KDP assessment
Client Name:
Client Email:
INDICTMENT#/DOCKET#:
Date of Birth:
Date Service Provided:
Case Manager:
Background Information
- What factors (emotional, social, or environmental) contributed to your decision drive; which led to your current legal charge?
- How do you view your behavior at the time of the incident?
Mental Health Care History
- Please describe your mental health care history, including whether you have ever received counseling or treatment, the reasons for seeking care, and any mental health diagnoses you may have received.
- Share whether you are currently participating in any mental health services or treatment programs.
- Please also describe any psychiatric history, including whether you have ever been hospitalized for mental health reasons and the circumstances that led to the hospitalization.
Substance Use
- Have you ever received treatment for alcohol or drug use?
- What substances do you currently use, if any?
- Have you ever driven under the influence of alcohol or drugs before this incident?
- Has anyone expressed concern about your substance use?
- Do you believe your substance use has affected your judgment or safety?
Trauma History
- Have you experienced stressful or traumatic events that still affect you?
- Do these experiences influence your emotional state, coping skills, or behavior?
- Have past legal issues or incarceration impacted your mental health?
Insight & Accountability
- How do you feel about the incident that led to your charge?
- What have you learned about your behavior and decision-making?
- Do you recognize any emotional triggers or patterns that contributed to the incident?
- What changes do you believe are necessary to prevent future incidents?
Behavioral Risk & Coping
- How do you typically cope with stress or strong emotions?
- Do you engage in impulsive or risk-taking behaviors?
- What healthier coping strategies are you willing to try?
Program Reflection
- What is your main takeaway from the program/class?
- What skills or insights have you gained regarding safe decision-making?