Cook County PHHS review identifies documentation issues, efficiency opportunities
Meghan Mohs of Birchwood Consulting presented findings from a department review to the Cook County Public Health and Human Services (PHHS) Board on Tuesday.
The presentation summarized a 75-page report Mohs was contracted to complete. Her review of the department was conducted in fall 2025 and concluded in February 2026. The report outlines a series of recommendations to improve efficiency and increase revenue through better documentation.
Mohs told the board that PHHS is “staffed at about the right level,” but identified opportunities to shift responsibilities among positions and deploy staff more efficiently.
“One of the specific recommendations was around paraprofessional staff,” PHHS Director Grace Grinager told WTIP. “Those are positions that they typically don’t require a bachelor’s or a master’s degree in Social Work or a related field. It would be like a more, not an entry-level position, but a position where you could come in and transfer skills and really get more on-the-job training to do work that’s really vital to the department.”
Echoing a goal previously identified by County Administrator Kristen Trebil-Halbersma, Mohs said PHHS needs a “comprehensive and updated policy and procedures manual.”
Improving documentation and time reporting — another issue raised by Trebil-Halbersma in a presentation in the fall of 2025— was a key theme of the report. Mohs said the Children and Family Services unit lacks consistent documentation.
“There’s an issue across social services with a lack of documentation,” Mohs said. “If you’re not documenting well, your fiscal unit can’t turn around and bill that social workers’ time. And that’s incredibly important for social services agencies to have those outside sources of revenue.”
PHHS Director Grace Grinager said improving documentation is a central takeaway.
“If I had to say there’s an overarching recommendation,” PHHS Director Grace Grinager told WTIP, “it’s to improve our documentation practices. And Megan made a really good point in her presentation that it’s really best practice for social work, and that it does also generate revenue.”
In behavioral health, Mohs recommended adding paraprofessional support staff, particularly certified peer specialists — individuals with lived experience of mental illness who are trained to provide direct services.
“They are very effective,” Mohs said during her presentation. “There is a lot of research supporting their effectiveness. A lot of counties have been using them for some time to fill these roles.”
Mohs also recommended that PHHS develop a policy clearly outlining when and how case information can be shared across units. She said it is common for individuals with high-intensity needs to have multiple workers assigned, making coordinated information-sharing critical while remaining compliant with privacy laws.
Children and Family Services was identified as a challenging area, consistent with trends in other counties. Mohs cited “problematic documentation” and the need to strengthen relationships with Grand Portage as key priorities.
During the review, Mohs said she identified missing documentation and cases that needed to be closed, as well as concerns about documentation quality.
“Once this was identified, I brought it to your leadership right away,” Mohs told the board. “They already had a sense some of this was happening and were on top of it and were able to further identify and remediate the problem right away.”
Cook County is currently under a state-imposed Indian Child Welfare Act performance improvement plan. Mohs said the county has developed a plan to address concerns related to Grand Portage and has provided additional training on tribal relations.
She added that practices should continue to improve when serving Native American residents, while noting that previous leadership in Children and Family Services had maintained strong communication with Grand Portage.
For the mobile crisis response team, Mohs recommended that the county pursue “alternative provider standards.” Grinager told WTIP that PHHS has already submitted an application for this to the state.
“Mobile crisis response is a service that we are required to provide by state statute, and it’s a service that must be available 24/7, 365. And it is a challenge with the number of calls we get to know how to best staff that service,” Grinager said. “We are currently contracted with Brightwater, which listeners might know under their former name, the HDC or the Human Development Center, so that when our responder staff is out sick or on vacation or also outside of work hours, Brightwater is covering for us.”
Commissioner Gary Gamble praised the presentation.
“I just wanted to make a statement that you and David Lee have done a masterful job in presenting your Public Health and Human Services review,” Commissioner Garry Gamble said after the presentation, “I am thoroughly impressed and extremely grateful.”
Commissioner Ginny Storlie said the report would take time to process.
“As a board member, it’s overwhelming, this report, right now,” Storlie said. “It’s a big job.”
Grinager said PHHS has already begun implementing some of the recommendations.
“Something I mentioned in today’s meeting was really starting to implement some of these recommendations right away,” she said. “So we weren’t having to wait months and months. The things that were really highest priority, we were able to address immediately.”
Meghan Mohs will continue to contract with Cook County, during which time she will work with Director Grace Grinager in implementing the recommendations in her report.
“There are a number of recommendations. It’s going to take time to move through those and having that kind of consulting or coaching relationship will really allow me to ask questions as I need and as time goes on,” Grinager told WTIP.
WTIP spoke to Grinager about the presentation from Meghan Mohs. The audio of that conversation can be found below.
Josh Hinke March 18, 2026
