Chapter DHS 50

DHS 50.09(7)(b) (b) Individual side-by-side sessions in which the supervisor is present while the staff person provides services and in which the supervisor assesses, teaches, and gives advice regarding the staff member’s performance during or after the session.

DHS 50.09(7)(c) (c) Group meetings to review and assess staff performance and provide staff advice or direction regarding specific situations or strategies.

DHS 50.09(7)(d) (d) Other professionally recognized methods of supervision, such as review using videotaped sessions or peer review, if the other methods are approved by the department and are specifically described in the written policies of the program.

DHS 50.09(8) (8) 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 50.09(9) (9) Clinical supervision shall comply with s. DHS 34.21 (7) (a) to (k).

DHS 50.09 History History: EmR1922: emerg. cr., eff. 11-2-19; CR 19-077: cr. Register July 2020 No. 775, eff. 8-1-20; correction in (2) (b), (6), (9) made under s. 35.17, Stats., Register July 2020 No. 775; CR 23-053: am. (4), (5) Register September 2023 No. 813, eff. 10-1-23.

DHS 50.10 DHS 50.10 Admissions.

DHS 50.10(1) (1) Criteria for admission. Admission is voluntary, except that a minor may be admitted to a YCSF under this section by a court order under s. 51.20 (13) (a) 3., Stats., or through the procedure under s. 51.13, Stats. No YCSF may accept a minor for detention under s. 51.15, Stats.

DHS 50.10(2) (2) Eligibility for services.

DHS 50.10(2)(a) (a) A YCSF provides emergency mental health services. To receive emergency mental health services, a youth shall be in a crisis or be in a situation which is likely to develop into a crisis if supports are not provided.

DHS 50.10(2)(b) (b) Admission may be preventative.

DHS 50.10(2)(c) (c) A YCSF may accept an eligible youth from an inpatient setting.

DHS 50.10(3) (3) Consent for admission. A YCSF may admit a youth only after obtaining the written and informed consent of the youth or their legal representative, 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 50.10(4) (4) Authorization. Admissions must be authorized by a staff member qualified under s. DHS 34.21(3) (b) 1. to 8. within 24 hours of admission.

DHS 50.10 History History: EmR1922: emerg. cr., eff. 11-2-19; CR 19-077: cr. Register July 2020 No. 775, eff. 8-1-20; correction in numbering in (2) made under s. 13.92 (4) (b) 1., Stats., Register July 2020 No. 775.

DHS 50.11 DHS 50.11 Program Components. A YCSF shall offer or arrange for all of the following minimum required services:

DHS 50.11(1) (1) A structured therapeutic milieu supervised by a clinical coordinator.

DHS 50.11(2) (2) Therapeutic interventions and skills-building which will help youth manage their emotions and behavior in ways that will benefit them and will assist them in avoiding future crises.

DHS 50.11(3) (3) A YCSF shall provide care coordination services to each youth. The care coordinator shall be staff in compliance with s. DHS 34.21 (3) (b) 1. to 14. Care coordination shall include all of the following:

DHS 50.11(3)(a) (a) Providing the youth or legal representative, or both, with an explanation of the nature and goals of the program, and the rights and responsibilities of the youth.

DHS 50.11(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, encouraging family-driven care whenever possible.

DHS 50.11(3)(c) (c) Serving as an advocate for the youth with other agencies and programs to help the youth obtain necessary services and coordinating treatment to prevent further crises.

DHS 50.11(4) (4) Discharge planning shall meet all of the following requirements:

DHS 50.11(4)(a) (a) Discharge planning shall be designed to support the successful reintegration of youth into family, community, and school activities, and to prevent recurrence of a crisis.

DHS 50.11(4)(b) (b) Discharge planning shall begin at the time of admission, outlining goals to be achieved during the youths’ stay.

DHS 50.11(4)(c) (c) Discharge planning shall include the youth, and the youth’s legal representative if available.

DHS 50.11(4)(d) (d) At discharge, all of the youth’s belongings and medications shall accompany the youth.

DHS 50.11(4)(e) (e) A discharge summary in writing shall be maintained in the youths’ record.

DHS 50.11 History History: EmR1922: emerg. cr., eff. 11-2-19; CR 19-077: cr. Register July 2020 No. 775, eff. 8-1-20.

DHS 50.12 DHS 50.12 Emergency safety interventions.

DHS 50.12(1) (1) Prohibited interventions. Mechanical restraints and chemical restraints are prohibited.

DHS 50.12(2) (2) General requirements. Seclusion and physical restraint shall only be administered by YCSF staff who have completed orientation and training described in s. DHS 50.08 and shall comply with the requirements for emergency safety interventions under s. 51.61 (1) (i), Stats., s. DHS 94.10, and this chapter.

DHS 50.12(3) (3) Administration requirements. All of the following requirements apply to the administration of seclusion and physical restraint:

DHS 50.12(3)(a) (a) Seclusion and physical restraint may only be administered when all other less restrictive methods have been exhausted.

DHS 50.12(3)(b) (b) Seclusion and physical restraint shall be administered for the shortest time possible and only until the youth is no longer a danger to self or others.

DHS 50.12(3)(c) (c) Seclusion and physical restraint shall be administered in a manner that is attentive to, and respectful of, the trauma history, dignity, and civil rights of the youth.

DHS 50.12(3)(d) (d) Seclusion and physical restraint shall be administered in a manner that avoids or causes the least possible physical or emotional discomfort, harm, and pain to the youth.

DHS 50.12(3)(e) (e) Regular access to bathroom facilities, drinking water, and necessary medication shall be provided according to the youth’s needs during the administration of seclusion or physical restraint. Temperature and lights shall be maintained at levels which are comfortable to the youth.

DHS 50.12(4) (4) Specific requirements for seclusion. A YCSF that opts to seclude youths in the event of an emergency or imminent threat of injury or death to the youth or another person at the YCSF shall do all of the following:

DHS 50.12(4)(a) (a) Program staff members shall provide uninterrupted supervision and monitoring of the youth and the entire seclusion area during seclusion by being in the room with the youth or by observation through a window into the room.

DHS 50.12(4)(b) (b) A YCSF shall maintain an incident log to document the use of seclusion. The log shall include the time when the seclusion began, the youth’s behaviors and staff member’s responses to those behaviors every 5 minutes, and the time seclusion ended.

DHS 50.12(4)(c) (c) Seclusion rooms shall be free of objects or fixtures with which the youth could inflict bodily harm.

DHS 50.12(4)(d) (d) Only one youth at a time may be placed in a seclusion room.

DHS 50.12(4)(e) (e) A youth may only be kept in the seclusion area by means of one of the following:

DHS 50.12(4)(e)1. 1. A staff member is in a position, such as in a doorway, to prevent a youth from leaving the seclusion area.

DHS 50.12(4)(e)2. 2. A door to a seclusion room is latched by positive pressure applied by a staff member’s hand without which the latch would spring back allowing the door to open on its own accord, or a program may use a magnetic door lock or a lock which requires the turn of a knob to unlock a door. Other designs of door locks shall not be used, including pad lock, key lock, or other locks of similar design.

DHS 50.12(5) (5) Specific requirements for physical restraint.

DHS 50.12(5)(a) (a) Physical restraint shall only be administered to a youth during an emergency, when there is a serious threat of violence to other youth or a staff member, personal injury, or attempted suicide.

DHS 50.12(5)(b) (b) At a minimum, 2 staff members trained in the use of emergency safety interventions shall be physically present during the administration of physical restraint, and shall continually monitor the condition of the youth and the safe use of physical restraint throughout the duration of the intervention.

DHS 50.12(5)(c) (c) All of the following are prohibited forms of physical restraint:

DHS 50.12(5)(c)1. 1. Pressure or weight on the chest, lungs, sternum, diaphragm, back, or abdomen, such as straddling or sitting on the torso.

DHS 50.12(5)(c)2. 2. Pressure, weight, or leverage on the neck or throat, on any artery, or on the back of the head or neck, or that otherwise obstructs or restricts the circulation of blood or obstructs an airway, such as choke holds or sleeper holds.

DHS 50.12(5)(c)3. 3. Wrestling holds or martial arts techniques.

DHS 50.12(5)(c)4. 4. Covering the face with any object, such as a pillow, towel, washcloth, blanket, or other fabric.

DHS 50.12(5)(c)5. 5. Pain or pressure points.

DHS 50.12(5)(c)6. 6. Hyperextension of limbs, fingers, or neck.

DHS 50.12(5)(c)7. 7. Forcible take downs from a standing position to the floor.

DHS 50.12(5)(c)8. 8. Restraint in a prone position.

DHS 50.12(5)(c)9. 9. Restraint in a supine position.

DHS 50.12(5)(c)10. 10. Restraint in a vertical position, with upper body pressed against a wall or hard surface.

DHS 50.12(5)(c)11. 11. Any other physical restraint that is not administered during an emergency, that is administered for longer than necessary to prevent immediate injury to a youth or others, or that is administered for a purpose other than to prevent immediate injury to a youth or others.

