Form 1122-0009 Semi Annual Progress Report for Supervised Visitation Pr

Semi-annual Progress Report for Safe Havens: Supervised Visitation and Safe Exchange Grant Program

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Semi-annual Progress Report for Safe Havens: Supervised Visitation and Safe Exchange Grant Program

OMB: 1122-0009

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THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.


OMB Clearance # 1122-0009 Expiration Date: 08/30/2014


U.S. Department of Justice Office on Violence Against Women

SEMI-ANNUAL PROGRESS REPORT FOR

Shape1 Safe Havens: Supervised Visitation and Shape2 Safe Exchange Grant Program

Brief Instructions: This form must be completed for each Safe Havens: Supervised Visitation and Safe Ex- change Grant Program (Supervised Visitation Program) grant received. The grant administrator or coordinator must ensure that the form is completed fully with regard to all grant activities. If the program involves more than one site (either for provision of services or for planning), there will still be only one form completed for each program. Grant partners, however, may complete sections relevant to their portion of the grant. Grant administrators or coordinators are responsible for compiling and submitting a single report that reflects all information collected from grant partners.


All grantees should read each section to determine which items they must answer, based on the activities engaged in under this grant during the current reporting period. Sections A1, B, C2, C3, E, and F of this form must be completed by all grantees. In subsections A2, C1, and C4, and section D, grantees must answer an initial question about whether they engaged in certain activities during the current reporting period. If the response is yes, then the grantee must complete that section or subsection. If the response is no, the rest of that section or subsection is skipped.


For example, if you receive funds to hire staff for the purposes of planning and protocol development, you will complete sections A, B, C2, C3, C4, E, and F (and answer ‘no’ in C1 and D); or if you receive funds to hire staff for services and training, you will complete sections A, B, C1, C2, C3, D, E, F (and answer ‘no’ in C4).


The activities of volunteers or interns should be reported if they are coordinated or supervised by Supervised Visitation Program-funded staff or if Supervised Visitation Program funds substantially support their activities.


For further information on filling out this form, refer to the separate set of instructions, which contains detailed definitions and examples illustrating how questions should be answered.




Shape3 Shape4 SECTION Page Number


Section A: General Information 1

A1: Grant Information 1

A2: Staff Information 3

Section B: Program Activities 4

Section C: Function Areas 5

C1: Training and Staff Development 5

C2: Coordinated Community Response 8

C3: Policies 10

C4: Planning 12

Section D: Services 14

Section E: Community Measures 19

Section F: Narrative 20












Supervised Visitation Program Semi-Annual Progress Report Office on Violence Against Women



SECTION

A1

Shape5 GENERAL INFORMATION

OMB Clearance # 1121-0279

Expiration Date: 07/31/2004

Shape6 Grant Information

OMB Clearance # 1122-0009 Expiration Date: 06/30/2011

All grantees must complete this subsection.



  1. Shape7











    Date of report







Shape8 Shape9 (format date with 6 digits, like - 01/31/09)

  1. Shape10 Current reporting period

January 1-June 30

July 1-December 31 (Year)


Shape11 3. Grantee name

Shape13 4. Grant number

(the federal grant number assigned to your Supervised Visitation Program grant)


Shape14 5. Type of implementing agency/organization

(Check one.)

Shape15 Shape16 Shape17 Shape18 Shape19 Court (state or local) Domestic violence program Sexual assault program State government Supervised exchange center


Shape20 5A. Is this a faith based organization?




Shape21 Supervised visitation center

Shape22 Shape23 Supervised visitation and exchange center Tribal government

Shape24 Shape25 Shape26 Unit of local government Other (specify):


Shape27 Shape28 Yes No

Shape29 6. Grant description

Shape30 Shape31 Shape32 (Check all that apply and report the number of sites for each type of grant.)



Type of grant

Number of planned sites

Number of operational sites


Supervised Visitation Program (development)








Supervised Visitation Program (continuation)








Shape33 Shape34 7. Point of contact

(person responsible for the day-to-day coordination of the grant)

Shape35 First name MI Last name Agency/organization name Address City State Zip code Telephone Facsimile E-mail

Shape36 8. Does this grant specifically address tribal populations?

Shape37 (Check yes if your Supervised Visitation Program grant focuses on tribal populations, and indicate which tribes or nations you serve or intend to serve.)

Shape38 Shape39 Yes No If yes, which tribes/nations:






Supervised Visitation Program Semi-Annual Progress Report 1 Office on Violence Against Women

OMB Clearance # 1121-0279 Expiration Date: 07/31/2004

Shape40 OMB Clearance # 1122-0009 Expiration Date: 06/30/2011



Shape41 9. What percentage of your Supervised Visitation Program grant funds was directed to each of these areas?

(Report the area(s) addressed by your Supervised Visitation Program grant during the current reporting period and estimate the approximate percentage of funds [or resources] used to address each area.

Grantees that are providing visitation and/or exchange services should use the number of cases in each area. Grantees that are in a planning phase should consider services that they anticipate provid- ing.)


Throughout this form, the term sexual assault includes both assaults committed by offenders who are strangers to the victim/survivor and assaults committed by offenders who are known to, related by blood or marriage to, or in a dating relationship with the victim/survivor. The term domestic violence/ dating violence applies to any pattern of coercive behavior that is used by one person to gain power and control over a current or former intimate partner or dating partner. Stalking is defined as a course of conduct directed at a specific person that would cause a reasonable person to fear for his or her safety or the safety of others, or suffer substantial emotional distress. Child abuse means a threat to a child’s health or welfare by physical, mental, or emotional injury or impairment, sexual abuse or exploi- tation, deprivation of essential needs, or lack of protection from these, by a person responsible for the child (or as defined by your state’s statutes.) (See separate instructions for more complete definitions.)





Sexual assault

Domestic violence/dating violence Stalking

Child abuse

TOTAL (must equal 100%)

Percentage of grant funds









100%

Shape42 0%





































Supervised Visitation Program Semi-Annual Progress Report 2 Office on Violence Against Women

SECTION

Shape43 A2 Staff Information

OMB Clearance # 1122-0009 Expiration Date: 06/30/2011



Were Supervised Visitation Program funds used to fund staff positions during the current reporting period?

Check yes if Supervised Visitation Program grant funds were used to pay staff, including part-time staff and contractors.


Shape44 Shape45 Yes—answer question 10 No—skip to section B

Shape46 10. Staff

(Report the total number of full-time equivalent [FTE] staff funded by the Supervised Visitation Program grant during the current reporting period. Report staff by functions performed, not by title or

location. Include employees who are part-time and/or only partially funded with these grant funds as well as consultants/contractors. Report grant-funded overtime. If an employee or contractor was

employed or utilized for only a portion of the reporting period, prorate appropriately. For example, if you hired a full-time administrator in October who was 100% funded with Supervised Visitation Program funds, you would report that as .5 FTE. Report all FTEs in decimals, not percentages. One FTE is equal to 1,040 hours 40 hours per week x 26 weeks. See separate instructions for examples of how to calculate and prorate FTEs.)


Staff

FTE(s)

Administrator (fiscal manager, executive director, project coordinator)



Shape47 Program/center coordinator (training coordinator, visitation services coordinator, volunteer coordinator)

Security

Supervision staff for visitation and exchange




Shape48 Shape49 Support staff (administrative assistant, receptionist, bookkeeper, accountant)

Trainer Translator/interpreter

Victim advocate (non-governmental, includes domestic violence, sexual assault and dual)


Other (specify):



TOTAL


0














Supervised Visitation Program Semi-Annual Progress Report 3 Office on Violence Against Women


OMB Clearance # 1121-0279 Expiration Date: 07/31/2004

Shape50 THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.

OMB Clearance # 1122-0009 Expiration Date: 06/30/2011


SECTION

B

Shape51 PROGRAM ACTIVITIES

All grantees must complete this section.



Shape52 11. Program activities

(Check all program activities supported with Supervised Visitation Program funds during the current reporting period.)

Shape53 Check ALL

that apply Program activities

Establishment or expansion of supervised visitation and exchange services.

Development of community-based consulting committees to plan and/or implement visi- tation and exchange services.

Shape54 Development and implementation of policies and procedures regarding security, intake, case referral, record keeping, and confidentiality.

Enhancement of program services to address special needs of underserved populations. Development and implementation of effective training for project staff and volunteers.


