Adams County proposes cost-neutral package to address therapist shortages, committee gives go-ahead

Adams County Health and Human Services staff presented four cost-neutral strategies to address a local shortage of therapists on (date not specified), telling the county committee the plan would increase access to care without raising the county levy.

The proposal recommended (1) a performance-based bonus tied to billable time, (2) improved advertising and targeted outreach, (3) flexible full- and part-time definitions (including lowering the threshold for benefits to 30 hours per week), and (4) creation of an internal pipeline that hires bachelor-level case managers who can complete master’s practicum hours while working for the county. Committee members voiced support and asked for follow-up on details such as prorating bonuses for part-time staff and enforcing multi-year commitments.

Why it matters: HHS staff told the committee the department received 225 new referrals this year and redirected more than 35% of them to outside agencies because of vacancies and capacity limits, and the county’s mental-health provider ratio is far worse than neighboring jurisdictions. With two current therapist vacancies, another pending resignation, and long historical hiring timelines, staff argued a coordinated, low-cost approach is necessary to avoid further service loss.

Presentation and recommendations

Presentation lead (Health and Human Services staff) told the committee the department has received 225 new referrals so far this year and that “over 35% of those referrals have been redirected to outside agencies” because vacancies limit local capacity. The presenter said the department has stepped back from school-based therapy and that many therapists are being recruited away by private providers offering higher pay and flexible packages.

On the proposed bonus structure, staff described a model tied to billable time already tracked in the county’s electronic health record. Under the example shown to the committee (based on 2024 data), therapists with increasing billable percentages would earn tiered bonuses, up to $6,000 for an 80% billable average. The presenter said the county’s analysis showed an estimated $8,000 gross cost for the hypothetical bonus pool in 2024, and that increased billed services could offset that cost.

The presentation included a plan to expand advertising and outreach (targeting recent counseling and social work graduates and using social media), to highlight county benefits including paid time off and participation in the Wisconsin Retirement System, and to pursue a daycare space in the planned HHS building to support recruiting younger workers.

On the internal pipeline, staff proposed two bachelor-level case manager positions focused on billable CCS services. Those employees would be targeted to students accepted to accredited master’s programs and permitted to complete practicum/internship hours while working. Staff said the county has discussed partnerships with UW system master’s programs and that the pathway would include a suggested five-year commitment to the county after licensure to encourage retention.

Questions, concerns and committee response

Committee members raised several questions about implementation. One member asked whether the bonus would apply to part-time staff; staff replied it would be prorated. Another member asked how a five-year commitment would be enforced; county staff and the county administrator’s office said similar commitments have been enforced before by requiring repayment of incentives if the employee leaves before the required period.

A committee member questioned whether a $6,000 maximum bonus would be sufficient to compete with offers from larger employers, saying, “I just see that $6,000 is probably not incentive to somebody that's making a 100,000 when they're in competition for a job that if they head off to, like, Madison….” That concern prompted discussion of nonwage benefits; another committee member noted county benefits and PTO accrual are competitive and said those should be emphasized in recruitment.

Kelly (Health and Human Services) emphasized the urgency. "The real challenge is we're gonna be down to 2 therapists on November 1, and we have got to do something quickly because the demand is there," Kelly said, describing current vacancy counts and pending resignations.

Outcome and next steps

This item was presented under reports and presentations; committee members indicated support to move forward with the concepts and asked staff to return with implementation details. Several members voiced explicit support during the meeting, including a request that staff proceed with planning for the presented, cost-neutral strategies. No formal motion to adopt a policy was made during the meeting; staff said the presentation was intended to secure direction to proceed with planning and alignment with the county administrator, finance and HR.

Votes at a glance

- Approval of minutes (public hearing and regular minutes for 09/08/2025): Motion by Terry; second by Pete; outcome: approved (committee voiced "Aye"). - Resolution requesting state investment to cover SNAP/Income Maintenance administrative impacts (resolution text not specified in transcript): Motion and second; outcome: passed (committee voiced "Aye").

Ending

Staff will return with more specific policy language and cost-neutral modeling for the bonus structure, details on proration for part-time staff, and proposed contract language for any required service commitments. Committee members asked staff to coordinate with county administration, finance and human resources before bringing final proposals back for formal action.