50 17 30 0 July August September October November December

# of total curbside meals # of unique curbside participants

The goals of the Elderly Nutrition Program are:  To reduce hunger and food insecurity;  To promote socialization of older individuals; and  To promote the health and well-being of older individuals by assisting such individuals to gain access to nutrition and other disease prevention and health promotion services designed to delay the onset of adverse health conditions resulting from poor nutritional health or sedentary behavior. Senior Dining is the biggest program in terms of dollars spent under the Older American’s Act. Funding for the program in 2020 was provided as follows:

Greater Wisconsin Agency on Aging Resources Contract* $191,927 Families First Coronavirus Response Act Funding $49,127

Coronavirus Aid Relief, and Economic Security Act Funding $107,212

Participant Contributions $85,894 Managed Care Organization Payments $10,983

* Not all of this funding was used in 2020. The unused funding can be carried over into 2021. Review of 2020 Goals: Key Outcome Indicator 1: 100% of seniors completing satisfaction surveys report that they are not experiencing hunger or food insecurity. There was no survey done in 2020 as it was not a requirement due to COVID-19. This goal was not met. Key Outcome Indicator 2: 95% of qualifying home-delivered meal requests are served - All New Home Delivered Meal requests are documented monthly. Documentation also includes any eligible participants whom we are not able to serve at that time, including the reason. Data was not captured for the first quarter of 2020 due to staff turnover. April through December 2020 we served 136/138 (98.5%) new Home Delivered Meal Requests. The 2 participants we were unable to serve in November were served in December once we acquired a volunteer driver for a new service area in Jefferson County. This goal was met. Additional 2020 Goals: 1. By the end of 2020, the Nutrition Program will open a restaurant model dining site in one rural community and achieve the participation of 12 participants per day. If successful, this model will be

duplicated in other identified rural areas at least 1 per year through 2021. This goal was not met due to the pandemic. This goal will not be carried into 2021 due to the continued closure of congregate meal sites. 2. Increase community interactions for program participants. - Community groups will participate each month, for a total of 12 service-learning projects. Outreach to community providers (Girls and Boy Scouts, 4 H, Adopt a grandparent) to complete service-learning projects will be completed via mailings, emails, and/or face to face with community group leaders. This goal was met and will continue in 2021. 3. The Nutrition Program will secure two shelf-stable meals in the event of inclement weather for 203 home-delivered meal participants and 582 congregate participants for a total of 1,570 emergency meals. This will be achieved by reaching out to local businesses for contributions. The goal is to have two meals secured and distributed for all active participants by 12/31/2020. Due to the closure of congregate meal sites in 2020 due to the pandemic, the Nutrition Program focused on the Home Delivered and Carryout Meal participants. Home delivered meal volunteers delivered two shelf-stable meals and snacks to all current Home Delivered and Curbside Carryout Meal participants on 12/28/20. This practice continues for newly added Home Delivered Meal participants until our shelf-stable meal supply runs out. This goal was met. 4. To increase rural nutrition program participation, the aging unit will educate rural residents about meals programs and ways of obtaining food and groceries by:  Noting additional external resources available (i.e. grocery delivery through stores) to the current resources guide currently provided.  Providing resource guides to 30 local businesses that will allow them to be displayed such as doctor’s offices, grocery stores, etc. As well as, displaying and distributing them at the ADRC.  Educating rural residents about services available During the global pandemic, Home Delivered Meal participants and their emergency contacts received handouts that provided information on area food pantries and restaurants that offered delivery or pick-up service, grocery stores that offered online ordering and delivery, and other meal services that provide specialized or therapeutic meals delivered to their door. We also promoted grocery store assistance to all Home Delivered Meal Participants. We added these handouts, and the ADRC contact information, and to the ADRC web page. In collaboration with Transportation Services, the Elderly Nutrition Program expanded our volunteer home- delivered meal service delivery area to include the rural areas of Fort Atkinson, and the Jefferson County communities of Cambridge, Edgerton, Whitewater, and Ixonia as well. These communities had a previously unmet need due to a lack of volunteer drivers to deliver meals to these areas. This goal was met. 2021 Goals: Key Outcome Indicator: 90% of new home-delivered meal participants will be assessed in the home within four weeks of beginning meal service to determine the individual’s need for nutrition and other services. 1. During the pandemic, the Home Meal Assessor will complete the assessment via a detailed telephone interview within four weeks of beginning meal service. 2. The assessment includes an eligibility assessment, a type of meal appropriate for the participant in his or her living environment, and an assessment for the need for nutrition-related and other supportive services, and referral as necessary. 3. In-home visits will resume when Public Health determines it is safe for the assessor and the participant. The Home Delivered Meal Assessor will complete a full reassessment in the participant’s home at least annually to determine continued eligibility and a need for home-delivered meals, as well as additional services that may be needed.

Additional 2021 Goals: 1. 95% of seniors completing satisfaction surveys report that they are not experiencing hunger or food insecurity. By the end of 2021, the Nutrition Program will mail or hand out a GWAAR/BADR approved customer satisfaction survey to all current meal participants including Home Delivered, Carry Out, and 37

Congregate (if congregate sites are open). The survey will include at least one question asking participants if they are experiencing hunger or food insecurity. The goal is a response rate of 40% of distributed surveys. 2. 95% of qualifying home-delivered meal requests are served. The Elderly Nutrition Program makes every effort to provide meals to an older person who is eligible for home-delivered meals. All new Home Delivered Meal requests are documented monthly. Documentation also includes any eligible participants whom we are not able to serve at that time, including the reason. The Nutrition Program Supervisor seeks solutions as soon as possible to provide a meal for an eligible older person for whom we could not provide a meal during that month. 3. The Nutrition Program will secure two shelf-stable meals to be used in the event of inclement weather for all current participants by 12/31/21. This will be achieved by reaching out to local businesses for contributions. The goal is to have two meals secured and distributed for all active participants by 12/31/2021. 4. By December 31, 2021, increase community engagement/interactions for program participants with completion of a minimum of 4 service-learning projects. Community groups or individuals will participate at least quarterly. Nutrition Project Council members and the Nutrition Program team will do outreach via mailings, emails, and/or face to face with community group leaders (Girls and Boy Scouts, 4 H, Adopt a grandparent, Schools, library) to complete service learning projects. 5. By December 31, 2021, recruit, hire, and train at least 5 new volunteer drivers who can deliver meals to rural participants throughout Jefferson County. The focus will be to market on Facebook, local newspapers, and newsletters. 6. Develop a proposal for a restaurant model in Jefferson County. Health Promotion At the national level, many priorities focus on maintaining good health and preventing or managing illness or injury. Greater Wisconsin Agency on Aging Resources (GWAAR) and the Department of Health Services (DHS) continually provide county aging units with a variety of materials for distribution. There are several evidence- based prevention programs that Greater Wisconsin Agency on Aging Resources (GWAAR) and DHS promote: Living Well with Chronic Conditions and Stepping On, a falls prevention program. In 2021 our budget allows $5,060 for prevention programs to be provided, plus any unspent 2020 funds. We received additional CARES funding for this program in 2020. The Home Delivered Meal Assessor (HDM Assessor) provides participants with basic nutrition education and medication management services during the assessment. In addition, until the congregate sites closed mid- March 2020, the HDM Assessor provided nutrition education via table tents, in-person food demonstrations, or in-person nutrition presentations, at least quarterly. The Nutrition Program Supervisor provides printed nutrition education handouts, at least quarterly, to all home-delivered meal and carryout meal participants via the monthly donation statements mailed to a participant’s home. On a regular basis, health and wellness is promoted by every ADRC team member. 2021 Health Promotion Goal: Key Outcome Indicator: The Aging and Disability Resource Center of Jefferson County will purchase, and implement 2 Evidence-Based Health Promotion Disease Prevention Programs in 2021. Transportation Services Jefferson County Provides transportation services to the elderly and persons with a disability through the s85.21 Specialized Transportation Program. Persons seeking access to medical care are given priority services, as well as those needing help in meeting their nutritional needs. Our transportation budget for 2021 is $349,281 in total expenses. This will be funded by the 85.21 transportation program contract, which is $222,837 in 2021 and calls for a 20% County Local match. The remainder of the funding is Managed Care Organization (MCO) payments, participant contributions, and County tax levy. Jefferson County began operating a Mobility Manager program in 2019. The Mobility Manager helps older adults, people with disabilities, and anyone facing barriers finding transportation. Mobility Managers focus on

38 meeting individual customer needs through a wide range of transportation options and service providers. In 2021, we will receive $66,989 from the Enhanced Mobility of Seniors & Individuals with Disabilities 5310 Grant Program for the Moility Manager Programs. In addition, in 2021, Jefferson County was awarded a 5310 Vehicle Operating Grant. This grant will provide the County with $32,800 toward the purchase of an additional vehicle for the transportation program. The County will contribute $8,200 of a local match from our vehicle escrow reserve. Specialized Transportation Program In 2020, Jefferson County Driver Escort program provided 6774 one-way trips for residents who are elderly and persons with disabilities through the s85.21 Specialized Transportation Program. Persons seeking access to medical care are given priority services, as well as those needing help in meeting their nutritional needs. The Driver Escort Program employs one full-time coordinator and 7 part-time driving staff and volunteer drivers. In 2020, our paid and volunteer drivers provided 8,572 hours of driving 178,092 miles for this service.

Driver / Escort Ridership

Quarter 2017 2018 2019 2020 Q1 1,051 1,305 1,154 2,371 Q2 1,160 1,302 1,829 1,329 Q3 1,080 1,063 1,956 1,417 Q4 1,150 1,352 2056 1657 Total 4,441 5,022 6,995 6,774 Y-to-Y Change (%) 13.1 39.3 -3.2

The ADRC of Jefferson County also coordinates transportation services for Jefferson County Veterans who need to go to nearby VA hospitals and clinics. Vehicles for this service are provided by the Jefferson County VA office. In 2020, the VA transportation service had a 60% decrease in ridership over the previous year. This decrease is attributed to the COVID-19 pandemic.

VA Van Ridership

Quarter 2017 2018 2019 2020 Q1 134 139 310 253 Q2 208 156 247 16 Q3 193 230 259 68 Q4 160 210 249 89 Total 695 735 1,065 426 Y-to-Y Chng (%) 5.8 44.9 -60.0

In January of 2021, satisfaction surveys were distributed to clients to gather information on the overall customer experience. Overall, 100% of the consumers responded well to excellent for rating our transportation service.

Review of 2020 Specialized Transportation Goals: Key Outcome Indicator: 100% of qualifying ride requests are provided. - This goal was not met as there were ride requests that were not met. 1. 100% of unmet ride requests were tracked to monitor community needs throughout 2020. 2. 100% of passengers were surveyed to gauge satisfaction with services and to gather information about unmet needs. Overall, 100% of the consumers responded well to excellent for rating our transportation service. We continue to review the unmet needs of consumers monthly. 3. In 2020, Jefferson County was an active committee member as part of the Easter Seals Project —Accessible Transportation Community Initiative. Six major sub-projects were worked on in 2019 and 2020 (Mobility Manager, Ride United, Senior Center Bus, Pedestrian Crossing Improvements, Wheelchair Cab for Shared Ride Taxi, Outreach & Sustainability) as part of this initiative. Overall, this project accomplished all planned projects within 2019 and 2020. The Easter Seals organization was well pleased with the results and acclaimed it as one of the most successful projects they had sponsored nationwide. 2021 Specialized Transportation Goals: Key Outcome Indicator: 90% of qualifying medical ride requests are met 1. 100% of unmet ride requests will be tracked to monitor community needs throughout 2021. 2. Jefferson County will participate in a project with 11 other counties and GWAAR for the Mobility Services for All Americans — General Transit Administration Grant. 3. In 2021, Jefferson County will expand its transportation services for the elderly and those living with disabilities by adding another wheelchair-equipped vehicle. Once this vehicle is acquired, Jefferson County Transportation Services should be able to provide 95% or more of all requested rides for clients who use a wheelchair or mobility device. Mobility Manager The Mobility Manager is responsible for community transportation planning, coordination, navigation, and travel training to assist people to choose, obtain and maintain transportation options that best accommodate their unique travel choices and needs. The Mobility Manager works with all the community transportation services to improve coordination of services and increase and/or develop accessible transportation resources in the communities and promote available transportation resources to county residents, businesses, and organizations of Jefferson County. Lastly, the Mobility Manager initiates activities and works closely with other agencies to promote mobility, health, and wellness for everyone, but with a focus on seniors and those living with disabilities.

Review of 2020 Mobility Manager Goals: 1. The Mobility Manager provided information to seniors and people with disabilities on the transportation options to accommodate their needs. In 2020, the Mobility Manager took the initiative to assist the elderly and those living with disabilities in new ways. Informational flyers were developed and distributed to help people sheltering at home safely meet their nutritional needs during the pandemic through a partnership with the Home Delivered Meals Program. These flyers included information about local food pantries, grocery store delivery, restaurant drive-up/takeout, and purchasing premade meals to be delivered to your home. This goal was met. 2. The Mobility Manager worked closely with all existing transportation services in the county to ensure service coordination and to complement and not duplicate these services. The Mobility Manager organized and hosted quarterly Transportation Coordination meetings whereby agency partnerships and providers review data, identify service gaps and help strategize to meet unmet transportation needs. This goal was met. 3. The Mobility Manager initiated activities with other agencies to promote mobility, health, and wellness with a focus on seniors and those living with disabilities. A “Wednesday Walks” program was developed by the Mobility Manager to promote mobility and wellness for seniors. This goal was met. 2021 Mobility Manager Goals: Key Outcome Indicator: Reach goal to provide recreational/nutritional (or non-medical) ridership of 300 rides by the end of 2021, utilizing Enhanced Mobility of Seniors & Individuals with Disabilities 5310 Grant Program funds. In 2021, a “Wednesday Walks” program will again be organized to promote mobility and wellness for seniors. A new Recreational Day Trip Program to provide monthly educational/recreational experiences will begin to better support the participant's non-medical ride needs. Additional 2021 Goals: Develop a proposal for a more efficient transportation coordination system in Jefferson County.

Elder Benefit Specialist Elderly Benefit Specialists (EBS) are advocates who are trained to help older persons who are experiencing problems with public or private benefits programs. Jefferson County employs two specialists, one is full-time, the other part-time. In 2020, the program served 433 unduplicated clients, in addition to the primary role to provide advocacy for Jefferson County seniors, the EBS program continued to host monthly Medicare workshops virtually due to the pandemic. Funding for this program in 2021 comes from the federal, state, and county tax dollars and is as follows: a. State EBS Contract from DHS - $28,215 b. State Health Insurance Program (SHIP) - $7,400 c. Medicaid based on consumers served and based on activities provided – annual contacts determines d. Aging & Disability Resource Center (ADRC) – annual contacts determines e. EBS OCI (SPAP) Prescription Drug Assistance - $6,102 f. MIPPA – Medicare Improvement for Patients and Providers Act - $5,275 g. State Senior Community Services (SSCS) - $7,986 Through applications and appeals, the tracked economic outcomes for Jefferson County residents totaled $1,910,499 in federal dollars compared to $81,400 in State and $63,550 in “other” dollars for a total of $2,055,449. Review of 2020 EBS Goals: Key Outcome Indicator: During the 12 months in 2020, the Elder Benefit Specialist Program will continue to serve all individuals requesting help without subjecting them to a waiting list. Jefferson County has not had to initiate a waitlist for EBS services. This goal was met. 1. Organize and run at least one fundraising event for the EBS program. These funds would go to supporting and developing the EBS volunteer program at this time. Due to the COVID-19 pandemic, this goal was not met as people were practicing social distancing. This goal was not met. 41

2. Create a recording of our “Welcome to Medicare” presentation via Zoom. This recording will be posted on the Jefferson County Elder Benefit Specialist page and also will be shared through other platforms as well. This may include the Jefferson County Facebook page as well as other online outlets. This goal was met. 2021 EBS Goals: Key Outcome Indicator: Reach 50 referrals offered to be made by EBS staff to other community resources by 12/31/21. We will accomplish this by tracking referral sources and core issues bringing clients in. Adjusting outreach to better reach referral sources. 1. Increase internal referrals. 2. Increase community referrals. 3. During the 12 months in 2021, the Elder Benefit Specialist Program will continue to serve all individuals requesting help without subjecting them to a waiting list. Additional 2021 Goals: DBS staff will co-present with EBS staff at four or more “Welcome to Medicare” Workshops. Adult Protective Services (APS) The Human Services Department of Jefferson County is the designated “lead agency” for receiving and responding to allegations of abuse or neglect of adults ages 60 and over as well as adults-at-risk ages 18-59. The Adult Protective Services department within the Human Services Department takes primary responsibility for receiving and responding to allegations of abuse, financial exploitation, neglect, and self-neglect. The APS unit is responsible for ensuring that the health and safety needs of the elderly and individuals with disabilities are met, especially those with cognitive impairments when substantial risk is evident. APS services are mandated by state statute and are severely underfunded. Several different statutes establish the county's responsibilities in responding to these situations. Adult Protective Services advocates for least restrictive interventions with the intention of utilizing guardianship as a last resort. APS reviews whether Power of Attorney documentation can be completed versus pursuing guardianship, to minimize, the infringement on an individual’s liberties. In 2020, APS was able to complete Power of Attorney for Healthcare and/or Finance for 4 separate cases. Results from 2020  49 reports of abuse/neglect were received o 2020 saw a 29% reduction in the number of reports received from 2019 (69). o 6 on Adults-at-Risk Age 18-59 o 43 on Elder Adults-at-Risk Age 60+ o In the majority of cases referred the abuse/neglect most often occurred where the person lived. o Persons with Alzheimer’s disease or related dementia are considered a high-risk group  166 Annual Review of Protective Placements or WATTS reviews  11 New Petitions for Guardianship - 7 Petitions for Protective Placements o These numbers are half of what the number of Petitions filed in 2019

Review of 2020 Goals: 1. Key Outcome Indicator: 100% of referrals are responded to within the time frames contained in the statute; case notation and legal time frames are met in 100% of cases referred. This goal was met. 2. To promote Elder Abuse Awareness, the Adult Protective Services staff will offer presentations on scams, guardianship roles and responsibilities, and Prevention of Elder Abuse. The plan would be to conduct 2 presentations a year: a guardianship presentation in the spring and a prevention program in the fall and have 10 for attendance at each presentation. Participants will be surveyed for the effectiveness of the presentation materials. The Spring session had 12 participants but the Fall presentation was canceled. This goal was not met. 3. Expand membership of the Adults at Risk I Team Meetings which are held quarterly. This goal was not met. 2021 APS Goals: Key Outcome Indicator: 100% of referrals are responded to within the time frames contained in the statute. Wisconsin DHS 46.90(5)(a)1 read; … “An elder-adult-at-risk agency's response to or another investigative agency's investigation of a report of alleged abuse, financial exploitation, neglect, or self-neglect that is not referred to the department shall be commenced within 24 hours after a report is received, excluding Saturdays, Sundays and legal holidays.” Additional 2021 Goals: 1. Case notation and legal time frames are met in 100% of cases referred. 2. Hoarding Taskforce – Start a Hoarding Taskforce in Jefferson County to effectively and efficiently respond to concerns of hoarding. 3. Financial Abuse Specialist Team (FAST) team – Start a FAST team in Jefferson County to effectively and efficiently respond to financial exploitation cases.

BEHAVIORAL HEALTH DIVISION ~Providing evidence-based treatment programs that are recovery oriented, trauma informed, person centered, and responsive to the needs of our County residents~

n the Behavioral Health Division 2020 was like no other year due to the global pandemic. All mental health and substance use services were transitioned to telehealth platforms. New rules were continuously I established for how and when to see people in person. We saw the need for all behavioral health services increase. We were able to successfully navigate these challenges. Below is a summary of the Division’s programs and funding and a detailed report of each follows. The Behavioral Health Division of Jefferson County Human Services is organized into four teams. Each team offers evidence based treatment options that support individuals’ recovery. We offer an integrated, county staffed, service delivery system and contract for additional service provision. We have 23 full time employees in a variety of roles on our four Division teams. The Division teams are: Emergency Mental Health/Crisis Intervention Services: This is the first point of contact for requesting services and responding to any crisis call. We are staffed 24 hours a day seven days a week. As part of our crisis services, we operate the Lueder House; which is a state licensed eight bed community based residential facility for adults with mental illness, who need crisis stabilization services. Mental Health and Alcohol and Other Drug Abuse (AODA) Outpatient Clinic: The Clinic provides individual and group psychotherapy for children and adults with same day access. We offer and arrange for detoxification services, inpatient psychiatric hospitalization, and residential Substance Use treatment. Comprehensive Community Services Program (CCS): CCS provides more intensive mental health and substance use treatment with a wrap around service array for children and adults. We have Bachelor and Master level service facilitators. We employ Peer Support Specialists. We offer Family Center Treatment as well as other evidence based practices. Community Support Program (CSP): CSP serves people who have a severe and persistent mental illness. Through a mobile team that has high fidelity to the Assertive Community Treatment model with an array of services are delivered in the community for consumers. The CSP team includes Peer Support Specialists as well Bachelor and Master level clinicians. Our Medical Director is a licensed adult and child psychiatrist. He is on site Monday through Friday and available after hours and weekends. He oversees all treatment programs and authorizes all necessary services. We remain steadfast in responding to the needs of county residents. To do so, we believe it is imperative to partner with community stakeholders. In 2021 we will add two school-based positions funded in part by the Greater Watertown Community Health Foundation. These positions will assist our schools in identifying when services might be needed, implement a social emotional curriculum for all youth, and provide therapy. We will offer and coordinate the eleventh Crisis Intervention Training in Jefferson County for Law Enforcement Officers. In 2021 we will continue to work closely with community partners on our Zero Suicide team to raise awareness, offer trainings, and increase community resources. In 2021, we will also advance trauma informed care principles with county stakeholders by offering training and consultation. We will also explore with community partners ways for all people to access needed services. We will continue to support MyStrength, a web-based resource that offers many wellness tools as well the Peer Support Warmline.

Below is a summary of the Division’s funding sources:

Following are detailed reports from each of the Division’s teams, which include data on the number of people served and a review of our services and yearly goals.

EMERGENCY MENTAL HEALTH CRISIS INTERVENTION SERVICES ~We believe mental health and substance use issues are most successfully treated, whenever possible, with a voluntary entity into treatment and services. ~ Our Emergency Mental Health (EMH) Crisis Intervention Services were certified under HS 34 in October of 2007. In becoming certified, the Department did not have to add any new services or new staff. The Department organized procedures, formalized policies, developed billing systems and trained staff across the entire agency. We continue to revise and update these policies and procedures. Human Services Crisis staffs, who are certified intake workers, complete all emergency detentions for the county. Intake/Crisis staff operates 24/7 on site, including weekends and holidays. We currently have 7 full-time crisis staff and one full time crisis outreach worker covering the 24/7 shifts. In 2020 for our certified Emergency Mental Health services, we billed $ 481,195 to Medicaid for our services and received payment of $ 226,276. We billed $ 221,720 to private Insurance and received payment of $ 9,922. We billed $ 141,060 to private pay individuals and received payments of $ 6,545. We billed MA HMO $ 176,421 and received payment of $ 9,072. We were also able to bill $ 6,490 to Medicaid for stabilization stays at Bayside in Madison and received payments of $ 2,277. The chart below shows the increase in calls and services over the past several years. When we began there were 995 EMH contacts, fast forward to 2020 were we had 17,233 contacts. Some of the reasons for the increase in the data below include but are not limited to: 1. In the United States the prevalence of mental illness in adults has been increasing. 2. We continue to do more outreach with the community and our community partners to make them aware of our crisis services and our mental health services we provide. 3. The majority of people who are involuntarily hospitalized have not had any prior contact with our crisis team or agency.

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 EMH contacts 995 3582 5114 5551 5509 5396 6065 8677 8914 10524 11786 13860 17233

ED's 114 107 106 124 125 154 142 126 127 156 167 114 108 Suicide calls 323 248 184 226 198 210 310 252 284 310 384 306 235

KEY OUTCOME INDICATOR Our key outcome indicator, a measure of how we are doing our work, is our diversion rate, i.e. the number of times we are able to find a disposition that is not an emergency detention. We adhere to the statute requiring the least restrictive setting for each person and we want each person to have the best possible outcome. To do this, we consider a number of factors: we complete a standardized suicide assessment; we consider lethality, means, opportunity, age, gender, access, and past history. When possible, we divert the person to a setting that is not a locked facility. Due to the pandemic, 2020 proved to be a challenging year. One of the challenges was the lack of stabilization options and diversion options due to facilities not taking out of county admissions and suspending admissions for a time. Without the other alternatives that we would usually have on hand, we saw an increase in hospitalizations.

Year 2019 2020 Total # Assessments 489 428 Total # Emergency Detentions 114 108 Total # Diversions 390 320 Percentage of Diversions 80% 75% We track and review factors regarding people that were placed under an emergency detention. These include whether they were in services, residents of another county, in family care, and/or placed in group homes. The chart below shows the comparison of the last three years. Detentions from Jail continue to be minimal. The number of detentions from group homes increased this last year. There are a number of contributing factors. Individuals were not able to go to day programming, work, or see their family for numerous months due to the pandemic. Regular structured daily activities changed. We did offer virtual bingo for several months to try and help licensed facilities provide some structure. We were able to partner with the Greater Watertown Community Health Foundation to buy prizes and drop them off at the participating facilities.

Lueder House The Lueder house, our crisis stabilization facility, is an 8 bed class A CBRF (community based residential facility). In 2020, there were 54 admissions at the Lueder House. The average length of stay for consumers was 30 days. Thirty-nine individuals were served by the Lueder House. Several were admitted more than once for crisis stabilization services. Of the 54 admissions, 8 were admitted for 30 days or more. The average length of stay for those 8 individuals was 158 days. The Lueder House continues to provide MyStrength, menu planning and cooking, daily goal sheets, sleep protocol, and DBT skills coaching to individuals staying there. Along with this they also assist people in looking for housing and job searches. We were also able to bill $ 369,045 to Medicaid for our crisis stabilization services and received payment of $ 123,922.

Youth Crisis Services In 2020 we held our third youth focused Crisis Intervention Team (CIT) Training for law enforcement. We continue to be involved in the Children’s Crisis grant which has been able to pay for Dialectical Behavior Therapy training and attendance at the State Crisis Conference. This past year the grant put funds toward youth in home crisis stabilization services. Through this grant we have been able to collaborate with other counties to problem solve and provide better youth crisis services and supports. The grant will be extended for another year and we will be able to continue to use this money toward training and improvements in services.

In 2020, there were 105 assessments done with youth and of those 5 were detained for an involuntary hospitalization giving us a diversion rate of 95%. Through our continued efforts to increase service to youth and in educating community partners we were able to increase our diversion rate by 6% from 2019. We had a total of 4 returns to more restrictive setting. We track emergency detentions to Winnebago Mental Health Institute (WMHI) as we are trying to divert from detaining individuals there. In 2020, we did not initiate any emergency detentions and 2 youth were returned to more restrictive setting to WMHI. One youth was returned two times for a total of 3 returns to more restrictive setting to WMHI. In 2019, we had initiated 4 emergency detentions to WMHI and 1 return to more restrictive setting to WMHI.

ZERO SUICIDE ~Zero Suicide is a commitment to suicide prevention in health and behavioral health care systems.~ According to the Action Alliance of Suicide Prevention, Zero Suicide is a commitment to suicide prevention in health and behavioral health care systems, and also a specific set of tools and strategies. It is both a concept and a practice. In April of 2015 a team of people from Jefferson County Human Services attended the Zero Suicide Academy. The team consisted of representatives from the behavioral health unit, health department, and consumers. We officially kicked off our Zero Suicide project on June 1, 2015 by placing a flyer explaining what Zero Suicide is and a Zero Suicide cookie on the desk of each staff person. The team developed a PowerPoint that played on the lobby TV to create more awareness for consumers and other community members. An organizational study was completed and we looked at the changes we wanted to make in 2015 to begin to achieve our goal of Zero Suicide. We trained staff on “Counseling of Lethal Means and Lethal Means Restriction.” We began using the Columbia Suicide Risk assessment across the agency and introduced it to Law Enforcement. In conjunction with the crisis team we worked on seeing people prior to being discharged from the hospital to go over discharge recommendations, needs once discharged, appointments with providers and what follow up would look like from the crisis team. Throughout 2015 we continued to create awareness by expanding our team to include a champion from each team within the department. Since our start in 2015 we have been able to achieve the following through Zero Suicide:  Trained staff and law enforcement in the use of the Columbia Suicide Severity Rating Scale. This scale is currently being use by our agency, law enforcement, hospitals, medical clinics, and some schools.  We have been able to expand our team to include individuals in the community including individuals with lived experience.  We created a brochure to educate people on the signs and risk factors for suicide. This brochure also contains many resources people can reach out to when feeling suicidal or when someone is concerned about someone else who may be suicidal.  We have held a resource fair at the Jefferson High School. We had two speakers who spoke about their experiences with suicide. One speaker spoke from a family member’s perspective and the other from their personal experiences with suicide. We had several informational booths with information on services provided by our agency, local outpatient clinics, the Veteran’s Services, and Sober living facilities to name a few. There was a monarch release in remembrance of those who died from suicide. We also placed yellow pinwheels in the lawn outside the entrance to represent those individuals who had died from suicide.  We have put up flyers in the bathrooms of the local taverns with the crisis number on pull tabs for individuals to be able to take with them.  We have held several rock painting events. Individuals painted rocks with inspirational words or messages and then hide them in our local communities for others to find.  We attended the Social Emotional Learning day at Cambridge middle school.  We have held two QPR (Question, Persuade, and Refer) training.

