904A-Pre-Dispositional Evaluation.docx
DOCX document 23 KB Posted
- Attached to
- PSYCHOLOGICAL EVALUATION SERVICES -FPB
- Solicitation number
- 5400019100
- Issued by
- Richland County, South Carolina
About this file
This document is a psychosocial and community psychology evaluation form template used by the South Carolina Department of Juvenile Justice (SCDJJ) across its Coastal, Midlands, and Upstate Evaluation Centers for pre-dispositional assessments of juveniles. The evaluation serves as a comprehensive assessment tool to inform judicial and departmental decisions regarding juvenile offenders and includes standardized sections for documenting referral information, sources of information, offense details, family and adolescent functioning, mental health symptomatology, psychological testing results, resiliency factors, diagnostic impressions, and clinical recommendations. The form mandates that evaluators conduct interviews with the juvenile and parents, contact community specialists and relevant agencies, review SCDJJ file information including mental health and school records, and administer appropriate psychological testing. Prior to evaluation, juveniles and parents must be informed of the evaluation's purpose, information collection methods, confidentiality limitations, and mandatory reporting obligations regarding child abuse or neglect, with documented acknowledgment of their understanding and cooperation.
The evaluation template establishes strict confidentiality protocols limiting report distribution to qualified professionals and authorized legal personnel, including attorneys, family court officials, and SCDJJ staff, with explicit warnings against unauthorized disclosure due to potential harm to the juvenile or interference with rehabilitative services. The form emphasizes that release to parents and caregivers must be preceded by thorough explanation by a qualified professional, and that information shared should be limited to only that pertinent to the requesting party's needs. This standardized evaluation instrument represents SCDJJ's systematic approach to comprehensive pre-dispositional assessment, incorporating psychological testing, developmental history, trauma assessment, school and peer functioning analysis, and clinical recommendations to support informed dispositional decision-making within the juvenile justice system.
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Text version
CONFIDENTAL
SOUTH CAROLINA DEPARTMENT OF JUVENILE JUSTICE
COASTAL/MIDLANDS/UPSTATE EVALUATION CENTER PSYCHOSOCIAL EVALUATION
OR
COMMUNITY PSYCHOLOGY EVALUATION
CONFIDENTAL
SOUTH CAROLINA DEPARTMENT OF JUVENILE JUSTICE
COASTAL/MIDLANDS/UPSTATE EVALUATION CENTER PSYCHOSOCIAL EVALUATION
OR
COMMUNITY PSYCHOLOGY EVALUATION (cont.)
| Name: | DOB: | ||
| JJMS #: | Date(s) of Evaluation (Commitment): | ||
| Evaluator(s): | Date of Report: | ||
| County: | Community Specialist: |
REFERRAL STATEMENT:
NOTICE:
This report is meant only for the use of qualified professionals and others involved from a legal perspective with this psychological evaluation for disposition. No unauthorized disclosure of this report or information contained in this report is allowed and any person who, without proper authorization, discloses information contained in this report assumes all liability associated therewith. Some individuals and family members may tend to misunderstand and/or distort the information presented herein, which could result in significant stress to the individual or may interfere with rehabilitative services. For individuals with certain mental health or behavioral issues, the consequences of disclosure may be serious. Release should be limited to only that information which is pertinent to the needs of the requesting party. Prior to release to parents/caregivers, the evaluation should first be explained thoroughly by a qualified professional.
Before beginning the evaluation, juvenile and parent(s), were informed of the purpose of the evaluation, what type of information would be requested, and how it would be used. They were also told that the results of the evaluation were not confidential and would be shared with the attorneys, family court officials, and South Carolina Department of Juvenile Justice (SCDJJ) personnel. They were informed that suspected child abuse or neglect must be reported to the proper authorities. Juvenile and parent(s) indicated that they understood the limits of confidentiality and expressed their willingness to cooperate with the evaluation.
SOURCES OF INFORMATION:
Interview with juvenile Interview with parent Contact with Community Specialist Contact with DSS Other Contacts DJJ file information (covers all collateral info documents, including mental health, school, etc) Psychological Testing (only those administered in this evaluation)
DJJ HISTORY AND SUMMARY OF CURRENT OFFENSE(S)
JUVENILE/PARENT ACCOUNT OF THE CURRENT OFFENSE(S)
(For sexual risk assessments, just state “See Psychosexual Assessment for this information”)
FAMILY FUNCTIONING
· Parent/Guardian
· Siblings; Other relevant family members
· Who is living in the home
· Family dynamics
· Relevant community/environmental factors
ADOLESCENT FUNCTIONING
Relevant History
· Developmental History
· Medical History
· Trauma History
· Placement History
· School Functioning
· Peer Relations
· Community Functioning
· Adjustment to Evaluation Center (for secure evaluations)
· Mental Health Symptomatology
Psychological Assessment and Interpretation Behavioral Observations/Mental Status
Cognitive and Academic Functioning
Personality/ Emotional Testing
Psychosexual Assessment (Only for offenses that are sexual in nature)
RESILIENCY FACTORS
SUMMARY AND CONCLUSIONS
DIAGNOSTIC IMPRESSIONS
RECOMMENDATIONS
904A 10-2019 904A 10-2019
File details come from the government source that posted it. Updated .