Chapter DHS 40

DHS 40.08(8) (8) Reporting.

DHS 40.08(8)(a) (a) Programs shall report all incidences of seclusion, physical restraint, injury, and involvement of law enforcement to the department within 24 hours of the incident occurring. Reporting shall be completed through the department’s online reporting system.

DHS 40.08(8)(b) (b) The department will evaluate the circumstances of each incident, conduct any appropriate follow-up, and identify programs in need of technical assistance, training, policy development, or other quality improvement.

DHS 40.08 Note Note: The department reporting link is: https://www.dhs.wisconsin.gov/mh/cadaytreatmentproviders.htm. Questions and information about reporting may be directed to the Division of Care and Treatment Services at 608-266-2717.

DHS 40.08 History History: CR 19-018: cr. Register June 2020 No. 774, eff. 7-1-20; correction in (4) (intro.), (5) (e) 3., (6) (d), (7) (e) made under s. 35.17, Stats., Register June 2020 No. 774; CR 23-053: am. (7) (a) (intro.) Register September 2023 No. 813, eff. 10-1-23.

DHS 40.09 DHS 40.09 Personnel qualifications.

DHS 40.09(1) (1) Minimum requirements.

DHS 40.09(1)(a) (a) Each staff member shall have the professional certification, training, experience, and ability to carry out his or her assigned duties.

DHS 40.09(1)(b) (b) Each staff member shall pass a criminal history and patient abuse record search as provided in s. 50.065, Stats., and a caregiver background check under ch. DHS 12, before working for the program.

DHS 40.09(1)(c) (c) Programs shall comply with caregiver misconduct reporting and investigation requirements in ch. DHS 13.

DHS 40.09 Note Note: For a state of Wisconsin background check, information on the process and fees can be found on-line at: http://www.doj.state.wi.us/dles/cib/Fees.asp, or contact the Crime Information Bureau, Wisconsin Department of Justice, P.O. Box 2718, Madison, WI 53701-2718.

DHS 40.09(2) (2) Qualifications of program director. The program director shall meet all of the following requirements:

DHS 40.09(2)(a) (a) Meet the qualifications for any of the program staff listed in sub. (3) (a) to (j).

DHS 40.09(2)(b) (b) Have at least one year of experience in a mental health setting working with youth.

DHS 40.09(2)(c) (c) Have at least 2 years of experience as an administrator of a program that provides mental health services to youth and families.

DHS 40.09(3) (3) Qualifications of program staff.

DHS 40.09(3)(a) (a) The clinical coordinator shall meet all of the following qualifications:

DHS 40.09(3)(a)1. 1. Be a licensed mental health professional.

DHS 40.09(3)(a)2. 2. Have at least 1,500 hours of clinical experience in a practice with youth who have mental illness or severe emotional disturbance.

DHS 40.09(3)(b) (b) A psychiatrist shall be a physician licensed to practice medicine and surgery and meet the requirements for certification in child psychiatry by the American board of psychiatry and neurology. If a program can demonstrate that no board-certified or eligible child psychiatrist is available, the program may employ a psychiatrist who has a minimum of 1 year of clinical experience working with youth.

DHS 40.09(3)(c) (c) Advanced practice nurse prescribers shall be certified in mental health treatment by an appropriate board and shall have had either training in providing psychiatric services, including work with youth with mental illness or severe emotional disturbance, or one year of experience working in a clinical setting with youth. An advanced practice nurse prescriber shall issue only those prescription orders appropriate to the advanced practice nurse prescriber’s areas of competence, as established by his or her education, training, or experience. Advanced practice nurse prescribers shall facilitate collaboration with other health care professionals, at least one of whom shall be a physician. Advanced practice nurse prescribers shall have completed 3,000 hours of supervised clinical psychotherapy experience in order to also provide psychotherapy.

DHS 40.09(3)(d) (d) Licensed mental health professionals shall have a minimum of one year of experience working in a clinical setting serving youth with mental illness or severe emotional disturbance.

DHS 40.09(3)(e) (e) Physician assistants, advanced practice nurses, registered nurses, and occupational therapists shall have either training in providing services to youth with mental illness or severe emotional disturbance, or one year of experience working in a clinical setting with youth.

DHS 40.09(3)(f) (f) Qualified treatment trainees shall have one year of a graduate level education program specific to serving youth with mental illness or severe emotional disturbance and shall provide psychotherapy to clients only under clinical supervision.

DHS 40.09(3)(g) (g) Occupational therapy assistants shall be certified and receiving supervision under chs. OT 1 to 5.

DHS 40.09(3)(h) (h) Therapeutic specialists shall have one year of experience working with, or one year of a formal educational program specific to serving youth with mental illness or severe emotional disturbance.

DHS 40.09(3)(i) (i) Mental health support workers shall have a minimum of one year of experience or formal education related to working with youth who have severe emotion disturbance or mental illness.

DHS 40.09(3)(j) (j) Mental health technicians and parent peer specialists shall be at least 18 years old and have a minimum of 30 hours pre-service training on their role in the program.

DHS 40.09(4) (4) Volunteers. A program may use volunteers to support the activities of staff. Volunteers shall receive a minimum of 10 hours pre-service training under the requirements of s. DHS 40.10 (6) (b) and shall be supervised by a licensed treatment professional employed by the program. Each volunteer shall pass a criminal history and patient abuse record search state background check as provided in s. 50.065, Stats., and a caregiver background check under ch. DHS 12, before being allowed to working for the program.

DHS 40.09 History History: CR 19-018: cr. Register June 2020 No. 774, eff. 7-1-20; correction in (2) (a) made under s. 13.92 (4) (b) 7., Stats., Register June 2020 No. 774.

DHS 40.10 DHS 40.10 Required personnel and services.

DHS 40.10(1) (1) Operational responsibilities. A program shall include all of the following administrators:

DHS 40.10(1)(a) (a) A program director who is responsible for program operations and ensuring that the program is in compliance with this chapter and other applicable state and federal laws.

DHS 40.10(1)(b) (b) A clinical coordinator who is responsible for ensuring that all staff members providing mental health services have the qualifications required for their roles in the program and comply with all requirements relating to assessment, treatment planning, service delivery, and service documentation.

DHS 40.10(1)(b)1. 1. The program director may also serve as the clinical coordinator, if the program director is qualified under s. DHS 40.09 (3) (a).

DHS 40.10(1)(b)2. 2. The program director shall identify one or more staff members qualified under s. DHS 40.09 (3) (a) to (e) to whom authority may be delegated in the absence of the clinical coordinator. The clinical coordinator or designee shall be on the premises at all times that youth are present at a program.

DHS 40.10(2) (2) Staffing requirements. At all times that youth are present at a program, the program shall have a minimum of two staff members qualified under s. DHS 40.09 (3) on site, at least one of whom shall be a mental health professional. The number of staff available shall be based on meeting the treatment needs of youth based on individualized treatment plans, with additional staff present when higher levels of clinical needs are indicated. Calculation of the staff-to-client ratios for the program shall not include volunteers. Programs shall meet all of the following staffing requirements:

DHS 40.10(2)(a) (a) If more than 10 youth are present at a community-based program, an additional staff member qualified under s. DHS 40.09 (3) shall be present for every 10 additional youth.

DHS 40.10(2)(b) (b) If more than 10 youth are present at a hospital-based program, an additional staff member qualified under s. DHS 40.09 (3) shall be present for every 5 additional youth.

DHS 40.10(3) (3) Service requirements. A program shall make available at least the following hours of direct clinical services, provided either by program staff members or professionals under contract to the program:

DHS 40.10(3)(a) (a) A community-based day treatment program shall comply with all of the following:

DHS 40.10(3)(a)1. 1. One hour per week of consultation shall be provided by a psychiatrist or advanced practice nurse prescriber. If a program is unable to utilize a psychiatrist or advanced practice nurse prescriber, they may utilize a psychologist as long as there is a written plan in place assuring that consultation with a psychiatrist or advanced practice nurse prescriber occurs for medication related concerns at least monthly or more frequently based on the individual needs of the youth.