In 2020 we were able to achieve the following:  We had a book reading and signing of How Fredrick Found His Light, by Katie Maxwell McIntryre.  The team also had yard signs made with our crisis number, the national suicide prevention number, and the text HOPE line number. As people were staying home and kids were attending school virtually, this was a way to make sure individuals had numbers and resources if needed.  Increase team members. We continue to review the deaths from suicide in Jefferson County. Below is data from 2018, 2019, and 2020 showing the number of deaths from suicide for each year and demographics. In 2018 the age range was from 27 to 63 years of age.  15 individuals died from suicide, 2 female and 13 males. Below it is broken down by the method used. 49

o 10 individuals by firearms o 2 individuals by overdosing o 1 individual by hanging o 1 individual by drowning o 1 individual by knife

In 2019 the age range was 18-97 years of age.  14 individuals died from suicide, 3 female and 11 males. Below it is broken down by the method used. o 8 individuals by firearms o 3 individuals by hanging o 1 individual by falling from high place o 1 individual by suffocation o 1 individual by knife

In 2020 the age range was from 15-68 years of age.  Thirteen inidividuals dide by suicide, 1female and 12 males. All but one individual was under 50 years old; with the majority being between 30-50 years old. Below it is broken down by the method used. o 7 individuals by firearms o 5 individuals by hanging o 1 individual by poisoning

NIATx Project In 2017, the crisis team completed a NIATx project to ensure comprehensive follow up with individuals under a mental health court order that are receiving services outside of our agency. What the team decided to have one person responsible for phone calls and monthly face to face meetings with these individuals. Phone calls were to the person, care taker if a minor, and the mental health provider. In 2018 we expanded on this and implemented a tracking system to ensure that everyone under a mental health court order was being seen at least monthly. Each month a report was run to make sure those individuals had been seen; if they had not then a crisis worker would contact the case manager and inquire why they hadn’t been seen. Appropriate follow up was conducted depending on why the person wasn’t seen. We were able to achieve 100% of individuals being seen at least 1 time a month for at least 4 months in a row. In 2019 we updated our policy and procedure for monitoring individuals on a chapter 51 or settlement agreement. We began seeing individuals, newly on orders, face to face on a weekly basis for the first 90 days and then the individual and team determined how often they needed to continue to be seen face to face. A checklist was developed for workers to utilize when people are discharged from the hospital after being placed on a settlement agreement or a mental health commitment. This ensures that individuals meet with a worker within the first 48 hours. During this meeting they complete a crisis plan and the individual is given a copy, hospital recommendations are reviewed, as well as the requirements of the court order. The worker assists in problem solving barriers to getting medications as well as attending appointments with treatment providers. Appointments are set up with providers if they haven’t already been. In 2020 we began sending “sunshine cards” to people. A sunshine card is a handwritten card we send out to individuals to show them that we are here for them and remind them they can call our crisis line 24 hours a day. Examples of why we send out sunshine cards include: 1. To follow up when we have helped on a voluntary hospitalization. 2. To follow up with someone that we are not able to contact by phone or in person. 3. To follow up with a person when their mental health order has expired. We decided that it was important to reach out at certain intervals after an order expires to ensure the individual is still doing well, to remind them that our services are available 24/7, and to sow them someone cares.

Review of 2020 Goals: 1. Key outcome indicator: Maintain current emergency detention diversion percentage, whenever possible, by continuing to review and improve voluntary options.

Due to the pandemic and fewer available diversions, 2020 was a challenging year. We were able to continue to safety plan when we were able and ended up with a diversion rate of 75% overall. The area we really saw a difference in diversion rates was with youth under 18 years of age. In 2019 the diversion rate for youth was 89% and in 2020 it was 95%. 2. Mental Health Flagging System: Increase the number of crisis plans to the Watertown Police Department and work with another municipality to implement the flagging system. In 2020 we continued to work with Watertown Police Department and also expanded our flagging system to work with Fort Atkinson Police Department. We sent crisis plans for individuals who were in group homes and in family care. We were able to identify these individuals by the notifications we receive when a managed care organization places someone in a licensed facility in our county. 3. Complete a NIATx project to improve services and outcomes within our Mental Health Crisis unit by December 2020. We continued to improve upon the Niatx project that we have worked on the past several years with individuals who are placed under a mental health commitment. This past year we started to implement sunshine cards for individuals who were followed by the crisis outreach worker while under the mental health commitment and received mental health services elsewhere. In the last quarter of 2020 we decide to implement this as another way to provide support to individuals who we were no longer having contact with but were at risk of having contact again. This card provides them with a reminder to call us when needed and to let them know that we are still here to help them. 4. Continue to work on forming a suicide prevention Coalition within Jefferson County through our Zero Suicide team. We still want to become a suicide prevention coalition. We have been trying to increase the number of team members to be able to sustain something like this. We will continue to work toward this in the next year. 5. The Zero Suicide team will continue to analyze the data surrounding deaths by suicide to determine what type of outreach or training would be instrumental in reducing the number of suicides. Each year we continue to do this. The one consistent data point is the majority of people dying by suicide are using firearms as the method. 6. Reduce the number of admissions to Winnebago Mental Health Institute from 2019. We were able to reduce the number of admissions for youth significantly. This was the first year we have not initiated an emergency detention of a youth to Winnebago. We did see an increase in admission to Winnebago for adults. This was in part due to the pandemic. We had some people that were positive for Covid at the time of the hospitalization and Winnebago was the only facility to be able to receive them. 7. The Crisis team will provide a resource folder to all contacts. This folder will contain information on where to find services and resources in Jefferson County, how to apply for insurance and food share and tools on maintaining wellness. We have continued to provide resource folders to individuals. We have also mailed them out to individuals at a later date. We continue to update and add to the resource folder.

Goals for 2021 1. Key outcome indicator: Maintain current emergency detention diversion percentage, whenever possible, by continuing to review and improve voluntary options. 2. Complete a NIATx project to improve services and outcomes within our Mental Health Crisis unit by December 2021. 3. Continue to work on forming a suicide prevention Coalition within Jefferson County through our Zero Suicide team. 4. The Zero Suicide team will continue to analyze the data surrounding deaths by suicide to determine what type of outreach or training would be instrumental in reducing the number of suicides. 5. Reduce the number of admissions to Winnebago Mental Health Institute from 2020. 6. Provide CIT training to the officers of Jefferson County by December 2021.

7. Collaborate with the Jefferson County Sheriff’s Department and the Fort Atkinson Police Department to implement a pilot project. This project would entail having the crisis worker who works with the group homes and managed care organizations respond with the police department when they are getting called to licensed facilities. The goal of this program would be to reduce unnecessary mental health crisis calls to the police department and have the calls come to our crisis unit.

MENTAL HEALTH AND SUBSTANCE USE COUNSELING- OUTPATIENT CLINICS ~Participants of the program are assessed for strengths and needs; the principles of hope and empowerment are integrated into each person’s plan. ~ The Mental Health, and Alcohol and Other Drug Abuse (AODA) Outpatient Clinics serve Jefferson County residents with mental health and substance use concerns. In 2020, there were 392 new consumers entered into mental health treatment and 238 new consumers entered into substance use treatment. As the chart below indicates, the clinic provided mental health services to 937 individuals and Substance Abuse services to 598 individuals. These numbers include clients seen by the Psychiatrist and Nurse Prescriber as well as those seen by clinic therapists. In 2020, 81 children were seen for mental health treatment through the outpatient clinic and an additional 17 children through the Comprehensive Community Services Program (CCS) ranging from elementary school-aged children to high school. Participants of the clinic are assessed for strengths and needs; the principles of hope and empowerment are integrated into clinic services. A treatment plan is created using the consumer’s strengths and resources to increase their potential for leading the life they want. Services are provided in the least restrictive manner; decreasing the disruption of the individual’s life while still providing support for recovery services that include a wide array of evidence-based practices. 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 MH 294 332 478 541 615 690 661 718 802 774 930 1,381 937 Clinic AODA 246 207 217 225 288 334 327 393 406 447 547 680 598 Clinic Totals 540 539 695 766 903 1,024 988 1,111 1,208 1,221 1,477 2,061 1,535

The clinic staff consists of a Medical Director/Psychiatrist, eleven full-time staff with masters’ degrees in Social Work, Counseling, Marriage and Family Therapy or Psychology, one of whom worked part-time in the county jail throughout most of 2020, as well as a Community Outreach Worker and the Clinic Supervisor. The clinic is also responsible for overseeing many civil commitments in our county and providing treatment for the individual on the commitment. Under WI § 51, persons who are assessed to be dangerous to themselves or others and have a mental health disorder may be detained involuntarily. If the court determines that these persons need to be treated, they are placed under an order for treatment, typically for 6 months. The person can seek treatment from the outpatient mental health clinic, or if the person has other resources, by another area provider. Clinic staff provided mental health psychotherapy services to an average of 371 people per given month in 2020, approximately 20 of those individuals were ordered under WI § 51.45. Review of 2020 Goals: 1. The outpatient clinic will implement telehealth psychotherapy and psychiatry services. The clinic implemented telehealth psychotherapy and psychiatry services in March of 2020 via the HIPAA compliant Zoom platform. 2. Clinic staff will attend an Ethics and Boundaries Training. Clinic staff attended ethics and boundaries training in 2020. 3. Clinic staff will continue Compassion Resiliency Training. Clinic staff continued compassion resiliency training and transitioned to the Center for Health Minds at work programming. 4. Clinic staff will continue to build on DBT skills in 2020 by attending agency training, participating in DBT consult group, and attending outside DBT training as appropriate. The clinic staff continued to build on DBT Skills in 2020 by attending additional training, specifically two clinicians attended DBT intensive training and the clinic supervisor attended DBT-C training.

5. Clinic staff will submit session recordings to be coded for efficiency in Motivational Interviewing skills and continue to build on MI skills throughout 2020. The newest clinician added to the outpatient clinic in 2020 attended level 1 and level 2 MI training. While staff did not submit session recordings in 2020, recording submissions, coding and coaching will restart in 2021. 6. Clinic staff will continue to participate in the Strengthening Treatment Access and Retention-Quality Improvement (STAR-QI) NIATx project with the Department of Health Services. The clinic staff continued to participate in the Strengthening Treatment Access and Retention-Quality Improvement (STAR-QI) NIATx project with the Department of Health Services. The Wisconsin STAR-QI Program began in October 2006 as a three-year grant from the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA). The purpose of the grant was to use the Network for the Improvement of Addiction Treatment (NIATx) Quality Improvement Model to improve organizational processes at the state and treatment agency level to impact client access to and retention in outpatient substance abuse treatment services. The STAR-QI quality improvement projects aim to:  Reduce the wait time between a client’s first request for service and the first treatment session  Reduce client no-shows  Increase addiction treatment centers’ admissions  Increase the treatment continuation rate between the first and fourth treatment sessions 7. Clinic staff will continue to utilize the Brief Addiction Monitor (BAM) and Patient Health Questionnaire-9 (PHQ-9) to track client progress in treatment. PHQ-9 scores will decrease overall and BAM protective factors will increase overall. The clinic staff continued to utilize the Brief Addiction Monitor (BAM) and Patient Health Questionnaire-9 (PHQ-9) to track client progress in treatment. PHQ-9 scores decreased overall and BAM protective factors increased overall. These key outcome indicators were met. a. Patient Health Questionnaire (PHQ-9): The PHQ-9 is a multipurpose tool utilized for screening, diagnosing monitoring, and measuring the severity of depression. It rates the frequency of symptoms which factors into the scoring severity index. Question 9 of the tool screens for the presence and duration of suicidal ideation. A non-scored follow-up question assigns weight to the degree to which symptoms of depression have affected the client’s level of functioning. b. Brief Addiction Monitor (BAM): The Brief Addiction Monitor is a 17-item monitoring tool that covers important substance use-related behaviors to support measurement-based care and outcomes assessment. Of the 17 questions, 4 are specific to alcohol or drug use. The remaining questions address aspects related to substance use, recovery, and treatment that include several life areas considered important for a multidimensional assessment of substance abusing clients and include interpersonal relationships, psychological/medical problems, and finances. The BAM measures three summary factors: Recovery Protection, Physical and Psychological Problems, and Substance Use and Risk. 8. Clinic staff will continue to build on current knowledge of opiate addiction and how to best serve clients by participating in substance use training and opioid forums throughout 2020. The clinic staff continued to build on current knowledge of opiate addiction and how to best serve clients by participating in substance use training and opioid forums throughout 2020. Training included (but not limited to): a. Wisconsin ASAM Training b. The Statewide Mental Health and Substance Abuse Conference c. The Wisconsin Statewide Substance Use Prevention Conference Evidenced-Based Practices Utilized in 2020 1. Dialectical Behavior Therapy (DBT) is a cognitive-behavioral treatment that was originally developed to treat chronically suicidal individuals diagnosed with borderline personality disorder (BPD) and it is now recognized as the gold standard psychological treatment for this population. Also, research has shown that it is effective in treating a wide range of other disorders such as substance dependence, depression, post- 54

traumatic stress disorder (PTSD), and eating disorders (http://behavioraltech.org/resources/whatisdbt.cfm). 8 of the 10 Clinic Therapists have been trained in providing dialectical behavior therapy. 2. Motivational Interviewing (MI) is a goal-directed, client-centered counseling style for eliciting behavioral change by helping clients to explore and resolve ambivalence. The operational assumption in MI is that ambivalent attitudes or lack of resolve is the primary obstacle to behavioral change so that the examination and resolution of ambivalence become its key goal. (http://www.nrepp.samhsa.gov/ViewIntervention.aspx?id=346). The clinic is utilizing this therapy protocol in both group and individual sessions. Clinic staff received intensive motivational interviewing training by MINT trainers throughout since 2014, and will continue throughout 2021. 3. Medication-Assisted Treatment for opioid addiction via the use of Buprenorphine, Vivitrol, and Naltrexone. (http://www.ncbi.nlm.nih.gov/books/NBK64164/). In 2017, the clinic ran four different treatment groups, specific for clients prescribed Buprenorphine. There were a total of 186 people receiving suboxone at some point in 2020. 4. Cognitive Behavior Therapy (CBT) is based on the scientifically supported assumption that most emotional and behavioral reactions are learned. Therefore, the goal of therapy is to help clients unlearn their unwanted reactions and to learn a new way of reacting. (http://www.nacbt.org/whatiscbt.htm). All clinic staff persons were trained in cognitive behavior therapy and CBT is used in both group and individual sessions. 5. Collaborative Assessment and Management of Suicidality training (CAMS). CAMS is a therapeutic framework for suicide-specific assessment and treatment of a client’s suicidal risk. CAMS is first and foremost a clinical philosophy of care. It is a therapeutic framework for suicide-specific assessment and treatment of a patient’s suicidal risk. It is a flexible approach that can be used across theoretical orientations and disciplines for a wide range of suicidal patients across treatment settings and different treatment modalities. The clinician and patient engage in a highly interactive assessment process and the patient is ultimately engaged in the development of their treatment plan. Every session of CAMS intentionally involves the patient’s input about what is and is not working. All assessment work in CAMS is collaborative; the patient is said to be a co-author of their treatment plan (http://cams- care.com/cams/?pgnc=1). 6. Trauma-Focused Cognitive Behavior Therapy (TF-CBT) is a components-based model of psychotherapy that addresses the unique needs of children with PTSD symptoms, depression, behavior problems, and other difficulties related to traumatic life experiences. TF-CBT addresses the multiple domains of trauma impact including but not limited to Posttraumatic Stress Disorder (PTSD), depression, anxiety, externalizing behavior problems, relationship and attachment problems, school problems, and cognitive problems. TF- CBT includes skills for regulating affect, behavior, thoughts and relationships, trauma processing, and enhancing safety, trust, parenting skills, and family communication. (http://www.nctsn.org/sites/default/files/assets/pdfs/tfcbt_general.pdf). Two of the Clinic Therapists are certified in providing trauma-focused cognitive behavior therapy. 7. Cognitive Behavior Therapy for Chronic Pain--Cognitive-behavioral therapy (CBT) has become a first-line psychosocial treatment for individuals with chronic pain. Evidence for efficacy in improving pain and pain- related problems across a wide spectrum of chronic pain syndromes has come from multiple randomized controlled trials. CBT has been tailored to and found beneficial for, special populations with chronic pain, including children and older adults. CBT is moderately effective in reducing pain scores while avoiding or reducing the opioid risks of overuse, addiction, overdose, and death. It can be used as a standalone treatment; in combination with other treatments, including effective non-opioid medications; or as part of efforts to reduce the opioid doses required to control chronic pain. https://www.apa.org/pubs/journals/releases/amp-a0035747.pdf https://www.sciencedaily.com/releases/2017/11/171109131231.htm

8. The Cognitive-Behavioral Interventions for Substance Use (CBI-SU) curriculum is designed for individuals that are moderate to high need in the area of substance abuse and well suited for criminal justice populations. The curriculum can be delivered as a stand-alone substance abuse intervention, or incorporated into a larger program, particularly those designed for clients in the corrections system. As the name of the curriculum suggests, this intervention relies on a cognitive-behavioral approach to teach participants strategies for avoiding substance abuse. The program places heavy emphasis on skill-building activities to assist with cognitive, social, emotional, and coping skill development. Such cognitive- behavioral strategies have routinely demonstrated high treatment effects, including when used with a correctional population. The University of Cincinnati (UC) serves as the sole owner and proprietor of the copyright in the CBI-SA manual and training program. An adolescent version is also available. https://cech.uc.edu/content/dam/refresh/cech-62/ucci/overviews/cbi-su-overview.pdf 9. Mindfulness-Based Relapse Prevention -- (MBRP), a mindfulness-based aftercare approach, integrates core aspects of RP with practices adapted from MBSR (mindfulness bases stress reduction) and MBCT (mindfulness-based cognitive behavior therapy). Identification of high-risk situations remains central to the treatment. Participants are trained to recognize early warning signs for relapse, increase awareness of internal (i.e., emotional and cognitive) and external (i.e., situational) cues previously associated with substance use, develop effective coping skills, and enhance self-efficacy. Mindfulness practices included in MBRP are intended to raise awareness of triggers, monitor internal reactions, and foster more skillful behavioral choices. The practices focus on increasing acceptance and tolerance of positive and negative physical, emotional, and cognitive states, such as craving, thereby decreasing the need to alleviate associated discomfort by engaging in substance use. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3280682/#R24 2021 Goals: 1. The outpatient clinic children’s therapists will be trained in DBT-C. 2. Clinic staff will continue to participate in Healthy Minds at Work. 3. Clinic staff will continue to build on DBT skills in 2021 by attending agency training, participating in DBT consult group, and attending outside DBT training as appropriate. 4. Clinic staff will submit session recordings to be coded for efficiency in Motivational Interviewing skills and continue to build on MI skills throughout 2021. 5. Clinic staff will continue to participate in the Strengthening Treatment Access and Retention-Quality Improvement (STAR-QI) NIATx project with the Department of Health Services. 6. Clinic staff will continue to utilize the Brief Addiction Monitor (BAM) and Patient Health Questionnaire-9 (PHQ-9) to track client progress in treatment. PHQ-9 scores will decrease overall and BAM protective factors will increase overall. 7. Clinic staff will continue to build on current knowledge of opiate addiction and how to best serve clients by participating in substance use training and opioid forums throughout 2021.

DETOXIFICATION SERVICES PUBLIC INTOXICATION DATA FOR JEFFERSON COUNTY Under Wisconsin statutes (51.45), a person incapacitated by alcohol can be placed under protective custody by a law enforcement officer and taken to an approved detoxification facility. Before discharge, the individual is informed of the benefits of further diagnosis and appropriate voluntary treatment. Upon discharge from such facility, our department is then responsible for arranging transportation for these people, whether it’s via Human Services staff or communicating with and arranging for family to provide transportation. If there is a concern about the individual’s well-being, department staff meet with the individual to complete an assessment and the appropriate referral is made; which can be emergency detention, voluntary hospitalization, residential treatment, intensive outpatient program, or outpatient services to include individual and possibly group therapy.

Detoxification Data 2013 2014 2015 2016 2017 2018 2019 2020

Admissions 89 75 86 94 130 99 63 67

Individuals 67 58 70 77 103 86 54 53

Individuals with multiple admissions 12 14 9 9 20 9 6 6

Days 114 109 108 112 157 117 67 80

Total cost of detoxification services $47,742 $48,500 $48,397 $49,544 $72,729 $57,503 $33,598 $41,115

All persons who enter detox services are offered substance use treatment. In reviewing individuals with multiple detoxification admissions; 4 of the 6 are known to have participated in some level of substance abuse treatment. INTOXICATED DRIVER PROGRAM Counties are mandated to provide an Intoxicated Driver Program (IDP) (HFS62). Each county is responsible for establishing and providing substance use assessments of drivers who have received an Operating While Intoxicated (OWI) conviction. An OWI conviction includes operating a motor vehicle while under the influence of alcohol, controlled substances, or other drugs. An OWI assessment can be ordered by the court or the Department of Transportation (DOT). The IDP assessor completes a personal assessment with the consumer using the Wisconsin Assessment of the Impaired Driver tool (WAID). A Driver Safety Plan (DSP) is developed based on the results of the assessment. A consumer can be referred to and required to participate in either driver safety education (Group Dynamics) through a local tech school if a substance use disorder is not identified or individual substance abuse treatment if a substance use disorder is identified. The individual is responsible for completing the DSP within a year. Failure to complete the driver’s safety plan will result in the driver’s license being revoked or in some cases, extended loss of licensure. In addition to completing the assessments, the assessor is responsible for monitoring the individual’s compliance with the DSP and reporting status updates to the DOT. In 2020, the IDP program completed 276 assessments and Driver Safety 2020 Plans. Of those assessments, 166 were first-time OWI convictions. This st number accounts for 60% of the assessments. Fifty-seven had their second 1 Offense 166 nd OWI conviction, 30 had three lifetime OWI convictions, 15 had four lifetime 2 Offense 57 OWI convictions, and eight had five or more lifetime OWI convictions. 3rd Offense 30 Group Dynamics is a 24-hour education program for first-time offenders. 4th Offense 15 Multiple Offenders is a 36-hour education program for individuals with more 5th Offense or more 8 than one OWI offense. One hundred and twenty-seven offenders were Total 276 referred to Group Dynamics and seven offenders were referred to the Multiple Offender Program. A total of 142 individuals were referred to outpatient substance abuse treatment. Of those individuals referred to treatment, 74 were referred to a private outpatient clinic in the community and 68 were referred to the outpatient clinic at Jefferson County Human Services.

COMPREHENSIVE COMMUNITY SERVICES PROGRAM (CCS) ~Providing qualifying consumers with services to move forward in their recovery goals. ~ The Jefferson County Comprehensive Community Services Program (CCS) completed its thirteenth full year. First certified in February 2006, Jefferson County’s CCS program was granted a two-year license in March 2007. This license has been renewed every two years, most recently in March 2019. Program Description CCS is a voluntary, recovery-based program that serves children (0-18), adults (18-62) and senior citizens (63- 100) with serious mental health and/or substance abuse disorders. As stated on the State’s Bureau of Mental Health Prevention Treatment and Recovery website, CCS services reduce the effects of an individual’s mental health and/or substance abuse disorders, assists people in living the best possible life, and helps participants on their journey towards recovery. CCS offers an array of psychosocial rehabilitative services which are tailored to each individual consumer. These services include: screening and assessment; service planning; service facilitation; diagnostic evaluations; medication management; physical health monitoring; peer support; individual skill development and enhancement; employment related skills training; individual and/or family psychoeducation; wellness management and recovery/recovery support services; psychotherapy and substance abuse treatment. Key Outcome Indicators For the 2020 year, the CCS goal was to maintain the percent of service plan objectives accomplished at 72%. The overall percentage of service plan objectives accomplished in 2020 was 89%. Eighty-eight percent of the objectives for children were accomplished and ninety percent of objectives were met by adults in the program. The CCS team will strive to maintain the percent of service plan objectives accomplished at 72%. All CCS staff worked on becoming proficient in the use of their Motivational Interviewing (MI) skills by attending MI trainings offered and MI coaching sessions. Staff continued to implement Cognitive Behavioral Therapy skills to assist with treating individuals with an array of diagnosis. Four of the CCS staff participated in the year-long learning collaborative which focused on the evidence based practice of Trauma Focused Cognitive Behavioral Therapy (TF-CBT) to use with children age 3-17 who have experienced or been exposed to trauma. In addition, eight CCS staff participated once per month in the TF-CBT clinical consultation group. Most staff utilized Dialectical Behavioral Therapy (DBT) skills during treatment. Twelve CCS staff participated in a DBT consultation group at our agency which meets weekly and these staff implemented DBT therapy into consumer service plans. The CCS team also participated in agency trainings focusing on learning DBT skills. One CCS supervisor began a six-month DBT-C learning collaborative, (an evidence based practice providing treatment to individuals between the ages of 7-12) focused on integrating this evidence based practice into CCS work. In addition, this supervisor brought the material back and has been incorporating this knowledge with seven CCS staff. Each of these staff will be expected to carry out DBT-C as an evidence-based practice with families. Four staff are nationally certified Family Centered Treatment clinicians which allows for them to utilize this evidence based model to assist with reunification and prevent out of home placements. One staff is working towards national certification and is compliant with all training timelines. One staff is certified as a Family Centered Treatment Supervisor and is also working towards becoming a nationally certified Level Two Family Centered Treatment clinician. All five Family Centered Treatment staff have actively implemented this model throughout the year. They have successfully discharged seventeen families from the program and maintained an in-home placement rate of 82%. General Data During 2020, 226 consumers ranging in age from 5 to 68 received services. This is an increase of fifty-nine in the number of people served in 2019. Throughout 2020, 97 new consumers were admitted and 58 consumers were discharged. Of the consumers admitted to the program, 55 were children and 42 were adults. Of the 58 consumers discharged, 29 were children and 29 were adults. Consumers had diagnoses of: schizophrenia, schizoaffective disorder, delusional disorder, bipolar disorder, major depression, disruptive mood dysregulation disorder, borderline personality disorder, post-traumatic stress disorder, various anxiety disorders, reactive attachment disorder, attention deficit hyperactivity disorder, obsessive compulsive disorder, conduct disorder, oppositional defiant disorder, intermittent explosive disorder, eating disorders, adjustment disorders, substance use disorders, cognitive disorders and autism. The CCS staff consists of a Psychiatrist, CCS Manager, three CCS Supervisors/Mental Health Professionals (One for the child and adolescent team, one for the family centered treatment team and one for the adult team), sixteen full time CCS service facilitators, four full time CCS family centered treatment psychotherapists, three full time psychosocial rehabilitation providers, and two full time administrative assistants. Consumer Satisfaction The CCS program conducts consumer satisfaction surveys for consumers and their families who have been enrolled in the CCS program for a minimum of six months. In 2020, there were 124 eligible consumers for these surveys of which we received 33 responses The CCS program conducted an adult consumer survey for adults aged 18 and older to measure the consumer satisfaction of our program regarding a positive experience. We had 18 adult respondents out of 70 who were eligible this year. Below is the means and percentages table which breaks the survey down into the following categories: overall mean, satisfaction, participation, access, outcomes, functioning, connectedness and quality. The mean and scale values range from 1.0 to 5.0. The item wordings in all statements are positively phrased, so a value closer to 1.0 represents a more positive experience. All categories remain at or below a mean score of 2.6 along with 88.9% of consumers had a mostly recovery oriented experience. Means and Percentages for Adult (aged 18 and older) Consumer Satisfaction Survey Scales

Adult Scale 1 Scale 2 Scale 3 Scale 4 Scale 5 Scale 6 Social Scale 7 overall mean Satisfaction Participation Access Outcomes Functioning Connectedness Quality

Average for all 1.9 1.5 1.4 1.7 2.4 2.6 2.3 1.4 consumers

% with mostly recovery oriented experience 88.9% 88.9% 88.9% 83.3% 55.6% 55.6% 61.1% 100%

% with mixed 11.1% 11.1% 11.1% 16.7% 38.9% 22.2% 33.3% 0.0% experience

% with less 0.0% 0.0% 0.0% 0.0% 5.6% 22.2% 5.6% 0.0% recovery oriented experience The CCS program conducted a Youth Consumer survey for youth aged 13-17 to measure the consumer satisfaction of our program regarding a positive experience. We had 9 Youth respondents out of 31 who were eligible. Below is the means and percentages table which breaks the survey down into the following categories: overall mean, Satisfaction, Participation, Access, Culture, Outcomes, and Social Connectedness. The mean and scale values range from 1.0 to 5.0. The item wordings in all statements are positively phrased, so a value closer to 1.0 represents a more positive experience. The Youth overall mean score, as well as all categories remain at or below a mean score of 2.1 along with 88.9% of youth consumers had a mostly recovery oriented experience.

Means and Percentages for YOUTH (aged 13-17) Consumer Satisfaction Survey Scales

YOUTH overall Scale 1 Scale 2 Scale 3 Scale 4 Scale 5 Scale 6 Social mean Satisfaction Participation Access Culture Outcomes Connectedness

Average for all 1.6 1.5 1.6 1.4 1.2 2.1 1.3 consumers % with more positive experience 100% 100% 88.9% 77.8% 100% 66.7% 100% % with mixed 0.0% 0.0% 11.1% 22.2% 0.0% 33.3% 0.0% experience % with less positive 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% experience The CCS program conducted a Family survey for children aged 12 and younger to measure the family satisfaction of our program regarding a positive experience. We had 6 family respondents out of 23 who were eligible. Below is the means and percentages table which breaks the survey down into the following categories: overall mean, Satisfaction, Participation, Access, Culture, Outcomes, and Social Connectedness. The mean and scale values range from 1.0 to 5.0. The item wordings in all statements are positively phrased, so a value closer to 1.0 represents a more positive experience. All categories remain at or below a mean score of 2.4 along with 83.3% of youth consumers had a mostly recovery oriented experience. Means and Percentages for FAMILY (aged 12 & younger) Satisfaction Survey Scales

overall Scale 1 Scale 2 Scale 3 Scale 4 Scale 5 Scale 6 Social mean Satisfaction Participation Access Culture Outcomes Connectedness

Average for all 1.8 1.4 1.5 1.5 1.5 2.4 2.1 consumers

% with more 83.3% 100.0% 100.0% 100.0% 100.0% 33.3% 66.7% positive experience % with mixed 16.7% 0.0% 0.0% 0.0% 0.0% 50.0% 33.3% experience % with less positive 0.0% 0.0% 0.0% 0.0% 0.0% 16.7% 0.0% experience Administrative In 2020 the CCS program was reimbursed $2,968,248 from Medicaid for services provided to consumers. This is an increase of $669,574 from 2019. CCS also received a reimbursement of $278,965 for the reconciliation from the 2019 year. In addition, CCS recovered $10,840 from MA in 2020 for services provided in 2019. We continue to focus on compliance, collaborative documentation, training and increasing our network of community providers. CCS lost eight full-time employees with one having retired, three changed positions within the county and four left the agency. This involved recruiting, interviewing and training new staff. Children In 2020, the CCS program served 112 children, ages 5 to 17; of these children, 65 were males and 47 were females. Fifty-five children were admitted to CCS and 29 were discharged. Of the 29 discharged, 8 children moved out of the county, 11 children chose to withdraw from the program and 10 children met their discharge criteria. During 2020, 4 children had a mental health commitment order. One mental health commitment order ended in 2020.

There were a total of 18 children admitted for psychiatric hospitalizations, several more than once. Fifteen of the children had voluntary admissions. There were 7 children who were admitted involuntarily to the hospital. Three of these children were emergency detained and four children were returned to a more restrictive environment per their mental health commitment order. In 2020, the average number of children/adolescents who were interested and looking for work during the first half of the year was about one per month. Throughout the second half of the year, the average number of children/adolescents who were interested and looking for work on average was fourteen per month. Two consumers volunteered. The number of children/adolescents who held a part time job in 2020 was about seven per month. The number of children/adolescent who held a full time job in 2020 was about three per month. Family Centered Treatment (FCT) Jefferson County continues to implement Family Centered Treatment (FCT) through the CCS program. FCT is an evidenced based practice which is home, community, and collaborative based while being committed to family preservation and reunification. FCT addresses the needs of a family as a whole, recognizing that what affects one family member affects all family members, through a more intensive treatment to strengthen the rapport with the family which includes skill development, coaching, therapeutic enactments, and intergenerational trauma treatment. FCT allows for family systems to restructure critical areas of functioning and utilizes emotions to strengthen attachments, as well as, addresses trauma through a systemic and intergenerational lens while being broad enough to be able to provide services for a variety of families and youth. FCT enrolled and served thirty five Jefferson County families in 2020. The Family Assessment Device (FAD) is a fidelity document which is utilized to track outcomes related to family functioning. The FAD is implemented at enrollment, 12 weeks in and at discharge. FCT staff completed the FAD with all enrolled and discharged families. In 2020 there were seventeen discharges. Average FAD scores at time of enrollment were 2.25, average FAD scores at discharge were 1.68 (29% decrease). Scores under 2.00 are indicative of typical family functioning.

