Plain language analysis
Mental health day treatment services for youth are community mental health services provided by programs certified by the Department to provide clinically-supervised, non-residential care to youth with mental illness, behavioral problems, or severe emotional disturbance. Chapter DHS 40 establishes requirements for program certification and operational requirements for admission, assessment, treatment planning, treatment, and discharge planning. Chapter DHS 40 has not been revised since 1996 and no longer reflects current terminology or best practices in mental health day treatment, treatment planning, and diagnostics. Following extensive consultation with and input from stakeholders in the mental health community, the Department proposes to update the rule chapter. Specific revisions include updates to program certification, service level designation, personnel and services, admissions, use of seclusion and restraints, and use of medications.
There are no reasonable alternatives to the proposed rule changes. Mental health day treatment has developed significantly since the rule was created in 1996.
Summary of, and comparison with, existing or proposed federal regulations
There appears to be no existing or proposed federal regulation that addresses the activities to be regulated by the proposed rule.
Comparison with rules in adjacent states
Illinois:
Illinois’ youth day treatment programs are regulated through the Illinois State Board of Education (ISBE) in 23 Ill. Adm. Code 401, Subpart A. The rule addresses approval of programs, placement and education of students, and operational requirements.
Iowa:
Iowa’s youth day treatment is not currently regulated by rule. Iowa’s Department of Human Services instead provides Psychiatric Medical Institutions for Children (PMIC) Provider Manual.
Michigan:
Michigan’s youth day treatment is regulated by the Michigan Department of Health and Human Services in Mich. Admin Code R 330. These rules establish requirements for various services, reporting requirements, program certification, review and evaluation, personnel, diagnosis and treatment.
Minnesota:
Minnesota’s youth day treatment is regulated by the Minnesota Department of Human Services in Minn. R. 9505.0370, 9505.0371, 9505.3072. These rules establish requirements relating to eligibility, required services, qualification of providers, and operations.
Summary of factual data and analytical methodologies
The Department relied on the following sources to draft the proposed rule and to determine the impact on day treatment facilities:
The Department formed an Advisory Committee consisting of day treatment providers and community stakeholders. Committee members reviewed drafts of the rule and provided comments. Their comments guided the development of the proposed rule.
Results from the Chapter DHS 40 Provider Survey sent to all day treatment providers in April 2016.
Consultation with Ellie Jarvie at Department of Health Services (2017).
Consultation with Hugh Davis at Wisconsin Ties (March, 2016).
Consultation with Joann Stephens and Kim Eithun-Harsher at the Wisconsin Office of Children’s Mental Health (March, 2016).
Davis, H. (2017). Wisconsin Family Ties’ Parent Peer Specialist Services: Innovative Approaches to Children’s Mental Health. Wisconsin Family Ties.
DHS seclusion and restraint survey database which contains seclusion and restraint data in Wisconsin day treatment facilities. Annual data comparison reviewed for 2010-2015 to assess levels of seclusion and restraint to determine appropriateness of inclusion of emergency measures in the updated rule. Analysis and supporting documents used to determine effect on small business
Wisconsin has 41 certified child and adolescent mental health day treatment facilities that may be affected by this rule. All facilities are community-based, operating at non-profit organizations or affiliated with hospitals. The Department conducted a provider survey with all day treatment providers in April 2016 to assess components of programming, treatment, and staffing. The Department formed an Advisory Committee consisting of diverse stakeholders that met nine times. The Advisory Committee included members from five separate day treatment facilities, two parents of children who have utilized day treatment services, executive director of the Wisconsin Association of Family & Children’s Agencies which includes members who provide day treatment services, and advocates from three agencies who represent children’s mental health issues. The public was notified of all Advisory Committee meetings pursuant to Wisconsin’s Open Meetings law. Committee members reviewed the initial draft and their comments guided the development of the proposed rule. In addition, the Department requested comments on the economic impact of the proposed rule by publishing a solicitation in the Administrative Register and on the Department’s administrative rules website (hhtps://www.dhs.wisconsin.gov/rules/permanent.htm). Comments were solicited between October 8, 2018 and October 22, 2018. Effect on small business
$33,364. See Fiscal Estimate and Economic Impact Analysis (DOA Form 2049) for further information on the effect on small business.
Agency contact person
Sarah Coyle
(608) 266-2715
Statement on quality of agency data
The data sources used to draft the rules and analyses are accurate, reliable, and objective and are listed in the Summary of Factual Data and Analytical Methodologies section of this rule order.
Place where comments are to be submitted and deadline for submission
Comments may be submitted to the agency contact person that is listed above until the deadline given in the upcoming notice of public hearing. The deadline for submitting comments and the notice of public hearing will be posted on the Wisconsin Administrative Rules Website at http://adminrules.wisconsin.gov after the hearing is scheduled.
RULE TEXT
SECTION 1. Chapter DHS 40 is repealed and recreated to read:
MENTAL HEALTH DAY TREATMENT FOR YOUTH
DHS 40.01 Authority and purpose.
This chapter is promulgated under the authority of s. 51.42 (7) (b), Stats., and is intended to regulate programs providing mental health day treatment services for youth.
DHS 40.02 Applicability. This chapter applies to all programs providing mental health day treatment services for youth in the state of Wisconsin. This chapter does not regulate other providers of day treatment services for youth, such as alcohol and other substance use disorder treatment programs regulated by ch. DHS 75. If a comprehensive program offers services to youth in addition to mental health day treatment, this chapter applies only to those program components that offer mental health day treatment. DHS 40.03 Definitions. In this chapter:
(1)
“Advanced practice nurse” has the meaning given in s. N 8.02 (1).(2)
“Advanced practice nurse prescriber” has the meaning given in s. N 8.02 (2).(3) “Assessment” means the process required under s. DHS 40.13. (4) “Biopsychosocial information” means the combination of physical, psychological, social, environmental, and cultural factors that influence a youth’s development and functioning including underlying driving forces or unmet needs that are expressed through challenging behavior that a youth is exhibiting.
(5) “Care coordination” means efforts by day treatment programs to work jointly with other service systems and agencies including: schools, corrections, child welfare, substance use disorder treatment, and mental and physical health providers, in order to enhance services and supports and reduce barriers to service delivery.
(6) “Chemical restraint” means any medication or substance that may decrease a youth’s independent functioning and that is not administered pursuant to a current treatment plan.
(7) “Client” means a youth receiving mental health day treatment services from a program.
(8) “Clinical collaboration” means a joint intellectual and clinical effort by mental health professionals, intended to produce therapeutic benefits and favorable outcomes.
(9) “Clinical supervision” means the process described in s. DHS 40.10 (5). (10) “Community-based program” means a program providing mental health day treatment services for youth in a facility that is not affiliated with a hospital.
