Chapter DHS 34

DHS 34.23(3)(e) (e) If the individual is threatening to harm self or others, the specificity and apparent lethality of the threat and the availability of the means to carry out the threat, including the individual’s access to any weapon or other object which may be used for doing harm.

DHS 34.23(3)(f) (f) If the individual appears to have been using alcohol or over-the-counter, prescription or illicit drugs, the nature and amount of the substance ingested.

DHS 34.23(3)(g) (g) The names of any people who are or who might be available to support the individual, such as friends, family members or current or past mental health service providers.

DHS 34.23(4) (4) Determination of need.

DHS 34.23(4)(a) (a) Based on an assessment of the information available after an initial contact, staff of the program shall determine whether the individual is in need of emergency mental health services and shall prepare and implement any necessary response.

DHS 34.23(4)(b) (b) If the person is not in need of emergency mental health services, but could benefit from other types of assistance, staff shall, if possible, refer the person to other appropriate service providers in the community.

DHS 34.23(5) (5) Response plan.

DHS 34.23(5)(a) (a) If the person is in need of emergency mental health services, staff of the program shall prepare and initiate a response plan consisting of services and referrals necessary to reduce or eliminate the person’s immediate distress, de-escalate the present crisis, and help the person return to a safe and more stable level of functioning.

DHS 34.23(5)(b) (b) The response plan shall be approved as medically necessary by a mental health professional qualified under s. DHS 34.21 (3) (b) 1. or 2. either before services are delivered or within 5 days after delivery of services, not including Saturdays, Sundays or legal holidays.

DHS 34.23(6) (6) Linkage and follow up.

DHS 34.23(6)(a) (a) After a response plan has been implemented and the person has returned to a more stable level of functioning, staff of the program shall determine whether any follow-up contacts by program staff or linkages with other providers in the community are necessary to help the person maintain stable functioning.

DHS 34.23(6)(b) (b) If ongoing support is needed, the program shall provide follow-up contacts until the person has begun to receive assistance from an ongoing service provider, unless the person does not consent to further services.

DHS 34.23(6)(c) (c) Follow-up and linkage services may include but are not limited to all of the following:

DHS 34.23(6)(c)1. 1. Contacting the person’s ongoing mental health providers or case manager, if any, to coordinate information and services related to the person’s care and support.

DHS 34.23(6)(c)2. 2. If a person has been receiving services primarily related to the abuse of alcohol or other drugs or to address needs resulting from the person’s developmental disability, or if the person appears to have needs in either or both of these areas, contacting a service provider in the area of related need in order to coordinate information and service delivery for the person.

DHS 34.23(6)(c)3. 3. Conferring with family members or other persons providing support for the person to determine if the response and follow-up are meeting the client’s needs.

DHS 34.23(6)(c)4. 4. Developing a new crisis plan under sub. (7) or revising an existing plan to better meet the person’s needs based on what has been learned during the mental health crisis.

DHS 34.23(7) (7) Crisis plan.

DHS 34.23(7)(a) (a) The program shall prepare a crisis plan for a person who is found to be at high risk for a recurrent mental health crisis under the criteria established in the coordinated community services plan under s. DHS 34.22 (1) (a) 7.

DHS 34.23(7)(b) (b) The crisis plan shall include whenever possible all of the following:

DHS 34.23(7)(b)1. 1. The name, address and phone number of the case manager, if any, coordinating services for the person.

DHS 34.23(7)(b)2. 2. The address and phone number where the person currently lives, and the names of other individuals with whom the person is living.

DHS 34.23(7)(b)3. 3. The usual work, school or activity schedule followed by the person.

DHS 34.23(7)(b)4. 4. A description of the person’s strengths and needs, and important people or things in the person’s life which may help staff to develop a rapport with the person in a crisis and to fashion an appropriate response.

DHS 34.23(7)(b)5. 5. The names and addresses of the person’s medical and mental health service providers.

DHS 34.23(7)(b)6. 6. Regularly updated information about previous emergency mental health services provided to the person.

DHS 34.23(7)(b)7. 7. The diagnostic label which is being used to guide treatment for the person, any medications the person is receiving and the physician prescribing them.

DHS 34.23(7)(b)8. 8. Specific concerns that the person or the people providing support and care for the person may have about situations in which it is possible or likely that the person would experience a crisis.

DHS 34.23(7)(b)9. 9. A description of the strategies which should be considered by program staff in helping to relieve the person’s distress, de-escalate inappropriate behaviors or respond to situations in which the person or others are placed at risk.

DHS 34.23(7)(b)10. 10. A list of individuals who may be able to assist the person in the event of a mental health crisis.

DHS 34.23(7)(c) (c) A person’s crisis plan shall be developed in cooperation with the client, his or her parents or guardian where their consent is required for treatment, the case manager, if any, and the people and agencies providing treatment and support for the person, and shall identify to the extent possible the services most likely to be effective in helping the person resolve or manage a crisis, given the client’s unique strengths and needs and the supports available to him or her.

DHS 34.23(7)(d) (d) The crisis plan shall be approved as medically necessary by a mental health professional qualified under s. DHS 34.21 (3) (b) 1. or 2.

DHS 34.23(7)(e) (e) Program staff shall use a method for storing active crisis plans which allows ready access in the event that a crisis arises, but which also protects the confidentiality of the person for whom a plan has been developed.

