Chapter DHS 40

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.

DHS 40.14(1)(b)5. 5. The involvement of a youth’s legal representative with the program and any services that a legal representative will participate in while the youth is in the program.

DHS 40.14(1)(b)6. 6. A summary of other services the youth will receive while enrolled in the program, including educational services, other services that the program will be providing for the youth, and services and supports that will be provided by other agencies or providers and the process by which those educational and other services will be coordinated with services provided by the program.

DHS 40.14(1)(b)6m. 6m. If any part of the services will be delivered via telehealth, a description of those services and clinical justification for delivering services via telehealth rather than in person.

DHS 40.14(1)(b)7. 7. The procedure for monitoring and managing any risk of suicide if the assessment identified risks.

DHS 40.14(1)(b)8. 8. Any medication the youth is receiving, the name of the physician prescribing the medication, the dosages prescribed, the purpose for which it is prescribed, the frequency of administration, a plan for monitoring its administration and effects by the physician, and a plan for care coordination with a psychiatrist or advanced practice nurse prescriber.

DHS 40.14(1)(b)9. 9. A transition services component that establishes when a transition process should begin, the staff member responsible for supporting transition services, and a process for the reintegration of the youth who is completing the program into family, community and school activities.

DHS 40.14(1)(c) (c) The treatment plan shall be signed by the youth or legal representative and the clinical coordinator. With informed consent, a service provider who is part of the treatment plan may also review and sign the treatment plan.

DHS 40.14(2) (2) Review of treatment progress.

DHS 40.14(2)(a) (a) At a minimum, the care coordinator shall reconvene the interdisciplinary treatment team as follows:

DHS 40.14(2)(a)1. 1. In community-based programs, within 30 calendar days following approval of the initial treatment plan and at least every 30 days thereafter.

DHS 40.14(2)(a)2. 2. In hospital-based programs, within 15 calendar days following approval of the initial treatment plan and at least every 15 days thereafter.

DHS 40.14(2)(b) (b) In reviewing case progress, the interdisciplinary treatment team shall determine all of the following:

DHS 40.14(2)(b)1. 1. The degree to which the measurable objectives in the treatment plan have been met.

DHS 40.14(2)(b)2. 2. Any significant changes suggested or required in the treatment plan.

DHS 40.14(2)(b)3. 3. Whether any additional assessment of functional improvement is recommended as a result of information received or observations made during the course of treatment.