Chapter DHS 63

DHS 63.10(1)(d)2. 2. Use of drugs or alcohol, or both, by a CSP professional supervised by the clinical coordinator or a designated staff member meeting qualifications under s. DHS 63.06 (2) (c);

DHS 63.10(1)(d)3. 3. Vocational and educational functioning, by a CSP professional supervised by the clinical coordinator or a designated staff member meeting qualifications under s. DHS 63.06 (2) (c);

DHS 63.10(1)(d)4. 4. Social functioning, by a CSP professional supervised by the clinical coordinator or a designated staff member meeting qualifications under s. DHS 63.06 (2) (c);

DHS 63.10(1)(d)5. 5. Self-care and independent living capacity, by a CSP professional supervised by the clinical coordinator or a designated staff member meeting qualifications under s. DHS 63.06 (2) (c);

DHS 63.10(1)(d)6. 6. Relationship with his or her family, by a CSP professional supervised by the clinical coordinator or a designated staff member meeting qualifications under s. DHS 63.06 (2) (c);

DHS 63.10(1)(d)7. 7. Medical health, by a psychiatrist or physician. A registered nurse may collect health-related information and history and perform partial examinations under supervision of a physician;

DHS 63.10(1)(d)8. 8. Dental health information and history may be collected by a psychiatrist, a physician or a CSP professional under the supervision of a physician; and

DHS 63.10(1)(d)9. 9. Other specified problems and needs, by a CSP professional supervised by the clinical coordinator or a designated staff member meeting qualifications under s. DHS 63.06 (2) (c).

DHS 63.10(1)(e) (e) Evidence that a service is medically necessary shall be indicated through the signature of a psychiatrist on the client’s treatment record following the psychiatrist’s review and approval of the service.

DHS 63.10(2) (2) Treatment planning.

DHS 63.10(2)(a) (a) The case manager assigned to a client under s. DHS 63.12 (1) shall ensure that an initial written treatment plan is developed at the time of the client’s admission to the CSP and that a comprehensive treatment plan is developed and written within one month after admission and is reviewed and updated in writing at least once every 6 months.

DHS 63.10(2)(b) (b) The treatment plan shall:

DHS 63.10(2)(b)1. 1. Be based on the initial assessment required under sub. (1) (a) and, when appropriate, on the in-depth assessment required under sub. (1) (a) and (d);

DHS 63.10(2)(b)2. 2. Be developed in collaboration with other CSP professional and paraprofessional staff, service provider staff, the client or guardian, if any, and, when feasible, the client’s family. The client’s participation in the development of treatment or service goals shall be documented;

DHS 63.10(2)(b)3. 3. Specify treatment goals along with the treatment, rehabilitation and service actions necessary to accomplish the goals. The goals shall be developed with both short-range and long-range expectations and shall be written in measurable terms;

DHS 63.10(2)(b)4. 4. Identify the expected outcomes and the staff or agencies responsible for providing the client’s treatment, rehabilitation and support services;

DHS 63.10(2)(b)5. 5. Describe criteria for termination of treatment, rehabilitation and support services; and

DHS 63.10(2)(b)6. 6. Be reviewed, approved and signed by the CSP’s psychiatrist and clinical coordinator and be included in the client’s treatment record.

DHS 63.10(2)(c) (c) Treatment or provision of services may begin before the treatment plans are completed.

DHS 63.10(2)(d) (d) The client’s progress and current status in meeting the goals set forth in the plan shall be reviewed by the staff working with the client at regularly scheduled case conferences at least every 6 months and shall be recorded in the client’s treatment record as follows:

DHS 63.10(2)(d)1. 1. The date and results of the review and any changes in the plan shall be recorded; and

DHS 63.10(2)(d)2. 2. The names of participants in the case conference shall be recorded.

DHS 63.10(2)(e) (e) The case manager shall discuss the results of the review required under par. (d) with the client or guardian, if any, and, if appropriate, the client’s parent and shall record the client’s or guardian’s acknowledgement of any changes in the plan.

DHS 63.10(3) (3) Place of treatment. Each CSP shall set a goal of providing over 50% of service contacts in the community, in non-office based or non-facility based settings. For a period of 2 years following the effective date of this chapter, a CSP shall submit to the department records of the places where treatment and services are provided to each client. The records shall cover time periods specified by the department.

