Treatment Completion Worksheet Date: Client Name: Other Client Identifying Information: Clinician Name: AREA FOR CONSIDERATION NOTES Section One: Cooperation With Treatment Attendance & External Not Met Partially Met Compliance with Met Treatment Expectations Not Met Duration of Treatment Partially Met Met Effort and Active Not Met Partially Met Participation in Met Treatment Not Met Ownership of Actions Partially Met Met Not Met Attainment of Partially Met Treatment Goals Met Section Two: Criminogenic Needs Not Met Self-management Partially Met Domain Met Not Met Social Involvement Partially Met Domain Met Not Met Sexuality Domain Partially Met Met Not Met Attitudes, Schemas and Partially Met Beliefs Domain Met Not Met Criminality Partially Met Domain Met Section Three: Additional Considerations Risk Level at Intake Current Risk Level I Very Low Risk I Very Low Risk – – Level II Below Average Risk II Below Average Risk – – III Average Risk III - Average Risk Initial Level/Current Level – IVa Above Average Risk IVa Average Risk – – IVb Well Average Risk IVb Well above Average Risk – – 12. Individual Factor(s) 13. Predicted Trajectory 14. Containment Team Judgment With consideration of the results of this Treatment Completion Worksheet has the person completed treatment? Yes, Successful Completion No, Continued Treatment is Necessary
Treatment Completion Worksheet Date: Client Name: Other Client Identifying Information: Clinician Name: AREA FOR CONSIDERATION NOTES Section One: Cooperation With Treatment Attendance & External Compliance with Treatment Expectations Not Met Partially Met Met Duration of Treatment Not Met Partially Met Met Effort and Active Participation in Treatment Not Met Partially Met Met Ownership of Actions Not Met Partially Met Met Attainment of Treatment Goals Not Met Partially Met Met Section Two: Criminogenic Needs Self-management Domain Not Met Partially Met Met Social Involvement Domain Not Met Partially Met Met Sexuality Domain Not Met Partially Met Met Attitudes, Schemas and Beliefs Domain Not Met Partially Met Met Criminality Domain Not Met Partially Met Met Section Three: Additional Considerations Level Initial Level/Current Level Risk Level at Intake I – Very Low Risk II – Below Average Risk III – Average Risk IVa – Above Average Risk IVb – Well Average Risk Current Risk Level I – Very Low Risk II – Below Average Risk III - Average Risk IVa – Average Risk IVb – Well above Average Risk 12. Individual Factor(s) 13. Predicted Trajectory 14. Containment Team Judgment With consideration of the results of this Treatment Completion Worksheet has the person completed treatment? Yes, Successful Completion No, Continued Treatment is Necessary
Appendices_Treatment_Completion_Worksheet_and_Statement_of_Successful_Completion1.docx