Personal Release Plan / Advocacy
In this interactive webinar, we welcome any member of our community that anticipates a surrender to federal prison. One or more of our team members will lead the call. We will use the following outline to help participants understand the journey ahead. Knowledge is power. Participants empower themselves by understanding what’s coming, removing some fear and anxiety that can come with the unknown.
Webinar Format:
- How to Join:
- Through email, we’ll send a webinar link for the Zoom meeting. You may click the link to join by video or audio. Participants will receive a reminder 10 minutes before the webinar.
- https://us02web.zoom.us/j/6299901910
- Privacy:
- We respect anyone’s wish to remain anonymous. It is not necessary to identify yourself. People can join by audio only (without video) if they prefer; to view the screen share, they will need video.
- We will record the session. All participants will receive a link to the recording, including screen shares.
- If you want to protect anonymity when joining, please choose an alias when joining the call (Other people may be on this group call.)
- Meeting Schedule:
- One or more of our team members will host the webinar.
- After a brief introduction, our host will follow the outline below, presenting on each topic.
- The outline in the left margin of this document will show the topics we intend to cover.
- The host will ask participants to remain muted for each presentation section.
- Interactions
- Following the presentation on each section, the host will invite participants to ask questions.
- Participants may click the “hand” icon on the toolbar.
- The hand icon will let the host know that a participant has a question.
- Participants may also leave comments or questions in the chat window by clicking the “chat” icon in the Zoom toolbar.
- Publishing
This page will live on the following Prison Professors URLs:
- Prison Professors website
- iTunes podcast
- YouTube channel
Previous Webinars in Series:
- Preparing to Surrender: https://prisonprofessors.com/pre-surrender-to-prison-webinar/
- Disciplinary Infractions: https://prisonprofessors.com/bop-disciplinary-code-webinar/
- Initial Adjustment: https://prisonprofessors.com/initial-prison-adjustment/
- Case Management: https://prisonprofessors.com/unit-management-relationships/
- Personal Release Plan: https://prisonprofessors.com/personal-release-plan-webinar/
Purpose of this project:
Our team will remain with you from the sentencing date, through the completion of term of Supervised Release. Look to our webinar page to learn more about steps you can take to advocate for yourself.
- Topics we intend to discuss on the Personal Release Plan Webinar / Advocacy:
- CARES / First Step Act / Second Chance Act
- Understand difference
- Understand purpose
- How a release plan relates to each
- When to create the release plan?
- Iterative growth
- Judge’s statement
- Director’s statement
- Probation Officer’s statement
- Your future
- Your reputation
- Staff Needs v. Your Needs
- Review Most Recent Memo: April 13, 2021: https://prisonprofessors.com/wp-content/uploads/2022/07/Home-Confinement-memo_2021_04_13.pdf
- Staff emphasis:
- CARES: Staff and community safety
- Congressional mandate
- Easier on staff: Job descriptions
- Who gets credit
- Show model of excellence
- Easier on staff: Job descriptions
- Background
- Procedural history—How did you get here?
- No history of violence
- Addressed
- Low-or-minimum PATTERN
- Work toward
- Test: https://www.bop.gov/inmates/fsa/pattern.jsp
- No detainer
- Clean disciplinary record
- Apprise staff that you’re conscious of your disciplinary record
- FRP Participation
- COVID Vulnerable?
- CDC Guidelines
- CDC Guidance
- https://www.cdc.gov/coronavirus/2019-ncov/community/correction-detention/guidance-correctional-detention.html
- COVID Vulnerable?
- No history of violence
- Time Factors for Release
- Calculator
- Sentence Length: Enter in months (43 months)
- Do you have more than one year: Y / N
- If yes, “Statutory Good Time” is 15% of sentence length: 6.45 months
- Net projected sentence: Sentence length – good time 37 months
- RDAP minus 12 equal 25 months
- Did you qualify?
- Did you complete?
- What is your progress?
- Do you have more than 36 months?
- Do you have between 30 and 36 months?
- Do you have more than 24 months?
- ETC–discuss below Substract another 18
- Sentence Length: Enter in months (43 months)
- Perspective
- Understand audience
- How do they define success?
- How do you define success?
- Find synergies
- Make the best decision
- Examples:
- New law -v- Old law
- Supreme Court rule
- Apply or not apply?
