Relinquishment Survey

Correct Relinquishment Survey Incorrect
• • • 0000
RELINQUISHMENT IDOC Facilities
IDOC ENTRY DATE REPORT DATE EMPLOYEE
IDOC NUMBER NUMBER O CAPP-MTC
� [10 0 0 0 0 0 [1111111 00 SICI
Q ISCI
000000 000000 000000 00000 O NICI
000000 000000 000000 00000 O PWCC
000000 000000 000000 00000 O SBWCC
000000 000000 000000 00000
000000 000000 000000 00000 RIDER Type
O Traditional
000000 000000 000000 00000
CAPP
000000 000000 000000 00000 0TC
000000 000000 000000 00000
Mental Health
00000 ® 000000 000000 OOOOO 0SOTP
000000 000000 000000 00000 0CRP
Events Dual Status Offender(Termer/Rider)
0 Failure to complete program requirements O Yes
0 Class A DOR O No
O Refusal Sanctions/Interventions Used Prior to Relinquishment
O Cardinal Rule Violation O Verbal Warning
O Loss of Privileges
IDOC Level of Care Initial Crime Type O TCM Staffing
O MHC O Alcohol O Behavioral/Coaching Contract
O MHP O Assault O Family Reprimand ("The Game"/Requirements)
O MHMN O Drug O Extra Duty
O *CMHS 1 O Murder & Man O Additional Assignments
O *CMHS 2 O Property O Infraction
O *ICMHS O Sex O C or B DOR
O *ACMHS O Increased Length of Stay
,---------------------------------- --------------------------------------1
Responsivity ;
Special Education under 21 Reading Under 6th Grade Language Barrier ;
O Yes 0 Yes 0 Yes
O No 0 No 0 No
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*Required Signature for relinquishment recommendations
*Case Managers:
Program Manager:
*Clinical Signature:
*Approval Authority:
[DOC-mq.j--t S­05,2014

EVENTS:
Drug-Crime wherein drugs played a role in the commission of crime(s).
Failure to complete programing requirements-failure to
meet competencies of assigned program Murder/Man-Murder-crime of killing somebody:the crime of killing
another person deliberately and not in self-defense or with any other
Class A DOR-Class A Disciplinary Offence Report extenuating circumstance recognized by law: Manslaughter-
Program Refusal-Offenders refuses to participate in unpremeditated killing:the unlawful killing of one person by another
recommended programs without advance planning
Property-Crimes that includes,among other crimes,burglary larceny,
Cardinal Rule Violation-Rules established in Therapeutic theft,motor vehicle theft arson,shoplifting,and vandalism.Property
and community models. Violation of these rules result in crime only involves the taking of money or property,and does not involve
immediate removal from program force or threat of force against a victim.
IDOC LEVEL OF CARE: Sex-Crimes such as rape,molestation,or sexual abuse,involving illegal
or coerced sexual activity.
MHP-Offenders at this level of care have been symptom and
medication free for three months or more and do not require DUAL STAUS OFFENDER:
further mental health treatment unless requested. Offender is classified as both a Termer and Rider
MHMN-Offenders at this level of care do not meet criteria SANCTIONS/INTERVENTIONS-USED PRIOR TO RECOMMENDATION OF
for a Major Mental Illness but are experiencing some degree RELEQUESMENT:-Sanctions-Actions designed for consequences that
of symptomatology,or there is a need for further evaluation could be positive and/or negative in order to modify the undesirable
if symptoms persist,or they are experiencing symptoms of behavior. Interventions:Actions which are not sanctions but which
mental illness secondary to a medical condition. provide an opportunity for the offender to reflect on his criminal thinking
CMHS 1-Offenders at this level of care are able to function in and conduct.
either a general population(GP)setting or a specialized unit
with minimal mental health support. They may be prescribed RIDER TYPE's:
psychotropic medications.
CMHS 2-Offenders at this level of care are able to function in Traditional-Substance abuse treatment program for moderate risk
a general population(GP)setting with medication offenders with educational needs. Curriculum is designed to be typically
management services.They are prescribed psychotropic completed in 120 days
medications and can request group therapy.
CAPP-Intensive substance abuse program for moderate risk offenders.
ICHMS-Offenders at this level of care are unable to function Curriculum is designed to typically be completed in 90 days.
in the general population without assistance. They require
more intensive mental health services.They are typically TC-Therapeutic Community is an intensive substance abuse program for
housed in a special housing unit. high risk offenders. Curriculum is designed to be typically completed in
270 days.
ACHMS-Offenders with this level of care exhibit a mental
illness with sufficient severity to prohibit their interaction Mental Health-Substance abuse treatment program designed to
with general population(GP). In most cases they present as incorporate elements of mental health maintenance strategies and
floridly psychotic or with debilitating mood instability. Due to treatment and reentry focused on the special needs of mental health
the severity of their illness,they are placed in a more offenders. Curriculum is designed to be typically completed in 180 days.
restrictive environment in which treatment can be initiated
without fear of the offender being victimized or victimizing SOTP-Sex offender assessment program designed to incorporate
others. assessment and treatment concepts for those retained jurisdiction
INITIAL CRIME TYPE: offenders who have been convicted of or have a history of sex offending
Alcohol-Crime wherein alcohol played a role in the behavior. Substance abuse treatment is included for offenders assessing
commission of crime(s). with substance abuse need. Curriculum is designed to be typically
Assault-Crime wherein intentional act by one person that completed in 180 days.
creates an apprehension in another of an imminent harmful CRP-Substance abuse treatment program designed to incorporate
or offensive contact. elements of anger management for offenders with history of violent
offenses.Curriculum is designed to be typically completed in 160 days.