Wisconsin Legislature: DHS 63.11(2)(c)

7. Medical health, by a psychiatrist or physician. A registered nurse may collect health-related information and history and perform partial examinations under supervision of a physician;

8. Dental health information and history may be collected by a psychiatrist, a physician or a CSP professional under the supervision of a physician; and

9. Other specified problems and needs, by a CSP professional supervised by the clinical coordinator or a designated staff member meeting qualifications under s. DHS 63.06 (2) (c).

(e) Evidence that a service is medically necessary shall be indicated through the signature of a psychiatrist on the client’s treatment record following the psychiatrist’s review and approval of the service.

(2) Treatment planning.

(a) The case manager assigned to a client under s. DHS 63.12 (1) shall ensure that an initial written treatment plan is developed at the time of the client’s admission to the CSP and that a comprehensive treatment plan is developed and written within one month after admission and is reviewed and updated in writing at least once every 6 months.

(b) The treatment plan shall:

1. Be based on the initial assessment required under sub. (1) (a) and, when appropriate, on the in-depth assessment required under sub. (1) (a) and (d);

2. Be developed in collaboration with other CSP professional and paraprofessional staff, service provider staff, the client or guardian, if any, and, when feasible, the client’s family. The client’s participation in the development of treatment or service goals shall be documented;

3. Specify treatment goals along with the treatment, rehabilitation and service actions necessary to accomplish the goals. The goals shall be developed with both short-range and long-range expectations and shall be written in measurable terms;

4. Identify the expected outcomes and the staff or agencies responsible for providing the client’s treatment, rehabilitation and support services;

5. Describe criteria for termination of treatment, rehabilitation and support services; and

6. Be reviewed, approved and signed by the CSP’s psychiatrist and clinical coordinator and be included in the client’s treatment record.

(d) The client’s progress and current status in meeting the goals set forth in the plan shall be reviewed by the staff working with the client at regularly scheduled case conferences at least every 6 months and shall be recorded in the client’s treatment record as follows:

1. The date and results of the review and any changes in the plan shall be recorded; and

2. The names of participants in the case conference shall be recorded.

(e) The case manager shall discuss the results of the review required under par. (d) with the client or guardian, if any, and, if appropriate, the client’s parent and shall record the client’s or guardian’s acknowledgement of any changes in the plan.

(3) Place of treatment. Each CSP shall set a goal of providing over 50% of service contacts in the community, in non-office based or non-facility based settings. For a period of 2 years following the effective date of this chapter, a CSP shall submit to the department records of the places where treatment and services are provided to each client. The records shall cover time periods specified by the department.

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

DHS 63.11 Required program components.

(1) Services. A CSP shall provide or make arrangements for the provision of the services specified in this section.

(2) Treatment. The CSP shall provide or make arrangements for provision of treatment services, which shall include:

(a) Crisis intervention services, including 24-hour telephone service, short-term emergency hospitalization and in-home or in-community emergency care by a CSP professional who has direct accessibility to the clinical coordinator or designated qualified staff member for consultation and assistance;

(b) Symptom management or supportive psychotherapy by a CSP professional, including:

1. Ongoing assessment of the client’s mental illness symptoms and the client’s response to treatment;

2. Symptom education to enable the client to identify his or her mental illness symptoms;

3. Teaching of behavioral symptom management techniques to alleviate and manage symptoms not reduced with medication; and

4. Promotion of personal growth and development by assisting the client to adapt to and cope with internal and external stresses;

1. A psychiatrist or physician shall:

a. Assess the client’s mental illness symptoms and behavior and prescribe appropriate medication;

b. Regularly review and document the client’s mental illness symptoms and behavior response to the medication; and

c. Monitor, treat and document any medication side effects;

2. A registered nurse may administer medication from a multidose container or by injection at the direction of a psychiatrist or another physician;

3. Staff may administer only single-unit oral medication doses that have been dispensed and labeled by a psychiatrist, another physician, a licensed pharmacist or a registered nurse at the direction of a psychiatrist or another physician;

4. Staff shall assess and document the client’s mental illness symptoms and behavior in response to medication and shall monitor for psychotropic medication side effects; and

5. Registered nurses shall report to the program psychiatrist and clinical coordinator and document in the chart adverse drug reactions and potential medication conflicts when drugs are prescribed by more than one physician; and

(d) Psychiatric and psychological services, including:

1. Psychiatric evaluation by a psychiatrist; and

2. Psychological evaluation by a clinical psychologist; and

(e) Family, individual or group psychotherapy by the clinical coordinator or designated staff member meeting qualifications under s. DHS 63.06 (2) (c).