- Supreme Court rule
- Parole -v- halfway house
- Cost-benefit analysis
- New law -v- Old law
- Compassionate release / CARES Act / Supervised Release
- Remember perspective
- When did judge impose sentence?
- What has changed?
- Remember perspective
- Would you prefer halfway house to prison?
- Two examples
- Understand audience
- Emphasis on Release Plan
- Who is audience?
- How do they define excellence?
- National Institute of Corrections
- Case Manager’s template (See below)
- Who is audience?
- CARES Consideration:
- Review Most Recent Memo: April 13, 2021: https://prisonprofessors.com/wp-content/uploads/2022/07/Home-Confinement-memo_2021_04_13.pdf
- 50% More of sentence if longer than 18 months
- 18 months or less, and served 25%
- CDC Guidance
- https://www.cdc.gov/coronavirus/2019-ncov/community/correction-detention/guidance-correctional-detention.html
- Earned Time Credits?
- How many months do you anticipate serving in prison?
- How many will you have low or minimum pattern score?
- How much time will you spend in transit?
- Up to 12 months available for time cut–depending upon completion of 24 months of ETC credits.
- No limit to amount of ETC credits to earn
- Only 12 months count toward time cut
- Remainder apply toward:
- Access to halfway house or home confinement
- Earlier termination of Supervised Release
- Remainder apply toward:
- Must appear on computation sheet
- October (Goal)
- Emphasis on the verifiable release plan
- National Institute of Corrections
- Tranisition from Jail to Community (TJC) Toolkit: https://info.nicic.gov/tjc/module-1-getting-started
- Module 7
- https://info.nicic.gov/tjc/module-7-transition-plan-development
- National Institute of Corrections
- Next Webinar
- TBD—Research
Group Assets:
- Learn from SMEs: https://prisonprofessors.com/subject-matter-experts/
- Advocacy Page: https://prisonprofessors.com/advocacy-news/
- Before Sentencing Page: https://prisonprofessors.com/before-sentencing/
- After Sentencing Page: https://prisonprofessors.com/after-sentencing/
- BOP Needs Assessment Programs: https://www.bop.gov/inmates/fsa/index.jsp
- Pattern: https://www.bop.gov/inmates/fsa/pattern.jsp
- SPARK: https://www.bop.gov/inmates/fsa/docs/bop_fsa_needs_validation_report_2021.pdf
- National Institute of Corrections: https://info.nicic.gov/tjc/module-7-transition-plan-development
Transition Plan1 | |||||||||||||||||||||||||||||||||
Inmate Last Name: | First Name: | MI: | GenderM □ F □ | ||||||||||||||||||||||||||||||
DOC Number: | SSN# | DOB: | Today’s Date: | ||||||||||||||||||||||||||||||
Name of Facility: | Person Completing Form: | ||||||||||||||||||||||||||||||||
Current Status: | Pretrial Detainee □ | Sentenced Inmate □ | |||||||||||||||||||||||||||||||
Date of Admission: | Expected Release Date: | ||||||||||||||||||||||||||||||||
Risk Level, Treatment, and Criminogenic Needs | |||||||||||||||||||||||||||||||||
Was the inmate’s screen and assessment questionnaire reviewed? | Yes □ | No □ | |||||||||||||||||||||||||||||||
Risk/Needs Assessment Score: | High □ | Medium □ | Low □ | ||||||||||||||||||||||||||||||
Interventions Needed | |||||||||||||||||||||||||||||||||
Identification | |||||||||||||||||||||||||||||||||
Social Security Card | Yes □ | No □ | Veteran Identification Card | Yes □ | No □ | ||||||||||||||||||||||||||||
Birth Certificate | Yes □ | No □ | Passport | Yes □ | No □ | ||||||||||||||||||||||||||||
Alien Registration Card | Yes □ | No □ | Valid State ID/Driver’s License | Yes □ | No □ | ||||||||||||||||||||||||||||