The FCT team is comprised of one supervisor and four clinicians, which totals five clinicians implementing the FCT model with families. In June 2020 the FCT team filled a vacant position. The FCT program continues to focus on training and implementation of the Family Centered Treatment model with all five staff providing services.

Jefferson County FCT 2020 Program Development - Four Level I FCT Clinicians - One FCT Supervisor - In progress: o One Level II FCT Clinician o One Level I FCT Clinician Staff completing in progress trainings are meeting all CCS/FCT training timelines and are able to implement the FCT model with families. The FCT team continues to receive weekly consultation and support from the FCT Foundation which has allowed for staff to enhance knowledge of model fidelity and clinically consult regarding acute cases to ensure appropriate model delivery. The FCT program underwent an annual Licensing Review in 2020 which included analysis of the following; updated Implementation Driver Assessment, review of client records to include dosage, service notes, and fidelity, all supervision notes for Jan 2020-March 2020 for all FCT clinicians, Family Centered Evaluation (FCE) per FCT clinician, updated Fidelity Tracker/FACT, team meeting minutes, contact information for collateral stakeholders, Family Satisfaction Survey results and all staff certifications as well as timeline of completion. Results from this reviewed and analyzed by the FCT Foundation include the following:

Installation drivers review three main categories (leadership, competency and organizational) with 10 subsections to provide feedback regarding current infrastructure with regards to implementing and sustaining any evidence-based practice in the human services field. Throughout 2020 all drivers were implemented and as a result all elements are currently in place, partially in place or in development. The FCT Foundation Annual Licensing Review also included the following key data analysis: - 82% of families maintained placement with family of origin. - 75% of families surveyed agreed that FCT has strongly improved family dynamics. - 73% of families have had 20 or more direct contacts. - The average length of treatment is 157 days.

Adults/Elderly In 2020, the CCS program provided services for 114 adults/elderly aged 18-68. Out of these 114 consumers, five were considered elderly. Of these adults/elderly, 65 were males and 49 were females. In 2020, 42 adults/elderly were admitted to CCS and 29 were discharged. Nine individuals moved out of county, 10 individuals withdrew from CCS, as they did not want to continue receiving this level of intense involvement. Five individuals were discharged for successfully meeting discharge criteria, some of whom went on to receive outpatient therapy services. Four consumer needed a higher level of treatment and one consumer passed away. During 2020, 22 adults were under a chapter 51 mental health commitment order. Eleven individuals were on existing orders prior to CCS enrollment. Eleven orders were able to expire in 2020. There were 9 voluntary psychiatric admissions. There were 7 involuntary psychiatric admissions. There were three emergency detentions. There were four return to more restrictive environments. Of the total adult/elderly consumers enrolled in CCS in 2020, an average number of adult/elderly consumers looking for employment was three on a monthly basis from January to June. The average number of consumers looking for employment during the second half of the year (July to December) was seventeen per month. Two consumers volunteered in 2020. The average number of adult/elderly consumers who held a part time job in 2020 was thirty-one consumers on a monthly basis. The average number of adult consumers who held a full time job in 2020 was six on a monthly basis. Service Plans/Reviews as it pertains to all CCS consumers Consumer service plans are reviewed every six months. There were 228 service plan reviews for the 2020 year. Eighty-nine percent of consumer objectives were met. One hundred percent of the objectives were met for 147 of these service plan reviews. The children met 88% of their objectives throughout 2020. There were a total of 107 children service plan reviews for the 2020 year. One hundred percent of the objectives were met for 70 of these service plan reviews. The adults/elderly met 90% of their objectives throughout 2020. There were a total of 121 adult service plan reviews for the 2020 year. One hundred percent of the objectives were met for 77 of these service plan reviews. We continued to use person centered planning when developing service plans with consumers and their recovery team. This approach to conducting the meeting and writing the plans has had a positive response from consumers, family members, contracted providers, and natural supports. Consumers have reported feeling in charge of their services and being able to direct the team in their needs. Family members and providers feel that they can easily read and understand the plan. The plans also inform the consumer and recovery team members of the services they are to receive. This increases accountability since everyone on the team knows his or her responsibility in assisting the consumer in building recovery. Additional service providers The Jefferson County CCS program along with our regional partners, Rock and Walworth counties, contracted with 32 organizations throughout 2020. Eleven of these organizations were new CCS contracts in 2020 with three developed by Jefferson County CCS program. Jefferson County CCS utilized 14 of these organizations to provide services to Jefferson County consumers. Because therapists, psycho-social rehabilitation workers, peer support specialists, occupational therapists and parent coaches employ psychosocial rehabilitation practices, their services were billable to Medical Assistance through the CCS program.  Twenty-one sole propietors provided contracted therapy services for Jefferson County CCS program. These individuals provided a mix of agency and in-home psychotherapy, wellness management and recovery, individual and/or family psychoeducation, individual skill development and enhancement, diagnostic evaluation, service planning and service facilitation.

CCS Coordinating Committee The CCS Coordinating Committee is currently comprised of consumers, staff, and individuals from the community. During 2020, the committee met quarterly via Zoom (due to COVID-19 precautions) for scheduled 1.5 hour long meetings. The meetings have focused on updates regarding CCS programming and regionalization, community events, and community resources. The coordinating committee additionally reviewed the CCS satisfaction surveys and CCS 2019 annual report information during the year. The CCS Coordinating Committee submitted the following recommendations for the CCS program for 2020: continued fundraising efforts to support community activities, food for groups and committee meetings and a possible summer picnic, development of a newsletter with consumer contributions to be distributed quarterly to CCS consumers and increased opportunities for group activities for CCS consumers to engage in socializing and networking. CCS Jefferson, Rock & Walworth (JRW) Region During 2020, our CCS program worked with Walworth County and Rock County (our regional partners) to continue to focus on consumer satisfaction and progress toward consumers’ desired outcomes. We continue to utilize a tracking system for additional identified quality improvement areas and review the data with the regional coordination committee and integrate the feedback into future development of quality improvement plans/processes. As part of the regionalization efforts, the JRW leadership team informed all staff and providers of training put on by the State throughout the year, as well as any additional training offered by provider organizations. NIATx 2019-2020 #1 “Change Your Crisis, Change Your Life” The goal for CCS was, by September 30, 2020, to develop and implement a tracking system to document that a minimum of 70% of consumers partificpated in the development of their crisis plan and received a copy of it. CCS staff met with county department leaders to discuss processes to assist with ensuring consumers have access to their developed crisis plans based on current technology and programs utilized. Through ongoing systemic change meetings, it was determined that the development of two forms would be necessary. CCS staff developed several new forms to assist with tracking the following: 1. Consumer Acknowledgement of Development of Crisis Plan. 2. Consumer Acknowledgement of Receipt of Crisis Plan. Through ongoing change team meetings CCS was able to disburse these newly developed forms and tracking system to CCS staff to implement with consumers. At the time of project completion the CCS program exceeded set goal and 84% of all open consumers had completed newly developed forms which indicated that they had actively participated in the completion of their crisis plan and received a copy of this document. Due to the COVID-19 pandemic a face to face presentation was not possible, however Change Team leaders and members compiled virtual presentation which was distributed to all STAR QA-QI members. NIATx 2020-2021 #2 “Documentation Decrease to Increase Caseload” In October 2020 CCS identified the goal of increasing access to treatment for services through increasing number of individuals served. Barriers to this goal were reviewed and it was identified that time spent correcting documentation errors were limiting caseload size. In order to increase access to treatment for community members it was determined that this NIATx project would focus on increasing caseloads by 5% through the decrease of documentation errors. Rapid cycles thus far have included obtaining and analyzing baseline data which includes review of documentation errors, current caseload size as well as meeting with DHS to ensure compliance with all NIATx requirements. In 2020 all documentation errors were reviewed and a training was compiled for CCS staff as well as stakeholders to review identified areas of concern. In July there were 376 documentation errors out of compliance with JCHSD or MA guidelines. Following the development and implantation of a virtual training August documentation errors decreased to 76. 64

The CCS NIATx change team will continue to review documentation errors as well as caseload size to identify correlating data regarding the decrease in time spent on documentation errors to allow for increasing caseload size in order to increase access to treatment for community members. This change project is expected to be completed in September 2021. REVIEW OF CCS PROGRAM GOALS FOR 2020 1. Key Outcome Indicator: 72% of all service plan objectives are met. (Accomplished) 2. The CCS JRW region will continue to develop contracts with providers who utilize evidenced based practices to serve the needs of the CCS program. (Accomplished) 3. CCS staff will introduce myStrength to all CCS consumers age 13 and older and incorporate myStrength into sessions with consumers. CCS staff will introduce myStrength to parents/caregivers of all aged consumers as well. (Accomplished) 4. Beginning May 1, 2020, once per month at team meetings staff will participate in a compassion resiliency activity. (There were two CCS Compassion Resilience meetings scheduled that took place on a monthly basis. Beginning in October 2020, staff were given the opportunity to complete the Healthy Minds @ Work challenge (from Healthy Minds and the work of Richard Davidson). Staff were able to complete multiple challenges and mindfulness activities during their work day to assist in increasing staff resilience). 5. Implement DBT modality of treatment for consumers who meet criteria and track outcomes using one of the following: Difficulties in Emotion Regulation Scale (DERS); Subjective Units of Distress Scale (SUDS) and/or Borderline Symptom List 23 (BSL-23). Continue weekly DBT consultation group. (DBT consult group was continued on a weekly basis throughout all of 2020. SUD scales were used with consumers who participated in DBT-PE. DERS were not completed or tracked on a regular basis and this is a 2021 goal). 6. Continue to provide a DBT skills training group for adolescents throughout 2020. (Due to COVID-19 in person skills groups were not held due to the health and safety concerns and in accordance with JCHSD guidelines. We were unable to provide this service via telehealth this year). 7. Continue to provide a DBT skills training group for adults throughout 2020. (Due to COVID-19 in person skills groups were not held due to the health and safety concerns and in accordance with JCHSD guidelines. We were eventually able to get provide this service via telehealth). 8. Implement a Dialectical Behavioral Therapy skills group targeted for systemic family skill development in a group based environment. (Due to COVID-19 in person skills groups were not held due to the health and safety concerns and in accordance with JCHSD guidelines. We were unable to provide this service via telehealth this year). 9. Incorporate family education into DBT treatment, including offering bi-weekly psychoeducation sessions to parents/caregivers of children who are using DBT skills. (Accomplished) 10. Implement Family Centered Treatment into the CCS program and track outcomes with the Family Assessment Device (FAD). (Accomplished) 11. Maintain all Family Centered treatment (FCT) licensing implementation requirements to provide FCT through the CCS program. (Accomplished) 12. Implement TF-CBT modality of treatment for consumers age 3-17 who have been exposed to or experienced trauma and track outcomes via the UCLA based PTSD reaction index. Continue once monthly TF-CBT consultation group. (Accomplished) 13. Implement a formalized screening tool for consumers experiencing substance use/abuse during the CCS comprehensive assessment. (This will remain a goal for 2021). 14. Implement Incredible Years parenting skills with consumers. (Accomplished) 15. Ensure compliance in Medicaid billing requirements and documentation by reviewing progress notes weekly, discussing documentation during clinical supervision and team meetings, continuing collaborative documentation, training new staff in regards to proper documentation and on-going monitoring of charts. (Accomplished) 16. Implement two quality improvement projects using the NIATx model by December 31, 2020. (Accomplished)

17. Continue to track outcomes for all CCS consumers and compare data from previous years to establish services for 2021. (Accomplished) 18. Present the 2019 annual report to the CCS Coordinating Committee by December 31, 2020. (Accomplished) CCS PROGRAM GOALS FOR 2021 1. Key Outcome Indicator: 72% of all service plan objectives are met. 2. The CCS JRW region will continue to develop contracts with providers who utilize evidence based practices to serve the needs of the CCS program. 3. CCS staff will introduce myStrength to all CCS consumers age 13 and older and incorporate myStrength into sessions with consumers. CCS staff will introduce myStrength to parents/caregivers of all aged consumers as well. 4. Implement DBT modality of treatment along with DBT for Substance Use Disorders for consumers who meet criteria and track outcomes using one of the following: Difficulties in Emotion Regulation Scale (DERS) and/or Subjective Units of Distress Scale (SUDS). Continue weekly DBT consultation group. 5. Incorporate DBT-C for children and families that fit within the criteria for the evidence base. Begin to implement a screening tool to assist with measuring outcomes. 6. Continue to provide a DBT skills training group for adults. 7. Incorporate family education into DBT treatment, including offering bi-weekly psychoeducation sessions to parents/caregivers of children who are using DBT skills. 8. Implement Family Centered Treatment into the CCS program and track outcomes with the Family Assessment Device (FAD). 9. Maintain all Family Centered treatment (FCT) licensing implementation requirements to provide FCT through the CCS program. 10. Implement TF-CBT modality of treatment for consumers age 3-17 who have been exposed to or experienced trauma and track outcomes via the UCLA based PTSD reaction index. Continue once monthly TF-CBT consultation group. 11. Implement the use of the Brief Addiction Monitor (BAM) screening tool for consumers experiencing substance use/abuse during the CCS comprehensive assessment. 12. Implement the use of The ASAM Criteria Tool (American Society of Addiction and Medicine) to assess substance use patterns and provide recommendations for levels of care to best support consumer’s recovery goals. 13. Ensure compliance in Medicaid billing requirements and documentation by reviewing progress notes weekly, discussing documentation during clinical supervision and team meetings, continuing collaborative documentation, training new staff in regards to proper documentation and on-going monitoring of charts. 14. Implement two quality improvement projects using the NIATx model by December 31, 2021. 15. Continue to track outcomes for all CCS consumers and compare data from previous years to establish services for 2021. 16. Present the 2020 annual report to the CCS Coordinating Committee by December 31, 2021. REVIEW OF CCS TRAINING GOALS FOR 2020 1. All newly hired CCS staff will be trained in the ACE study, as well as trained in how to implement the ACE questionnaire to assess risk and resiliency factors. (Newly hired staff were trained in the ACE study and were coached in completing ACE screening with consumers and/or their caregivers). 2. Family Centered Treatment (FCT) Supervisor will complete all training and certification requirements to become Level Two Family Centered Treatment certified. This will allow for FCT Supervisor to implement FCT unrestricted as well as clinically train and certify all Level One FCT clinicians. (In progress – FCT Supervisor continues to work towards completion of Level II Certification and has completed 76% of all check-offs. All training timelines are in compliance). 3. All FCT staff will complete and/or maintain all Family Centered treatment Level One national certification requirements to allow for the ongoing implementation of this evidenced based practice. (Four out of five FCT staff have obtained FCT Level I Certification. One staff is in compliance with all training timelines for certification). 66

4. Throughout 2020, FCT staff will facilitate and provide training to CCS staff to increase skill development related to systemic family functioning. This transfer of learning training will allow for FCT/CCS staff to enhance skills related to addressing and providing clinical enactments to families based on targeted areas of family functioning. (Accomplished) 5. Additional CCS staff will participate in the DBT intensive training in 2020. A portion of the CCS team will continue to participate in the DBT consultation group for DBT training/supervision and will implement these skills in sessions and/or groups. These staff will provide DBT skills training to the CCS team during team training meetings to assist all staff with enhancing their skills when working with consumers. Staff will utilize the DERS, SUDS and/or BSL-23 with consumers as a way to measure outcomes based DBT therapy and skills learned/used. (In progress - At the end of 2020, 11 CCS staff members were attending DBT Consult. During individual supervision, staff are discussing and/or receiving supervision on how to engage consumers in DBT skills. CCS staff who have not attended the DBT intensive training receive regular feedback on how to engage consumers in DBT skills to supplement their treatment). 6. The CCS child/adolescent team will begin to implement knowledge of DBT-C.: (In progress - DBT-C training was originally intended to take place in April 2020, with a follow up portion in October 2020. Due to COVID-19, this training was delayed until October 2020. One CCS supervisor attended this training and began a work group to teach Parent Management Training as it relates to DBT-C and implementing knowledge of DBT-C within CCS). 7. Throughout 2020, all CCS staff will tape one MI session with a consumer and participate in a coaching session with a CCS MI coach or national MINT trainer and develop goals to enhance MI proficiency. All CCS staff will participate in the Motivational Interviewing Learning Labs (MILLS) offered as a way to increase their knowledge and use of MI skills. All newly hired CCS staff will be trained in MI Basics. (All newly hired CCS staff attended MI Basics and completed one MI tape with feedback from the national MINT trainers). 8. All CCS staff providing services to adult consumers will be trained in the evidence based practice of Illness Management and Recovery and implement this with consumers. (This was not accomplished). CCS TRAINING GOALS FOR 2021 1. All CCS staff providing services to adult consumers will be trained in the evidence-based practice of Illness Management and Recovery and implement this approach with consumers. 2. All CCS staff will be trained in the AODA-focused BAM (Brief Addiction Monitor) assessment and will begin to administer this during initial comprehensive assessments and/or comprehensive assessment updates. 3. All CCS staff will attend a DERS assessment refresher training. 4. Staff working with consumers struggling with substance use disorders will be trained in the ASAM assessment and use this tool to assist in developing clinical recommendations for appropriate levels of care to receive substance use treatment. 5. Staff working with consumers struggling with substance use will either attend DBT SUD training or will be taught/shown the material from this training to incorporate into their clinical work. 6. CCS will develop a monthly, bimonthly, or quarterly internal meeting based on inclusion and diversity. 7. CCS staff will be trained in basic CBT components through individual and group supervision. 8. Throughout 2021, all CCS staff will tape one MI session with a consumer, participate in a coaching session with a CCS MI coach or national MINT trainer and develop goals to enhance MI proficiency. All newly hired CCS staff will be trained in MI Basics. 9. CCS staff will begin to implement DBT-C with identified families who fall within inclusion criteria for this evidence based practice. 10. All CCS staff will attend an ACE/Resilience refresher training. 11. All FCT staff will maintain necessary requirements to be Level One Certified through the Family Centered Treatment Foundation. 12. Eligible FCT staff will maintain necessary requirements to be certified as an FCT Supervisor through the Family Centered Treatment Foundation. 13. Eligible FCT staff will complete necessary training to become Level Two Certified through the Family Centered Treatment Foundation.

14. All CCS staff will attend ongoing monthly trainings provided through the Family Centered Treatment Foundation as schedules allow. 15. All CCS staff providing services to adults will be trained in Illness Management and Recovery and implement this evidence based practice with consumers.

COMMUNITY SUPPORT PROGRAM ~Advancing mental health services for people with severe and persistent mental illness~ The Community Support Program (CSP) is an evidenced based practice based on Assertive Community Treatment for people with severe and persistent mental illness such as Schizophrenia, Schizoaffective Disorder, Bipolar Disorder, and Major Depression. People served in CSP also have experienced difficulty in a range of life areas such as education, vocational, psychiatric, health, activities of daily living, financial, and social or family relationships. The goals of the program are to assist people in moving forward in their recovery by helping them to achieve goals identified. The services can be titrated up or down depending on the individuals’ current needs. The program strives to keep people in the community living the type of life they want to live. To achieve these goals the programs offers a variety of services including psychotherapy, group therapy, case management, crisis intervention, medication monitoring and support, vocational assistance, and psychosocial rehabilitation to assist people in meeting their needs. Individual treatment plans are developed to work toward the goals the person chooses. Services are provided by a team of professionals, as all mental health services are provided through the community support program as part of the model. This year was a challenging one for CSP due to the COVID pandemic. As part of the evidence based model, CSP services are primarily offered in consumers’ homes and other community locations such as schools, medical offices, employment sites, and local businesses. Due to the COVID pandemic and the efforts to stop the spread, the program changed its service delivery to primarily telehealth for a period of time. Since many people in CSP do not have access to the internet or smart phones, the majority of these services were offered via telephone. Consumers were seen outside or with PPE if the situation required it, such as crisis assessment, dropping medications and spending checks, and seeing people whose symptoms impacted their ability to have their services delivered via telehealth. Spring of 2020, was a learning time for everyone as policies changed, and as the guidelines to stop the spread of COVID morphed with the development of the pandemic. While there were challenges, there were also program gains. Services were even more closely monitored, natural supports and the individuals in the program own resources were developed. As is often is true with the people we serve, people in the program were shown to be very resilient and many made significant progress in their recovery within their new environment. As it became more difficult to admit people to hospitals and the Lueder Haus, people were challenged to manage symptoms in their home environment and gained more confidence in their own abilities to cope. In 2020, the CSP program served 145 individuals. There were 17 new admissions and 12 discharges. The team includes a psychiatrist, CSP Manager, 2 Clinical Coordinators, 11 CSP professionals, a mental health technician, a program assistant, and a part time nurse contracted through the health department. Three staff in CSP are also certified peer support specialists. The CSP serves consumers across the life span with the youngest person being thirteen and the oldest being several consumers in their seventies. Within the Assertive Community treatment model the team continues to provide a variety of evidence based practices. These include: 1. Motivational interviewing (MI): An evidence based approach used to enhance motivation for change in various areas including health, substance use, and life goals. All CSP staff are trained in motivational interviewing and provide this to each consumer in CSP to assist them in meeting their recovery goals. 2. Enhanced Illness Management and Recovery (E-IMR): An evidence based approach for people with a severe and persistent mental illness and substance use that focuses on education across a variety of topic areas, skill training, and works toward assisting people in meeting their goals. Three staff were trained in 2020 and attended a monthly learning collaborative. This will be further implemented in 2021 by training the rest of the staff and assessing people’s need for this intervention. 3. Dialectical Behavior Therapy (DBT): An evidence based practice to assist people in building a life worth living as well as addressing target behaviors such as suicidal ideation, acts of self-harm, and substance use. The treatment includes skills training, coaching calls, individual therapy, consultation group for

the people providing the therapy. All staff are trained to teach the skills and most consumers are offered some version of mindfulness and other pertinent skills. 4. Collaborative Assessment and Management of Suicidality (CAMS): All staff was trained in this assessment framework and all the people served by the program experiencing significant suicidal ideation are offered either CAMS or DBT. 5. Bucket Approach for Tobacco Cessation: All staff were trained in the Bucket Approach in 2020. The program received a Tobacco Integration award to assist in implementing tobacco cessation into their program. CSP offered people incentives for formulating a quit plan, setting a quit date, having a quit attempt, and quitting smoking for thirty days. Utilizing this approach the team was able to help seven people quit smoking. We again decided to implement the Recovery Oriented System Inventory (ROSI). The ROSI is the result of a research project that included consumers and non-consumer researchers and state mental health authorities who worked to operationalize a set of mental health system performance indicators for mental health recovery. The ROSI was developed over several phases with a focus group of consumers who were able to develop a 42 item self-report adult consumer survey. A factor analysis resulted in the domains of staff approach, employment, empowerment, basic needs, person centered, and barriers being able to be measured. The ROSI was found to be valid and reliable over the three phases of implementation. Thirty five individuals turned in the ROSI survey for 2020.

Means and Percentages for ROSI Consumer Survey Scales

ROSI Scale 1 - Scale 2 Scale 4 Scale 5 - Scale 6 Overall Person - Scale 3 - - Staff - Basic Mean Centered Barriers Empower Employ Approach Needs Average for All Consumers 3.3 3.4 1.8 3.1 2.7 1.5 3.1 % w/ Mostly Recovery-Oriented Experience 79.4% 85.3% 52.9% 76.5% 36% 75.8% 76.7% % w/ Mixed Experience 11.8% 11.8% 38.2% 17.6% 56% 15.2% 16.7% % w/ Less Recovery- Oriented Experience 0% 2.9% 8.8% 5.9% 8% 9.1% 6.7%

Note: Means can range from a low of 1.0 to a high of 4.0. However, item wording for the shaded scales are negatively phrased, so a low mean represents a more recovery-oriented experience (meaning the consumer disagreed with the negative statements.) In 2020, more consumers reported a more mixed recovery experience or a less recovery oriented experience than in the past. In part, this might be due to the implementation of telehealth, the postponement of activities for the people in the program, and more stringent guidelines on how services were implemented. The teams least recovery focused area is Employment. The team will attempt to address this need in 2021 by starting to implement Individualized Placement and Support Services, an evidenced based practice for employment for people with a severe and persistent mental illness. Some of the specific accomplishments for the year 2021 include: 1. One person moved out of a supported apartment placement and into her own apartment. 2. Two people stepped down from CBRF placement settings to supported apartments to work toward living independently.

3. There were only two Winnebago admissions for 2020 for people involved in CSP. Both of these people were out of county and sent to Winnebago without CSP input. 4. Only six people were returned to a more restrictive setting in 2020 down from eleven last year. Review of 2020 Goals: Meet key indicator outcome of: Assist consumers in meeting at least 70% of their treatment plan objectives. The team assisted the consumers in meeting 72.1% of their treatment plan objectives for 2020. For some of the people in the program, goals needed to be changed if they were linked to a community component but when this is factored in the result for 2020 is down only a bit from the 73% of goals achieved in 2019. Train clinical coordinators and CSP manager on reflective supervision. This training was not implemented in 2020 due to time constraints over the year with the changes and modifications to the program due to the pandemic. Begin the compassion resiliency material in monthly team meetings. The CSP manager and clinical coordinators did begin, during the summer of 2020, teaching the compassion resiliency material in a monthly team meeting. The material was discontinued at the end of 2020 when the county invested in the Healthy Minds at Work program to assist in staff wellness. Complete a NIATx project surrounding billing and note monitoring. NIATx is a continuous quality improvement protocal. A project focused on reducing the staff’s billing errors found in note monitoring was implemented in 2020. As four people were now doing the note monitoring, more time was able to be spent in reducing errors and helping the staff to do documentation correctly. A policy was developed, outlining the billing codes, locations, and other modifiers. The components of proper documentation were also developed and handed out to the staff. A team meeting was also later held to review billing components and to help the staff reduce errors. Billing errors spiked in early spring due to the frequent updates on the telehealth procedures. Errors reached a high of 410 notes in April, decreased to 205 in May, and by December the note monitoring errors were 81. This goal was completed. Run Motivational Interviewing boosters in monthly team meetings and code tapes of staff. This goal was only partially met. Two sets of Zoom Introduction to MI were run for new staff in March and April. Those tapes were coded and coaching sessions were done with staff. Some MI boosters were run but not each month as at the beginning of the year many team meetings were focused on problem solving as opposed to more advanced training for staff. Implement two new clinical coordinator positions and revise supervision policy. Two new clinical coordinators started on February first. The team was split into three segments and supervision rotated every four months. A new CSP log for team meetings was developed by MI, a spreadsheet to monitor supervision hours, and a new supervision policy was written as well. This goal was met. Update CSP policy and procedures. The CSP policy and procedures were updated and written in the new agency format. They were completed by the CSP state audit in September. Revise staff orientation to train new staff. Three new staff were hired in 2020 to work in CSP. Training for the new mental health technician was implemented using the new state training module offered through the behavioral health training partnership. Staff received daily meetings with the CSP manager to provide opportunities for learning and questions since few people were in the office to receive on-site guidance. This goal was met. Implement the clozapine finger prick test for CBC bloodwork. Materials were obtained to run the CBC bloodwork needed for clozapine management. The nurse was trained to utilize the machine. Results are sent directly to the clozapine management registry from the agency providing the materials. This process provided several efficiencies. The blood no longer needed to be taken to

Fort Hospital lab for analysis, staff no longer needed to track down missing lab results, and the staff no longer needed to enter the results into the registry. This goal was met. Goals for 2021 1. Learn more about Reflective Supervision and implement some of the techniques in individual supervision and team meetings. 2. Begin to implement an Individual Placement and Support employment program at CSP. 3. Help consumers to obtain 70% of treatment plan objectives as an outcome measure. 4. Conduct Assertive Community Treatment training for the team. 5. Train the Community Support Professionals in Brief Cognitive Behavioral Therapy for Suicide Prevention. 6. Provide additional staff training in Motivational Interviewing and role play its use in individual supervision. 7. Foster staff wellness by encouraging personal wellness plans and Healthy Minds at Work. 8. Continue to revise staff supervision materials for better tracking and professional development. 9. Utilize NIATx to further reduce billing errors from 2020 and improve efficiency. 10. Offer and record an E-IMR training for staff.

COMMUNITY RECOVERY SERVICES ~Providing qualifying consumers with services to move forward in their recovery goals~ Community Recovery Services provide eligible consumers with services to move forward in their recovery goals. The services provided are peer support, employment services and community living supportive services. The program is funded through Medicaid. In 2020, eleven consumers were served in the program. There were three admissions and five discharges. All sixteen consumers received community living supportive services. All of the consumers received supports in adult residential placements. Of the three discharges one was able to live in her own apartment, and two transferred to the Family Care program to receive other support there. One person voluntarily discharged as they did not want to remain in placement. The final person passed away. Although the program remains small in size, we have seen impressive outcome measures in the past several years with individuals successfully living more independently in the community. In 2020, the program met its goal of transitioning two people to a less restrictive setting, and one person moved to an independent setting. We continued to train and monitor providers for quality assurance in documentation for Medicaid. Quality was monitored and frequent contacts were made with providers to train, coach, and resolve problems.

Review of CRS goals from 2020: 1. Continue to train staff in the new documentation method and improve billing reimbursements over the course of the year as staff become competent in the new method. CRS providers were trained using SAMSHA materials. COVID negatively impacted the program with even higher staff turnover in the residential settings. This turnover resulted in staff not completing the training and not being able to bill. Billing for the year was lower but there were two fewer individuals in the program. 2. Move one consumer into independent housing in the community. One person moved out of placement and into her own independent setting. 3. Step down one consumer to a less restrictive setting that is in placement. Two consumers stepped down from a CBRF to a less restrictive setting in supportive apartments. All 2020 goals were accomplished.

CRS goals for 2021: 1. Improve the number of compliant notes from our existing providers. Meet with the current providers to provide additional training on documentation. 2. Move one consumer to a less restrictive setting. 3. Implement better tracking of training for CRS providers. This is the providers responsibility but is not consistently accuring. In 2021 we will develop and implement the tool for providers to use.

