Section DHS 40.10 - Required personnel and services(1) OPERATIONAL RESPONSIBILITIES. A program shall include all of the following administrators: (a) A program director who is responsible for program operations and ensuring that the program is in compliance with this chapter and other applicable state and federal laws.(b) A clinical coordinator who is responsible for ensuring that all staff members providing mental health services have the qualifications required for their roles in the program and comply with all requirements relating to assessment, treatment planning, service delivery, and service documentation. 1. The program director may also serve as the clinical coordinator, if the program director is qualified under s. DHS 40.09(3) (a).2. The program director shall identify one or more staff members qualified under s. DHS 40.09 (3) (a) to (e) to whom authority may be delegated in the absence of the clinical coordinator. The clinical coordinator or designee shall be on the premises at all times that youth are present at a program.(2) STAFFING REQUIREMENTS. At all times that youth are present at a program, the program shall have a minimum of two staff members qualified under s. DHS 40.09 (3) on site, at least one of whom shall be a mental health professional. The number of staff available shall be based on meeting the treatment needs of youth based on individualized treatment plans, with additional staff present when higher levels of clinical needs are indicated. Calculation of the staff-to-client ratios for the program shall not include volunteers. Programs shall meet all of the following staffing requirements:(a) If more than 10 youth are present at a community-based program, an additional staff member qualified under s. DHS 40.09 (3) shall be present for every 10 additional youth.(b) If more than 10 youth are present at a hospital-based program, an additional staff member qualified under s. DHS 40.09 (3) shall be present for every 5 additional youth.(3) SERVICE REQUIREMENTS. A program shall make available at least the following hours of direct clinical services, provided either by program staff members or professionals under contract to the program: (a) A community-based day treatment program shall comply with all of the following: 1. One hour per week of consultation shall be provided by a psychiatrist or advanced practice nurse prescriber. If a program is unable to utilize a psychiatrist or advanced practice nurse prescriber, they may utilize a psychologist as long as there is a written plan in place assuring that consultation with a psychiatrist or advanced practice nurse prescriber occurs for medication related concerns at least monthly or more frequently based on the individual needs of the youth.2. One hour per week of health-related services shall be provided by a physician, physician assistant, advanced practice nurse, or registered nurse for every 4 full-time youth in the program.3. Six hours per week of group sessions shall be provided in the program. Only a master's-level mental health professional may provide psychotherapy group sessions. A mental health support worker may provide non-psychotherapy group sessions. Group sessions shall include no more than 10 youth with one staff or a maximum of 12 youth if 2 staff are present with the group.4. One hour per week of care coordination services shall be provided by a mental health support worker or a mental health professional for every 2 full-time youth in the program.5. Two hours per week of individual or family psychotherapy shall be provided by a mental health professional for each full-time youth in the program. One of the two required hours may be provided by a mental health support worker if they are under the supervision of the mental health professional implementing a piece of the individualized treatment plan.6. At least 2 hours per week of support services shall be provided by mental health professionals, mental health support workers, mental health technicians, occupational therapists, or therapeutic specialists in the program.(b) Intensive hospital-based day treatment programs shall comply with all of the following: 1. One hour per week of consultation shall be provided by a psychiatrist or advanced practice nurse prescriber.2. One hour per week of health-related services shall be provided by a physician, physician assistant, advanced practice nurse, or registered nurse for every 4 full-time youth in the program.3. Crisis response, medical, and nursing services shall be readily available at all times youth are present in the program.4. A physician, physician assistant, registered nurse, or advanced practice nurse shall be on duty and on-site in the program at all times that youth are present.5. Eight hours per week of group sessions shall be provided in the program. Only a master's-level mental health professional may provide psychotherapy group sessions. A mental health support worker may provide non-psychotherapy group sessions. Group sessions shall include no more than 10 youth with one staff or a maximum of 12 youth if 2 staff are present with the group.6. One hour per week of care coordination services shall be provided by a mental health support worker or mental health professional for every full-time youth in the program.7. Four hours per week of individual or family psychotherapy shall be provided by a mental health professional for each full-time youth in the program. Two of the four required hours may be provided by a mental health support worker if they are under the supervision of the mental health professional implementing a piece of the individualized treatment plan.8. At least 4 hours per week of support services shall be provided by mental health professionals, mental health support workers, mental health technicians, occupational therapists, or therapeutic specialists in the program.(4) HOURS OF OPERATION. The amount of time a youth spends at a program shall be established by the individual treatment plan developed under s. DHS 40.14 for each youth, but a program shall be in operation and able to provide services for the following period: (a) A community-based program shall be in operation and available to provide services to youth for a minimum of 4 hours a day, 5 days a week, and may suspend operations for no more than 4 weeks each year.