SOP 213.11-att-1: Supervision Assessment

SOP 213.11
Attachment 1

3/9/20
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SUPERVISION ASSESSMENT

_NAME: ________________________________________ CASE NUMBER:_____________________

_CURRENT OFFENSE(S):____________________________________________________________________

I. CASE MANAGEMENT ISSUES (Circle the Appropriate Response for Each Category)

1. Marital/Family Relationships
__0__Reported stability and support for one year or more.
__1__No problem reported. Not applicable.
__2__Separation and/or divorce within the last year.
__3__Self-reported incidents (monthly) of arguments and/or emotional turmoil.
__4__Self-reported history of frequent (weekly) argument and/or emotional turmoil.
__5__Self-reported history of violence/assaultive behavior among immediate family members.
__6__Prior arrest(s) to include assaultive behavior directed toward members of immediate family.

2. Emotional Stability
__0__History and/or report indicates long-term, well-adjusted stable personality.
__1__No stated or apparent difficulties.
__3__Rational behavior with some periods of emotional upset.
__4__History of mental health out-patient/inpatient treatment (not A/D) or history of psychotropic medication
for diagnosed mental illness (more than one year ago).
__6__In the last year, out-patient treatment for mental illness (not A/D) or history of prescribed psychotropic
medication for mental illness.
__8__In the last year, history of mental illness hospitalization (not A/D) or currently taking psychotropic
medication for mental illness.

3. Employment
__0__Continuous period of employment of two years or more (same position and/or same employer).
__1__Continuous employment for more than one year (same employer).
__2__Period(s) of unemployment for two months or longer or three job changes within one year.
__3__Period(s) of unemployment for six months or longer or more than four job changes within one year.
__4__Dismissed/terminated for cause.

4. Impression of Detainee Through Interview and Record Review
__0__Cooperative, accepts responsibility, has insight and motivation for change.
__2__Cooperative but not particularly motivated to seek programming or change.
__4__Passive with some indications of negative attitude and potential adjustment problems.
__6__Uncooperative, poor adjustment and attitude, not responsive to staff directives.
__8__Openly hostile and threatening. Poor staff and peer relationships. Disregards rules.

5. Number of Probation/Parole Revocations
__0__None.
__2__One or two.
__4__Three or more.

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6. Number of Felony Convictions (includes present offense; incarceration or probated sentence).
__0__None.
__2__One or two.
__4__Three or more.

_Case Management Score Total ________. (Score of 26 points or more may warrant increase of one level of part II )._

II. SECURITY ISSUES (Circle the Appropriate Response for Each Category)

1. Escape History
__0__No history of escape/ flight.
__5__History of Flee/Allude, Abscond from Community Supervision, Bail Jumping, and/or AWOL.
10 Escape from an open institution (diversion center, transitional center).
XX Escape from a closed institution (no time limit).

2. History of Assaultive Offenses (Convictions)
__0__No prior assaultive criminal history.
__5__Two or less prior misdemeanor convictions.
10 One prior felony conviction/ 3+ misdemeanor convictions.
15 Two or more prior felony (assaultive) convictions.

3. Pending Charges
__0__No pending charges.
__5__Pending misdemeanor charge(s).
10 Pending felony (non-assaultive) charge(s).
15 Pending felony (assaultive) charge(s).

4. Sex Offender History
__0__No history of convictions for felony sex offenses.
__2__Conviction for non-aggressive sex offenses specifically to include Prostitution, Pandering,
Solicitation, and Sodomy.
_XX_ One or more convictions for felony sex offenses.

5. Severity of Current Offense
__0__Low severity.
__2__Low/moderate severity.
__6__Moderate severity.
10 High severity.
16 Greatest severity.

6. Substance Abuse History
__0__No history of drug/alcohol abuse.
__2__A history of any of the three factors listed below occurring longer than 12 months ago.
__4__Self-report or other documentation of regular use of alcohol or non-prescription drugs in the past
12 months.
__6__Within the past twelve months has one or more of the following: 1) arrest and/or conviction for
a/d related offense, 2) positive urine screen, or 3) in-patient or out-patient A/D treatment.

SOP 213.11
Attachment 1

3/9/20
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7. Length of Sentence (use min. sentence length)
__0__119 days or less.
__2__120 to 179 days.
__6__180 to 365 days.
_10__366 or more days.

Security Issues Scoring Total ________________ Date Completed__________________________________.

______________________________________________
Counselor Signature

Form Recommends: (Circle One)
Level I Score Range 0 - 20
Level II Score Range 21 - 47
Level III Score Range 48 - 74
Level IV Score of XX in any category

Is Case Management total 26 points or greater? Y or N.
Classification Committee Recommends: ________________________________________________________
Reason for Decision (if committee differs with form recommendation)_________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

Classification Committee Signatures: Chairperson__________________________________________________
Member_______________________________________________
Member_______________________________________________

_____________________________________ _______/______/_______
Approved/Superintendent Date

- * * * * * * * * * * * * * * * * * * * * * * *
RECLASSIFICATION

FROM LEVEL ________________________ TO LEVEL _____________________

REASON (Be
Specific):__________________________________________________________________________________

__________________________________________________________________________________________

__________________________ ___________________________ _________________________
Committee Member Committee Member Chairperson
__________________________
Date
_______________________________________ __________________________
Approved/Superintendent Date
c: Detainee File

RETENTION SCHEDULE: Upon completion, this attachment will be placed in the Probationer/Detainee file.