DHS 40.10(3)(a)2. 2. One hour per week of health-related services shall be provided by a physician, physician assistant, advanced practice nurse, or registered nurse for every 4 full-time youth in the program.

DHS 40.10(3)(a)3. 3. Six hours per week of group sessions shall be provided in the program. Only a master’s-level mental health professional may provide psychotherapy group sessions. A mental health support worker may provide non-psychotherapy group sessions. Group sessions shall include no more than 10 youth with one staff or a maximum of 12 youth if 2 staff are present with the group.

DHS 40.10(3)(a)4. 4. One hour per week of care coordination services shall be provided by a mental health support worker or a mental health professional for every 2 full-time youth in the program.

DHS 40.10(3)(a)5. 5. Two hours per week of individual or family psychotherapy shall be provided by a mental health professional for each full-time youth in the program. One of the two required hours may be provided by a mental health support worker if they are under the supervision of the mental health professional implementing a piece of the individualized treatment plan.

DHS 40.10(3)(a)6. 6. At least 2 hours per week of support services shall be provided by mental health professionals, mental health support workers, mental health technicians, occupational therapists, or therapeutic specialists in the program.

DHS 40.10(3)(b) (b) Intensive hospital-based day treatment programs shall comply with all of the following:

DHS 40.10(3)(b)1. 1. One hour per week of consultation shall be provided by a psychiatrist or advanced practice nurse prescriber.

DHS 40.10(3)(b)2. 2. One hour per week of health-related services shall be provided by a physician, physician assistant, advanced practice nurse, or registered nurse for every 4 full-time youth in the program.

DHS 40.10(3)(b)3. 3. Crisis response, medical, and nursing services shall be readily available at all times youth are present in the program.

DHS 40.10(3)(b)4. 4. A physician, physician assistant, registered nurse, or advanced practice nurse shall be on duty and on-site in the program at all times that youth are present.

DHS 40.10(3)(b)5. 5. Eight hours per week of group sessions shall be provided in the program. Only a master’s-level mental health professional may provide psychotherapy group sessions. A mental health support worker may provide non-psychotherapy group sessions. Group sessions shall include no more than 10 youth with one staff or a maximum of 12 youth if 2 staff are present with the group.

DHS 40.10(3)(b)6. 6. One hour per week of care coordination services shall be provided by a mental health support worker or mental health professional for every full-time youth in the program.

DHS 40.10(3)(b)7. 7. Four hours per week of individual or family psychotherapy shall be provided by a mental health professional for each full-time youth in the program. Two of the four required hours may be provided by a mental health support worker if they are under the supervision of the mental health professional implementing a piece of the individualized treatment plan.

DHS 40.10(3)(b)8. 8. At least 4 hours per week of support services shall be provided by mental health professionals, mental health support workers, mental health technicians, occupational therapists, or therapeutic specialists in the program.

DHS 40.10(4) (4) Hours of operation. The amount of time a youth spends at a program shall be established by the individual treatment plan developed under s. DHS 40.14 for each youth, but a program shall be in operation and able to provide services for the following period:

DHS 40.10(4)(a) (a) A community-based program shall be in operation and available to provide services to youth for a minimum of 4 hours a day, 5 days a week, and may suspend operations for no more than 4 weeks each year.

DHS 40.10(4)(b) (b) An intensive hospital-based program shall be in operation and available to provide services to youth for a minimum of 6 hours a day, 5 days a week, and may suspend operations for no more than 4 weeks each year.

DHS 40.10(4)(c) (c) Any youth participating for less than the minimum hours of operation in par. (a) or (b) shall be designated a part-time youth. Two part-time youth shall be calculated as the equivalent of one full-time youth.

DHS 40.10(5) (5) Clinical supervision.

DHS 40.10(5)(a) (a) The clinical coordinator shall have responsibility for oversight of the job performance and actions of each staff member who is providing clinical services and support services, and require each staff member to adhere to all laws and regulations governing care and treatment and the standards of practice for their individual professions.

DHS 40.10(5)(b) (b) Each program shall develop and implement a written policy for clinical supervision and clinical collaboration designed to provide sufficient guidance to assure the delivery of effective services. Each policy shall address all of the following:

DHS 40.10(5)(b)1. 1. A system to determine the status and achievement of youth outcomes to determine if treatment provided is effective, and a system to identify any necessary corrective actions.

