SOP 508.23-att-6: Specialized Mental Health Treatment Unit Comprehensive Treatment Plan
Full Text
SOP 508.23
Attachment 6
04/27/18
|Specialized
Mental Health
Treatment Unit
(SMHTU)
Comprehensive
Treatment Plan
(to be completed upon
admission and reviewed
weekly or bi-weekly by
the SMHTU counselor
and SMHTU treatment
team with the offender
present)|Offender Identification
Facility: ___________________________________
Name: ____________________________________
ID#: __________________DOB: ______________
Race: ____________ Sex: __________________|Col3|Col4|
|---|---|---|---|
|Admission Diagnosis:|Admission Diagnosis:|Admission Diagnosis:||
|Problem #______
|Problem #______
|Problem #______
||
|Goal:
Target
Date:|Goal:
Target
Date:|Goal:
Target
Date:||
|Interventions:
|Interventions:
|Person Responsible:
______________________
______________________
(Title)
Enter Date: _____________
Revised/Resolved: _______
Date: __________________||
|Problem #_______
|Problem #_______
|Problem #_______
||
|Goal:
Target Date:|Goal:
Target Date:|Goal:
Target Date:|
|
|Interventions:
|Interventions:
|Person Responsible:
______________________
______________________
(Title)
Enter Date: _____________
Revised/Resolved: _______
Date: __________________||
|
Mental Health Counselor: ______________________________________
___________________________________ __________________
Offender Signature Date Signature Date|
Mental Health Counselor: ______________________________________
___________________________________ __________________
Offender Signature Date Signature Date|
Mental Health Counselor: ______________________________________
___________________________________ __________________
Offender Signature Date Signature Date||
Retention Schedule: Upon completion, this form shall be placed in the offender’s mental health file (section 1). 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 ten (10)
years.