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(1) Programs shall make reasonable efforts to provide care coordination by executing memoranda of understanding or other forms of interagency agreement with local educational agencies or other services or programs that provide services to program youth.
(2) This chapter does not modify the educational rights and obligations of the youth in the program, any legal representative, or any local educational agency providing services in coordination with a mental health day treatment program certified under this chapter.
History: CR 19-018: cr. Register June 2020 No. 774, eff. 7-1-20.
DHS 40.07 Program components.
(1) Required policies and procedures. A program shall develop and implement written policies and procedures for:
(a) Admission and orientation.
(b) Fee agreements.
(c) Assessments.
(d) Contents and implementation of individualized treatment plans.
(e) Implementation of person-centered care, including:
1. Cultural responsiveness.
2. Developmentally appropriate and age-appropriate service planning and delivery.
3. Legal representative involvement.
4. Strength-based approaches and planning.
5. Trauma-informed and responsive approaches and planning.
(f) Care coordination.
(fm) Policy on telehealth, including when telehealth can be used and by whom, patient privacy and information security considerations, and the right to decline services provided via telehealth.
(g) Confidentiality and compliance with 42 CFR part 2, 45 CFR parts 160, 162, and 164, s. 51.30, Stats., and ch. DHS 92.
(h) Compliance with Title 2 of the Americans with Disabilities Act of 1990.
(i) Client rights and grievance processes under s. 51.61, Stats., and ch. DHS 94.
(j) Crisis prevention and response, including the program’s use of support services, seclusion, and physical restraint and the process for obtaining a written authorization from a physician that allows seclusion and physical restraint for a youth prior to utilizing any emergency intervention with that youth.
(k) Services for minor youth transitioning to adulthood.
(L) Discharge, transfer, and continuity of care.
(m) Quality assurance and performance improvement.
(n) Written personnel policies.
(2) Involvement in treatment planning for youth.
(a) A program shall provide all of the following to a youth or legal representative upon request:
1. Copies of the policies and procedures, required under sub. (1).
2. Written documentation of each staff member’s qualifications per s. DHS 40.09 (2) to (4).
3. Admission paperwork that explains the program and forms required for enrollment prior to the admission meeting, and assistance with understanding the paperwork.
4. A copy of ch. DHS 40.
5. Information about fees, payment sources, and how to access any applicable financial resources, and other community resources that are potentially helpful and how to access them.
(b) A program shall include the youth or legal representative throughout all parts of the treatment process, including screening, assessment, treatment, and discharge. A program shall make reasonable efforts to include any persons or family members that the youth or legal representative has authorized to participate in treatment or treatment planning. All of the following apply to the program’s engagement of the youth or legal representative:
1. The assessment process shall engage the youth or legal representative to recognize the strengths and needs of the youth, and ensure that the youth or legal representative’s perspectives, opinions, and preferences are included as part the treatment plan.
2. A program shall inform the youth or legal representative of the proposed services and supports within the treatment plan and provide a written copy of the plan.
3. Transition services shall consider the needs and preferences of the youth or legal representative.
(c) To ensure that the proposed services reflect a partnership between the youth or legal representative and program staff, a program shall do all of the following, as available and needed:
1. Employ, contract, or coordinate for the services of parent peer specialists who can help a youth or legal representative understand the operations of the program and support effective input in the planning and implementation of services.
2. Establish flexible schedules for meetings and activities so that legal representatives can participate without taking time off from work.
3. Make arrangements for transportation to the program if possible when legal representatives lack the ability to travel to the program using their own resources.
4. Adjust program services and activities to accommodate cultural and linguistic preferences and needs.
5. Use technological resources to encourage participation when in-person meetings are not possible, consistent with requirements to ensure confidentiality of treatment information.
(3) General requirements. In addition to services that are necessary to achieve the treatment objectives identified in each youth’s assessment and individual treatment plan, all of the following minimum requirements services shall be provided:
(a) Community-based program. A community-based program shall offer all of the following:
1. Individual, group and family psychotherapy provided by trained mental health professionals.
2. A structured therapeutic milieu supervised by a clinical coordinator.
3. Care coordination.
4. Support services.
5. Crisis response services.
6. Implementation of transition services designed to support the reintegration of a youth who is completing the program into family, community and school activities and to prevent recurrence of the problems which led to the original placement in the program.
(b) Intensive hospital-based programs. An intensive hospital-based program shall offer minimum required services under par. (a) and shall increase the hours of direct clinical services under s. DHS 40.10 (3) (b) and increase the hours of operation under s. DHS 40.10 (4) (b) to meet the needs of youth who have severe symptomology and need closer supervision.
