30-Day Review-Women
Reviews must be complete every 30 days and upon discharge from the program.
Resident Name
*
First Name
Last Name
Today's Date
*
-
Month
-
Day
Year
Date
Intake Date
*
-
Month
-
Day
Year
Date
Program Category?
*
SBH
Sober Living
Respite
Justice Involved
Homeless
Veteran
Other
Facility
*
12th Street A
12 Street B
St Alberts
Canyon Meadows
Cameo Court
N. Truckee
Medicaid Provider
HPN
Silver Summit
Anthem
Molina
None
Other
MEASURES OF SUCCESS
Measures of Success Score
Resident must achieve a minimum of 80 points to move on to the next phase of the program. Resident is to remain on black out period until objectives are achieved.
1. Picture ID
*
Yes
No
Valid Picture ID
2. SS Card
*
Yes
No
Social Security Card
3. Ex-Felon Registration
*
Yes
No
N/A
Ex-felon registration
4. SNAP/Medicaid
*
Yes
No
NA
Applied/Received SNAP/Medicaid
5. Medical Needs
*
Yes
No
NA
Schedule and/or attend medical appointments
6. Mental Health Needs
*
Yes
No
NA
Schedule and/or attend mental health appointments
7. EmployNV * Requirement of LC program for justice involved residents
*
Yes
No
NA
Register with EmployNV (Outreach Program Specialist Department of Employment, Training & Rehabilitation Employment Security Division 4001 S. Virginia St. Reno, Nevada 89502 T: (775) 284-9624 C: (775) 997-5165 E: c-
8. School * If no High School Diploma or GED, must be enrolled in GED program.
*
Yes
No
NA
Enrolled in continuing education
9. GED or High School Diploma
*
Yes
No
Must complete GED if answer is NO
10. Resume.
*
Yes
No
NA
Completed Resume (copy to be placed in client file)
11. PRSS Meetings
*
Yes
No
Attend scheduled meetings with PRSS
12. Self-Help Groups * Minimum of 3 documented groups/meetings per week required.
*
Yes
No
Attend self-help groups
13. Spiritual Services * Minimum of 1 documented spiritual service of residents choice required.
*
Yes
No
Attend spiritual services
14. Family Reunification
*
Yes
No
NA
Begin family reunification
15. WOW Groups
*
Yes
No
NA
Attend Women of Worth groups
16. Drug/Alcohol Use
*
Yes
No
Abstinence from drugs/alcohol or other addictive disorders
17. Interactions
*
Yes
No
Positive interaction with house mates and program staff
18. Behavior
*
Yes
No
Received Warning of Non-compliance
19. Rules (Life Changes)
*
Yes
No
Adherence to program rules and expectations
20. Rules (CJ supervision)
*
Yes
No
NA
Adherence to rules and expectations of criminal justice mandates
21. Tuesday Life Skills Groups
*
Yes
No
NA
Attend Tuesday groups
22. Counseling
*
Yes
No
NA
Attend Counseling
Did resident leave the program during her initial 30-day period?
Yes - self discharge
Yes - to a higher level of care
Yes - completed
No - continued stay
Resident is moving to the following facility
ensure proper facility is selected in the CRM
Recommendation to continue Black Out Period (Resident must address ALL of these Measures of Success to move out of Black Out)
Yes
No
Discharge
Comments
Staff Name
First Name
Last Name
Save & Continue Later
Submit
Print to PDF
Criminal Justice Involvement?
*
Yes - current
Yes - within past 6 months
No - never
No - not in the past three years
Should be Empty: