SOP 508.44-att-2: Integrated Treatment Programs 4 Quadrant Assignment (Attachment 2)

Division:
Unknown
Effective Date:
October 19, 2023
Topic Area:
508 Policy - MH Evaluations/Screenings/Treatment
PowerDMS:
View on PowerDMS
Length:
299 words

Summary

This is an assignment tool used to match incarcerated individuals to counselors based on the severity of their mental health disorders and substance use disorders. Using a four-quadrant matrix, clinical staff determine the appropriate level and type of mental health treatment services needed. The assignment is based on clinical judgment of the intake counselor and psychologist/psychiatrist and helps guide offenders to counselors with relevant credentials and experience.

Key Topics

  • mental health assessment
  • substance use disorder
  • treatment assignment
  • quadrant assignment
  • integrated treatment
  • mental health screening
  • counselor assignment
  • clinical intake
  • mental health disorders
  • criminogenic risk
  • treatment planning
  • mental health services

Full Text

508.44
Attachment 2
10/19/2023

Facility:____________________________ Date of Assignment:_____________

Name:_____________________________ GDC#:________________________

DOB:______________________________ Race:_________________________

Integrated Treatment Programs 4 Quadrant Assignment

_In addition to all of the assessment information collected, this tool is a guideline for assigning offenders to the counselor with the most appropriate_
_credentials and experience. It is not intended to be a diagnostic tool. The assignment is based on the clinical judgment of the intake counselor and the_
_psychologist/psychiatrist_ .

|I II III IV
Quadrant Assigned:|IV
Counselor Assigned:|
|---|---|
|Reason for Quadrant:
______________________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________________|Reason for Quadrant:
______________________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________________|
|||
|Comments (Please list mental health diagnosis in this section and suggested activity therapy and therapy groups ):|Comments (Please list mental health diagnosis in this section and suggested activity therapy and therapy groups ):|
|
______________________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________________
|
______________________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________________
|

|Substance Use Disorder Severity|Col2|Quadrant III|Quadrant IV|
|---|---|---|---|
|Substance Use Disorder
Severity|HIGH|_High severity substance use disorder / Low or moderate_
_severity mental health disorder_

Mental Health Disorders:

Substance Use Disorders:

Criminogenic Risk:

|_Highsubstance use disorder / High severity mental health disorder_


Mental Health Disorders:

Substance Use Disorders:

Criminogenic Risk:

|
|Substance Use Disorder
Severity||Quadrant I|Quadrant II|
|Substance Use Disorder
Severity|LOW|_Lowseverity substance use disorder / Low severity mental_
_health disorder_

Mental Health Disorders:

Substance Use Disorders:

Criminogenic Risk:

|_Lowseverity substance use disorder / Moderate to high severity_
_mental health disorder_

Mental Health Disorders:

Substance Use Disorders:

Criminogenic Risk:
|
|Substance Use Disorder
Severity||LOW
HIGH|LOW
HIGH|
|Substance Use Disorder
Severity||Mental Health Disorder

Severity|Mental Health Disorder

Severity|

Intake Counselor Name: __________________________________________ Intake Counselor Signature:_____________________________________
(print) (signature)

Title: ___________________________________________

Clinical Director Name: __________________________________________ Clinical Director: ________________________________________
(print) (signature)

Revised 06/2020

Retention: Attachment 2 will be placed in the offender’s mental health record, section one (1). At the end of the offender’s need for mental health services and/or
sentence, the mental health record will be placed within the offender’s health record and retained for 10 years.

Attachments (3)

  1. Addiction Severity Index Summary Assessment (212 words)
  2. Integrated Treatment Programs 4 Quadrant Assignment (Attachment 2) (299 words)
  3. Summary of Monthly Progress in the ITF (Attachment 3) (138 words)
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