Chapter DHS 40

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.

DHS 40.12(1)(c) (c) The youth is reasonably likely to benefit from the services being offered by the program.

DHS 40.12(1)(d) (d) The youth is experiencing one or more of the following:

DHS 40.12(1)(d)1. 1. Significant dysfunction in 2 or more of the basic domains of life and that require the services offered by the program in order to acquire or restore the skills necessary to perform adequately in those areas.

DHS 40.12(1)(d)2. 2. Need for a period of transition from a hospital, residential treatment center or other institutional setting as part of the process of returning to live in the community.

DHS 40.12(1)(d)3. 3. A period of acute crisis or other severe stress, so that without the level of services provided by the program, there is a high risk of hospitalization or other institutional placement.

DHS 40.12(2) (2) Authorization for services.

DHS 40.12(2)(a) (a) Except as provided in s. 51.14, Stats., a program may admit a youth only after obtaining the written and informed consent of the youth or legal representative, or pursuant to an order of a court with jurisdiction over the youth under ch. 48, 55, or 938 Stats., or if authorized by a county department under s. 51.42 or 51.437, Stats., to which the youth has been committed pursuant to s. 51.20 (13), Stats.

DHS 40.12(2)(b) (b) Admission of minors shall comply with the requirements of s. 51.13, Stats.

DHS 40.12(3) (3) Care coordination. A program shall assign a care coordinator to each youth and provide the youth or legal representative with the care coordinator’s contact information, a description of the role of the care coordinator, and an explanation of support that is available. The care coordinator shall be a mental health professional or mental health support worker and shall be responsible for all of the following:

DHS 40.12(3)(a) (a) Providing the youth or legal representative with a thorough explanation of the nature and goals of the program, and the rights and responsibilities of the client.

DHS 40.12(3)(b) (b) Facilitating the youth’s assessment, developing and implementing the treatment plan, conducting ongoing case reviews, and identifying services to support the youth at discharge.

DHS 40.12(3)(c) (c) Coordinating the program’s operations on behalf of the youth with other agencies and schools serving the youth.

DHS 40.12(3)(d) (d) Maintaining contact and communication with the youth or legal representative, facilitating the participation of the youth or legal representative in the treatment plan, and encouraging family-driven care whenever possible.

DHS 40.12(3)(e) (e) Serving as an advocate for the youth or legal representative with other agencies and programs to help the youth obtain necessary services and benefits from those other agencies and programs.

DHS 40.12(4) (4) Safety plan. An individualized safety plan shall be completed prior to the start of services that considers risk factors, trauma history, medications and possible side effects, and methods for de-escalation of behaviors that are designed to avoid the use of emergency safety interventions in addressing the needs of the youth.

DHS 40.12 History History: CR 19-018: cr. Register June 2020 No. 774, eff. 7-1-20; correction in (3) (a) made under s. 35.17, Stats., Register June 2020 No. 774.

DHS 40.13 DHS 40.13 Assessment.

DHS 40.13(1) (1) Interdisciplinary treatment team.

DHS 40.13(1)(a) (a) Within 5 working days following the decision to admit a youth into the program, the care coordinator shall assemble an interdisciplinary treatment team to begin an assessment of the strengths, needs, and current status of the youth.

DHS 40.13(1)(b) (b) The team shall include all of the following:

DHS 40.13(1)(b)1. 1. The youth, to the extent appropriate to his or her age, maturity and clinical condition, if available and willing to participate.

DHS 40.13(1)(b)2. 2. The youth’s legal representative.

DHS 40.13(1)(b)3. 3. The youth’s care coordinator.

DHS 40.13(1)(b)4. 4. The program’s clinical coordinator.

DHS 40.13(1)(c) (c) The youth or legal representative shall be asked to participate in identifying additional members of the interdisciplinary team. With consent of the youth or legal representative, reasonable efforts should be made to include all of the following:

DHS 40.13(1)(c)1. 1. An occupational therapist or a registered nurse, based on youth needs identified in the screening summary.

DHS 40.13(1)(c)2. 2. An educational professional from the youth’s school.

DHS 40.13(1)(c)3. 3. Representatives of any other profession or agency necessary in order to adequately and appropriately respond to the treatment needs of the youth which were identified in the referral materials or the intake screening process.

DHS 40.13(1)(c)4. 4. Family members who are involved in the life of the youth.

DHS 40.13(1)(c)5. 5. If the youth has been placed under the supervision of a county department, the social worker who has been assigned to the case.

DHS 40.13(2) (2) Assessment.

DHS 40.13(2)(a) (a) The purpose of the assessment is to identify the individual strengths and needs of the youth to address the level of functioning as well as specific strategies that will be utilized to treat the youth. The clinical coordinator shall prepare a written report describing and evaluating all of the following:

DHS 40.13(2)(a)1. 1. Biopsychosocial information that is sufficient to identify the goals that the youth or legal representative want to accomplish through their participation in the program, the needs that will have to be addressed to reach those goals, and the strengths of the youth that can form the foundation of the individual treatment plan to meet the identified needs and achieve the chosen goals, through conducting a respectful and thorough series of interviews that engage the youth or legal representative. Biopsychosocial information includes developmental history, significant past events, significant past relationships and prominent influences, behavioral history, financial history, and overall life adjustment.