Shape55 12. Program priorities addressed by your grant

Shape56 (In addition to the program activities identified above, the Supervised Visitation Grant Application and Program Guidelines may have identified program priority areas that would receive priority consider- ation. If your program addressed any of these priority areas during the current reporting period, list them below.)






































Supervised Visitation Program Semi-Annual Progress Report 4 Office on Violence Against Women



SECTION

C1

Shape57 FUNCTION AREAS

Training and Staff Development

OMB Clearance # 1122-0009 Expiration Date: 06/30/2011


OMB Clearance # 1121-0279 Expiration Date: 07/31/2004

Shape58 Were your Supervised Visitation Program funds used for training and/or staff development during the current reporting period?

Check yes if Supervised Visitation Program-funded staff provided training or staff development, or if grant funds directly supported the training or staff development.

Shape59 Shape60 Yes—answer questions 13-17 No—skip to C2

For purposes of this reporting form, training means providing information on sexual assault, domes- tic violence, dating violence, child abuse, and/or stalking that enables professionals to improve their response to victims/survivors as it relates to their role in the system. Staff development is training at- tended by staff funded under your Supervised Visitation Program grant.

Shape61 13. Training and staff development events provided

(Report the total number of training events and the total number of staff development events provided during the current reporting period with Supervised Visitation Program funds.)

Shape62 Total number of training events provided (excluding staff development events)

Total number of staff development events provided

Shape63 14. Number of people trained

Shape64 Shape65 (Report the number of people trained during the current reporting period by Supervised Visitation Program-funded staff or training supported by Supervised Visitation Program funds. Use the category that is most descriptive of the people who attended the training event. If you do not know how many people to report in specific categories, you may report the overall number in “Multidisciplinary,” but this category should be used only as a last resort. Do not include staff funded under your Supervised Visita- tion Program grant who attended staff development events.)

People trained Number People trained Number

Advocacy organization staff (NAACP, AARP)

Attorneys/law students (does not in- clude prosecutors)

Batterer intervention program staff

Child welfare workers/children’s advo- cates

Corrections personnel (probation, parole, and correctional facilities staff)

Court personnel (judges, clerks, media- tion staff)

Government agency staff (vocational rehabilitation, food stamps, TANF)

Guardians ad Litem

Health professionals (doctors, nurses)

Law enforcement officers

Legal services staff (does not include attorneys)

Mental health professionals


Multidisciplinary (various disciplines at same training)

Prosecutors

Shape66 Sex offender treatment provider

Shape67 Social service organization staff (non- governmental - food bank, homeless shelter)

Shape68 Shape69 Substance abuse treatment provider

Shape70 Shape71 Shape72 Supervised visitation and exchange center staff (staff not funded under your Supervised Visitation Program grant)

Shape73 Shape74 Translators/interpreters

Shape75 Shape76 Tribal government/Tribal government agency staff

Shape77 Victim advocates (non-governmental, includes sexual assault, domestic vio- lence, and dual)

Shape78 Shape79 Victim assistants (governmental, includes victim-witness specialists/ coordinators)

Shape80 Shape81 Shape82 Shape83 Volunteers Other (specify):

TOTAL 0

Supervised Visitation Program Semi-Annual Progress Report 5 Office on Violence Against Women

OMB Clearance # 1122-0009 Expiration Date: 06/30/2011

Shape84 15. Training content areas

(Indicate all topics covered in training events provided with your Supervised Visitation Program funds during the current reporting period. Do not include topics covered in staff development events. See definitions of training and staff development at the beginning of subsection C1. Check all that apply.)

Domestic violence, dating violence, sexual assault, and child abuse

Shape85 Advocate response

Shape86 Shape87 Shape88 Child abuse overview, dynamics, and services Child development

Shape89 Shape90 Shape91 Shape92 Child protective services Child witnesses Custody statutes/codes Confidentiality

Dating violence overview, dynamics, and services

Shape93 Domestic violence overview, dynamics, and services

Shape94 Shape95 Dynamics relating to non-offending parents and offending parents

Shape96 Family law Parenting issues

Shape97 Shape98 Resources for families Safety planning

Shape99 Shape100 Shape101 Sexual assault overview, dynamics, and services Stalking overview, dynamics, and services Supervised visitation and exchange

Other (specify):

Justice system

Shape102 Civil court procedures

Shape103 Shape104 Child abuse statutes/codes Custody statutes/codes

Shape105 Domestic violence/dating violence statutes/codes Expert testimony

Shape106 Family law Judicial response

Shape107 Shape108 Shape109 Law enforcement response Mandatory reporting requirements Probation response

Protection orders (including full faith and credit)

Sexual assault statutes/codes Stalking statutes/codes Supervised visitation and exchange Other (specify):

Shape110 Shape111 Underserved populations

Issues specific to families who:

Shape112 Shape113 are American Indian or Alaska Native are Asian

Shape114 Shape115 are black or African American are elderly

are Hispanic or Latino

Shape116 are homeless or living in poverty

Shape117 are immigrants, refugees, or asylum seekers

Shape118 are lesbian, gay, bisexual, transgender, or intersex

Shape119 Shape120 Shape121 are Native Hawaiian or other Pacific Islander have disabilities

Shape122 Shape123 Shape124 have limited English proficiency have mental health issues have substance abuse issues live in rural areas

Other (specify):

Organization and community issues

Shape125 Collaboration

Shape126 Shape127 Shape128 Shape129 Community response to sexual assault Coordinated community response Technology

Other (specify):



  1. Shape130 Number of staff who attended staff development events

Shape131 (Report the number of staff funded under your Supervised Visitation Program grant who attended staff development events.)

Number of people






Supervised Visitation Program Semi-Annual Progress Report 6 Office on Violence Against Women

OMB Clearance # 1121-0279 Expiration Date: 07/31/2004

Shape132

  1. Shape133 (Optional) Additional information

Shape134 (Use the space below to discuss the effectiveness of training activities funded or supported by your Supervised Visitation Program grant and to provide any additional information you would like to share about your training activities beyond what you have provided in the data above. An example might in- clude: “The visitation center program director and the children’s program director at the local domestic violence center developed a training curriculum based upon ‘The Batterer as Parent’ by Lundy Bancroft and Jay Silverman. This training was delivered to local professionals, including attorneys, mental health professionals, and child protective service workers. Evaluation results showed increased knowledge in the effects of DV on children and how to work with battering parents.”)(Maximum 2000 Characters)




























































Supervised Visitation Program Semi-Annual Progress Report 7 Office on Violence Against Women


OMB Clearance # 1121-0279 Expiration Date: 07/31/2004

Shape135



SECTION

C2

Shape136 Coordinated Community Response

Shape137 All grantees must complete this subsection.

  1. Coordinated community (CCR) response activities

(Check the appropriate boxes to indicate the agencies or organizations, even if they are not memoran- dum of understanding [MOU] partners or consulting committee members, that you provided family re- ferrals to, received referrals from, engaged in consultation with, provided technical assistance to, and/ or attended meetings with, during the current reporting period, according to the usual frequency of the interactions. If the interactions were not part of a regular schedule, you will need to estimate the fre- quency with which these interactions occurred during the current reporting period. If Supervised Visita- tion Program-funded staff participated in a task force or work group, indicate that under “Meetings” by checking the frequency of the meetings and the types of organizations participating. Indicate which of these agencies/organizations are consulting committee members for your Supervised Visitation Pro- gram grant. In the last column, indicate the agencies or organizations with which you have an MOU for the purposes of the Supervised Visitation Program grant.)

If you have a planning grant, report planning meetings, consulting committee members, and MOU partners.



Agency/organization

Family referrals, consulta- tions, technical assistance

Meetings

Consulting committee member

MOU

partner

Daily Weekly Monthly Weekly Monthly Quarterly

Advocacy organization

(NAACP, AARP)







Batterer intervention program









Child advocacy program

















Child protective services























Shape138 Shape139 Shape140 Shape141 Shape142 Shape143 Shape144 Shape145 Shape146 Shape147 Corrections (probation, parole, and correctional facilities)

Court

Domestic violence pro- gram

Educational institutions/ organizations

Faith-based organization Government agency

(INS, Social Security, TANF)

Health/mental health organization

Law enforcement agency

Prosecutor’s office























Sexual assault organiza- tion



















Social service organiza- tion (non-governmental)































Substance abuse treat- ment provider



















Tribal government/Tribal government agency



































Shape148 Shape149 Shape150 Shape151 Shape152 Shape153 Shape154 Shape155 Legal organization (legal services, bar as- sociation, law school)












Shape156 Other (specify):


Supervised Visitation Program Semi-Annual Progress Report 8 Office on Violence Against Women





OMB Clearance # 1121-0279 Expiration Date: 07/31/2004

Shape157 Shape158 19. (Optional) Additional information

OMB Clearance # 1122-0009 Expiration Date: 06/30/2011

(Use the space below to discuss the effectiveness of CCR activities funded or supported by your Super- vised Visitation Program grant and to provide any additional information you would like to share about your CCR activities beyond what you have provided in the data above. An example might include an in- crease in appropriate referrals to the supervised visitation center from the three local courts following a series of planning meetings of a multi-disciplinary workgroup with membership from judges, domes- tic violence programs, law enforcement agencies, and the supervised visitation center.

