Place where comments are to be submitted and deadline for submission
Comments may be submitted to the agency contact person that is listed above until the deadline given in the upcoming notice of public hearing. The deadline for submitting comments and the notice of public hearing will be posted on the Wisconsin Administrative Rules Website at http://adminrules.wisconsin.gov after the hearing is scheduled.
RULE TEXT
SECTION 1. Chapter DHS 40 is repealed and recreated to read:
MENTAL HEALTH DAY TREATMENT FOR YOUTH
DHS 40.01 Authority and purpose.
This chapter is promulgated under the authority of s. 51.42 (7) (b), Stats., and is intended to regulate programs providing mental health day treatment services for youth.
DHS 40.02 Applicability. This chapter applies to all programs providing mental health day treatment services for youth in the state of Wisconsin. This chapter does not regulate other providers of day treatment services for youth, such as alcohol and other substance use disorder treatment programs regulated by ch. DHS 75. If a comprehensive program offers services to youth in addition to mental health day treatment, this chapter applies only to those program components that offer mental health day treatment. DHS 40.03 Definitions. In this chapter:
(1)
“Advanced practice nurse” has the meaning given in s. N 8.02 (1).(2)
“Advanced practice nurse prescriber” has the meaning given in s. N 8.02 (2).(3) “Assessment” means the process required under s. DHS 40.13. (4) “Biopsychosocial information” means the combination of physical, psychological, social, environmental, and cultural factors that influence a youth’s development and functioning including underlying driving forces or unmet needs that are expressed through challenging behavior that a youth is exhibiting.
(5) “Care coordination” means efforts by day treatment programs to work jointly with other service systems and agencies including: schools, corrections, child welfare, substance use disorder treatment, and mental and physical health providers, in order to enhance services and supports and reduce barriers to service delivery.
(6) “Chemical restraint” means any medication or substance that may decrease a youth’s independent functioning and that is not administered pursuant to a current treatment plan.
(7) “Client” means a youth receiving mental health day treatment services from a program.
(8) “Clinical collaboration” means a joint intellectual and clinical effort by mental health professionals, intended to produce therapeutic benefits and favorable outcomes.
(9) “Clinical supervision” means the process described in s. DHS 40.10 (5). (10) “Community-based program” means a program providing mental health day treatment services for youth in a facility that is not affiliated with a hospital.
(11) “Co-occurring disorder” means any combination of both a mental health disorder and a substance use disorder.
(12) “Crisis response services” means written policies and procedures for identifying risk of suicidal ideation, attempted suicide, or risk of harm to self or others.
(13) “Cultural responsiveness” means the process by which staff engage respectfully and effectively with a youth or legal representative of all cultures, languages, classes, races, ethnic backgrounds, disabilities, religions, genders, sexual orientations, and other diversity factors in a manner that does all of the following:
(a) Recognizes, affirms, and values the worth of youth, families and communities.
(b) Protects and preserves the dignity of youth, families and communities.
(c) Provides choices for action that are aligned with the context and preferences that derive from their culture and worldview.
(14) “Deficiency” means a failure to meet a requirement of this chapter.
(15) “Department” means the Wisconsin department of health services.
(16) “Educational service” means a program provided by a local education agency that has a unique identification code assigned by the Wisconsin department of public instruction and that provides or directly supervises PK-12 services.
(17) “Evidence-based practice” means a practice, such as a systemic decision-making process or a service that has been shown, through available scientific evidence, to consistently improve measurable client outcomes.
(18) “Family-driven care” means care that facilitates involvement by family and legal representatives in a youth’s care, in order to improve outcomes.
(19) “Gender-sensitive service” means a service that comprehensively addresses gender-related needs and fosters positive gender identity development.
(20) “Intensive Hospital-based program” means a program providing mental health day treatment services for youth with an acute level of need. This setting is meant to support youth with severe symptomology who need closer supervision.
(21) “Legal representative” means any of the following:
(a) A guardian of the person, as defined under s. 54.01 (12), Stats. (b) An adult client’s health care agent, as defined in s. 155.01 (4), Stats. (c) A parent of a minor as defined in s. 48.02 (13), Stats., a guardian as defined in s. 48.02 (8), Stats., or a legal custodian, as defined in s. 48.02 (11), Stats. (d) Any other individual or entity with legal authority to represent the client.
(22) “Licensed treatment professional” means any of the following, whose license is in good standing at the time of practice:
(a) A physician licensed under s. 448.03 (1) (a), Stats., who has completed a residency in psychiatry. (b) A psychologist or a private practice school psychologist licensed under ch. 455, Stats. (c) A marriage and family therapist licensed under s. 457.10 or 457.11, Stats. (d) A professional counselor licensed under s. 457.12 or 457.13, Stats. (e) A clinical social worker licensed under s. 457.08 (4), Stats. (23) “Local educational agency” means a school district, as provided in s. 115.01 (3), Stats., a cooperative educational services agency (CESA) established under ch. 116, Stats. or a board established under s. 115.817, Stats. (24) “Major deficiency” means a determination by the department that any of the following occurred:
(a)
The program or a staff member created a risk of harm to a client or violated a client right created by this chapter. (b) A staff member had sexual contact, as defined in s. 940.225 (5)(b), Stats., with a client. (d) A staff member was included on the Caregiver Misconduct Registry under ch. DHS 13 and did not receive a rehabilitation determination from the department for all instances of substantiated misconduct. (e) The program or a staff member submitted or caused to be submitted a false statement for purposes of obtaining certification under this chapter.
