Chapter DHS 61

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

DHS 61.95 DHS 61.95 Procedures for approval. Outpatient psychotherapy clinics are certified by the department under the standards set forth in ch. DHS 35.

DHS 61.95 History History: Cr. Register, May, 1981, No. 305, eff. 6-1-81; r. and recr. (4), Register, October, 1985, No. 358, eff. 11-1-85; CR 06-080: r. and recr. Register May 2009 No. 641, eff. 6-1-09.

DHS 61.96 DHS 61.96 Required personnel. Qualifications for a mental health professional in an outpatient psychotherapy clinic are set forth in ch. DHS 35.

DHS 61.96 History History: Cr. Register, May, 1981, No. 305, eff. 6-1-81; am. (1) and (3), cr. (4), Register, September, 1982, No. 321, eff. 10-1-82; am. (1) (b), (2) and (3), Register, April, 1984, No. 340, eff. 5-1-84; CR 06-080: r. and recr. Register May 2009 No. 641, eff. 6-1-09.