Picture Identification | Yes □ | No □ | Military Discharge Papers | Yes □ | No □ | ||||||||||||||||||||||||||||
Certificate of Naturalization | Yes □ | No □ | High School Diploma/GED Certificate | Yes □ | No □ | ||||||||||||||||||||||||||||
Are any identification documents in inmate’s property? | |||||||||||||||||||||||||||||||||
If yes, specify type of documentation: | |||||||||||||||||||||||||||||||||
If no, explain how identification is being obtained: | |||||||||||||||||||||||||||||||||
Benefit Eligibility | |||||||||||||||||||||||||||||||||
Public Assistance | Yes □ | No □ | Food Stamps | Yes □ | No □ | ||||||||||||||||||||||||||||
Medicaid | Yes □ | No □ | SSI | Yes □ | No □ | ||||||||||||||||||||||||||||
SSD | Yes □ | No □ | Veteran | Yes □ | No □ | ||||||||||||||||||||||||||||
Transportation | |||||||||||||||||||||||||||||||||
If known – Time of Release | |||||||||||||||||||||||||||||||||
Will someone pick up the inmate? | Yes □ | No □ | |||||||||||||||||||||||||||||||
If yes, who? | |||||||||||||||||||||||||||||||||
If no, how will the inmate get home? | |||||||||||||||||||||||||||||||||
Housing | |||||||||||||||||||||||||||||||||
Address at Release: | Apt #: | ||||||||||||||||||||||||||||||||
City: | State: | Zip Code: | |||||||||||||||||||||||||||||||
Home Phone: | Cell Phone: | Work Phone: | |||||||||||||||||||||||||||||||
Residents in House: | |||||||||||||||||||||||||||||||||
Does the inmate expect to be released to known housing? | Yes □ | No □ | |||||||||||||||||||||||||||||||
Does the inmate expect to be released to a homeless shelter? | Yes □ | No □ | |||||||||||||||||||||||||||||||
Type of housing assistance required: | |||||||||||||||||||||||||||||||||
Medical/Mental Health/Dental | |||||||||||||||||||||||||||||||||
Primary health care needed: | Yes □ | No □ | |||||||||||||||||||||||||||||||
Medical specialist needed: | Yes □ | No □ | |||||||||||||||||||||||||||||||
Mental health provider needed: | Yes □ | No □ | |||||||||||||||||||||||||||||||
Medication needed: | Yes □ | No □ | |||||||||||||||||||||||||||||||
Date of last full physical: | |||||||||||||||||||||||||||||||||
Substance Abuse Counseling/Treatment | |||||||||||||||||||||||||||||||||
Alcohol counseling/treatment needed: | Yes □ | No □ | |||||||||||||||||||||||||||||||
Substance abuse counseling/treatment needed: | Yes □ | No □ | |||||||||||||||||||||||||||||||
Level of care required: | Outpatient □ | Residential □ | |||||||||||||||||||||||||||||||
Family | |||||||||||||||||||||||||||||||||
Will have custody of children: | Yes □ | No □ | If yes, how many? | Ages: ___, ___, ___, ___, ___ | |||||||||||||||||||||||||||||
Family counseling needed: | Yes □ | No □ | |||||||||||||||||||||||||||||||
Education | |||||||||||||||||||||||||||||||||
Has GED | Yes □ | No □ | Has H.S. diploma | Yes □ | No □ | ||||||||||||||||||||||||||||
Continuing education needed: | Yes □ | No □ | |||||||||||||||||||||||||||||||
Employment | |||||||||||||||||||||||||||||||||
Job skills training needed: | Yes □ | No □ | Area of interest: | ||||||||||||||||||||||||||||||
Job placement needed: | Yes □ | No □ | Special skills: | ||||||||||||||||||||||||||||||
Financial Obligations | |||||||||||||||||||||||||||||||||
Court: | Child Support: | Medical: | Civil: | ||||||||||||||||||||||||||||||
Other: | Other: | ||||||||||||||||||||||||||||||||
In-Jail Program Participation | |||||||||||||||||||||||||||||||||
Completion Information | Postrelease Referral | ||||||||||||||||||||||||||||||||
