Attachment #3.pdf
PDF 183 KB Posted
- Attached to
- PSYCHOLOGICAL EVALUATION SERVICES
- Solicitation number
- 5400024264
- Issued by
- South Carolina
About this file
This file is a template form used by the South Carolina Department of Juvenile Justice (SCDJJ) for conducting psychosocial and community psychology evaluations at its Coastal, Midlands, and Upstate Evaluation Centers. The form, designated as 904A and dated October 2019, serves as a standardized instrument for documenting comprehensive psychological assessments of juveniles within the state's justice system. The evaluation encompasses multiple data collection sources including interviews with the juvenile and parents, contact with community specialists and Department of Social Services, review of SCDJJ file information, and psychological testing as applicable. The form is structured to capture detailed information across several domains: family functioning, adolescent functioning including developmental and medical history, trauma history, school and peer relationships, mental health symptomatology, and resiliency factors, with specialized sections for psychosexual assessments when applicable to the nature of the offense.
The form emphasizes strict confidentiality protections, explicitly restricting disclosure to qualified professionals and authorized personnel involved in legal disposition matters. Prior to evaluation, juveniles and parents are informed of the evaluation's purpose, the types of information to be collected, confidentiality limitations, and mandatory reporting obligations for suspected child abuse or neglect. The report concludes with diagnostic impressions and recommendations based on the comprehensive assessment data. The template does not specify pricing terms, contract duration, renewal options, or funding sources, as it functions as an internal evaluation instrument rather than a standalone contract document or solicitation.
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Other files
| File | Type | Posted |
|---|---|---|
| Attachment #5.pdf | ||
| Solicitation.pdf | ||
| Attachment #2.pdf | ||
| Attachment #1.pdf | ||
| Attachment #4.doc | DOC document | |
| No Award.docx | DOCX document |
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Text version
CONFIDENTAL
SOUTH CAROLINA DEPARTMENT OF JUVENILE JUSTICE
COASTAL/MIDLANDS/UPSTATE EVALUATION CENTER PSYCHOSOCIAL EVALUATION
OR
COMMUNITY PSYCHOLOGY EVALUATION
904A 10-2019
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”)
CONFIDENTAL
SOUTH CAROLINA DEPARTMENT OF JUVENILE JUSTICE
COASTAL/MIDLANDS/UPSTATE EVALUATION CENTER PSYCHOSOCIAL EVALUATION
OR
COMMUNITY PSYCHOLOGY EVALUATION (cont.)
904A 10-2019
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
File details come from the government source that posted it. Updated .