Policies and Procedures Manual
The mission of the Dunn County Diversion Court is to increase community safety and restore sober, productive and law abiding citizens to the community by breaking the cycle of drug and alcohol addiction through effective, long-term treatment with intensive court supervision.
The Dunn County Diversion Court Program is a court that is specifically designated and staffed to handle cases involving drug offenders through an intensive, judicially monitored program of alcohol and drug treatment, rehabilitation services, and strict community supervision. The Diversion Court concept is based on an innovative program that was first developed in Miami, Florida in 1989. The Diversion Court concept has since received widespread attention as an effective treatment strategy for drug-involved criminal offenders. There are more than 1,000 such programs now in operation in jurisdictions throughout the nation.
Diversion Courts are built upon a unique partnership between the criminal justice system and the drug treatment community, one which structures treatment intervention around the authority and personal involvement of a Diversion Court Judge. Diversion Courts are also dependent upon the creation of a non-adversarial courtroom atmosphere where a single Judge and a dedicated treatment team of court officers and staff work together toward a common goal of breaking the cycle of drug abuse and criminal behavior. It should be noted that Diversion Courts are fair, but not equal.
Because of the unique problems and opportunities that present themselves in working with drug-involved criminal offenders, treatment and rehabilitation strategies must be “reality-based” and must therefore recognize:
• Addicts are most vulnerable to successful intervention when they are in the crisis of initial arrest and incarceration, so intervention must be immediate and up-front.
• Preventing gaps in communication and ensuring offender accountability are critically important. Therefore, court supervision must be highly coordinated and very comprehensive.
• Addiction to drugs is a longstanding, debilitating, and insidious condition, so treatment must be long-term and comprehensive.
• Addiction to drugs seldom exists in isolation from other serious problems that undermine rehabilitation, so treatment must include integration of other available services and resources such as educational and vocational assessment.
• Relapse and intermittent advancement are part of the recovery process so progressive sanctions and incentives must be integral to the Diversion Court strategy.
2. Reduce drug and alcohol related crimes, as well as other unrelated crimes, to increase community safety.
3. Ensure the Diversion Court participant begins the Diversion Court program as soon as possible.
4. Offer effective sanctions, rewards, and treatment programming.
5. Increase employment stability and assure participants obtain an HSED/GED.
6. Ensure the Diversion Court participant contributes to all Court related costs.
1. Diversion Courts integrate alcohol and other drug treatment services with justice system case processing.
2. Using a non-adversarial approach, prosecution and defense counsel promote public safety while protecting each participant’s due process rights.
3. Eligible participants are identified early and promptly placed in the diversion court program.
4. Diversion Courts provide access to a continuum of alcohol, drug, and other related treatment and rehabilitation services.
5. Abstinence is monitored by frequent alcohol and other drug testing.
6. A coordinated strategy governs diversion court responses to participants’ compliance.
7. Ongoing judicial interaction with each diversion court participant is essential.
8. Monitoring and evaluation measure the achievement of program goals and gauge effectiveness.
9. Continuing interdisciplinary education promotes effective diversion court planning, implementation, and operations.
10. Forging partnerships among diversion courts, public agencies, and community-based organizations generates local support and enhances Diversion court program effectiveness.
• A Circuit Court Judge
• A Diversion Court Coordinator• A Probation and Parole Agent• A representative from the District Attorney’s Office• A representative from the Public Defender’s Office/Defense Attorney• Treatment Personnel• An Evaluator• A representative from Law EnforcementJudge
*Preside over courtroom proceedings
*Explain legal rights, options, and program requirements at orientation and confirm them with each participant as they enter the program
*Impose appropriate incentives and sanctions
*Work with the treatment team
*Review treatment progress and address it directly with the participant in Court, considering the recommendations of the treatment team
*Preside over termination proceedings
*Maintain a confidential diversion court file
*Supervise diversion court administration
*Ensure compliance with diversion court program rules by participants
*Provide final decision in outcome of participant’s progress or termination
District Attorney
*Review potential participants for eligibility
*Make referrals to diversion Court *Maintain a non-adversarial role during Court proceedings *Asure compliance with State law *Actively participate in staffing when necessary *Negotiate and complete plea agreements on behalf of the State *Recommend appropriate sanctions and incentives *Educate peer professionals on effectiveness of program and changes in state law that effect the program *Community advocate for effectiveness of program *Make recommendations for charging and/or sentencing after revocation if the participant is terminated from the program
Public Defender’s Office/Defense Attorney *Attend team meetings as necessary *Discuss pros and cons with potential participant before entering diversion court *Review cases for potential legal issues *Discuss resolution of case with District Attorney before entering diversion court *Remain accessible to participant *Advocate for fair process *Be prepared to practice a different kind of law in non-adversarial manner *Provide representation for the participant in termination proceedings if eligible
Coordinator *Evaluate potential participates for eligibility *Conduct assessments and intake *Make referrals for programming as needed *Verify & monitor participant compliance with program and treatment requirements *Collect all relevant information and distribute at treatment team meetings *Monitor budget and financial management *Review policies and practices and monitor need for changes *Facilitate team/staff meetings *Set agenda for meetings *Community liaison *Help coordinate funding sources/Grant Writing/Grant Management *Gather data for evaluator *Monitor data management system *Supervise day-to-day operations *Maintain a confidential file on each participant
Probation & Parole Agent *Case management and community supervision of each participant *Referral to community resources *Drug testing *Home/School/Employment Visits *Collateral Contacts *Monitor and encourage participant’s compliance with program *Imposition of sanctions and rewards *Attend treatment team meetings and Diversion court *Maintain ongoing communication and sharing of information with Coordinator *Identify potential participants for Alternatives to Revocation *Gather data for the evaluator *Maintain a confidential diversion court file for each participant *Coordinate with law enforcement
Treatment Provider *Assessment and referral as needed *Use strength-based methodology *Update related parties (Coordinator, P&P Agent, Court) on progress of participate in a timely fashion *Establish rapport with participant *Maintain confidentiality protection *Ensure signing of all confidential releases required for communication with diversion court team *Provide group and individual sessions for participants *Coordinate/Advocate for pro-social activities
Evaluator *Evaluate process and outcomes *Give information to help improve the diversion court and make it more successful *Help facilitate team understanding of areas needing improvement *Setting up evaluation process – what and how information will be collected and maintained, how analyzed, etc…
Law Enforcement *Partner with community agencies to achieve diversion court goals *Provide possible referrals for diversion court program *Assist Probation & Parole in home visits and checks on participants *Community policing – officers will get to know participants *Report any violations they become aware of *Provide representative for Advisory Board and attend meetings as needed *Comply with grant/state regulations *Make participants who are in the Huber Center available for random UA testing *Permit participants who are in the Huber Center attend treatment and meetings *Provide treatment in the jail as possible *Notify the Treatment Team of violations committed by the participants *Escort incarcerated participants to and from Diversion Court proceedings and supervise them during the proceedings
Potential candidates meeting the following criteria will be considered for admission to the Dunn County Diversion Court Program. Individuals not meeting these criteria may be considered at the discretion of the Diversion Court Team.
A. Resident of Dunn County. B. Each participant will need to meet the DSM-IV criteria for Alcohol/Drug Dependence. C. Proposed participants will be either post-adjudication or in ATR status from the Department of Corrections for the offenses of DUI, possession, use, or sale of a controlled substance or a drug related crime, as a felony or habitual misdemeanor. D. No prior felony convictions for violent crimes and no prior felony convictions involving a weapon. E. The Diversion Court Coordinator shall interview each defendant referred for possible participation in the program. Each proposed participant will participate in any assessments requested by staff, treatment providers, or others involved in the screening process. The Diversion Court Coordinator will make a recommendation to the Diversion Court Team, who will either admit or deny the application. F. The Diversion Court Participant must voluntarily agree to abide by the Diversion Court Program rules. G. No existing in state or extraditable warrants or pending charges that are not resolved at the time Diversion Court participation begins. VI. INTAKE/REFERRAL
Referrals to the Diversion Court Program should take place as soon as possible after the arrest of a potential diversion court candidate and may come from the following sources: 1. The Arresting Agency 2. The District Attorney’s Office 3. The Defense Attorney 4. The Department of Corrections 5. The Sentencing Judge
It is anticipated that the potential candidate will be given information regarding the Diversion Court Program by law enforcement at the time of arrest, or by the District Attorney, the Defense Attorney, Probation & Parole, or the Sentencing Judge. A referral to the Diversion Court Program will be made and the potential candidate will then attend Diversion Court to observe. If the potential candidate is interested in participating, the referral will be made to the Diversion Court representative in the District Attorney’s office for evaluation and case resolution involving Diversion Court. If the case is appropriate for Diversion Court, the case will be referred to the Diversion Court Coordinator for screening. The Diversion Court Coordinator will immediately begin the screening and assessment process. If the Diversion Court Coordinator deems the potential candidate appropriate for the program, according to the eligibility standards previously set forth, the potential candidate will then be reviewed by the Diversion Court Treatment Team for acceptance into the program, or will be denied entry.
