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Program Report
| Monthly Report | | | | | | | | | | | | |
| *Insert Program Name* | | | | | | | | | | | | |
| Instructions: This report will be emailed to the SCDJJ Program Monitor by the 5th each month. Please list each juvenile enrolled in your program during the monthly report period and indicate which services he/she received during that period using the drop down box provided in each field. Also include the admissions date and the discharge date when applicable. When a juvenile is discharged from your program, please indicate if it was a successful or unsuccessful discharge. Unsuccessful discharges require a brief summary of the reason for discharge. | | | | | | | | | | | | |
| Juvenile Name | JJMS# | County | Status | Admission Date | Anger Management Program | Cognitive Behavior Therapy | Substance Abuse Program | Vocational Training/ Job Readiness | Earned GED/ HS Diploma | Release Date | Discharge Type | Describe circumstances of Unsuccessful Discharge |
Monthly Report
| South Carolina Department of Juvenile Justice | | | |
| Community Alternatives Monthly Report | | |
| | Select | |
| | Program Name | |
| | Select | 2017 |
| | Month | Year |
| Part 1: Statistical Information | | |
| Monthly | Year to Date |
| Number of Referrals: | | |
| Number of Referrals Accepted: | | |
| Number of Admissions: | | |
| Gender of Juveniles Admitted: | |
| Males: |
| Females: |
| Race of Juvneiles Admitted: | |
| African American |
| Caucasian |
| Hispanic |
| Other |
| Juvenile Age upon Admission |
| Length of Stay for Successful Terminations |
| Number of Dischages: | |
| Successful: |
| Unsuccessful: |
| # Discharged within prescribed timeframe |
| # Discharged after one extention |
| # Discharged with more than one extention |
| Length of Stay for Successful Terminations |
| Length of Stay for Unsuccessful Terminations |
| Overall Average Length of Stay |
Utilization Percentages
| Upon Discharge - Juveniles returned to: | | Monthly | Year to Date |
| Higher Level of Care | | |
| Same Level of Care | | |
| Lower Level of Care | | |
| In Patient Psychiatric | | |
| In Patient Substance Abuse | | |
| Home | | |
| Secure Custody | | |
| Other (Specify) | | |
| County Distribution of Juveniles | (See Attachment) |
| Part 2: Administrative Information | |
| 1. Education / Vocation: | | | Monthly | Year to Date |
| a. # Graduate Equivalency Diplomas | | | |
| b. # High School Diplomas | | | |
| c. Average Grade Level Improvement of those who left during the month | | | |
| | Math | | |
| | Reading | | |
d. Percentage of juveniles receiving vocational instruction who left during this month
| 2. Event Reports (ERMIS) | |
| Incident 1: |
| Type: |
| Juvenile(s): |
| Race: |
| Staff: |
| Medical Attention?: |
| Physical Restraint?: |
| Action Taken: |
| See attached for additional events, if applicable. |
| # of Runaways: |
| # of Escapes: |
| # Juveniles injured in an assault |
| # Juveniles with Substatiated Abuse and Neglect Allegations |
| # Juveniles who sufferred from an Accidential Injury |
| 3. Transition Planning: | | |
| Family Involvement: | |
| Number of juveniles who visited with their family | |
| Case Manager Involvement | |
| Number of juveniles who visited with their Case Manager | |
| | Visits could be in person or via video conference |
| 4. Personnel: | |
| Personnel Changes: |
| New Hires: |
| Termination: |
| Resignation: |
| Personnel Actions: |
Staff Training:
5. Regulatory Inspections:
DSS, DJJ, DHEC, Fire, etc.
6. Programming / Future Planning:
7. Budgetary:
8. Directors Comments:
| Director's Signature: | |
| By signing this document, I affirm the information reported is accurate. |
| Additional Events, if applicable. | |
| Event Reports (ERMIS) #2 | |
| Incident 1: |
| Type: |
| Juvenile(s): |
| Race: |
| Staff: |
| Medical Attention?: |
| Physical Restraint?: |
| Action Taken: |
| Event Reports (ERMIS) #3 | |
| Incident 1: |
| Type: |
| Juvenile(s): |
| Race: |
| Staff: |
| Medical Attention?: |
| Physical Restraint?: |
| Action Taken: |
| Event Reports (ERMIS) #4 | |
| Incident 1: |
| Type: |
| Juvenile(s): |
| Race: |
| Staff: |
| Medical Attention?: |
| Physical Restraint?: |
| Action Taken: |
| Event Reports (ERMIS) #5 | |
| Incident 1: |
| Type: |
| Juvenile(s): |
| Race: |
| Staff: |
| Medical Attention?: |
| Physical Restraint?: |
| Action Taken: |
Denied Referrals
| South Carolina Department of Juvenile Justice | | | |
| Referrals Denied Admission Explaination | | |
| | Select | |
| | Program Name | |
| | Select | Select |
| | Month | Year |
| I. Denied Referrals | | |
| Current Month | YTD |
| Number of Denied Referrals | 0 | 0 |
| II. Explanation for Denied Referrals (current month) |
| Juvenile #1 |
| Date of Referral: |
| Date of Response: |
| Juvenile Name: |
| JJMS Number: |
| Brief Justification: |
Juvenile #2
| Date of Referral: |
| Date of Response: |
| Juvenile Name: |
| JJMS Number: |
| Brief Justification: |
Juvenile #3
| Date of Referral: |
| Date of Response: |
| Juvenile Name: |
| JJMS Number: |
| Brief Justification: |
Juvenile #4
| Date of Referral: |
| Date of Response: |
| Juvenile Name: |
| JJMS Number: |
| Brief Justification: |
Drop Down List
| YesNo | DischargeType |
| Yes | Successful |
| No | Unsuccessful |
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