AA/NA | Yes □ | No □ | N/A □ | Yes □ | |||||||||||||||||||||||||||||
Anger Management | Yes □ | No □ | N/A □ | Yes □ | |||||||||||||||||||||||||||||
Cognitive Behavioral Change | Yes □ | No □ | N/A □ | Yes □ | |||||||||||||||||||||||||||||
Domestic Violence | Yes □ | No □ | N/A □ | Yes □ | |||||||||||||||||||||||||||||
Education | Yes □ | No □ | N/A □ | Yes □ | |||||||||||||||||||||||||||||
Employment Skills | Yes □ | No □ | N/A □ | Yes □ | |||||||||||||||||||||||||||||
Inmate Worker | Yes □ | No □ | N/A □ | Yes □ | |||||||||||||||||||||||||||||
Parenting | Yes □ | No □ | N/A □ | Yes □ | |||||||||||||||||||||||||||||
Religious Studies | Yes □ | No □ | N/A □ | Yes □ | |||||||||||||||||||||||||||||
Substance Abuse | Yes □ | No □ | N/A □ | Yes □ | |||||||||||||||||||||||||||||
Other: | Yes □ | No □ | N/A □ | Yes □ | |||||||||||||||||||||||||||||
Other: | Yes □ | No □ | N/A □ | Yes □ | |||||||||||||||||||||||||||||
Post-Release Community Referrals | |||||||||||||||||||||||||||||||||
Check each need and then fill out a separate referral for each need. | |||||||||||||||||||||||||||||||||
Aging & Disability Services □ | Community Corrections □ | Domestic Violence □ | Drug or Alcohol Treatment □ | Education □ | |||||||||||||||||||||||||||||
Employment □ | Coping Skills –Family/Children □ | Management of Financial Resources □ | Food/Clothing □ | Health CareBenefits □ | |||||||||||||||||||||||||||||
Housing □ | Identification □ | Income/Benefits/Entitlements □ | Life Skills Training | Medical/Dental Care/Local Health Clinic □ | |||||||||||||||||||||||||||||
Mental Health Care □ | Medication Assistance □ | Rent Assistance □ | Social Security □ | Transportation □ | |||||||||||||||||||||||||||||
Unemployment □ | Vocational Training □ | ||||||||||||||||||||||||||||||||
1. Referral Type: | |||||||||||||||||||||||||||||||||
In-Custody: □ | At Discharge: □ | Post-Release: □ | |||||||||||||||||||||||||||||||
Agency Referred To: | Contact Phone: | Contact Person: | |||||||||||||||||||||||||||||||
Appointment Date/Time: | Location: | Referral Faxed/E-mailed: Yes □ No □ | Fax # or E-mail Address | ||||||||||||||||||||||||||||||
Reentry Accountability Plan: | |||||||||||||||||||||||||||||||||
My self-defeating behavior that blocks my success with this issue: | |||||||||||||||||||||||||||||||||
My behavioral goal to address my issue is: | |||||||||||||||||||||||||||||||||
My action plan to meet the above goal: | Target Completion Date: | Completion Date: | |||||||||||||||||||||||||||||||
Staff action plan to meet the above goal: | |||||||||||||||||||||||||||||||||
Comments: | |||||||||||||||||||||||||||||||||
2. Referral Type: | |||||||||||||||||||||||||||||||||
In-Custody: □ | At Discharge: □ | Post-Release: □ | |||||||||||||||||||||||||||||||
Agency Referred To: | Contact Phone: | Contact Person: | |||||||||||||||||||||||||||||||
Appointment Date/Time: | Location: | Referral Faxed/E-mailed: Yes □ No □ | Fax # or E-mail Address | ||||||||||||||||||||||||||||||
Reentry Accountability Plan: | |||||||||||||||||||||||||||||||||
My self-defeating behavior/problem that block my success with this issue: | |||||||||||||||||||||||||||||||||
My behavioral goal to address my problem is: | |||||||||||||||||||||||||||||||||
My action plan to meet the above goal: | Target Completion Date: | Completion Date: | |||||||||||||||||||||||||||||||
Staff action plan to meet the above goal: | |||||||||||||||||||||||||||||||||
Comments: | |||||||||||||||||||||||||||||||||
3. Referral Type: | |||||||||||||||||||||||||||||||||
