The centers shall provide the responsible board with a copy of the annual review of the service plan.
DHS 61.43 History
Cr. Register, January, 1980, No. 289
, eff. 2-1-80; corrections made under s. 13.93 (2m) (b) 7., Stats., Register, June, 1995, No. 474
; corrections in (1) and (2) made under s. 13.93 (2m) (b) 7., Stats., Register, October, 1999, No. 526
; corrections in (1) and (2) (a) made under s. 13.92 (4) (b) 7., Stats., Register November 2008 No. 635
Special living arrangements services.
Special living arrangements may provide living quarters, meals and supportive services up to 24 hour per day for people in need of assistance in the areas of community and daily living but who require less care and supervision than is characteristic of individuals needing domiciliary or nursing home care. Special living arrangement services may be provided in foster homes, group foster homes, halfway houses, community based residential facilities, child welfare institutions, homes and apartments.
Staff shall possess the personal qualities, skills and education necessary to meet the needs of the residents and comply with the appropriate sections of Wisconsin statutes, administrative codes and licensing rules.
Program requirements shall comply with appropriate sections of Wisconsin statutes, administrative codes and licensing rules.
The individual receiving special living arrangement services shall be employed or otherwise engaged away from the residential setting in accordance with the individual's service plan except in child welfare institutions.
When special living arrangements are provided on a respite basis they shall meet the requirements of this section.
Special living arrangement services shall be provided as recommended in the service plan.
Appointed staff supervising the special living arrangement shall send a written report to the case manager or his or her designee at least every 6 months. The report shall contain a statement on progress toward the goals of the service plan and the recommendations for change in the service plan.
DHS 61.44 History
Cr. Register, January, 1980, No. 289
, eff. 2-1-80.
Transportation services provide for the necessary travel of a developmentally disabled individual and if necessary, escorts to and from places in which the individual is receiving services recommended in the individual's service plan. Transportation may include taking services to the homebound, and includes but is not limited to delivery of raw materials and pick up of the finished product from homebound industries.
Any person operating a motor vehicle which transports either people with developmental disabilities or the products of their homebound industry, shall hold an appropriate operator's license from the department of transportation.
All motor vehicle operators shall be covered by liability insurance.
Motor vehicles shall be inspected by, and meet the requirements of the department of transportation.
When possible, regularly scheduled public transportation shall be used.
When possible, transportation services shall be coordinated with the efforts of voluntary agencies and other agencies serving community groups.
DHS 61.45 History
Cr. Register, January, 1980, No. 289
, eff. 2-1-80.
Protective services are a system of continuing socio-legal services designed to assist individuals who are unable to manage their own resources or to protect themselves from neglect, abuse, exploitation or degrading treatment and to help them exercise their rights as citizens. This system ensures that no right of a person with a developmental disability shall be modified without due process. It must be emphasized that insofar as protective services are concerned, it is not the services that are distinctive but rather the individual for whom the services are intended, along with reasons why the services are being provided.
Protective services shall be provided under applicable sections of chs. 48
, Stats., and applicable sections of the department's administrative code.
If any developmental disabilities services are provided as part of protective services, they shall comply with the appropriate standard.
DHS 61.46 History
Cr. Register, January, 1980, No. 289
, eff. 2-1-80; correction in (2) made under s. 13.92 (4) (b) 7.
, Stats., Register November 2008 No. 635
Inpatient program - introduction and definitions. DHS 61.70(1)(1)
The following standards have been developed for community inpatient mental health services receiving state aids, whether directly operated by counties or contracted with private providers. The standards are intended to be consistent with those stated in Standards for Psychiatric Facilities, published by the American Psychiatric Association, 1969; with the psychiatric footnotes to the Accreditation Manual for Hospitals, published by the Joint Commission on Accreditation of Hospitals, December, 1970; and with recent federal court decisions in Wisconsin and other states. They are intended to insure that each mental health inpatient service will provide appropriate treatment to restore mentally disordered persons to an optimal level of functioning and return them to the community at the earliest possible date. In order to do this the service must:
Have an ethical, competent staff responsible for carrying out a comprehensive treatment program;
Integrate its services with those provided by other facilities in the county which serve the mentally ill, mentally retarded, and alcoholics and drug abusers;
Preserve the dignity and rights of all its patients; and
"Community mental health inpatient services", hereafter called "services", means a county-operated unit, general hospital psychiatric unit, or private psychiatric hospital whose primary objective is to provide care and intensive treatment for the mentally ill, alcoholics and drug abusers.
