Wisconsin Legislature: DHS 34.21(2)(b)1.

History: Cr. Register, September, 1996, No. 489, eff. 10-1-96.

DHS 34.11 Standards.

(1) General. A basic emergency service mental health program shall:

(a) Provide immediate evaluation and mental health care to persons experiencing a mental health crisis.

(b) Make emergency services available within the county’s mental health outpatient programs, mental health inpatient program or mental health day treatment program and shared with the other 2 programs.

(2) Personnel.

(a) Only psychiatrists, psychologists, social workers and other mental health personnel who are qualified under s. DHS 34.21 (3) (b) 1. to 15. may be assigned to emergency duty. Staff qualified under s. DHS 34.21 (3) (b) 16. to 19. may be included as part of a mobile crisis team if another team member is qualified under s. DHS 34.21 (3) (b) 1. to 15.

(b) Telephone emergency service may be provided by volunteers after they are carefully selected for aptitude and after a period of orientation and with provision for inservice training.

(d) Medical, preferably psychiatric, consultation shall be available to all staff members at all times.

(3) Program operation and content.

(a) Emergency services shall be available 24 hours a day and 7 days a week.

(b) A program shall operate a 24-hour crisis telephone service staffed by mental health professionals or paraprofessionals, or by trained mental health volunteers backed up by mental health professionals. The crisis telephone service shall have a published telephone number, and that number shall be widely disseminated to community agencies and the public.

(c) A program shall provide face to face contact for crisis intervention. Face to face contact for crisis intervention may be provided as a function of the county’s outpatient program during regular hours of outpatient program operation, with an on-call system for face-to-face contact for crisis intervention at all other times. A program shall have the capability of making home visits or seeing patients at other off-headquarter locations, and shall have the resources to carry out on-site interventions when this is clinically desirable. A program may use telehealth in conjunction with in-person services.

(d) When appropriate, emergency service staff may transfer clients to other county mental health programs.

History: Cr. Register, September, 1996, No. 489, eff. 10-1-96; correction in (2) (a) made under s. 13.93 (2m) (b) 7., Stats., Register October 2004 No. 586; CR 23-053: am. (3) (c) Register September 2023 No. 813, eff. 10-1-23.

Subchapter III — Standards for Emergency Service Programs Eligible for Medical Assistance Program or Other Third Party Reimbursement

DHS 34.20 Applicability.

(1) A county may operate or contract for the operation of an emergency mental health services program that is eligible for medical assistance program reimbursement or eligible for third-party payments under policies governed by s. 632.89, Stats.

(2) An emergency mental health services program eligible for medical assistance program reimbursement or eligible for third-party payments under policies governed by s. 632.89, Stats., that is operated by a county or under contract for a county shall comply with subch. I and this subchapter.

History: Cr. Register, September, 1996, No. 489, eff. 10-1-96.

DHS 34.21 Personnel.

(1) Policies.

(a) An emergency mental health services program shall have written personnel policies.

(b) A program shall maintain written documentation of employee qualifications and shall make that information available upon request for review by clients and their guardians or parents, where guardian or parent consent is required for treatment, and by the department.

(2) General qualifications.

(a) Each employee shall have the ability and emotional stability to carry out his or her assigned duties.

(b)

1. An applicant for employment shall provide references regarding professional abilities from at least 2 people and, if requested by the program, references or transcripts from any post secondary educational institution attended and employment history reports or recommendations from prior employers.

2. References and recommendations shall be documented either by letter or in a signed and dated record of a verbal contact.

(c) A program shall review and investigate application information carefully to determine whether employment of the individual is in the best interests of the program’s clients. This shall include a check of relevant and available conviction records. Subject to ss. 111.322 and 111.335, Stats., an individual may not have a conviction record.

Note: See s. 165.82, Stats., relating to the fee charged by the Wisconsin department of justice for a criminal records check.

(d) A program shall confirm an applicant’s current professional licensure or certification if that licensure or certification is a condition of employment.

(3) Qualifications of clinical staff.

(a) In this subsection, “supervised clinical experience” means a minimum of one hour per week of supervision by a mental health professional qualified under par. (b) 1. to 9., gained after the person being supervised has received a master’s degree.

(b) Program staff retained to provide mental health crisis services shall meet the following minimum qualifications:

1. Psychiatrists shall be physicians licensed under ch. 448, Stats., to practice medicine and surgery and shall have completed 3 years of residency training in psychiatry or child psychiatry in a program approved by the accreditation council for graduate medical education and be either board-certified or eligible for certification by the American board of psychiatry and neurology.

2. Psychologists shall be licensed under ch. 455, Stats., and shall be listed or meet the requirements for listing with the national register of health service providers in psychology or have a minimum of one year of supervised post-doctoral clinical experience related directly to the assessment and treatment of persons with mental disorders.

3. Psychology residents shall hold a doctoral degree in psychology meeting the requirements of s. 455.04 (1) (c), Stats., and shall have successfully completed 1500 hours of supervised clinical experience as documented by the Wisconsin psychology examining board.

4. Psychiatric residents shall hold a doctoral degree in medicine as a medical doctor or doctor of osteopathy and shall have successfully completed 1500 hours of supervised clinical experience as documented by the program director of a psychiatric residency program accredited by the accreditation council for graduate medical education.

5. Certified independent clinical social workers shall meet the qualifications established in ch. 457, Stats., and be certified by the examining board of social workers, marriage and family therapists and professional counselors.

6. Psychiatric nurses shall be licensed under ch. 441, Stats., as a registered nurse, have completed 3000 hours of supervised clinical experience and hold a master’s degree in psychiatric mental health nursing from a graduate school of nursing accredited by the national league for nursing.

7. Professional counselors and marriage and family therapists shall meet the qualifications required established in ch. 457, Stats., and be certified by the examining board of social workers, marriage and family therapists and professional counselors.

8. Master’s level clinicians shall be persons with a master’s degree and coursework in areas directly related to providing mental health services, including clinical psychology, psychology, school or educational psychology, rehabilitation psychology, counseling and guidance or counseling psychology. Master’s level clinicians shall have 3000 hours of supervised clinical experience or be listed in the national registry of health care providers in clinical social work, the national association of social workers register of clinical social workers, the national academy of certified mental health counselors or the national register of health service providers in psychology.

9. Post-master’s level clinician interns shall have obtained a master’s degree as provided in subd. 8. and have completed 1500 hours of supervised clinical experience, documented as provided in subd. 4.

10. Physician assistants shall be certified and registered pursuant to ss. 448.05 and 448.07, Stats., and chs. Med 8 and 14 and shall have had at least one year of experience working in a clinical mental health facility, or there shall be a specific plan for the person to acquire equivalent training and skills within 3 months after beginning employment.

11. Registered nurses shall be licensed under ch. 441, Stats., as a registered nurse, and shall have had training in psychiatric nursing and at least one year of experience working in a clinical mental health facility, or there shall be a specific plan for the person to acquire equivalent training and skills within 3 months after beginning employment.

12. Occupational therapists shall have obtained a bachelors degree and have completed a minimum of one year of experience working in a mental health clinical setting, and shall meet the requirements of s. DHS 105.28 (1).

13. Certified social workers, certified advance practice social workers and certified independent social workers shall meet the qualifications established in ch. 457, Stats., and related administrative rules, and have received certification by the examining board of social workers, marriage and family therapists and professional counselors.

14. Other qualified mental health professionals shall have at least a bachelor’s degree in a relevant area of education or human services and a minimum of one year of combined experience providing mental health services, or work experience and training equivalent to a bachelor’s degree including a minimum of 4 years of work experience providing mental health services.

15. Specialists in specific areas of therapeutic assistance, such as recreational and music therapists, shall have complied with the appropriate certification or registration procedures for their profession as required by state statute or administrative rule or the governing body regulating their profession, and shall have at least one year of experience in a mental health clinical setting.

16. Certified occupational therapy assistants shall have at least one year of experience in a mental health clinical setting and shall meet the requirements of s. DHS 105.28 (2).

17. Licensed practical nurses shall be licensed under ch. 441, Stats., as a licensed practical nurse and have had either training in psychiatric nursing or one year of experience working in a clinical mental health setting.

18. Mental health technicians shall be paraprofessionals who are employed on the basis of personal aptitude and life experience which demonstrates their ability to provide effective emergency mental health services.

19. Clinical students shall be students currently enrolled in an academic institution and working toward a degree in a professional area identified in this subsection who are providing services to the program under the supervision of a staff member meeting the qualifications under this subsection for that professional area.

(4) Required staff.

