SOP_NUMBER: 508.31-att-4 TITLE: Crisis Stabilization Unit Treatment Plan DIVISION: Mental Health Services TOPIC_AREA: 508 Policy-MH Suicide Prevention/ACU/CSU/BTU EFFECTIVE_DATE: 2019-12-09 WORD_COUNT: 124 POWERDMS_URL: https://public.powerdms.com/GADOC/documents/513937 URL: https://gps.press/sop-data/508.31-att-4/ 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 ATTACHMENTS: 1. CSU_ACU Daily Nursing Clinical Assessment URL: https://gps.press/sop-data/508.31-att-1/ 2. Crisis Stabilization Unit Psychiatric Admission Form (M70-02-02) URL: https://gps.press/sop-data/508.31-att-2/ 3. Abbreviated Psychiatric Admission for CSU (M70-02-03) URL: https://gps.press/sop-data/508.31-att-3/ 4. Crisis Stabilization Unit Treatment Plan URL: https://gps.press/sop-data/508.31-att-4/ 6. Crisis Stabilization Unit Discharge Summary URL: https://gps.press/sop-data/508.31-att-6/ 7. Crisis Stabilization Unit Admission Log URL: https://gps.press/sop-data/508.31-att-7/ 8. CSU Referral Report (M70-02-08) URL: https://gps.press/sop-data/508.31-att-8/ 9. CSU Discharge Summary Note (Form M70-02-09) URL: https://gps.press/sop-data/508.31-att-9/ 10. Crisis Stabilization Unit (CSU) Admission Cover Page URL: https://gps.press/sop-data/508.31-att-10/ ======================================================================== 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.