West Virginia Adult Treatment Courts (Mental Health Court And Drug Court) Exit Interview
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1
2MHCT
DCT
WEST VIRGINIA ADULT TREATMENT COURTS
(Mental Health Court and Drug Court)
EXIT INTERVIEW
Participant:
________________________________________________
[print name]
Date of Exit Interview:
_______/_________/_________
Intent to Continue Treatment?
No, Not Needed
No, but Recommended/Should Be
□
□
Why Not? _____________________________
Yes
□
[If yes, check all that apply]
For MI
Outpatient
Local MH facility
□
□
□
For SA
Inpatient
Private Provider
□
□
□
Intent to Continue Attending Community Support Program(s)?
No, Not Needed
No, but Recommended
□
□
Why Not? _____________________________
Yes
□
[If yes, check all that apply]
NAMI
AA
Other:
□
□
□
[Identify]
WVMHCA
NA
____________________
□
□
Intent to Further Education Post Program?
No
□
Yes
□
[Check All Applicable]
□ HS/GED
□ College Classes
□ College Degree seeking (List) ________________________________________
□ Certificates seeking (List) ___________________________________________
□ Vocational Classes (describe type) ____________________________________
How would you rank the Treatment Court you participated in on a 1 to 10 scale, one being
the lowest and 10 being the highest? _________
Name of Treatment Court: _____________________________________________
How do you respond to the following statements?
SA= STRONGLY AGREE
A= AGREE
N= NEITHER AGREE NOR DISAGREE
D= DISAGREE
SD= STRONGLY DISAGREE
SCA Treatment Court Form 107 (Revised 11/07/2011)
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