SOP 508.20-att-2: Restrictive Housing Rounds - 48 Hour / Weekly Progress Note

Division:
Mental Health Services
Effective Date:
August 2, 2022
Reference Code:
VG40-0001
Topic Area:
508 Policy - MH Administration/Staff/Certification
PowerDMS:
View on PowerDMS
Length:
184 words

Summary

This form documents mental health assessments for incarcerated individuals placed in restrictive housing. Mental health staff must complete this progress note within 48 hours of placement and then weekly for all mental health offenders in restrictive housing to monitor for mental health contraindications and evaluate the need for additional services.

Key Topics

  • restrictive housing
  • mental health rounds
  • progress notes
  • solitary confinement
  • mental status examination
  • suicidal ideation
  • self-harm
  • psychiatric assessment
  • offender mental health
  • housing placement

Full Text

SOP 508.20
Attachment 2

8/2/22

GEORGIA DEPARTMENT OF CORRECTIONS Institution: ____________________________________

MENTAL HEALTH SERVICES Name: _______________________________________

"Restrictive Housing Rounds" ID#: _________________________________________

48 Hour / Weekly Progress Note DOB: ________________________________________
(circle)
Date: ___________________ Race: ________________ Sex: _____________________________
**********************
DATA: Date offender was placed in Restrictive Housing: ___________________________________________

Reason for Restrictive Housing Placement: ________________________________________________

Chief Complaint(s): ____________________________________________________________________
____________________________________________________________________________________

Offender MSE findings: (comment on pertinent findings)

[ ] Psychosis: _________________________________________________________________
_________________________________________________________________

[ ] Depression: ________________________________________________________________
_________________________________________________________________

[ ] Self-Injurious Thoughts: _____________________________________________________
_________________________________________________________________

[ ] Suicidal Intent: _____________________________________________________________
_________________________________________________________________

[ ] Aggression: ________________________________________________________________
__________________________________________________________________

[ ] Situational Upset: ___________________________________________________________
___________________________________________________________________

[ ] MSE within normal range (no problems)__________________________________________
___________________________________________________________________

ASSESSMENT: Are there any contra-indications to Restrictive Housing? [ ] Yes [ ] No

Comments: __________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

PLAN: _As long as the offender remains in Restrictive Housing will monitor weekly for contra-indications to housing_
_assignment and the need for further services. ___________________________________________________________

*********************

_________________________________________________________________________________________________
Staff Signature/Title

This is to be done:

Within 48 (forty-eight) hours of a mental health offender being placed in Restrictive Housing.
Weekly on ALL mental health offenders in Restrictive Housing.

Form no. M40-01-03 Page 1 of 1

Retention Schedule: Upon completion, this form shall be placed in the offender’s mental health file (section one). At the end of the offender’s need for mental health
services and/or sentence, the mental health file shall be placed within the offender’s health record and retained for 10 years.

Attachments (3)

  1. Restrictive Housing Rounds Log (84 words)
  2. Restrictive Housing Rounds - 48 Hour / Weekly Progress Note (184 words)
  3. Restrictive Housing Rounds - 30/90 Day Progress Note (180 words)
Machine-readable: JSON Plain Text