DHS 50.12(5)(d) (d) Immediately, upon the termination of a physical restraint, a medical staff member, such as a physician, advanced practice nurse prescriber, physician assistant, or registered nurse shall conduct a follow-up assessment of the condition of the youth to ensure that the youth was not injured and shall document the finding of the assessment in the youth’s clinical record. If a staff member who is a physician or nurse is not present on site, a licensed treatment professional shall conduct the in-person assessment immediately upon termination of the physical restraint and notify a medical staff consultant.

DHS 50.12(5)(e) (e) If any injury is noted following a physical restraint, a staff member shall notify the youth’s legal representative and make a referral for medical care.

DHS 50.12(6) (6) Debriefing.

DHS 50.12(6)(a) (a) Unless clinically contraindicated, within 24 hours of administering a seclusion or physical restraint, a clinical staff member shall talk with the youth about each of the following:

DHS 50.12(6)(a)1. 1. The circumstances that contributed to the seclusion or physical restraint and an evaluation of the appropriateness of the staff member’s actions.

DHS 50.12(6)(a)2. 2. The youth’s psychological well-being and the emotional impact of the intervention.

DHS 50.12(6)(a)3. 3. Any modifications that can be made in the youth’s services or treatment plan to prevent seclusion, physical restraint, or both, in the future.

DHS 50.12(6)(b) (b) A YCSF shall notify a youth’s parent or legal representative of any seclusion or physical restraint within 12 hours of it being administered to the youth. The YCSF shall document in the youth’s clinical record any situation in which notification has been attempted and the YCSF has been unable to contact the legal representative.

DHS 50.12(6)(c) (c) Each administration of seclusion or physical restraint shall be documented in the youth’s clinical record and shall specify all of the following:

DHS 50.12(6)(c)1. 1. Events precipitating the seclusion or physical restraint.

DHS 50.12(6)(c)2. 2. Less restrictive interventions attempted prior to the seclusion or physical restraint.

DHS 50.12(6)(c)3. 3. Length of time the seclusion or physical restraint was used.

DHS 50.12(6)(c)4. 4. Assessment of the appropriateness of the seclusion or physical restraint based on threat of harm to self or others.

DHS 50.12(6)(c)5. 5. Assessment of any physical injury to the youth, other youth, or to staff members.

DHS 50.12(6)(c)6. 6. The youth’s response to the emergency safety intervention.

DHS 50.12(6)(d) (d) The clinical coordinator or their designee shall review all seclusion and physical restraint documentation within 24 hours of intervention, and in consultation with others determine whether changes to the youth’s safety plan or treatment plan are necessary, including whether a higher level of care is necessary. These findings and recommendations shall be documented in the youth’s clinical record.

DHS 50.12(6)(e) (e) The clinical coordinator or their designee shall debrief with other youth present in a trauma-informed manner.

DHS 50.12(7) (7) Reporting.

DHS 50.12(7)(a) (a) Facilities shall report all incidences of seclusion, physical restraint, injury, elopement, or 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 50.12(7)(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 50.12 Note Note: The department’s reporting link is: https://www.dhs.wisconsin.gov/mh/ycsf.htm. Questions and information about reporting may be directed to the Division of Care and Treatment Services at 608-266-2717.

DHS 50.12 History History: EmR1922: emerg. cr., eff. 11-2-19; CR 19-077: cr. Register July 2020 No. 775, eff. 8-1-20; correction in (5) (b), (c) 4., (d) made under s. 35.17, Stats., Register July 2020 No. 775; CR 23-053: am. (5) (d), (6) (a) (intro.) Register September 2023 No. 813, eff. 10-1-23.

DHS 50.13 DHS 50.13 Investigation, notification, and reporting requirements.

DHS 50.13(1) (1) Death reporting.

DHS 50.13(1)(a) (a) Youth death related to physical restraint, seclusion, psychotropic medication, or suicide. No later than 24 hours after the death of a youth, the YCSF shall report the death to the department if there is reasonable cause to believe the death was related to the use of a physical restraint, seclusion, or psychotropic medication, or was a suicide, as provided in s. 51.64, Stats.

DHS 50.13 Note Note: Death reporting process and forms may be found at: https://www.dhs.wisconsin.gov/regulations/report-death/proc-reportingdeath.htm.

DHS 50.13(1)(b) (b) Youth death related to an accident, injury, natural causes, or other reasons. When a youth dies for any reason other than the use of a physical restraint, seclusion, psychotropic medication, or suicide, the YCSF shall send a report to the department within 3 business days of the youth’s death.

DHS 50.13 Note Note: The department’s reporting link is: https://www.dhs.wisconsin.gov/mh/ycsf.htm.