ࡱ> %` bjbj |̟̟e \ >>>8,?@|9PA>CCCCMPWN#Oh@BBBBBB$hPf ]RJzM]R]RfCC9V9V9V]R&C C@9V]R@9V9VNhx h|CA a->Rz0~T 09@z(ASA`h|A h|OPh9VPTPOOOffU^OOO9]R]R]R]R#>> 46 "X   USTF PROJECT CODE: REPORTING QUARTER: (CHECK ONE):NAME OF AGENCY: JULY 1 TO SEPTEMBER 301  FORMCHECKBOX NAME OF PROGRAM: OCTOBER 1 TO DECEMBER 312  FORMCHECKBOX PERSON COMPLETING FORM/PHONE #: JANUARY 1 TO MARCH 313  FORMCHECKBOX DATE SUBMITTED:APRIL 1 TO JUNE 304  FORMCHECKBOX CHECK AGENCY REPORTING QUARTER:1  FORMCHECKBOX 2  FORMCHECKBOX 3  FORMCHECKBOX 4  FORMCHECKBOX  1. 2. 3. 4. 5. 6. Beginning Active Caseload (First Day of Qtr.)New Enrollees to Program Element During Qtr.Transfers to Program Element During Qtr.Transfers From Program Element During Qtr.Terminations From Program Element During Qtr.Ending Active Caseload (Last Day of Qtr.) TARGET GROUPS7. Number of Target Group Members:7A.Number of Consumers referred for diversion by law enforcement before arrest or complaint.7B.Number of Consumers referred for diversion by police, county corrections, prosecutors, defense council or the court at the time of initial detention/first appearance hearings.7C.Number of Consumers referred for diversion after initial detention/ first appearance hearings by county corrections staff, prosecutors, defense attorneys or the court.7D.Number of Consumers referred for any type of diversion by mental health agencies, family, doctors and others. (not 1-3)7E.Number of Consumers referred by mental heath personnel or family for re-entry services (prior to or at completion of jail/prison sentence).7F.Number of Consumers referred by county corrections for re-entry services (prior to or at completion of sentence).7G.Number of Consumers referred by state prison and or parole for re-entry services (prior to or at completion of sentence).  USTF PROJECT CODE: REPORTING QUARTER: (CHECK ONE):NAME OF AGENCY: JULY 1 TO SEPTEMBER 301  FORMCHECKBOX NAME OF PROGRAM: OCTOBER 1 TO DECEMBER 312  FORMCHECKBOX PERSON COMPLETING FORM/PHONE #: JANUARY 1 TO MARCH 313  FORMCHECKBOX DATE SUBMITTED:APRIL 1 TO JUNE 304  FORMCHECKBOX CHECK AGENCY REPORTING QUARTER:1  FORMCHECKBOX 2  FORMCHECKBOX 3  FORMCHECKBOX 4  FORMCHECKBOX  1.Number of referred individuals clinically evaluated for service eligibility (e.g. do evidence of a mental illness) FORMTEXT      2.Number of clinical assessments completed (more in depth psychiatric/clinical/bio-psychosocial assessments) FORMTEXT      3.Number of completed clinical assessments & recommendations used in diverting individuals resulting in less or no jail days pre-sentencing FORMTEXT      4.Number of consumers enrolled in the program for pre booking (pre-arrest) jail diversion FORMTEXT      5.Number of consumers enrolled in the program for post booking diversion but not detained in jail. FORMTEXT      