1. (1) Risk of serious harm. The facility shall do all of the following:

   1. (a) Obtain documented information from a transporting agency’s observation pertaining to a youth’s mental health and potential for suicide or self-harm.
   2. (b) Determine whether the youth has ever considered or engaged in self-harm or attempted suicide.
   3. (c) Require staff to immediately notify qualified medical and mental health professionals of all incidents of self-harm or attempted self-harm. The notification and incident shall be documented.
   4. (d) Require staff to immediately notify qualified medical and mental health professionals of youth who have communicated having ideation, plan, or intent to engage in self-harm or suicide. The notification and incident shall be documented.

2. (2) Suicide or self-harm watch. The facility shall do all of the following:

   1. (a) Identify designated supervisory staff to be notified if a youth is determined to be a suicide or self-harm risk.
   2. (b) Designate areas within the facility and provide security precautions for youth who are placed on suicide or self-harm watch.
   3. (c) Establish monitoring procedures for youth on suicide or self-harm watch, including frequency and documentation of wellness checks under s. DOC 347.48.

3. (3) Youth supervision. The facility shall do all of the following:

   1. (a) Identify staff who may initiate a suicide or self-harm watch.
   2. (b) Require notification to qualified mental health professionals when the youth is placed on suicide or self-harm watch. Assessment by a qualified mental health professional shall be completed as soon as practicable.
   3. (c) Identify qualified mental health professionals who are authorized to remove a youth from a suicide or self-harm watch status after an in-person assessment.
   4. (d) Establish requirements for the frequency of communication between health care and facility staff regarding the status of a youth who is on suicide or self-harm watch.
   5. (e) Establish an intervention protocol during an apparent suicide or self-harm attempt, including life-sustaining measures.
   6. (f) Notify the youth’s parent or legal guardian any time a youth is placed on suicide or self-harm watch.
   7. (g) Notify the youth’s case worker in the county or tribe of supervision any time a youth is placed on suicide or self-harm watch.
   8. (h) Identify persons to be notified in case of attempted or completed suicides or self-harm.

4. (4) Documentation. The facility shall document actions taken and decisions made regarding youth who are at risk of attempting suicide or self-harm, including all of the following:

   1. (a) Individual initiating the suicide or self-harm watch.
   2. (b) Date and time watch was initiated.
   3. (c) Reason watch was initiated.
   4. (d) Date, time, and name of supervisor contacted.
   5. (e) Date and time of referral to a qualified mental health professional.
   6. (f) Written documentation from the qualified mental health professional removing a youth from a suicide or self-harm watch including name, date, and time.
   7. (g) Date and time of notification to youth’s parent or legal guardian under sub. (3) (f).
   8. (h) Date and time of notification to youth’s case worker in the county or tribe of supervision under sub. (3) (g).
5. (5) Support services. The facility shall provide access to debriefing and support services for youth and staff following a suicide or self-harm incident.

History

History: CR 20-030: cr. Register October 2021 No. 790, eff. 11-1-21.