SOP_NUMBER: 508.23-att-8
TITLE: Specialized Mental Health Treatment Unit Monthly Report (Monthly Utilization Review)
DIVISION: Unknown
TOPIC_AREA: Mental Health - Suicide Prevention/ACU/CSU/BTU
EFFECTIVE_DATE: 2018-04-27
WORD_COUNT: 447
POWERDMS_URL: https://public.powerdms.com/GADOC/documents/339285
URL: https://gps.press/sop-data/508.23-att-8/
SUMMARY:
This is a monthly reporting form used by Georgia Department of Corrections facilities to track and document the census, activities, and outcomes of specialized mental health treatment units. The form collects data on inmate caseloads by race, medication usage, referrals and evaluations, treatment activities (counseling, therapy groups, psycho-educational groups), disciplinary incidents, ACU/CSU admissions, and self-injury and assault incidents. Facilities must submit completed forms to Central Office by the 3rd of each month.
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
ATTACHMENTS:
1. Specialized Mental Health Treatment Unit Recommendation Form
URL: https://gps.press/sop-data/508.23-att-1/
2. Consent to Receive Specialized Mental Health Treatment
URL: https://gps.press/sop-data/508.23-att-2/
3. Specialized Mental Health Treatment Unit Admission Form
URL: https://gps.press/sop-data/508.23-att-3/
4. Activity Therapy Assessment – for Specialized Mental Health Treatment Program
URL: https://gps.press/sop-data/508.23-att-4/
5. Specialized Mental Health Treatment Unit (SMHTU) – Orientation to the Program
URL: https://gps.press/sop-data/508.23-att-5/
6. Specialized Mental Health Treatment Unit Comprehensive Treatment Plan
URL: https://gps.press/sop-data/508.23-att-6/
7. Specialized Mental Health Treatment Unit (SMHTU) Discharge Summary
URL: https://gps.press/sop-data/508.23-att-7/
8. Specialized Mental Health Treatment Unit Monthly Report (Monthly Utilization Review)
URL: https://gps.press/sop-data/508.23-att-8/
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FULL TEXT:
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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.