6.Number of consumers enrolled in the program for post booking diversion while detained in jail. FORMTEXT      7.Number of consumers enrolled in the program for re-entry from county corrections (prior to or at completion of sentence) FORMTEXT      8.Number of consumers enrolled in the program for re-entry from state prison or parole (prior to or at completion of sentence) FORMTEXT      9.Number of consumers with pre-release or diversion plans developed FORMTEXT      10.Number of APN/Psychiatrist psychiatric evaluations completed FORMTEXT      11.Number face to face nursing units with consumers for medication administration and management FORMTEXT      12.Number of staff face to face units in a correctional facility FORMTEXT      13.Number of staff face to face units with consumers taking place off-site (any location in the community, except jail or provider agency ) FORMTEXT      14.Number of staff face to face units with a consumer taking place at the agency site(s) FORMTEXT      15.Number of staff face to face units with an enrolled consumer s family (any location) FORMTEXT      16.Number of non-family collateral face to face units on behalf of consumers that take place FORMTEXT      17.Total units of service to be provided (#s 11  17 of those applicable) FORMTEXT      18.Aggregate hours of telephone contacts with consumers or collaterals FORMTEXT      19.Number of e-mails made with the consumer or collateral FORMTEXT      20.Number of criminal justice staff trained/educated/cross trained with or without mental health staff present. 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FORMTEXT       Total number of consumers with the following disposition in the quarter:  a) Number of consumers diverted pre booking (pre-arrest)  b) Number diverted post booking without detention in a county correctional facility. (arrested but not incarcerated)  c) Number of consumers successfully diverted post booking while detained in a county correctional facility.  d) Number of consumers with a reduction of days spent detained in a county correctional facility.  e) Number of consumers successfully diverted from a state prison sentence  f) Number of consumers successfully provided re-entry services prior to and after serving their sentence in a county correctional facility.  g) Number of consumers successfully provided re-entry services prior to and after serving their sentence in state prison or on parole.  h) Number of criminal justice staff trained/educated/cross trained with or without mental health staff present.  i) Number of hours of training/education with criminal justice with or without mental health staff present. Total number of consumers successfully linked to the following services and supports:  a. mental health services b. co-occurring treatment  c. health providers (medical/dental) d. temporary housing/shelter  e. permanent housing f. supported housing g. entitlements/financial:  h. DVRS/One Stop i. integrated employment j. education/training     8/08 Submit forms 30 days after the close of the Quarter to the QCMR Coordinator at the following address: Page 2 of 3 Division of Mental Health Services, PO Box 727, Trenton, NJ, 08625-0727 8/08 Submit forms 30 days after the close of the Quarter to the QCMR Coordinator at the following address: Page 1 of 3 Division of Mental Health Services, PO Box 727, Trenton, NJ, 08625-0727 2/02 Page 1 of 1 ANNEX A: Supported Employment QUARTERLY CONTRACT MONITORING REPORT (QCMR) CLIENT MOVEMENT REPORT Justice Involved Services QUARTERLY CONTRACT MONITORING REPORT (QCMR) CLIENT MOVEMENT REPORT Justice Involved Services t#$2BDFH\^`jlprιΡ{iZHZHi#h%Shn5CJOJQJ^JaJhid5CJOJQJ^JaJ#h%Shy5CJOJQJ^JaJhJ5CJOJQJ^JaJ,jh%Sh]2CJU^JaJmHnHu/j:h%Sh]2CJOJQJU^JaJ)jh%Sh]2CJOJQJU^JaJ h%Sh]2CJOJQJ^JaJh9CJOJQJ^JaJU hs\h9CJOJQJ^JaJnpr ~|upppkfpapX  gdgd]2gd/J\gd%Sgdykd2;$$Ifl4F#&X 0    4 lalf4   :<Lfz|~ҟ(<>xz|~ƸmƸ_Nm h/mh/mCJOJQJ^JaJhEWCJOJQJ^JaJ.jhCJOJQJU^JaJmHnHu h%Sh/J\CJOJQJ^JaJ h%Sh%SCJOJQJ^JaJ hs\h]2CJOJQJ^JaJh]2CJOJQJ^JaJh%SCJOJQJ^JaJ h%ShyCJOJQJ^JaJ4jh%Sh/J\CJOJQJU^JaJmHnHu~ܠ*,.<hjlv*DFHPܢޢͼmͮ\NhyCJOJQJ^JaJ hs\h]2CJOJQJ^JaJ.jh9CJOJQJU^JaJmHnHu.jhCJOJQJU^JaJmHnHu h%ShCJOJQJ^JaJhCJOJQJ^JaJ hs\hCJOJQJ^JaJh%SCJOJQJ^JaJ h%Sh%SCJOJQJ^JaJ%h%Sh]2B*CJOJQJaJphjnDHޢ~ .2̥"&ȦħHJP gd  gdy  gd|ģ ,.02:ʥإ "$&.Ŝ}eWhEWCJOJQJ^JaJ.jhEWCJOJQJU^JaJmHnHuh!).CJOJQJ^JaJ h%ShyCJOJQJ^JaJ h%Sh]2CJOJQJ^JaJ.jh]2CJOJQJU^JaJmHnHuh]2CJOJQJ^JaJ hs\h]2CJOJQJ^JaJhCJOJQJ^JaJhidCJOJQJ^JaJ.ƦԦ §ħȧʧп~f~UG6 h%ShrCJOJQJ^JaJhidCJOJQJ^JaJ h%ShnCJOJQJ^JaJ.jh4CJOJQJU^JaJmHnHu h%ShCJOJQJ^JaJh45CJOJQJ^JaJhid5CJOJQJ^JaJ#h%Sh5CJOJQJ^JaJ h%Sh!).CJOJQJ^JaJ h%ShEWCJOJQJ^JaJhEWCJOJQJ^JaJ hs\hEWCJOJQJ^JaJDFJNPV ַ֦}lַ[M}hSCJOJQJ^JaJ h%ShCJOJQJ^JaJ hidhidCJOJQJ^JaJ.jhqa%CJOJQJU^JaJmHnHu h%ShnCJOJQJ^JaJ h%ShidCJOJQJ^JaJ h%Shqa%CJOJQJ^JaJh4CJOJQJ^JaJhqa%CJOJQJ^JaJhEWCJOJQJ^JaJhrCJOJQJ^JaJ:<@BDFhjrtv̻̪̻zi̻̻[MhidCJOJQJ^JaJhCJOJQJ^JaJ hqa%hqa%CJOJQJ^JaJ h%ShSCJOJQJ^JaJhSCJOJQJ^JaJ hShSCJOJQJ^JaJ h%ShCJOJQJ^JaJ h%Shqa%CJOJQJ^JaJhqa%CJOJQJ^JaJhEWCJOJQJ^JaJ.jhEWCJOJQJU^JaJmHnHu ptvz|~  R&@gdNgdt $a$gd a  2 R&@gd a  R&@gd agdЩҩ&:^nprtvxz|~ɸɧwɸff^ZV^ZV^ZV^ZVRh5hHchjhU h%ShCJOJQJ^JaJhSCJOJQJ^JaJ hShSCJOJQJ^JaJ h%Sh'BCJOJQJ^JaJ h%ShnCJOJQJ^JaJ h%Shqa%CJOJQJ^JaJhqa%CJOJQJ^JaJ h%ShSCJOJQJ^JaJ.jhqa%CJOJQJU^JaJmHnHub ʭ 4HvѽѮџpbPI hJh5#h!).h55CJOJQJ^JaJhPuh556CJ^JhPuh5CJOJQJ^J#h'mh55CJOJQJ^JaJh'mh556CJ^Jh'mh5CJOJQJ^JhHch55CJOJQJh55OJQJh5CJOJQJhh5h5CJOJQJaJhhNh5CJOJQJaJhh5CJOJQJaJh  "$&(*,.024$a$gdN$a$$a$gdt  2 R&@gdNHvgd$a$gdJ(Wgdb$a$gdb$a$gdNgdN h%ShCJOJQJ^JaJht z&P+p,p-p.p/R4567:pt / =! 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