CHILD & FAMILY DIVISION ~ The Child and Family Division work together in genuine partnership with families, communities, and other agencies to provide support and services to assist children and families in reaching their full potential. ~

he Child and Family Division of Jefferson County Human Services is designed to provide interventions and services from birth to adulthood. These treatment-based services and interventions come in a T variety of forms provided by the following teams; Birth to Three, the Busy Bee Pre-school, Child Alternate Care, Child in Need of Protective Services, Access, Children’s Long Term Support, Coordinated Service Teams, Incredible Years, Intake, Youth Justice, and Restorative Justice Programs. These diverse teams that make up our Child and Family Division serve the residents of Jefferson County through a variety of multifaceted programs. The long-term goal across the division is to partner with the family to develop a comprehensive client-centered treatment plan that provides coaching and service provisions for long-term independent success. The primary focus of this division is to provide safety, permanence, and well-being across the continuum from birth to the age of the majority. New in 2020 was the addition of our Parents Supporting Parents Program (PSP) that was added to represent the voice of lived experience for current Child Protective Services (CPS) families. These former CPS involved parents known as Family Wellbeing Specialists (FWS), are highly trained staff that will assist current families in navigating the CPS system. Jefferson County is one of three sites in the state to receive this multi-year funding after a competitive award process, and our new Family Wellbeing Coordinator will play a vital role in training, site reporting, supervision, and sustainability. A core belief of our division is that children have the right to live in a safe environment and, if needed, with appropriate intervention and services to assist them until our interventions are no longer required. In 2020 our division, along with the entire agency, dealt with the COVID-19 pandemic as we pivoted to a virtual setting to assure staff and community safety. As our state and federal partners navigated new policy and rules, our division met with DCF regularly to ensure we served our clients safely, yet in compliance with state standards. DCF granted many in-person exceptions via state policy. However face-to-face contact as it relates to child safety was not granted an exception and our intake unit has been on-site throughout the pandemic assessing safety in person while doing so in a safe manner. A measure is taken to deal with all of the multifaceted issues that Human Services faces, was to continue the tradition of participating in the variety of opportunities provided by DCF and DHS. Through the successful application and awarding process, the division continued the long tradition of successful partnerships with the state in the form of the Targeted Safety Support Funding, Foster Parent retention funding, Citizen Review Panel, Infant Mental Health, Trauma Informed Care, Alternative Response, and Motivational Interviewing. New in 2020 was the Innovation in Social Emotional Development Grant by the Wisconsin Department of Health Services to integrate the Brazelton’s Touchpoints Model of Development to our current service delivery in birth to Three. The Children’s Long Term Support program added staff to meet the demands of the waitlist elimination, and as a result of the pandemic, we focused on preventing truancy with our school partners. Additionally, permanency was a focus across the division as an increase in reunification, adoption, and guardianships were established. In 2018 Jefferson County implemented priority-based budgeting for all of the departments to move to a priority-driven process to assign resources to the programs providing the most value to the residents. With this implementation, the fiscal manager reviewed and ranked our programming utilizing a three-point scale based on mandates, reliance, cost recovery, demand, and population served. These scores were validated utilizing an inter-rater reliability process with other department heads and county supervisors. Due to the large population served, along with the Federal and State mandates, in conjunction with the rise in demand, all areas in the Child and Family area received a “4” or at the top of the scale. Continuing into 2020, all of our scores remained the same as we use this process to guide our decision-making. 74

The Child and Family Division revenue comes from county tax levy, state and federal funds as denoted in the following graph. The most significant expenses for the division are customarily alternate care costs, staff wages, and benefits.

Birth to THREE Program ~Supporting Families in Promoting the Healthy Growth And Development of Their Children~

The Birth to Three Mission Statement The Birth to Three Program is committed to children with developmental delays under the age of three and to their families. We value the family’s primary relationship with their child and work to enhance the child’s development and support the family’s knowledge, skills, and abilities as they interact with and raise their child.

When families have questions or concerns about their child’s development, they can find support through early intervention programs such as the Jefferson County Birth to Three Program. What is the Birth to Three Program? The Birth to Three Program is a federally mandated program that supports families of children with developmental delays or disabilities under the age of three. As outlined in Part C of the Individuals with Disabilities Education Act (IDEA), the early intervention services provided by Birth to Three are designed in collaboration with parents to meet the needs of infants and toddlers with developmental disabilities. When it is determined that Birth to Three programming matches the child’s and family’s needs a plan is developed to support caregivers in promoting healthy growth and development through everyday routines and activities. How is the Birth to Three Program governed? The federal agency that oversees the Wisconsin Birth to Three Program is the U.S. Department of Education, Office of Special Education Programs (OSEP). The Wisconsin Department of Health Services (DHS), Bureau of Children’s Services governs local Birth to Three agencies such as Jefferson County Human Services. The Governor’s Birth to 3 Program Interagency Coordinating Council (ICC) advises, analyzes, and monitors the implementation of the Wisconsin early intervention system. In 1988 the Governor appointed ICC to adopt seven principles that serve as a framework for program implementation.

WISCONSIN’S BIRTH TO 3 PROGRAM Guiding Principles (developed by the ICC)

• Children’s optimal development depends on their being viewed first as children and second as children with a developmental delay or disability. • Children’s greatest resource is their family. • Parents are partners in activities that serve their children. • Just as children are best supported within the context of family, the family is best supported within the context of the community. • Professionals are most effective when they can work as a team member with parents and others. • Collaboration is the best way to provide comprehensive services. • Early intervention enhances the development of children.

Why put the “early” in early intervention (EI) programs like Birth to Three? The first three years of life offer a unique opportunity for promoting healthy growth and development. Research shows that from birth to age three, a child’s brain is developing faster than any other time in life. The foundations for future learning and life-long success are built from positive, meaningful interactions and experiences early in childhood. Parents and caregivers play a lead role in providing nurturing relationships and stimulating environments for young children. The Jefferson County Birth to Three Program values parents and caregivers as their children’s primary teachers. Our services enhance parents’ and caregivers’ understanding of their children’s unique abilities and support them in promoting healthy growth and development throughout daily routines and activities.

What are the benefits of EI programming? High-quality EI programs have been proven to positively impact outcomes for children and families, as well as provide economic advantages for communities. The evidence-based practices used by the Jefferson County Birth to Three Program support early relationships. Building the capacity of caregivers to meaningfully engage with children and develop strong relationships fosters healthy growth and development.

Research shows that the return on investment in programming is highest in the earliest years of life. Services that support healthy brain development are proven to foster better social, economic, and health outcomes for children and families. Early intervention programs strengthen the economic potential for communities now and in the future.

How are inclusivity and equitable access insured? The legislation that authorizes the Birth to Three Program states that “disability is a natural part of the human experience and in no way diminishes the right of individuals to participate in or contribute to society.” Birth to Three services is designed to ensure that children with delays and disabilities have opportunities to fully engage in family and community activities. Programs are federally mandated to ensure equitable access to and participation in culturally competent services to all children who qualify, including historically underrepresented populations.

Jefferson County Birth to Three was able to provide services to 100% of families in their preferred

language in 2020 thanks to the ongoing support of bilingual staff and contracts with language

interpretation and translation companies.

Evidence-Based Practices in Birth to Three The evidence-based practices used as the foundation of Jefferson County Birth to Three services integrate the families’ experiences and priorities with research in early development and the expertise of professionals to develop individualized and meaningful services. What does Birth to Three look like?

Birth to Three programs is required under Part C law to use evidence-based practices such as natural learning environments (NLE), parent coaching, and the Primary Coach Approach to Teaming (PCATT) when working with children and families. Natural learning environments are more than the places where children spend most of their time; they include the daily routines and activities that families participate in at home and in the community. Parent and caregiver engagement with and responsiveness to their child are other important aspects of NLEs.

Jefferson County Birth to Three uses a family routines assessment to gather information about how families spend their days, how they engage in their communities, what is going well, and where they feel they could use support.

Birth to Three services are provided in a parent coaching model. Birth to Three providers, partner with parents to promote a child’s participation in real-life activities. They support parents’ in encouraging growth and development during everyday routines, not just when the provider is present. Research shows that increasing the capacity of the parent to promote their child’s development significantly impacts child and family outcomes.

The Primary Coach Approach to Teaming (PCATT) is a family-centered, capacity-building model of service. It ensures that parents receive consistent, unduplicated, timely, individualized, and comprehensive information and supports. The primary coach is the team liaison identified as the best fit for supporting the parent in promoting their child’s participation in everyday life, routines, and activities. Supports are based on the desired outcomes of the family, the relationship between coach and parent, the provider’s specialized knowledge, and the availability of coach/family. The primary coach’s role is to coach families in recognizing their child’s cues and helping them respond in ways that support development. Families have access to a full team of professionals with a variety of knowledge and experience in early childhood development.

The Jefferson County Birth to Three Team includes members with expertise in early childhood education, parent education, infant and family mental health, speech and language, occupational therapy, physical therapy, feeding, and sensory processing.

How is Effectiveness Measured? The effectiveness of Birth to Three services is measured using the Child Outcomes rating process. A Child Outcomes Summary Form (COSF) is completed at program entry and exit for each child receiving services for more than six months. The COSF reports a child’s progress toward three nationally recognized outcomes as required by the U.S. Department of Education: Positive Social-Emotional Skills, Acquiring and Using Knowledge and Skills; and Taking Appropriate Actions to Meet Needs.

What percent of children rated on Child Outcomes in 2020 showed growth? Positive Social-Emotional Skills: 99% Acquiring and Using Knowledge and Skills: 100% Taking Appropriate Actions to Meet Needs: 100%

Jefferson County Birth to Three Initiatives in 2020 Brazelton’s Touchpoints Model of Development Grant Jefferson County Birth to Three, in collaboration with Dodge County Birth to Three, was awarded the Innovation in Social-Emotional Development Grant by the Wisconsin Department of Health Services to integrate the Brazelton’s Touchpoints Model of Development into current service delivery. This will support 79 the social-emotional development of children by enhancing success within the overall family system in navigating and supporting developmental milestones. According to T. Berry Brazelton, M.D., and Joshua Sparrow, M.D., children go through spurts of development referred to as “touchpoints” in their first years of life. These spurts result in disruption of the family system, leaving the parent or caregiver feeling isolated or alone. Development crises are rooted in the disorganization and reorganization of the child and parent or caregiver. When the succession of touchpoints are mapped out and organized around caregiving themes, parents and providers can anticipate, identify, and navigate touchpoints as the parent goes through their daily routine with the child. By successfully supporting their child through touchpoints, both child and parent can feel a sense of satisfaction and encouragement within their family system. The purpose of the Touchpoints Model is to help parents and caregivers feel like allies with their child’s systems of care. When supported and prepared for the disruption that these spurts may cause, the parent can be a strong and nurturing support for the child. This, in turn, helps the child connect a positive and rewarding relationship within their family system. The stability within the family system will promote healthy social-emotional development for the child. TalkReadPlay Activation Partners Birth to Three staff has been actively involved in the TalkReadPlay campaign since it was launched by Every Child Thrives in 2018 with the support of The Greater Watertown Community Health Foundation. TalkReadPlay is a community awareness campaign designed to educate parents and caregivers about early brain development and help them create more brain-building opportunities with their children. The Jefferson County Birth to Three Program continues to be an activation partner for the “TalkReadPlay with Your Child Every Day” campaign. In 2020, Jefferson County staff were asked to support other local agencies in their journey to become activation partners. TalkReadPlay Home Visiting The TalkReadPlay Home Visiting Program has continued in Number of families who received 2020 with the support of the Greater Watertown TalkReadPlay Home Visiting in 2020: Community Health Foundation. TalkReadPlay Home 2019: 12 visiting is offered as the parent education component of 2020: 21 Birth to Three services to families who ask for or could benefit from support in understanding child development. In 2019, three staff were trained in the Parents As Teacher (PAT) curriculum which is used as the foundation of TalkReadPlay Home visiting. In 2020, one new staff was trained in PAT. Subscriptions to the PAT online resources were renewed for staff so they could continue accessing parent education materials.

Child Outcomes Summary Form (COSF) Ratings: Exit The Jefferson County Birth to Three Team has fully embedded the Exit Child Outcomes rating process into team discussions. Each member of the early intervention team participates in the rating process. Outcomes rated on the COSF are rated at the same points in services and are rated using the same protocol. “Birth to Three was an absolute gift and my family and I are so very grateful.”--LS Books for Babies Thanks to the support of the Greater Watertown Community Health Foundation, Birth to Three was able to continue the Books for Babies program in 2020. The Books for Babies program makes developmentally appropriate books available to all children in the program. Service providers offer each family a book that matches their child’s abilities every six months. The provider coaches the caregiver on how to engage their child in exploring the book in developmentally appropriate ways.

Books for Babies fosters social and emotional development through building on early relationships between caregiver and child. Language and motor skills are practiced as children explore the pictures and words in their books through talking, listening, and pointing with their caregivers. By getting to keep the books after the home visit, caregivers are empowered to continue the brain-building activities and learning experiences with their children. Infant Massage This year one Birth to Three staff was certified in Infant Massage. She was able to provide a virtual Infant Massage experience through a partnership with the Watertown Public Library and the Watertown Family Center. It was a five-week class session with an average of seven families participating. Several families from the community and one family served by the Birth to Three Program attended. The ages of the infants ranged from 6 weeks to 18 months old. Families were allowed to spend quality time with their children and learned how to interact with their babies using nurturing touch. They also had the opportunity to share and discuss topics such as infant behavioral states and cues, infant reflexes, sleep, and sleep patterns, periods of crying, and Shaken Baby prevention. “Thank you, Steffani! I really appreciated how personalized you made the experience. Infant massage class was definitely one of my absolute favorite parts of maternity leave. I wish I had discovered this with our oldest daughter when she was a baby. I have done some of the massage strokes with her since learning in this class, but I think the bonding between parent and baby through baby massage is a very unique experience. “--Anonymous Super Staffings in Birth to Three Birth to Three piloted an expanded teaming option to better serve the families of children with complex needs. When the team feels that the time available for staffing a child’s services in a weekly full team meeting is not adequate, the team of core service providers can request monthly super staffing. The super staffing allows for the direct service providers, including those from other programs, to meet and discuss progress and service plans to ensure comprehensive care.

Birth to Three, super staffings were piloted with two families in 2020. Feedback from service providers

and families indicated that the ability to extend teaming through super staffing was beneficial.

Family Engagement The Birth to Three Program offered a new type of family engagement in 2020 with support from United Way. Each family enrolled in the program was provided with a bag of activities and a booklet describing how to engage in the activity with their child. Families had the opportunity to join in a zoom meeting with the Birth to Three teams to talk about the activities and ask any questions they had. 100 bags were delivered to families in the fall of 2020.

Family Engagement Activities Bags Included: Pinwheels Bubbles Sidewalk chalk Beach Balls Scarfs Maracas Crayons Water Squirters Glue Sticks Kazoos

Responses to the COVID-19 Pandemic 2020 brought unique opportunities and challenges in Birth to Three due to the COVID-19 pandemic. In March, the Wisconsin Birth to Three Program suspended all face-to-face services. Jefferson County Birth to Three initiated a multi-level response to service limitations throughout the health crisis to ensure families had access to the services and supports they needed. In late March and early April, each family in the program was

81 contacted to discuss a COVID-19 Family Outreach Plan. Families were offered the option to continue services via telehealth or put services on hold. Staff reached out to families frequently through spring and summer to update their plan and offer resources. The Return to Face To Face Policy was developed in August allowing families to request a face-to-face visit with their primary service provider outside or in the county building while following the county guidelines for health and safety. Starting in November, families could request a face-to-face visit and an initial evaluation be held in their homes while continuing to follow county guidelines for in-person visits.

The Unique Opportunities of 2020:  Parent coaching was enhanced by the use of tele-therapy.  Virtual services allowed for children placed out of county to be serviced by Jefferson County.  Some families prefer virtual services to having providers come to their home.  Professional development offerings were more accessible.  An email listserv was developed for more effective and timely communication.  The Wisconsin Birth to Three Program developed PSA materials to support public awareness.  The Wisconsin Birth to Three Program developed the All in for Kids family newsletter.

Service Provision in 2020

Child Find Child Find and community awareness ensure that Jefferson County Birth to Three has a comprehensive referral network.

“Five Stars! You all are the best and so helpful. We love Rachelle and Carole!”—Anonymous

2020 Public Awareness and Child Find Activities  Participated in Jefferson’s Community Night Out  Served on the Watertown Family Center Board  Chaired the Southeast Chapter of Wisconsin Alliance for Infant Mental Health  Participated in the Greater Watertown Community Health Foundation initiatives  Hosted Infant Massage Classes  Shared WI Birth to Three Outreach material with medical providers, child care, and health departments

Referrals

Jefferson County Birth to Three received 221 new referrals in 2020.

Anyone with concerns for a child’s development can make a referral to Birth to Three. The majority of Jefferson County’s referrals come from medical providers and parents. We also receive referrals from hospitals, specialty clinics, child care, and local social service agencies.

“We are so grateful for our time with Birth to Three. The individualized support we received gave our little guy the confidence he needed to finally start talking, develop a large vocabulary and gain clairty of speech. Thank you!”--END

Assessment and Evaluations Birth to Three evaluations combined with the family assessments provide a comprehensive view of how a 230 evaluations were completed by child functions within the context of their family and Birth to Three staff in 2020 everyday routines.

Evaluation and assessment information is collected through parent interviews, observations of the child, and play-based, standardized evaluation tools. The Birth to Three Team creates a developmental summary from the collected information to share with the family. The summary guides the discussion regarding the child’s eligibility for services.

Eligibility Determination Children are determined eligible for Birth to Three services based on one of three criteria:

 Significant delay in any area of development  Atypical behaviors that are negatively impacting development  A diagnosed condition likely to result in developmental delay

101 children were found eligible for Birth to Three services in 2020.

“My son gained a lot from visits! Not only did he love playing and seeing Missy, he learned so much in such a short period of time. The exercises and ‘homework’ given definitely improved his speech. Overall, very happy!”--TL

Individualized Family Service Plan (IFSP)

After a child is determined eligible for services, the Birth to Three-Team, with the family, develops a service plan individualized to the family’s priorities and concerns. The child’s present levels of development, the family strengths and resources, and the expected outcomes for the child are documented in the IFSP. The document is reviewed at least every six months or whenever there is a change in services.

Carole was very helpful in setting goals and giving us easy ways to practice in between visits”--X Ongoing Services Jefferson County Human Services employs six staff to facilitate Birth to Three programming. One program supervisor oversees five, full-time service coordinators that have multiple roles in programming. One service coordinator is the program’s Point of Referral. One service coordinator is a bilingual provider and interpreter. Four service coordinators are coaches for the TalkReadPlay home visiting program. Two service coordinators also serve as early childhood educators. Rehab Resources, a division of Greenfield Rehabilitation Agency, Inc., is contracted to provide therapy services. Programming is supported by three speech therapists, an occupational therapist, and a physical therapist. A direct supervisor and a full-time office manager oversee rehab resources programming.

The full team meets weekly to discuss meaningful service provision for families. Team meetings are structured to support the use of evidence-based practices such as the Primary Coach Approach to Teaming. Each child’s services are reviewed at least quarterly by the team. Service coordinators meet with each family every six months to review their child’s development and progress toward the goals written in the service plan.

113 families received ongoing Birth to Three services in 2020.

Transition Planning Most children continue Birth to Three until they are no longer in need of services or until they turn three years of age. All children exiting the program receive transition planning to support moving into their next stages of early childhood. Early childhood transition options include school district programming, Head Start, child care, play groups, or other appropriate community services.

Transitions for children turning three

55% were transitioned into an early childhood setting to continue services.

44% were not in need of early childhood programming beyond Birth to Three.

Sustainability Birth to Three services is funded through a variety of sources. Private insurances, the federal government, the state of Wisconsin, and Jefferson County Human Services provide funding to support programming. Birth to Three service coordination is eligible for reimbursement through Wisconsin Medical Assistance (MA), as Targeted Case Management (TCM).

Estimated revenue from TCM in 2020: $14,677.39

The County Birth to Three programs is responsible for collecting reimbursement through the Parent Cost Share Program. Families deemed able to contribute to the cost of services per the guidelines developed by the state are billed at a monthly rate. Rates are based on family size and family income. Cost Share payments can range from $25 to $150 a month and are not directly related to reimbursement provided by insurance. Parent Cost Share billing is monitored monthly to ensure families are not being asked to pay more than the cost of services to the county.

2020 revenue from Parent Cost Share: $7811.00

To help ease any financial hardships that might have occurred for families due to child care issues, job loss, medical leave, quarantines, or other circumstances related to the COVID-19 health emergency, all cost share fees for March and April were waived. Quality Assurance and Monitoring In a continuous effort to ensure high-quality, meaningful services, the Birth to Three Team regularly reviews programs and state data collection. Data on programming is requested from families through a county- generated TalkReadPlay and Family Exit Survey.

Quality Assurance and Monitoring In a continuous effort to ensure high-quality, meaningful services, the Birth to Three Team regularly reviews programs and state collected data. Data on programming is requested from families through a county- generated TalkReadPlay and Family Exit Survey. Family Surveys The impact of the TalkReadPlay campaign on the effectiveness of Birth to Three services is measured by a survey given out at plan reviews that are designed to collect information about the caregivers’ competence and confidence in promoting their child’s development through talking, reading, and playing with their child during their everyday activities.

TalkReadPlay With Your Child Everyday Survey

 100% strongly agreed or agreed that programming improved their ability to be their child’s first teacher.  100% strongly agreed or agreed that they learned ways to help their child learn and grow.  100% reported interacting with their child through talking, reading or playing every day or most days after participating in programming.

Family Exit Surveys are provided at the discharge-from -services meeting. The Family Exit Survey asks families to rate their experience in the program by scoring the following 7 statements on a five-point scale ranging from superior services to poor services.

The results of those surveys is as follows:

“We are deeply grateful for the support provided by our son’s Birth to Three Team! His OT and PT were my lifelines during a time that was confusing and frustrating.”--GH Birth to Three Indicators The Birth to Three Indicators has been identified by the federal government as the essential components for implementing high-quality EI programming. The state tracks data related to the eight, Birth to Three Indicators to monitor compliance. The Indicators focus on the identification of potentially eligible children and program effectiveness. The state DHS Birth to Three Program website defines the indicators as: Indicator 1: Timely Services Indicator 1, Timely Receipt of Services, is a compliance indicator with a target of 100%. Each state defines what constitutes timely services. The indicator refers to the percentage of children for whom all services are timely. Indicator 2: Natural Environments Indicator 2 documents the extent to which early intervention services are provided in natural environments. “Natural environments” are settings that are either home-based or community-based. Indicator 3: Infant and Toddler Outcomes Indicator 3 is the percent of infants and toddlers with individualized family service plans (IFSPs) who demonstrate improvement:  Outcome 1: Positive social-emotional skills (including social relationships).  Outcome 2: Acquisition and use of knowledge and skills (including early language/communication).  Outcome 3: Use of appropriate behaviors to meet their needs. Indicator 4: Family Outcomes Indicator 4 measures the percent of families participating in Birth to Three who report that early intervention services have helped the family:  Know their rights.  Effectively communicate their children's needs.  Help their children develop and learn. Indicators 5 and 6: Child Find Child Find are defined as the methods and procedures each county uses to identify infants and toddlers potentially eligible for the Birth to Three Program. Indicator 7: Timely IFSPs Indicator 7 is a compliance indicator with a target of 100%. Indicator 7 measures the percentage of Birth to Three eligible infants and toddlers for whom an evaluation and assessment and an initial IFSP meeting were conducted within a 45-calendar day timeline. Indicator 8: Transition Indicator 8 is a compliance indicator with a performance target of 100%. This indicator tracks the percent of all children exiting Birth to Three who received timely transition planning to support the child's transition to preschool and other appropriate community services by their third birthday.

The Jefferson County Birth to Three Program was recognized for 100% compliance with Federal Indicators in 2020!

Review of 2020 Goals: Key Outcome Indicator: The Birth to Three Program will be issued a notification of 100% compliance with the Federal Compliance Indicators by DHS based on the annual data review. The Jefferson County Birth to Three Program was issued a notification of 100% compliance to the Federal Compliance Indicators for 2020. This indicator was met.

1. Support Birth to Three caregivers in building strong, nurturing relationships that foster positive social and emotional development in their children. In 2020, staff will identify and implement three strategies for promoting healthy early relationships through Birth to Three programming. This goal was accomplished. In 2020, the Birth to Three Team identified Brazelton’s Touchpoints Model of Development as an approach for supporting positive social and emotional outcomes for children and families. Jefferson County Birth to Three, in collaboration with Dodge County Birth to Three, applied for funds to implement the Touchpoints Approach through the Innovation in Social-Emotional Development Grant offered by the Wisconsin Department of Health Services. The Birth to Three programs was awarded grant funding and started implementation in June of 2020. Full implementation will be reached in 2021. The Birth to Three Team identified Infant Massage as a service that would support positive social and emotional outcomes for children and families. One provider was certified in Infant Massage in 2020. She hosted an Infant Massage series in partnership with the Watertown Family Center and Watertown Public Library. The Birth to Three Team also recognized that increasing capacity to offer TalkReadPlay home visiting families would support positive social and emotional outcomes. With support from the Greater Watertown Community Health Foundation, the team was able to train one service coordinator who didn’t receive the initial training. The team was also able to renew subscriptions to the online Parent as Teacher curriculum used as the foundation for TalkReadPlay home visiting services. 2. Enhance services through collaboration with other programs being accessed by Birth to Three families. Birth to Three will engage Children’s Long Term Support (CLTS) and the child welfare teams in conversations around how to best support families accessing multiple county services. By December of 2020, a guide for partnering with other county teams will be added to the Birth to Three training manual. This goal was accomplished. Birth to Three staff met with the CLTS team and the child welfare supervisors to discuss collaboration around new referrals. In January of 2020, CLTS team members joined a staff meeting to discuss how to more effectively collaborate when families are participating in both programs. At the beginning of 2020, Birth to Three staff discussed the new automated referral system from the Wisconsin Statewide Automated Child Welfare System (eWiSACWIS) to Birth to Three state data system (PPS) with child welfare staff. Throughout the year, a protocol was developed to ensure referrals are received and processed in a timely fashion. The Birth to Three Training Manual includes a process for responding to referrals that come through the Program Participation System (PPS) inbox. 3. Increase staff confidence and competence in applying Trauma Informed Care (TIC) principles in their work. Six learning opportunities around TIC will be provided during team meetings in 2020. This goal was accomplished. The Birth to Three Team participated in several learning activities that were based on TIC principles. The team explored the Compassion Resilience Toolkit, completing a team activity and watching two, Compassion in Action: COVID-19 videos. One professional development hour was spent reviewing the resources available through the My Strengths app. Five professional development hours were dedicated to how Motivational Interviewing skills can enhance engagement with families. 4. Ensure that the Birth to Three Team is making progress toward proficiency in Motivational Interviewing (MI) skills. Each team member will create a professional development goal related to MI to be documented on their 2020 annual performance reviews. This goal was accomplished. The Birth to Three Team participated in a foundational of MI training. They also participated in an eight hour training developed specifically to support providers in promoting active and meaningful engagement in services with caregivers. 5. Ensure continued program growth and improvement by completing at least one NIATx project in 2020. This goal was accomplished. The second quarter of 2020 showed a decline in service and billable time recorded in the electronic daily activity log system (EDALS). EDALS tracks the service and billable activities of staff on a day-to-day basis. Birth to Three staff identified that programming changes brought on by the COVID-19 pandemic led to a decrease in the amount of service and billable time being recorded. The Birth to Three Team strategized three ways to optimize service and billable time. In July, the team identified opportunities to capture more service and billable time. Service coordinators started using these opportunities to collect more time for their caseloads. In August, the team explored collecting service and billable time during team meetings. It was determined that each service coordinator needed more teaming time to be able to appropriately capture service and billable time from meetings. The team meeting was extended to provide all service coordinators 30 minutes to team their caseloads. Staff was

able to start including time to team upcoming IFSP reviews and quarterly updates on their agendas. In September, the team started designating time frames during team meetings to be captured as service and billable time. From July to December of 2020 there was a 2.5% increase in billable time and a 10% increase in service time making the third-quarter averages the same in the first quarter of 2020. 2021 Goals: Key Outcome Indicator: The Birth to Three Program will be issued a notification of 100% compliance with the Federal Compliance Indicators by DHS based on the annual data review. 1. Successfully integrate Brazelton’s Touchpoints Model of Development into service delivery by December of 2021 as evidenced by feedback on the county-conducted family surveys and the state social-emotional grant evaluation process. 2. Support positive outcomes for children by developing an evaluation process that more effectively identifies children with social and emotional delays. By December of 2021, a tool that is sensitive to social and emotional delays will be used to evaluate children that show or are at risk for social and emotional delays. 3. Ensure that the Birth to Three Team is making progress toward proficiency in Motivational Interviewing (MI) skills. Each team member will create a professional development goal related to MI to be documented on their 2021 annual performance reviews. 4. Ensure continued program growth and improvement by completing at least one NIATx project in 2021.

BUSY BEES PRESCHOOL ~Providing positive early learning experiences in a fun-filled morning ~

Busy Bees Preschool offers engaging learning experiences for two and three year olds. Preschool runs two mornings a week for two and a half hours. The program is open from September through May with a six-week session provided during the summer.

The preschool class is a combination of children invited to enroll through the Jefferson County Birth to Three Program and children from the community. Busy Bees hosts up to 7 community children whom attend two days a week. Up to 12 children receiving Birth to Three services are enrolled in programming for one day a week.

Children in the Birth to Three Program are invited to enroll in preschool based on

their developmental goals and access to other school readiness programming.

Busy Bees’ Programming Busy Bees Preschool offers fun-filled, enriching mornings with structured routines and consistent behavior expectations. The unique abilities of the preschoolers are celebrated through rich learning experiences that build on their skills. The teachers promote learning through open-ended questions, guidance, and scaffolding which fosters growth and development. Children increase their school readiness skills, social skills, and overall confidence by participating in Busy Bee’s Preschool. Classroom activities emphasize language and concept development through free play, music, finger-plays, books, gross and fine motor activities, art experiences, and daily living skills. Wisconsin Model Early Learning Standards serve as a guide for planning learning experiences. Lesson plans address all domains of learning with developmentally appropriate practices or DAP. Classroom activities emphasize language and concept development through free play, music, finger-plays, books, gross and fine motor activities, art experiences, and daily living skills. Wisconsin Model Early Learning Standards serve as a guide for planning learning experiences. Lesson plans address all domains of learning with developmentally appropriate practices or DAP. What does developmentally appropriate practice (DAP) look like? DAP is defined as a teacher or caregiver nurturing a child’s development using practices that are based on theories of early education, are individualized to the strengths and needs of the child, and value the child’s community, family history, and family culture.

90 Increased free-play time Research shows that young children learn best by exploring their environment and making discoveries through play with a variety of items. The role of the teacher is to create an engaging environment and to follow the children’s lead during play. The foundations for creativity, problem-solving, self-regulation and life-long learning are built during early play experiences. Increased one-on-one interactions Increased free-play time allows for more one-on-one, adult-child interactions. One-on-one interactions foster healthy social and emotional development, strengthens cognitive connections, and enhances language development. Increased child-directed learning A variety of intentionally planned learning activities are accessible for the preschoolers to engage in. Children get to choose the learning activities they participate in. The teacher helps guide learning by engaging and exploring in the learning activities with children. Child-directed learning promotes social skills, self-efficacy, and life-long enjoyment of learning. Process-focused art experiences Process-focused art allows children to explore and learn about different art mediums while gaining developmental skills. Process art generates an end product from a child’s ability to plan, problem-solve, and think creatively rather than an expectation of what the end product should be. Busy Bees’ Teachers The preschool is staffed by three bachelor-degreed educators. Also, licensed speech therapists, an occupational therapist, and a physical therapist provide support in the classroom as part of Birth to Three programmings. Busy Bees’ Families Busy Bees recognizes that strong relationships between the teacher, the child, and the family are the foundation for healthy growth and development. Families are encouraged to participate in their child’s learning experience through daily communication and observation opportunities. A daily note is sent home letting parents know what their child did during the day. An observation window enables parents to watch their child engage in classroom activities. Parent/teacher conferences occur twice a year providing time for teachers and parents to discuss the child’s learning experiences and developmental progress. Response to the COVID-19 Pandemic In March of 2020, the Busy Bees’ classroom was closed. The classroom remained closed through the rest of the year. Staff created unique support activities that the preschool families and all families participating in Birth to Three could engage in from home. Staff also supported childcare facilities that continued to care for children during the pandemic.