(a) Program administrator. A program shall designate a program administrator, or equivalently titled person, who shall have overall responsibility for the operation of the program and for compliance of the program with this chapter.

(b) Clinical director.

1. The program shall have on staff a clinical director or similarly titled person qualified under sub. (3) (b) 1. or 2. who shall have responsibility for the mental health services provided by the program.

2. Either the clinical director or another person qualified under sub. (3) (b) 1. to 8. who has been given authority to act on the director’s behalf shall be available for consultation in person or by phone at all times the program is in operation.

(5) Additional staff. A program shall have staff available who are qualified under sub. (3) (b) 1. to 19. to meet the specific needs of the community as identified in the emergency mental health services plan under s. DHS 34.22 (1).

(6) Volunteers. A program may use volunteers to support the activities of the program staff. Volunteers who work directly with clients of the program or their families shall be supervised at all times by a program staff member qualified under sub. (3) (b) 1. to 8.

(7) Clinical supervision.

(a) Each program shall develop and implement a written policy for clinical supervision to ensure that:

1. The emergency mental health services being provided by the program are appropriate and being delivered in a manner most likely to result in positive outcomes for the program’s clients.

2. The effectiveness and quality of service delivery and program operations are improved over time by applying what is learned from the supervision of staff under this section, the results of client satisfaction surveys under s. DHS 34.26, the review of the coordinated community services plan under s. DHS 34.22 (1) (b), comments and suggestions offered by staff, clients, family members, other providers, members of the public and similar sources of information.

3. Professional staff have the training and experience needed to carry out the roles for which they have been retained, and receive the ongoing support, supervision and consultation they need in order to provide effective services for clients.

4. Any supervision necessary to enable professional staff to meet requirements for credentialing or ongoing certification under ch. 455, Stats. and related administrative rules and under other requirements promulgated by the state or federal government or professional associations is provided in compliance with those requirements.

(b) The clinical director is accountable for the quality of the services provided to participants and for maintaining appropriate supervision of staff and making appropriate consultation available for staff.

(c) Clinical supervision of individual program staff members includes direct review, assessment and feedback regarding each program staff member’s delivery of emergency mental health services.

(d) Program staff providing emergency mental health services who have not had 3000 hours of supervised clinical experience, or who are not qualified under sub. (3) (b) 1. to 8., receive a minimum of one hour of clinical supervision per week or for every 30 clock hours of direct crisis mental health services they provide.

(e) Program staff who have completed 3000 hours of supervised clinical experience and who are qualified under sub. (3) (b) 1. to 8., participate in a minimum of one hour of peer clinical consultation per month or for every 120 clock hours of direct crisis mental health services they provide.

(f) Day to day clinical supervision and consultation for individual program staff is provided by mental health professionals qualified under sub. (3) (b) 1. to 8.

(g) Clinical supervision is accomplished by one or more of the following means:

1. Individual sessions with the staff member to review cases, assess performance and let the staff member know how he or she is doing.

2. Individual side-by-side sessions in which the supervisor is present while the staff person provides emergency mental health services and in which the supervisor assesses, teaches and gives advice regarding the staff member’s performance.

3. Group meetings to review and assess staff performance and provide staff advice or direction regarding specific situations or strategies.

4. Other professionally recognized methods of supervision, such as review using videotaped sessions and peer review, if the other methods are approved by the department and are specifically described in the written policies of the program.

(h) Clinical supervision provided for individual program staff is documented in writing.

(i) Peer clinical consultation is documented in either a regularly maintained program record or a personal diary of the mental health professional receiving the consultation.

(j) The clinical director is permitted to direct a staff person to participate in additional hours of supervision or consultation beyond the minimum identified in this section in order to ensure that clients of the program receive appropriate emergency mental health services.

(k) A mental health professional providing clinical supervision is permitted to deliver no more than 60 hours per week of direct crisis mental health services and supervision in any combination of clinical settings.

(8) Orientation and ongoing training.

(a) Orientation program. Each program shall develop and implement an orientation program for all new staff and regularly scheduled volunteers. The orientation shall be designed to ensure that staff and volunteers know and understand all of the following:

1. Pertinent parts of this chapter.

2. The program’s policies and procedures.

3. Job responsibilities for staff and volunteers in the program.

4. Applicable parts of chs. 48, 51 and 55, Stats., and any related administrative rules.