MKE Family Intervention Services | What We Do | Public Policy Institute

Milwaukee Family Intervention Services (MFIS) is a case management program serving Milwaukee County residents in need of intervention services for their family. MFIS is specifically for caregivers and youth experiencing mental health issues, behavioral concerns, truancy, educational concerns and CHIPS/JIPS petitions.

Services are intended for parents, legal guardians or other adults providing primary care for youth. You must have one or more children ages 10-17 to participate.

Families who are enrolled will participate in case management and therapeutic services. This includes individual and family sessions with that adult and youth.

All MFIS services are provided free of charge to the family.

Please complete the intake form below to find out if you are eligible for MFIS.

For questions or help completing the intake form, call 414-949-3497.

MFIS Intake Form: Find Out If You Are Eligible

Please complete the questions below.

If you need assistance completing the intake or need additional information

please call our intake specialist at 414-949-3497.

Para completar el formulario de admisión al MFIS en español, haga clic aquí.

Person completing this form (Required)

If you chose "other," please provide details

Agency that referred you

Staff person who referred you

Reason for referral (Required)

Tell us about your child or children.

Youth 1 Name

First Name *

Last Name *

Youth 1 Date of Birth (Required)

Youth 1 Sex (Required)

Youth 1 Race (Check all that apply)

White
Black / African American
Native American and Alaska Native
Asian
Choose Not to Answer

Youth 1 Ethnicity

Hispanic / Latino / Latinx
Not Hispanic / Latino / Latinx
Choose Not to Answer

Youth 2 Name

Youth 2 Date of Birth

Youth 2 Sex

Male
Female
Choose Not to Answer

Youth 2 Race (Check all that apply)

White
Black / African American
Native American or Alaska Native
Asian
Choose Not to Answer

Youth 2 Ethnicity

Hispanic / Latino / Latinx
Not Hispanic / Latino / Latinx
Choose Not to Answer

Youth 3 Name

Youth 3 Date of Birth

Youth 3 Sex

Male
Female
Choose Not to Answer

Youth 3 Race (Check All that Apply)

White
Black / African American
Native American or Alaska Native
Asian
Choose Not to Answer

Youth 3 Ethnicity

Hispanic / Latino / Latinx
Not Hispanic / Latino / Latinx
Choose Not to Answer

Youth 4 Name

Youth 4 Date of Birth

Youth 4 Gender

Male
Female
Choose Not to Answer

Youth 4 Race (Check All that Apply)

White
Black / African American
Native American or Alaska Native
Asian
Choose Not to Answer

Youth 4 Ethnicity

Hispanic / Latino / Latinx
Not Hispanic / Latino / Latinx
Choose Not to Answer

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Are there additional children in the family? If so, please add their names and ages here.

Tell us about the child who needs services through MFIS.

Which child are you seeking services for? (Required)

School name (Required)

Grade (Required)

Does this youth have an IEP?

Tell us about the family.

Parent/Caregiver 1 Name

First Name *

Last Name *

Parent/Caregiver 1 Date of Birth (Required)

Parent/Caregiver 1 Gender

Male
Female
Choose Not to Answer

Parent/Caregiver 1 Race (Check All that Apply)

White
Black / African American
Native American and Alaska Native
Asian
Choose Not to Answer

Parent/Caregiver 1 Ethnicity

Hispanic / Latino / Latinx
Not Hispanic / Latino / Latinx
Choose Not to Answer

Parent/Caregiver 2 Name

Parent/Caregiver 2 Date of Birth

Parent/Caregiver 2 Gender

Male
Female
Choose Not to Answer

Parent/Caregiver 2 Race (Check All that Apply)

White
Black / African American
Native American or Alaska Native
Asian
Choose Not to Answer

Parent/Caregiver 2 Ethnicity

Hispanic / Latino / Latinx
Not Hispanic / Latino / Latinx
Choose Not to Answer

Are there any other adults in your household? If so, please add their names and relationship to the youth.

Preferred language (Required)

Does anyone at home speak English?

Do you need special accommodations for a disability, or an interpreter? Please provide details.

Home Address

Country

Address Line 1 *

City *

State/Province *

Postal Code *

Phone (Required)

Secondary Phone

Email (Required)

Preferred method of contact (Required)

When is the best time to reach you?

Morning
Afternoon
Evening

Are you comfortable having MFIS staff in your home?

Do you have pets in your home?

If you do have pets in the home, please specify.

Please provide any additional details about the youth and family's situation.

Does the youth have a Probation Officer or are they involved withother Children's Court services?

Does the youth have a worker with Child Protective Services?

Are you currently enrolled in the Stronger Families Milwaukee program?

Yes
No
Unsure

Is the youth or their sibling(s) enrolled in Wraparound Services (CCS, O-YEAH, REACH, CORE)?

Has the youth or their sibling(s) had a prior MFIS or FISS assessment?

If the youth had been assessed for FISS or MFIS, when did that happen?

Is the family interested in therapeutic support services/counseling?

eWISACWIS (Guardian) Number (for purpose of checking status in system and reaching out to open worker if necessary)

What is the youth's eWISACWIS status?

Open
Closed
Unknown

Have you already filed a JIPS/CHIPS petition? (This petition is for removal of the child from the home or court-ordered services)

What date was the CHIPS/JIPS petition filed?

If no, are you interested in a referral to JIPS/CHIPS petition?

Please tell us about your insurance coverage.

Do you have insurance coverage?

Do you have T19 (BadgerCare Plus/Medicaid/MA) or private insurance coverage?

T19 (BadgerCare Plus/Medicaid/MA)
Private Insurance
I do not have insurance coverage

If you are covered by T19 (BadgerCare Plus/Medicaid/MA), please tell us which program and your policy number.

If you have private insurance coverage, please tell us the name of the insurer and your policy number.

Thank you for completing the intake form for Milwaukee Family Intervention Services. An Intake Specialist will contact you to confirm you are eligible for services.