The Busy Bees classroom in 2020 Prior to the Busy Bees Preschool being closed due to the COVID-19 health crisis in March of 2020, eighteen children had participated in programming. Nine children were receiving speech therapy supports in the classroom. Six preschoolers were being supported by an early childhood teacher. One child was receiving both occupational and physical therapy services during their time in the preschool.

Busy Bees Support Activities in 2020 Home Activity Bags

Childcare During COVID Director’s Meetings

Virtual Preschool

91 Home Activity Bag A bag was delivered to families with toys and activity cards to encourage caregivers to continue providing developmentally appropriate one-on-one play with their child while at home.

Activity Bag Activities: Bubbles Scarves Maracas Sidewalk chalk Pinwheels Kazoos Beach balls Water Squirters

Each bag also included a simple list of instructions:  find a special playtime  pick an item to play with  find the corresponding information card  pick a developmental area to work on  pick an activity to do with your child

Childcare During COVID Director’s Meetings In October, Busy Bees’ staff hosted a meeting for local childcare providers to support them in running a center during COVID. Eight directors and a resource person from Community Coordinated Child Care, Inc. (4-C) attended the meeting to discuss topics such as handling cleaning, check-in and out procedures, and sick child protocols. In November, Busy Bees’ staff organized a meeting for local childcare with the Jefferson County Health Department to discuss how the health department could align services to better address childcare needs. Nine directors and two health department representatives joined the meeting. Virtual Preschool Pilot Program Busy Bees’ staff developed a virtual preschool program in the fall of 2020 to be piloted in November and December. The program was designed for all Birth to Three families to be able to participate and to be shared with community partners. A survey was sent to Birth to Three families to gather information on the best time and day of the week to hold the sessions. The survey also helped determine what art supplies families had at home to complete art activities. Crayons and glue sticks were provided in the home activities bag to ensure families had access to the supplies they needed for preschool. Each virtual preschool session included a song, a book read aloud, and an art activity. Sessions also included a movement or vocabulary-building activities. Virtual preschool was designed for parents and caregivers to engage with their children. Takeaways from the pilot program were that families were interested in having access to virtual preschool programming and that the timing of live sessions limited families' ability to participate. The pilot program is being used as a guide for developing ongoing virtual preschool programming that will begin in January of 2021. YoungStar Participation

Busy Bees Preschool maintained a five star rating through March of 2020! YoungStar activities were suspended when the preschool was closed in March.

5 Star Meets highest levels of quality standards

4 Star Meets elevated levels of quality standards

3 Star Meets proficient levels of quality standards

2 Star Meets health and safety standards

1 Star Does not meet standards

YoungStar is Wisconsin’s child care quality improvement system. Programs participating in the YoungStar rating process are formally rated every two years. The rating process includes a review of employees’ qualifications, learning environments, business practices, and wellness practices. Technical assistance is provided to support programs in identifying opportunities for quality improvement. The classroom environment is observed by a formal rater to complete the process. Programs have the opportunity to be awarded up to 40 quality indicator points from the rating and observation process. The number of indicator points earned dictates the number of stars the program is awarded. Busy Bees started the rating process in January of 2020 but was unable to complete the formal observation due to the classroom being closed because of the pandemic. Review of 2020 Goals: Key Outcome Indicator: Busy Bees Preschool will maintain a 4-star rating from the YoungStar Program. Busy Bees Preschool maintained a 5-star rating from the YoungStar Program in 2020. This indicator has been met. 1. Enhance the use of Trauma Informed Care (TIC) practices in the preschool. Preschool staff will identify and implement three ways to enrich programming with TIC practices in 2020. This goal has been accomplished. The daily schedule was modified to be more developmentally appropriate for children that struggle with self-regulation and challenging behaviors. The modifications were intentionally developed through the lens of TIC and Adverse Childhood Experiences. In the fall of 2020, all preschool staff received training in Motivational Interviewing skills to better engage families in their children’s growth and development. In response to the suspension of face-to-face services, the preschool staff developed virtual programing to support healthy and nurturing early relationships outside of the classroom. 2. Support caregivers as their child’s first and best teacher through preschool programming. By the end of 2020, preschool staff will identify and implement two strategies for empowering caregivers to engage in their children’s learning. This goal has been accomplished. In the fall of 2020, all families received home activities bags with a variety of activities caregivers could do with their child to help promote development. Each bag included an activity card with a description of how to do the activities and what the child learned while they played. The preschool staff also supported caregivers as their child’s best teacher by scheduling two-family engagement zoom events. Families were encouraged to join staff to discuss how the activities were going and ask any questions they had. 2021 Goals: Key Outcome Indicator: Busy Bees Preschool will maintain a 4-star rating from the YoungStar Program. 1. Enhance classroom management practice by exploring the fit of Conscious Discipline techniques to the preschool setting. Three Conscious Discipline techniques will be tried in the classroom over the 2021-2022 school year to determine if they support learning in the Busy Bees Preschool setting. 2. A caregiver will be offered access to a variety of positive parenting programs to support their role as their child’s first and best teacher. Over the 2021-2022 school year, parents will receive information on three different opportunities to participate in positive parenting programs.

93 CHILD ALTERNATE CARE ~Alternate Care services were developed to provide for the physical, emotional, and social needs of the child until the child can be reunited with his or her family~ The Child Alternate Care team provides services for the residents of Jefferson County which includes licensing kinship (relative homes), level 1 and level 2 foster homes, as well as locating placements at all levels of care to include foster care, group homes, residential treatment centers, and juvenile corrections. Pro-actively, staff cultivates and locates respite care and facilitates voluntary placements throughout the year to avoid formal prolonged placements. Additionally, our department arranges formal court-ordered placements as well. Once again in 2020, we were the recipient of an additional Foster Parent retention grant through the Department of Children of Families (DCF), which allowed us to continue a variety of activities and initiate new retention activities. In back-to-back years, these awards totaling $72,000 funded monthly foster parent support groups, summer picnics, annual foster care appreciation dinners, and National Foster Parent appreciation activities. In 2020 these activities looked different as we delivered these virtually due to the pandemic, but the effects were still felt and appreciated by our foster parents throughout the county. Foster parent recruitment activities continued, which yielded a tremendous turnout and subsequently allowed us to license new foster homes because of these efforts. Additionally, presents were purchased, wrapped, and delivered by the division’s holiday helpers who spent a Saturday delivering the gifts across the county while singing holiday carols at a safe distance. The wide eyes and the surprises on the faces of our foster youth were simply priceless. All of these activities assist with the support and retention of Foster Parents and allow an opportunity for our foster youth to participate in normalized interactions and milestones that otherwise wouldn’t be possible. In 2020, housing continued to be an issue for many families in Jefferson County, and our various housing initiatives continued to support families in the community at our various housing units dedicated to stabilizing families and preventing removal. These endeavors were once again successful as we assisted four additional families to remain intact and avoid placement of the children outside their biological home. These housing opportunities are infused with a variety of community-based services to build yet another evidence-based approach to the work that we do at Human Services. Child Alternate Care spends a great deal of the workday locating respites, out-of-home placements, as well as licensing foster homes and relative homes for children that are not able to remain in the home or community safely. A mechanism that the department utilizes to deter long-term placements is the use of respite. Respite is used to give parents or caretakers a short reprieve from the stressors of parenting in a difficult situation. This service is utilized with biological parents to preserve in-home placements, as well as with alternate care providers to preserve difficult out-of-home placements. Jefferson County has several formal respite providers that will assist in crisis planning to preserve these placements, but the department has steadily increased the use of family and other informal providers to assist in decreasing this formalized service. This year that included school staff, neighbors, family friends, and club leaders to name a few. In 2020 alternate care provided 151 respite opportunities, which continues a six-year trend as we continue to decrease the use of formal providers and strive for the use of informal respite opportunities. This is another example of a successful NIATx project completed seven years ago. Due to the success around the utilization of informal providers for short-term respite, the initiative and philosophy to utilize natural pre-existing relationships for court-ordered formal providers for families became a division-wide effort and was a major focus again in 2020. As part of our continuous quality improvement process, otherwise known as NIATX, a division-wide “family find” committee was formed with the stated goal of increasing our use of relative or “like-kin” providers for children or youth who needed a formal out-of-home placement. The development and implementation of our NIATx project followed the Plan-Do-Study-Act (PDSA) model beginning with awareness across the agency around the best practice of utilizing relatives and “like-kin” at team meetings and during staffings. An emphasis was placed on increasing our pre-existing efforts to locate anyone that may have a connection to the family as we utilized many families find tools such as connectedness

94 mapping to locate any family connections to become a potential provider. A checklist of staff expectations was developed that is used at the time of removal and every three months thereafter if a child is still not placed with a relative. Finally, an engaging letter to a potential relative or “like-kin” providers was developed to supplant the state-driven letter, along with a folder with resources, FAQs, links, videos, and contact information to invite prospective providers to be a part of the young person’s life. As you can see below these efforts have paid off as part of a rising three-year trend that supersedes the state and national average of around 40%.

Great efforts and priority are placed on alternate care placement searches . Placements are determined based on fit, well-being, potential reunification success, and proximity to the biological home. These child alternate care services were developed to provide for the physical, emotional, and social needs of the child until the child can be reunited with his or her family. When this is not possible, other forms of permanency are utilized such as independent living, various forms of guardianship, adoption, and other planned living arrangements (OPLA). It is intended that through respites, short-term placements, regular family interactions, and supportive services, children will be reunited with their families as soon as necessary protective capacities are increased and child and community safety is not at risk. Great measures are taken to work with contracted providers, and kinship placements to form a team concept working toward the goal of successful permanency along with the birth family, extended family, informal and formal providers. To this end, our foster care coordinator licensed 11 total homes in 2020 to include five relative homes, five general foster homes, and one child- specific-non-relative home. These efforts allow children and youth to remain with familiar faces in this time of separation and add to our community options.

ALTERNATE CARE PHILOSOPHY  To avoid placements whenever possible, by providing protection, support, and services in our communities.  To work towards permanence for the child from the moment of out-of-home placement. The first choice is often to strengthen the child’s family system and reunify that child.  To keep placements short and develop them within the community whenever possible.  To identify the factors in the family that create unsafe situations, as well as the family strengths and resources to build upon positive pre-existing conditions while dealing with the underlying needs.

95  To minimize the use of institutional placements by creating unique community options with providers. Another commitment Jefferson County continues to make to alternate care is in the area of prevention. In 2019, the department continued its involvement in the In-Home Safety Services program sponsored by the Department of Children and Families (DCF), now known as TSSF (Targeted Safety Support Funding). This program is aimed at identifying opportunities to control the identified safety threats in the home of origin by utilizing informal and formal providers to serve as the safety control, allowing children to stay in the home. DCF provides funding for in-depth safety planning where a family meets specific criteria. Funding is awarded for respite, parent coaches, one-on-one supports, alcohol and drug monitoring, safety checks at all hours of the night, and crisis support, among other things. In 2020, the TSSF funds can be accessed by our ongoing CPS unit and behavior change services can be utilized along with safety controls for a more holistic, well-rounded approach. In 2020 we were able to stop a three-year trend in the increasing number of new children placed into out-of- home care. In 2019, we saw the number of new children placed into care increase dramatically to 64, from 49 in 2018 and 44 in 2017. This upswing was due to the continued use of heroin and alcohol and drug use in general. This, along with emerging mental health needs stressed our entire agency and specifically our alternate care system. In 2020, with the increased use of TSSF, we saw a substantial decrease to 33 new children that entered our alternate care system, which was a 48% decrease from 2019. This was great news for our community, the alternate care system, and most importantly the youth. In 2020 we were able to successfully find permanency for 51 youth exiting placement, which was astounding and exemplifies the hard work it took to offset a difficult 2019 spike in placements. As mentioned, 2020 saw 51 children formally discharged (exit from care) from placement. The breakdown of the various forms of permanence in Jefferson County for 2020 consisted of the following: • 18 children or 35.3% were reunified to a parent • 20 children or 39.2% % were discharged due to the department setting up a guardianship • 9 children or 17.6 % were adopted  4 or 7.9% reached the age of majority and/or are living with a relative In accordance with the outstanding permanency outcomes listed above, and the efforts across the entire agency, the alternate care budget experienced another significant decrease in 2020 to $1,123,734. This is down from $1,741,931 in 2019, and $2,047,916 in 2018 and significantly down from the four year high of $2,380,469 in 2017. This is a savings of $618,197 from last year alone and a four-year decrease of $1,256,735. This is a robust four-year decrease in our alternate care budget which reached a nine-year low in 2020. The alternate care budget is the top priority and concern for the division every year, both fiscally and for child well- being. Children and adolescents need permanence, safety, and well-being. While out-of-home placements and multiple placements are necessary to assure safety at times, we know that these situations can be associated with poor life outcomes for children. The department attempts to avoid placements and deter costs in several ways. We believe with the use of TSSF, new housing options, respite, Family Find, and overall philosophy, we can maintain these numbers.

96 Jefferson County has always focused on our out-of-home population and over the last number of years we have added several measures with extreme intensity. Through the use of our Key Outcome Indicators (KOI) that have driven placement scrutiny, participation in statewide and internal workgroups, as well the use of monthly county data reports, the department has made great strides in our Federal Indicators. The department takes great pride in these targeted efforts to improve the outcomes for our most vulnerable children and is pleased to provide our data points below. The Department of Children and Families measures each county on several placement related performance items which is directly related to the Federal Child and Family Services Review (CFSR). Below is a breakdown of the placement related items:  Timeliness to Permanency is a federal benchmark that measures discharged children who are returned home. This federal measurement expects that 40.5% or more of children should reach permanency within 12 months of placement. Despite once again continuing to increase our overall ability to reunify children with the home of origin, our 2020 timeliness numbers did fall a bit in terms of timeliness to 26%. Our timeliness to Permanency for our youth in placement from 12-23 months is a robust 61%, compared to the state average of only 44% and well above the federal mark of 43%. A priority for 2021 will be to expedite permanency when safe to do so and shift the timeliness to within the first 12 month of placement.

97  Placement stability is a federal benchmark that indicates that all children placed outside the home should not have more than 4.12 moves per 1000 days in placement. We are pleased to report that since 2015 we continue to keep this ever important number below the state average and the Federal benchmark assuring fewer moves for our youth and children. In 2020 we were at 3.74, which still exceeds the federal benchmark. We know that placement disruption is a negative life experience and we do everything we can to locate a quality fit from the onset and maintain these placements whenever appropriate.

 Re-entry into out-of-home care is a federal benchmark that tracks the re-entry rate of children BACK into care after discharge from a placement. The federal benchmark expects that no more than 8.6% of all children discharged from placement via reunification will re-enter alternate care within 12 months. Unfortunately, after a two-year decrease, we did see an increase in this statistic for 2020. A continued point of frustration when using detention and shelter as a one-night safety option is having to count it as a re-entry. This results in inflated re-entry numbers. (4 of the 12 youth who were considered to have re-entered, were for one night at shelter or detention)

 Maltreatment in out-of-home care is a federal benchmark that tracks substantiated abuse of a child by a facility or foster parent while placed in their care at a rate of 0.57% or less. Jefferson County did not have any allegations or substantiations of child abuse while in care in 2020.

98 Late in 2018, we began work on a joint project with our juvenile court. The department and the Judges developed a Judicial Engagement Team (JET). In collaboration with the Casey Foundation and the statewide Children’s Court Improvement Program, we set forth a goal to decrease the time children waited from the date of removal until a TPR is completed. A review of our data compared to the balance of the state indicated the need to improve our timeliness in this area. Dane County circuit court was willing to assist due to their recent work in this area. Our JET project was unveiled to several stakeholders across the county that could play a role in decreasing the wait time to TPR. The circuit court judges, district attorney’s office, corporation council, GALs, public defenders, public bar, human services staff, as well as our county administrator, director, and family court attended the kick-off meeting facilitated by the Casey Family Foundation. It was at this time the department shared data and continuous quality improvement projects along with past successful initiatives, to build consensus around the need for the same fortitude to make this proposed change. The Judicial Engagement Team continued to meet several times in 2019 brainstorming variables that could influence our project in the right direction. First, parents were assigned council at the time of removal to decrease a lapse in hearings and allow for advocacy. To date, the circuit court has appointed 22 attorneys to CHIPS families with children placed outside the home and we have seen our exits from care increase drastically from previous years. Second, in addition to utilizing corporation counsel, Human Services continued our TPR contracts with three attorneys to expedite TPR filings without delay. Finally, all six-month reviews are now taking place judicially. Quarterly status hearings are now being held regularly on children placed outside the home to remind parents of timelines, determine a course of action, and discuss what the next steps are for each out-of- home case. The final variable added to the JET initiative was to hold conferences between the parents, attorneys, and Human Services staff before all reviews. Despite the pandemic, this goal has to been met. As you can see in the graph below, a hallmark of our culture and service provision at JCHSD is to see children and youth placed in the least restrictive placement possible. Once again, an overwhelming majority of our youth placements are at the foster home level, while others require more restrictive placements such as group home or residential care. We take great measures to avoid these highly restrictive settings and utilize them only when community and child safety cannot be assured. Because the needs of children who require alternate care are high, programming efforts, particularly mental health services, are used in conjunction with placements. The following chart shows our placement of youth into some form of out-of-home care from 2013 to 2020. This number represents short Temporary Physical Custody (TPC) placements through long-term placements. The numbers also include the need for multiple placements for some children due to court- ordered changes, moving from more restrictive to less restrictive as the youth re-integrates back into the community, as well as placements that are not a quality fit for the child or juvenile. In 2020 all of our categories of placement decreased in accordance with fewer children and youth in care. Once again the most used placement option is the least restrictive option of foster care, followed by the use of group homes and very few placements at the residential treatment level. We are pleased with our ability to keep an overwhelming majority of our placements in a community setting while providing mental health and other community services despite complex and challenging needs. Alternate Care Placements - Children SETTING 2013 2014 2015 2016 2017 2018 2019 2020 Foster Care 82 127 112 108 114 105 119 108 Residential Treatment Center 2 6 7 12 9 7 9 4 Juvenile Corrections 0 0 0 0 0 0 0 0 Group Homes 11 13 17 12 16 6 8 7 TOTALS 95 146 136 132 139 128 136 119

99 Shelter and Detention Placements A final statistic that is extremely important to Child Alternate Care is the use of detention facilities and secure detention for youth. The use of these measures is taken very seriously. Secure detention is authorized only as a way of protecting the community and requires supervisor approval at the time of placement. Also, the use of secure detention can be ordered by the court at a variety of legal proceedings which occur from time to time. In 2020, only 11 youth were placed in detention, down from 15 in 2019. An item worthy of note is that the department only spent $18,050 on detention costs in 2020 which is an all-time low. The department continued to contract with Rock County for a daily shelter care bed which was utilized as a means to avoid more restrictive placements and to keep our youth close for treatment and family interaction purposes.

100 CHILDREN IN NEED OF PROTECTION AND SERVICES (CHIPS) ~Innovatively creating and utilizing evidence based programs, initiatives, and practice standards as a means of achieving safe and timely permanence for the children of Jefferson County.~

Child maltreatment is a major concern and can be a precursor to a myriad of health and well-being issues. Child abuse reports are received from members of the public, including neighbors, relatives, and friends of families where abuse or neglect is a concern or potential concern. A large number of reports are also received from schools, police departments, physicians, and other service providers or professionals. Each report is handled according to Wisconsin State Statutes Chapter 48 requirements for child abuse investigation and child protection. Once a report is made, our Intake staff handles the investigations through the court disposition. Our Child Protective Services workers are required to continuously make judgments that deeply affect the lives of children and their families. These decisions can include removing children from their homes in cases of severe danger and requesting the intervention of the court. While other cases do not require action on our part at all, both types of decisions carry potential benefits and consequences for families and the department. Once a determination has been made that a case will move forward either through the court process or on an informal basis, the Children in Need of Protection and Services (CHIPS) team becomes involved. Ongoing work is being assigned earlier in the life of the case whether the case is being resolved with a formal petition or informal dispositional agreement. This assures that the family interaction plan and safety plans are being implemented and followed in accordance with standards and party agreements. This progressive practice allows for a more seamless transition for the family between Intake and Ongoing staff and enhances the engagement process with the family throughout the case transfer process and life of the case. The Children in Need of Protection and Services (CHIPS) team is comprised of a supervisor, seven ongoing case managers, two-family development workers, and a case aide, which was a new position added in 2020. The ongoing case managers are responsible for monitoring open CHIPS orders, and collaboratively planning with families to meet both the elements of the court order and the family’s goals. The Family Development Workers (FDW) and the case aide assist case managers by facilitating supervised family interactions, assisting with transportation needs, providing parent coaching, and are at times responsible for overseeing courtesy supervision cases from other counties in which there are no safety monitoring requirements. Additionally, FDW’s will let case managers know when they have available time in their schedules to fill and are more than willing to complete other tasks that may arise such as drug swabs, making charts for cases, and assisting with the organization and distribution of the multitude of donations that are received from the community. In 2020, the case aide was also a lead facilitator in the caring for Children who have Experienced Trauma class, formerly known as Trauma Informed Parenting. Once a case is transferred to the Ongoing CHIPS team, an ongoing case manager is assigned and a treatment plan for the child(ren) and parents is developed. Each case is unique with overriding factors such as poverty, domestic abuse, unmet mental health treatment needs, medical concerns for the child which may not be treated or sufficiently addressed, chronic homelessness, criminal charges and sentences, and significant AODA treatment needs. To address these issues the CHIPS team works closely with internal Human Service providers such as the Workforce Development Center (WDC), Comprehensive Community Services (CCS), Community Support Program (CSP), the Aging and Disability Resource Center (ADRC), the Waiver Program (CLTS), the Mental Health Clinic, as well as the Agency Medical Director, Dr. Mel Haggart. The CHIPS team also works closely with community providers including area hospitals and clinics, PAVE- Protect, Advocate, Validate, Educate, local law enforcement agencies, the Corporation Counsel’s Office, schools, and private child-placing agencies. The CHIPS team approaches each case with goals aimed at ensuring the safety of the children involved while at the same time providing for their permanence. If the children were placed outside the home at any time, permanence options include reunification with parent(s), Ch. 48 Subsidized Guardianship, Termination of Parental Rights, and Adoption or other planned permanent living arrangements (OPPLA).

101

In 2020, when fully staffed, the seven ongoing case managers carried an average of 10.8 cases which is a .5 case increase from 2019, and 1.5 more than in 2018. At the start of 2020, there were 81 open cases and at the close of 2020 there were 70 open cases. The highest case count throughout the year topped out at 87 and the lowest number of cases was 65. With regard to out-of-home care, the CHIPS team was responsible for 78 children placed in out-of-home care at the start of 2020 and 61 children placed in out-of-home care at the end of the year. The CHIPS team oversaw 76 children subject to in-home orders at the start of 2020 and there were 50 children subject to in-home orders at the close of the year. In 2020, the CHIPS team helped 33 children who had been placed in out-of-home care find permanency. Three children were the subject of Termination of Parental Rights (TPR) proceedings that were finalized in 2020. All three were successfully adopted or are in the process of being adopted at the start of 2021. An additional ten TPR proceedings were initiated in 2020 but remained pending at the end of 2020 due to lengthy court litigation and delays due to COVID-19. Twelve children were reunified with one or both biological parents. Seventeen children found permanency via Guardianship in accordance with their Permanency Plans and one youth “aged out” or found Permanency via (OPPLA) meaning they turned 18 while still placed in care and are living independently at this time. The key outcome indicator used by the CHIPS team in 2020 was the same KOI used in 2019 and the goal was to help children placed in out-of-home care move forward in a more timely fashion on their respective paths to permanency. This entailed case managers giving a presentation to all Children and Families Division supervisors in regard to children who have been placed out-of-home for nine months. The presentation attendees reviewed and discussed what services were already in place for the family, brainstormed what new or alternative services might be helpful, and problem-solved how to help parents overcome any existing obstacles or barriers to reunification. By nine months into a child’s out-of-home placement, we have a good understanding of the needs of a family and whether significant progress has been made toward reunification. If parents are not actively working on their court-ordered conditions of return, the staffing may also include discussion about recommending a change to the child’s permanency goals at the twelve-month Judicial Review. These meetings have proven helpful in moving cases forward toward permanence in a more timely fashion, assisting families achieve ultimate objectives by breaking down larger goals into small steps. The meetings also help the case managers look and think outside the box when working with families by tapping into the extensive expertise and experience brought to the meeting by all the Children & Families Division supervisors. The CHIPS team works closely with many internal and external service providers to achieve desirable case outcomes. The CHIPS team enjoys the support of two family development workers. The primary role of the family development worker is to supervise family interaction between parents and children placed out-of- home; however, providing court testimony, one-on-one services, and other case aid duties that arise are now more prominent. The purpose of the family development worker’s position is to provide services to families and assist case managers in placing children in-home on a permanent basis; this includes providing in-home services when children remain placed with their parents as well as services to assist families in getting their children placed back in the home when they are in out-of-home care. This is achieved by supporting families through one-on-one modeling/teaching of parenting skills, providing transportation to various appointments, and tracking and documenting client progress as it relates to set goals. Family development workers are the eyes and ears of the case managers as this role involves seeing many of the case participants on a more frequent basis. The family development workers are also involved with the Incredible Years parenting class and CAPS month. When a family development worker becomes involved in a case, they receive a referral from a case manager that includes parent and child information, a brief description of why services are being requested, what those services are, any unique needs related to the children or parents, and parental/family strengths. This allows the family development workers to provide individualized services based on the needs and strengths of each

102 family. One-on-one services can include but are not limited to, help with parenting skills, budgeting, and managing finances, and improving cleanliness and physical safety within the home environment. The family development workers, in conjunction with the case managers, review a visit expectations form with the families and all parties sign the form indicating they have read and understood what is being asked of them during their time with their children. The expectations are both general and tailored to specific families, and may include things such as bringing age-appropriate activities, meals and being/ talking respectfully to workers and foster parents during transition times. One-on-one parenting services are based on specific client needs but workers often incorporate pieces from the Incredible Years Parenting Program curriculum due to their involvement in teaching that program. The Incredible Years is an evidence-based parenting program that was established by using 25 years of research by Dr. Carolyn Webster-Stratton who is a licensed clinical psychologist, professor, and director of the Parenting Clinic at the University of Washington. The classes offered vary by the following age groups: 0-1, 1-3, 3-6, and 6-12. Additionally, there is a special curriculum for those who are parenting children who have an autism diagnosis. The programs for each age group vary in length from eight weeks to eighteen weeks. Classes include watching vignettes, discussing those vignettes, role-playing, games, quizzes, and homework which includes documenting the use of the skills learned and discussed in class as well as reading chapters from the Incredible Years book. The program is based on a pyramid with the premise being that we want to do more of the things at the bottom and less of the things at the top. The skills at the bottom are focused on building a positive relationship with your child and increasing their positive behaviors. Those things include spending quality time with them and using praise, encouragement, and rewards. In the middle of the pyramid is establishing household rules, clear limits, and the importance of following through with those rules and limits. At the top of the pyramid are ways to handle misbehavior such as ignoring, distracting, redirecting, and consequences (timeouts and/or removal of privileges). To use this in one-on-one sessions we either formally do an in-home version of the program or individualize the sessions and pull from the Incredible Years curriculum and other resources as needed. Jefferson County Human Services has a visitation room designed to be as comfortable as possible for children and parents who are unable to visit with one another in-home or in the community. This room is equipped with video/audio recording equipment which allows staff to record visitation if needed. This allows staff to review sessions and continue to fine-tune our approach. Staff, in conjunction with a therapist, have been able to use this equipment to provide Parent-Child Interaction Therapy or PCIT. PCIT is used to improve the quality of parent-child relationships by changing the parent-child interactions. At times, family development workers and case managers partner with legal professionals, psychologists who complete our parenting assessments, as well as other Jefferson County Human Services professionals, such as mental health workers, to put together individualized parenting recommendations for clients. This process involves a therapist watching the parent and child through a one-way mirror and coaching that parent using a microphone and earpiece. This equipment was updated in 2019 to ensure the best technical experience and feedback possible to the family. The room has also been updated using child abuse prevention funds as well as the trauma informed care initiative to make the space more inviting. The room has a couch and table and there are calming paint colors, as well as artwork. A bookcase was added, along with other toys, pillows, and activities for the children and parents to use while in the room. The room also has diapers, wipes, and other snacks and supplies in case a parent does not provide or cannot afford these items. Visit supervision requirements vary from case to case due to each parent’s specific needs learning styles, and mindset for taking direction. Sometimes staff will take a more hands-on approach by modeling and giving on- the-spot suggestions or prompts throughout a visit, other times staff will take a more passive, observation-only role during the visit and provide feedback afterward if necessary. The feedback can be given verbally or by completing a written form which is then provided to parents to review, process, and discuss later. Additionally, to make visits occur, family development staff frequently provide transportation for the children and/or parents. When possible, visits take place in a family’s home environment. When that is not possible, visits take place somewhere in the community or the visitation room at the Human Services building.

103 Every year the CHIPS team takes part in initiatives aimed at improving our practice and improving outcomes for children and families involved in the child welfare system. One of the ongoing initiatives, Motivational Interviewing is a collaborative, person centered form of guiding to elicit and strengthen motivation to make meaningful change. The fidelity to this collaborative form of communication is important to the team because as we continue to move forward we use the transfer of learning exercises during team meetings and make MI a focus on every case during worker supervision. MI has become an integral part of the environment at Jefferson County and to further strengthen skills, staff continues to attend training and learning labs each year. Jefferson County took the time to train qualified internal staff to in turn train new employees and to enhance current practices throughout the year. Each team has at least one MI coach, which will ensure the fidelity to this initiative for years to come. Every April, the CHIPS team puts together activities and displays, in addition to raising funds for Child Abuse Prevention Month. The planning for the events and activities starts months in advance and takes the efforts of everyone on the Team to be successful. Unfortunately in 2020, COVID hit just before the team could follow through on all the planned CAPS activities, and events were canceled. However, because 2019 was a record year for fundraising we were still able to help families in the same ways we were in years prior. Additionally, 2020 saw many community donations to the agency for families during the holiday months and throughout the year.

