Chapter DHS 34

DHS 34.22(3)(d)2. 2. Be available 24 hours a day and 7 days a week.

DHS 34.22(3)(d)3. 3. Be available for both voluntary admissions and for persons under emergency detention under s. 51.15, Stats., or commitment under s. 51.20, Stats.

DHS 34.22(3)(e) (e) Linkage and coordination services. Linkage and coordination services to support cooperation in the delivery of emergency mental health care in the county in which the program operates. Linkage and coordination services shall do all of the following:

DHS 34.22(3)(e)1. 1. Be provided for the purpose of achieving one or more of the following outcomes:

DHS 34.22(3)(e)1.a. a. Connection of a client with other programs to obtain ongoing mental health treatment, support and services, and coordination to assist the client and his or her family during the period of transition from emergency to ongoing mental health services.

DHS 34.22(3)(e)1.b. b. Coordination with other mental health providers in the community for whom the program is designated as crisis care backup, to ensure that adequate information about the other providers’ clients is available if a crisis occurs.

DHS 34.22(3)(e)1.c. c. Coordination with law enforcement, hospital emergency room personnel and other county service providers to offer assistance and intervention when other agencies are the initial point of contact for a person in a mental health crisis.

DHS 34.22(3)(e)2. 2. Be available 24 hours a day, 7 days a week as a component of the services offered under pars. (a) to (d).

DHS 34.22(3)(e)3. 3. Be provided by persons qualified under s. DHS 34.21 (3) (b) 1. to 19.

DHS 34.22(3)(f) (f) Services for children and adolescents and their families. Each program shall have the capacity to provide the services identified in pars. (a) to (e) in ways that meet the unique needs of young children and adolescents experiencing mental health crises and their families. Services for young children and adolescents and their families shall do all of the following:

DHS 34.22(3)(f)1. 1. Be provided for the purpose of achieving one or more of the following outcomes:

DHS 34.22(3)(f)1.a. a. Resolution or management of family conflicts when a child has a mental health crisis and prevention of out-of-home placement of the child.

DHS 34.22(3)(f)1.b. b. Improvement in the young child’s or adolescent’s coping skills and reduction in the risk of harm to self or others.

DHS 34.22(3)(f)1.c. c. Assistance given the child and family in using or obtaining ongoing mental health and other supportive services in the community.

DHS 34.22(3)(f)2. 2. Include any combination of telephone, mobile, walk-in, hospitalization and stabilization services determined to be appropriate in the coordinated emergency mental health services plan developed under sub. (1), which may be provided independently or in combination with services for adults.

DHS 34.22(3)(f)3. 3. Be provided by staff who either have had one year of experience providing mental health services to young children or adolescents or receive a minimum of 20 hours of training in providing the services within 3 months after being hired, in addition to meeting the requirements for providing the general type of mental health services identified in pars. (a) to (e).

DHS 34.22(3)(f)4. 4. Be provided by staff who are supervised by a staff person qualified under s. DHS 34.21 (3) (b) 1. to 8. who has had at least 2 years of experience in providing mental health services to children. A qualified staff person may provide supervision either in person or be available by phone.

DHS 34.22(4) (4) Optional stabilization services.

DHS 34.22(4)(a) (a) In addition to services required under sub. (3), a program may provide stabilization services for an individual for a temporary transition period, with weekly reviews to determine the need for continued stabilization services, in a setting such as an outpatient clinic, school, detention center, jail, crisis hostel, adult family home, community based residential facility (CBRF) or a foster home or group home or child caring institution (CCI) for children, or the individual’s own home. A program offering stabilization services shall do all of the following:

DHS 34.22(4)(a)1. 1. Provide those services for the purpose of achieving one or more of the following outcomes:

DHS 34.22(4)(a)1.a. a. Reducing or eliminating an individual’s symptoms of mental illness so that the person does not need inpatient hospitalization.

DHS 34.22(4)(a)1.b. b. Assisting in the transition to a less restrictive placement or living arrangement when the crisis has passed.

