Wisconsin Legislature: DHS 63.11(3)(c)

(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.

(a) The case manager shall determine what support, consultation and education the client’s family may need from the CSP to manage the symptoms and illness of the client family member.

(b) The case manager shall coordinate support and consult with the client’s family at time intervals as specified in the client’s treatment plan.

(c) The case manager shall provide the client’s other support systems with education and information about chronic mental illness and community support program treatment.

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

DHS 63.13 Client rights. A CSP shall have policies and procedures that ensure that client rights are protected in accordance with s. 51.61, Stats., and ch. DHS 94. The CSP shall require all case managers to assist clients in asserting their rights under s. 51.61, Stats., and ch. DHS 94.

History: Cr. Register, April, 1989, No. 400, eff. 5-1-89; corrections made under s. 13.92 (4) (b) 7., Stats., Register November 2008 No. 635.

DHS 63.14 Complaints. A CSP shall have procedures for reporting and investigating alleged unethical, illegal or grossly negligent acts affecting clients and violation of written policies and procedures. The procedures shall also address both client and staff reporting of complaints regarding program procedures, staff and services.

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

DHS 63.15 Client records.

(1) A CSP shall maintain a treatment record for each client. The record shall include information that is sufficiently detailed to enable a person not familiar with the CSP to identify the types of services the client has received.

(2) The CSP director is responsible for the maintenance and security of client treatment records.

(3) Client treatment records shall be maintained in a central location.

(4) Client treatment records shall be kept confidential and safeguarded as required under s. 51.30, Stats., and ch. DHS 92.

(5) The treatment recordkeeping format shall provide for consistency within the CSP and shall facilitate information retrieval. Treatment records shall include:

(a) Results of all examinations, tests and other assessment information;

(b) Reports from referring sources;

(d) Medication records, which shall document ongoing monitoring of administration of medications and the detection of adverse drug reactions. All medication orders in the client treatment record shall specify the name of the medication, dose, route of administration, frequency of administration, person administering and name of the physician who prescribed the medication;

(e) Records of referrals of the client to outside resources;

(f) Reports from outside resources;

(g) Multidisciplinary case conference and consultation notes;

(h) Consent for disclosure of information release forms;

(i) Progress notes which shall document the location where the service was provided; and

(j) Discharge documentation.