104 The challenges we look forward to in 2021 include maintaining the fidelity of former training and initiatives and continuing to modify our practice as new challenges and evidenced-based practices arise. With the addition of the case aide position, whose duties are fluid at this time, we look forward to providing even more time and attention to the families we work with. Practice change and modification will require an increased transfer of learning exercises and more targeted supervision on each case. The CHIPS team includes staff with a great deal of expertise and experience and several members of the team are key contributors or actual trainers in Motivational Interviewing, Incredible Years Parenting, and Trauma Informed Care. Having these resources available to the entire CHIPS team on an ongoing basis will ensure that the team can embrace new challenges in 2021. Review of 2020 Goals: Key Outcome Indicator: All out-of-home placements will be formally screened for permanency options at nine months of continued placement in out-of-home care. 85% of all out-of-home placements were screened within nine months of continued placement. The other 15% were screened within ten months of continued placement. 1. The CPS unit, in conjunction with other units, will continue to offer at least three sessions of the Incredible Years parenting program, both in-house and within the community. Additionally, CPS team members will co-facilitate and support the Strengthening Family Systems class to ensure longevity. This goal was only partially attained due to the COVID-19 pandemic. Although there were more IY sessions offered in 2020 over previous years (please see IY section of the annual report for details), there was only 1 session in which one of the CPS team members co-facilitated. This was due to COVID- 19 and the virtual format. The same two facilitators taught the classes throughout the year. One of the CPS team members did play a big role in assuring the Strengthening Family Systems: Caring for Children Who Have Experienced Trauma class continued to move forward. Due to COVID- 19, the class was not offered in 2020; however, it did begin in early 2021, after the curriculum was revised and reformatted to accommodate virtual instruction. 2. The CPS unit will review and revise the opening paperwork contents and process to assure that it meets the needs of the CHIPS team as well as agency requirements. This goal was attained. The opening paperwork was reviewed and unnecessary items were removed. The process for which the paperwork is completed was changed for the better, due to COVID- 19. The necessary paperwork is getting to parents and other departments within human services more timely than it previously had. The team feels that there is still more modification that can be done to the paperwork, and will review this goal again in 2021. 3. The CPS unit will revise the Parent Handbook/Guide to Court Process, which was shared by another county, to tailor it to Jefferson County. This will be shared with parents and caretakers on new CPS cases in 2020. This goal was partially attained. This goal was worked on by members of the CPS team in 2020, the final draft of the handbook is still in process and will be reviewed before distribution. 4. To ensure that the CPS Ongoing unit is making progress toward proficiency in Motivational Interviewing skills, each team member will participate in all professional development activities hosted by the county, including the completion of a coaching opportunity in 2020. This goal was attained. The CPS team continued to use MI throughout the year with their clients as well as in the virtual groups and team meetings that were held. The team also participated in the transfer of learning exercises during CPS internal team meetings. 5. To improve processes in identified areas, the CPS Ongoing unit will work on a NIATx project in 2020. Although CPS team members were involved in several workgroups throughout 2020, no one was specifically involved in a NIATx project. This goal was not attained.

105 2021 Goals: Key Outcome Indicator: Case managers and CPS supervisor, when appropriate, will hold a full disclosure meeting with parents on all out-of-home cases within 60 days of the internal case transfer staffing. 1. At least 75% of the team members from CPS will participate in a workgroup or committee offered in 2021. They will use the transfer of learning during team meetings to keep their co-workers apprised of current happenings. 2. The CPS team will continue working on the goal of streamlining the opening paperwork process. 3. The CPS team will, twice monthly, select a case to staff during the team meeting. The staffing will be specific to safety, and potential reunification or other permanency options. 4. To ensure that the CPS team is making progress toward proficiency in Motivational Interviewing skills, each team member will submit a recording for a coaching opportunity. Additionally, CPS team members will participate in any agency wide professional development activities.

106 Children’s Long Term Support Waiver Program “Helping families support their children with disabilities in their own home.” Children’s Long Term Support (CLTS) Waiver Program Description The Children’s Long Term Support (CLTS) Waiver Program is a Home and Community-Based Services waiver that provides Medicaid funding for children who have substantial limitations in their daily activities and need support to remain in their home or community. Eligible children include those with developmental disabilities, severe emotional disabilities, and physical disabilities. Funding can be used to support a range of services based on an assessment of the needs of the child and his or her family. These services to the families should be community inclusive and person-centered while utilizing providers that are aligned with this philosophy and chosen by the family. These services are delivered at the county level, while the Department of Health Services (DHS) provides the administration of the waiver program. CLTS program provided support and services to 280 families in 2020.

“We have grown in the understanding of our child and we've grown in the understanding of ourselves. We have changed our family, each of us individually. I don't know how we would get through this without this help.” - Parent Supporting Families through the Pandemic As a county, we are committed to protecting the health and safety of our families. Contact with families continues to be essential during the pandemic. Heightened support and service coordination requirements are necessitated by the need to maintain quality services. CLTS staff supported families during the COVID-19 pandemic in the following ways allowing parents/guardians to effectively care for their child.  Serving families remotely with Support and Service Coordination  Agencies and providers serving families remotely for continuity of services  Checking in on families more frequently as deemed by the family  Increasing services upon request

“Our Support and Service Coordinator knows that my son (recipient of CLTS services) depends on healthy (mentally & physically) parents so she always checks in on how we are ALL doing. She’s helped us brainstorm ways to pay for things he needs that we struggle to pay for. She presents ideas for him getting the best out of school, recreation & home life. It is very obvious he is a little boy with a bright future to her, not just a name or a case number. She’s suggested programs his siblings could benefit from. I always enjoy her phone check-ins especially during this really difficult time of social isolation.” - Parent

State Level Waitlist Initiative This initiative began in 2017 when the 2017-2018 state budget provided funding to reduce gaps between available funds and demand for services. Locally, our CLTS program hired more staff and streamlined procedures to move children through the enrollment process faster. The initiative has allowed families to have quicker access, reduced stress, challenges, and barriers. CLTS State Waitlist Elimination Initiative has made remarkable progress in just three years.  Over 6,000 new children have been served  Children waiting for services has decreased from 876 days to 131 days  Program capacity has increased from 6,000 to 11,300 children being served

107 Transitioning from County to State Level Waitlist This transition is an effort to reduce the time families have to wait to access CLTS services and supports. County waiver agencies across Wisconsin now enroll more children in less time than ever before. This transition started in October 2020 with a full transfer to DHS oversight in January of 2021. Children placed on the waitlist in November and December 2020 need to be removed from the waitlist by March 31, 2021. The below data shows the extreme growth in enrollment and expedited transition from the waitlist to services.

This graph compares county to state children enrolled within 30 days. The percentage of children that were made fully funded at the beginning of the reporting period, and enrolled within the 30-day compliance timeline. Jefferson County CLTS program is 100% compliant, whereas the balance of the state is still finding solutions.

This graph illustrates the total number of children at the end of each reporting period that is funded and has yet to be enrolled. Jefferson County only has one child to enroll by 3/31/2021.

Transitioning from Compass Wisconsin Threshold to County Agencies for Access and Eligibility Currently, Compass is a unified point of intake, application, and eligibility determination for Children Long- Term Support, Katie Beckett, and Children’s Community Options Program (CCOP). The Department of Health Services (DHS) is transitioning this role from Compass to local County Waiver Agencies for CLTS and CCOP. Planning for this change started in September of 2020. Enrollment and eligibility will be the role of the County Waiver Agency by June 1, 2021.

108 Deciding Together Parents, caregivers, and children are the experts in their own lives and should always be part of the decision- making process. Deciding Together is a team approach used to develop and support a child’s outcomes and services included on the individual service plan (ISP). All decisions made about the child’s supports and services should be based on the family and child’s unique needs and goals. We surveyed families in December of 2020 to evaluate the family’s feeling of inclusion with the development of their child’s ISP.

How are we doing? In a continuous effort to ensure high-quality meaningful services, the CLTS Program surveyed 190 families with a return of 61 surveys. This is an 80% survey return rate.

Using the Deciding Together Process, I am involved in the discussion and planning of my child’s services?

 96.72 % of families strongly agree or agree they are involved with planning their child’s services. “They provide extra hope and emotional wellbeing!” - Parent “We feel as though we are not alone.” - Parent

109 I am satisfied with the frequency of contact I have with my Support and Service Coordinator.

 93.45% of families strongly agree or agree they are satisfied with the contact they have with their Support and Service Coordinator. “Knowing that they are here to help greatly reduces my stress.” - Parent

The services my family receives from the CLTS Waiver Program are an important part of my family’s support system.

 98.36 strongly agree or agree that the services they receive are an important part of their family’s support system.

110 “It's great to have our support and service coordinator as someone to go to when I need help with services. We never had that before, previously I had to call all over and got little to no results. She is a blessing!” - Parent

“Our children have gotten services they wouldn’t have gotten otherwise and services we didn't know existed.” - Parent My Support and Service Coordinator is easy to talk to about concerns and needs I have for my child.

 98.36% of families strongly agree or agree their Support and Service Coordinator is easy to talk to. “I can call with questions and get answers quickly.” - Parent

Foster Care Spending Ratio Fourteen children who resided in out-of-home placements throughout 2020 received Children’s Long Term Support Services. As illustrated on the graph, the annual cost for these 14 children to reside in out-of-home placement was $125,248.31. In the Children’s Long Term Support Program, the federal waiver program financially assisted with 59% of the cost, or $73,896.50, while CCOP supplied the remianing balance at 41% of the cost, or $51,351.81. These funds eliminated the use of tax levy dollars. Children in foster care qualifying for CLTS services are a cost-saving measure to the alternate care budget along with foster parents receiving the needed extra support and services to maintain the child in a home environment.

111 Parent Group At the request of parents, CLTS staff organized a parent group as a way to become involved and provide feedback on local programming. First, parents expressed the desire to create a provider registry and an application process that can be referred to for new respite providers. New respite documents were created, which included a child profile and a new application. Documents are currently being used for respite provider requests. Other parent group topics were from the Department of Vocational Rehabilitation Services, Aging Disability Resource Center, Disability Rights Advocacy, and Supportive Decision Making. Due to the pandemic, we took some time during each meeting to check in with families to be sure they were feeling supported. INCLUSION “We are happy to report a successful journey. We cannot thank you enough for making the adaptive star chair happen. Teri from Adaptive Star said, “We don’t say no! We WILL find a way!” Between the two organizations, it became a reality. We can say this has added enjoyment for Andrew and our family. Thank you from the bottom of our hearts.” - Parent and Grandparents

“They have helped us set up some respite care that has been so beneficial. They have also helped with several resources and community involvement.” - Parent

“Our Grandson has become more confident in social environments because continuing guidance and knowledge of which services would benefit our Grandson’s continuous growth into the mainstream communities.” - Grandparent

“I cannot express in words how grateful we are for the fence. My daughter asked to play in the backyard with the dogs tonight. Granted it is new, but I think the defined space was amazing and I could sit out there and not worry about her running away. Thank you so much!” - Parent

“Our son has received numerous pieces of mobility and safety equipment that have been significantly successful in his slow development and helped support addressing the ever changing symptoms of his extremely rare syndrome.” - Parent

Review of 2020 Goals: Key Outcome Indicator: CLTS program will meet enrollment timeframes (DHS Activity Timeline) 95% of the time. The Jefferson County CLTS Program met enrollment timeframes of 100% as evidenced by the 2020 external audit completed by Metastar. The internal audit shows enrollment timeframes were met 100% of the time. This indicator has been met. 1. CLTS program staff will utilize the Deciding Together Guide 100% of the time to increase teaming across systems of care to allow family voice and choice when developing family-driven plans, as evidenced by the 2020 internal audit. This goal was accomplished. CLTS staff utilize the Deciding Together to learn more about the child and family and how to best support them. 2020 internal audit shows all families have indicated through a signed document that they have been informed and involved in the development of their child’s ISP through the utilization of the Deciding Together Tool.

112 2. CLTS program staff will strategically plan for the transfer of Compass Wisconsin Threshold referral intake and assessment process to Jefferson County by December 31, 2020. This goal was accomplished. A transition plan was developed and submitted to DHS on September 29, 2020. This goal outlined the plan to offer the referral intake eligibility and assessment position to an internal Support and Service Coordinator. This role was accepted on November 30, 2020. This plan was approved by DHS on October 14, 2020. Jefferson County will assume full responsibility for the assessment, eligibility, and enrollment of children to the CLTS Program on June 1, 2021. 3. CLTS program staff will eliminate the waitlist by December 31, 2020, as evidenced by the PPS system. This goal was partially accomplished. DHS has indicated that counties now enroll more children in less time than ever before. The PPS system indicated on December 31, 2020, that Jefferson County had six children remaining on their waitlist. In November 2020, DHS required County Waiver Agencies to have children who were referred and enrollable in October, November, and December 2020 removed from the PPS system by March 31, 2021. New enrollable children that were entered into the PPS system in January had to be removed from the system by January 31, 2021. Jefferson County met the goal of enrolling children that were required to be enrolled by January 31, 2021. 4. CLTS program staff will complete the Jefferson County CLTS Program training index to be utilized by new staff and current staff for continuity of forms and communication by June 30, 2020. This goal was accomplished. CLTS Administrative Staff and Supervisor presented the training index to the team for review. At this time minor changes were made. Newly hired support and service coordinators utilized the training index through their training timeframe of January 2, 2020, through December 31, 2020. During their training, they identified the index to be useful and easily accessible. The training index has been shared with other programs. The index is a tool that will be utilized by all staff on an ongoing basis. The training index will be continually updated to meet DHS requirements and mandates. The training index was a 2020 request of the Children and Families Division Manager. 5. To ensure that the CLTS program staff is making progress toward proficiency in Motivational Interviewing skills, each team member will participate in all professional development activities hosted by the county, including the completion of a coaching opportunity in 2020. This goal was accomplished. CLTS staff were trained through our contracted MI trainer in the use of using “Motivational Interviewing and Deciding Together” in October 2020. This training was developed and implemented specifically for CLTS staff. Each staff received a certificate of completion. Staff had the opportunity to participate in ongoing MI training and Learning Lab activities. 2021 Goals: Key Outcome Indicator: CLTS program staff will meet enrollment timeframes (DHS Activity Timeline) 95% of the time. 1. CLTS program staff will achieve 86% or higher in the categories of Provider Licensure/Certification and Provider Training as evidenced by the 2021 internal audit conducted by the supervisor and administrative assistant using the Metastar tool. 2. CLTS program staff will achieve 86% or higher in the area of Evidence of Services Received as evidenced by the 2021 audit conducted via the internal audit using the Metastar tool. 3. CLTS program staff will assure transparency of communication by sharing pertinent information from the Department of Health Services and Jefferson County CLTS with families through email correspondence every month. The success of this endeavor will be evidenced through a survey distributed to families in January of 2022. 4. CLTS program staff will continue to update and utilize the training Index for the continuity of service provision across the team, as an effective means of transition to the new CLTS Supervisor, as well as assure consistency. 5. To ensure that the CLTS program staff is making progress toward proficiency in Motivational Interviewing skills, each team member will participate in all professional development activities hosted by the county, including the completion of a coaching opportunity in 2021.

113 COORDINATED SERVICES TEAM/WRAPAROUND “Keeping children with social, emotional, mental health and cognitive needs in their home” Program Description and Updates Jefferson County’s Coordinated Services Team (CST) is an intervention and support model that offers participants a team-centered, strengths-based assessment and planning process. The vision of CST is to implement a practice changes and system transformation. This occurs by developing a strengths-based system of care driven by a shared set of core values, which is reflected and measured by the way CST providers interact and deliver supports and services to families involved in multiple systems of care such as child welfare, youth justice, mental health, special education, and substance use. In 2020, CST provided Care Coordination to 30 youth and had 28 new referrals. When screening the family for CST services it may be determined that the child and family may require intensive mental health services not offered through the CST process. When this occurs these referrals are staffed internally. Depending on the service needs of the family they may be referred to Comprehensive Community Services, Community Support Program, or the Mental Health Clinic due to the higher level of need. Referral Source Referrals are received from internal programs and external sources. As you can see in the graph below, our highest referral source again this year was from internal programs (Youth Justice, Intake, CRP, CPS, and the Mental Health Clinic), totaling a little over a quarter of all referrals received. Tied for the second-highest sources of referrals were schools and parents making “self” referrals for their children. This year we received referrals from three different school districts throughout the county; Watertown, Jefferson, and Waterloo. This is a lower number of districts than in previous years, presumably due to the pandemic and use of virtual schooling throughout the county. Self-referrals represent families who have heard of the CST process and make contact with the Project Coordinator directly, requesting services. All referrals are received and screened, utilizing a Family Centerd approach that relies on parent participation. Other referral sources in 2020 were: mental health providers at Rogers Behavioral Health and Columbia County. One of the goals the CST team had in our DHS work plan in 2020 was to increase the community referrals from about 6% in 2018 to at least 15% in 2020 and maintain at least 15% of the referrals from the community through 2020. Through hosting informational sessions: at the end of the year, 46 % of the total referrals for 2020 were community- based, meaning originating from outside of Human Services and the school districts.

Family Satisfaction Throughout 2020 the Jefferson County Coordinated Services Team (CST) Project distributed Family Satisfaction Surveys to parents of active youth participants about their team’s experience; these surveys are distributed to families once a year, asking them to rate the services only from the last six months, and are anonymous. Five surveys were returned, with the Project Director recording and analyzing the data. Parents were asked to

114 respond to statements using a 5-point scale ranging from “Strongly Agree” to “Strongly Disagree”, with “Undecided” as the middle of the scale. All surveys had either “agree” or “strongly agree” marked for most (there was one outlier with an answer of “unknown” to question number 9) of the questions, which were: 2020 Family Satisfaction Survey Questions

1. I feel that I am treated as an important member of my child and family team. 2. I am satisfied with the goals the Team and I have set. 3. The Team takes time to listen to my concerns. 4. My family is getting better at coping with life and its daily challenges. 5. I would refer another family/ child to the WRAPAROUND project. 6. My care coordinator speaks up for my child and family. 7. The Team is sensitive to my cultural/ ethnic/ religious preferences and values. 8. The Team schedules services ad meetings at times that are convenient for me and my family. 9. If my child is 14 or older, the Team has a plan to ensure he/ she can get needed services when 18. 10. I feel the Team understands my child's strengths and needs. 11. I know the Team uses my child's strengths in setting goals and making plans. 12. Overall, I am satisfied with the efforts of the Team on my family's behalf. Youth Voice It is important to the CST Project that teams listen to and respect the ideas, opinions, knowledge, and actions of involved youth. Our CST surveys youth experiences, recognizing the importance of youth involvement. The Jefferson County CST Project distributed Youth Closure Surveys to youth about their experience in 2020. This year, for the third in a row, only two surveys were returned, with the Project Director recording and analyzing the data. The children were asked to respond to statements using a 5-point scale ranging from “Strongly Disagree” to “Strongly Agree”. The overwhelming answer to the youth questions was “agree” to all questions, with “strongly agree” as a close second (1 or both of the youth answered unknown to questions 2, 3, 5, 7, and 9). 2020 Youth Satisfaction Survey Questions

1. I was treated with respect by people. 2. I trust the people on my Team. 3. I have reached goals that are important to me. 4. The Team helped my family. 5. Adults who are important in my life listen to me. 6. My family knows about the services we need or want. 7. The services I need or want are available. 8. Our Team held regularly scheduled meetings. 9. We have a safety/ crisis plan we can rely on.

115 JEFFERSON COUNTY COORDINATED SERVICE TEAM CANS ASSESSMENT OUTCOMES FOR 2020 The Jefferson County Coordinated Service Team (CST) Initiative reported 28 youth as participating in 2020 of which 10 were disenrolled in 2020. Complete data was reported to the State Department of Health Services for eight of the youth who were disenrolled and qualified for reporting. Youth and families are assessed with a comprehensive tool called Child and Adolescent Needs and Strengths (CANS). This data is reported to the State DHS at enrollment and disenrollment to monitor their progress. Youth and families are rated on a 4-point scale as to the severity of their needs or the level of their strengths. The top two ratings are reported below describing youth with moderate to high needs and youth with moderate to high-level strengths. The percentage of youth with needs and strengths at enrollment and discharge are displayed to illustrate improvements made by youth in the Jefferson CST.

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117 Out-of-Home Placements, Diversions, and Cost Savings One of the qualifications for enrollment in CST is that the child is at risk of out-of-home placement. This risk is determined by many factors including the severity of youth behavioral needs, past duration of youth needs, success or failure of past interventions, and family or caregiver stability. Practice within CSTs is to prevent these potential out-of-home placements where appropriate by developing supports and services that meet youth needs in the community instead. How can the impact of preventing out-of-home placements for at-risk youth be measured? The Child and Adolescent Needs and Strengths (CANS) assessment used by CSTs provides some answers. The items in the CANS assessment can be scored with an algorithm to determine the overall level of need. The algorithm uses items from the Behavioral Health, Functioning, Risk Behavior, School, and Trauma to determine the youth’s level of need for placement. CANS author John Lyons, Ph.D., developed this algorithm for the Wisconsin Department of Children and Families (DCF) to determine this level of need, which corresponds with a recommended level of placement. Thus, the CANS assessment can be used to project a youth’s potential level of placement based on assessed needs even if no placement occurs. The results of the calculations generate three basic levels of need that are best described by the associated recommended placement: 1) community services, 2) group home placement, and 3) residential treatment center. In this report, the per diem rates (2020) and average lengths of stay (2019) for these types of placements were obtained from the Wisconsin DCF. Using this information and the CANS recommended level of need (placement); cost savings can be calculated for youth projected as diversions from these out-of-home placement settings who were served through the Jefferson CST initiative instead. The cost savings are illustrated below. Of the five youth enrolled in the CST in 2020, one had a level of need appropriate for community care. Four youth had a level of need appropriate for a group home level and no youth had a level of need appropriate for residential treatment. The estimated cost savings for these four youth placed in the Jefferson CST was $42,624.

118 Review of 2020 Goals: Key Outcome Indicator: Ninety percent of all children will remain in their home with the use of CST services. The Key Outcome Indicator was met. 100% of the children, while enrolled in CST, remained in their homes. 1. Care coordinators will coordinate and facilitate coordinating committee meetings in 2020. They will send personal invitations to parents and increase the parent participation/ attendance at the meetings by two parents, at least 50% of the time. Personal invitations were sent to parents before each of the three coordinating committee meetings in January, September, and November. Before the initial meeting in January, six parents stated interest in being able to attend one or more of the meetings held. There were two parents in attendance at the meeting in January, and no parents at the remaining meetings during the year. The parents indicated that scheduling conflicts with children’s school schedules, language barriers, and to hectic schedules resulted in not being able to make the meetings. Typically there are at least four coordinating committee meetings throughout the calendar year. 2020 was very different due to COVID 19 and the virtual platform of all meetings after March, and the added stressor for all parties given the difficulties of school schedules being in-person or virtual. This goal was not accomplished. 2. Care coordinators will host informational sessions within the community to make schools, parents, and other community partners aware of the process and services offered by CST. This will be measured through the percentage of community referrals constituting 15% or more of total referrals in 2020. The goal for the care coordinators was three informational sessions throughout the year; they were able to host two. Despite falling a bit short on the goal they set for themselves of three sessions, the community referrals were still higher than they were in 2019, at 46%, which is well above the mark of 15%. This goal was accomplished. 3. 50% of the youth in the Community Outreach program will participate in three or more of the service- based projects that are offered. This will be measured through the participation of youth and the records kept by the community outreach worker. There were no service-based projects offered to youth in 2020, due to the COVID 19 pandemic and adherence to CDC guidelines. The projects are typically done with a group of youth and something is given back to the community. For instance, in 2019, the youth painted flower pots and distributed them to assisted living facilities and nursing homes. This goal was not accomplished due to the COVID-19 Pandemic. 4. To ensure that the CST team is making progress toward proficiency in Motivational Interviewing skills, each team member will participate in all professional development activities hosted by the county, including the completion of a coaching opportunity in 2020. The CST team continued to use MI throughout the year with their consumers as well as in the virtual groups and team meetings that were held. The team also participated in the transfer of learning exercises during CST internal team meetings. This goal was accomplished. 2021 Goals: Key Outcome Indicator: 90% of all children will remain in their home with the use of CST services. 1. To ensure that the CST team is making progress toward proficiency in Motivational Interviewing skills, each team member will submit a recording for a coaching opportunity. Additionally, CST team members will participate in any agency-wide professional development activities. 2. Care coordinators will coordinate and facilitate coordinating committee meetings in 2021. They will send personal invitations to parents, and there will be a survey sent to find the most convenient time, to increase the parent participation/ attendance at the meetings by two parents, at least 50% of the time. 3. 50% of the youth in the Community Outreach program will participate in three or more of the service- based projects that are offered. This will be measured through the participation of youth and the records kept by the community outreach worker. These activities will be based on giving back to the community and maybe either individual or group projects, depending on CDC and county guidelines.

119 INCREDIBLE YEARS PARENTING PROGRAM ~Classes encourage parents to connect with other parents and enhance parenting skills~ Incredible Years Parenting Class and Program Description The Incredible Years (IY) Program is a series of interlocking, evidence-based programs for parents, children, and teachers, supported by over 30 years of research. The goal of the Incredible Years is to prevent and treat young children's behavior challenges and promote their social, emotional, and academic competence. The programs have been shown to work across cultures and socioeconomic groups. Through Jefferson County Human Services, community members and court-ordered parents are all offered the opportunity to take an Incredible Years parenting class. Barriers to attendance are eliminated by offering childcare, transportation, and a meal. This program is offered through the collaboration of Human Services staff through the CHIPS team, Wraparound team, and Community Response Programming staff offering the teaching, coordination, and aforementioned childcare and meal serving/ preparation. Additionally, forming partnerships with community stakeholders has been beneficial as they assist with things such as physical locations, monetary donations for meals and gas cards, as well as childcare and transportation. 2020 was unique in that more classes were being offered due to less time commitment of staff, and the removal of potential barriers, such as transportation and securing a location. Any parent may self-enroll in IY, while other referrals come from Jefferson County program Case Managers, intake department, therapists, doctors, teachers, and probation/parole officers, and other counties. The class offered is based on referral needs. There are four age groups/classes, which parents may choose from: 0-1 years, 1-3 years, 3-6 years, or 6-12 years. Additionally, there are “specialty” classes now offered: Autism classes, Advanced Parenting classes, and the Supporting Your Child’s Education class. Each class varies in length from 10-18 weeks but occurs once a week for a two-hour block of time. This was modified during 2020 for some sessions to be two classes per week for one hour each. This was at the request of participants who had children home and potentially unknown schedules due to COVID- 19. During class time, parents have the opportunity to gain positive parenting skills. Parents learn skills that include how to play and interact with their child, recognize emotions and social cues, how to use persistence, emotion, social and academic coaching, how to effectively use logical and natural consequences, and to set limits, routines and rules in the home successfully. Providing these classes educates parents to realistically and then successfully, use positive parenting skills instead of using harsh discipline and engaging in negative or unhealthy relationships in the home even with the daily stressors and demands of today’s world. This in turn reduces the need for more intensive interventions, creates opportunities for healthier and more positive child-parent relationships. Within the last few years the IY program has grown exponentially, averaging four classes per year in 2017 to offering eight classes in 2019, and 11 in 2020. In November of 2018, IY began to offer a modified IY class lasting six weeks in length, targeting spending time with your child, relationship building, coaching, effective limit setting, and praise and encouragement. This is offered to parents incarcerated in the Jefferson County jail who are unable to access Huber privileges and are likely to be incarcerated for six weeks or more. Additionally, in 2019, Jefferson County sent two employees to Seattle Washington to take classes on how to facilitate an Autism Spectrum and Language Delays IY class, to be implemented and also shared with teachers across the County. The number of referrals and parents taking the IY class continues to increase, as does the community’s awareness of the program and desire to participate or host and encourage parental attendance. In 2020 consumers were offered 10 regular sessions and one modified session for support at the end of the year, including two sessions that started but were interrupted due to COVID- 19.

120 The breakdown is as follows:  2: 0-1 year baby sessions: o 5 parents accepted and attended o 10 parents total were offered the class  1: 1-3 years toddler sessions + 1 modified baby class: o 5 parents accepted and attended o 10 parents offered o 2 of the 5 parents attending this class were also offered a modified baby class at the same time to meet the needs in the home. o 1 of these parents opted to continue to take the original toddler class and the modified class at the same time and 1 chose to only participate in the modified baby class  2: 3-6 years sessions: o One session began as an in-person class. This class had two classes that were completed before being interrupted. o The second session was online and offered to all parents from the face to face plus 7 new parents. o 14 parents attended -28 total parents offered  2: 6-12 years sessions: o Session one was ¾ completed in person and finished online o The second session one fully online o 29 parents attended - 41 parents the class offered  2: Jail classes were offered : o Session 1: Male’s session completed face to face (Jan-Feb) o 28 male parents signed up for the session. Each session is capped at 12 participants. 18 meet the criteria for participation. 6 turned down participation or were released. 12 participated. o 10 women signed up for the session to start in March. Which was canceled. o 28 parents were offered a class for the jail session only 12 counted as attended  1: Supporting Your Child’s Education Session: o 3 parents attended and 6 parents were offered  Total: o 115 parents in 2020 were offered a parenting class o 79 parents attended at least one class per session and completed the paperwork to attend Side note on the numbers:  The second jail session was canceled the day it was to start due to COVID- 19 so those numbers are in the offered to parent count but not counted in the attended count (10 parents)  The second IY session for the 3-6 years that was offered in-person has mixed numbers counted:  If the parent took the session offered again at a later date as an online session then the parent was not included in the count for the in-person session started earlier that was interrupted due to COVID- 19.  Since not all parents choose to participate in the online 3-6 classes if a parent choose not to come back they were only counted as offered but not counted attended-regardless of attending the first 3 classes face to face. This is so parents were not counted twice and because the class was not available to all parents that originally attended the in-person classes due to time of class, availability/speed of internet, comfort level with technology, or due to children being home. Children’s IY Class The Incredible Years Small Group Children’s Training Series is a comprehensive, interactive, video-based curriculum provided in a small group setting. The social Skills group was first implemented in 2017 at the Lake

121 Mills Elementary School and were held once a week for 40 minutes, spanning almost the entire school year. The group was comprised of five first-grade students. In a group, children learn social skills, problem-solving skills, and develop strategies to manage emotions healthily. This enables children to have reduced behavioral issues, a decrease in the need for interventions, and become emotionally competent. Group leaders communicate each week with each student’s parents, teacher, and school social worker to promote the transfer of learning both at home and in their classroom. Through the learning curve of implementing a new class, the IY facilitators fine-tuned the class structure and length to meet the unique needs of the setting. The class is now held three times a year; fall, spring, and summer and the number of weeks it is held have been reduced. The class has been going very well since the restructuring and the facilitators feel it is a great success. Lake Mills Elementary continues to support the collaboration and staff work closely to identify children who would benefit from the social skills group. During 2020 the facilitators worked with the Watertown School District and will be offering classes in that district in 2021, expanding the school offerings from two per year to four per year, as well as continuing to offer the session in the summer. There were a total of three classes in 2019, one in the community during the summer and two in the Lake Mills Elementary School. There were a total of 11 youth who participated, including ten males and one female. Nine of the youth resided in Lake Mills, one in Watertown, and one in Whitewater. In 2020 the IY facilitators utilized funds to purchase props for the classes. Some of the items included a projector, iPads, games, and activities as well as two puppets. Wally is pictured just below holding one of the games we utilize with youth and families.