"Patient" means anyone receiving care in a community mental health inpatient service.
DHS 61.70 History
Cr. Register, December, 1973, No. 216
, eff. 1-1-74; renum. from PW-MH 60.61, and am. (2), Register, September, 1982, No. 321
, eff. 10-1-82.
Inpatient program standards. DHS 61.71(1)(a)(a) Psychiatry.
Each mental health inpatient service shall have a psychiatrist who has competed an approved residency training program in psychiatry as its director of mental health services. This director shall be responsible for organization and maintenance of an active mental health treatment program and shall assume responsibility for the admission, treatment, discharge planning, and release of patients from the inpatient service. The director of mental health services and additional psychiatrists, as needed, shall be available for daily inpatient visits, in order to carry out an adequate treatment program. Additional provision shall be made for emergency contact between such visits. Each service shall provide for a minimum of .8 hour a week psychiatric treatment time per patient under care. The psychiatric staff will assume responsibility for patient care, utilizing the services of the medical staff for necessary general medical care.
Registered nurses and licensed practical nurses. Each service shall employ sufficient registered nurses and licensed practical nurses to provide full-time nursing service for each shift 7 days a week. All registered nurses and licensed practical nurses employed to provide nursing service must have a current Wisconsin certificate to practice as a RN or LPN, and appropriate experience and/or further education for the responsibility of the position. The following schedule of licensed nursing coverage is minimal, with the added provisions that at least one staff member on the day and evening shift be a registered nurse. In computing the number of licensed personnel needed on each shift, the totals should be rounded up if .5 or more, down if less than .5. There must always be at least one licensed person on duty on each shift, even if the number required is less than .5.
- See PDF for table
2. Aides and other paraprofessionals.
Each service shall employ a sufficient number of aides or other paraprofessionals to provide a ratio of 1.25 hours of such time per patient per day. In computing this ratio, dietary, maintenance and housekeeping staff, volunteers or building security shall not be included as aides. There shall be at least one aide or other treatment staff person on duty in each ward when patients are present to insure adequate patient supervision. In determining adequate care the department has the authority to determine what constitutes units of coverage. Paraprofessionals entitled mental health technicians or mental health workers may be employed. They shall be selected on the basis of their personal qualities and aptitude. They must have a period of orientation and inservice training, and work under the supervision designated treatment staff.
(c) Activity therapy.
Each service shall employ at least one full-time registered occupational therapist and one certified occupational therapy assistant or a graduate of the division of mental hygiene's Activity Therapy Assistant Course. Where other health care services are located in the same or continuous property, one full-time occupational therapist may serve the other health care service as well as the inpatient mental health services. The mental health inpatient service shall maintain a ratio of 1.6 hours of activity therapy staff time per patient per week. A registered music therapist or art therapist may fill the requirement for activity therapy positions after one registered occupational therapist has been employed. Where work therapy is utilized, each service shall designate the registered occupational therapist, unless the service has employed a vocational rehabilitation counselor. In this circumstance the vocational rehabilitation counselor shall be in charge of industrial therapy.
(d) Social services.
Each service shall employ one full-time social worker and provide for a minimum of .8 hour a week social work time per patient under care. Social workers must have a master's degree from an accredited school of social work or a bachelor's degree in social work, or social science. The first social worker hired must have a master's degree in social work.
(e) Psychological services.
Each service shall employ or contract for the services of a clinical psychologist licensed in the state of Wisconsin to provide psychological testing, counseling and other psychological services. A minimum ratio of .8 hour per week psychology time per patient under care shall be provided.
A special exception to any of the foregoing personnel requirements may be granted in unusual circumstances, if a service develops an alternative proposal, satisfactory to the department, to provide an innovative approach to patient care, which provides levels of services equivalent to those required in these standards. An exception may also be granted to a proposal which substitutes personnel with qualifications equal to those listed above.
