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Seclusion and Restraint Report, F-01977 (02/2021)

Facility/provider information

This survey reports incidents of seclusion and restraint use in programs certified under Wis. Admin. Code ch. DHS 40, Mental Health Day Treatment Services for Youth, and DHS 50, Youth Crisis Stabilization Facilities.

Per Wis. Admin. Code §§ DHS 40.058(8) (a) and 50.12(7) (a), programs/facilities shall report all incidences of seclusion, physical restraint, injury, and involvement of law enforcement to the department within 24 hours of the incident occurring. Reporting shall be completed through the department's online reporting system and (b) The department will evaluate the circumstances of each incident, conduct any appropriate follow-up, and identify programs in need of technical assistance, training, policy development, or other quality improvement.

Do not provide any identifying information such as names of individuals, dates of birth, etc. in this report unless requested.

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