The Diversion Court calendar is a priority and will be a specialized, separate court, operating on a weekly basis and dedicated to the assessment, treatment, and supervision of eligible candidates. Diversion Court shall be held in . The treatment team will meet prior to court at . Family members are welcome to attend Diversion Court meetings, however the doors to the Courtroom will be closed in a timely manner. No minors will be allowed in Court. Bailiffs will be available to take PBT’s if necessary. The potential participant will be required to observe at least one Diversion Court proceeding prior to acceptance into the program.
VIII. CONFIDENTIALITY
Each Diversion Court participant will be required to sign a waiver of confidentiality authorizing the disclosure of health, medical, mental health, AODA, criminal, employment, and educational records. Each participant will sign the waiver of confidentiality at the time of screening for Diversion Court and it will be updated as necessary. Failure to sign a waiver of confidentiality will result in rejection into or termination from the program. Attached in Section XXIV is the Court Order regarding the waiver of confidentiality and participation in Diversion Court. Participants will also be required to sign a faith-based programming waiver, if they choose to participate in a faith-based program.
The Dunn County Diversion Court Program shall consist of three phases followed by a Continuing Care Phase. Each phase will be a minimum of 4 months long and the continuing care phase will be a minimum of 6 months long. The Diversion Court Team, upon recommendation of the Diversion Court Coordinator, shall determine when promotion to a higher phase is appropriate. The Diversion Court Coordinator will complete a comprehensive AODA assessment on each participant. After the assessment is completed, the Diversion Court Team will determine the level and location of each participant’s treatment. A critical component of successful Diversion Court participation involves intensive supervision and random UA/BA testing to determine compliance with the rules of the Diversion Court Program. The frequency of the random UA/BA’s will be determined by the phase each participant is in and is subject to change based on violations and the recommendation of the Treatment Team. If a UA returns positive and the participant requests a confirmation test be done, the participant will be required to pay for the test within 48-hours (exceptions will be made on an individual basis). If the confirmation test returns positive, the money will be kept and put towards the Diversion Court Program. If the confirmation test returns negative, the money will be returned to the participant.
Prospective Diversion Court Participants will need to agree and follow these expectations in order to be considered for Diversion Court. Once a prospective participant is sentenced, they can then officially be accepted into the Diversion Court, if they have followed the expectations outlined. Sobriety time may be counted for phase advancement. - Attendance at 3 recovery groups each week (must be documented). - Weekly appearances before the Diversion Court Judge. - At least one office visit per week with the Diversion Court Coordinator & Probation Agent - At least one home visit per month, by Diversion Court Coordinator, Probation Agent, or a Police Officer. - Must obtain employment (full time or part time). - 2 weekly UA’s (random) - Community service hours (as determined by Diversion Court Judge). - Follow all other recommendations as determined by Diversion Court Team
The minimum requirements for successful completion of Phase I are: - 60 consecutive days of total abstinence from the use of drugs and alcohol. - Attendance at 3 recovery groups each week (must be documented). - Weekly appearances before the Diversion Court Judge. - At least one office visit per week with the Diversion Court Coordinator & Probation Agent - At least one home visit per month, by Diversion Court Coordinator, Probation Agent, or a Police Officer. - Must obtain employment (full time or part time). - A minimum of one budget management meeting (must demonstrate you can manage a budget or obtain assistance with budget management). - Obtain sober sponsor (that individual will need to attend one diversion court hearing prior to completion of phase I). - 2 weekly UA’s (random) - Community service hours (as determined by Diversion Court Judge). - Follow all other recommendations as determined by Diversion Court Team - Application must be made to the court for phase advancement and approved by the Diversion Court Team. You may attach letters of support for advancement.
The minimum requirements for successful completion of Phase II are: - 120 days of total abstinence from the use of drugs and alcohol - Attendance at 3 recovery groups each week (must be documented) - Bi-weekly appearance before the Diversion Court Judge - At least one office visit per week with the Diversion Court Coordinator & Probation Agent - At least one home visit per month, by Diversion Court Coordinator, Probation Agent or a Police Officer - You must have weekly contact with sponsor (that individual will need to attend one diversion court hearing prior to completion of phase II). - Maintain employment. - You must develop a payment plan for Diversion Court (all fines and financial obligations will need to be up to date, prior to completion of phase II). - 2 weekly UA’s (random) - Follow all other recommendations as determined by Diversion Court Team - Application must be made to the court for phase advancement and approved by the Diversion Court Team. You may attach letters of support for advancement.
The minimum requirements for successful completion of Phase III are: - 180 days of total abstinence from the use of drugs and alcohol - Attendance at 3 recovery groups each week (must be documented) - Monthly appearances before the Diversion Court Judge - At least 2 office visits per month with the Diversion Court Coordinator & Probation Agent - A minimum of 2 home visits by Diversion Court Coordinator, Probation Agent or a Police Officer - Maintain employment - Budget management demonstrated - All court fines, fees and financial obligations to the Diversion Court must be paid, prior to graduation - 1 weekly UA (random) - Follow all other recommendations as determined by the Diversion Court Team - Application for graduation, along with a continuing care plan must be approved by Diversion Court Team prior to graduation
The minimum requirements for successful completion of the continuing care phase are: - Continued Sobriety - At least one meeting a month with the Diversion Court Coordinator and Probation Agent - A minimum of 2 appearances before the Diversion Court Judge - Maintain employment - UA’s are voluntary, not mandatory
Upon successful completion of all four phases, including the payment of all assessed fees, and upon recommendation of the Diversion Court Team, the Diversion Court Team shall declare the Diversion Court Participant a graduate of the Diversion Court Program. The graduation ceremony will be a celebration of completing all established guidelines.
Diversion Court Participants in Phases III or IV will be given an opportunity to assist Phase I participants in their adjustment to the Diversion Court. Upon recommendation of the Diversion Court Team, a Phase III client will be assigned to a new Phase I client. They will then be given the opportunity to assist the Phase I client with treatment, transportation and other areas of ongoing rehabilitation.
Upon graduation, all Diversion Court Program Graduates will be invited to join the Alumni Association. The rules of the association shall be established by the members of the Alumni Association and with the approval of the Diversion Court Team.
While Diversion Court Participants complete the Program, there are certain behaviors that will be expected of them and that will increase the likelihood they will successfully complete the program. These may include but are not limited to:
• Take responsibility for your own behavior (both good and bad) • No Probation rule violations • No new arrests or criminal charges • Attend AA/Relapse Prevention Groups and complete a 12-Step Program • Attend & complete other programming • On-time & present for all Diversion Court proceedings • Obtain & maintain employment and residential stability • Keep all appointments with Probation Agent, Coordinator, TX providers • Positive reports from collateral sources (spouse, parent, employer, etc…) • If applicable, attend school and obtain HSED/GED • Pay financial obligations as directed and in full • No missed or dirty UA/BA’s • No verbally or physically abusive or threatening behavior • Positive home visit situation (well kept home, no contraband) • Maintain clean personal appearance • Follow curfew • Promotion to next phase • Completion of community service hours • If applicable, take all prescribed medications • Obtain Driver’s License • Identify self as a Diversion Court Participant to Police if stopped for any reason
Incentives for maintaining sobriety and abiding by the conditions of the Diversion Court Program and Probation may include, but are not limited to, the following: • Having a treatment team invested in the participant’s success • Positive feedback/praise from the Judge, TX team member, or family member • Early Up in Court • Applause in Court • Special acknowledgement for maintaining sobriety & other accomplishments • Increase in privileges • Lowered reporting standards with the Coordinator and Probation Agent • Reduced testing • Before & after pictures • Education about community resources • Phase acceleration • Opportunity to mentor a new member • Early termination from probation • Reduction from a Felony charge to Misdemeanor • Alumni gatherings • Bikes • Graduation ceremony • Assorted Gift Rewards
Any Violations of the rules of the Diversion Court Program will result in the immediate imposition of sanctions, as determined by the Diversion Court Judge and/or the Treatment Team. The Diversion Court Treatment Team may individualize sanctions as deemed appropriate. Sanctions may include, but are not limited to, the following: • Verbal warning • Admonishment by the Judge or a Treatment Team member • Curfew • Limitation or decrease in privileges • Essays • Journaling • Peer review • Community service hours • Take away driving privileges • Electronic Monitoring (EMP) • Increased supervision and/or UA/BA testing • Repeat a program phase • Unique sanctions such as wash squad cars, clean the jail, pick up trash • Disciplinary custody • Imposition of Jail Time • Increased group or treatment participation • Halfway House or Inpatient treatment placement • Termination from the program • Extension of or Revocation of probation
A Diversion Court participant can be terminated from the Diversion Court Program for any of the following: a) Commission of a violent crime b) Abandonment of the Diversion Court Program for four (4) weeks c) Clear evidence that a participant is dealing drugs or driving while under the influence of an intoxicant d) Clear evidence that a participant has been involved in any threatening, abusive, or violent verbal/physical behavior towards anyone e) Any other grounds that the Diversion Court finds sufficient for termination f) Revocation of Probation/Parole/Extended Supervision
A diversion court participant may be suspended from diversion court due to continued relapse or new legal charges. If the treatment team recommends a participant be suspended for new legal charges, the diversion court participant may still attend diversion court until their legal charges are resolved. If the diversion court participant is referred to an institutional treatment facility by the treatment team, their progress or lack of progress will be monitored by the probation agent liaison. Their return to diversion court will be based upon their discharge status from the institutional treatment center.
A Diversion Court participant will not have the option to quit the Diversion Court Program. Successful completion of or expulsion from the Diversion Court Program are the only two acceptable ways to leave the Diversion Court Program.
Dunn County Diversion Court Program
Patient:
1. _____________________________________ _______________________ Name (Last, First, Middle Initial) Date of Birth
_____________________________________ _______________________ Street Address Social Security Number
___________________________________ ________________________ City State Zip Former or Maiden Name ____________________ DOC Number
2. Authorize Records Released to/from: Authorize Records Released from/to:
___________________________________ _______________________________ Name Name
___________________________________ _______________________________ Street Address Street Address
____________________________________ _______________________________ City State Zip City State Zip
I authorize the individual/agency/organization(s) named above to disclose to each other the PHI (Protected Health Information) identified below on an ongoing basis until the expiration of this authorization.
3. Type or extent of information to be released: (Check all applicable categories)
____ Medical history, examination, reports ____ Laboratory Reports ____ AODA Abuse ____ Treatment or tests ____ Consultations ____ Mental Health ____ ADHD Evaluation ____ Prescriptions ____ Other Reports ____ Verbal exchange of information ____ Client on Premises ____ Hospital records including reports ____ Other:
4. Purpose or need for release: To facilitate Dunn County Diversion Court participation including AODA assessment, orientation, planning, treatment, evaluation and implementation.
7. I further understand that I have the right to refuse to sign this authorization and the Dunn County Diversion Court will not condition my treatment on whether I give authorization for the requested disclosure. However, it has been explained to me that failure to sign this authorization or future authorizations requested may have the consequence of making me ineligible to participate in the program, or suspension or termination from the program.
8. Unless you have specifically requested in writing that the disclosure be made in a certain format, we reserve the right to disclose information as permitted by this authorization in any manner that we deem to be appropriate and consistent with applicable law, including, but not limited to, verbally, in paper format or electronically. I hereby waive all provisions of law which prohibit the release of the information identified above and hereby release the person or entity I have authorized to release information or its recipient from any legal responsibility or liability which may arise from the acts I have authorized.
9. I understand that if the person or entity that receives the information is not a health care provider or health plan covered by federal privacy regulations, the information described above may be redisclosed and no longer protected by those regulations. Federal law prohibits the person or organization to whom disclosure is made from making any further disclosure of substance abuse treatment information unless further disclosure is expressly permitted by the written authorization of the person to whom it pertains or as otherwise permitted by 42 C.F.R. Part 2.
10. General Statement of Rights. Federal and state laws protect the confidentiality of my PHI including but not limited to s. 51.30, Stats., Mental Health Act; ss. 146.82-83, WI Stats., Miscellaneous Health Provisions; 42 CFR Part 2, relating to AODA information; and 42 CFR Parts 160 and 164, Health Insurance Portability and Accountability Act (HIPAA).
Right to Receive Copy of This Authorization. I have a right to receive a copy of this form after I sign it.
Right to Withdraw This Authorization. I have the right to withdraw this authorization at any time by providing a written statement of withdrawal to the individual/agency authorized to disclose PHI. My withdrawal of consent will not be effective until the individual/agency authorized to disclose PHI receives it, and will not be effective regarding the uses and/or disclosures of my PHI made prior to receipt of my withdrawal statement. Withdrawal of the authorization may result in my suspension or termination from the diversion court program.
Re-disclosure. If I authorize release of PHI to an individual or agency not covered by federal or state laws that prohibit re-disclosure, my PHI may not remain confidential.
Right to Inspect and/or Copy PHI. I have the right to inspect and receive copies of my PHI as permitted by law. I may be charged a reasonable fee for these copies.
HIV Test Results. My HIV test results may be released under this authorization as well as without my authorization as described in HIV Information Regarding Testing and Disclosure POC-11, available to me upon my request.
11. I understand and authorize that information and documents received through the use of this authorization may be copied and shared between members of the diversion court treatment team, and from time to time, the members of that team may change. Members at the time of the signing of this authorization are:
Judges: Coordinator: Probation Agent: Asst. District Attorney: Public Defender: Evaluator:
12. I further understand and authorize that information and documents received through the use of this authorization may be disclosed to other participants in diversion court and observers of diversion court including but not limited to members of the public and/or media. No pictures or representations of me nor identifying information about me may be disclosed to the public other than in the diversion courtroom without my express written consent.
I have read this authorization or had it read to me. I have had an opportunity to discuss and ask questions. By signing this authorization I am confirming that it accurately reflects my wishes regarding disclosure of confidential information.
__________________________________________ _________________________ Signature of Patient/Client Date
______ Check here if patient/client refuses to sign authorization.
___________________________________ __________________________ Signature of Staff Witness Date
A photocopy of this authorization shall be as valid and acceptable as the original. This release is executed in conformity with Wis. Stats. 146.81-83, 51.30, 252.15, HSS Wis. Admin Code, Federal Regulations 42 CFR Part 2, Parts 160 and 164 DUNN COUNTY DIVERSION COURT PROGRAM
_____________________________ _______________________________________ Date Rod W. Smeltzer Circuit Court Judge, Branch 2 Dunn County
___________________________ ____________________________________ Date William C. Stewart, Jr. Circuit Court Judge, Branch 1 Dunn County
1) I, ___________________________________________________________________, with a date of birth of __________________________________________, and an address of ___________________________________________________________________________ have entered a guilty plea in Case No. _____________________________, to wit; violation of _____________________________________________________________________________. I understand that by entering into this Diversion Court Contract, I am bound by the terms of my sentence as follows: _____________________________________________________________ ___________________________________________________________________________________________________________________________________________________________.
2) I understand that the validity of this contract is conditioned upon my eligibility for the Diversion Court Program. If at any time after the execution of this agreement and in any phase of the Diversion Court Program, it is discovered that I am, in fact, ineligible to participate in the program, I may be immediately terminated from the program and criminal proceedings will be reinstated. I will not be allowed to withdraw my previously-entered plea of guilty unless my ineligibility is based on facts or information which should have been known to the prosecutor prior to Diversion Court admission, or upon Constitutional grounds. _______
3) I understand that if I enter this program and fail to complete it, I may be barred from future participation. _______
4) I understand that participation in Diversion Court involves a minimum time commitment of twelve months, and may include an aftercare component consisting of up to an additional six months. _______
5) I understand that during the entire course of the Diversion Court program, I will be required to attend court sessions, treatment sessions, submit to random drug testing, remain clean and sober, and law abiding. I agree to abide by the rules and regulations imposed by the Diversion Court Team. I understand that if I do not abide by these rules and regulations, I may be sanctioned or terminated from the program. _______
6) I understand that sanctions may include time in custody, increased treatment episodes, increased testing, community service and such other sanctions as may be deemed appropriate by the Diversion Court Team. _______
7) I agree to cooperate in an assessment/evaluation for planning an individualized drug treatment program adequate to my needs. I understand that my treatment plan may be modified by the treatment provider or the Diversion Court Team as circumstances arise, and I agree to comply with the requirements of any such modifications. _______
8) I understand that I will be required to pay for some or all of the cost of my treatment, and I will complete a financial declaration if necessary. _______
10) I understand that substituting, altering or trying in any way to change my body fluids for purposes of testing will be grounds for immediate termination from diversion court. _______
11) I understand that participating in Diversion Court requires me to be drug and alcohol free at all times. I will not possess (including marijuana) or alcohol, or drug or alcohol paraphernalia. I will not associate with people who use or possess drugs, nor will I be present while drugs or alcohol are being used by others. ___ 12) I agree to be drug/alcohol tested at any time by a police officer, probation office, treatment provider, or at the request of the Court of any agency designated by the court. _______
16) I may not participate in Diversion Court if I am currently an affiliated gang member. _______ 17) I will inform all treating physicians that I am a recovering addict, and may not take narcotic or addictive medications or drugs. If a treating physician wishes to treat me with narcotic or addictive medications or drugs, I must disclose this to my treatment provider and get specific permission from the Diversion Court Team to take such medication. _______
18) I agree to be responsible for what goes into my body that may affect drug test results. Before taking medication of any kind, I will check with the pharmacist to ensure that it is non-narcotic, non-addictive and contains no alcohol. I will pre-register any and all medications, prescribed or over-the-counter, with my treatment provider and with Diversion Court. _______
19) I agree that I will not leave any treatment program without prior approval of my treatment provider and the Diversion Court Team. _______
20) I understand that I may dispute positive test results, but that re-testing will be at my expense, and that I may face more severe sanctions for a re-test that is still positive. _______
21) For the purposes of regular Diversion Court review hearings, I agree to waive my right to have my attorney of record present. I understand that my case may be discussed without my attorney or the prosecutor present. _______
22) I understand that my individual course of treatment may include residential treatment, education and/or self-improvement courses such as anger management, parenting or relationship counseling. _______
23) I understand that during the early phases of treatment and recovery, I may be precluded from working or from gaining employment. I further understand that within the time directed by the Diversion Court Team, I will seek employment, job training, and/or further education as approved by the Diversion Court Team, and that failure to do so may result in sanctions or termination. _______
24) I agree to keep the Diversion Court Team, treatment provider and law enforcement liaison, if any, advised of my current address and phone number at all times and whenever changed. My place of residence is subject to Diversion Court approval, and I will not leave Dunn County without prior approval from the Diversion Court Team. _______
26) I agree to execute the Consents for Disclosure of Confidential Health and Medical and Non Health Information. I understand that any information obtained through the use of these consents will be kept apart from the Court file. _______
27) I understand that my failure to successfully complete and graduate from the Diversion Court program will result in reinstatement of criminal proceedings against me. I understand that my failure to complete Diversion Court cannot be a basis for withdrawing my previously-entered guilty plea. _______
28) Upon my successful completion of the Diversion Court program, the City Attorney or District Attorney’s Office will take the action related to my criminal sentence as previously agreed unless there is objection from the Court. _______
I have read the above contract and I understand what I have read. I am willing to enter into this agreement with the Dunn County Diversion Court Program.
_________________________________________ ______________________________ Participant’s Signature Date
_________________________________________ ______________________________ Attorney for Participant Date
_________________________________________ ______________________________ Prosecuting Attorney Date
_________________________________________ ______________________________ Diversion Court Judge Date FAITH-BASED PROGRAMMING WAIVER
My Probation/Parole Agent has recommended that I participate in a program for treatment of alcohol and/or other drug abuse. I understand that the Department of Corrections may not compel me to participate in any treatment program having a religious component, unless I have also been offered a non-religious program alternative, and I have freely chosen the program with a religious component.
I am choosing to participate in the treatment program at:
and I understand that is has a religious component. I understand that a non-religious treatment program will be provided for me if I choose not to participate in this program on grounds of my religious freedom.
DUNN COUNTY DIVERSION COURT PROGRAM
Part A Referral For Services To be completed by Referring Agent Use your TAB KEY to move from box to box. Press X to mark a check box. To remove X press it a 2nd time. Referral Date (Month/Day/Year) Projected Eligibility Date for Services (Month/Day/Year) Agent Name and Area Number Agent Address Agent Telephone Number Offender Name (As Shown on Court Order) Offender Current Address Offender Telephone Number Marital Status 0 Single, never married 0 Married 0 Separated 0 Widowed Race 0 White 0 Black 0 American Indian 0 Hispanic 0 Asian or Pacific Islander
Does individual have outstanding warrant or pending charges? 0 Yes 0 No If yes, explain: Current Violations/Reason For Referral:
Offense(s) and Sentences which led to most recent period of supervision:
Special Needs: Yes No Yes No 0 0 Alcohol Problems 0 0 History of Violence 0 0 Drug Abuse Problems 0 0 History of Committing Sexual Assaults 0 0 Health Problems 0 0 Mental Health Problems Specify: 0 0 Pregnant 0 0 Relationship Problems 0 0 Other 0 0 Development or Learning Specify: Disabilities
Is offender taking medication?
