(2) Therapeutic interventions and skills-building which will help youth manage their emotions and behavior in ways that will benefit them and will assist them in avoiding future crises.
(3) A YCSF shall provide care coordination services to each youth. The care coordinator shall be staff in compliance with s. DHS 34.21 (3) (b) 1. to 14. Care coordination shall include all of the following: (a) Providing the youth or legal representative with an explanation of the nature and goals of the program, and the rights and responsibilities of the youth.
(b) Facilitating the youth’s assessment, developing and implementing the treatment plan, conducting ongoing case reviews, and identifying services to support the youth at discharge, encouraging family-driven care whenever possible.
(c) Serving as an advocate for the youth with other agencies and programs to help the youth obtain necessary services and coordinating treatment to prevent further crises.
(4) Discharge planning shall meet all of the following requirements:
(a) Discharge planning shall be designed to support the successful reintegration of youth into family, community, and school activities, and to prevent recurrence of a crisis.
(b) Discharge planning shall begin at the time of admission, outlining goals to be achieved during the youths’ stay.
(c) Discharge planning shall include the youth, and the youth’s legal representative if available.
(d) At discharge, all of the youth’s belongings and medications shall accompany the youth.
(e) A discharge summary in writing shall be maintained in the youths’ record.
DHS 50.12 Emergency Safety Interventions.
(1) PROHIBITED INTERVENTIONS. Mechanical restraints and chemical restraints are prohibited.
(2) GENERAL REQUIRMENTS. Seclusion and physical restraint shall only be administered by YCSF staff who have completed orientation and training described in s. DHS 50.08 and shall comply with the requirements for emergency safety interventions under s. 51.61 (1) (i), Stats., s. DHS 94.10, and this chapter.
(3) ADMINISTRATION REQUIREMENTS. All of the following requirements apply to the administration of seclusion and physical restraint:
(a) Seclusion and physical restraint may only be administered when all other less restrictive methods have been exhausted.
(b) Seclusion and physical restraint shall be administered for the shortest time possible and only until the youth is no longer a danger to self or others.
(c) Seclusion and physical restraint shall be administered in a manner that is attentive to, and respectful of, the trauma history, dignity, and civil rights of the youth.
(d) Seclusion and physical restraint shall be administered in a manner that avoids or causes the least possible physical or emotional discomfort, harm, and pain to the youth.
(e) Regular access to bathroom facilities, drinking water, and necessary medication shall be provided according to the youth’s needs during the administration of seclusion or physical restraint. Temperature and lights shall be maintained at levels which are comfortable to the youth.
(4) SPECIFIC REQUIREMENTS FOR SECLUSION. A YCSF that opts to use seclusion shall do all of the following:
(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 YCSF 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 responses 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 one youth at a time 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 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, or a 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 pad lock, key lock, or other locks of similar design.
(5) SPECIFIC REQUIREMENTS FOR PHYSICAL RESTRAINT.
(a) Physical restraint shall only be administered to a youth during an emergency, when there is youth, other youths, or a staff member present, such as during the occurrence of a serious threat of violence, self-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) All of the following are prohibited forms of physical restraint:
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.
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’s 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 doctor or nurse is not present on site, a licensed treatment professional shall conduct the face-to-face 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 face-to-face 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. What modifications can be made in the youth’s services or treatment plan to prevent future seclusion and physical restraint.
(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, 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 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. 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, per s. 51.46, Stats. (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.
(2) Investigating and reporting abuse, neglect, or misappropriation of property. A YCSF shall be considered an entity, under ch. DHS 13, and shall comply with the requirements for entities provided in ch. DHS 13.
(3) Notification of changes affecting a youth.
(a) The YCSF shall immediately notify the youth's legal representative when there is an incident or injury to the youth resulting in a significant change in the youth's physical or mental condition.
(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 notify the department of health services within 24 hours when there is an allegation of physical, sexual or mental abuse, or neglect of a youth. Notification may be reported here: https://www.dhs.wisconsin.gov/mh/ycsf.htm. (e) 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.
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. Subchapter III – Facilities
DHS 50.15 General Requirements.
DCF 57.40(1)(a)(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.
