Wisconsin Legislature: DHS 63.06(6)

(b) A CSP shall maintain written documentation of employees’ qualifications and shall make that information available for inspection by clients and by the department.

(2) Required staff. A CSP shall employ:

(a) A director, who shall have overall responsibility for the program. The director shall meet the qualifications for any of the program staff listed under sub. (4) (a) 1. to 8.;

(b) A psychiatrist on a full-time, part-time or consulting basis to provide necessary psychiatric services. The psychiatrist shall meet the qualifications specified under sub. (4) (a) 2.; and

(c) A clinical coordinator who shall have overall responsibility for and provide direct supervision of the CSP’s client treatment services and supervision of CSP clinical staff. The clinical coordinator shall be a psychiatrist or psychologist or have a master’s degree in social work, clinical psychology or psychiatric mental health nursing or have met equivalent requirements. The coordinator shall have either 3,000 hours of supervised clinical experience in a practice where the majority of clients are adults with chronic mental illness or 1,500 hours of supervised clinical experience in a CSP.

(3) Staffing ratios. The client-to-staff ratio may not exceed 20 clients to one full-time equivalent staff person, except that the department may permit, in accordance with a request for a waiver under s. DHS 63.05, that the ratio may not exceed 25 clients to one full time equivalent staff person. Only staff who meet the qualifications under subs. (2) and (4) (a) may be counted in the staff-to-client ratio.

(4) Qualifications.

(a) CSP staff shall have the following qualifications:

1. A CSP professional shall have a bachelor’s degree in a behavioral science or a related field with 1,000 hours of supervised post-degree clinical experience with chronically mentally ill persons, or a bachelor’s degree in a field other than behavioral sciences with 2,000 hours of supervised postdegree clinical experience with persons with chronic mental illness;

2. A psychiatrist shall be a physician licensed under ch. 448, Stats., to practice medicine and surgery and shall have satisfactorily completed 3 years’ residency training in psychiatry in a program approved by the American medical association;

3. A clinical psychologist shall be licensed under ch. 455, Stats.;

4. A clinical social worker shall have a master’s degree from a graduate school of social work accredited by the council on social work education;

5. A registered nurse shall hold a current certificate of registration under ch. 441, Stats., and shall have experience or education related to the responsibilities of his or her position;

6. Occupational therapists and recreational therapists shall have bachelor’s degrees in their respective professions;

7. A rehabilitation counselor shall be certified or eligible for certification by the commission on rehabilitation counselor certification;

8. A vocational counselor shall possess or be eligible for a provisional school counselor certificate and shall have a master’s degree in counseling and guidance; and

9. A mental health technician shall be a paraprofessional who is employed on the basis of personal aptitude. A mental health technician shall have a suitable period of orientation and in-service training and shall work under the supervision of a clinical coordinator under sub. (2) (c).

(b) When volunteers are used, they shall be supervised by professional staff under par. (a) 1. to 8. The CSP shall have written procedures for the selection, orientation and inservice training of volunteers.

(5) Clinical supervision.

(a) Each CSP shall develop and implement a written policy for clinical supervision of all staff who provide treatment, rehabilitation and support services to CSP clients.

(b) Clinical supervision of individual CSP staff shall include direct clinical review, assessment and feedback regarding their delivery of treatment, rehabilitation and support services to individual CSP clients and teaching and monitoring of the application of CSP principles and practices.

(c) Clinical supervision shall be provided by a clinical coordinator meeting the qualifications under s. DHS 63.06 (2) (c) or by staff who meet the qualifications under s. DHS 63.06 (2) (c) and who are designated by the clinical coordinator to provide clinical supervision.

(d) Clinical supervision shall be accomplished by one or more of the following means:

1. Individual sessions with staff to review cases, assess performance and give feedback;

2. Individual sessions in which the supervisor accompanies an individual staff member to meet with individual clients in regularly scheduled sessions or crisis situations and in which the supervisor assesses, teaches and gives feedback regarding the staff member’s performance regarding the particular client;

2m. Any other form of professionally recognized method of supervision designed to provide sufficient guidance to assure the delivery of effective services to consumers by the staff member;

3. Regular client report or review staff meetings and treatment planning staff meetings to review and assess staff performance and provide staff direction regarding individual cases.

(e) For every 20 clients or every 40 hours of direct service in the CSP, the clinical supervisor shall spend at least 4 hours a week providing supervision.

(f) Clinical supervision provided to individual CSP staff shall be documented in writing.

(6) Orientation and training.

(a) Each CSP shall develop and implement an orientation and training program which all new staff and regularly scheduled volunteers shall complete. The orientation shall include:

1. Review of the applicable parts of this chapter.

2. Review of CSP policies.

3. Review of job responsibilities specified in the job description.

4. Review of ch. DHS 94, patient rights.

5. Review of ch. DHS 92, confidentiality of treatment records.

6. Review of agency’s use of telehealth, including when telehealth can be used and by whom, privacy and security considerations, and the right to decline services provided via telehealth.

(b) Each CSP shall develop and implement a training plan for all staff, including:

1. Use of staff meeting time which is set aside for training.

2. Presentations by community resource staff from other agencies.

3. Attendance at conferences and workshops.

4. Discussion and presentation of current principles and methods of treatment, rehabilitation and support services for chronically mentally ill persons.

History: Cr. Register, April, 1989, No. 400, eff. 5-1-89; correction in (6) (a) 4. made under s. 13.93 (2m) (b) 7., Stats., Register December 2004 No. 588; corrections in (6) (a) 4. and 5. made under s. 13.92 (4) (b) 7., Stats., Register November 2008 No. 635; CR 20-068: am. (1) (a) Register December 2021 No. 792, eff. 1-1-22; CR 23-053: am. (5) (d) 1., 2., cr. (5) (d) 2m., am. (6) (a) 1. to 4., cr. (6) (a) 6., am. (6) (b) 1. to 3. Register September 2023 No. 813, eff. 10-1-23.