(4) Support services. Each program shall provide support services that include all of the following:
(a) Methods for documenting, measuring, and tracking progress on measurable objectives contained in a youth’s treatment plan.
(b) Strategies for all of the following:
1. Reducing or eliminating the use of emergency safety interventions.
2. Teaching and increasing positive replacement behaviors, based on baseline measures at intake.
3. Building relationships between youth and staff members that promote trust and safety.
4. Empowering youth to take responsibility for their behavior and regulating their emotions.
5. Sensory interventions within the treatment milieu to enhance functioning and assist with behavioral challenges.
(5) Voluntary time out. Support services shall be provided to a youth prior to using a voluntary time out. Voluntary time out should be used as a least restrictive measure, prior to involuntary seclusion or physical restraint, unless there is imminent danger due to a youth’s aggression to self or others. Voluntary time out shall be encouraged for the shortest time possible and only for the length of time necessary for the youth to de-escalate or regulate his or her emotions. Programs shall encourage voluntary time out for youth who show signs of agitation or anxiety.
History: CR 19-018: cr. Register June 2020 No. 774, eff. 7-1-20; correction in (1) (g) made under s. 35.17, Stats., Register June 2020 No. 774; CR 23-053: cr. (1) (fm) Register September 2023 No. 813, eff. 10-1-23; CR 23-046: am. (2) (a) 2. Register April 2024 No. 820, eff. 5-1-24.
DHS 40.08 Emergency safety interventions.
(1) Prohibited interventions. Mechanical restraints, with the exception of procedures in sub. (5) (e) and chemical restraints are prohibited.
(2) General requirements for seclusion and physical restraint. Seclusion and physical restraint shall comply with the requirements under s. 51.61 (1) (i), Stats., s. DHS 94.10, and this chapter.
(3) Staff requirements. Seclusion and physical restraint shall only be administered by program staff members who have completed orientation described in s. DHS 40.10 (6) (b).
(4) Administration requirements. Seclusion and physical restraint may only be administered when all of the following requirements are met in addition to the requirements under s. 51.61 (1) (i), Stats., and s. DHS 94.10:
(a) When all other less restrictive methods have been exhausted.
(b) For the shortest time possible and only until the youth is no longer a danger to self or others.
(c) In a manner that is attentive to, and respectful of the trauma history, dignity, and civil rights of the youth.
(d) To avoid or cause the least possible physical or emotional discomfort, harm, and pain to the youth.
(e) Allowing adequate access to bathroom facilities, drinking water, and necessary medication.
(5) Specific requirements for seclusion.
(a) Program staff members shall provide uninterrupted supervision and monitoring of the youth and entire seclusion area during seclusion by being in the room with the youth or by observation through a window into the room.
(b) A program shall maintain an incident log to document the use of seclusion. The log shall include the time when the seclusion began, the youth’s behaviors and staff member’s response to those behaviors every 5 minutes, and the time seclusion ended.
(c) Seclusion rooms shall be free of objects or fixtures with which the youth could inflict bodily harm.
(d) Only a single youth may be placed in a seclusion room.
(e) A youth may only be kept in the seclusion area by means of one of the following:
1. A staff member is in a position, such as in a doorway, to prevent a youth from leaving the seclusion area.
2. A staff member physically holds a door shut to a seclusion room.
3. A door to a seclusion room is latched by positive pressure applied by a staff member’s hand without which the latch would spring back allowing the door to open on its own accord, except that a hospital-based program may use a magnetic door lock or a lock which requires the turn of a knob to unlock a door. Other designs of door locks shall not be used, including padlock, key lock, or other locks of similar design.
(6) Specific requirements for physical restraint.
(a) Physical restraint shall only be administered to a youth during an emergency, when there is a serious threat of violence to other youth or a staff member, personal injury, or attempted suicide.
(b) At a minimum, two staff members trained in the use of emergency safety interventions shall be physically present during the administration of physical restraint, and shall continually monitor the condition of the youth and the safe use of physical restraint throughout the duration of the intervention.
(c) Methods of physical restraint that are likely to cause bodily harm are prohibited, such as:
1. Pressure or weight on the chest, lungs, sternum, diaphragm, back, or abdomen, such as straddling or sitting on the torso.
2. Pressure, weight, or leverage on the neck or throat, on any artery, or on the back of the head or neck, or that otherwise obstructs or restricts the circulation of blood or obstructs an airway, such as choke holds or sleeper holds.
3. Wrestling holds or martial arts techniques.
4. Covering the face with any object, such as a pillow, towel, washcloth, blanket, or other fabric.
5. Pain or pressure points.
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Published under s. 35.93, Stats. Updated on the first day of each month. Entire code is always current. The Register date on each page is the date the chapter was last published.