DHS 34.22(4)(a)2. 2. Identify the specific place or places where stabilization services are to be provided and the staff who will provide the services.

DHS 34.22(4)(a)3. 3. Prepare written guidelines for the delivery of the services which address the needs of the county as identified in the coordinated emergency mental health services plan developed under sub. (1) and which meet the objectives under subd. 1.

DHS 34.22(4)(a)4. 4. Have staff providing stabilization services who are qualified under s. DHS 34.21 (3) (b) 1. to 19., with those staff qualified under s. DHS 34.21 (3) (b) 9. to 19. supervised by a person qualified under s. DHS 34.21 (3) (b) 1. to 8.

DHS 34.22(4)(b) (b) If a program elects to provide stabilization services, the department shall provide or contract for on-site consultation and support as requested to assist the program in implementing those services.

DHS 34.22(4)(c) (c) The county department of the local county may designate a stabilization site as a receiving facility for emergency detention under s. 51.15, Stats., provided that the site meets the applicable standards under this chapter.

DHS 34.22(5) (5) Other services. Programs may offer additional services, such as information and referral or peer to peer support designed to address needs identified in the coordinated emergency mental health services plan under sub. (1), but the additional services may not be provided in lieu of the services under sub. (3).

DHS 34.22(6) (6) Services provided under contract by other providers. If any service under subs. (3) to (5) is provided under contract by another provider, the program shall maintain written documentation of the specific person or organization who has agreed to provide the service and a copy of the formal agreement for assistance.

DHS 34.22(7) (7) Services in combined emergency services programs. Counties may choose to operate emergency service programs which combine the delivery of emergency mental health services with other emergency services, such as those related to the abuse of alcohol or other drugs, those related to accidents, fires or natural disasters, or those for children believed to be at risk because of abuse or neglect, if the services identified in sub. (3) are available as required and are delivered by qualified staff.

DHS 34.22 History History: Cr. Register, September, 1996, No. 489, eff. 10-1-96; correction in (3) (c) 4. made under s. 13.93 (2m) (b) 7., Stats., Register October 2004 No. 586; correction in (1) (a) 6. made under s. 13.92 (4) (b) 7., Stats., Register November 2008 No. 635; CR 23-053: am. (1) (a) 8. a., (3) (b) (intro.), cr. (3) (b) 4., am. (3) (c) 3., cr. (3) (c) 5., am. (5) Register September 2023 No. 813, eff. 10-1-23.

DHS 34.23 DHS 34.23 Assessment and response.

DHS 34.23(1) (1) Eligibility for services. To receive emergency mental health services, a person shall be in a mental health crisis or be in a situation which is likely to develop into a crisis if supports are not provided.

DHS 34.23(2) (2) Written policies. A program shall have written policies which describe all of the following:

DHS 34.23(2)(a) (a) The procedures to be followed when assessing the needs of a person who requests or is referred to the program for emergency mental health services and for planning and implementing an appropriate response based on the assessment.

DHS 34.23(2)(b) (b) Adjustments to the general procedures which will be followed when a person referred for services has a sensory, cognitive, physical or communicative impairment which requires an adaptation or accommodation in conducting the assessment or delivering services or when a person’s language or form of communication is one in which staff of the program are not fluent.

DHS 34.23(2)(c) (c) The type of information to be obtained from or about a person seeking services.

DHS 34.23(2)(d) (d) Criteria for deciding when emergency mental health services are needed and for determining the type of service to be provided.

DHS 34.23(2)(e) (e) Procedures to be followed for referral to other programs when a decision is made that a person’s condition does not constitute an actual or imminent mental health crisis.

DHS 34.23(2)(f) (f) Procedures for obtaining immediate backup or a more thorough evaluation when the staff person or persons making the initial contact require additional assistance.

DHS 34.23(2)(g) (g) Procedures for coordinating referrals, for providing and receiving backup and for exchanging information with other mental health service providers in the county, including the development of crisis plans for individuals who are at high risk for crisis.