In-Custody: □ | At Discharge: □ | Post-Release: □ | |||||||||||||||||||||||||||||||
Agency Referred To: | Contact Phone: | Contact Person: | |||||||||||||||||||||||||||||||
Appointment Date/Time: | Location: | Referral Faxed/E-mailed: Yes □ No □ | Fax # or E-mail Address | ||||||||||||||||||||||||||||||
Reentry Accountability Plan: | |||||||||||||||||||||||||||||||||
My self-defeating behavior/problem that blocks my success with this issue: | |||||||||||||||||||||||||||||||||
My behavioral goal to address my problem is: | |||||||||||||||||||||||||||||||||
My action plan to meet the above goal: | Target Completion Date: | Completion Date: | |||||||||||||||||||||||||||||||
Staff action plan to meet the above goal: | |||||||||||||||||||||||||||||||||
Comments: | |||||||||||||||||||||||||||||||||
4. Referral Type: | |||||||||||||||||||||||||||||||||
In-Custody: □ | At Discharge: □ | Post-Release: □ | |||||||||||||||||||||||||||||||
Agency Referred To: | Contact Phone: | Contact Person: | |||||||||||||||||||||||||||||||
Appointment Date/Time: | Location: | Referral Faxed/E-mailed: Yes □ No □ | Fax # or E-mail Address | ||||||||||||||||||||||||||||||
Reentry Accountability Plan: | |||||||||||||||||||||||||||||||||
My self-defeating behavior/problem that blocks my success with this issue: | |||||||||||||||||||||||||||||||||
My behavioral goal to address my problem is: | |||||||||||||||||||||||||||||||||
My action plan to meet the above goal: | Target Completion Date: | Completion Date: | |||||||||||||||||||||||||||||||
Staff action plan to meet the above goal: | |||||||||||||||||||||||||||||||||
Comments: | |||||||||||||||||||||||||||||||||
Completion of Plan | |||||||||||||||||||||||||||||||||
Full plan completed and discussed with inmate? | Yes □ | No □ | |||||||||||||||||||||||||||||||
If no, why? | Inmate refused □ | Court release before plan completed □ | Incomplete for other reasons □ | Specify: | |||||||||||||||||||||||||||||
Case Manager/Counselor Information | |||||||||||||||||||||||||||||||||
Name of Case Manager/Counselor: | |||||||||||||||||||||||||||||||||
Facility: | Inmate Housing Area: | ||||||||||||||||||||||||||||||||
Date Memorandum of Agreement Signed: | Date Discharge Plan Completed: | ||||||||||||||||||||||||||||||||
Case Manager/Counselor (signature): | Phone #: | ||||||||||||||||||||||||||||||||
Supervisor: | Phone #:E-mail Address: | ||||||||||||||||||||||||||||||||
Inmate Agreement | |||||||||||||||||||||||||||||||||
I have participated in the completion of this transition plan, received a copy of this transition plan, emergency numbers for assistance in the community, and necessary psychiatric referrals (if necessary). | |||||||||||||||||||||||||||||||||
Inmate’s Name: | |||||||||||||||||||||||||||||||||
Inmate’s Signature: | Date: | ||||||||||||||||||||||||||||||||
[1] Transition plan adapted from the following plans: New York City Department of Corrections Rikers Island Discharge Enhance (RIDE) Plan; New York City Department of Corrections Discharge Planning Questionnaire; Davidson County, Tennessee, Sheriff’s Office Re-Entry Release Plan; Washington, D.C., Department of Corrections Discharge Planning Form; Travis County, Texas, Inmate Discharge Plan; GAINS Re-Entry Checklist for Inmates Identified with Mental Health Service Needs; SAMHSA Sample Prison/Jail Substance Use Disorder Program Discharge Summary to Help with the Reentry Process; State of Missouri Department of Corrections; Douglas County, Kansas, LoCIRP reentry plan.
