Chapter DHS 34

DHS 34.21(3)(b) (b) Program staff retained to provide mental health crisis services shall meet the following minimum qualifications:

DHS 34.21(3)(b)1. 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.

DHS 34.21(3)(b)2. 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.

DHS 34.21(3)(b)3. 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.

DHS 34.21(3)(b)4. 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.

DHS 34.21(3)(b)5. 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.

DHS 34.21(3)(b)6. 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.

DHS 34.21(3)(b)7. 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.

DHS 34.21(3)(b)8. 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.

DHS 34.21(3)(b)9. 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.

DHS 34.21(3)(b)10. 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.

DHS 34.21(3)(b)11. 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.

DHS 34.21(3)(b)12. 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).

DHS 34.21(3)(b)13. 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.

DHS 34.21(3)(b)14. 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.

DHS 34.21(3)(b)15. 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.

DHS 34.21(3)(b)16. 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).

DHS 34.21(3)(b)17. 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.

DHS 34.21(3)(b)18. 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.

DHS 34.21(3)(b)19. 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.

DHS 34.21(4) (4) Required staff.

DHS 34.21(4)(a) (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.

DHS 34.21(4)(b) (b) Clinical director.

DHS 34.21(4)(b)1. 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.

DHS 34.21(4)(b)2. 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.

DHS 34.21(5) (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).

DHS 34.21(6) (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.

DHS 34.21(7) (7) Clinical supervision.

DHS 34.21(7)(a) (a) Each program shall develop and implement a written policy for clinical supervision to ensure that:

DHS 34.21(7)(a)1. 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.

DHS 34.21(7)(a)2. 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.

DHS 34.21(7)(a)3. 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.

DHS 34.21(7)(a)4. 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.

DHS 34.21(7)(b) (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.

DHS 34.21(7)(c) (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.

DHS 34.21(7)(d) (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.

DHS 34.21(7)(e) (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.

DHS 34.21(7)(f) (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.

DHS 34.21(7)(g) (g) Clinical supervision is accomplished by one or more of the following means:

DHS 34.21(7)(g)1. 1. Individual sessions with the staff member to review cases, assess performance and let the staff member know how he or she is doing.

DHS 34.21(7)(g)2. 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.

DHS 34.21(7)(g)3. 3. Group meetings to review and assess staff performance and provide staff advice or direction regarding specific situations or strategies.

DHS 34.21(7)(g)4. 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.

DHS 34.21(7)(h) (h) Clinical supervision provided for individual program staff is documented in writing.

DHS 34.21(7)(i) (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.

DHS 34.21(7)(j) (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.

DHS 34.21(7)(k) (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.

DHS 34.21(8) (8) Orientation and ongoing training.

DHS 34.21(8)(a) (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:

DHS 34.21(8)(a)1. 1. Pertinent parts of this chapter.

DHS 34.21(8)(a)2. 2. The program’s policies and procedures.

DHS 34.21(8)(a)3. 3. Job responsibilities for staff and volunteers in the program.

DHS 34.21(8)(a)4. 4. Applicable parts of chs. 48, 51 and 55, Stats., and any related administrative rules.

DHS 34.21(8)(a)5. 5. The provisions of s. 51.30, Stats., and ch. DHS 92 regarding confidentiality of treatment records.

DHS 34.21(8)(a)6. 6. The provisions of s. 51.61, Stats., and ch. DHS 94 regarding patient rights.

DHS 34.21(8)(a)7. 7. Basic mental health and psychopharmacology concepts applicable to crisis situations.

DHS 34.21(8)(a)8. 8. Techniques and procedures for assessing and responding to the emergency mental health service needs of persons who are suicidal, including suicide assessment, suicide management and prevention.

DHS 34.21(8)(a)9. 9. Techniques for assessing and responding to the emergency mental health service needs of persons who appear to have problems related to the abuse of alcohol or other drugs.

DHS 34.21(8)(a)10. 10. Techniques and procedures for providing non-violent crisis management for clients, including verbal de-escalation, methods for obtaining backup, and acceptable methods for self-protection and protection of the client and others in emergency situations.

DHS 34.21(8)(a)11. 11. Policy on telehealth, including when telehealth can be used and by whom, patient privacy and information security considerations, and the right to decline services provided via telehealth.

DHS 34.21(8)(b) (b) Orientation training requirement.

DHS 34.21(8)(b)1. 1. Each newly hired staff person who has had less than 6 months of experience in providing emergency mental health services shall complete a minimum of 40 hours of documented orientation training within 3 months after beginning work with the program.

