SOP 508.31-att-4: Crisis Stabilization Unit Treatment Plan

Division:
Mental Health Services
Effective Date:
December 9, 2019
Topic Area:
508 Policy-MH Suicide Prevention/ACU/CSU/BTU
PowerDMS:
View on PowerDMS
Length:
124 words

Summary

This form is used to document individualized treatment plans for offenders admitted to the Crisis Stabilization Unit (CSU). The form captures patient identification, admission diagnosis, identified problems with corresponding goals and target dates, planned interventions, and responsible staff members. It requires signatures from both the patient and the Mental Health Counselor and is retained in the offender's medical file for ten years.

Key Topics

  • Crisis Stabilization Unit
  • CSU
  • treatment plan
  • mental health counseling
  • suicide prevention
  • crisis intervention
  • offender mental health
  • therapeutic goals
  • mental health interventions
  • psychiatric treatment
  • ACU
  • BTU

Full Text

SOP 508.31
Attachment 4

12/9/19

|Crisis Stabilization
Unit
Treatment Plan|Patient Identification
Facility: _________________________________________
Offender: ________________________________________
GDC ID#:___________________ DOB: _______________
Race: ______________ Sex: ________________________|Col3|
|---|---|---|
|
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:__________________|
|
________________________________________ ___________________________________
Patient Signature Date Mental Health Counselor Signature Date
|
________________________________________ ___________________________________
Patient Signature Date Mental Health Counselor Signature Date
|
________________________________________ ___________________________________
Patient Signature Date Mental Health Counselor Signature Date
|

Form no. M70-02-04 Page 1 of 1

Retention Schedule: Upon completion, this form shall be placed in the offender’s medical file (Infirmary Section with CSU/ACU packets) and
retained for ten (10) years.

Attachments (9)

  1. CSU_ACU Daily Nursing Clinical Assessment (299 words)
  2. Crisis Stabilization Unit Psychiatric Admission Form (M70-02-02) (218 words)
  3. Abbreviated Psychiatric Admission for CSU (M70-02-03) (105 words)
  4. Crisis Stabilization Unit Treatment Plan (124 words)
  5. Crisis Stabilization Unit Discharge Summary (290 words)
  6. Crisis Stabilization Unit Admission Log (61 words)
  7. CSU Referral Report (M70-02-08) (732 words)
  8. CSU Discharge Summary Note (Form M70-02-09) (130 words)
  9. Crisis Stabilization Unit (CSU) Admission Cover Page (93 words)
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