Chapter DHS 34

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.

DHS 34.22(1)(c) (c) Prior to application for recertification under s. DHS 34.03 (6), a program shall review its coordinated emergency mental health services plan and adjust it based on information received through surveys under s. DHS 34.26, consultation with other participants in the plan’s development and comments and suggestions received from other resources, including staff, clients, family members, other service providers and interested members of the public.

DHS 34.22(2) (2) General objectives for emergency mental health services. A program providing emergency mental health services shall have the following general objectives:

DHS 34.22(2)(a) (a) To identify and assess an individual’s immediate need for mental health services to the extent possible and appropriate given the circumstances in which the contact with or referral to the program was made.

DHS 34.22(2)(b) (b) To respond to that need by providing a service or group of services appropriate to the client’s specific strengths and needs to the extent they can be determined in a crisis situation.

DHS 34.22(2)(c) (c) When necessary and appropriate, to link an individual who is receiving emergency mental health services with other community mental health service providers for ongoing treatment and support.

DHS 34.22(2)(d) (d) To make follow-up contacts, as appropriate, in order to determine if needed services or linkages have been provided or if additional referrals are required.

DHS 34.22(3) (3) Required emergency mental health services. An emergency mental health services program shall provide or contract for the delivery of all of the following services:

DHS 34.22(3)(a) (a) Telephone service. A telephone service providing callers with information, support, counseling, intervention, emergency service coordination and referral for additional, alternative or ongoing services. The telephone service shall do all of the following:

DHS 34.22(3)(a)1. 1. Be directed at achieving one or more of the following outcomes:

DHS 34.22(3)(a)1.a. a. Immediate relief of distress in pre-crisis and crisis situations.

DHS 34.22(3)(a)1.b. b. Reduction of the risk of escalation of a crisis.

DHS 34.22(3)(a)1.c. c. Arrangements for emergency onsite responses when necessary to protect individuals in a mental health crisis.

DHS 34.22(3)(a)1.d. d. Referral of callers to appropriate services when other or additional intervention is required.

DHS 34.22(3)(a)2. 2. Be available 24 hours a day and 7 days a week and have a direct link to a mobile crisis service, a law enforcement agency or some other program which can provide an immediate, onsite response to an emergency situation on a 24 hour a day, 7 day a week basis.

DHS 34.22(3)(a)3. 3. Be provided either by staff qualified under s. DHS 34.21 (3) (b) 1. to 19. or by fully trained volunteers. If the telephone service is provided by volunteers or staff qualified under s. DHS 34.21 (3) (b) 9. to 19., a mental health professional qualified under s. DHS 34.21 (3) (b) 1. to 8. shall be on site or constantly available by telephone to provide supervision and consultation.

DHS 34.22(3)(a)4. 4. If staff at a location other than the program, such as a law enforcement agency or a 911 center, are the first to answer calls to the telephone service, ensure that those staff are trained by program staff in the correct way to respond to persons in need, are capable of immediately transferring the call to an appropriate mental health professional and identify themselves as being part of the emergency mental health services system rather than the law enforcement agency or other organization where the calls are being picked up.

DHS 34.22(3)(b) (b) Mobile crisis service. A mobile crisis service that can provide onsite intervention for individuals experiencing a mental health crisis. The mobile crisis service shall do all of the following:

DHS 34.22(3)(b)1. 1. Be directed at achieving one or more of the following outcomes:

DHS 34.22(3)(b)1.a. a. Immediate relief of distress in crisis situations.

DHS 34.22(3)(b)1.b. b. Reduction in the level of risk present in the situation.

DHS 34.22(3)(b)1.c. c. Assistance provided to law enforcement officers who may be involved in the situation by offering services such as evaluation criteria for emergency detention under s. 51.15, Stats.

DHS 34.22(3)(b)1.d. d. Coordination of the involvement of other mental health resources which may respond to the situation.

DHS 34.22(3)(b)1.e. e. Referral to or arrangement for any additional mental health services which may be needed.

DHS 34.22(3)(b)1.f. f. Providing assurance through follow up contacts that intervention plans developed during the crisis are being carried out.

DHS 34.22(3)(b)2. 2. Be available for at least 8 hours a day, 7 days a week during those periods of time identified in the emergency mental health services plan when mobile services would be most needed.

DHS 34.22(3)(b)3. 3. Have the capacity for making home visits and for seeing clients at other locations in the community. Staff providing mobile services shall be qualified under s. DHS 34.21 (3) (b) 1. to 15., except that staff qualified under s. DHS 34.21 (3) (b) 15. 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 14. A mental health professional qualified under s. DHS 34.21 (3) (b) 1. to 8. shall either provide in-person supervision or be available to provide consultation by phone.

DHS 34.22(3)(b)4. 4. Permit the provision of additional mobile crisis services via telehealth when those services are provided concurrent with onsite response.