SOP 508.20-att-3: Restrictive Housing Rounds - 30/90 Day 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:
180 words

Summary

This form is used by mental health staff to document progress notes for inmates in restrictive housing who have been confined for 30 days or longer. Staff must complete an initial progress note within the first 30 days of restrictive housing placement and then every 90 days thereafter. The form documents the offender's mental status examination findings, identifies any contraindications to restrictive housing, and outlines the plan for ongoing mental health monitoring.

Key Topics

  • restrictive housing
  • progress note
  • mental health rounds
  • mental status examination
  • MSE
  • suicidal intent
  • self-harm
  • depression
  • psychosis
  • aggression
  • solitary confinement
  • segregation
  • inmate mental health
  • psychiatric monitoring
  • contraindications

Full Text

SOP 508.20
Attachment 3

8/2/22

GEORGIA DEPARTMENT OF CORRECTIONS Institution: ____________________________________

MENTAL HEALTH SERVICES Name: _______________________________________

"Restrictive Housing Rounds" ID#: _________________________________________

30 / 90 Day 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 for contra-indications to housing assignment_
_and the need for mental health services. __________________________________________________________________
*********************
_________________________________________________________________________________________________
Staff Signature/Title

This is to be done:

On general population offenders in Restrictive Housing 30 days or longer. (Initial 1st 30 days of

confinement and every 90 days thereafter).

Form no. M40-01-04 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)
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