DHS 34.23(7)(f) (f) A crisis plan shall be reviewed and modified as necessary, given the needs of the client, but at least once every 6 months.

DHS 34.23(8) (8) Service notes. As soon as possible following a client contact, program staff shall prepare service notes which identify the person seeking a referral for emergency mental health services, describe the crisis and identify or describe all of the following:

DHS 34.23(8)(a) (a) The time, place and nature of the contact and the person initiating the contact.

DHS 34.23(8)(b) (b) The staff person or persons involved and any non-staff persons present or involved.

DHS 34.23(8)(c) (c) The assessment of the person’s need for emergency mental health services and the response plan developed based on the assessment.

DHS 34.23(8)(d) (d) The emergency mental health services provided to the person and the outcomes achieved.

DHS 34.23(8)(e) (e) Any provider, agency or individual to whom a referral was made on behalf of the person experiencing the crisis.

DHS 34.23(8)(f) (f) Follow-up and linkage services provided on behalf of the person.

DHS 34.23(8)(g) (g) If there was a crisis plan under sub. (7) on file for the person, any proposed amendments to the plan in light of the results of the response to the request for services.

DHS 34.23(8)(h) (h) If it was determined that the person was not in need of emergency mental health services, any suggestions or referrals provided on behalf of the person.

DHS 34.23 History History: Cr. Register, September, 1996, No. 489, eff. 10-1-96; CR 23-053: am. (3) (a) Register September 2023 No. 813, eff. 10-1-23.

DHS 34.24 DHS 34.24 Client service records.

DHS 34.24(1) (1) Maintenance and security.

DHS 34.24(1)(a) (a) A program shall maintain accurate records of services provided to clients, including service notes prepared under s. DHS 34.23 (8) and crisis plans developed under s. DHS 34.23 (7).

DHS 34.24(1)(b) (b) The program administrator is responsible for the maintenance and security of client service records.

DHS 34.24(2) (2) Location and format. Client service records shall be kept in a central place that is not accessible to persons receiving care from the program, shall be held safe and secure, shall be managed in accordance with standard professional practices for the maintenance of client mental health records, and shall be arranged in a format which provides for consistent recordkeeping within the program and which facilitates accurate and efficient record retrieval.

DHS 34.24(3) (3) Disposition upon program closing. An organization providing emergency mental health services under contract with the county shall establish a written plan for maintenance and disposition of client service records in the event that the program loses its certification or otherwise terminates operations. The plan shall include a written agreement with the county department to have the county department act as the repository and custodian of the client records for the required retention period or until the records have been transferred to a new program.

DHS 34.24(4) (4) Confidentiality. Maintenance, release, retention and disposition of client service records shall be kept confidential as required under s. 51.30, Stats., and ch. DHS 92.

DHS 34.24 History History: Cr. Register, September, 1996, No. 489, eff. 10-1-96; correction in (4) made under s. 13.93 (2m) (b) 7., Stats., Register, April, 2000, No. 532; correction in (4) made under s. 13.92 (4) (b) 7., Stats., Register November 2008 No. 635.

DHS 34.25 DHS 34.25 Client rights.

DHS 34.25(1) (1) Policies and procedures. All programs shall comply with s. 51.61, Stats., and ch. DHS 94 on the rights of clients.

DHS 34.25(2) (2) Conflict resolution.

DHS 34.25(2)(a) (a) A program shall inform clients and their parents or guardian, where the consent of the parent or guardian is required for services, that they have the option of using either formal or informal procedures for resolving complaints and disagreements.

DHS 34.25(2)(b) (b) A program shall establish a process for informal resolution of concerns raised by clients, family members and other agencies involved in meeting the needs of clients.

DHS 34.25(2)(c) (c) A program shall establish a grievance resolution system which meets the requirements under s. DHS 94.27 for a grievance resolution system.

DHS 34.25 History History: Cr. Register, September, 1996, No. 489, eff. 10-1-96; corrections in (1) and (2) (c) made under s. 13.92 (4) (b) 7., Stats., Register November 2008 No. 635.

DHS 34.26 DHS 34.26 Client satisfaction.

DHS 34.26(1) (1) Each program shall have a process for collecting and recording indications of client satisfaction with the services provided by the program. This process may include any of the following:

DHS 34.26(1)(a) (a) Short interviews with persons who have received emergency services.

DHS 34.26(1)(b) (b) Evaluation forms to be completed and returned by clients after receiving services.

DHS 34.26(1)(c) (c) Follow-up conversations.

DHS 34.26(2) (2) Information about client satisfaction shall be collected in a format which allows the collation and comparison of responses and which protects the confidentiality of those providing information.

DHS 34.26(3) (3) The process for obtaining client satisfaction information shall make allowance for persons who choose not to respond or are unable to respond.

DHS 34.26(4) (4) Prior to a recertification survey under s. DHS 34.03 (6) (c), the program administrator shall prepare and maintain on file a report summarizing the information received through the client satisfaction survey process and indicating:

DHS 34.26(4)(a) (a) Any changes in program policies and operations or to the coordinated community services plan under s. DHS 34.22 (1) made in response to client views.

DHS 34.26(4)(b) (b) Any suggestions for changes in the requirements under this chapter which would permit programs to improve services for clients.

DHS 34.26 History History: Cr. Register, September, 1996, No. 489, eff. 10-1-96; CR 23-053: am. (1) (a), (c) Register September 2023 No. 813, eff. 10-1-23.