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FLORIDA DEPARTMENT OF CORRECTIONS
OFFICE OF HEALTH SERVICES
HEALTH SERVICES BULLETIN NO. 15.05.11 Page 1 of 7
SUBJECT: PLANNING AND IMPLEMENTATION OF INDIVIDUALIZED MENTAL
HEALTH SERVICES
EFFECTIVE DATE: 10/19/98
I. PURPOSE:
To provide minimum guidelines and requirements for the development and review of
individualized mental health service plans for inmates receiving mental health services.
II. POLICY:
A. Each mentally disordered inmate who is receiving ongoing mental health services
shall have an individualized service plan (ISP). The ultimate goal of the ISP is to
assist the inmate to function adequately within the prison environment. The ISP
shall be the outcome of the collaborative effort of the multidisciplinary services
team (MDST) and the inmate who will jointly work on the development and
implementation of the ISP.
B. The ISP shall reflect the inmate's current mental health status and needs based on
the biopsychosocial assessment, diagnosed mental disorders, and functional
strengths and limitations attributable to mental disorder(s). It shall identify his/her
mental health problems which may negatively impact on his/her ability to adjust to
incarceration. The ISP shall also include achievable time-limited objectives written
in measurable terms which reduce symptoms, enhance current functioning, or
maintain current functioning. The ISP shall also identify those problems for which
there are currently no available resources within the institution or which are not
currently the focus of treatment.
C. When inmates are transferred between institutions or levels of care, the ISP shall be
updated (revised) to identify new service providers and the current focus of services,
while ensuring continuity of care.
III. DEFINITIONS:
A. Biopsychosocial Assessment (BPSA): a summary of important and pertinent
information obtained by the case manager from a clinical interview or interviews, a
review of the inmate's classification and health record with special attention to the
most recent psychiatric and/or psychological evaluations and prepared prior to the
development of an individualized service plan (see attachment #1 example). The
HEALTH SERVICES BULLETIN NO. 15.05.11 Page 2 of 7
SUBJECT: PLANNING AND IMPLEMENTATION OF INDIVIDUALIZED MENTAL
HEALTH SERVICES
BPSA shall be completed as part of the identification of treatment needs and shall
be updated at least yearly while the inmate is in treatment.
B. Individualized Service Plan (ISP): a dynamic, written description of current
problems, goals, and treatments which is developed and implemented by the
multidisciplinary services team (MDST) and the inmate. The ISP shall be recorded
on DC4-643A Individualized Service Plan (parts I, II and III) (see attachment #2
example and appendix I Instructions for Writing Individualized Service Plan) and
shall be revised regularly to reflect the inmate's progress.
C. Multidisciplinary Services Team (MDST): a group of staff members representing
different professions, disciplines, or service areas which provides assessment, care,
and treatment to the inmate and develops, implements, reviews, and updates the ISP.
While the case manager has the task of writing the draft ISP with input from the
MDST (and also has to see that the ISP is implemented, revised and reviewed in a
timely manner), the responsibility for the ISP is shared by the entire MDST. The
minimum staff which shall compose the MDST will be as follows:
1. S-1/S-2 patients—case manager and psychologist.
2. S-3 patients—case manager and psychologist, psychiatrist and RN specialist.
3. S-4/S-5 patients—case manager, psychologist, psychiatrist, RN specialist,
human services counselor (and/or activity therapist) and correctional officer.
D. Service Planning Conference: a meeting of the MDST members (sometimes with
the inmate present) during which assessment data and individual clinical
perspectives are utilized to develop, review, and update the ISP. Conferences shall
be scheduled to coincide with required reviews of the ISP. Conferences shall be
held on or before the date due and shall be documented on DC4-643B
Individualized Service Plan Review (see attachment #3 example). The MDST shall
also schedule conferences as necessary to review inmate progress and update the
ISP. MDST conferences shall be documented as an incidental note (if the inmate is
not present) or as a progress note (if the inmate is present) in the health record.
E. Problem Index: a systematic list of problems which is organized and classified into
five basic domains or categories of patient behavior and functioning. Within each
domain, problems are further divided into standard problem areas (each of which is
assigned a discrete number). Area numbers serve as the key elements in the tracking
system of the clinical record. The problem index is contained in appendix II
Problem Index. All problems shall be written in descriptive and measurable terms
HEALTH SERVICES BULLETIN NO. 15.05.11 Page 3 of 7
SUBJECT: PLANNING AND IMPLEMENTATION OF INDIVIDUALIZED MENTAL
HEALTH SERVICES
(e.g., #118 Hallucinations - patient responds five (5) times daily since 1992 to
voices others cannot hear).
F. Intervention Index: a list of commonly used treatment interventions and activities.
The intervention index is contained in appendix III Intervention Index. This list is
not inclusive of all possible intervention alternatives that may be used.
IV. REQUIREMENTS FOR ISP DEVELOPMENT AND REVISION:
A. The single point of accountability for the ISP shall be the case manager. The
assignment of the case manager by the senior psychologist will be documented in
the chart via an incidental note. The case manager shall be responsible for drafting
the ISP with input from the inmate; the MDST shall finalize the ISP at a service
planning conference. The case manager shall also ensure that the ISP is
implemented, reviewed, and revised in a timely manner. The case manager shall be
assigned within 72 hours (excluding weekends and holidays) of:
1. Assigning an inmate with a grade of S-2 or higher.
2. Receiving an inmate with a grade of S-2 or higher.
3. Admitting an inmate to a TCU, or a CSU, or CMHI.
B. An inmate identified in need of ongoing mental health services shall have a case
manager assigned and an individualized service plan initiated. The need for mental
health services and the development of the ISP shall be based on a thorough
assessment of the inmate as compiled in the biopsychosocial assessment, a
psychiatric evaluation if applicable, and psychological testing when needed (see
appendix IV Mental Health Services Planning Reference Sheet). Whenever an
inmate receiving outpatient mental health services is transferred, the ISP shall be
reviewed and revised within the time frames specified in section VIB below.
C. The individualized service plan shall reflect the inmate’s strengths and limitations
(see appendix V Index of Strengths and Limitations) which may impact adjustment
to incarceration and the provision of mental health services. The ISP shall reflect
current psychiatric diagnosis, based on the current version of the Diagnostic and
Statistical Manual of Mental Disorders, and significant functional problems
whether or not such problems are a focus of planned treatment services.
D. The ISP problem descriptions shall be written in behavioral terms and shall include
specific baseline data on frequency and intensity of observed symptoms and
HEALTH SERVICES BULLETIN NO. 15.05.11 Page 4 of 7
SUBJECT: PLANNING AND IMPLEMENTATION OF INDIVIDUALIZED MENTAL
HEALTH SERVICES
functional limitations. For example, frequency (episodes take place on three of
seven days); duration (episodes last for ten minutes); or intensity (patient rates
anxiety as seven (7) on a scale of one (1) (low) to 10 (ten) (high). ISP short-term
goals shall be time limited, appropriate to the time limitations for attaining the goals,
and written in objective, measurable behavioral terms.
E. The ISP shall also specify the type of interventions, the frequency of the
interventions, and the staff responsible for providing the interventions. The ISP
shall be reviewed and modified in accordance with the time frames specified in
sections V Outpatient Services and VI Inpatient Services and reflect the inmate’s
progress, or lack thereof, and all modifications necessary.
1. The case manager shall review DC4-644 Intake Psychological Screening
Report, mental health progress notes (if any), any previous mental health
records available, the DC4-655 Psychiatric Evaluation (if the inmate has
been evaluated by a psychiatrist). The case manager shall complete or revise
the biopsychosocial assessment and interview the inmate to obtain his/her
input for the ISP. The case manager shall document the needs and goals
identified by the inmate as well as those identified by the staff with an
indication as to whether the inmate concurred with such in a SOAP note
titled Service Planning Interview.
2. The case manager shall consult the problem index and the intervention
index, develop a draft ISP (DC4-643A), and schedule a service planning
conference.
3. At the service planning conference, the multidisciplinary services team shall
review the clinical data (including the psychiatric evaluation and the
biopsychosocial assessment), finalize, and sign the ISP. If the inmate is not
present at the service planning conference, the inmate shall sign part III of
the ISP at the next clinical encounter (see appendix VI Example of an
Individualized Service Plan).
HEALTH SERVICES BULLETIN NO. 15.05.11 Page 5 of 7
SUBJECT: PLANNING AND IMPLEMENTATION OF INDIVIDUALIZED MENTAL
HEALTH SERVICES
V. OUTPATIENT SERVICES:
A. The initial individualized service plan shall be completed within 14 (calendar) days
of the inmate being assigned a mental health classification of S-2 or S-3. Upon
transfer of an S-2 or S-3 inmate, the current ISP shall be reviewed and revised as
needed within 14 calendar days of the completed transfer. These time frames
include:
1. Permanently assigned S-2 and S-3 inmates (including those permanently
assigned to reception centers).
