Empowering Change with NIATx: Expanding Peer Support Services in Wisconsin’s Comprehensive Community Services Program

 By Maureen Fitzgerald, Communications Manager, Great Lakes ATTC, MHTTC, and PTTC

Comprehensive Community Services (CCS) is a unique Wisconsin Department of Health Services (DHS) program designed to provide a wide range of community-based, recovery-oriented, and person-centered mental health and substance use disorder services to eligible individuals across the lifespan. The program, part of the DHS Division of Care and Treatment Services Bureau of Prevention Treatment and Recovery, works to help individuals with mental health and substance use challenges receive the care and support they need in their communities, rather than in institutional or residential settings.

CCS began in 2005 through an administrative rule and grew to include half of the state’s counties. To increase the use of CCS statewide, Wisconsin leadership changed the funding structure of the program and encouraged tribal nations and counties to work in regional models. In 2014, under the leadership of the BPTR Integrated Services Section Manager Kenya Bright, DHS started a statewide expansion. CCS now operates in 70 of Wisconsin's 72 counties and three tribal nations. CCS programs offer an array of 13 service components to over 15,000 individuals across the lifespan each year.

With this expansion winding down, CCS staff have shifted their focus towards enhancing the program's quality and stability as one of DHS’ few truly integrated behavioral health programs.

 “The Division of Care and Treatment Services has a history of collaborating with NIATx on quality and process improvement projects,” says CCS Coordinator Heather Carlson. “At the end of 2021, our Bureau of Prevention Treatment and Recovery colleagues with the Coordinated Services Teams (CST) Initiatives hosted a NIATx Change Leader Academy, which served as a nice reminder of the NIATx process and how it could be applied to our psychosocial services realm."

Heather is now leading a NIATx initiative with her fellow CCS coordinators Mike Van Sistine and Danielle Graham-Heine. Their goal is to increase the number of CCS programs providing certified peer specialist services.

Peer support services are an integral part of the CCS recovery-oriented model and person-centered care service array. They contribute to the overall well-being and recovery of individuals with mental health and substance use challenges by offering support, hope, and empowerment through peer relationships and shared experiences.

The change team

Kenya Bright serves as the executive sponsor for the CCS change team, with Heather and Mike serving as co-change leaders. Joining them on the team are Danielle Graham-Heine, BPTR peer coordinators Lynn Maday-Bigboy and Marguerit Galindo, and BPTR data specialist Laura Gebhardt. The team meets monthly, while the change leaders hold weekly meetings.

“We’ve also actively engaged other interested parties, including peer recovery workgroups, to build support at different levels within our division,” says Mike.

A system-level walk-through to define the big aim

Working with NIATx coach Scott Gatzke, the CCS change team recognized the need to adapt the NIATx walk-through exercise.

"Our team had to adopt a unique approach for our walk-through, given that we were assessing the CCS statewide system as a whole, rather than focusing on individual agencies," explains Mike. "To accomplish this, we leveraged the insights from our comprehensive annual survey. The survey consists of 71 questions administered to every CCS program and includes several questions pertaining to peer services.”

The 2022 survey showed that not all CCS programs were offering certified peer services, even in areas where state workforce data showed they were likely available. Thirty of the CCS certified programs did not use a certified peer specialist; of those, 27 appeared to have a certified peer specialist available in their county or tribe.

"This initial survey laid the groundwork for our change project," Mike explains. "To gain deeper insights into peer services, we decided to send out a focused survey to programs that do not presently provide peer services or that just began to offer them in 2022."

The team set a change project aim to increase the number of CCS programs offering certified peer specialist services in areas where those services appear to be available (based on 2022 workforce development data) from a baseline of 42 programs to a goal of 52 programs by December 31, 2024.

Change team strategy

"We've sent targeted surveys to 27 CCS programs that meet our change project's inclusion criteria: CCS programs that are not currently offering certified peer support services in areas where the services are available,” says Mike. “Our goal was to find out more about the specific hurdles they’re facing when it comes to offering certified peer specialist services.” Targeted surveys were also sent to six programs that began providing peer support services in 2022, to help gain insight into the factors that led them to provide these services.

The survey questions were designed to uncover whether the hurdles were related to a lack of awareness about the availability of peer support specialists, a misunderstanding of the potential roles these specialists can play, or if there were other barriers preventing them from providing these services.

 “One-third of respondents cited a lack of availability of peer support specialists in the area, which doesn’t align with some of our existing data,” adds Heather. Other reasons cited for not providing certified peer support services included a lack of knowledge or awareness about peer support specialists, perceived lack of need, challenges in sustaining peer services, and a lack of understanding about the certified peer specialist role.

NIATx Principle #1 in Action

The change team has organized a series of focus groups with CCS programs that completed the targeted surveys.  

“Information from the focus groups will further inform our discussions with our peer colleagues and CCS change team members to help us craft the initial interventions for our upcoming pilot phase,” adds Mike. “At the same time, we will also identify the 3-5 pilot programs where we can test these interventions.”

“The change team has done a great job in adapting the NIATx approach to a system level change goal,” says Scott Gatzke. “Their statewide walk-through using survey data and the follow-up focus groups are a great application of NIATx principle 1, “Understand and involve the customer,” he adds. “The focus groups also offer a unique opportunity to tap into customer insights on solutions that will help meet the change project goal.”