Chapter DHS 40

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.

DHS 40.10(6)(c)1.b. b. Discussion and presentation of principles and methods of treatment for youth with mental illness or severe emotional disturbance.

DHS 40.10(6)(c)2. 2. Each staff member who provides direct services to youth shall participate in a minimum of 30 hours of documented training each year on topics relevant to that staff member’s responsibilities in the program and specific to the ages of the youth served in the program. A maximum of 18 hours of this training may include in-service and consultation provided by staff members or consultants of the program.

DHS 40.10(6)(d) (d) Department review of training. Documentation of training shall be made available to department staff upon request.

DHS 40.10 History History: CR 19-018: cr. Register June 2020 No. 774, eff. 7-1-20; correction in (3) (a) 3., (b) 5., (4) (c), (5) (b) 2., (d), (6) (b) (intro.), 13. made under s. 35.17, Stats., Register June 2020 No. 774; CR 23-053: am. (2) (intro.) Register September 2023 No. 813, eff. 10-1-23.

DHS 40.11 DHS 40.11 Referral and Screening.

DHS 40.11(1) (1) Policies.

DHS 40.11(1)(a) (a) The program director or clinical coordinator or designee shall review all referrals and verify the medical necessity and clinical appropriateness for day treatment services for the referred youth.

DHS 40.11(1)(b) (b) A program shall establish written selection criteria for use when screening an applicant for admission, including all of the following:

DHS 40.11(1)(b)1. 1. Sources from which referrals may be accepted by the program and how those sources make referrals.

DHS 40.11(1)(b)2. 2. Procedures for making admission decisions.

DHS 40.11(1)(b)3. 3. Any funding restrictions which will be applied to admissions such as availability of insurance, required support for the placement from other agencies or the youth or legal representatives ability to pay.

DHS 40.11(1)(b)4. 4. Any client characteristics for which the program has been specifically designed, including the nature or severity of disorders, including co-occurring disorders, which can be managed within the program, type of needs that can be addressed, whether male or female youth, or both, may be admitted, and the length of time that services may be provided to a youth.

DHS 40.11(2) (2) Admission. A program may not admit a youth unless all of the following information has been requested, the request has been documented, and reasonable efforts have been made to obtain a complete record of the youth’s mental health needs:

DHS 40.11(2)(a) (a) The most recent psychiatric assessment.

DHS 40.11(2)(b) (b) The Individualized Education Plan from the local education agency that is serving the client if the youth has an Individualized Education Plan.

DHS 40.11(2)(c) (c) Discharge summaries from any psychiatric hospitalizations that have occurred within the past 12 months.

DHS 40.11(2)(d) (d) Available information about any prior trauma history that the youth may have, and any risks of harm to self or others that the youth may present.

DHS 40.11(2)(e) (e) Records of all mental health or substance use disorder treatment or services that the applicant has received during the past 12 months.

DHS 40.11(3) (3) Screening summary.

DHS 40.11(3)(a) (a) Once a program has screened an applicant for services and has decided to admit the applicant, a mental health professional shall prepare a written screening summary. The screening summary shall be completed prior to the first day of the youth attending the program. The purpose of the screening summary is to demonstrate the youth’s appropriateness for the type of day treatment being initiated and reveal the diagnostic thought process and reasons that led to the decision to admit.

DHS 40.11(3)(b) (b) The screening summary shall include all of the following:

DHS 40.11(3)(b)1. 1. The names of individuals involved in the referral for admission, those contacted during the screening process, and the dates of meetings or other contacts with those individuals.

DHS 40.11(3)(b)2. 2. A summary of reviewed materials deemed to be valid, reliable, and reflect the current functioning of the youth during the screening process.

DHS 40.11(3)(b)3. 3. A summary of the reasons for admission or denial.

DHS 40.11(3)(b)4. 4. A diagnostic summary and a summary of medications, dosages, and dates.

DHS 40.11(3)(b)5. 5. A profile of the needs and strengths of the youth.

DHS 40.11(3)(b)6. 6. A summary of the services which will be offered while the assessment and treatment plan are prepared under ss. DHS 40.13 and 40.14, and setting the date on which the youth may begin attending the program.

DHS 40.11(3)(b)7. 7. A description of educational and community resources available.

DHS 40.11(3)(b)8. 8. A summary of other less and more restrictive service alternatives to day treatment that were considered and an explanation of why they were determined to not be appropriate to meet the youth’s needs.

DHS 40.11(3)(b)9. 9. A summary of other less restrictive services to day treatment in which the youth is dually involved and the reason for continued dual enrollment.

DHS 40.11(3)(b)10. 10. An initial discharge plan with measurable criteria for determining how the youth’s needs may be met by less restrictive services following discharge.

DHS 40.11 History History: CR 19-018: cr. Register June 2020 No. 774, eff. 7-1-20; correction in (3) (b) 4. made under s. 35.17, Stats., Register June 2020 No. 774.

DHS 40.12 DHS 40.12 Admission.

DHS 40.12(1) (1) Criteria for admission. All of the following are required for a program to admit a youth:

DHS 40.12(1)(a) (a) The youth has a psychiatric diagnosis of mental illness.

DHS 40.12(1)(b) (b) The youth is unable to obtain sufficient benefit from a less restrictive treatment program.