Shape159 (Maximum 2000 Characters)



























































Supervised Visitation Program Semi-Annual Progress Report 9 Office on Violence Against Women



SECTION

C3

Shape160 Policies

All grantees must complete this subsection.

OMB Clearance # 1122-0009 Expiration Date: 06/30/2011


Were your Supervised Visitation Program funds used to develop, substantially revise, or implement policies or protocols during the current reporting period?

Check yes if Supervised Visitation Program-funded staff developed, substantially revised, or implement- ed policies or protocols, or if Supervised Visitation Program funds directly supported the development, revision, or implementation of policies or protocols.

Shape161 Shape162 Yes—answer questions 20-21 No—skip to C4

Shape163 20. Types of policies or protocols developed, substantially revised, or implemented during the current reporting period

(Check all the types of policies or protocols developed, substantially revised, or implemented during the current reporting period. Check all that apply.)

Center operations

Shape164 Confidentiality

Shape165 Shape166 Shape167 Shape168 Shape169 Flexible hours of operation Income-based fees (sliding scale) Program does not charge fees Recordkeeping and report writing

Shape170 Shape171 Staff, board, and/or volunteers represent the diversity of your service area Other (specify):

Service provision

Shape172 Shape173 Shape174 Appropriate response to underserved populations Child-friendly (toys, games, appropriate décor) Court feedback procedures

Shape175 Shape176 Courtesy monitoring Document exchange procedures

Shape177 Shape178 Mandatory training on domestic violence/dating violence, sexual assault, child abuse, and stalking Out-of-jurisdiction referrals

Shape179 Parent education program procedures Service termination

Shape180 Shape181 Supervised exchange procedures Other (specify):

Security and safety

Shape182 Different entrances for parties

Shape183 Shape184 Escort for children and custodial parent Metal detectors

Shape185 Panic button(s)

Shape186 Private, secure drop-off locations for children

Shape187 Private, secure entrances for children and custodial parent Security guards

Shape188 Security measures in place (cameras, staff, etc.)

Shape189 Shape190 Shape191 Security staff observations Staggered arrival/departure times Other (specify):

Supervised Visitation Program Semi-Annual Progress Report 10 Office on Violence Against Women


OMB Clearance # 1121-0279 Expiration Date: 07/31/2004

Shape192 THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.

OMB Clearance # 1122-0009 Expiration Date: 06/30/2011

Shape193 21. (Optional) Additional information

(Use the space below to discuss the effectiveness of policy development activities funded or supported by your Supervised Visitation Program grant and to provide any additional information you would like to share about your policy development activities beyond what you have provided in the data above. An example might include an increase in the number of families participating in the supervised visitation program following the development and implementation of an income-based fee scale.)

Shape194 (Maximum 2000 characters)


























































Supervised Visitation Program Semi-Annual Progress Report 11 Office on Violence Against Women

THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.

OMB Clearance # 1121-0279

Expiration Date: 07/31/2004

Shape195 OMB Clearance # 1122-0009 Expiration Date: 06/30/2011

SECTION

Shape196 C4 Planning


Are you in the planning phase of a Safe Havens Development Grant?

Check yes if you have a Supervised Visitation Program development grant and you are in the planning phase. Only those grantees who received a Supervised Visitation Program development grant and who are in the planning phase will answer questions 22-25.

Shape197 Shape198 Yes—answer questions 22-25 No—skip to section D

Shape199 22. Planning meetings

Total number of people attending





Shape200 Shape201 (Report the total number of planning meetings and the total number of people attending planning meetings during the current reporting period.)


Total number of planning meetings




Shape202 23. Planning activities conducted

(Check all that apply.)

