SOP 508.23-att-8: Specialized Mental Health Treatment Unit Monthly Report (Monthly Utilization Review)
Summary
Key Topics
- mental health treatment
- monthly report
- specialized mental health unit
- serious mentally ill
- severe personality disorders
- dementia
- traumatic brain injury
- caseload data
- psychotropic medication
- counseling
- individual therapy
- group therapy
- psycho-educational groups
- activity therapy
- ACU admissions
- CSU admissions
- self-injury
- assaults
- involuntary medication
- utilization review
Full Text
SOP 508.23
Attachment 8
04/27/18
Georgia Department of Corrections – Specialized Mental Health Treatment Unit
Monthly Report (Monthly Utilization Review)
Institution: _______________________________ Month/Year: __________________
Specialized Mental Health Treatment Unit:
[ ] Serious Mentally Ill [ ] Severe Personality Disorders & Mental Illness [ ] Dementia/Traumatic Brain Injuries
[ ] Impulse Control Disorders [ ] Severely Dangerous Mentally Ill
[ ] Developmental Delays/Deficits [ ] Transitional Program
|Caseload in the Program
on the last day of the
month by race:|White:|Cases on Psychotropic
Medication on the last day of
the month. ____________|Cases NOT on Psychotropic
medication on the last day of
the month. _____________|
|---|---|---|---|
|
Caseload in the Program
on the last day of the
month by race:|Black:|Black:|Black:|
|
Caseload in the Program
on the last day of the
month by race:|Other:|Other:|Other:|
|
Caseload in the Program
on the last day of the
month by race:|
Total: ___________
|
Total: ___________
|
Total: ___________
|
|Referral/Evaluations for
the program:|
Total #:|
# from inside the facility: |
# from outside the facility:|
|
Caseload Additions: _____||Caseload Terminations:
Due to: Transfer___
Max out ___
|Other(List reason):|
|||||
|Disciplinary reports:||||
|ACU admissions from the
caseload:||CSU admissions from the
caseload:||
|# of Self-injuries:|# of Assaults:|||
|# of Involuntary
medication hearings:||# on Involuntary
Medication:
||
|||||
|TREATMENT:|TREATMENT:|TREATMENT:|TREATMENT:|
|Medication Reviews:|Other type of treatment(list):
|Other type of treatment(list):
|Other type of treatment(list):
|
|Counseling Contacts:|Counseling Contacts:|Counseling Contacts:|Counseling Contacts:|
|Individual Therapy:
|Individual Therapy:
|Individual Therapy:
|Individual Therapy:
|
|# of Therapy Groups (include group names): Number of Offenders attending for the month: ________
|# of Therapy Groups (include group names): Number of Offenders attending for the month: ________
|# of Therapy Groups (include group names): Number of Offenders attending for the month: ________
|# of Therapy Groups (include group names): Number of Offenders attending for the month: ________
|
|# of Psycho-educational Groups (include group names): Number of Offenders attending for the month: ________
|# of Psycho-educational Groups (include group names): Number of Offenders attending for the month: ________
|# of Psycho-educational Groups (include group names): Number of Offenders attending for the month: ________
|# of Psycho-educational Groups (include group names): Number of Offenders attending for the month: ________
|
|# of Activity Therapy Groups (include group names): Number of Offenders attending for the month: ________
|# of Activity Therapy Groups (include group names): Number of Offenders attending for the month: ________
|# of Activity Therapy Groups (include group names): Number of Offenders attending for the month: ________
|# of Activity Therapy Groups (include group names): Number of Offenders attending for the month: ________
|
|Additional information to report (use additional paper if necessary):|Additional information to report (use additional paper if necessary):|Additional information to report (use additional paper if necessary):|Additional information to report (use additional paper if necessary):|
|||||
Retention Schedule: Upon completion, a copy of this form shall be sent to Central Office by the 3 [rd] of each month and the original shall be maintained in the mental health
area for 10 years.