DHS 34.23(2)(h) (h) Criteria for deciding when the situation requires a face-to-face response, the use of mobile crisis services, stabilization services, if available, or hospitalization.

DHS 34.23(2)(i) (i) Criteria and procedures for notifying other persons, such as family members and people with whom the person is living, that he or she may be at risk of harming himself or herself or others.

DHS 34.23(2)(j) (j) If the program dispenses psychotropic medication, procedures governing the prescription and administration of medications to clients and for monitoring the response of clients to their medications.

DHS 34.23(2)(k) (k) Procedures for reporting deaths of clients which appear to be the result of suicide, reaction to psychotropic medications or the use of physical restraints or seclusion, as required by s. 51.64 (2), Stats., and for:

DHS 34.23(2)(k)1. 1. Supporting and debriefing family members, staff and other concerned persons who have been affected by the death of a client.

DHS 34.23(2)(k)2. 2. Conducting a clinical review of the death which includes getting the views of a mental health professional not directly involved in the individual’s treatment who has the training and experience necessary to adequately examine the specific circumstances surrounding the death.

DHS 34.23(3) (3) Initial contact. During an initial contact with an individual who may be experiencing a mental health crisis, staff of the program shall gather sufficient information, as appropriate and possible given the nature of the contact, to assess the individual’s need for emergency mental health services and to prepare and implement a response plan, including but not limited to any available information regarding:

DHS 34.23(3)(a) (a) The individual’s location.

DHS 34.23(3)(b) (b) The circumstances resulting in the contact with the program, any events that may have led up to the contact, the apparent severity of the immediate problem and the potential for harm to self or others.

DHS 34.23(3)(c) (c) The primary concerns of the individual or a person making the initial contact on behalf of the individual.

DHS 34.23(3)(d) (d) The individual’s current mental status and physical condition, any over-the-counter, prescription or illicit drugs the individual may have taken, prior incidents of drug reaction or suicidal behavior and any history of the individual’s abuse of alcohol or other drugs.

DHS 34.23(3)(e) (e) If the individual is threatening to harm self or others, the specificity and apparent lethality of the threat and the availability of the means to carry out the threat, including the individual’s access to any weapon or other object which may be used for doing harm.

DHS 34.23(3)(f) (f) If the individual appears to have been using alcohol or over-the-counter, prescription or illicit drugs, the nature and amount of the substance ingested.

DHS 34.23(3)(g) (g) The names of any people who are or who might be available to support the individual, such as friends, family members or current or past mental health service providers.

DHS 34.23(4) (4) Determination of need.

DHS 34.23(4)(a) (a) Based on an assessment of the information available after an initial contact, staff of the program shall determine whether the individual is in need of emergency mental health services and shall prepare and implement any necessary response.

DHS 34.23(4)(b) (b) If the person is not in need of emergency mental health services, but could benefit from other types of assistance, staff shall, if possible, refer the person to other appropriate service providers in the community.

DHS 34.23(5) (5) Response plan.

DHS 34.23(5)(a) (a) If the person is in need of emergency mental health services, staff of the program shall prepare and initiate a response plan consisting of services and referrals necessary to reduce or eliminate the person’s immediate distress, de-escalate the present crisis, and help the person return to a safe and more stable level of functioning.

DHS 34.23(5)(b) (b) The response plan shall be approved as medically necessary by a mental health professional qualified under s. DHS 34.21 (3) (b) 1. or 2. either before services are delivered or within 5 days after delivery of services, not including Saturdays, Sundays or legal holidays.

DHS 34.23(6) (6) Linkage and follow up.

DHS 34.23(6)(a) (a) After a response plan has been implemented and the person has returned to a more stable level of functioning, staff of the program shall determine whether any follow-up contacts by program staff or linkages with other providers in the community are necessary to help the person maintain stable functioning.

DHS 34.23(6)(b) (b) If ongoing support is needed, the program shall provide follow-up contacts until the person has begun to receive assistance from an ongoing service provider, unless the person does not consent to further services.

DHS 34.23(6)(c) (c) Follow-up and linkage services may include but are not limited to all of the following:

DHS 34.23(6)(c)1. 1. Contacting the person’s ongoing mental health providers or case manager, if any, to coordinate information and services related to the person’s care and support.

DHS 34.23(6)(c)2. 2. If a person has been receiving services primarily related to the abuse of alcohol or other drugs or to address needs resulting from the person’s developmental disability, or if the person appears to have needs in either or both of these areas, contacting a service provider in the area of related need in order to coordinate information and service delivery for the person.

DHS 34.23(6)(c)3. 3. Conferring with family members or other persons providing support for the person to determine if the response and follow-up are meeting the client’s needs.

DHS 34.23(6)(c)4. 4. Developing a new crisis plan under sub. (7) or revising an existing plan to better meet the person’s needs based on what has been learned during the mental health crisis.

DHS 34.23(7) (7) Crisis plan.

DHS 34.23(7)(a) (a) The program shall prepare a crisis plan for a person who is found to be at high risk for a recurrent mental health crisis under the criteria established in the coordinated community services plan under s. DHS 34.22 (1) (a) 7.

DHS 34.23(7)(b) (b) The crisis plan shall include whenever possible all of the following:

DHS 34.23(7)(b)1. 1. The name, address and phone number of the case manager, if any, coordinating services for the person.

DHS 34.23(7)(b)2. 2. The address and phone number where the person currently lives, and the names of other individuals with whom the person is living.

DHS 34.23(7)(b)3. 3. The usual work, school or activity schedule followed by the person.

DHS 34.23(7)(b)4. 4. A description of the person’s strengths and needs, and important people or things in the person’s life which may help staff to develop a rapport with the person in a crisis and to fashion an appropriate response.

DHS 34.23(7)(b)5. 5. The names and addresses of the person’s medical and mental health service providers.

DHS 34.23(7)(b)6. 6. Regularly updated information about previous emergency mental health services provided to the person.

DHS 34.23(7)(b)7. 7. The diagnostic label which is being used to guide treatment for the person, any medications the person is receiving and the physician prescribing them.

DHS 34.23(7)(b)8. 8. Specific concerns that the person or the people providing support and care for the person may have about situations in which it is possible or likely that the person would experience a crisis.

DHS 34.23(7)(b)9. 9. A description of the strategies which should be considered by program staff in helping to relieve the person’s distress, de-escalate inappropriate behaviors or respond to situations in which the person or others are placed at risk.

DHS 34.23(7)(b)10. 10. A list of individuals who may be able to assist the person in the event of a mental health crisis.

DHS 34.23(7)(c) (c) A person’s crisis plan shall be developed in cooperation with the client, his or her parents or guardian where their consent is required for treatment, the case manager, if any, and the people and agencies providing treatment and support for the person, and shall identify to the extent possible the services most likely to be effective in helping the person resolve or manage a crisis, given the client’s unique strengths and needs and the supports available to him or her.

DHS 34.23(7)(d) (d) The crisis plan shall be approved as medically necessary by a mental health professional qualified under s. DHS 34.21 (3) (b) 1. or 2.

DHS 34.23(7)(e) (e) Program staff shall use a method for storing active crisis plans which allows ready access in the event that a crisis arises, but which also protects the confidentiality of the person for whom a plan has been developed.

DHS 34.23(7)(f) (f) A crisis plan shall be reviewed and modified as necessary, given the needs of the client, but at least once every 6 months.

DHS 34.23(8) (8) Service notes. As soon as possible following a client contact, program staff shall prepare service notes which identify the person seeking a referral for emergency mental health services, describe the crisis and identify or describe all of the following:

DHS 34.23(8)(a) (a) The time, place and nature of the contact and the person initiating the contact.

DHS 34.23(8)(b) (b) The staff person or persons involved and any non-staff persons present or involved.