Funding Source The Incredible Years Parenting Class and Children’s Small Group Training is funded through Watertown Area United Way and United Way of Jefferson and North Walworth Counties.

122 Review of 2020 Goals: 1. IY facilitators will teach four modified eight-week sessions of Social Skills for Children in Lake Mills and Watertown school districts and will teach an eleven-week session during the summer at a community venue within Jefferson County. This goal was partially accomplished and modified due to COVID- 19. Two of the planned four sessions were held despite the pandemic, one each in Lake Mills and Watertown school districts during the spring term. The 11-week session was held over the summer in a modified format, via Zoom. Additionally, there was a youth group held in the fall for youth who had already participated in the spring session of the Social Skills group. This was also held virtually, via Zoom. 2. IY facilitators will host at least two parenting sessions at community venues in Jefferson County. This will include a community venue in the southern part of the county, targeting the Lake Mills, Fort Atkinson, and Jefferson areas. This goal was not accomplished due to the COVID-19 pandemic. This goal became inapplicable in 2020 due to the COVID- 19 pandemic, because all sessions were held via Zoom. 3. IY facilitators will host: Helping Preschool Children with Autism: parents and teachers as partners. This will be offered to school staff in the fall of 2020. This goal was not accomplished due to COVID- 19 restrictions and scheduling/ availability conflicts of the school staff. 4. IY facilitators will offer at least four modified parenting classes at the Jefferson County Jail in 2020. This goal was not accomplished. In 2020, only two classes were offered, and only one was seen through to completion. This was due to the COVID- 19 pandemic and the restrictions on the number of people allowed to gather, as well as the inability of the jail to accommodate the virtual platform of the classes, offered later in the year. 2021 Goals: 1. IY facilitators will teach four modified eight-week sessions of Social Skills for Children in Lake Mills and Watertown school districts, one at each district in both the spring and fall terms. There will also be an 11- week session during the summer. Any or all of these sessions may be held virtually via Zoom depending on the COVID- 19 precautionary measures. 2. IY facilitators will offer at least one Advanced Parenting Class and curriculum to parents who have completed the initial IY Parenting class. 3. IY facilitators will host either Helping Preschool Children with Autism: parents and teachers as partners or Autism Spectrum and Language Delay programming. This will be determined by the interest, availability, and need of participants within the community and school districts.

123 THE INTAKE UNIT Who Are We? The Intake Unit is comprised of 1 Access Worker, 5 Initial Assessment Workers, 2 Juvenile Court Intake Workers, 1 Family Advocate, 1 Parent Coach, 1 Administrative Assistant, and their Supervisor. What Do We Do? The Intake Unit is the point of access for interventions and services for children, youth, and families in Jefferson County. The Intake Unit carries out many responsibilities, including:  Receiving Access Reports  Conducting Initial Assessments  Processing Truancy and Youth Justice Referrals  Carrying out Community Response Programming  Processing Kinship Care Referrals What Is An Access Report? The Intake Unit is responsible for receiving and screening Access Reports, which are also known as CPS Reports. A report can be made by anyone at any time and can be made by phone, letter, fax, email, or in person. When allegations of child maltreatment are reported, they are documented in an Access Report. The information received is analyzed and the totality of circumstances, including information from any previous CPS history with a family, is assessed and a determination is made regarding the need for CPS intervention. CPS intervention is only warranted when there is a report that a child may be unsafe, abused or neglected, or at risk of maltreatment, as defined in Wisconsin State Statutes and CPS Standards. The following outlines the total number of CPS Reports made to our Intake Unit for the past 5 years, as well as how many were screened in for Initial Assessment. While the number of total CPS Reports made has fluctuated over the past 5 years, the number of CPS Reports screened in for Initial Assessment has remained fairly consistent. It should be noted that our screening decisions are congruent with the State’s screening decision average.

2016 2017 2018 2019 2020 Jefferson State of County WI Screened In CPS Reports 259 262 270 280 265 32% 34% Screened Out CPS 506 638 616 546 551 68% 66% Reports Total CPS Reports 765 900 886 826 816 100% 100% Made One might question why only a third of CPS Reports made are screened in for CPS intervention. It is important to know that families have the right to parent their children as they choose so if the reported allegations, even if true, would not meet the statutory definition of abuse or neglect, then CPS intervention cannot occur. If it’s determined that the report doesn’t meet the legal standards of child maltreatment or threatened maltreatment to warrant CPS intervention, the family may still be referred for appropriate services, such as Community Response Programming, which is outlined later in this section of the Annual Report.

124 What Is An Initial Assessment? An Initial Assessment is typically known as a CPS investigation. As mentioned, an Initial Assessment can only be conducted when allegations rise to a level of maltreatment or threatened maltreatment as defined in Wisconsin State Statutes and CPS Standards. The purpose of this intervention is to ensure child safety while also partnering with families to meet their needs to enhance parental protective capacities and improve family functioning. A comprehensive Safety Assessment is completed as part of every Initial Assessment where the alleged maltreatment is by a parent, sibling, primary caretaker, and/or household member. Allegations of neglect are the most reported, and the most investigated, type of maltreatment. Data, both for Jefferson County and statewide, continues to indicate that drug and alcohol use by parents is the primary cause of neglect and unsafe findings for their children.

2016 2017 2018 2019 2020 Safety Assessments 221 228 236 255 266 Completed Children’s Safety 453 503 525 602 511 Assessed Safe Decisions 193 201 211 208 212 Found Unsafe Decisions 28 27 25 47 29 Found

It should be noted that even if a child has been assessed to be unsafe in their home environment, this does not inevitably mean the child needs to be removed from the home. In fact, in the majority of these situations, we can safely maintain children in their homes through the use of both formal and informal supports, services, and resources, and research shows that families are more likely to be successful when this can occur. Jefferson County has been an In-Home Safety Services (IHSS) site since 2012, and in 2020 this programming evolved into what’s now called Targeted Safety Support Funding (TSSF). This initiative has supported the implementation of concentrated in-home safety plans that control dangerous threats to child safety that would otherwise potentially require the removal of children from their homes. Components of this initiative include concentrated safety monitoring through home visits and phone calls, formal and informal supports to families, and timely connection to necessary services and resources. The graph below shows our use of this programming for the past five years, which includes how many families have been referred, how many out-of- home placements of children were prevented, and the savings in alternate care costs. One of our key outcome indicators with TSSF’s new programming was to decrease screened in re-referrals (CPS Reports) for families that receive TSSF programming. This key outcome was measured by tracking whether families were screened in for Initial Assessment, either while receiving TSSF programming or within one year of receiving the programming. In reviewing the 2020 data, it shows that over 90% of the families served under this programming did not have subsequent Initial Assessments within the 2020 reporting period.

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2016 2017 2018 2019 2020 Families Referred 12 14 23 20 26 To IHSS/TSSF Out-Of-Home Placements 25 28 43 49 50 Prevented Savings In Alternate Care $126,000 $111,000 $126,000 $198,000 $330,000 Costs

What Are Truancy & Youth Justice Referrals? The Intake Unit is also responsible for processing Truancy Referrals and Youth Justice Referrals. Truancy Referrals are made by schools when youth have been habitually truant from school, as defined per Wisconsin State Statute. Delinquency referrals are generated by law enforcement when youth commit criminal offenses, as defined per Chapter 938. Traditional wisdom would suggest that a punitive and probationary approach is necessary for addressing truancy and delinquent behavior; however, research suggests that a strength-based, family-focused, and trauma-informed approach has better outcomes for youth and their families. As illustrated in the data below, the number of Delinquency Referrals for the past three years has been rather steady, whereas the number of Truancy Referrals received from 2019 to 2020 decreased significantly, which certainly was attributed to the Covid-19 pandemic and how schools had to navigate these new and unprecedented circumstances. While the number of formal Truancy Referrals decreased, concerns of youth being absent from virtual schooling were being reported to our Department at an alarming rate. As a result, the Intake Unit restructured the roles of its two Juvenile Court Intake Workers in which one of them is now solely assigned the Truancy Referrals. This has allowed for concentrated truancy intervention programming and partnerships with schools and families. One of our areas of focus is working preventatively with schools and families when truancy concerns arise, in hopes that formal Truancy Referrals never have to be made. It should be noted that even when Truancy Referrals are made, as part of the Intake process we strive to work with schools and families to identify the underlying reasons for the truancy and connect them with appropriate services and resources in the hopes court intervention will not be necessary. Whether under preventative intervention or through the Intake process, such services and resources could include referrals to Diversionary Programming, mental health services, Wraparound programming, or Community Response Programming.

2016 2017 2018 2019 2020 Delinquency Referrals 334 294 211 213 196 Truancy Referrals 29 36 40 68 15 Total Referrals 363 330 251 281 211 What Is Community Response Programming? The Intake Unit established its Community Response Programming (CRP) in the fall of 2018 and provides voluntary supports to families who have had screened out CPS Reports or that have been referred to CRP at the close of an Initial Assessment. The overall goal of Community Response Programming is to strengthen families, prevent child abuse and neglect, and prevent families from having re-referrals to CPS. This programming is vital in prevention, targeting, and engaging these families in services designed to reduce risk factors and promote family strengths associated with child safety and wellbeing. Our Family Advocate and

126 Parent Coach have strong community partnerships and offer direct service or referrals in the areas of domestic violence, vocational assistance, family medical needs, financial support, household or family needs, housing, mental health services, parent education, and child development, as well as substance abuse services. The data below shows the effectiveness of our Community Response Programming here in Jefferson County.

September – December 2018 2019 2020 Referrals Made To CRP 51 109 162 Families Who Accepted Programming 18 40 69 Need For CPS Intervention During/After CRP Participation 3 3 18 Need For Formal Court Involvement During/After CRP Participation 0 0 5 What Are Kinship Care Referrals? The Intake Unit has overseen Kinship Care Referrals since 2017. When a youth or child has to be placed outside their home, the goal is for them to be placed with relatives who are then eligible for Kinship Care funding, either voluntarily or by court order, depending on the nature of the placement. Before the Intake Unit overseeing these referrals, they were only reviewed on an annual basis when the Kinship Care Renewal Application process was required. This meant that some families may have been actively receiving Kinship Care funding throughout that prior year when they were no longer eligible. This also meant that families that were eligible for Kinship Care funding may have been put on a Waitlist due to the budgetary allocation of this funding. After the completion of a division-wide NIATx project (continuous quality improvement), these Kinship Care cases are now reviewed every quarter which has dramatically decreased the Waitlist and ensures proper allocation of Kinship Care funding. 2017 2018 2019 2020 Voluntary Kinship Care 20 15 25 38 Court Ordered Kinship Care 30 31 32 23 How Does Our Intake Unit Compare To Other Counties? Our Intake Unit always goes above and beyond in meeting timelines and standards, as well as carrying out best practices for the consumers we serve. This is especially true through the Covid-19 Pandemic and our Intake Unit staff deserve the utmost recognition for this. Many of the Child Welfare and Youth Justice rules were temporarily suspended as a result of the pandemic; however, these were not suspended for many of the duties that the Intake Unit staff are responsible for, such as child safety. While the rules were waived to allow for virtual contacts and home visits, the Intake Unit staff continued to complete in-person contacts, Forensic Interviews, and home visits to ensure child and community safety. Since the onset of the pandemic, Jefferson County was only one of six counties in Wisconsin that were above 95% in completing timely face-to-face contacts on Initial Assessments, and we were only one of 18 counties that were above 95% in completing Initial Assessments within the required 60-day timeline. This is tremendous work and shows the dedication and commitment the Intake Unit staff have to the children, youth, and families we serve.

127 Review of 2020 Goals: Key Outcome Indicator: Meet 100% of CPS and Juvenile Justice mandated timelines. According to DCF reporting, the Intake Unit completed 268 Initial Assessments in 2020. Our performance scorecard for completing Initial Assessments within the mandated 60-day timeline was 99%, whereas the state average was 73%. The Intake Unit’s performance scorecard for completing initial face-to-face contact on Initial Assessments within the screened-in response time was 97%, whereas the state average was 80%. Data compiled internally indicates that 100% of Juvenile and Truancy Referrals were processed accordingly within the mandated 40-day timeline. These indicators ranked among the highest performing in the state. 1. The Community Response Programming will continue its strategic planning, outreach, and implementation to promote parental resilience, facilitate community supports and resources, and enhance parenting skills and child development. This goal was accomplished. Our Family Advocate and Parent Coach have fostered strong community partnerships and offer direct services and/or are a referral source for services, such as domestic violence advocacy, vocational assistance, family medical needs, financial support, household or family needs, housing, mental health services, parent education, and child development, as well as substance abuse services. 2. The Youth Diversionary Programming will continue its strategic planning, outreach, and implementation with the goal of decreased delinquency and truancy referrals decreased recidivism, decreased out-of- home placements, increased school attendance, and decreased school suspensions and expulsions. This goal was accomplished. Our Diversionary program continues to foster strong relationships with schools, law enforcement, and legal partners and offer direct services and interventions and/or are a referral source for services, such as mental health services, substance abuse services, parent support, and mentoring. Additionally, one of the Juvenile Court Intake Worker’s positions was restructured with the focus of this position being on Truancy Referrals and diversionary work with at-risk youth. 3. Continue building upon our skillset and proficiency in Motivational Interviewing through the implementation of the tools and skills in our daily practice, as well as monthly reviews of each other’s MI recording samples. This goal was accomplished. The Intake Unit staff pride themselves on carrying out the essence of Motivational Interviewing in their daily practice. Staff is continually expanding their range of MI skills and proficiency by participating in MI Trainings, which were offered virtually in 2020. Each of the 10 Intake Workers also submitted sample recordings that the team peer-reviewed and provided coding and feedback on, which offered a robust transfer of learning environment each time these peer reviews were held. 4. The Intake Unit will continue its program development and implementation of the Jefferson County Children in Crisis Response Guide through quarterly Multidisciplinary Team Meetings, ongoing outreach, and technical assistance, as well as updates to the Guide as needed. This goal was accomplished. Jefferson County was recognized as an official Wisconsin DEC County in 2019 and our Response Guide was adopted later that same year. Multidisciplinary Team Meetings were conducted in 2020, which included a review of case practice, as well as an ongoing review of the Response Guide. 5. Continue to provide outreach and awareness regarding Child Protective Services through Mandated Reporter Training to Agency staff, schools, law enforcement, and other community partners. This goal was accomplished. A Community Stakeholder Presentation was held in March 2020 which included participation from Human Services staff, law enforcement, school staff, legal parties, medical providers, and other community partners. Ongoing outreach and awareness were also facilitated through regular meetings and correspondence with local schools.

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2021 Goals: Key Outcome Indicator: Meet 100% of CPS and Juvenile Justice mandated timelines. 1. A continuing goal for the Intake Unit is to maintain compliance with all CPS and Juvenile Justice State and Federal Standards and timelines. 2. The Community Response Programming will continue year 4 of its outreach and implementation to promote parental resilience, facilitate community supports and resources, and enhance parenting skills and child development. 3. The Truancy Intervention Programming will continue its strategic planning, outreach, and implementation with the goal of decreased truancy referrals, decreased recidivism, increased school attendance, and decreased school suspensions and expulsions. 4. The Intake Unit will continue its program development and implementation of the Jefferson County Children In Crisis Response Guide through quarterly Multidisciplinary Team Meetings, ongoing outreach, and technical assistance, as well as updates to the guide as needed. Two particular areas of focus in 2021 will be refining the protocol for sex trafficking cases, as well as onboarding treatment and service providers. 5. The Intake Unit will continue its support of the Jefferson County Diversity Committee through the implementation of the Strategic Plan, participation in training opportunities, as well as sharing transfer of learning opportunities at team meetings every month. 6. An ongoing goal for the Intake Unit is to continue building upon our skillset and proficiency in Motivational Interviewing through the implementation of the tools and skills in our daily practice, as well as monthly reviews of each other’s MI recording samples.

129 YOUTH JUSTICE SERVICES “We ourselves feel that what we are doing is just a drop in the ocean. But the ocean would be less because of that missing drop.” ~Mother Teresa The Jefferson County Youth Justice Team provides several services to at-risk youth in Jefferson County. In addition to our family-based case management services offered to families who are referred through the Juvenile Court System, we also provide programming to families, children, and youth in the community who are at risk of becoming involved in the Youth Justice System. The work we do with our consumers is trauma- informed, treatment-focused, and collaborative with families and other system partners. The Youth Justice Team is a part of the Children and Families Division and is comprised of the Deputy Director, Youth and Family Services Supervisor, and eight family case managers. The Youth Justice Team recognizes the dignity of each and every youth and family. Who do we serve? Juveniles Alleged to be Delinquent *- includes any person over the age of 10 who is alleged to have violated any state or federal criminal law. Under 1995 Wisconsin Act 77, the general jurisdiction of the juvenile court was lowered from age 17 to age 16. 17-year-olds do not fall under the original jurisdiction of juvenile courts in Wisconsin. More information can be found in Wis. Stats. sec. 938.12.

Juveniles in Need of Protection or Services (JIPS) * - Youth may be alleged to require protection or services if certain conditions apply: JIPS Non-Truancy conditions include a parent or guardian unable or needing assistance to control a young person; a youth who runs away from home; or a youth who commits a delinquent act before age 10. JIPS Truancy conditions include habitual truancy from school. Youth adjudicated JIPS may be referred for a variety of services, but they cannot be sent to a correctional facility, juvenile detention facility, or a secured residential care center. More information on JIPS jurisdiction can be found in Wis. Stats. sec. 938.13.

Youth at risk of being involved in the criminal justice system – Our programming serves families that include one or more youth in a family exhibiting signs that they are at risk of becoming involved in the youth justice system – either through a formal delinquency referral or a JIPS referral. Referrals can come from a variety of sources, including schools, law enforcement, parents, or other providers.

Like many people across the globe, 2020 posed some significant changes, challenges, adjustments, and positive outcomes as a result of the COVID 19 pandemic. The Youth Justice Team was one of many who picked up their work belongings in March and headed to their homes to build a new normal as telecommuters. Those early days produced a lot of anxiety as we wondered and awaited what the virus would bring and how it would affect our families and our work. Shortly thereafter, we, along with millions of Americans, became proficient jugglers of the responsibilities of a parent, teacher, worker, IT specialist, and home designer. To get ahead of the isolation and loneliness that telecommuting can bring our team found meaningful and fun ways to connect virtually every day. And as the summer began then ended, the leaves turned, the winds turned colder and the snow fell, the team had built a new normal serving the youth of Jefferson County. This year, our pages tell the story of 2020, a year that will never be forgotten (as much as people wish they could), and how our team and the families we serve navigated and triumphed through and over those rocky waters. *(adopted from the DCF Youth Justice data report)

130 Key Positive Outcomes of Shutdown and Work Changes Though most people look back on 2020 as a year they wish they could forget, there were many positive gains our team experienced due to the state shutdown and the forced changes brought on by the pandemic. The idea of working from home is not new and had been explored in very small increments before the shutdown. Though it did not come without its challenges, the Youth Justice Team, like millions of other workers across the country increased their technological skills, learned new ways of connecting, and continued to produce incredibly high levels of service to the families served by Jefferson County Human Services. Initially, our team checked in with each other virtually every day to offer connection, encouragement, and creative ideas on staying well and maintaining stability through tumultuous times. Though stuck at home, we enjoyed more time with our loved ones, cleaner houses, new paint colors on our walls, and the beauty of being outside in nature. By providing primarily virtual services for non-crisis-related contacts, families saw a different side of us, a side that perhaps was more relatable. We also found new ways to utilize other key partners, such as our Functional Family Case Management (FFCM) national consultant. Finally, as you will see below, we pushed the boundaries to deliver specialized virtual treatment services to the families we serve. All of these necessary adaptations now can become staples in our work; and for that, we say that 2020 was one pretty great year.

ART Group goes Virtual Last year presented some perplexing situations regarding delivering services to our youth. A number of the youth who are referred to the formal Youth Justice System have significant needs in the areas of attitudes/beliefs, peers, and aggression. A large part of our role as case managers is to provide services that match the area of need, and those services need to be backed by science and research. Our team is lucky to have two of our YJ workers now fully certified as Aggression Replacement Training (ART) facilitators. ART is an evidence-based curriculum designed to meet the needs of youth who are at high risk of committing additional crimes and becoming deep system involved. It includes portions that address cognitions related to criminal thinking and aggressive actions, increasing competencies through instruction and role-plays in appropriate and positive social interactions, and also in moral reasoning. Facilitating this group to an in-person class of youth can be challenging in and of itself, and the thought of changing the group to a virtual format caused a fair amount of anxiety for the team. It didn’t take a considerable amount of contemplation to decide to move forward with the virtual group – we knew that it was important to do what we needed to maintain continuous programming. Our ART teachers did an amazing job of adapting the ART curriculum into a virtual format for a number of our high-risk boys. Though there were several obstacles to overcome, the group was a great success; and though we hope to be able to hold the next class back in our building or other community settings, it is a great option if necessary in the future.

Challenges Related to Pandemic Response In addition to some great side effects of the pandemic, some struggles and hurdles were especially difficult for our team to manage. A common theme we tend to see in our work with youth involved in the justice system is trauma. We know that unresolved trauma often leads to difficulties in school, whether it is reflected in attending, destructive behaviors, learning problems, truancy, or a combination of any or all of these. Due to several factors, 2020 brought an uptick in truancy issues and referrals – both for the youth we had already been serving as well as students who may not ever have struggled in school or with attendance. Though many of these were addressed informally, the number of youth in Jefferson County who experienced truancy was up in 2020. Other challenges pertained to how we engage with families and the challenges that accompany forming relationships through a screen versus sitting in their living rooms. Though it is easier to meet more often with families in a virtual format, at times it can be much more difficult to build rapport and achieve positive engagement. Some workers also opined that less in-person contact from their workers mistakenly led some youth to believe that court-ordered conditions were optional. Mental health symptoms also seemed to

131 increase for several individuals in 2020, and our youth and families were no exception. Hospitalizations, mental health crisis, runaway reports, and contacts based on mental health were elevated last year. Lastly, “COVID fatigue” seemed to come in waves throughout the year as numbers rose, fell, and rose again, vacations were canceled and constant adjustment was required to maintain a decent work/life balance. And whether related to the pandemic or not, 2020 brought the Youth Justice Team staff turnover as well. We said goodbye to two valuable members of our team and welcomed two more in 2020.

Overall, 2020 was difficult but had more positive takeaways than adverse ones. Read on to explore some more of the highlights.

Jefferson County Youth Justice Awarded Grant to Address Disproportionate Minority Contact In November of 2020, our team was awarded a grant from the Governor’s Commission on Juvenile Justice. A call to action after months of eye- opening tragic events, we chose to focus on creating preventative and restorative programming to address disproportionate contact in the Youth Justice System in Jefferson County.

This is an exciting opportunity to partner with three amazing schools in Jefferson County to train teachers, administration, staff, law enforcement, and Human Services workers in Restorative Circles. This new and innovative program is designed to take a step back even further than our remarkable diversion programming and prevent system involvement altogether for students who act out in school and might otherwise be referred to Jefferson County for Disorderly Conduct, Criminal Damage to Property, or other potential lower- level crimes. This practice is restorative in nature, holding youth accountable for their actions while also drawing out their strengths, increasing competencies and ultimately making the victim whole. The program is expected to fully launch in September 2021.

Youth Justice Diversion Programming Last year our team introduced our new Diversion Program to our stakeholders. Over the past year, our Prevention Resources and Engagement Program (PREP) services continued to expand and flourish with great results. This program is a key piece of the overall youth justice programming, as it provides much needed intervention to those youth who have committed a crime or have been identified as at risk for a truancy referral, but to put them through the formal system could increase their risk of further system involvement. Youth Justice Programs across the country have seen similar trends in the youth and families that come into this system. To recap, PREP offers three different subcategories of diversionary programming, depending on the need of the youth.

The Intensive Collaborative Services program is designed for youth with a high level of needs, whose behaviors related to complex trauma, mental health, or developmental disabilities present as delinquent acts. Assessment and intensive case management to connect youth and families to much needed community resources are offered to these families to stabilize these youth and prevent further system involvement. As stated in the graph on the following page, this part of the program serves a high number of youth and families and their needs, as indicated, are significant.

The Juvenile Court Diversion program is designed to provide a “light touch” of youth justice-related programming to those who have committed a crime and would benefit from the Balanced and Restorative Justice (BARJ) principles, but mixing them with more delinquent youth could easily promote further system involvement. Services include teen court, apology letter exercises, individual skill enhancement sessions, and Restorative Circles/victim impact groups are offered in this program within PREP.

132 Lastly, the Truancy Intervention and Prevention Services (Quick TIPS) program is offered to all of our youth referred to us by our local school districts or law enforcement for chronic truancy. We know that truancy is a complex issue that can be significantly more layered than what appears on the surface, especially with younger children. Mental health or AODA issues of the youth, as well as parents or caregivers, can be common contributing factors that lead to truancy issues.

The graphs to the left reflect both the success and the complexity of the PREP Diversion Program in 2020. The top graph shows that out of 22 youth who received PREP services

in 2020, only 14% received another juvenile referral. The middle graph indicates that 85% of youth served in the program achieved successful closure. And the bottom graph shows the complex needs that the youth have who are served by PREP, with 72% of youth having a mental health diagnosis.

Youth Assessment Screening Instrument (YASI) The Jefferson County Youth Justice team has a rich history of providing innovative services, supported by research, and in line with best practices. We know it is crucial not to overserve our referred youth who have a low risk to re-offend and high protective factors – and overserving those youth in the criminal justice system can increase their risk of recidivism. At the other end of the spectrum, it is imperative to serve youth who are

133 high risk to re-offend and have low protective factors with services designed to address the target behaviors, beliefs, and domains that have led them to commit crimes.

Our team continued our practice what we adapted in 2019 to utilize the YASI to inform decisions regarding how best to serve the youth who enter the Youth Justice system. The risk and protective levels indicate the dosage of ongoing intervention and progress of the youth at the six-month mark. The treatment modality is gleaned from the YASI assessment as well, as this assessment maps out the thoughts and actions that reach the core of the criminal behaviors. The graphs below indicate the risk and protective levels of the youth who were served by the ongoing Youth Justice Team. The ongoing workers complete a full assessment on youth determined to be appropriate to advance in the formal system. These are primarily high and moderate-risk youth with limited protective factors.

As reflected in the graphs to the left, of those youth who were administered full assessments by ongoing YJ workers, 52% were considered to be high risk to reoffend, and only 14% were low risk – which makes sense, as we as an ongoing team want to make sure we are not overserving youth. The protective factors reflect more than half of youth have either moderate or low protective factors. Though not reflected in the graphs, the ongoing team also uses YASI full assessment information to determine the top target behaviors and uses that information to work with the family to build the case plan. The services offered to the youth and families are designed to address the highest domains. For example, a youth who shows high needs and low strengths in the area of aggression and peers might be referred to an Aggression Replacement Training group or may do a Carey Guide with their worker on those domains.

Ongoing Service Model – Fostering Resilient Families Program Jefferson County provides an innovative family approach to working with youth either at risk of or involved in, the justice system. ”Fostering Resilient Families,” is the family relationship-centered program we offer each of our youth justice families. Fostering Resilient Families is trauma-informed and works off of the premise that improving family outcomes reduces the risk of further involvement in the criminal justice system. Case Managers engage with the whole family to maximize opportunities for change. The Functional Family Case

134 Management model is the centerpiece of the FRF program. FFCM goals are to engage families, reduce negativity and blame, motivate families to make positive changes within the family context, and provide services to all family members who need them, ensuring that each person in the family receives services and treatment to address their needs in such areas as educational, employment, mental health, and AODA. The model is strength-based, and workers integrate a relational focus into every visit with the families. Our goal is to help families healthily find hope and function without our intervention and presence in their lives.

Incentives are a key component to the Fostering Resilient Families program as well. Each family member is allowed to earn incentives for making positive contributions to the functioning of his/her family. Each family designs an individualized goal plan that includes positive behaviors that contribute to the happiness of the whole family. For example, kids in the family can earn points for getting themselves up and out the door, doing their homework, being respectful to family members, doing chores, attending therapy, taking medications, etc. Parents can earn points for completing a family routine, following said routine, participating in a trauma parenting group, looking for a job, taking steps to go back to school, trying new parenting techniques, etc. Members of the household can also earn family points by meeting family goals. The points equate to a plethora of choices of incentives, ranging from options that do not cost anything, to gift cards and tangible items. Restitution payments can also be earned as part of the incentive program. For example, a youth may choose to use part or all of their points to apply toward their restitution, rather than a privilege or item with monetary value. Some families decline incentives and some workers have struggled with this practice as well. It is an area we have included and have had success in over the past year. As seen below, this program seems to be having a great impact on the outcomes of the families we serve.

We have been providing the Fostering Resilient Families program, which marries a family/relational based case management model with structured incentives, since 2018. This graph represents recidivism rates from 2016- 2020. This measure of recidivism was based on JCHSD receiving any new referrals while the youth was open/under supervision. Since we began our new programming in 2018, recidivism rates continue to decline.

As reviewed in previous annual reports, the Fostering Resilient Families program began after the team was awarded a large Youth Innovations grant by the Department of Children and Families under the category of Robust Case Planning. The end of 2019 also brought the closure of the grant that led to the creation of the Fostering Resilient Families program, though not the program itself. The program as it remains solid. We continue to have consultation calls with our national consultant for Functional Family Case Management and also utilize an internal quality assurance tool during regular team consultations. The Jefferson County Youth Justice team is highly respected around the state and we are incredibly proud of our efforts to earn that reputation. We are committed to innovative practice and will continue to push ourselves to keep growing and doing what is best for our families.

135 2021 YJ Ongoing Year at a Glance

Though most of the youth we served on the Youth Justice Team were Caucasian; Hispanic and African American youth were overrepresented in our system according to the 2010 census. We are addressing this issue by partnering with schools to divert youth of color from the system by offering restorative practices for school based infractions that would otherwise be referred to the Youth Justice System.

Youth Justice case averages dropped in 2020. This was not surprising and

echoed what other counties were reporting across the state due to the COVID crisis. Furthermore, restrictions with the court process also related to the pandemic caused a bottleneck in court that resulted in lower case assignments for a period of time in the spring, summer and into the fall. We have already seen this number rising as things continue to open up more. Also, Case Managers continue to offer an array of additional prevention and early intervention services, including virtual outreach, treatment groups and prosocial activities, and high family caseloads can hinder that valuable service.

