Wisconsin Legislature: DHS 50.12(7)(b)

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.

6. Hyperextension of limbs, fingers, or neck.

7. Forcible take downs from a standing position to the floor.

8. Restraint in a prone position.

9. Restraint in a supine position.

10. Restraint in a vertical position, with upper body pressed against a wall or hard surface.

11. Any other physical restraint that is not administered during an emergency, that is administered for longer than necessary to prevent immediate injury to a youth or others, or that is administered for a purpose other than to prevent immediate injury to a youth or others.

(d) Immediately, upon the termination of a physical restraint, a medical staff member, such as a physician, advanced practice nurse prescriber, physician assistant, or registered nurse shall conduct a follow-up assessment of the condition of the youth to ensure that the youth was not injured and shall document the finding of the assessment in the youth’s clinical record. If a staff member who is a physician or nurse is not present on site, a licensed treatment professional shall conduct the in-person assessment immediately upon termination of the physical restraint and notify a medical staff consultant.

(e) If any injury is noted following a physical restraint, a staff member shall notify the youth’s legal representative and make a referral for medical care.

(6) Debriefing.

(a) Unless clinically contraindicated, within 24 hours of administering a seclusion or physical restraint, a clinical staff member shall talk with the youth about each of the following:

1. The circumstances that contributed to the seclusion or physical restraint and an evaluation of the appropriateness of the staff member’s actions.

2. The youth’s psychological well-being and the emotional impact of the intervention.

3. Any modifications that can be made in the youth’s services or treatment plan to prevent seclusion, physical restraint, or both, in the future.

(b) A YCSF shall notify a youth’s parent or legal representative of any seclusion or physical restraint within 12 hours of it being administered to the youth. The YCSF shall document in the youth’s clinical record any situation in which notification has been attempted and the YCSF has been unable to contact the legal representative.

(c) Each administration of seclusion or physical restraint shall be documented in the youth’s clinical record and shall specify all of the following:

1. Events precipitating the seclusion or physical restraint.

2. Less restrictive interventions attempted prior to the seclusion or physical restraint.

3. Length of time the seclusion or physical restraint was used.

4. Assessment of the appropriateness of the seclusion or physical restraint based on threat of harm to self or others.

5. Assessment of any physical injury to the youth, other youth, or to staff members.

6. The youth’s response to the emergency safety intervention.

(d) The clinical coordinator or their designee shall review all seclusion and physical restraint documentation within 24 hours of intervention, and in consultation with others determine whether changes to the youth’s safety plan or treatment plan are necessary, including whether a higher level of care is necessary. These findings and recommendations shall be documented in the youth’s clinical record.

(e) The clinical coordinator or their designee shall debrief with other youth present in a trauma-informed manner.

(7) Reporting.

(a) Facilities shall report all incidences of seclusion, physical restraint, injury, elopement, or involvement of law enforcement to the department within 24 hours of the incident occurring. Reporting shall be completed through the department’s online reporting system.

(b) The department will evaluate the circumstances of each incident, conduct any appropriate follow-up, and identify programs in need of technical assistance, training, policy development, or other quality improvement.

Note: The department’s reporting link is: https://www.dhs.wisconsin.gov/mh/ycsf.htm. Questions and information about reporting may be directed to the Division of Care and Treatment Services at 608-266-2717.

History: EmR1922: emerg. cr., eff. 11-2-19; CR 19-077: cr. Register July 2020 No. 775, eff. 8-1-20; correction in (5) (b), (c) 4., (d) made under s. 35.17, Stats., Register July 2020 No. 775; CR 23-053: am. (5) (d), (6) (a) (intro.) Register September 2023 No. 813, eff. 10-1-23.

DHS 50.13 Investigation, notification, and reporting requirements.

(1) Death reporting.

(a) Youth death related to physical restraint, seclusion, psychotropic medication, or suicide. No later than 24 hours after the death of a youth, the YCSF shall report the death to the department if there is reasonable cause to believe the death was related to the use of a physical restraint, seclusion, or psychotropic medication, or was a suicide, as provided in s. 51.64, Stats.

Note: Death reporting process and forms may be found at: https://www.dhs.wisconsin.gov/regulations/report-death/proc-reportingdeath.htm.

(b) Youth death related to an accident, injury, natural causes, or other reasons. When a youth dies for any reason other than the use of a physical restraint, seclusion, psychotropic medication, or suicide, the YCSF shall send a report to the department within 3 business days of the youth’s death.

Note: The department’s reporting link is: https://www.dhs.wisconsin.gov/mh/ycsf.htm.

(2) Investigating and reporting elopement, abuse, neglect, or misappropriation of property.

(a) A YCSF shall be considered an entity, under ch. DHS 13, and shall comply with caregiver misconduct reporting requirements for entities provided in ch. DHS 13. Caregiver misconduct must be reported within 7 calendar days of the incident or the date the entity knew or should have known of the incident.

Note: The department’s caregiver misconduct reporting link is: https://www.dhs.wisconsin.gov/caregiver/complaints.htm

(b) Elopement, physical, sexual or mental abuse, or neglect by non-caregivers or youth shall be reported to the department within 24 hours of the incident or the date the entity knew or should have known the incident occurred.