(f) A license, certification, or required approval of the program expired, was revoked, or was suspended by any local, state, or federal authority, or the program’s Medicaid or Medicare provider certification was suspended or terminated for any basis under s. DHS 106.06 or federal law, or by any local, state, or federal authority. (25) “Measurable objective” means a clear statement of the behavioral changes that are to be made, the conditions under which the behaviors are to occur, and a criterion for success.
(26) “Mechanical restraint” means any physical device, used for the purpose of limiting or controlling a youth’s movement.
(27) “Mental health day treatment service” means non-residential care, prescribed by a physician, and provided in a clinically supervised therapeutic milieu that provides an integrated system of individual, family, and group psychotherapy, care coordination, and support services pursuant to a treatment plan.
(28) “Mental health professional” means a licensed treatment professional, a qualified treatment trainee, or a recognized psychotherapy practitioner that practices within the scope of their practice.
(29) “Mental health support worker” means an individual who has a bachelor’s or master’s degree and provides services to implement the treatment plan.
(30) “Mental health technician” means an individual who assists mental health support workers and mental health professionals with implementation of support services.
(31) “Mental illness” means a mental health disorder that a mental health professional determines substantially diminishes a youth’s ability to carry out age-appropriate activities of daily living, except mental illness does not include dementia or a developmental disability.
(32) “Occupational therapist” has the meaning given in s. 448.96 (4), Stats. (33) “Occupational therapy assistant” has the meaning given in s. 448.96 (6), Stats. (34) “Parent peer specialist” means a person with knowledge gained from parenting youth with social, emotional, behavioral, mental health or substance use challenges and who has training to increase their skills to guide and support other parents or those in a parenting role.
(35) “Physical restraint” means use of physical force for the purpose of interfering with the movement of a youth, which includes forcibly moving or transporting a youth from one location to a seclusion room or area. Physical restraint does not include briefly holding a youth, without force, to calm or comfort her or him, or holding a youth’s hand to safely escort him or her from one area to another and similar physical guidance and prompting techniques of brief duration.
(36) “Positive behavior support” means specific proactive strategies, documented in the treatment plan, intended to replace challenging behaviors with positive and functional alternatives.
(37) “Physician” has the meaning given in s. 448.01 (5), Stats. (38) “Physician assistant” has the meaning given in s. 448.01 (6), Stats. (39) “Prescriber” means a physician, a physician assistant acting within the conditions and limitations set forth in s. 7, or an advanced practice nurse prescriber acting within the conditions and limitations set forth in s. N 8.06. (40) “Program” means a community-based program or a hospital-based program.
(41) “Psychotherapy” has the meaning given in s. 457.01 (8m) for marriage and family therapy, professional counseling, and social workers or 455.01 (6), Stats for psychologists (42) “Psychotropic medication” means a prescription drug as defined in s. 450.01 (20), Stats., that is prescribed by a prescriber to treat or manage mental illness. (43) “Qualified treatment trainee” means either of the following:
(a) A graduate student who is enrolled in an accredited institution in psychology, counseling, marriage and family therapy, social work, nursing or a closely related field and is doing a supervised practicum for their graduate degree program.
(b) A person who has been awarded a graduate degree by an accredited institution and has completed coursework in psychology, counseling, marriage and family therapy, social work, nursing or a closely related field who has not yet completed the applicable supervised practice requirements described under s. MPSW 4.01, 12.01, or 16.04, or Psy 2.10. (44) “Recognized psychotherapy practitioner” means an individual who may lawfully practice psychotherapy within the scope of a license, permit, registration or certificate granted by this state, other than under ch. 455 or 457, Stats. (45) “Registered nurse” means a person licensed under s. 441.06, Stats. as a registered nurse. (46) “Seclusion” means the involuntary confinement and isolation in a room or area from which the youth is prevented from leaving.
(47) “Sensory interventions” means a treatment or therapy that makes use of, or aims to improve, sensitivity to one or more of the senses.
(48) “Service” means a crisis response service, a mental health day treatment service, a support service, transition service, trauma-informed service, or minimum required service under s. DHS 40.07 (4). (49) “Severe emotional disturbance” means an emotional or behavioral problem for a youth that currently meets, or at any time during the past year, met criteria for a mental disorder specified within a recognized diagnostic classification, and that produces a functional impairment which substantially interferes with or limits functioning in family, school, employment, relationships, or community activities.