DHS 40.13(2)(a)2. 2. The current mental health status of each youth including frequency, severity and duration of the symptoms and behaviors and the manner in which the symptoms and behaviors impact the youth’s ability to function, attitude, judgement, memory, speech, thought content, perception, intellectual functioning, general appearance, diagnosis, or medical impression.

DHS 40.13 Note Note: The Diagnostic and Statistical Manual of Mental Disorders is published by the American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders. Washington, DC, American Psychiatric Association, 2013. The Diagnostic and Statistical Manual of Mental Disorders may be ordered through http://www.appi.org/Pages/DSM.aspx or other sources.

DHS 40.13(2)(a)3. 3. Completing an evaluation of all of the following:

DHS 40.13(2)(a)3.a. a. Current living arrangements, social relationships, support systems, including the youth’s level of social and behavioral functioning in the home, school and community, and the youth’s relationship with his or her family members, including an assessment of family member strengths and weaknesses which might affect treatment.

DHS 40.13(2)(a)3.b. b. A youth’s trauma history and experiences and how treatment approaches will avoid re-traumatization.

DHS 40.13(2)(a)3.c. c. A youth’s ability to work in a group setting.

DHS 40.13(2)(a)3.d. d. The youth’s level of academic functioning and educational history, including areas where the youth shows interest, skill and achievement.

DHS 40.13(2)(a)3.e. e. A youth’s history of criminal activity, including sexual perpetration, peer-to-peer violence, battery, and safety concerns.

DHS 40.13(2)(a)3.f. f. The youth’s health, medical history, and prescribed medications, including a youth’s prior history of dangerous reactions to psychotropic medications, including procedures for assessing and monitoring the desired objectives and side effects of medications which the youth is taking, dealing with the results of possible medication interactions, medication overdose, an error in medication administration, an unanticipated reaction to the medication, the effects of a concurrent medical illness or condition occurring while the client is receiving the medication, and monitoring the medication regime to determine if any of the medications, solely or in combination, may mask or mimic psychiatric symptoms or behaviors.

DHS 40.13(2)(a)3.g. g. Suicide risk and self-harm history and risk including criteria for deciding when the level of risk of suicide requires the use of crisis response services or hospitalization.

DHS 40.13(2)(a)3.h. h. For a youth over the age of 15, the youth’s vocational and independent living history, skills and needs.

DHS 40.13(2)(a)3.i. i. The youth’s current or recent use of drugs or alcohol and the possible presence of any co-occurring disorder that will have to be addressed through the treatment plan.

DHS 40.13(2)(a)3.j. j. Any other assets and needs of the youth which affect the youth’s ability to participate effectively in relationships and activities in home, community and school environments.

DHS 40.13(2)(a)3.k. k. Past treatment, including where it occurred, for how long, and by whom.

DHS 40.13(2)(a)3.L. L. Recommendations for completing any new test or evaluation which the interdisciplinary treatment team finds is necessary for development of an effective treatment plan for the youth, including psychological, neuropsychological functional, cognitive, behavioral, developmental or early and periodic screening and diagnosis under s. DHS 107.22.

DHS 40.13(2)(b) (b) The written assessment shall inform and be completed prior to development of the treatment plan.

DHS 40.13(2)(c) (c) The written assessment shall be signed by the youth or legal representative and the clinical coordinator.

DHS 40.13 History History: CR 19-018: cr. Register June 2020 No. 774, eff. 7-1-20.

DHS 40.14 DHS 40.14 Treatment Plan.

DHS 40.14(1) (1) Treatment plan.

DHS 40.14(1)(a) (a) The interdisciplinary treatment team shall prepare a written treatment plan for a youth based upon the written assessment under s. DHS 40.13 (2) within 15 calendar days after admission. The treatment plan shall describe measurable objectives that will be met and services that will be provided to the youth.

DHS 40.14(1)(b) (b) The written treatment plan shall include all of the following:

DHS 40.14(1)(b)1. 1. The youth’s strengths, treatment strategies, and measurable outcomes to be accomplished.

DHS 40.14(1)(b)2. 2. Clinical and support services to reduce or eliminate the symptoms causing the youth’s problems or inability to function in day to day living, and to increase the youth’s ability to function as independently as possible.

DHS 40.14(1)(b)3. 3. The schedules, frequency, nature of services recommended to support the achievement of the youth’s goals, irrespective of the availability of services or funding, and the responsible party for that intervention.

DHS 40.14(1)(b)4. 4. The proposed length of time the youth will participate in the program and the amount of time that the youth will attend the program each week.