SOP_NUMBER: 508.44-att-2
TITLE: Integrated Treatment Programs 4 Quadrant Assignment (Attachment 2)
DIVISION: Unknown
TOPIC_AREA: 508 Policy - MH Evaluations/Screenings/Treatment
EFFECTIVE_DATE: 2023-10-19
WORD_COUNT: 299
POWERDMS_URL: https://public.powerdms.com/GADOC/documents/738976
URL: https://gps.press/sop-data/508.44-att-2/
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
ATTACHMENTS:
1. Addiction Severity Index Summary Assessment
URL: https://gps.press/sop-data/508.44-att-1/
2. Integrated Treatment Programs 4 Quadrant Assignment (Attachment 2)
URL: https://gps.press/sop-data/508.44-att-2/
3. Summary of Monthly Progress in the ITF (Attachment 3)
URL: https://gps.press/sop-data/508.44-att-3/
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FULL TEXT:
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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.