Transition Plan1 | |||||||||||||||||||||||||||||||||
Inmate Last Name: | First Name: | MI: | GenderM □ F □ | ||||||||||||||||||||||||||||||
DOC Number: | SSN# | DOB: | Today’s Date: | ||||||||||||||||||||||||||||||
Name of Facility: | Person Completing Form: | ||||||||||||||||||||||||||||||||
Current Status: | Pretrial Detainee □ | Sentenced Inmate □ | |||||||||||||||||||||||||||||||
Date of Admission: | Expected Release Date: | ||||||||||||||||||||||||||||||||
Risk Level, Treatment, and Criminogenic Needs | |||||||||||||||||||||||||||||||||
Was the inmate’s screen and assessment questionnaire reviewed? | Yes □ | No □ | |||||||||||||||||||||||||||||||
Risk/Needs Assessment Score: | High □ | Medium □ | Low □ | ||||||||||||||||||||||||||||||
Interventions Needed | |||||||||||||||||||||||||||||||||
Identification | |||||||||||||||||||||||||||||||||
Social Security Card | Yes □ | No □ | Veteran Identification Card | Yes □ | No □ | ||||||||||||||||||||||||||||
Birth Certificate | Yes □ | No □ | Passport | Yes □ | No □ | ||||||||||||||||||||||||||||
Alien Registration Card | Yes □ | No □ | Valid State ID/Driver’s License | Yes □ | No □ | ||||||||||||||||||||||||||||
Picture Identification | Yes □ | No □ | Military Discharge Papers | Yes □ | No □ | ||||||||||||||||||||||||||||
Certificate of Naturalization | Yes □ | No □ | High School Diploma/GED Certificate | Yes □ | No □ | ||||||||||||||||||||||||||||
Are any identification documents in inmate’s property? | |||||||||||||||||||||||||||||||||
If yes, specify type of documentation: | |||||||||||||||||||||||||||||||||
If no, explain how identification is being obtained: | |||||||||||||||||||||||||||||||||
Benefit Eligibility | |||||||||||||||||||||||||||||||||
Public Assistance | Yes □ | No □ | Food Stamps | Yes □ | No □ | ||||||||||||||||||||||||||||
Medicaid | Yes □ | No □ | SSI | Yes □ | No □ | ||||||||||||||||||||||||||||
SSD | Yes □ | No □ | Veteran | Yes □ | No □ | ||||||||||||||||||||||||||||
Transportation | |||||||||||||||||||||||||||||||||
If known – Time of Release | |||||||||||||||||||||||||||||||||
Will someone pick up the inmate? | Yes □ | No □ | |||||||||||||||||||||||||||||||
If yes, who? | |||||||||||||||||||||||||||||||||
If no, how will the inmate get home? | |||||||||||||||||||||||||||||||||
Housing | |||||||||||||||||||||||||||||||||
Address at Release: | Apt #: | ||||||||||||||||||||||||||||||||
City: | State: | Zip Code: | |||||||||||||||||||||||||||||||
Home Phone: | Cell Phone: | Work Phone: | |||||||||||||||||||||||||||||||
Residents in House: | |||||||||||||||||||||||||||||||||
Does the inmate expect to be released to known housing? | Yes □ | No □ | |||||||||||||||||||||||||||||||
Does the inmate expect to be released to a homeless shelter? | Yes □ | No □ | |||||||||||||||||||||||||||||||
Type of housing assistance required: | |||||||||||||||||||||||||||||||||
Medical/Mental Health/Dental | |||||||||||||||||||||||||||||||||
Primary health care needed: | Yes □ | No □ | |||||||||||||||||||||||||||||||
Medical specialist needed: | Yes □ | No □ | |||||||||||||||||||||||||||||||
Mental health provider needed: | Yes □ | No □ | |||||||||||||||||||||||||||||||
Medication needed: | Yes □ | No □ | |||||||||||||||||||||||||||||||
Date of last full physical: | |||||||||||||||||||||||||||||||||
Substance Abuse Counseling/Treatment | |||||||||||||||||||||||||||||||||
Alcohol counseling/treatment needed: | Yes □ | No □ | |||||||||||||||||||||||||||||||
Substance abuse counseling/treatment needed: | Yes □ | No □ | |||||||||||||||||||||||||||||||
Level of care required: | Outpatient □ | Residential □ | |||||||||||||||||||||||||||||||
Family | |||||||||||||||||||||||||||||||||
Will have custody of children: | Yes □ | No □ | If yes, how many? | Ages: ___, ___, ___, ___, ___ | |||||||||||||||||||||||||||||
Family counseling needed: | Yes □ | No □ | |||||||||||||||||||||||||||||||
Education | |||||||||||||||||||||||||||||||||
Has GED | Yes □ | No □ | Has H.S. diploma | Yes □ | No □ | ||||||||||||||||||||||||||||
Continuing education needed: | Yes □ | No □ | |||||||||||||||||||||||||||||||
Employment | |||||||||||||||||||||||||||||||||
Job skills training needed: | Yes □ | No □ | Area of interest: | ||||||||||||||||||||||||||||||
Job placement needed: | Yes □ | No □ | Special skills: | ||||||||||||||||||||||||||||||
Financial Obligations | |||||||||||||||||||||||||||||||||
Court: | Child Support: | Medical: | Civil: | ||||||||||||||||||||||||||||||
Other: | Other: | ||||||||||||||||||||||||||||||||
In-Jail Program Participation | |||||||||||||||||||||||||||||||||
Completion Information | Postrelease Referral | ||||||||||||||||||||||||||||||||
AA/NA | Yes □ | No □ | N/A □ | Yes □ | |||||||||||||||||||||||||||||
Anger Management | Yes □ | No □ | N/A □ | Yes □ | |||||||||||||||||||||||||||||
Cognitive Behavioral Change | Yes □ | No □ | N/A □ | Yes □ | |||||||||||||||||||||||||||||
Domestic Violence | Yes □ | No □ | N/A □ | Yes □ | |||||||||||||||||||||||||||||
Education | Yes □ | No □ | N/A □ | Yes □ | |||||||||||||||||||||||||||||
Employment Skills | Yes □ | No □ | N/A □ | Yes □ | |||||||||||||||||||||||||||||
Inmate Worker | Yes □ | No □ | N/A □ | Yes □ | |||||||||||||||||||||||||||||
Parenting | Yes □ | No □ | N/A □ | Yes □ | |||||||||||||||||||||||||||||
Religious Studies | Yes □ | No □ | N/A □ | Yes □ | |||||||||||||||||||||||||||||
Substance Abuse | Yes □ | No □ | N/A □ | Yes □ | |||||||||||||||||||||||||||||
Other: | Yes □ | No □ | N/A □ | Yes □ | |||||||||||||||||||||||||||||
Other: | Yes □ | No □ | N/A □ | Yes □ | |||||||||||||||||||||||||||||
Post-Release Community Referrals | |||||||||||||||||||||||||||||||||
Check each need and then fill out a separate referral for each need. | |||||||||||||||||||||||||||||||||
Aging & Disability Services □ | Community Corrections □ | Domestic Violence □ | Drug or Alcohol Treatment □ | Education □ | |||||||||||||||||||||||||||||
Employment □ | Coping Skills –Family/Children □ | Management of Financial Resources □ | Food/Clothing □ | Health CareBenefits □ | |||||||||||||||||||||||||||||
Housing □ | Identification □ | Income/Benefits/Entitlements □ | Life Skills Training | Medical/Dental Care/Local Health Clinic □ | |||||||||||||||||||||||||||||
Mental Health Care □ | Medication Assistance □ | Rent Assistance □ | Social Security □ | Transportation □ | |||||||||||||||||||||||||||||
Unemployment □ | Vocational Training □ | ||||||||||||||||||||||||||||||||
1. Referral Type: | |||||||||||||||||||||||||||||||||
In-Custody: □ | At Discharge: □ | Post-Release: □ | |||||||||||||||||||||||||||||||
Agency Referred To: | Contact Phone: | Contact Person: | |||||||||||||||||||||||||||||||
Appointment Date/Time: | Location: | Referral Faxed/E-mailed: Yes □ No □ | Fax # or E-mail Address | ||||||||||||||||||||||||||||||
Reentry Accountability Plan: | |||||||||||||||||||||||||||||||||
My self-defeating behavior that blocks my success with this issue: | |||||||||||||||||||||||||||||||||
My behavioral goal to address my issue is: | |||||||||||||||||||||||||||||||||
My action plan to meet the above goal: | Target Completion Date: | Completion Date: | |||||||||||||||||||||||||||||||
Staff action plan to meet the above goal: | |||||||||||||||||||||||||||||||||
Comments: | |||||||||||||||||||||||||||||||||
2. Referral Type: | |||||||||||||||||||||||||||||||||
In-Custody: □ | At Discharge: □ | Post-Release: □ | |||||||||||||||||||||||||||||||
Agency Referred To: | Contact Phone: | Contact Person: | |||||||||||||||||||||||||||||||
Appointment Date/Time: | Location: | Referral Faxed/E-mailed: Yes □ No □ | Fax # or E-mail Address | ||||||||||||||||||||||||||||||
Reentry Accountability Plan: | |||||||||||||||||||||||||||||||||
My self-defeating behavior/problem that block my success with this issue: | |||||||||||||||||||||||||||||||||
