Chapter DHS 61

DHS 61.75(1)(g) (g) Additional personnel may include licensed practical nurses, occupational therapy assistants, other therapists, psychiatric aides, mental health technicians or other paraprofessionals, educators, sociologists, and others, as applicable.

DHS 61.75(1)(h) (h) Volunteers may be used in day treatment and programs are encouraged to use the services of volunteers.

DHS 61.75(2) (2) Services.

DHS 61.75(2)(a) (a) A day treatment program shall provide services to meet the treatment needs of its patients on a long or short term basis as needed. The program shall include treatment modalities as indicated by the needs of the individual patient. Goals shall include improvement in interpersonal relationships, problem solving, development of adaptive behaviors and establishment of basic living skills.

DHS 61.75(2)(b) (b) There shall be a written individual plan of treatment for each patient in the day treatment service. The plan of treatment shall be reviewed no less frequently than monthly.

DHS 61.75(2)(c) (c) There shall be a written individual current record for each patient in the day treatment service. The record shall include individual goals and the treatment modalities used to achieve these goals.

DHS 61.75 History History: Cr. Register, March, 1977, No. 255, eff. 4-1-77; renum. from PW-MH 60.67, Register, September, 1982, No. 321, eff. 10-1-82.

DHS 61.76 DHS 61.76 Rehabilitation program. The community mental health program shall be responsible for the provision of an organized rehabilitation service designed to reduce the residual effects of emotional disturbances and to facilitate the adjustment of individuals with mental illnesses, intellectual disabilities, or emotional disturbances in the community through a variety of rehabilitation services. When possible, these services should be provided in conjunction with similar services for other disabilities. A rehabilitation program shall comply with all of the following:

DHS 61.76(1) (1) Required personnel. A person responsible for coordination of rehabilitation services shall be named and all staff shall have qualifications appropriate to their functions. Each such person shall have the required educational degree for his or her profession and shall meet all requirements for registration or licensure for that position in the state of Wisconsin.

DHS 61.76(2) (2) Program operation and content. Because of the variety of programs and services which are rehabilitative in nature, individual program content is not enumerated. Such facilities as halfway houses, residential care facilities, foster and group homes shall meet all departmental and other applicable state codes. The department of health services shall evaluate each proposal for funding of rehabilitation services on the basis of individual merit, feasibility and consistency with the approved community plan required in s. 51.42, Stats. Applicants for aid under this section must fully describe the rehabilitation service designed to meet the particular needs of the residents of their county or counties, taking into consideration existing community resources and services.

DHS 61.76 History History: Cr. Register, March, 1977, No. 255, eff. 4-1-77; renum. from PW-MH 60.68, Register, September, 1982, No. 321, eff. 10-1-82; correction in (2) made under s. 13.92 (4) (b) 6., Stats., Register November 2008 No. 635; CR 20-068: am. (intro.) Register December 2021 No. 792, eff. 1-1-22.

DHS 61.77 DHS 61.77 Consultation and education program. Prevention is as important to mental illness as it is to physical illness. Certain facts and relationships between mental illness and environmental factors, individual personal contacts, and human development stages can be the basis for sound primary prevention programs. Education programs designed to increase the understanding and acceptance of the mentally ill are especially vital as increased numbers of persons receive needed treatment in their own community. Such programs can help prevent the chronicity of recurrence of mental illness. They can bring persons to seek counsel or treatment earlier and help to remove what has been an unacceptable “label” for family, friends, and co-workers. Because consultation and education programs are required elements of community mental health programs, the activities must be as well defined, organized and provided for as those for other program elements. Mental health staff and time allocations must be made and structured consultation and education programs designed and carried out.

DHS 61.77(1) (1) Consultation required personnel. The mental health coordinator or designee shall be responsible for the consultation program. Mental health staff shall respond to individual consultation requests. In addition staff shall actively initiate consultation relationships with community service agency staff and human service personnel such as clergy, teachers, police officers and others.

DHS 61.77(2) (2) Consultation service content.

DHS 61.77(2)(a) (a) No less than 20% of the total mental health program staff time, exclusive of clerical personnel and inpatient staff shall be devoted to consultation. The service shall include:

DHS 61.77(2)(a)1. 1. Case-related consultation.

DHS 61.77(2)(a)2. 2. Problem-related consultation.

DHS 61.77(2)(a)3. 3. Program and administrative consultation.

DHS 61.77(2)(b) (b) There shall be a planned consultation program using individual staff skills to provide technical work-related assistance and to advise on mental health programs and principles. The following human service agencies and individuals shall have priority for the service:

DHS 61.77(2)(b)1. 1. Clergy

DHS 61.77(2)(b)2. 2. Courts

DHS 61.77(2)(b)3. 3. Inpatient services

DHS 61.77(2)(b)4. 4. Law enforcement agencies

DHS 61.77(2)(b)5. 5. Nursing/transitional homes

DHS 61.77(2)(b)6. 6. Physicians

DHS 61.77(2)(b)7. 7. Public health nurses

DHS 61.77(2)(b)8. 8. Schools

DHS 61.77(2)(b)9. 9. Social service agencies

DHS 61.77(3) (3) Education required personnel. The qualified educator maintained by the community board shall be responsible for the mental health education program. Refer to this chapter. Mental health staff members shall cooperate and assist in designing and carrying out the mental health education program, providing their specialized knowledge on a regular, established basis to a variety of specified activities of the service. In cooperation with the education specialist maintained by the board, additional education staff may be employed on a full-time or part-time basis. Education services can also be contracted for through the same procedures followed for other service elements contracts.

DHS 61.77(4) (4) Education service content. No less than 10% of the total mental health program staff time exclusive of clerical personnel and inpatient staff shall be devoted to education. The service shall include:

DHS 61.77(4)(a) (a) Public education.

DHS 61.77(4)(b) (b) Continuing education.

DHS 61.77(4)(b)1. 1. Inservice training.

DHS 61.77(4)(b)2. 2. Staff development.

DHS 61.77(5) (5) Education program. There shall be a planned program of public education designed primarily to prevent mental illness and to foster understanding and acceptance of the mentally ill. A variety of adult education methods shall be used including institutes, workshops, projects, classes and community development for human services agencies, individuals and for organized law groups and also the public information techniques for the general public. There shall be a planned program of continuing education using a variety of adult education methods and available educational offerings of universities, professional associations, etc. for agency staff and related care-giving staff.

DHS 61.77 History History: Cr. Register, March, 1977, No. 255, eff. 4-1-77; renum. from PW-MH 60.69, Register, September, 1982, No. 321, eff. 10-1-82; correction made under s. 13.93 (2m) (b) 7., Stats., Register, June, 1995, No. 474.

DHS 61.78 DHS 61.78 Additional requirements for programs serving children and adolescents - introduction and personnel.

DHS 61.78(1) (1) Introduction. The following standards have been developed for community mental health services for children and adolescents. Except for the substitution of minimal hourly requirements, these standards are intended to be in addition to ss. DHS 61.70 through 61.77 and are consistent with those stated in Standards for Psychiatric Facilities Serving Children and Adolescents, published by the American Psychiatric Association; and the Joint Commission on Accreditation of Hospitals. Planning psychiatric facilities and services for children and adolescents is difficult and complex. These standards are intended to insure a continuity of care notwithstanding the complexities involved. To accomplish this each service must:

DHS 61.78(1)(a) (a) Consider the children and adolescents’ development needs as well as the demands of the illness;

DHS 61.78(1)(b) (b) Have cognizance of the vital meaning to children and adolescents that group and peer relationships provide;

DHS 61.78(1)(c) (c) Recognize the central importance of cognitive issues and educational experiences;

DHS 61.78(1)(d) (d) Recognize the children and adolescents’ relative dependence on adults;

DHS 61.78(1)(e) (e) Place some importance on the children and adolescents receiving repeated recognition for accomplishments;

DHS 61.78(1)(f) (f) Provide an individualized treatment program by so structuring the environment to allow for optimal maturational, emotional and chronological growth.

