SOP_NUMBER: 508.20-att-2
TITLE: Restrictive Housing Rounds - 48 Hour / Weekly Progress Note
REFERENCE_CODE: VG40-0001
DIVISION: Mental Health Services
TOPIC_AREA: 508 Policy - MH Administration/Staff/Certification
EFFECTIVE_DATE: 2022-08-02
WORD_COUNT: 184
POWERDMS_URL: https://public.powerdms.com/GADOC/documents/1026385
URL: https://gps.press/sop-data/508.20-att-2/

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

ATTACHMENTS:
  1. Restrictive Housing Rounds Log
     URL: https://gps.press/sop-data/508.20-att-1/
  2. Restrictive Housing Rounds - 48 Hour / Weekly Progress Note
     URL: https://gps.press/sop-data/508.20-att-2/
  3. Restrictive Housing Rounds - 30/90 Day Progress Note
     URL: https://gps.press/sop-data/508.20-att-3/

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FULL TEXT:
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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.