General consideration. An important factor in a mental health treatment program in an inpatient service is a therapeutic atmosphere. Although intangible, the presence or lack of this atmosphere is pervasive and immediately apparent. It is important that all staff members treat each patient with respect, providing all freedoms his or her condition permits and allowing the patient to retain a sense of individuality, freedom of choice and independence. Patients shall be encouraged to behave appropriately and in a socially acceptable way. Patients shall be permitted to dress in individually selected street clothing and retain sentimentally important personal possessions as clinically indicated. They shall be permitted to write letters, subject to restrictions only as clinically indicated. Home-like living quarters with drapes, pictures and furnishings shall be provided, and normal needs for privacy and feelings of modesty respected. Conversely, severe restriction of freedom of movement by prison-like practices; implicit or explicit expectations of dangerous, unpredictable behavior; use of punishment, especially seclusion and restraint, in the guise of therapy; exploitation of patient labor; use of spoons only as eating utensils and the like, shall not be permitted.
2. Staff functions.
To maximize the therapeutic effect of hospitalization, all aspects of mental health inpatient care must be integrated into a continuous treatment program. The activities of all staff— psychiatrists, physicians, psychologists, social workers, activity therapists, nurses, aids, chaplains and others—must be coordinated in a concerted treatment effort, utilizing the special skills and roles of each in a complementary manner to effect a total therapeutic purpose. The services of volunteers must be used in the same way. The specific treatment responsibilities of psychiatrists, psychologists, social workers and activity therapists are generally well understood, but the contributions of volunteers and other staff, such as chaplains and food service workers, also have important implications for patients' welfare. Their work must be carried out in a manner which furthers the total treatment program. Nursing staff shall be full partners in therapeutic team and, as a significant portion of their nursing responsibilities, shall participate in activities such as group therapy, supportive counseling, and socializing experience for patients. Mental health aides are valuable contributors to the therapeutic milieu. As staff members who are constantly in close contact with patients, their activities are to be geared carefully to provide patients with emotional support and respite from inquiry into their difficulties, promote their independence, and provide them with companionship and assistance in personal care and grooming, recreational activities, social behavior, care of property and day to day living.
Every newly received patient shall be evaluated by the professional staff within 48 hours after admission. This evaluation shall include psychiatric examination, the initiation of family contact and social history taking, and psychological examination when indicated. A plan of treatment and/or disposition shall be formulated and periodically reviewed. Progress notes on all cases shall be written frequently and regularly as the patient's condition requires, but in no instance less than once a week.
(c) Clinical records.
The mental health inpatient service shall maintain a current treatment plan and clinical record on each patient admitted to the service.
(d) Drug and somatic therapy.
Every patient deemed an appropriate candidate shall receive treatment with modern drugs and somatic measures in accordance with existent laws, established medical practice, and therapeutic indications as determined by current knowledge.
(e) Group therapy.
Each mental health inpatient service is encouraged to develop group therapy programs, including remotivation groups where appropriate. Nursing and aid staff should be trained in these therapy techniques.
(f) Activity therapy.
The occupational therapist shall organize and maintain an activity therapy program on a year-round full time basis. This treatment and rehabilitation program shall be reality oriented and community focused. The program shall be carried on both in the facility and in the community. The activity therapy department shall also provide a program of recreational activities to meet the social, diversional and general developmental needs of all patients. A recreational therapist may be employed for this purpose. Activity therapy should be part of each patient's treatment plan and should be individually determined according to needs and limitations. The record of the patient's progress in activity therapy should be recorded weekly and kept with the patient's clinical record.
(g) Industrial therapy.
Industrial therapy assignments shall be based on the therapeutic needs of the patient rather than the needs of the inpatient service. Industrial therapy shall be provided only upon written order of the psychiatrist. The written order shall become part of the patient's clinical record. The industrial therapy assignment of patients shall be reviewed by the treatment staff weekly. The review shall be written and included in the patient's clinical record. Continued use of industrial therapy will require a new order from the psychiatrist weekly.
Adequate religious services must be provided to assure every patient the right to pursue the religious activities of his or her faith.
Each service shall provide regularly scheduled visits by clergy.
Each service may utilize the services of a clinical pastoral counselor as a member of the treatment team, provided he or she has had clinical training in a mental health setting.
(i) Use of mechanical restraint and seclusion.
Mechanical restraint and seclusion are measures to be avoided if at all possible. In most cases control of behavior can be attained by the presence of a sympathetic and understanding person or appropriate use of tranquilizers and sedatives upon order of the psychiatrist. To eliminate unnecessary restraint and seclusion, the following rules shall be observed.
Except in an emergency, no patient shall be put in restraints or seclusion without a medical order. In an emergency the administrator of the service or designee may give the order. Such action shall be reviewed by a physician within 8 hours.
Patients in seclusion—restraints must be observed every 15 minutes and a record kept of observations.
(j) Extramural relations.
Inpatient mental health services are one component of community based comprehensive mental health program provided or contracted by the unified boards under s. 51.42
, Stats. As a component of the community based comprehensive program the inpatient service program must be integrated and coordinated with all services provided through the unified board. Evidence of integration and coordination shall be detailed in the unified board's plan. Professional staff should be used jointly by the inpatient and other services and clinical records shall be readily transferable between services.
1. Alternate care settings.
Every effort shall be made to find and develop facilities for patients who require medical or social care or less than full time inpatient mental health treatment. Such facilities, known as alternate care settings, shall include but not be limited to group homes, foster homes, residential care facilities, nursing homes, halfway houses, partial hospitalization and day services. Special effort shall be made to place patients in family care settings whenever possible.
2. Vocational rehabilitation.
The inpatient service shall establish an ongoing relationship with vocational rehabilitation counselors. Every effort shall be made to identify patients amenable to vocational rehabilitation and to refer them to the appropriate agency. Sheltered workshops shall be utilized to the fullest possible extent.
3. Family and community ties.
Active effort shall be made to maintain the family and community ties of all patients. In many cases the inpatient service staff must take the initiative to develop and maintain family contact. Visiting of patients in the hospital and patient visits outside the hospital shall be as frequent and as long as circumstances permit. Maintaining community ties would include such activities as arranging for patients to do their own shopping, attending church, continuing employment, and participating in recreational activities within the community.
DHS 61.71 History
Cr. Register, December, 1973, No. 216
, eff. 1-1-74; renum. from PW-MH 60.62, Register, September, 1982, No. 321
, eff. 10-1-82; corrections made under s. 13.93 (2m) (b) 5., Stats., Register, June, 1995, No. 474
Enforcement of inpatient program standards. DHS 61.72(1)(1)
All community mental health inpatient services receiving state aid must meet the above standards. Departmental personnel familiar with all aspects of mental health treatment shall review each inpatient service at least annually in connection with state funding of county programs.
State funding shall be discontinued to any inpatient service not maintaining an acceptable program in compliance with the above standards after the service has had reasonable notice and opportunity for hearing by the department as provided in ch. 227, Stats.
The service will be deemed in compliance with these standards if its governing body can demonstrate progress toward meeting standards to the department; however, all services must be in full compliance with these standards within a maximum of 2 years of the issuance of these rules.
DHS 61.72 History
Cr. Register, December, 1973, No. 216
, eff. 1-1-74; renum. from PW-MH 60.63, Register, September, 1982, No. 321
, eff. 10-1-82.
DHS 61.73 Other community program standards - introduction.
The following standards have been developed for community mental health programs receiving state aids, whether directly operated by counties or contracted from private providers. The standards are intended to insure that each mental health program will provide appropriate treatment to restore mentally disordered persons to an optimal level of functioning and, if possible, keep them in the community.
DHS 61.73 History
Cr. Register, March, 1977, No. 255
, eff. 4-1-77; renum. from PW-MH 60.64, Register, September, 1982, No. 321
, eff. 10-1-82.
Day treatment program.
Day treatment is a basic element of the mental health program providing treatment while the patient is living in the community. Its services shall be closely integrated with other program elements to ensure easy accessibility, effective utilization and coordinated provision of services to a broad segment of the population. Day treatment provides treatment services for patients with mental or emotional disturbances, who spend only part of the 24 hour period in the services. Day treatment is conducted during day or evening hours.
Day treatment staff shall include various professionals composing a mental health team. They shall be directly involved in the evaluation of patients for admission to the service, determining plan of treatment and amount of time the patient participates in the service and in evaluating patients for changes in treatment or discharge.
A qualified mental health professional shall be on duty whenever patients are present.
A psychiatrist shall be present at least weekly on a scheduled basis and shall be available on call whenever the day treatment service is operating.
A social worker shall participate in program planning and implementation.
A psychologist shall be available for psychological services as indicated.
A registered nurse and a registered activity therapist shall be on duty to participate in program planning and carry out the appropriate part of the individual treatment plan.
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.
Volunteers may be used in day treatment and programs are encouraged to use the services of volunteers.
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.
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.
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.