(3) Rehabilitation. The CSP shall provide or make arrangements for provision of rehabilitation services, which shall include:

(a) Employment-related services provided in community-based settings to assess the effect of the client’s mental illness on employment and to develop an ongoing employment rehabilitation plan to enable the client to get and keep a job. Employment-related services include:

1. Individualized initial and ongoing assessment by a CSP professional, including a thorough work and academic history and on-site work assessments in community-based, structured jobs;

2. Identification of behaviors that interfere with the client’s work performance and development of interventions to alleviate the problem behaviors by a CSP professional;

3. Individual vocational supportive counseling by a CSP professional to enable the client to identify and cope with symptoms of mental illness that affect his or her work;

4. Work-related supportive services, such as assistance with grooming and personal hygiene, securing appropriate clothing, wake-up calls, transportation, on-the-job support and crisis assistance; and

5. On-the-job performance assessment and evaluation by a CSP professional;

(b) Social and recreational skill training, including supervised teaching activities and experiences provided individually or in small groups to:

1. Improve communication skills;

2. Facilitate appropriate interpersonal behavior; or

3. Familiarize clients with available social and recreational opportunities and increase their use of these opportunities; and

(c) Activities of daily living services provided in community-based settings including individualized support, problem solving, training and supervision to assist the client to gain or utilize the skills required to:

1. Carry out personal hygiene and grooming tasks;

2. Carry out household activities, including housecleaning, cooking, grocery shopping and laundry;

3. Develop or improve money management skills; and

4. Use available transportation.

(4) Support services. The CSP shall provide or make arrangements for provision of support services, which shall include case management under s. DHS 63.12 and individualized support, problem solving, training and supervision to help the client obtain:

(a) Services to meet physical health or dental health needs;

(b) Needed legal services;

(d) Financial support such as supplemental security income, social security disability insurance and general relief and money management services; and

(e) Living accommodations, including locating, financing and maintaining safe and normal living arrangements and enabling the client to relate to his or her landlord and neighbors in an acceptable manner.

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

DHS 63.12 Case management.

(1) Single point of contact for a client. Each CSP client shall have a designated case manager who shall be responsible for maintaining a clinical treatment relationship with the client on a continuing basis whether the client is in the hospital, in the community, or involved with other agencies. Case managers shall meet the qualifications for clinical coordinators under s. DHS 63.06 (2) (c) or staff under s. DHS 63.06 (4) (a) 1. to 8.

(2) Coordination of treatment.

(a) The case manager shall work with other CSP professional and paraprofessional staff and other agencies to:

1. Coordinate the assessment under s. DHS 63.10 (1) and ensure that a diagnosis is made;

2. Develop and implement the treatment plan under s. DHS 63.10 (2); and

3. Directly provide or coordinate treatment and services.

(b) The case manager shall work with other CSP staff and community agency staff to ensure that treatment plans are updated in accordance with s. DHS 63.10 (2) (a).

(3) Coordination of referrals.

(a) A CSP shall have policies and procedures that facilitate coordination of referrals and ensure follow-up of clients referred to other community service providers.

(b) The case manager shall work with other community agency or community service staff to:

1. Coordinate linkages and referrals;

2. Coordinate contracting for specialized assessment and diagnosis or treatment, rehabilitation and support services; and

3. Integrate other agency or service activities into the CSP treatment plan.

(4) Monitoring symptom status.

(a) The case manager shall assess, on a consistent basis, the client’s symptom status. Changes in status shall be documented in the client’s treatment record to measure progress or decompensation.

(b) The case manager shall keep the CSP program director and clinical coordinator informed of all changes in symptom status by signed notation in the client’s treatment record.

(c) The case manager shall coordinate the provision of emergency services when a client is in crisis and shall provide documentation in the client’s treatment record of emergency services provided.

(5) Supportive psychotherapy and education. The case manager shall coordinate the provision of or provide supportive psychotherapy and education in symptom and illness management to the client.

(6) Advocacy.

(a) The case manager shall advocate for and help his or her clients obtain needed benefits and services, including general relief, supplemental security income, housing subsidies, food stamps, medical assistance and legal services.

(b) The case manager shall work with existing community agencies to develop needed CSP resources, including housing, employment options and income assistance.

(7) Education, support and consultation to clients’ families and other major supports.