Section DHS 61.79 - Children and adolescent inpatient program The following personnel requirements are minimum. There is no intention to restrict new programs to these minimal staffing patterns. Existing treatment programs which exceed these requirements may not be reduced without extensive and thorough review and a clear realization of what services would be lost by reduction.
(1) REQUIRED PERSONNEL.(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.(b)Nursing service.1. The following schedule of licensed nursing coverage is minimal. Day Shift | Evening Shift | Night Shift* (see below) |
.64 hrs/pat/day | .64 | .32 |
or |
4.48 hrs/pat/wk | 4.48 | 2.24 |
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: Day Shift Children (0-12) | Evening Shift | Night Shift |
.98 hrs/pat/day | 1.28 | .64 |
or |
6.86 hrs/pat/wk | 8.96 | 4.48 |
Day Shift Adolescent (over 12) | Evening Shift | Night Shift |
.80 hrs/pat/day | 1.10 | .40 |
or |
5.60 hrs/pat/wk | 7.70 | 2.80 |
(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.(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.(e)Psychological service. Each service must provide a minimum of one hour per week of psychology time for each patient under care.(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.(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.(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.(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. See Image
(2) PROGRAM OPERATION AND CONTENT. (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.(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.(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.(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.(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.Wis. Admin. Code Department of Health Services DHS 61.79
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.Amended by, CR 20-068: am. (2) (a) Register November 2021 No. 792, eff. 1/1/2022