(b) An intensive hospital-based program shall be in operation and available to provide services to youth for a minimum of 6 hours a day, 5 days a week, and may suspend operations for no more than 4 weeks each year.(c) Any youth participating for less than the minimum hours of operation in par. (a) or (b) shall be designated a part-time youth. Two part-time youth shall be calculated as the equivalent of one full-time youth.(5) CLINICAL SUPERVISION. (a) The clinical coordinator shall have responsibility for oversight of the job performance and actions of each staff member who is providing clinical services and support services, and require each staff member to adhere to all laws and regulations governing care and treatment and the standards of practice for their individual professions.(b) Each program shall develop and implement a written policy for clinical supervision and clinical collaboration designed to provide sufficient guidance to assure the delivery of effective services. Each policy shall address all of the following: 1. A system to determine the status and achievement of youth outcomes to determine if treatment provided is effective, and a system to identify any necessary corrective actions.2. Identification of clinical issues, including incidents that pose a significant risk of an adverse outcome for youth that should warrant clinical collaboration, or clinical supervision that is in addition to the supervisions specified under s. MPSW 4.01, 12.01, or 16.04, or s. Psy 2.10, or for a recognized psychotherapy practitioner, whichever is applicable.(c) Clinical supervision shall be documented in a supervision or collaboration record, containing entries that are signed and dated by the staff member providing supervision.(d) Clinical supervision shall comply with s. MPSW 4.01, 12.01, or 16.04, or s. Psy 2.10, whichever is applicable.(6) PERSONNEL ORIENTATION AND TRAINING. (a)General requirement. The program director shall ensure each staff member and volunteer receives orientation and ongoing training necessary to perform his or her duties. The program shall develop a written orientation policy.(b)Orientation. The program shall maintain documentation showing that each new staff member listed under s. DHS 40.09 (3) (a) to (f) has completed the training requirements specified in subds. 1. to 16., either as part of orientation to the program or as part of prior education or training. The program director shall require all other staff members and volunteers to complete only the training requirements specified under this paragraph that are necessary, as determined by the program director, for the staff member or volunteer to successfully perform job duties. Training requirements include all of the following: 1. A review of this chapter.2. A review of the program's policies and procedures.3. Mental health treatment concepts applicable to providing day treatment services, including the principles of trauma-informed services and trauma history as they are specifically implemented through the program's operations and interactions with youth, the manner in which trauma may be a compounding variable in treatment, and how to identify and anticipate triggers related to trauma that lead to behavior and mental health symptoms.4. Use of sensory interventions and strategies that promote self-regulation.5. Techniques and procedures for providing emergency interventions.6. Principles and techniques for developing and providing culturally responsive and gender-sensitive mental health services.7. The reactions and side effects of psychotropic medication.8. Techniques for assessing and responding to the needs of youth who have challenges with co-occurring illnesses and disabilities.9. How to assess a youth to detect suicidal tendencies and to manage youth at risk of attempting suicide or causing harm to self or others.10. Resiliency concepts and principles that ensure connection to others and to the community.11. Applicable parts of chs. 48, 51, 55, 115, and 938, Stats., and any related administrative rules.12. The provisions of ch. DHS 94 and s. 51.61, Stats., regarding client rights.13. Current standards regarding documentation and the provisions of 45 CFR parts 160, 162, 164, 42 CFR part 2 regarding confidentiality of treatment records, s. 51.30, Stats., and ch. DHS 92.14. The basic provisions of civil rights laws, including the Americans with Disabilities Act of 1990 and the Civil Rights Act of 1964, as the laws apply to staff members providing services to youth with disabilities.15. Job responsibilities of staff members in the program.16. Any other subject that the program determines is necessary to enable the staff member to perform the staff member's duties effectively, efficiently, and competently.(c)Ongoing training.1. Each program shall develop a written training plan for each staff member, which shall include all of the following: a. Time set aside for training.b. Discussion and presentation of principles and methods of treatment for youth with mental illness or severe emotional disturbance.2. Each staff member who provides direct services to youth shall participate in a minimum of 30 hours of documented training each year on topics relevant to that staff member's responsibilities in the program and specific to the ages of the youth served in the program. A maximum of 18 hours of this training may include in-service and consultation provided by staff members or consultants of the program.(d)Department review of training. Documentation of training shall be made available to department staff upon request.Wis. Admin. Code Department of Health Services § DHS 40.10
Cr. Register, August, 1996, No. 488, eff. 9-1-96.Adopted by, CR 19-018: cr. Register June 2020 No. 774, eff. 7-1-20; correction in (3) (a) 3., (b) 5., (4) (c), (5) (b) 2., (d), (6) (b) (intro.), 13. made under s. 35.17, Stats., Register June 2020 No. 774, eff. 7/1/2020Amended by, CR 23-053: am. (2) (intro.) Register September 2023 No. 813, eff. 10/1/2023Copies of the form for reporting these deaths can be obtained from any Department regional office. Department regional offices are located in Eau Claire, Green Bay, Madison, Milwaukee, Rhinelander, Spooner and Waukesha.