Note: The department’s reporting link is: https://www.dhs.wisconsin.gov/mh/ycsf.htm.

(c) Misappropriation of property by non-caregivers or youth shall be reported to the department within 7 calendar days of the incident or the date the entity knew or should have known of the incident.

Note: The department’s reporting link is: https://www.dhs.wisconsin.gov/mh/ycsf.htm.

(3) Notifying other interested parties.

(a) The YCSF shall immediately notify the youth’s legal representative when there is an elopement, incident or injury to the youth requiring intervention from a physician or other professional.

(b) The YCSF shall immediately notify the youth’s legal representative when there is an allegation of physical, sexual or mental abuse, or neglect of a youth that occurred at the YCSF or under the supervision of YCSF staff.

(c) The YCSF shall notify the youth’s legal representative within 72 hours when there is an allegation of misappropriation of property.

(d) The YCSF shall follow all procedures required of mandated reporters.

(4) Documentation of the incident. All written reports required under this section shall include, at a minimum, the time, date place, individuals involved, details of the occurrence, and the action taken by the provider to safeguard the youths’ health, safety, and well-being.

History: EmR1922: emerg. cr., eff. 11-2-19; CR 19-077: cr. Register July 2020 No. 775, eff. 8-1-20; correction in (1) (a) made under s. 35.17, Stats., Register July 2020 No. 775.

DHS 50.14 Client Rights. All YCSF operations and services shall comply with s. 51.61, Stats. and ch. DHS 94 on the rights of clients.

History: EmR1922: emerg. cr., eff. 11-2-19; CR 19-077: cr. Register July 2020 No. 775, eff. 8-1-20.

Subchapter III – Facilities

DHS 50.15 General Requirements.

(1) General requirements.

(a) A facility shall comply with the state building code requirements in chs. SPS 361 to 366, and any applicable local ordinances or municipal building regulations.

(b) The YCSF shall maintain the facility in a state of good repair and in a clean, safe and sanitary condition.

(d) Any YCSF that shares a facility with another program must, at a minimum, meet the facility requirements in ss. DHS 50.15 to 50.18. The YCSF must be securely separated from other programs.

(2) Exits.

(a) Habitable rooms on the second floor shall have access to at least 2 exits. At least one of the exits shall be a stairway to the first floor or to grade.

(b) Habitable rooms above the second floor shall have at least 2 exits that are both stairways to the second floor or to grade or that are to one stairway to the second floor and one stairway to grade. Windows and balconies may not be designated as exits.

(c) Habitable rooms below grade shall have at least 2 exits. At least one exit shall be a stairway to grade or a door that is below grade level that leads to grade level by an outdoor stairway. The second exit may be either a stairway leading to a first floor above grade or a window that can be opened from the inside without the use of tools, is at least 22 inches in the smallest dimension, is at least 5 square feet in area, and has a lower sill not more than 4 feet from the floor and a window escape ladder for use in an emergency evacuation.

(3) Water and sewer.

(a) Water supply.

1. The facility shall have an adequate and safe water supply.

2. If the facility’s water supply is from a private well, the well shall be approved by the department of natural resources. Water samples from an approved well shall be tested at least annually for lead and bacteria by a laboratory certified under ch. ATCP 77.

(b) Sewage. The facility shall have an adequate sewage disposal system.

(c) Water temperature. The facility shall be equipped with a water heater sufficient to meet the needs of all youths. The hot water delivered to the facility’s sinks, tubs, and showers shall not exceed 120° Fahrenheit.

(4) Heating, cooling and ventilation.

(a) All rooms, including bedrooms must be provided with adequate heating, cooling, and ventilation.

(b) Portable space heaters shall not be used.

(5) Lighting. All habitable rooms shall have electric lighting sufficient to meet the needs of the facility and its youths.

(6) Space requirements. The YCSF shall ensure compliance with all of the following space requirements:

(a) Bathroom requirements.

1. Bathrooms shall be indoors.

2. A bathroom that can be accessed only through a room used as a bedroom may not be counted as being available for use by youths who do not occupy that bedroom.

(b) Bedroom requirements.

1. A bedroom that is used by one youth shall have at least 80 square feet of floor space.

2. A bedroom that is used by more than one youth shall have a minimum of 50 square feet of floor space for each youth.

3. The minimum space between beds shall be at least 2 feet.

4. Each bed shall have a clean mattress that is covered with a mattress pad and a waterproof covering when necessary, a pillow, at least 2 sheets, a bedspread, and blankets adequate for the season.

5. Each youth shall be provided their own bed.

(c) Kitchen or food storage and preparation area. The YCSF must have a refrigerator, a food heating appliance such as stove or microwave, cooking and eating utensils, and any other appliance or utensil that may be required to meet the needs of each youth. Appliances must be kept in good working order.

(d) Lounge requirement. A YCSF must have a common area for a youth lounge.

(e) Study area. A YCSF must provide adequate quiet area(s) for educational study. A youth’s bedroom may be used for this purpose.