136 This chart reflects the high number of youth who struggle with mental health and/or alcohol and other drug addictions. As reflected, the Youth Justice team served a high number of youth who were afflicted with a mental health diagnosis, and a rising number of youth who struggle with AODA use. It is unclear whether or not the pandemic impacted these numbers, but it certainly wouldn’t be surprising. Targeted Case Management

The Youth Justice Team has been providing targeted case management, both as a billing source and for overall best practice, for many years. Targeted case management works well with Functional Family Case Management and we have been able to blend the component of YASI with TCM to offer a comprehensive assessment of the juvenile and his/her family. Furthermore, the PREP Diversion program, a new component of the Youth Justice Programming, also uses TCM as a model and bills for services. During the assessment, the case manager looks at several different life domains, including trauma, life satisfaction, strengths, mental health, family functioning, and others. A goal-driven case plan is created with the youth and family, using both the results of the YASI as well as the findings in the TCM assessment to determine what the case manager will assist with and what services need to be put in place. The plan is reviewed regularly with the youth and family, and a new plan with new goals is completed every six months. In addition to the treatment benefits of this practice model, $154,377 was billed out of TCM-D in 2020, and the total dollars recouped for the county was $42,298.98. Despite the lower caseloads, the team was still able to bring in a higher amount of dollars back to the county because of their diligent efforts in this area.

Focus on relative placements Jefferson County values maintaining youth in their homes, and when it is necessary to place a youth out-of- home, we try very hard to place them in a family home, preferably with their own family or a community member who is “like kin” to that individual. Due to our dedication to placing youth with family or someone they identify as a family when out-of-home placement is needed, we as a team chose our 2020 Key Outcome Indicator in the area of increasing relative placements for our youth in out-of-home care. Our efforts were valiant and highly successful in this area in 2020. An average of 69% of youth who were placed out-of-home in a family setting in 2020 was placed with a relative or like kin family. This is well above the national average and we are incredibly proud of our hard work in this area. 2020 Goal is: Key Outcome Indicator: 80% of the youth who are placed in out-of-home care will reside in a family setting, and of those placed in a family setting, at least 50% will be placed with their own family or like kin. As of January 31, 2020, 83% of youth placed out of the home on a Delinquency or JIPS Order are placed in a family setting; and of those youth placed outside of the home in a family setting, 60% reside with family or like kin. This goal was met in its entirety in 2020. On average, 86% of youth who resided in an out-of-home placement on a youth justice order were placed in a family home. And of those youth formally placed in a family home, on average, 69% of those youth were placed with biological relatives or like kin families. Our team is proud of this accomplishment, as we fully understand how traumatic placing a child outside of their home is and the importance of placing youth with a family with whom they already have a connection.

137 1. To ensure high and moderate-risk youth are offered services that match their identified areas of need, a minimum of three groups (i.e, ART, WRAP, JCIP, AODA with a contracted provider, etc.) will be offered throughout the year. This goal was accomplished. Three Youth Justice Case Managers provided an in- person Aggression Replacement Training group early in the year; and though it was challenging to continue this goal due to the COVID-19 pandemic, our team did offer two virtual ART groups in 2020. Additionally, all three case managers became certified ART instructors in 2020 – a huge accomplishment and a great asset to our Jefferson County Youth Justice programming. 2. To ensure services are available that address prosocial/leisure/recreation and positive peer and companion areas of the YASI, the team will continue to offer pool groups in the summer and add more options throughout the year. This goal was not able to be accomplished due to the COVID-19 pandemic. Unfortunately, we were not able to provide any group community programming in 2020, however, we did try to get creative with virtual outreach opportunities to engage with our youth. We are looking forward to the opportunity to get back to this goal further down the road. 3. To strengthen team cohesiveness, we will look at providing the team both educational and experiential activities at least twice a year and revisit issues among the team that influence team trust. This goal was accomplished. Our team took many opportunities during the pandemic to strengthen connections between us and grow as a team under incredibly challenging circumstances. We increased our contacts through regular team virtual check in’s, had a virtual dance party, and made a video of our team singing a parody of the Brady Bunch theme song. Furthermore, one of our workers organized a personality activity, and each of us learned about our personality style and how we best communicate and interact with others as well as our teammates’ profiles. This is invaluable information that we will use moving forward to continue to strengthen our team bonds. 4. To increase program fidelity and best case practice, the team will finalize and roll out the graduated responses grid, service matching matrix, and various risk assessment screening tools (i.e, electronic monitoring, detention, offense severity tool) in 2020. This goal was nearly accomplished. A subcommittee of team members met throughout the year to create a guide that will help workers with decision-making and service facilitation. Though this was a bit more difficult with having to work on this virtually, the product is in its final stages of completion and will be officially rolled out to the team in early 2021. 5. To increase confidence and proficiency in delivering evidenced-based practices to our youth and families, we will integrate skill practice into team meetings (such as Carey Guide, FFCM skill practice, MI, BITs, etc.) This goal was accomplished. The team focused heavily on Functional Family Case Management skills in 2020. Each month, another FFCM skill is selected and discussed in detail each week at the Wednesday team meeting. This practice will continue into 2021 and other topics/practices will be added as well. 6. The team will develop a subcommittee to review and plan fundraising activities, ensuring that they are cost-effective and purposeful. This goal was accomplished. The committee met early during the pandemic to discuss future fundraising ideas. Unfortunately, it was difficult to identify ideas that could be done virtually, so no actual fundraising events were held, but the committee has plans to discuss more of those ideas moving forward. 7. To increase program objectives, a minimum of 50% of families will receive incentives programming in 2020. This goal is in progress. The team made major progress in this area in 2020, thanks to a team member who took a major leadership role to provide more training to the team in using incentives, creating and implementing plans, and utilizing the software that accompanies this part of the program. This worker has been passionate about the incentives program since its inception and created training videos that workers can use to increase their knowledge of tying incentives to target areas, creating written incentive plans, and using the software tools that support those processes. More and more workers are utilizing incentive plans with families on a more consistent basis, and there is still room to grow for some workers. 8. Each member of the team will continue to work toward achieving proficiency in Motivational Interviewing, as evidenced by the submission of a tape or tape that is coded to proficiency or demonstrate

138 improvement. This goal was accomplished. Less face-to-face meetings were held with families in 2020, due to the pandemic. Some families were open to taping virtual Zoom sessions, though some were not. Creativity was required, and more individual coaching was done through role-plays and discussion during individual supervision sessions. Motivational Interviewing coaching is integrated into weekly supervision and team meetings. Now that more families are comfortable with virtual sessions, it is likely that all workers will be able to submit a taped virtual session in 2021. 2021 Goals: Key Outcome Indicator: 80% of the youth who are placed in out-of-home care will reside in a family setting, and of those placed in a family setting, at least 50% will be placed with their own family or like kin. 1. To ensure high and moderate-risk youth are offered evidence-based services that match their identified areas of need, the Aggression Replacement Training curriculum will be offered a minimum of two times in group format throughout the year. 2. To ensure services are available that address prosocial/leisure/recreation and positive peer and companion areas of the YASI, the team will continue to individual and/or group activities as appropriate and safe and develop group community service opportunities. 3. To increase program fidelity and best case practice, the team will complete the rollout of the graduated responses grid, service matching matrix, and various risk assessment screening tools (i.e, electronic monitoring, detention, offense severity tool). 4. To increase confidence and proficiency in delivering evidenced-based practices to our youth and families, we will continue to integrate skill practice into weekly team meetings (such as Carey Guide, FFCM skill practice, MI, BITs, etc.) 5. To decrease racial disparities in Youth Justice in Jefferson County, the team will partner with three area schools to implement restorative practices as a diversion to system involvement. This will be a Niatx project. 6. To better address truancy, the team will research and explore different evidence-based practices around this unique population of youth and families. 7. Each member of the team will continue to work toward achieving proficiency in Motivational Interviewing, as evidenced by the submission of a tap or tape that is coded to proficiency or demonstrate improvement.

139 ECONOMIC SUPPORT DIVISION ~Providing benefits and coordinating resources to strengthen our community’s Individuals and families~

he Economic Support Programs for Jefferson County are administrated at the Workforce Development Center (WDC). Our location at the Workforce Development Center provides staff with the ability to coordinate the services of the on-site providers: Job Service, the Division of Vocational Rehabilitation, T and the WORKSMART Program. Our community partnerships continue to result in effective service coordination. Our partners include Community Action Coalition, Goodwill Industries, Salvation Army, Forward Services, local Food Pantries, St. Vincent de Paul, and Employers. Employment services are provided regionally to facilitate coordination for customers who live in one county and are employed in another. If you are interested in learning more about the current job listings, job fairs, labor market data, and resources available to meet your workforce needs, the websites of www.jobcenterofwisconsin.com and www.worksmartnetwork.org are the key sites. The unemployment rate for Jefferson County in December of 2019 was 2.9% and in December of 2020, it was 4.7%. The Economic Support Division of Jefferson County Human Services facilitates customer access to financial assistance programs. The case managers assist the customers in applying for benefits, determine eligibility, update changes, explain program requirements, assess for possible fraud, and coordinate referrals to other resources. All Economic Support staff process Healthcare and FoodShare benefits, while staff also specialize in Child Care, Family Care, and the Children's First program. Jefferson County is a member of the seven-county- Southern Consortium which includes the counties of Crawford, Grant, Green, Iowa, Lafayette, and Rock. The Southern Consortium monthly caseload for December 2020 was 48,512 households which is 6.43% of the Statewide caseload. Jefferson County comprises 18.05% of the Southern Consortium caseload. As a consortium, we coordinate job functions, manage the entire workload, determine program eligibility, and implement consortium-wide policies to increase efficiency. The Consortium operates the Southern Consortium Call Center (SCC) at 1-888-794-5780. Contacting the SCC connects the customer to an Economic Support case manager located within the seven counties who have access to their case specifics and is readily available to assist. Jefferson County has twenty-one Economic Support case managers and two administrative staff within our division. The Division’s revenue comes from Federal, State, and County funds and is reflected in the graph to right. The contract funding is directed to Rock County, the Consortium Lead County, and then disbursed to each county based upon their caseload percentage.

140

The Division’s overall goal is to enhance and maintain a successful income maintenance consortium and meet mandated performance standsards. The key indicators of our success are measured by our ability to meet timeliness, accuracy, and customer satisfaction performance standards established by the State of Wisconsin. Daily workload dashboards in coordination with quarterly, monthly, and weekly reports specifically address each aspect of these key indicators and are reviewed and monitored continuously. Based upon the data obtained, consortium staff training and procedural changes are developed to assure we consistently meet these standards. ECONOMIC SUPPORT The Economic Support Division determines household eligibility for programs designed to improve financial stability and healthcare access. Often our programs are necessary to meet emergency needs such as job loss, medical concerns, or homelessness. Each program serves a specific population and incorporates different income guidelines and requirements. In 2020, like all other agencies, we learned to quickly manage major changes in our benefit issuance and service delivery systems. In March, we sent home nineteen Economic Support staff with the belief that it would be short-term. Our partner agency staff also worked from home. As of April 2021, the majority of staff continue to work remotely. Three management staff and the receptionist remained at the Workforce Development Center to provide emergency benefit assistance and authorize emergency shelter. We observed all safety precautions and initially met with the customers outside. Due to the Federal COVID Emergency Order, numerous program eligibility requirements were suspended to provide much-needed additional support for our customer who have a lower household income, many of whom were now out of work. Their annual reviews, FoodShare interviews, and verification of income were no longer required. Importantly, all Medicaid recipients as of March 18, 2020, could not be terminated from their medical coverage. Customers received the maximum FoodShare allotment for their household size not dependent upon their income and expenses. Additionally, Pandemic temporary food benefits (P-EBT) were issued to families of children who normally received free or reduced meals at school but could not because they are doing virtual learning at home full or part-time. The majority of these suspension policies still are in effect today. We learned in 2020 that we were able to continue to achieve accuracy, timeliness, and quality customer services on the call center despite the physical separation of our division and consortium staff. We successfully trained a new staff member using zoom platform. The person was able to observe and actively listen to the call center interactions. We continued to keep staff engaged and provided bi-weekly training on constantly changing policies. We were able to assist our customers when they needed it the most.

141 Jefferson Caseloads - December Point in Time 2020 – 8,184 households 2019 - 7,890 households 2018 - 7,880 households Requests for program benefits can be initiated by contacting the Southern Consortium Call Center at 1-888-794-5780, applying online at www.access.wisconsin.gov., contacting the Economic Support Division at 920-674-7500, or by coming into the agency and requesting to speak to a lobby services case manager. The customer may also use the MyACCESS mobile application where they can check benefits, get reminders and submit required documents. SOUTHERN CONSORTIUM CALL CENTER (SCC) – Our call center is comprised of the Economic Support Case Managers from seven counties- Crawford, Grant, Green, Iowa, Jefferson, Lafayette, and Rock. There are 10 consortiums in the State of Wisconsin. The call center is the focal point for the customer’s questions, change reporting, and completion of applications and reviews. In 2020, the Southern Consortium Call Center agents answered and helped 36,986 callers in the first quarter—26,860 callers in the second quarter—29,275 callers in the third quarter and lastly 22,219 callers in the fourth quarter for a yearly total of 115,340 customer calls, a decrease of 41,806 calls from 2019. The large decrease in calls occurred because new Federal COVID Emergency rules were established. These rules prevented the termination of healthcare benefits, postponed annual reviews, provided monthly maximum FoodShare benefits, did not require customers to provide verification, and extended unemployment benefits. Accordingly, the customers had fewer questions and did not need to reapply for benefits. In 2021, these numbers will increase when the emergency rules have ended. The Jefferson County staff completed a monthly average of 20.19% of all the calls taken by our consortium. This volume was accomplished with an average speed of answer of 1.13 minutes (3.24 minutes in 2019) and a call average answer rate of 98.08% (93.93% in 2019) Again, the data is better due to lower call volume. The consortium contract requires an answer rate not to exceed 10 minutes 95% of the time. The call center agents must meet State established performance standards in the timeliness of calls answered the length of the call, customer wait time, and the accuracy of their benefit processing. The chart displays the Southern Call Center statistics from November 2019 to December 2020. SOUTHERN CONSORTIUM CENTER STATISTICS FOR NOVEMBER 2019 THROUGH DECEMBER 2020

MEDICAL ASSISTANCE – Is a State and Federally funded program that provides low-income customers comprehensive, affordable healthcare. Numerous individual programs are included in the umbrella of Medical Assistance: BadgerCare, Medicaid, Medicaid Purchase Plan, Family Planning Waiver, Medicare Savings, Family Care, and Long Term Care programs. Each program has individual financial and non-financial criteria for eligibility. The Forward Health card verifies coverage. Most Medical Assistance customers also participate in a

142 Health Management Organization. On the Medicaid website http://www.dhs.wisconsin.gov/health-care- coverage you can access information on the individual program benefits and requirements. BADGERCARE – Is a State and Federally funded program for low-income adults, pregnant women, and children. Eligibility for BadgerCare is determined using IRS tax filing guidelines and household information which is similar to the guidelines used for the Federal Marketplace. Applications completed through the online ACCESS system will provide the customer with an immediate eligibility determination if all required verifications can be done using existing data exchanges. The site is https://access.wisconsin.gov The chart displays the AVERAGE number of individual customers receiving benefits from specific Medicaid categories in Jefferson County from 2016 to 2020. In 2019, the most recent data available, the amount paid to medical providers for Jefferson County residents was $120,124,865 Due to the current Federal COVID Emergency Order all customers eligible for Medicaid as of March 18, 2020, will remain eligible until the Federal Emergency Order ends despite any changes in their income or household composition. This factor influences the increase in 2020 recipients. Recipients of Medical Assistance-2016 to 2020

Average Monthly Nursing Elderly Caseload Families Home Disabled Totals

2016 9,571 138 2,598 12,307

2017 9,534 137 2,645 12,316

2018 9,394 137 2,689 12,220

2019 9,343 117 2,741 12,201

2020 10,311 118 2,846 13,275

The graph displays the consistent increase of certified Medicaid individuals for Jefferson County

143 FOODSHARE-(SNAP) Is a Federal Program funded by the USDA that provides a monthly allotment to low- income households to purchase food. Eligibility is based upon income, household composition, shelter expenses, and other criteria. The eligible customer receives a QUEST debit card to purchase food. New in 2020, customers are now able to make online food purchases from community businesses. The use of their EBT card helps support our local economy. The number of FoodShare households receiving benefits increased in 2020 due to the COVID financial impact. Beginning in April of 2020, households also received additional emergency FoodShare benefits each month up to the maximum allowed per household size. This increased the monthly average issuance from $610,7333 in 2019 to $1,089,572 in 2020. The chart displays the number of FoodShare recipients and issuance amounts from 2017 to 2020. The FoodShare website is http://www.dhs.wisconsin.gov/foodshare.

Average FoodShare Average Monthly Average Monthly Year Recipients Monthly Total Groups Issuance

2017 6,979 3,453 $684,535

2018 6,428 3,233 $631,137

2019 6,123 3,102 $610,733

2020 6,839 3,548 $1,089,572

WISCONSIN SHARES- CHILD CARE - Is a Federal and State-funded program that provides child care subsidies for low-income working families to assist in their payment of child care expenses. Staff establishes authorizations for each child and our customers receive a MYWICHILDCARE debit card containing their monthly subsidy. The customer makes their subsidy payment directly to the provider and is responsible for any remaining balance. We contract our child care certification program to 4C (Community Coordinated Child Care) as they have access to extensive resources including a resource library and connections to their food program. Specific child care eligibility criteria and program information is located at https://www.dcf.wisconsin.gov. Following is the recipient data for the Jefferson County Wisconsin Shares program for 2018, 2019, and 2020. *2018 -- 245 families received authorizations for 403 unduplicated children. The average yearly payment per child was $2,881.18. Payments were made to 72 child care providers of $1,161,115.78. There were 259 children under the age of 6 years and 144 children over the age of 6 served. *2019 -- 230 families received authorizations for 370 unduplicated children. The average yearly payment per child was $3,342.55. Payments were made to 74 child care providers of $1,236,745.17. There were 247 children under the age of 6 and 123 children over the age of 6 served. *2020 – 223 families received authorizations for 354 unduplicated children. The average yearly payment per child was $3,798.78. Payments were made to 65 childcare providers of $1,344,766.68. There were 289 children under the age of 6 and 117 children over the age of 6 served. CHILDREN FIRST- A State-funded program that provides employment case management services to noncustodial parents who are not currently meeting the required financial support for their children. Participation in the program is court-ordered. The Children First case manager assesses the customer’s employment barriers and assigns activities to connect them to stable employment and consistent payment of their child support. Program funding is based upon the number of customers served in the county’s Child Support caseload. Each participant must complete a drug screen. **2018-7 participants and 4 gained employment **2019- 3 participants and 1 gained employment. **2020 – We had funding for 10 participants

144 however due to the COVID emergency we did not receive any requests for assistance. The 2021-2022 contract provides funding for 15 participants. Program information is at https://dcf.wisconsin.gov/cs/children-first THE JEFFERSON ST. VINCENT DE PAUL SOCIETY - Provides our division access to local funding for the customer’s emergency needs when living in the Jefferson School District. These include rent, hotel vouchers, utilities, and emergency expenses unmet by other programs. The household may receive a maximum amount of $300 in two years. Their generosity continues to be greatly appreciated to help our families and individuals. Following is the data for households served in 2018, 2019, and 2020. **2018- 180 households received $23,759.32. This amount included $8,909 for rent. $10,520 for local hotel vouchers, $2,061.37 for utilities and $2,268.95 for other needs. **2019- 203 households received $33,484.41. This amount included $10,392.00 for rent, $15,606.83 for local hotel vouchers, and $4,310.36 for utilities and $3,175.22 for other needs. **2020-168 households received $27,804.22. This amount included $6,829.00 for rent, $17,350.74 for local hotel vouchers, and $1,383.05 for utilities and $2,241.43 for other needs. WISCONSIN HOME ENERGY ASSISTANCE PROGRAM (WHEAP) - This is a Federal and State-funded program that provides payment during the Wisconsin heating season to low-income customers who need help paying their heating costs. Their payment is made directly to their fuel provider. Customers who meet the criteria may also receive additional Crisis funding. In 2020, eligibility was based upon only the previous month's income (previously it was the prior three months' income) to assist those who had changes in their financial status due to the COVID pandemic. Jefferson County continues to contract with Energy Services, Inc. to administer the program. Following is the recipient data for households served in 2018, 2019, and 2020. Program information and the new online application can be found at http://energybenefit.wi.gov **2018 2,381 Households received $1,146, 969 in Energy Assistance payments. ** 501 Households received $176,895 in Crisis Assistance. ** 47 Households received $95,900 in heating unit repairs or replacements. **2019 2,222 Households received $1,156,466 in Energy Assistance payments. **215 Households received $75,036 in Crisis Assistance **52 Households received $88,046 in heating unit repairs or replacements. **2020 2.413 Households received 1,206,430 in Energy Assistance payments. **315 Households received $116,110 in Crisis Assistance **37 Households received $65,321 in heating repairs or replacements. FRONT END VERIFICATION AND FRAUD- Jefferson County continues to implement mandated strategies and to investigate potential fraud and reduce the abuse of taxpayer dollars. Jefferson County and the Southern Consortium utilize an Error-Prone Profile to dictate specific circumstances when the case managers are required to complete enhanced verification or additional investigations to determine if accurate benefits are being issued. Our division receives approximately 800 – 1000 discrepancy matches per quarter from the State Wage Income Collection Agency (SWICA) and other income discrepancy reports. These are reviewed for unreported income and/or increases in income that may have caused benefit overpayments. For employment discrepancies, the case manager gathers the actual wages from the customer and/or employer and compares the actual wages to reporting requirements and previously reported wages. If a benefit overpayment exists, a claim is established and recoupment initiated from ongoing benefits. Individuals who are no longer receiving benefits are required to make monthly payments or are referred for IRS recovery. However, the income reports were suspended in 2020 due to the COVID Emergency Order with an undetermined reinstatement

145 date. The volume of future matches may also change due to an increased number of customers who have had changes in their employment status during the pandemic. The Benefit Recovery Tracking System (BRITS) is a State web–based system that tracks our investigation referrals for customers. The system reduces workload, creates efficiencies in data collection, increases program integrity, and facilitates overpayments or potential prosecutions. Fraud Investigator Training is provided to have staff understand the benefit recovery process in its entirety. Staff training includes fraud prevention, completing desk investigations, proving intent, preparing for administrative hearings, writing comprehensive reports, and all aspects of the overpayment calculation process. In 2019, Jefferson County initiated 275 investigations of potential fraud in the FoodShare and HealthCare programs which resulted in $275.616.00 in overpayment claims and a future savings of $219,087.00. In 2020, Jefferson County initiated 234 investigations that resulted in $202,564.00 in overpayment claims and $94,317.00 in future savings. In 2020, only 20 external investigations were completed due to the COVID Emergency Order. External referrals included 7 completed by the Office of Inspector General (OIG) at the State level and 13 completed by Central Sates Investigations (CSI), our consortium contracted investigative agency. The above statistics include investigations completed by all their agencies and the overpayment claim and cost savings data reflect and incorporate SWICA discrepancy resolutions. The investigations, overpayment claims, and cost savings significantly decreased with the suspension of previously required verifications and the postponement of quarterly SWICA matches in 2020. However, the staff continued to monitor benefits for accuracy with an increased focus on preventing future overpayments. Staff also continued to review individual eligibility to determine any Intentional Program Violations (IPV), which is a penalty that prohibits the customer from receiving future benefits for a minimum of one year. There were two IPV sanctions applied in 2020. REVIEW OF 2020 GOALS –TO MEET MANDATED PERFORMANCE STANDARDS AND ISSUE ACCURATE, TIMELY BENEFITS. 1. Key Outcome Indicator- To determine eligibility for applications/reviews within 30 days of receipt. Performance Standard 95% **The Southern Consortium processed applications at an average monthly rate of 99.50% **The Southern Consortium processed reviews at an average monthly rate of 98.99% **Jefferson County processed an average of 478 applications per month, for a total of 5,737 in 2020 **Weekly reports show that Jefferson County achieved application processing at 100% for 21 weeks in 2020 **Developed internal procedures for effective processing- assigned specific duties to teams, lead workers **Maintained weekly/daily monitoring of timely processing reports, reviewed at staff meetings **Developed new worker training process (unable to do in person) to observe, respond and process eligibility. **Provided enhanced one on one experiences using ZOOM. 2. Key Outcome Indicator- The Southern Consortium Call Center will answer 100% of incoming calls within 10 minutes. Performance Standard 95% **The Southern Consortium took 115,340 calls in 2020, a decrease from 157,146 in 2019. **The average number of calls taken per month was 9,611, a decrease from 13,095 in 2019. **The Southern Consortium average monthly answer rate was 98.08% **The Southern Consortium average speed of answer was 1.13 minutes **The Southern Consortium average talk time was 10.51 minutes 3. Key Outcome Indicator- Staff will strive for 100% accuracy in eligibility processing. (FFY 2020) **Consortium FoodShare Average Active Error Rate was 1.84% on 47 cases (10/19 to 7/20) State 8.23% **Jefferson County FoodShare Average Active Error Rate was 0% on 12 cases (10/19 to 7/20) ** Consortium FoodShare CAPER (denials/procedural) Error Rate was 23.53% on 17 cases. State 28.49% **Lead worker completed designated monthly reports previously shared among staff to increase efficiency **Bi-weekly consortium program and policy training by ZOOM, PowerPoint, and desk aids created **Tracked Quality Control and Second Party Review errors, corrected, responded, and provided staff training

146 4. Key Outcome Indicator - To resolve and complete all discrepancies received quarterly from DHS within in mandated 45 days of receipt. ** Discrepancies suspended for 2020 after the first quarter due to COVID emergency rule. First completed 100%. **Each team responsible for their discrepancies, requesting actual income, comparing actual to reported income, reviewing notices and timeframes to determine potential overpayment in benefits **Detailed spreadsheet completed to gather and track all discrepancies received **Supervisor enhanced monitoring and mentoring of staff completing overpayment calculations **Staff completed training on past overpayment calculations, increased usage of BRITS data entries, tracking 5. Key Outcome Indicator- To coordinate and enhance knowledge of resources for our customers. Build ongoing connections with DHS/DCF/DOA **Developed new resources using technology, website training, diversity program participation **Management and staff are active members of numerous Southern Consortium and DHS/ DCF committees **Staff coordinates and actively participates in the annual Ready Kids for School Supply Distribution **Created new brochure display, consistent review of lobby materials, and designated area for new programs ** Updated lobby PowerPoint with relevant and constantly changing COVID programs

OUR 2021 GOALS-TO MEET MANDATED PERFORMANCE STANDARDS AND FACILITATE PROGRAM ACCESS 1. Key Outcome Indicator- To determine eligibility on applications/reviews within 30 days of receipt. Mandated Performance Standard 95%. **100% of program requests will be processed within 30 days **100% of FoodShare expedited benefits will be processed timely within 7 days **FoodShare on Demand applications processed within 48 hours **Staff will monitor team dashboard daily, assign and fully complete tasks. Shared workload **Continue development of internal efficiencies, review of division processes, training. New NIATx projects 2. Key Outcome Indicator- The Southern Consortium Call Center (SCC) and Jefferson County will answer 100% of the incoming calls within 10 minutes. Mandated performance Standards 95% **100% of calls answered timely as monitored by daily DHS SCC statistics and call center supervisor review **Maintain monthly team calendars of call center assignments and plans to meet emergency needs **All documents and requests for benefits processed during initial customer contact **Provide quality customer service verified by customer self-reporting and satisfaction surveys **Train and learn to navigate new call center system to begin August 2021 3. Key Outcome Indicator- Staff will strive for 100% accuracy in eligibility processing **Lead workers maintain responsibilities for specific monthly reports **Discussion and monthly review of Second Party and Quality Control Errors **Bi-weekly training by Consortium trainer. Discussions at agency staff meetings to ensure full understanding **On-site visits from consortium trainer for staff refresher training **Completion of mandated and refresher training on DHS/DCF Training site **Active management/staff membership in State committees and Consortium workgroups **Staff will participate in refresher training to be prepared as suspended eligibility rules are reinstated 4. Key Outcome Indicator- To complete and resolve all discrepancies received quarterly from DHS within the mandated 45 days of receipt. To complete overpayment determinations within 6 months. **Team members will consistently and timely resolve discrepancies by collecting wages and updating benefits **Staff will consistently and actively explain reporting requirements to customers ** Increased tracking of timely completion of BRITS referrals and overpayments calculations **Supervisor will monitor completion of discrepancies, BRITS referrals, overpayments and assign fair hearings **Designated staff attendance at Office of Inspector General training ** All past due overpayments will be completed by end of 2021

147 5. Key Outcome Indicator- To increase staff knowledge and awareness of resources to enhance staff and customer’s self-development skills **Staff to gain a greater understanding, learn, explore personal wellness techniques and improve customer interactions through MyStrength, compassion resilience, mindfulness, diversity training, cultural competency **Share self-development skills with WDC partners/customers **Promote new program initiatives on lobby PowerPoint and resource table. Change focus quarterly **Continue WDC all partner staff meetings to share program resources **Provide Bridges Out of Poverty Presentation **Increase interest and awareness of local volunteer opportunities **Participate in the continued development of HOPE Program for homeless customers

Many new challenges were presented to us in 2020. The challenges provided our division with new growth opportunities. This included the development of creative ways to provide access to benefits for our customers who experienced even greater financial hardships and coordinated engagement and training of staff working in the office and remotely. Based upon a Federal COVID Waiver, our customers received the maximum FoodShare allotment for their household size each month beginning in April of 2020. Here are two examples of customer appreciation received were: An elderly man who called to thank us all for the extra FoodShare benefits he received. He stated he lives in an apartment with other elderly people and at coffee that morning they were discussing the extra FoodShare benefits and were worried that they would have to pay the additional benefits back. He was delegated to contact the call center and learned they were entitled to have them. He praised and thanked us. He could not wait to tell his friends it was correct and they could keep the extra benefits. Another customer sent a personal handwritten note thanking us for the extra FoodShare benefits and sending her prayers for our safety. We often forget when working with a large volume of customers how each individual interaction and benefit given can make such an impact and then we are graciously reminded.

148 INFORMATION & ACKNOWLEDGEMENTS If you have any questions regarding anything in this report or you know someone who is in need of our services, please contact us at the following address: JEFFERSON COUNTY HUMAN SERVICES DEPARTMENT 1541 Annex Rd, Jefferson, WI 53549 Phone Number: 920-674-3105 Fax Number: 920-674-6113 TDD Number: 920-674-5011 Website: www.jeffersoncountywi.gov AGING & DISABILITY RESOURCE DIVISION 1541 Annex Rd, Jefferson, WI 53549 Phone Number: 920-674-8734 Toll-Free: 1-866-740-2372 ECONOMIC ASSISTANCE Workforce Development Center 874 Collins Rd, Jefferson, WI 53549 Call Center: 1-888-794-5780 Phone Number: 920-674-7500 Fax Number: 920-674-7520 Report Prepared by: Kathi Cauley, Director Kelly Witucki, Office Manager Statistics and Program Reports by: Brian Bellford Elizabeth Boucher Tiffany Congdon Barb Gang Jessica Godek Jill Johnson Mary Jurczyk Erica Lowrey Holly Pagel Kim Propp Brent Ruehlow ReBecca Schmidt Marj Thorman Sandy Torgerson Laura Wagner Dominic Wondolkowski

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