60-Day Review
Client Name:
*
Date:
*
Case Manager:
*
Length of Stay in Program:
*
COUNSELING & RECOVERY SERVICES
1. Are you currently participating in counseling or therapy?
*
Yes
No
Provider/Agency:
*
Frequency of Sessions:
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Weekly
Bi-Weekly
Monthly
Other
How would you describe your participation and progress in counseling?
*
2. Are you attending recovery support meetings?
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Yes
No
If yes, what type?
*
NA
AA
Celebrate Recovery
Other
Sponsor Name (if applicable):
*
How often do you attend meetings?
*
EMPLOYMENT & INCOME
1. Current Employment Status:
*
Full-Time
Part-Time
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Other Employment Status
*
Temporary
Unemployed
Seeking Employment
Disability/SSI
Other
Employer:
*
Hours Worked Weekly:
*
2. If unemployed, what steps are being taken to secure employment?
*
3. Employment Goal for Next Month:
*
TRANSPORTATION
Current Transportation Method:
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Personal Vehicle
Bus Pass
Electric Bike
Bicycle
Walking
Rides from Others
Other
If you own a vehicle:
Vehicle Registered?
*
Yes
No
Vehicle Insured?
*
Yes
No
Valid Driver's License?
*
Yes
No
Transportation Needs or Barriers:
*
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SAVINGS & FINANCIAL PROGRESS
Current Amount Saved:
*
Savings Goal by Next Monthly Review:
*
What is your plan to reach this goal?
*
HOUSING GOALS
What are your housing goals upon leaving the program?
Housing Goals
*
Independent Living
Shared Housing
Family Reunification
Sober Living
Other
Target Move-Out Timeline:
*
Steps currently being taken toward housing:
*
SHORT-TERM & LONG-TERM GOALS
Short-Term Goal (Next 30 Days):
*
Action Steps:
*
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Long-Term Goal (6-12 Months):
*
Action Steps:
*
PERSONAL DEVELOPMENT
Personal Short-Term Goal:
*
Personal Long-Term Goal:
*
SUPPORT SYSTEM & REUNIFICATION
Current Support System (Check all that apply):
*
Family
Children
Friends
Sponsor
NA/AA Community
Faith Community
Other
How would you describe your current support system?
*
Are there any reunification goals with family or children?
*
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SOBRIETY & RECOVERY CHECK-IN
How do you feel about your sobriety and recovery progress this month?
*
What challenges or concerns do you currently have regarding your sobriety?
*
What strengths or successes have helped your recovery this month?
*
PROGRAM FEES & FINANCIAL OBLIGATIONS
Current Program Fees Status:
*
Current
Behind
Payment Plan
Other
Other Financial Obligations:
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Child Support
Court Fines
Probation Fees
Credit Debt
Medical Bills
Other
Are you current with these obligations?
*
Yes
No
If no, what is your plan to address them?
*
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Next
Do you need assistance creating a financial plan?
*
Yes
No
Action Plan:
*
CASE MANAGER NOTES
*
GOALS FOR NEXT MONTH
1.
*
2.
*
3.
*
Client Signature:
*
Date:
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Case Manager Signature:
*
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