0 Yes 0 No If yes, explain (include diagnosis, prescribing physician, prescription info, funding source, etc): Educational Achievement (Check appropriate box and enter grade if appropriate):
This referral also includes the following information:
0 Court Order, Criminal Complaint and Prior Record 0 Social Information 0 Violation Report(s) 0 Signed Release of Confidential Information 0 Information in Regard to Alcohol, other Drug Problems and Prior Treatment Experience 0 Other (specify) Instructions: Indicate by a check mark, the offender’s involvement with drug or alcohol abuse problems at the time the offender is being referred to the program. Substance Abuse Problems (as noted by agent and/or offender report) Check if Appropriate 0 Alcohol 0 Cocaine/Crack 0 Marijuana/Hashish/Cannabis/THC 0 Heroin 0 Non-Prescription Methadone 0 Dilaudid/Hydromorphone 0 Other Opiates and Synthetics (Cocaine, Morphine, Oxycocone, Demerol, Opium, Fentanyl, Oxymorphone, etc.) 0 PCP (Phencyclidine) 0 LSD 0 Other Hallucinogens (MDA, MDMA, Peyote, Mescaline, Psilocybin, Psilocin, STP) 0 Methamphetamines/Ice 0 Other Amphetamines (Benzedrine, Speed, Dexedrine, Methedrine, Ritalin, Preludin, and any other Amines and related drugs) 0 Other Stimulants (Phentermine, Benzphetamine, Mazindol, Phendimetrazine, Pemoline, Chlortermine, etc) 0 Benzodiazepines (Diazepam, Flurazepam, Chlordiazepoxide, Clorazepate, Lorazepam, Alprazolam, Oxazepam, Temazepam, Prazepam, Triazolam, Clonazepam, and Halazepam) 0 Other Tranquilizers (Meprobamate, Equanil, Milton) Barbiturates (Phenobarbital, Seconal, Nemutal, Amobarbital, etc) 0 Other non-barbiturate sedatives or hypnotics (Methaqualone, Quaaludes, Glutethimide, Chloral Hydrate, Ethchlorvynol, Placidyl, etc) 0 Inhalants (Ether, Glue, Aerosols, Solvents, Gases, Chloroform, Nitrous Oxide) 0 Over-the-Counter diet, alert, sleep aids, cough syrup, etc 0 Other (Specify)
Means of Taking Substances Prior to Program Involvement Indicate the means by which the offender regularly took the substance into his/her body (if known): Y N 0 0 Oral (by mouth swallowing) 0 0 Smoking (inhale by burning or heating substance) 0 0 Inhalation (inhale or snort through the nose or mouth without burning substance) 0 0 Injection (intravenous, intramuscular or skin popping) 0 0 Other (Specify)
Treatment Information: Prior Treatment History: Date: Location: Outcome
Is offender: Y N 0 0 Currently in treatment, if so, where?_
0 0 Currently referred to the Day Monitoring Program for UA/BA testing (If so, what is s/he being tested for and what is schedule?
DUNN COUNTY DIVERSION COURT Attorney Referral
ELIGIBILITY STANDARDS Potential candidates meeting the following criteria will be considered for admission to the Dunn County Diversion Court Program. A. Resident of Dunn County. B. Each participant will need to meet the DSM-IV criteria for Alcohol/Drug Dependence. C. Proposed participants will be either post-adjudication or in ATR status from the Department of Corrections for the offenses of DUI, possession, use, or sale of a controlled substance or a drug related crime, as a felony or habitual misdemeanor. D. No prior felony convictions for violent crimes and no prior felony convictions involving a weapon. E. The Diversion Court Coordinator may interview each defendant referred for possible participation in the program. Each proposed participant will participate in any assessments requested by staff, treatment providers, or others involved in the screening process. The Diversion Court Coordinator will make a recommendation to the Diversion Court Team, who will either admit or deny the application. F. The Diversion Court Participant must voluntarily agree to abide by the Diversion Court Program rules. G. No existing in-state or extraditable warrants, or pending charges that are not resolved at the time Diversion Court participation begins.
Referral Date (Month/Day/Year) Projected Eligibility Date for Services (Month/Day/Year)
Does individual have outstanding warrant or pending charges? Yes No If yes, explain:_______________________________________
Current Offenses/Reason For Referral:
Prior Offenses (Include if misd or fel) and Drug/Alcohol Use History:
Check If Applies to Offender:
__ Relationship Issues __ Drug Abuse Problems __ History of Committing Sexual Assaults __ Dev/Learning Disabilities __ Health /Other Problems __ Mental Health Problems