2. New intakes at reception centers who remain within the reception center
longer than 60 days. Transient S-2 and S-3 inmates at reception centers
shall have the ISP reviewed and revised as needed in accordance with
intervals specified for outpatient services.
a. If the ISP is not completed before a new intake is transferred to a
permanent institution, the case manager shall write an incidental note
to that effect and include the problem areas (from the Problem
Index) which require a follow-up at the permanent institution.
b. The ISP shall be completed within 14 calendar days of the inmate’s
transfer to a permanent institution.
B. After the initial ISP is completed, it shall be reviewed by the MDST 30 days after it
is finalized. The ISP shall then be reviewed and revised as needed, 120 days after
the initial review, and every 180 days thereafter that the inmate continues to receive
mental health services.
C. If a transferring inmate had been receiving mental health services prior to transfer,
the inmate’s ISP shall be reviewed and revised as needed within 14 calendar days of
the transfer to ensure continuity of mental health care. Once this 14-day review and
revision has been completed, subsequent ISP reviews shall be conducted at the
intervals required prior to the inmate’s transfer, unless the ISP has been modified
significantly or the inmate’s clinical condition has changed substantially. Further,
the ISP shall always be reviewed and revised as needed subsequent to any
significant event (e.g., IMR placement or outside court proceedings).
HEALTH SERVICES BULLETIN NO. 15.05.11 Page 6 of 7
SUBJECT: PLANNING AND IMPLEMENTATION OF INDIVIDUALIZED MENTAL
HEALTH SERVICES
VI. INPATIENT SERVICES:
A. S-4 Inmates in Transitional Care Units:
1. An ISP shall be completed within 14 calendar days of admission. The
inmate shall be present, whenever this is feasible, at the service planning
conference and at ISP reviews. The absence and the reason for the absence
of an S-4 at such meetings shall be documented in an incidental note.
2. The inmate and the MDST shall meet to review and, if necessary, update the
ISP at the following intervals: 30 days, after the initial ISP was finalized,
and every 90 days thereafter following the finalizing of the initial ISP. The
ISP shall be revised and the review shall be documented on the ISP review.
B. S-5 Inmates in Crisis Stabilization Units:
1. Within five (5) calendar days of admission, the inmate and the MDST shall
meet to review and finalize the ISP. Thereafter, the ISP shall be reviewed
and revised as needed every 14 calendar days after completion of the initial
ISP. The ISP shall be revised and the review shall be documented on the
ISP review.
2. The inmate shall be present, whenever this is feasible, at the service
planning conference and at ISP reviews. The absence and the reason for the
absence of an S-5 at such meetings shall be documented in an incidental
note.
C. Inmates at the Corrections Mental Health Institution:
1. A written or verbal order for admission shall be recorded within 1 (one) hour
of admission.
2. A psychiatric evaluation shall be completed or updated within three (3) days
of admission.
3. The initial review and revision of the individualized service plan shall be
completed within seven (7) days of admission. The multidisciplinary
services team shall review and revise the ISP within 30 days after the
inmate’s admission, whenever the inmate’s level is changed, or after any
HEALTH SERVICES BULLETIN NO. 15.05.11 Page 7 of 7
SUBJECT: PLANNING AND IMPLEMENTATION OF INDIVIDUALIZED MENTAL
HEALTH SERVICES
clinically significant event (e.g., placement on SOS). The ISP shall be
reviewed and revised as needed at least every 30 days.
VII. INSTITUTIONAL OPERATING PROCEDURE:
Each institution shall have a health services internal operating procedure related to actual
implementation and compliance with this health services bulletin.
Assistant Secretary for Health Services Date
Attachments:
#1 DC4-643C Bio-Psychosocial Assessment and Continuation Sheet (example)
#2 DC4-643A (Parts I, II, and III) Individualized Service Plan (example)
#3 DC4-643B Individualized Service Plan Review (example)
Appendices:
I Instructions for Writing Individualized Service Plan
II Problem Index
III Intervention Index
IV Mental Health Services Planning Reference Sheet
V Index of Strengths and Limitations
VI Example of an Individualized Service Plan
This Bulletin Supersedes: HSB 15.05.11 dated 11/9/95
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