Section DHS 63.08 - Criteria for admission(1) CRITERIA. Admission to a CSP shall be limited to an individual who has chronic mental illness which by history or prognosis requires repeated acute treatment or prolonged periods of institutional care and who exhibits persistent disability or impairment in major areas of community living as evidenced by: (a)1. A condition of chronic mental illness and a diagnosis listed in the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) within one of the following classification codes: a. 295.1, .2, .3, .6 and .9 - Schizophrenia;b. 296.2, .3, .4, .5, .6 and .7 - Affective disorders;c. 297.1 - Delusional disorder; ord. 295.7 and 298.9 - Other psychotic disorders.2. A significant risk of either continuing in a pattern of institutionalization or living in a severely dysfunctional way if CSP services are not provided; and3. Impairment in one or more of the functional areas listed under sub. (2); or(b)1. A condition of chronic mental illness with another diagnosis listed in the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R), provided that documentation in the client record shows that: a. There have been consistent and extensive efforts to treat the client, such as use of special structured housing, more frequent outpatient appointments combined with proactive efforts such as home visiting when the client does not come in for appointments, cooperative efforts by various outpatient, housing, vocational and crisis agencies to coordinate and plan treatment and face-to-face crisis intervention services on a regular basis, with or without crisis housing. The efforts have persisted for at least a year, except in unusual circumstances such as a serious and sudden onset of dysfunction, causing the client's condition to move beyond basic outpatient clinical standards of practice; andb. The client exhibits persistent dangerousness to self or others;2. A significant risk of either continuing in a pattern of institutionalization or living in a severely dysfunctional way if CSP services are not provided; and3. Impairment in one or more areas listed under sub. (2).(2) AREAS OF FUNCTIONAL IMPAIRMENT. The functional areas in which individuals admitted to a CSP may show impairment are as follows:(a)Vocational, educational or homemaker functioning.1. Impairment in vocational functioning is manifested by an inability to be consistently employed at a self-sustaining level or an ability to be employed only with extensive supports, except that a person who is able to earn sustaining income but is recurrently unemployed because of acute episodes of mental illness shall be considered vocationally impaired; Note: The following are examples of persons who function at a fairly high level in general terms but still manifest vocational impairment:
A person who works 30 hours a week for years at a sheltered workshop at minimum wage, enough to sustain himself or herself, but who has shown repeated inability to work in competitive job sites because of loss of support and of the structure of sheltered work; and
A person who works 40 hours a week at a wage that may be somewhat more than minimum without extensive supports but who is unemployed 2 to 4 months of most years because of acute psychosis and loses his or her job when psychotic.
2. Impairment in educational functioning is manifested by an inability to establish and pursue educational goals within a normal time frame or without extensive supports; Note: As an example, protracted part-time or intermittent full-time courses of study indicate impairment when goals are not being met or repeated class failure or frequent changes in major areas of study manifest an impairment in educational functioning.
3. Impairment in homemaker functioning is manifested by an inability to consistently and independently carry out home management tasks, including household meal preparation, washing clothes, budgeting and child care tasks and responsibilities; and4. When part-time homemaker and educational or vocational roles coexist, the functional level of the combined roles shall be assessed according to existing community norms;(b)Social, interpersonal or community functioning.1. Impairment in social or interpersonal functioning is manifested by a person's inability to independently develop or maintain adult social relationships or to independently participate in adult social or recreational activities and is evidenced by: a. Repeated inappropriate or inadequate social behavior or an ability to behave appropriately or adequately only with extensive or consistent support or coaching or only in special contexts or situations, such as social groups organized by treatment staff; orb. Consistent participation in adult activities only with extensive support or coaching and when involvement is mostly limited to special activities established for the mentally ill or other persons with interpersonal impairments;2. Impairment in community functioning is manifested by a pattern of significant community disruption, including family disruption or social unacceptability or inappropriateness, that may not recur often but is of such magnitude that it results in severe consequences, including exclusion from the person's primary social group or incarceration, or in severe impediments to securing basic needs such as housing; and Note: The following are examples of higher functioning persons who still manifest the impairments under par. (b):
A person who socialized appropriately and effectively in one-to-one contacts with staff or in social groups organized by a CSP but is very isolative otherwise and does not socialize on his or her own;
A person who anxiously participates in a community group or activity only with much weekly coaching by and frequent accompaniment of treatment staff, but who does not reach the point of going to this activity on his or her own or with only minimal coaching;
A person who socializes on his or her own in relationships and groups, but who, after a period of time, drives away many friends because of inappropriate or ineffective behavior and therefore is recurrently lonely; and
A divorced woman's periodic threats to "steal" her children (who are in the custody of her ex-husband) from their day care center that lead to loss of visiting privileges with the children and therefore loss of the emotional sustenance the children bring.
(c)Self-care or independent living. Impairment in self-care or independent living is manifested by: 1. A person's inability to consistently perform the range of practical daily living tasks required for basic adult functioning in the community, including:a. Grooming, hygiene, washing of clothes and meeting nutritional needs;b. Care of personal business affairs;c. Transportation and care of residence;d. Procurement of medical, legal and housing services; ande. Recognition and avoidance of common dangers or hazards to self and possessions; or2. A person's persistent or recurrent failure to perform daily living tasks specified in subd. 1., except with significant support or assistance by others such as friends, family or relatives.Wis. Admin. Code Department of Health Services DHS 63.08
Cr. Register, April, 1989, No. 400, eff. 5-1-89.