FIRST DISTRICT MENTAL HEALTH COURT Monthly Follow-up Data

Transcription

1 FIRST DISTRICT MENTAL HEALTH COURT Monthly Follow-up Data CLIENT NAME: CLIENT ID: MONTH: DATE: How many days has client been incarcerated during the month? How many times was client required to appear in MHC court during the month? How many unexcused court dates did client miss during the month? NEW ARRESTS Case # Charge Arrest Date Was warrant issued? Department Status NON ARREST VIOLATIONS Missed medication/treatment appointments Missed appointments with MHC Probation Officer Failure to appear to court Medication non-adherence Positive UA or refusal to submit to urine testing Use of alcohol or other non-prescribed substances Violations of residential or other housing rules Discontinuing treatment Failure to follow MHC directions or assignments Failure to comply with MHC imposed restrictions Other Week 1 Week 2 Week 3 Week 4 1

2 SANCTIONS Week 1 Week 2 Week 3 Week 4 Reprimand More frequent court dates More frequent report to MHC probation officer Additional treatment participation Loss of privileges at treatment or housing program Transfer to more restrictive treatment program Unannounced visits by MHC staff Community Service hours Increased frequency of U/A testing Jail time (indicate days if appropriate) Warrant for arrest Consequence pending Loss of MHC advancement level Curfew imposed Judicial assignment Other, specify 1 : REINFORCEMENTS Week 1 Week 2 Week 3 Week 4 Reduced frequency of court appearances Reduced frequency of AP&P monitoring Reduced frequency of MHC monitoring/supervision Transfer to less restrictive housing or treatment program Approval of travel pass or furlough. Reduced frequency of UA testing Supplemental reinforcements (gift certificates, vouchers, etc.) Other, specify: TREATMENT ADHERENCE Medication adherence past 30 days. Medication management adherence past 30 days. Psychotherapy treatment adherence past 30 days. Psychosocial treatment adherence past 30 days. Drug/alcohol treatment adherence past 30 days. Active Passive Resistive % 60 74% < 60% N/A PSYCHIATRIC HOSPITAL ADMITS PAST 30 DAYS Hospital Admit Date Discharge Date LOS 2

3 HOUSING PAST 30 DAYS Homeless Jail Friend Residence Family Residence Group Home Subsidized Semi- Independent Independent Total # days EMPLOYMENT ACTIVITY PAST 30 DAYS Unemployed Part time employment Full time employment Supported employment Competitive employment VOLUNTEER ACTIVITY PAST 30 DAYS Full Part # Hours per Week Court Assignment (Identify Volunteer Setting): STUDENT ACTIVITY PAST 30 DAYS Full Part GED Classes BATC USU Other Schooling Other Schooling (identify): MENTAL HEALTH/SA TX PAST 30 DAYS BRDA BRMH Obtained Privately FACT Team Case management services Representative payee services Medication management services (APRN or Psychiatrist) Individual therapy Group Therapy 3

4 Behavior management Individual skills development Group skills development Personal services Psycho-educational services Respite care Supported living (BRMH group home) Day Treatment services Mental Health crisis services (outpatient) Hospital ED crisis services Other (specify): BRDA program at Health Department Detox-Acute Inpatient SA treatment-hospital Residential SA treatment (non-hospital based) SA Halfway house, recovery home, sober living home Outpatient Substance Abuse (non BRDA program) SA self-help OTHER SERVICES (non MH/SA based) Clubhouse services Marriage, Family, Anger Management, Coping Skills Groups, etc. Job preparation/training/coaching Other, specify: EXIT INFORMATION Case dismissed Step reduction in class of criminal offense GRADUATION Satisfied term of probation Other: TERMINATION WITHDRAWAL New charges Repeated non compliance / program resistant / counter motivated Consumer opted out of program voluntarily DEATH Suicide/mental illness related Natural causes/accidental 4

5 DATE OF PROGRAM EXIT 5