DHS 63.07 Outreach and screening. A CSP shall have written procedures for contacting and identifying persons with chronic mental illness and for having those persons referred to the CSP. The procedures shall include:

(1) Outreach activities and direct contact with potential CSP clients;

(2) Outreach referral agreements with psychiatric inpatient units, outpatient units and community service providers; and

(3) Screening by a clinical coordinator of each person referred to the CSP under sub. (2) to determine whether the person meets the admission criteria in s. DHS 63.08.

History: Cr. Register, April, 1989, No. 400, eff. 5-1-89.

DHS 63.08 Criteria for admission.

(1) Criteria. Admission to a CSP shall be limited to an individual who has chronic mental illness which by history or prognosis requires repeated acute treatment or prolonged periods of institutional care and who exhibits persistent disability or impairment in major areas of community living as evidenced by:

(a)

1. A condition of chronic mental illness and a diagnosis listed in the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) within one of the following classification codes:

a. 295.1, .2, .3, .6 and .9 - Schizophrenia;

b. 296.2, .3, .4, .5, .6 and .7 - Affective disorders;

c. 297.1 - Delusional disorder; or

d. 295.7 and 298.9 - Other psychotic disorders.

2. A significant risk of either continuing in a pattern of institutionalization or living in a severely dysfunctional way if CSP services are not provided; and

3. Impairment in one or more of the functional areas listed under sub. (2); or

(b)

1. A condition of chronic mental illness with another diagnosis listed in the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R), provided that documentation in the client record shows that:

a. There have been consistent and extensive efforts to treat the client, such as use of special structured housing, more frequent outpatient appointments combined with proactive efforts such as home visiting when the client does not come in for appointments, cooperative efforts by various outpatient, housing, vocational and crisis agencies to coordinate and plan treatment and face-to-face crisis intervention services on a regular basis, with or without crisis housing. The efforts have persisted for at least a year, except in unusual circumstances such as a serious and sudden onset of dysfunction, causing the client’s condition to move beyond basic outpatient clinical standards of practice; and

b. The client exhibits persistent dangerousness to self or others;

2. A significant risk of either continuing in a pattern of institutionalization or living in a severely dysfunctional way if CSP services are not provided; and

3. Impairment in one or more areas listed under sub. (2).

(2) Areas of functional impairment. The functional areas in which individuals admitted to a CSP may show impairment are as follows:

(a) Vocational, educational or homemaker functioning.

1. Impairment in vocational functioning is manifested by an inability to be consistently employed at a self-sustaining level or an ability to be employed only with extensive supports, except that a person who is able to earn sustaining income but is recurrently unemployed because of acute episodes of mental illness shall be considered vocationally impaired;

Note: The following are examples of persons who function at a fairly high level in general terms but still manifest vocational impairment:

A person who works 30 hours a week for years at a sheltered workshop at minimum wage, enough to sustain himself or herself, but who has shown repeated inability to work in competitive job sites because of loss of support and of the structure of sheltered work; and

A person who works 40 hours a week at a wage that may be somewhat more than minimum without extensive supports but who is unemployed 2 to 4 months of most years because of acute psychosis and loses his or her job when psychotic.

2. Impairment in educational functioning is manifested by an inability to establish and pursue educational goals within a normal time frame or without extensive supports;

Note: As an example, protracted part-time or intermittent full-time courses of study indicate impairment when goals are not being met or repeated class failure or frequent changes in major areas of study manifest an impairment in educational functioning.

3. Impairment in homemaker functioning is manifested by an inability to consistently and independently carry out home management tasks, including household meal preparation, washing clothes, budgeting and child care tasks and responsibilities; and

4. When part-time homemaker and educational or vocational roles coexist, the functional level of the combined roles shall be assessed according to existing community norms;

(b) Social, interpersonal or community functioning.

1. Impairment in social or interpersonal functioning is manifested by a person’s inability to independently develop or maintain adult social relationships or to independently participate in adult social or recreational activities and is evidenced by:

a. Repeated inappropriate or inadequate social behavior or an ability to behave appropriately or adequately only with extensive or consistent support or coaching or only in special contexts or situations, such as social groups organized by treatment staff; or

b. Consistent participation in adult activities only with extensive support or coaching and when involvement is mostly limited to special activities established for the mentally ill or other persons with interpersonal impairments;

2. Impairment in community functioning is manifested by a pattern of significant community disruption, including family disruption or social unacceptability or inappropriateness, that may not recur often but is of such magnitude that it results in severe consequences, including exclusion from the person’s primary social group or incarceration, or in severe impediments to securing basic needs such as housing; and

Note: The following are examples of higher functioning persons who still manifest the impairments under par. (b):

A person who socialized appropriately and effectively in one-to-one contacts with staff or in social groups organized by a CSP but is very isolative otherwise and does not socialize on his or her own;

A person who anxiously participates in a community group or activity only with much weekly coaching by and frequent accompaniment of treatment staff, but who does not reach the point of going to this activity on his or her own or with only minimal coaching;

A person who socializes on his or her own in relationships and groups, but who, after a period of time, drives away many friends because of inappropriate or ineffective behavior and therefore is recurrently lonely; and

A divorced woman’s periodic threats to “steal” her children (who are in the custody of her ex-husband) from their day care center that lead to loss of visiting privileges with the children and therefore loss of the emotional sustenance the children bring.

1. A person’s inability to consistently perform the range of practical daily living tasks required for basic adult functioning in the community, including:

a. Grooming, hygiene, washing of clothes and meeting nutritional needs;

b. Care of personal business affairs;

c. Transportation and care of residence;