Domestic Violence Treatment Progress Assessment (DVTPA) Monthly/Quarterly Summary Treatment Agency: ___________________________ Therapist: Client Name: ____________________ DOB: __________ Probation Officer: Treatment Start Date: ________________ Treatment Level: Month Review Date: ____________________ Quarterly Date Reviewed with Client:

Dates of attended treatment sessions:

IMMEDIATE CONCERNS: 1. 2. 3. 4. 5. 6. 7. 8.

SCORING: Check if an issue

Not Accountable with community supervision and treatment conditions Using alcohol or illicit drugs Not maintaining stable employment Not maintaining stable living arrangements Not Compliant with psychiatric and medical recommendations Hostility Stalking dynamics/obsession with the victim Suicidal/Homicidal

*Any check-marked areas creates immediate safety concerns for victim and an increase in risk for offender. Item requires immediate action to mitigate if possible by the M.T.T. and increase in supervision.

Scoring Guide Codes: 0=No 1=In Progress 2=Yes/Competency Completed N/A=Not Applicable Client Therapists’ CLIENT COMPETENCY AREAS Self-Report Score Scoring (Based on Observation, Program Assignments and Offender Report)

1. 2. 3. 4. 5. 6. 7.

Actively participates in treatment. Confronts others appropriately in group. Commitment to elimination of abusive behavior. Eliminates manipulative behavior. Completed personal change plan. Demonstrates development of empathy. Accepts full responsibility for offense and abusive behavior. *Denial Level (If applicable)

8. Understands pattern of power and control issues. 9. Does not view themselves as the victim. 10. Accepts consequences of abusive behavior. 11. Challenges cognitive distortions. 12. Define types of violence. 13. Identifies & manages personal pattern of violence. 14. Understanding of inter-generational effects of violence. 15. Uses appropriate communication skills. 16. Offender understands and uses “time-out.” 17. Recognizes financial responsibility. 18. Not engaging in any known forms of violence & abuse. 19. Understands distorted view of self, others & relationships. 20. Identifies chronic abusive beliefs about victim and thought patterns that support abusive behavior 21. Uses pro-social community supports. 1  Revised 10‐2‐12 Davies & Associates                   FORM MAY BE COPIED WITHOUT ALTERATIONS, FOR CONTACT INFORMATION CALL (970) 353‐0422

22. Understands cycle of violence. 23. Positive parenting skills with children. (living with biological children) 24. Demonstrates appropriate interaction with children and partner in a co-parenting or step-parenting situation (Client a step-parent or visiting parent) 25. Understands healthy sexual behaviors & consent. 26. Other: 27. Other:

Comments from Competency Areas: Number Comments:

STRENGTHS: 1. 2. 3. 4. 5. 6. 7.

Client Self- Report

Therapist scoring


Pro-Social Friends Social Activity Spirituality Happiness Creativity Fun Time/Hobbies Health

Risk concerns for this month/review period:

Counselor Comments:

Please indicate other services provided, agency name and frequency: U.A. Color: ____________ B.A. Color: ___________ Monitoring Location: Scram: _______________ ETG: ________________ Antabuse: Mental Health Counseling: ______________________ Substance Counseling: Other Services:

Primary Therapist


2  Revised 10‐2‐12 Davies & Associates                   FORM MAY BE COPIED WITHOUT ALTERATIONS, FOR CONTACT INFORMATION CALL (970) 353‐0422

Monthly Report.pdf

Demonstrates development of empathy. 7. Accepts full responsibility for offense and abusive behavior. *Denial Level (If applicable). 8. Understands pattern of ...

75KB Sizes 7 Downloads 75 Views

Recommend Documents

Monthly Newsletter
Sep 16, 2015 - are really cool, having access to this digital ... Posting to blogs and creating other ... Ed. Tech: Jen MacDonald Jameson (SUN Room K-2).

Monthly Owl.pdf

monthly memos -
OSU Extension Services and. Weinland Park Community Civic Association. Would you like to improve your. English? Godman Guild's next ESOL class will.

Monthly Investment Strategy
Jun 29, 2017 - VIBHA 6% margin. 2017 BCH. LPH. CHG. CMR. VIBHA. EBITDA margin. 1-2 ppt 2017-2018 margin. BDMS Wellness Clinic Center. BH. Sector Rating ...... CSC. 31-Dec. 1.72. 2.44. 1.98. 1.30. 1.85. 1.49. 1.58. 2.08. 1.33. 1.45. 59.0. 8.1. 55.4. 1

Monthly Investment Strategy
Indonesia. +11.50. +111.38. +779.19. +646.24. Philippines. -3.58. -132.56 ...... MEGA. 31-Dec. 0.34. 0.19. 0.25. 0.13. 0.31. 0.18. 0.19. 0.12. 0.29. 0.23. 0.00. 26.5.

Monthly Friday Movie.pdf
Page 1 of 1. Pastor Emery Moss Jr. Presents. MOVIE NIGHT - APOLOGETIC SESSIONS. The Last Friday of Each Month. September 25, 2015. Showing.

Monthly Donation form.pdf
Monthly Donation form.pdf. Monthly Donation form.pdf. Open. Extract. Open with. Sign In. Main menu. Displaying Monthly Donation form.pdf. Page 1 of 287.

Washington Monthly 2016 College Rankings
Aug 29, 2016 - Yet no publication has ranked the top schools for them. Until now. ... Best Colleges for Adult Learners Rankings. 26 ... Colleges are drowning in online applications, .... our longtime accountant and financial advisor, and,.

Library monthly report -
Library monthly report. Generated on 2016-08-16T16:07:02.743Z. Book sales. Name. Author. Sales. A Tale of Two Cities Charles Dickens 351. The Lord of the Rings J. R. R. Tolkien 125. The Da Vinci Code. Dan Brown. 255. The Hobbit. J. R. R. Tolkien 99.

Page 1 of 1. - - -. --. -. Page 1 of 1. SEPTEMBER MONTHLY PLAN.pdf. SEPTEMBER MONTHLY PLAN.pdf. Open. Extract. Open with. Sign In. Main menu. Displaying SEPTEMBER MONTHLY PLAN.pdf. Page 1 of 1.

SBBTM Monthly Bulletin.pdf
~Please TURN OFF pagers, cell phones (vibrate). ~Be mindful of your children during service. ~Refrain from unnecessary walking during the Word of.

Monthly Budget Planner.pdf
Page 2 of 2. Monthly Budget Planner.pdf. Monthly Budget Planner.pdf. Open. Extract. Open with. Sign In. Main menu. Displaying Monthly Budget Planner.pdf.

Monthly Meal Planner.pdf
There was a problem previewing this document. Retrying... Download. Connect more apps ... Monthly Meal Planner.pdf. Monthly Meal Planner.pdf. Open. Extract.

Washington Monthly 2016 College Rankings
Aug 29, 2016 - ed more bachelor's degrees than certificates or associate's degrees) .... ment of Education Leadership, Management, and Policy at Seton Hall.

Seraj -Monthly-Planning.pdf
Whoops! There was a problem loading more pages. Retrying... Seraj -Monthly-Planning.pdf. Seraj -Monthly-Planning.pdf. Open. Extract. Open with. Sign In.

Monthly Gratitude Diary.pdf
Whoops! There was a problem loading more pages. Retrying... Monthly Gratitude Diary.pdf. Monthly Gratitude Diary.pdf. Open. Extract. Open with. Sign In.Missing: