Parole File Review Form (pdf)

Identifying Information

Project ID#:

Identification Number (YIN):

Name:

Gender:

DOB:

Offense County:

Commitment Offense:

What is your youth's race/ethnicity?

  • White
  • Black
  • Latino/a
  • Other

Initial Incarceration (information obtained from master file)

Admission Date:

Which standardized measures were used during initial incarceration intake (and screening date)?

  • TCU II
    Date:
  • Clinical Needs Assessment
    Date:
  • Psychological Evaluation
    Date:
  • JAIS
    Date:
  • Other: __________
    Date:

Pre-incarceration assessment by provider:

  • Community Mental Health Agency
    Date:
  • Hospital
    Date:
  • Probation
    Date:
  • School
    Date:
  • Court Clinic
    Date:
  • Other: __________
    Date:

What screening recommendations were made?

  • Special Education Services
  • Mental Health Services
    • Individual Therapy
    • Group Therapy
    • Medication
    • Family Therapy
    • Trauma Treatment
  • Substance Abuse Treatment
  • Recreational Activities
  • Anger Management
  • Other: __________
  • Not Applicable
  • Missing

Was there documentation of service provision?

  • Special Education Services
  • Mental Health Services
    • Individual Therapy
    • Group Therapy
    • Medication
    • Family Therapy
    • Trauma Treatment
  • Substance Abuse Treatment
  • Recreational Activities
  • Anger Management
  • Other: __________
  • Not Applicable
  • Missing

Parole Information (information obtained from master file)

Parole Date:

Release Zip Code:

Parole Condition:

  • Close supervision
  • Participate in substance abuse program/evaluation
  • Participate in sex offender counseling health clinic
  • Electronic monitoring
  • No negative peer affiliations
  • Submit yourself to outpatient care as pesribed by mental health clinic
  • Comply with curfew as specified: __________
  • Seek employment
  • Attend parenting classes
  • Submit to random urinalysis
  • Obtain GED/high school diploma
  • Participate in day reporting center
  • No internet access
  • Comply with any other special conditions of parole: __________

Parole Information (information obtained from parole file)

Did the parole agent refer the youth to any of the following services?

Did the parole agent refer the youth to any of the following services? Date(s) of Referral
Special Education Services
Mental Health Services
Substance Abuse Treatment
Identification
Other: __________
Not Applicable
Missing

Did the parole agent link the youth to any of the following services?

Did the parole agent link the youth to any of the following services? Date(s) of Linkage
Special Education Services
Mental Health Services
Substance Abuse Tratement
Identification
Other: ____________
Not Applicable
Missing

Please indicate the frequency of each of the following parole contacts prior to warrent issuance.

ED/EM

Movement

Technician Visit

Agent Contact with Treatment Provider

Agent Contact with Host

Agent Phone Contact with Youth

Agent FTF Contact with Youth

Attempted Phone Contact with Youth

Attemeted FTF Contact with Youth

Agent Contact with Other (Please describe and indicate frequency):

Please describe any problem associated with the host site as well as the agent's efforts to rectify these problems.

  • Not Applicable

Please describe any concerns that the youth identifies as well as the agent's efforts to address these concerns

  • Not Applicable

Was the youth non-compiant with any of the parole conditions prior to revocation?

  • Yes
  • No
  • Missing

How many instances of non-compliance occurred?

  • Not applicable

Please list each instance of non-compliance.

  • Not applicable

What was the agent's response to each instance of non-compliance?

  • None

Did any instances of non-compliance lead to a revision of parole conditions?

  • Yes
  • No

If yes, what were the new parole conditions?

  • Not applicable
  • EM/ED
  • Other
    Please describe:

Parole Revocation (information obtained from parole form)

Date Warrent Issued:

Description of Violation/Criminal Charge Leading to Warrent

Date Notified of Right to Preliminary Hearing (NOC/VR):

Waived:

  • Yes
  • No

Did the NOC/VR occur within 72 hours of arrest?

  • Yes
  • No
    If no, please explain:

Preliminary Hearing Date

  • Not Applicable
  • Missing

Parole Board Hearing Date:

  • Missing

Was the youth in detention/jail prior to commitment to facility?

  • Yes
  • No
    Dates:

Date Returned to Facility

File Review Notes

Coder - Parole Form:
Date:
Data entry date:

Coder-Master File:
Date:
Data entry date: