Team
Client Initials format A.B.
Client Identifier/Case File number
Date ATR Completed
Assessment Round/Year
Times ATR completed for this client
No longer needs intensive services
Has struce in daily life
Stable symptoms over last 6 mths
Stable housing over last several mths
Psych hospitalization within last 6 mths
Has insight into mental illness
Has been incarcerated within last 6 mths
Has benefits in place
Is engaged in treatment
Is independent
Is compliant with medication
Has complex needs
Has adequate resources
Has social support
Is gainfully employed
Keeps appts without help
Behaviors have not been stable over the last 6 mths
Has met treatment goals
ATR total score: Sum of Questions 1-18
Categorical group client falls under based on total ATR score
Date of entry to ACTT
Number of years with ACTT
Years with ACTT Categories
Date of entry to a transitioned form of service (i.e.: Stepdown or ICM)
Number of years with Stepdown or Transitioned Service
Years with Stepdown/Transitioned Service Categories
Age on ATR completion
Age Category
Gender
Source of Income
Other Income
Culture/Ethnic Group Coded
Current Housing
Primary Diagnosis
Primary Diagnosis Other - Specify as string
Secondary Diagnosis
Secondary Diagnosis Other - Specify as string
Concurrent Disorder - No, Yes, or In Remission
Employed Yes/No
Employment Type - Part Time, Full Time or Volunteer
Change in Status for client since ATR completion?
Client Status/Outcome details/notes since leaving this ACT team