My behavioral goal to address my problem is: | |||||||||||||||||||||||||||||||||
My action plan to meet the above goal: | Target Completion Date: | Completion Date: | |||||||||||||||||||||||||||||||
Staff action plan to meet the above goal: | |||||||||||||||||||||||||||||||||
Comments: | |||||||||||||||||||||||||||||||||
3. Referral Type: | |||||||||||||||||||||||||||||||||
In-Custody: □ | At Discharge: □ | Post-Release: □ | |||||||||||||||||||||||||||||||
Agency Referred To: | Contact Phone: | Contact Person: | |||||||||||||||||||||||||||||||
Appointment Date/Time: | Location: | Referral Faxed/E-mailed: Yes □ No □ | Fax # or E-mail Address | ||||||||||||||||||||||||||||||
Reentry Accountability Plan: | |||||||||||||||||||||||||||||||||
My self-defeating behavior/problem that blocks my success with this issue: | |||||||||||||||||||||||||||||||||
My behavioral goal to address my problem is: | |||||||||||||||||||||||||||||||||
My action plan to meet the above goal: | Target Completion Date: | Completion Date: | |||||||||||||||||||||||||||||||
Staff action plan to meet the above goal: | |||||||||||||||||||||||||||||||||
Comments: | |||||||||||||||||||||||||||||||||
4. Referral Type: | |||||||||||||||||||||||||||||||||
In-Custody: □ | At Discharge: □ | Post-Release: □ | |||||||||||||||||||||||||||||||
Agency Referred To: | Contact Phone: | Contact Person: | |||||||||||||||||||||||||||||||
Appointment Date/Time: | Location: | Referral Faxed/E-mailed: Yes □ No □ | Fax # or E-mail Address | ||||||||||||||||||||||||||||||
Reentry Accountability Plan: | |||||||||||||||||||||||||||||||||
My self-defeating behavior/problem that blocks my success with this issue: | |||||||||||||||||||||||||||||||||
My behavioral goal to address my problem is: | |||||||||||||||||||||||||||||||||
My action plan to meet the above goal: | Target Completion Date: | Completion Date: | |||||||||||||||||||||||||||||||
Staff action plan to meet the above goal: | |||||||||||||||||||||||||||||||||
Comments: | |||||||||||||||||||||||||||||||||
Completion of Plan | |||||||||||||||||||||||||||||||||
Full plan completed and discussed with inmate? | Yes □ | No □ | |||||||||||||||||||||||||||||||
If no, why? | Inmate refused □ | Court release before plan completed □ | Incomplete for other reasons □ | Specify: | |||||||||||||||||||||||||||||
Case Manager/Counselor Information | |||||||||||||||||||||||||||||||||
Name of Case Manager/Counselor: | |||||||||||||||||||||||||||||||||
Facility: | Inmate Housing Area: | ||||||||||||||||||||||||||||||||
Date Memorandum of Agreement Signed: | Date Discharge Plan Completed: | ||||||||||||||||||||||||||||||||
Case Manager/Counselor (signature): | Phone #: | ||||||||||||||||||||||||||||||||
Supervisor: | Phone #:E-mail Address: | ||||||||||||||||||||||||||||||||
Inmate Agreement | |||||||||||||||||||||||||||||||||
I have participated in the completion of this transition plan, received a copy of this transition plan, emergency numbers for assistance in the community, and necessary psychiatric referrals (if necessary). | |||||||||||||||||||||||||||||||||
Inmate’s Name: | |||||||||||||||||||||||||||||||||
Inmate’s Signature: | Date: | ||||||||||||||||||||||||||||||||
[1] Transition plan adapted from the following plans: New York City Department of Corrections Rikers Island Discharge Enhance (RIDE) Plan; New York City Department of Corrections Discharge Planning Questionnaire; Davidson County, Tennessee, Sheriff’s Office Re-Entry Release Plan; Washington, D.C., Department of Corrections Discharge Planning Form; Travis County, Texas, Inmate Discharge Plan; GAINS Re-Entry Checklist for Inmates Identified with Mental Health Service Needs; SAMHSA Sample Prison/Jail Substance Use Disorder Program Discharge Summary to Help with the Reentry Process; State of Missouri Department of Corrections; Douglas County, Kansas, LoCIRP reentry plan.