DHS 40.10(5)(b)2. 2. Identification of clinical issues, including incidents that pose a significant risk of an adverse outcome for youth that should warrant clinical collaboration, or clinical supervision that is in addition to the supervisions specified under s. MPSW 4.01, 12.01, or 16.04, or s. Psy 2.10, or for a recognized psychotherapy practitioner, whichever is applicable.

DHS 40.10(5)(c) (c) Clinical supervision shall be documented in a supervision or collaboration record, containing entries that are signed and dated by the staff member providing supervision.

DHS 40.10(5)(d) (d) Clinical supervision shall comply with s. MPSW 4.01, 12.01, or 16.04, or s. Psy 2.10, whichever is applicable.

DHS 40.10(6) (6) Personnel orientation and training.

DHS 40.10(6)(a) (a) General requirement. The program director shall ensure each staff member and volunteer receives orientation and ongoing training necessary to perform his or her duties. The program shall develop a written orientation policy.

DHS 40.10(6)(b) (b) Orientation. The program shall maintain documentation showing that each new staff member listed under s. DHS 40.09 (3) (a) to (f) has completed the training requirements specified in subds. 1. to 16., either as part of orientation to the program or as part of prior education or training. The program director shall require all other staff members and volunteers to complete only the training requirements specified under this paragraph that are necessary, as determined by the program director, for the staff member or volunteer to successfully perform job duties. Training requirements include all of the following:

DHS 40.10(6)(b)1. 1. A review of this chapter.

DHS 40.10(6)(b)2. 2. A review of the program’s policies and procedures.

DHS 40.10(6)(b)3. 3. Mental health treatment concepts applicable to providing day treatment services, including the principles of trauma-informed services and trauma history as they are specifically implemented through the program’s operations and interactions with youth, the manner in which trauma may be a compounding variable in treatment, and how to identify and anticipate triggers related to trauma that lead to behavior and mental health symptoms.

DHS 40.10(6)(b)4. 4. Use of sensory interventions and strategies that promote self-regulation.

DHS 40.10(6)(b)5. 5. Techniques and procedures for providing emergency interventions.

DHS 40.10(6)(b)6. 6. Principles and techniques for developing and providing culturally responsive and gender-sensitive mental health services.

DHS 40.10(6)(b)7. 7. The reactions and side effects of psychotropic medication.

DHS 40.10(6)(b)8. 8. Techniques for assessing and responding to the needs of youth who have challenges with co-occurring illnesses and disabilities.

DHS 40.10(6)(b)9. 9. How to assess a youth to detect suicidal tendencies and to manage youth at risk of attempting suicide or causing harm to self or others.

DHS 40.10(6)(b)10. 10. Resiliency concepts and principles that ensure connection to others and to the community.

DHS 40.10(6)(b)11. 11. Applicable parts of chs. 48, 51, 55, 115, and 938, Stats., and any related administrative rules.

DHS 40.10(6)(b)12. 12. The provisions of ch. DHS 94 and s. 51.61, Stats., regarding client rights.

DHS 40.10(6)(b)13. 13. Current standards regarding documentation and the provisions of 45 CFR parts 160, 162, 164, 42 CFR part 2 regarding confidentiality of treatment records, s. 51.30, Stats., and ch. DHS 92.

DHS 40.10(6)(b)14. 14. The basic provisions of civil rights laws, including the Americans with Disabilities Act of 1990 and the Civil Rights Act of 1964, as the laws apply to staff members providing services to youth with disabilities.

DHS 40.10(6)(b)15. 15. Job responsibilities of staff members in the program.

DHS 40.10(6)(b)16. 16. Any other subject that the program determines is necessary to enable the staff member to perform the staff member’s duties effectively, efficiently, and competently.

DHS 40.10(6)(c) (c) Ongoing training.

DHS 40.10(6)(c)1. 1. Each program shall develop a written training plan for each staff member, which shall include all of the following:

DHS 40.10(6)(c)1.a. a. Time set aside for training.