7.1 Screen completion date

Indicate the date (mm/dd/yyyy) on which all sections of the screen were complete. It may take more than one day to complete all sections, especially if a screener must wait for information from health care providers. It is acceptable for one person to enter the demographic information (module 2) and for the certified screener to complete the clinical entries (modules 3–6). The screen completion date is the date when all sections were completed by the certified screener, not the date information is entered into the screen application.

6.1 Introduction

There are two diagnoses tables on the screen. The first is for mental illness and substance use related diagnoses. The second is to indicate other general medical diagnoses. Psychiatric diagnoses are needed for eligibility for mental health and substance use programs. Other or general medical diagnoses do not affect eligibility for mental health and substance use programs. The other diagnoses are included on the screen to improve the well-being and access to quality health care for people with mental illness and/or substance use needs.

5.1 Self-injurious behaviors

The item includes cutting, burning, pica, polydipsia, and head banging. This does not include suicide attempts, unhealthy habits, or other high-risk activities.

• Pica is eating inedible objects such as metal or coins.
• Polydipsia is drinking excessive amounts of water, which can be fatal.

5.2 Substance use

Substance use does not include the use of tobacco or caffeine.

4.1 Introduction

Discussing crisis events with applicants can be challenging for a variety of reasons. Some applicants may not remember when or how these events occurred, or applicants may not want to discuss these events because they are too difficult to think about. Screeners may need to consult written records or speak with other people (with the applicant’s permission) to determine the frequency of these items. If no such resources are available (example: the applicant just moved to Wisconsin), complete the screen based on the best information available.

3.1 Introduction

Need for assistance defined

Eligibility for services is based on an applicant’s need for assistance. Need for assistance is any kind of support from another person (monitoring, supervising, reminders, verbal cueing, or hands-on assistance) needed because of a mental health and/or substance use disorder. When someone has complex needs, it is difficult, if not impossible, to separate the reasons for their functional impairments. For such individuals, mark help needed in community living skills in the screen.

2.1 Introduction

Demographic information collected for the screen does not determine eligibility for services. Some demographic information may be used by state, Tribal nation, and county officials for resource and budget planning.

Screeners should use the other box to fill in answers that may not be provided in the screen.

2.2 Basic information

Agency information - assigned to

This is a read-only field that the application will fill in automatically with the name of the screening agency. Use the transfer utility to move a screen to another agency.

1.1 Introduction and history

Wisconsin’s Mental Health and Substance Use Disorder Functional Eligibility Screen (hereafter “the screen”) was developed in 2001. It is a secure online screen with programmed logic to determine eligibility for mental health and substance use disorder programs for adults (18 and over). It can be completed for youth (16 and over) to allow for advanced planning.