Consultant finds "organizational turbulence," urges Cook County PHS to centralize policies and fix documentation

Megan Mo, a consultant with Birchbark Consulting, told the Cook County Public Health & Human Services Board on March 17 that the department has experienced “organizational turbulence” and recommended an actionable, prioritized set of changes the new director can use over the next one to three years.

Mo summarized a 75‑page report she compiled after interviews, on‑site visits and document review. She said the report focused on areas where the county faces operational risk and possible non‑compliance and stressed that many recommendations are already being implemented. “If you take all those three steps as a social worker, you don't need to worry about revenue because the revenue will just follow,” Mo said, arguing that better documentation and time reporting will both protect clients and capture outside revenue.

The nut graf: Mo identified four categories for reform—operating practices, administrative practices, program practices and leadership development—and singled out three near‑term priorities for the board: create a single, centralized policy and procedure manual; remedy documentation gaps that affect client safety and billing; and pursue alternatives for mobile crisis services appropriate to a small, rural county.

Mo pointed to specific examples. She recommended a unified data‑practices policy to reconcile state privacy laws and federal confidentiality rules that govern substance use services, arguing that a single, well‑trained practice would reduce errors and prevent future problems. She also urged tailored fiscal reporting that highlights high‑cost drivers such as out‑of‑home placements and suggested using rolling averages to budget volatile items.

On behavioral health, Mo recommended hiring certified peer specialists to pair with licensed social workers, reducing staff “windshield time” and allowing licensed staff to focus on billable clinical work. She also recommended that responsibility for mobile crisis services eventually be shifted to behavioral health supervision and that Cook County apply for alternative provider standards with DHS so rural constraints (staffing and travel) can be addressed through telehealth and regional partnerships.

Board members pressed on practical implications. Commissioner Gamble and others emphasized the fiscal importance of documentation in a small county where a single high‑cost case can shift results; Mo agreed and said better documentation improves both practice and revenue. Commissioners also raised longstanding IT modernization issues tied to legacy systems (SSIS, MMIS/MAXIS) and urged continued state advocacy.

Director Grace reported steps already underway in response to the report: weekly leadership meetings split to prioritize implementation; a new intranet inventory and the beginning of a centralized policy manual; an SSIS data cleanup led by Olivia Bonander with county attorney support; improved onboarding and targeted documentation training; and submission to DHS for alternative mobile crisis provider standards. Kristen Plowman and county administrators also described countywide leadership training and HR policy work.

The board did not take formal votes on most recommendations at the March 17 meeting but praised the report as actionable and requested that departmental leaders return with implementation plans, options analysis and timelines for decision points. Mo said she will continue to consult as the county implements changes.

The board’s next procedural step is regular director reports on implementation; the department indicated updates will be included in the director’s monthly report and presented to advisory councils when recommendations have broader community impact.