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confirmation that the defendant signed the MHD authorization allowing release of personal health information.",{"name":70,"@type":61,"acceptedAnswer":71},"How is the treatment plan structured in the MHD Treatment Plan template?",{"text":72,"@type":64},"It collects client demographics, insurance and providers, qualifying diagnoses, and brief clinical history, then organizes clinically appropriate goals with objectives and interventions across domains such as mental health, substance use, physical health, housing, benefits and finances, employment and education, social supports, and legal 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Court’s Mental Health Diversion eligibility and suitability determination.  \nNote: This report does not opine on public safety risk.  \nYour Honor:  \nBased on an assessment of the defendant conducted on (insert date), I attest to the following: There is available treatment for the defendant's qualifying diagnosis(es) .  \n􀂅 Yes  \n􀂅 No  \n􀂅 Other:    \nThe Defendant has given their informed consent to participate in and comply with treatment asa condition of Mental Health Diversion.  \n􀂅 Yes  \n􀂅 No  \nThe defendant has signed the MHD authorization allowing me, his treatment provider to release Personal Health Information as part of MHD participation.  \n􀂅 Yes  \n􀂅 No  \nRecommendations:  \n☐ Because the defendant declined to sign a Release Information form for MHD, I/my organization cannot disclose their personal health information to the court.  \n☐ Because I/my organization do/does not offer treatment for the defendant’s qualifying diagnosis, I/my organization unable to recommend MHD.  \n☐ The following treatment plan is recommended as a condition of my client’s participation in Mental Health Diversion:  \n6.3 MHD TREATMENT PLAN TEMPLATE  \nMental Health Diversion Treatment Plan  \nClient Name:  \nDOB:  \nCounty of Residence:  \nInsurance Coverage:  \nHealth Plan (if relevant):  \nTreatment Providers:  \nEnhanced Care Manager (if applicable): Name and Contact Information Behavioral Health Case Manager/Therapist: Name and Contact Information Conservator (if applicable): Name and Contact Information  \nOther Provider: Name and Contact Information  \nQualifying Diagnosis(es):  \nPrimary Diagnosis:  \nSecondary Diagnosis(es):  \nOther Clinically Relevant Conditions  \n(i.e. chronic illnesses, pregnancy, traumatic brain injury, etc)  \nThe following treatment plan identifies clinically appropriate goals, treatment providers, and accountability measures, and ensures the client is connected to care that promotes their stability and meets the requirements of Penal Code § 1001.36.  \nBrief History  \nThis section should include psych history including meds, hospitalizations, treatment, etc.  \nTips: **remove before submitting to the court***(Treatment plan sections can include more than one problem. Add and remove Goals, Objectives and Interventions as needed. Remove section if not relevant to client, e.g. patient doesn’t have a substance use disorder)  \n** Requests made by the client to modify this plan, if any, are documented in the relevant sections. **  \nMental Health  \nProblem:  \nGoal:  \nObjectives & Interventions:  \n• Objective:  \n􀁒 Intervention:  \n• Objective  \n􀁒 Intervention:  \n• Objective:  \n􀁒 Intervention: Substance Use  \nProblem:  \nGoal:  \nObjectives & Interventions:  \n• Objective:  \n􀁒 Intervention:  \n􀁒 Intervention:  \n• Objective:  \n􀁒 Intervention:  \n• Objective:  \n􀁒 Intervention:  \n• Objective:  \n􀁒 Intervention:  \nPhysical Health  \nProblem:  \nGoal:  \nObjectives & Interventions:  \n• Objective:  \n􀁒 Intervention:  \n• Objective:  \n􀁒 Intervention: Housing  \nProblem:  \nGoal:  \nObjectives & Interventions:  \n• Objective:  \n􀁒 Intervention:  \n• Objective:  \n􀁒 Intervention:  \n􀁒 Intervention: Benefits & Finances Problem:  \nGoal:  \nObjectives & Interventions:  \n• Objective:  \n􀁒 Intervention:  \n􀁒 Intervention:  \n• Objective:  \n􀁒 Intervention: Employment & Education  \nProblem:  \nGoal:  \nObjectives & Interventions:  \n• Objective:  \n􀁒 Intervention:  \n• Objective:  \n􀁒 Intervention: Social Supports  \nProblem:  \nGoal:  \nObjectives & Interventions:  \n• Objective:  \n􀁒 Intervention:  \n• Objective:  \n􀁒 Intervention: Legal  \nProblem:  \nGoal: .  \nObjectives & Interventions:  \n• Objective:  \n􀁒 Intervention:  \n• Objective:  \n􀁒 Intervention:","cbCaitaNFJBW0nXX","https://ap.wps.com/l/cbCaitaNFJBW0nXX","pdf",396080,"English","# 6.2 MHD Suitability Report Template\n## Report Purpose and Required Attestations\n## Consent and Authorization\n## Recommendations\n# 6.3 MHD Treatment Plan Template\n## Client and Coverage Details\n## Qualifying Diagnosis(es)\n## Brief History\n## Mental Health Goals, Objectives & Interventions\n## Substance Use Goals, Objectives & Interventions\n## Physical Health Goals, Objectives & Interventions\n## Housing Goals, Objectives & Interventions\n## Benefits & Finances\n## Employment & Education\n## Social Supports\n## Legal","[{\"question\":\"What is the purpose of the MHD Suitability Report template?\",\"answer\":\"It is prepared to inform the San Francisco Superior Court’s determination of eligibility and suitability for Mental Health Diversion under California Penal Code § 1001.36, and it includes a note that it does not opine on public safety risk.\"},{\"question\":\"What confirmations and authorizations does the suitability report require?\",\"answer\":\"It requires attestations that treatment is available for the qualifying diagnosis(es), confirmation of the defendant’s informed consent to participate and comply with treatment, and confirmation that the defendant signed the MHD authorization allowing release of personal health information.\"},{\"question\":\"How is the treatment plan structured in the MHD Treatment Plan template?\",\"answer\":\"It collects client demographics, insurance and providers, qualifying diagnoses, and brief clinical history, then organizes clinically appropriate goals with objectives and interventions across domains such as mental health, substance use, physical health, housing, benefits and finances, employment and education, social supports, and legal needs.\"}]","MHD Suitability Report Template - Mental Health Diversion - Treatment Plan Template | PDF",1790100706]