DHS 61.78(2) (2) Personnel requirements. The following personnel requirements are relevant only to children and adolescents’ services and are applicable for each program. These requirements are in addition to the personnel qualifications listed in the General Provisions of Standards for Community Mental Health, Developmental Disabilities, and Alcoholism and Other Drug Abuse Services, ss. DHS 61.01 to 61.24.

DHS 61.78(2)(a) (a) Psychiatry. Special effort shall be made to procure the services of a child psychiatrist who is licensed to practice medicine in the state of Wisconsin and is either board eligible or certified in child psychiatry by the American board of psychiatry and neurology. If a child psychiatrist is unobtainable, special effort shall be made to procure a psychiatrist who has had a minimum of 2 years clinical experience working with children and adolescents.

DHS 61.78(2)(b) (b) Nursing service.

DHS 61.78(2)(b)1. 1. Registered nurses and licensed practical nurses. Special effort shall be made to procure the services of registered nurses and practical nurses who have had training in psychiatric nursing. A portion of this training shall have been with emotionally disturbed children and adolescents.

DHS 61.78(2)(b)2. 2. Aides, child care workers and other paraprofessionals. Each service shall make a special effort to recruit the aides, child care workers and paraprofessionals who have the following background.

DHS 61.78(2)(b)2.a. a. College or university credit or non-credit courses related to child care.

DHS 61.78(2)(b)2.b. b. Vocational courses planned for child development.

DHS 61.78(2)(b)2.c. c. High school diploma and experience in children or adolescents’ related activities.

DHS 61.78(2)(c) (c) Activity therapy. Each program, excluding outpatient, shall provide at least one full-time activity therapist. In addition to having formal training in children and adolescents’ growth and development, preference shall be given to those professionals who have had clinical training or professional experience with emotionally disturbed children and adolescents.

DHS 61.78(2)(d) (d) Social service. The social worker shall have had 2 years experience working with children and adolescents.

DHS 61.78(2)(e) (e) Psychological service. Each service shall employ or contract for the service of a clinical psychologist who shall have the appropriate experience in the area of children and adolescents. Providers of psychological services who do not meet these requirements shall be supervised by a qualified psychologist.

DHS 61.78(2)(f) (f) Educational service. Each child and adolescent service shall have associated with that service at least one teacher either employed by the service or by a local educational agency.

DHS 61.78(2)(g) (g) In-service. All personnel shall participate in a documented in-service education program at a minimum of 48 hours per year, relating to areas of mental health concepts of children and adolescents.

DHS 61.78 History History: Cr. Register, March, 1977, No. 255, eff. 4-1-77; am. (2) (c), Register, March, 1979, No. 279, eff. 4-1-79; renum. from PW-MH 60.70 and am. (1) (intro.) and (2) (intro.), Register, September, 1982, No. 321, eff. 10-1-82.

DHS 61.79 DHS 61.79 Children and adolescent inpatient program. The following personnel requirements are minimum. There is no intention to restrict new programs to these minimal staffing patterns. Existing treatment programs which exceed these requirements may not be reduced without extensive and thorough review and a clear realization of what services would be lost by reduction.

DHS 61.79(1) (1) Required personnel.

DHS 61.79(1)(a) (a) Psychiatry. Each child and adolescent mental health inpatient service shall provide a minimum of 1.4 hours a week psychiatric treatment time per patient under care. Additional psychiatrists, as needed, shall be available for inpatient visits in order to carry out an adequate treatment program. For emergency purposes a psychiatrist will be on call 24 hours a day each day the facility is in operation. A psychiatrist shall be readily accessible by telephone and ideally, be able to reach the facility within one hour of being called.

DHS 61.79(1)(b) (b) Nursing service.

DHS 61.79(1)(b)1. 1. The following schedule of licensed nursing coverage is minimal.

DHS 61.79(1)(b)2. 2. Aides, child care workers and other paraprofessionals. Child care workers are primarily responsible for day-to-day living experiences of the children. They also carry out assigned aspects of the treatment program under the direction and supervision of designated treatment staff. Each service shall employ a sufficient number of aides, child care workers and paraprofessionals to provide the following minimal care:

DHS 61.79(1)(c) (c) Activity therapy. The inpatient service shall maintain a ratio of 1.6 hours of activity therapy staff time per patient per week. Additional therapists may be employed as needed. In addition sufficient free time for unstructured but supervised play or activity will be provided.

DHS 61.79(1)(d) (d) Social service. Each service shall employ at least one full time social worker and provide for a minimum of 1.6 hours per week per patient under care.

DHS 61.79(1)(e) (e) Psychological service. Each service must provide a minimum of one hour per week of psychology time for each patient under care.

DHS 61.79(1)(f) (f) Educational service. Each mental health inpatient service for children and adolescents is responsible for providing or arranging for special educational programs to meet the needs of all patients being served in the facility. If the service provides its own school program, 4.8 hours per patient per week of teacher time is considered minimal care.

DHS 61.79(1)(g) (g) Vocational service. If indicated by patient need each inpatient service shall make available a vocational program to each adolescent 14 years of age and older according to the individual patient’s age, developmental level and clinical status. This program will be under the auspices of a vocational counselor and is to be carried out in conjunction with, and not in place of the school program. Vocational counseling and training shall be a minimum of 1.3 hours per patient per week, if the service operates its own school program and .8 hour per patient per week, if the facility uses public or other schools.

DHS 61.79(1)(h) (h) Speech and language therapy. Each mental health inpatient service shall provide one hour per patient per week minimal care of speech and language therapist time for children and adolescents diagnosed as requiring such therapy.

DHS 61.79(1)(i) (i) Add-on factor. To account for vacation time, sick leave or other absences to which employees may be entitled, the application of a “post shift” factor of 1.59 should be calculated for treatment posts staffed 7 days a week and 1.13 for those staffed 5 days a week. In addition, a 20% factor should be used to account for patient charting, planning and other non-face to face care which is required to maintain the program.

DHS 61.79(2) (2) Program operation and content.

DHS 61.79(2)(a) (a) General consideration. Children and adolescents shall be accepted for other than emergency inpatient treatment only if the child or adolescent requires treatment of a comprehensive and intensive nature and is likely to benefit from the program the inpatient facility has to offer or outpatient alternatives for treatment are not available. No child or adolescent shall be admitted to any inpatient facility more than 60 miles from home without permission of the department. Each inpatient service shall specify in writing its policies and procedures, including intake and admission procedures, current costs, the diagnostic, treatment and preventive services it offers and the manner in which these are regularly conducted. Intake and admission procedures must be designed and conducted to ensure as far as possible a feeling of trust on the part of the child and family. In preparation for admission, the diagnosis and evaluation as well as the development of the treatment plan shall take into consideration the age, life experience, life styles, individual needs and personality, clinical condition, special circumstances necessitating admission and special problems presented by the patient and family. Complete assessment shall include clinical consideration of each of the fundamental needs of the patient; physical, psychological, chronological and developmental level, family, education, social, environmental and recreational. In addition to establishing a diagnosis and carrying out treatment, each service must also make provision for the diagnosis and treatment of any concurrent or associated illness, injury, or disability. When treatment is to be concluded, the responsible agency will plan with the child, parents and other significant persons or community agencies to ensure an environment that will encourage continuing growth and development.

DHS 61.79(2)(b) (b) Family participation. Mental health inpatient service shall involve the family’s participation. Information about the patient’s home experiences will be obtained and the family shall be informed of the patient’s problems, progress and experiences in the facility. Information regarding contacts with parents shall be made part of the clinical record. There shall be appropriate educational programs for families designed to enhance their understanding of the goals of the facility and to help them feel welcome as active and participating partners. Participation for families should be scheduled at times when they can reasonably be expected to attend. Family therapy can be included at the discretion of the therapist.

DHS 61.79(2)(c) (c) Special education program. Each inpatient service is responsible to see that all patients shall be helped to secure a formal education. There shall be flexibility in the special education program and each program shall be tailored to each individual in order to maximize potential growth.

DHS 61.79(2)(d) (d) Vocational program. If appropriate, plans for work experience shall be developed as part of the overall treatment plan for each adolescent, 14 years of age and older. In planning such experiences, the vocational counselor shall consider the individual’s aptitudes and abilities, interests, sensorimotor coordination, and self and vocational perception. When appropriate, work experiences shall be utilized to promote structured activity, provide opportunities for accomplishment, increase the patient’s self-confidence and self-esteem, and provide vocational training and preparation.

DHS 61.79(2)(e) (e) Activity therapy. Appropriate programs of activity therapy and social activities shall be provided for all patients for daytime, evenings and weekends, (emphasis on latter 2), to meet the needs of the patient and the goals of the program. Programs shall be structured to reflect patterns and conditions of everyday life. These programs shall be planned to aid the patients in exploring the nature of their individuality and creativity, in motor, cognitive and social skills, and integrating these into a positive sense of self and to meet therapeutic goals as described.

DHS 61.79 History History: Cr. Register, March, 1977, No. 255, eff. 4-1-77; renum. from PW-MH 60.71, Register, September, 1982, No. 321, eff. 10-1-82; CR 20-068: am. (2) (a) Register December 2021 No. 792, eff. 1-1-22.

DHS 61.80 DHS 61.80 Children and adolescent outpatient program.

DHS 61.80(1) (1) Required personnel. Of the treatment personnel required for any out-patient service, a minimum of 30% staff time must be devoted to children and adolescents services. If qualified children and adolescents mental health professionals are not available on a full or part-time basis, arrangements shall be made to obtain their services on a consulting basis. The staffing patterns of the facility shall be adequate for the provision of high quality of care and shall be appropriate in relationship to: characteristics of patient population; the hours and days the facility operates; chronological and developmental ages of patients; assessment, therapeutic and follow-up programs; intensity and kinds of treatment; nature of disorders, amount of work done with families and significant others; geographic characteristics of territory to be covered; community education and consultation programs; amount of training and research done by facility.

DHS 61.80(2) (2) Program operation and content.

DHS 61.80(2)(a) (a) Accessibility. Outpatient services insofar as possible should be scheduled at times that are reasonably convenient to the patients and families served, in relation to the availability of transportation and considering work or school requirements. The outpatient service shall make provision for walk-in clients, provide for home visits, if clinically indicated, offer clinical consultation to clients in day care services, head start programs, schools, youth centers, jails, alternate care facilities and other community programs. An appointment system that serves to minimize waiting time, in addition to a system for follow-up of broken appointments, should be established.

DHS 61.80(2)(b) (b) Program content.

DHS 61.80(2)(b)1. 1. The patient shall participate in the intake process and in the decision that outpatient treatment is indicated to the extent appropriate to age, maturity and clinical condition. The patient’s family, wherever possible, shall have explained to them the nature and goals of the outpatient treatment program and their expected participation and responsibilities. Insofar as possible, the family shall be informed and involved appropriately in decisions affecting the patient during intake treatment, discharge and follow-up.

DHS 61.80(2)(b)2. 2. The psychiatric outpatient service shall document about each patient: responsibility for financial support, arrangements for appropriate family participation in the treatment program when indicated; authorization and consent for emergency medical care if the patient becomes ill or has an accident while in treatment and the family cannot be reached; arrangements for transportation to and from the facility; and authorization if the patient is to go to other community areas, facilities or events as part of the outpatient program; releases for sharing of confidential materials when necessary; appropriate consents for participation in research programs.

DHS 61.80(2)(b)3. 3. Assessment shall include clinical consideration of the physical, psychological, development, chronological age, environmental, family, social, educational and recreational factors related to the child and adolescent.

DHS 61.80(2)(b)4. 4. The relationship between any adult, who has current and/or continuing responsibility for the child’s and adolescent’s life, and the patient shall be carefully evaluated at regular intervals.

DHS 61.80 History History: Cr. Register, March, 1977, No. 255, eff. 4-1-77; renum. from PW-MH 60.72, Register, September, 1982, No. 321, eff. 10-1-82.

subch. V of ch. DHS 61 Subchapter V — Outpatient Psychotherapy Clinic Standards