DHS 34.21(8)(b)2. 2. Each newly hired staff person who has had 6 months or more of prior experience in providing emergency mental health service shall complete a minimum of 20 hours of documented orientation training within 3 months after beginning work with the program.

DHS 34.21(8)(b)3. 3. Each volunteer shall receive at least 40 hours of orientation training before working directly with clients or their families.

DHS 34.21(8)(c) (c) Ongoing training program. Each program shall develop and implement an ongoing training program for all staff, which may include but is not limited to:

DHS 34.21(8)(c)1. 1. Time set aside for in-service training.

DHS 34.21(8)(c)2. 2. Presentations by community resource staff from other agencies.

DHS 34.21(8)(c)3. 3. Attendance at conferences and workshops.

DHS 34.21(8)(c)4. 4. Discussion and presentation of current principles and methods of providing emergency mental health services.

DHS 34.21(8)(d) (d) Ongoing training requirement.

DHS 34.21(8)(d)1. 1. Each professional staff person shall participate in at least the required number of hours of annual documented training necessary to retain certification or licensure.

DHS 34.21(8)(d)2. 2. Staff shall receive at least 8 hours per year of inservice training on emergency mental health services, rules and procedures relevant to the operation of the program, compliance with state and federal regulations, cultural competency in mental health services and current issues in client’s rights and services. Staff who are shared with other community mental health programs may apply inservice hours received in those programs toward this requirement.

DHS 34.21(8)(e) (e) Training records. A program shall maintain as part of its central administrative records updated, written copies of its orientation program, evidence of current licensure and certification of professional staff, and documentation of orientation and ongoing training received by program staff and volunteers.

DHS 34.21 History History: Cr. Register, September, 1996, No. 489, eff. 10-1-96; corrections in (3) (b) 12., (8) (a) 5. and 16. made under s. 13.93 (2m) (b) 7., Stats., Register, April, 2000, No. 532; corrections in (3) (b) 12., 16., (8) (a) 5. and 6. made under s. 13.92 (4) (b) 7., Stats., Register November 2008 No. 635; CR 23-053: am (7) (d), (e), (k), cr. (8) (a) 11. Register September 2023 No. 813, eff. 10-1-23.

DHS 34.22 DHS 34.22 Services.

DHS 34.22(1) (1) Plan for coordination of services.

DHS 34.22(1)(a) (a) Each emergency mental health services program shall prepare a written plan for providing coordinated emergency mental health services within the county. The coordinated emergency mental health services plan shall include all of the following:

DHS 34.22(1)(a)1. 1. A description of the nature and extent of the emergency mental health service needs in the county.

DHS 34.22(1)(a)2. 2. A description of the county’s overall system of care for people with mental health problems.

DHS 34.22(1)(a)3. 3. An analysis of how the services to be offered by the program have been adapted to address the specific strengths and needs of the county’s residents.

DHS 34.22(1)(a)4. 4. A description of the services the program offers, the criteria and priorities it applies in making decisions during the assessment and response stages, and how individuals, families and other providers and agencies can obtain program services.

DHS 34.22(1)(a)5. 5. A description of the specific responsibilities, if any, which other mental health providers in the county will have in providing emergency mental health services, and a process to be used which addresses confidentiality and exchange of information to ensure rapid communication between the program and the other providers and agencies.

DHS 34.22(1)(a)6. 6. Any formal or informal agreements to receive or provide backup coverage which have been made with other providers and agencies, and any role the program may play in situations in which an emergency protective placement is being sought for a person under s. 55.135, Stats.

DHS 34.22(1)(a)7. 7. Criteria for selecting and identifying clients who present a high risk for having a mental health crisis, and a process for developing, maintaining and implementing crisis plans under s. DHS 34.23 (7) on their behalf.

DHS 34.22(1)(a)8. 8. A description of the agreements, including any written memoranda of understanding which the program has made with law enforcement agencies, hospital emergency rooms within the county, the Winnebago or Mendota mental health institute, if used for hospitalization by the county, or the county corporation counsel, which do all of the following:

DHS 34.22(1)(a)8.a. a. Outline the role program staff will have in responding to calls in which a person may be in need of hospitalization, including providing services on-site and through telehealth.

DHS 34.22(1)(a)8.b. b. Describe the role staff will have in screening persons in crisis situations to determine the need for hospitalization.

DHS 34.22(1)(a)8.c. c. Provide a process for including the emergency mental health services program in planning to support persons who are being discharged from an inpatient stay, or who will be living in the community under a ch. 51, Stats., commitment.

DHS 34.22(1)(b) (b) If a program provides emergency services in conjunction with alcohol and other drug abuse (AODA) services, child protective services or any other emergency services, the coordinated emergency mental health services plan shall describe how the services are coordinated and delivered.