Statement of Successful Treatment Completion This document verifies that Type Full Client Name Here has completed all requirements of treatment at Type Provider Agency Name Here in Type City, State, Zip Here (city, state and zip code). Treatment was completed on Type Provider Full Name Here Certified Independent Provider signing this certificate CASOMB Provider Certification Number: Type Provider Certification Number Here Signature: ___________________________________ Type Supervising Officer/Agent Name Here Supervising Officer/Agent signing this certificate County: Type County Here Signature: ___________________________________ Note: For purposes of the CASOMB Sex Offender Treatment Provider Agency Requirements the term “successful treatment completion” is defined as having sufficient progress in meeting the and objectives of an “demonstrated individualized treatment plan” at the time of release from treatment. When the time the client has successfully completed treatment he or she shall receive a statement of successful treatment completion. Provider agencies will submit a copy of the statement to CASOMB and to the supervising agency, if any. Treatment completion does not mean that the client has successfully completed the sex offender management program, or that they will never reoffend. When active treatment ends, supervision and other elements of the Containment Model may continue. These elements may include, but are not limited to, monitoring, follow up sessions, aftercare meetings, polygraph testing, risk assessments, and other services which may be required as part of a sex offender management program. (See CASOMB Sex Offender Treatment Provider Agency Certification Requirements) KEEP THIS DOCUMENT The client is required to keep this document such time that he or she is no longer required to register.
Statement of Successful Treatment Completion This document verifies that Type Full Client Name Here has completed all requirements of treatment at Type Provider Agency Name Here in Type City, State, Zip Here (city, state and zip code). Treatment was completed on Type Provider Full Name Here Certified Independent Provider signing this certificate CASOMB Provider Certification Number: Type Provider Certification Number Here Signature: ___________________________________ Type Supervising Officer/Agent Name Here Supervising Officer/Agent signing this certificate County: Type County Here Signature: ___________________________________ Note: For purposes of the CASOMB Sex Offender Treatment Provider Agency Requirements the term “successful treatment completion” is defined as having “demonstrated sufficient progress in meeting the and objectives of an individualized treatment plan” at the time of release from treatment. When the time the client has successfully completed treatment he or she shall receive a statement of successful treatment completion. Provider agencies will submit a copy of the statement to CASOMB and to the supervising agency, if any. Treatment completion does not mean that the client has successfully completed the sex offender management program, or that they will never reoffend. When active treatment ends, supervision and other elements of the Containment Model may continue. These elements may include, but are not limited to, monitoring, follow up sessions, aftercare meetings, polygraph testing, risk assessments, and other services which may be required as part of a sex offender management program. (See CASOMB Sex Offender Treatment Provider Agency Certification Requirements) KEEP THIS DOCUMENT The client is required to keep this document such time that he or she is no longer required to register.
Appendices_Treatment_Completion_Worksheet_and_Statement_of_Successful_Completion1.docx