DHS 63.10 History History: Cr. Register, April, 1989, No. 400, eff. 5-1-89.

DHS 63.11 DHS 63.11 Required program components.

DHS 63.11(1) (1) Services. A CSP shall provide or make arrangements for the provision of the services specified in this section.

DHS 63.11(2) (2) Treatment. The CSP shall provide or make arrangements for provision of treatment services, which shall include:

DHS 63.11(2)(a) (a) Crisis intervention services, including 24-hour telephone service, short-term emergency hospitalization and in-home or in-community emergency care by a CSP professional who has direct accessibility to the clinical coordinator or designated qualified staff member for consultation and assistance;

DHS 63.11(2)(b) (b) Symptom management or supportive psychotherapy by a CSP professional, including:

DHS 63.11(2)(b)1. 1. Ongoing assessment of the client’s mental illness symptoms and the client’s response to treatment;

DHS 63.11(2)(b)2. 2. Symptom education to enable the client to identify his or her mental illness symptoms;

DHS 63.11(2)(b)3. 3. Teaching of behavioral symptom management techniques to alleviate and manage symptoms not reduced with medication; and

DHS 63.11(2)(b)4. 4. Promotion of personal growth and development by assisting the client to adapt to and cope with internal and external stresses;

DHS 63.11(2)(c) (c) Medication prescription, administration, monitoring and documentation, as follows:

DHS 63.11(2)(c)1. 1. A psychiatrist or physician shall:

DHS 63.11(2)(c)1.a. a. Assess the client’s mental illness symptoms and behavior and prescribe appropriate medication;

DHS 63.11(2)(c)1.b. b. Regularly review and document the client’s mental illness symptoms and behavior response to the medication; and

DHS 63.11(2)(c)1.c. c. Monitor, treat and document any medication side effects;

DHS 63.11(2)(c)2. 2. A registered nurse may administer medication from a multidose container or by injection at the direction of a psychiatrist or another physician;

DHS 63.11(2)(c)3. 3. Staff may administer only single-unit oral medication doses that have been dispensed and labeled by a psychiatrist, another physician, a licensed pharmacist or a registered nurse at the direction of a psychiatrist or another physician;

DHS 63.11(2)(c)4. 4. Staff shall assess and document the client’s mental illness symptoms and behavior in response to medication and shall monitor for psychotropic medication side effects; and

DHS 63.11(2)(c)5. 5. Registered nurses shall report to the program psychiatrist and clinical coordinator and document in the chart adverse drug reactions and potential medication conflicts when drugs are prescribed by more than one physician; and

DHS 63.11(2)(d) (d) Psychiatric and psychological services, including:

DHS 63.11(2)(d)1. 1. Psychiatric evaluation by a psychiatrist; and

DHS 63.11(2)(d)2. 2. Psychological evaluation by a clinical psychologist; and

DHS 63.11(2)(e) (e) Family, individual or group psychotherapy by the clinical coordinator or designated staff member meeting qualifications under s. DHS 63.06 (2) (c).

DHS 63.11(3) (3) Rehabilitation. The CSP shall provide or make arrangements for provision of rehabilitation services, which shall include:

DHS 63.11(3)(a) (a) Employment-related services provided in community-based settings to assess the effect of the client’s mental illness on employment and to develop an ongoing employment rehabilitation plan to enable the client to get and keep a job. Employment-related services include:

DHS 63.11(3)(a)1. 1. Individualized initial and ongoing assessment by a CSP professional, including a thorough work and academic history and on-site work assessments in community-based, structured jobs;

DHS 63.11(3)(a)2. 2. Identification of behaviors that interfere with the client’s work performance and development of interventions to alleviate the problem behaviors by a CSP professional;

DHS 63.11(3)(a)3. 3. Individual vocational supportive counseling by a CSP professional to enable the client to identify and cope with symptoms of mental illness that affect his or her work;

DHS 63.11(3)(a)4. 4. Work-related supportive services, such as assistance with grooming and personal hygiene, securing appropriate clothing, wake-up calls, transportation, on-the-job support and crisis assistance; and

DHS 63.11(3)(a)5. 5. On-the-job performance assessment and evaluation by a CSP professional;

DHS 63.11(3)(b) (b) Social and recreational skill training, including supervised teaching activities and experiences provided individually or in small groups to:

DHS 63.11(3)(b)1. 1. Improve communication skills;

DHS 63.11(3)(b)2. 2. Facilitate appropriate interpersonal behavior; or

DHS 63.11(3)(b)3. 3. Familiarize clients with available social and recreational opportunities and increase their use of these opportunities; and

DHS 63.11(3)(c) (c) Activities of daily living services provided in community-based settings including individualized support, problem solving, training and supervision to assist the client to gain or utilize the skills required to:

DHS 63.11(3)(c)1. 1. Carry out personal hygiene and grooming tasks;

DHS 63.11(3)(c)2. 2. Carry out household activities, including housecleaning, cooking, grocery shopping and laundry;

DHS 63.11(3)(c)3. 3. Develop or improve money management skills; and

DHS 63.11(3)(c)4. 4. Use available transportation.

DHS 63.11(4) (4) Support services. The CSP shall provide or make arrangements for provision of support services, which shall include case management under s. DHS 63.12 and individualized support, problem solving, training and supervision to help the client obtain:

DHS 63.11(4)(a) (a) Services to meet physical health or dental health needs;

DHS 63.11(4)(b) (b) Needed legal services;

DHS 63.11(4)(c) (c) Needed transportation services;

DHS 63.11(4)(d) (d) Financial support such as supplemental security income, social security disability insurance and general relief and money management services; and

DHS 63.11(4)(e) (e) Living accommodations, including locating, financing and maintaining safe and normal living arrangements and enabling the client to relate to his or her landlord and neighbors in an acceptable manner.

DHS 63.11 History History: Cr. Register, April, 1989, No. 400, eff. 5-1-89.

DHS 63.12 DHS 63.12 Case management.

DHS 63.12(1) (1) Single point of contact for a client. Each CSP client shall have a designated case manager who shall be responsible for maintaining a clinical treatment relationship with the client on a continuing basis whether the client is in the hospital, in the community, or involved with other agencies. Case managers shall meet the qualifications for clinical coordinators under s. DHS 63.06 (2) (c) or staff under s. DHS 63.06 (4) (a) 1. to 8.

DHS 63.12(2) (2) Coordination of treatment.

DHS 63.12(2)(a) (a) The case manager shall work with other CSP professional and paraprofessional staff and other agencies to:

DHS 63.12(2)(a)1. 1. Coordinate the assessment under s. DHS 63.10 (1) and ensure that a diagnosis is made;

DHS 63.12(2)(a)2. 2. Develop and implement the treatment plan under s. DHS 63.10 (2); and

DHS 63.12(2)(a)3. 3. Directly provide or coordinate treatment and services.

DHS 63.12(2)(b) (b) The case manager shall work with other CSP staff and community agency staff to ensure that treatment plans are updated in accordance with s. DHS 63.10 (2) (a).

DHS 63.12(2)(c) (c) The case manager shall organize and conduct case-specific staffings with other agencies, as needed.

DHS 63.12(3) (3) Coordination of referrals.

DHS 63.12(3)(a) (a) A CSP shall have policies and procedures that facilitate coordination of referrals and ensure follow-up of clients referred to other community service providers.

DHS 63.12(3)(b) (b) The case manager shall work with other community agency or community service staff to:

DHS 63.12(3)(b)1. 1. Coordinate linkages and referrals;

DHS 63.12(3)(b)2. 2. Coordinate contracting for specialized assessment and diagnosis or treatment, rehabilitation and support services; and

DHS 63.12(3)(b)3. 3. Integrate other agency or service activities into the CSP treatment plan.

DHS 63.12(4) (4) Monitoring symptom status.

DHS 63.12(4)(a) (a) The case manager shall assess, on a consistent basis, the client’s symptom status. Changes in status shall be documented in the client’s treatment record to measure progress or decompensation.

DHS 63.12(4)(b) (b) The case manager shall keep the CSP program director and clinical coordinator informed of all changes in symptom status by signed notation in the client’s treatment record.

DHS 63.12(4)(c) (c) The case manager shall coordinate the provision of emergency services when a client is in crisis and shall provide documentation in the client’s treatment record of emergency services provided.