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					                                      AGENCY PROGRESS REPORT
                                               15th Judicial Circuit
                                       Palm Beach County Drug Court Office
                                         3228 Gun Club Road, Rm. B-126
                                           West Palm Beach, FL 33406


Participant’s Name: _________________________________ Date: ________/________/________

Drug Court I.D.#: _______________________ Referral Agency I.D.#: _______________________

A) Name of Program/Service: ___________________________________________________________

B) Level of participation (check one):

 1) Daily                               2) Weekly                       3) Twice weekly

 4) Monthly                             5) Other (specify): _______________________________________

C) Progress Rating Scales (circle only one number per category)

                                                                   N/A   Poor   Fair   Good    Excellent

          Drug Treatment:                                          0     1      2      3       4

          Alcohol Treatment:                                       0     1      2      3       4

          Residential Treatment:                                   0     1      2      3       4

          Mental Health Counseling:                                0     1      2      3       4

          Family Counseling:                                       0     1      2      3       4

          Employment / Vocational Training:                        0     1      2      3       4

          Community Service:                                       0     1      2      3       4

          Other (specify): _________________                       0     1      2      3       4

          Prognosis:                                               0     1      2      3       4

D) If other than routine treatment plan changes, specify: ______________________________________

E) Scheduled termination date (check one):                   1) Unknown  2) _______/_______/_____

F) Counseling Sessions: Individual Scheduled                Attended     Groups Scheduled      Attended

                              a. _____/_____/____           yes  no    a. _____/_____/____   yes  no 

                              b. _____/_____/____           yes  no    b. _____/_____/____   yes  no 




Treatment Agency Progress Report Form – Palm Beach County, FL
                              c. _____/_____/____           yes  no     c. _____/_____/____    yes  no 

                              d. _____/_____/____           yes  no     d. _____/_____/____    yes  no 

G) U/A Test Results:                    Date of test              Tested for:           Result

                                        ____/____/____            _______________       __________________

                                        ____/____/____            _______________       __________________

                                        ____/____/____            _______________       __________________

                                        ____/____/____            _______________       __________________


H) Comments:

_____________________________________________________________________________________

_____________________________________________________________________________________



Agency Representative________________________________________




Treatment Agency Progress Report Form – Palm Beach County, FL
                                           DEFINITIONS OF AGENCY
                                               RATING SCALES

Rating Scale Subject Area                                    Definition
Drug Treatment:                                              This scale measures how well a participant is
                                                             responding to drug treatment by meeting the objectives
                                                             of the treatment, keeping scheduled appointments, and
                                                             getting along with treatment staff.
Alcohol Treatment:                                           This scale measures how well a participant is
                                                             responding to alcohol treatment by con- trolling his or
                                                             her use/abuse of alcohol, keeping scheduled
                                                             appointments, and getting along with treatment staff.
Residential Treatment:                                       This scale measures how well a participant is
                                                             responding to residential treatment by adhering to the
                                                             rules of the program, and how well he or she gets along
                                                             with the program staff.
Mental Health Counseling:                                    This scale measures how well a participant is
                                                             responding to mental health counseling, including
                                                             keeping scheduled appointments, getting along with
                                                             treatment staff, and following the course of action
                                                             prescribed by the Mental Health Counselor.
Family Counseling:                                           This scale measures how well a participant is
                                                             responding to family counseling, including keeping
                                                             scheduled appointments, getting along with treatment
                                                             staff, following through with family obligations as
                                                             determined by the counseling session(s).
Employment / Vocational Training:                            This scale measures how persistently a participant
                                                             pursues job possibilities, training, or educational
                                                             opportunities.
Community Service:                                           This scale measures how well a participant is fulfilling
                                                             his or her community service sanctioned by the Drug
                                                             Court.
Other (specify): _________________                           This scale should be a participant behavior that your
                                                             program considers important, applies to all or most
                                                             participants, and can be rated according to the scale
                                                             provided.




  Treatment Agency Progress Report Form – Palm Beach County, FL

				
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