Shape203 Shape204 Conducting needs assessments Creating goals and objectives

Shape205 Shape206 Creating personnel and agency policies Identifying location(s) for visitation center(s) Identifying resources

Shape207 Shape208 Identifying visitation center models Other (specify):

Shape209 24. Number of site visits to visitation and/or exchange centers

(Report the number of site visits to visitation and/or exchange centers.)

Shape210 Number of visits




























Supervised Visitation Program Semi-Annual Progress Report 12 Office on Violence Against Women



OMB Clearance # 1121-0279 Expiration Date: 07/31/2004

Shape211 THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.

OMB Clearance # 1122-0009 Expiration Date: 06/30/2011

Shape212 25. (Optional) Additional information

(Use the space below to discuss the effectiveness of planning activities funded or supported by your Supervised Visitation Program grant and to provide any additional information you would like to share about your planning activities beyond what you have provided in the data above. An example might include describing the location that has been found for the future visitation center and listing the com- munity resources/members [construction, painting, refurbishing, etc.] that have contributed to making the center usable.)

Shape213 (Maximum 2000 characters)





























































Supervised Visitation Program Semi-Annual Progress Report 13 Office on Violence Against Women

SECTION

Shape214 D SERVICES

OMB Clearance # 1122-0009 Expiration Date: 06/30/2011

OMB Clearance # 1121-0279 Expiration Date: 07/31/2004

Shape215 Were your Supervised Visitation Program funds used to provide services to families during the current reporting period?

Check yes if Supervised Visitation Program-funded staff provided services to families, or if Supervised Visitation Program grant funds were used to support services to families during the current reporting period.

Shape216 Shape217 Yes—answer questions 26-36 No—skip to section E

Shape218 Shape219 26. Number of families served, partially served, and families seeking services who were not served Please do to answer this question without referring to the separate set of instructions for further expla- nation and examples of how to distinguish among these categories. (Report the following, to the best of your ability, as an unduplicated count for each category during the current reporting period. This means that each family who sought or received services during the current reporting period should be counted only once and in only one of the listed categories. Do not count or report families that do not meet grant eligibility or statutory requirements.)



    1. Shape220 Shape221 Served: Families who received the service(s) they requested, if those services were provided under your Supervised Visitation Program grant

    2. Partially served: Families who received some service(s), but not all of the ser- vices they requested, if those services were provided under your Supervised Visita- tion Program grant

TOTAL SERVED and PARTIALLY SERVED (26A +26B)

    1. Families seeking services who were not served: Families who sought services and did not receive service(s) they needed, if those services were provided under your Supervised Visitation Program grant

Shape222 27. Reasons families seeking services were not served or were partially served

Number of families

Shape223 Shape224 Shape225 Shape226 Shape227 Shape228 (Check all that apply. If you check “Party(ies) not accepted into program,” report on the reason(s) in question 28.)


Reasons not served or partially served


Hours of operation


Insufficient/lack of culturally appropriate services


Insufficient/lack of services for people with disabilities


Insufficient/lack of language capacity (including sign language)


Party(ies) not accepted into program


Program reached capacity





Program rules not acceptable to party(ies)


Services inappropriate or inadequate for people with substance abuse issues





Services inappropriate or inadequate for people with mental health issues


Services not appropriate for party(ies)





Transportation






Other (specify):









Shape229 Supervised Visitation Program Semi-Annual Progress Report 14 Office on Violence Against Women


OMB Clearance # 1121-0279 Expiration Date: 07/31/2004

Shape230 Shape231 Shape232 Shape233 Shape234 Shape235 Shape236 Shape237 Shape238 Shape239 OMB Clearance # 1122-0009 Expiration Date: 06/30/2011

Shape240 28. Number of families not accepted into program and reasons

(Report the total number of families who were not accepted into the program during the current report- ing period by the reason they were not accepted.)








Reason

Number of families declined

Conflict of interest



Client unwilling to agree with program rules




Too dangerous



Other (specify):






0



TOTAL

Shape241 29. Demographics of family members served or partially served

Shape242 Shape243 Shape244 (Report the numbers of parents and children served. These numbers should be based on the individu- als in the families counted in questions 26A and 26B. Because individuals may identify in more than one category of race/ethnicity, the total for “Race/ethnicity” may exceed the total number of victims/ survivors reported in 26A and 26B. However, the total number of victims/survivors reported under “Race/ethnicity” should not be less than the total number of victims/survivors reported in 26A and 26B. The total number of victims/survivors reported under “Gender” and the total number reported under “Age” should equal the total number of victims/survivors reported in 26A and 26B. Those vic- tims/survivors for whom gender, age, and/or race/ethnicity are not known should be reported in the “Unknown” category.)


Custodial parents

Non-custodial parents

Children

Race/ethnicity (Individuals should not be counted

more than once in either the category “American Indian and Alaska Native” or in the category Native Hawaiian and other Pacific Islander.” )



Black or African American






American Indian and Alaska Native








Asian






Native Hawaiian and other Pacific Islander








Hispanic or Latino






White








Unknown






TOTAL RACE/ETHNICITY

(should not be less than ,the sum of 26A and 26B)

0

0


0

Gender




Female






Male








Unknown






TOTAL (Parent Columns should equal ,the sum of 26A and 26B)


0



0


0

Age




0 to 6






7 to 12








13 to 17






18 to 24








25 to 59






60+








Unknown






TOTAL (Parent Columns should equal ,the sum of 26A and 26B)


0



0


0

Other demographics




People with disabilities






People with limited English proficiency








People who are immigrants/refugees/asylum seekers






People who live in rural areas








Shape245 Shape246 Shape247 Supervised Visitation Program Semi-Annual Progress Report 15 Office on Violence Against Women

OMB Clearance # 1121-0279 Expiration Date: 07/31/2004

Shape248 OMB Clearance # 1122-0009 Expiration Date: 06/30/2011

Shape249 30. Number of families by primary victimization and referral source

(Report the number of families by primary type of victimization and referral source. This is an undupli- cated count and each family should only be counted once. This should equal , the sum of 26A and 26B. Refer to the separate set of instructions for further explanation and examples.)

Shape250 Domestic


Referral Source



Child welfare agency Other social services Criminal court order Family court order Juvenile court order DV court order Protection order

Other civil court order

Mediation services Self-referral

Shape251 Shape252 Other (specify):

Total

number of families

Sexual assault

violence/ dating violence


Stalking

Child

abuse TOTAL


0


0


0


0


0


0


0



0



0


0



Shape253 Shape254 Shape255 0


TOTAL



0


0


0


0


0


Shape256 Shape257 Shape258 31. Family issues

(Report all of the issues identified for each family, including victimization and other problems or challenges. The column “Total number of families” should equal the sum of 26A and 26B and should be identical to the numbers in the “Total number of families” column reported in question

Shape259 30. Multiple victimizations and problems may be reported for each family.)

Total number of families


Sexual assault

Domestic violence/ dating violence



Stalking


Child abuse


Emotional abuse


Substance abuse


Threat of parental abduction


Mental illness


Home- lessness


Violation of court orders

Other

(specify):


































Shape261 Shape260 32. Services provided with Supervised Visitation Program funds

(Report the number of families receiving each of these services and the number of times the services were provided during the current reporting period. See separate instructions for examples.)










Type of service

Number of families

Number of times services provided

Group supervision





One-to-one supervision







Supervised exchange





Telephone monitoring
















Shape262 Other (specify):



Supervised Visitation Program Semi-Annual Progress Report 16 Office on Violence Against Women

OMB Clearance # 1121-0279 Expiration Date: 07/31/2004

Shape263 OMB Clearance # 1122-0009 Expiration Date: 06/30/2011

Shape264 33. Visits terminated

(Document each supervised visitation that is terminated for any reason. Report the total number of vis- its terminated during the current reporting period. See definition of terminated in the separate instruc- tions.)

Reason

Total occurrences

Custodial

Non-custodial

Child

Child’s request







Non-compliance with program rules










No-shows







Parent’s request










Other (specify):










TOTAL


0



0



0


Shape266 Shape265 34. Safety and security problems

(Report the number of safety and security problems, including the number of parental abduction cases that occurred during supervised visitation and/or supervised exchange funded under the Supervised Visitation Program grant during the current reporting period.)


















Safety or security problem

Number of occurrences

Attempted parental abductions





Attempted to contact other party







Parental abductions





Security staff unavailable







Threats





Violence







Violation of protection order





Other (specify):










0


0



TOTAL

Shape267 35. Services terminated or completed

(Report the number of families whose services were terminated or completed during the current report- ing period. Report the family by the primary reason.)
























Reason terminated or completed

Number of families

Cessation of threats/use of violence



Change in court order




Child refuses to participate



Deceased




Deported



Habitual non-compliance with program rules




Habitual no-shows or cancellations



Incarcerated




Moved



Mutual agreement of both parties




Parent completed treatment program



Supervisor's discretion




Unknown



Other (specify):







0



Shape268 Shape269 TOTAL

Supervised Visitation Program Semi-Annual Progress Report 17 Office on Violence Against Women




OMB Clearance # 1121-0279 Expiration Date: 07/31/2004

Shape270 36. (Optional) Additional information

OMB Clearance # 1122-0009 Expiration Date: 06/30/2011

Shape271 Shape272 (Use the space below to discuss the effectiveness of services funded or supported by your Supervised Visitation Program grant and to provide any additional information you would like to share about services beyond what you have provided in the data above. An example might include the results of an internal survey that shows that custodial parents feel increased safety for themselves and their children due to the services and safety measures available at your visitation center.) (Maximum 2000 characters)






























































Supervised Visitation Program Semi-Annual Progress Report 18 Office on Violence Against Women





OMB Clearance # 1121-0279 Expiration Date: 07/31/2004

SECTION

E

Shape273 Shape274 COMMUNITY MEASURES

All grantees must complete this section.

OMB Clearance # 1122-0009 Expiration Date: 06/30/2011


Shape275 37. Parental abductions

(Report the number of parental abduction cases, identified through criminal prosecution and custody

violation court records, that occurred in the judicial districts that routinely use your supervised visita- tion and/or exchange center[s] during the current reporting period.)


Number of parental abductions

Criminal




Civil





Shape276 38. Limitations

Shape277 (If the information provided in question 37 is limited in any way, describe the efforts you made to ob- tain that information, the reasons for the limitations, and what steps you are taking to address those limitations. For example, if the data includes non-parental abductions, and/or if your jurisdiction’s data collection methods do not provide information on parental abductions, and/or if you have begun to implement different data collection tools, please report that here.)















































Supervised Visitation Program Semi-Annual Progress Report 19 Office on Violence Against Women

SECTION

Shape278 F

All grantees must answer question 39





OMB Clearance # 1121-0279 Expiration Date: 07/31/2004

Shape279 NARRATIVE

OMB Clearance # 1122-0009 Expiration Date: 06/30/2011


Please limit your response to the space provided.


  1. Shape280 Report on the status of your Supervised Visitation grant goals and objectives as of the end of the cur- rent reporting period. Page 21.

(Report on the status of the goals and objectives for your grant as of the end of the current reporting period, as they were identified in your grant proposal or as they have been added or revised. Indicate whether the activities related to your objectives for the current reporting period have been completed, are in progress, are delayed, or have been revised. Comment on your successes and challenges, and provide any additional explanation you feel is necessary for us to understand what you have or have not accomplished relative to your goals and objectives. If you have not accomplished objectives that should have been accomplished during the current reporting period, you must provide an explanation.)

Shape281 All grantees must answer questions 40 and 41 on an annual basis. Submit responses on the January to June reporting form only.

Please limit your response to the space provided.

  1. Shape282 What do you see as the most significant areas of remaining need, with regard to improving services to victims/survivors of sexual assault, domestic violence, dating violence, and stalking, increasing the safety of families and enhancing community response (including offender accountability for both

batterers and sex offenders?)

Page 24.

(Consider geographic regions, underserved populations, service delivery systems, types of victimization, and challenges and barriers unique to your state or service area.)

  1. Shape283 What has the Supervised Visitation Program funding allowed you to do that you could not do prior to

receiving this funding?

Page 26.

(e.g. expand hours, develop new services and/or programs, build partnerships, and provide additional security)

Shape284 Questions 42 and 43 are optional.

Please limit your response to the space provided.




  1. Provide any additional information that you would like us to know about your Supervised Visitation Program grant and/or the effectiveness of your grant.

(If you have other data or information regarding your program that would more fully or accurately reflect

Shape285 the effectiveness of your Supervised Visitation Program other than the data you have been asked to provide on this form, answer this question. If you have not already done so elsewhere on this form, feel free to discuss any of the following: policies, and/or protocols, community collaboration, the removal or reduction of barriers and challenges for families, promising practices, positive or negative unintended consequences,

and parental abductions.)

Page 28.

  1. Provide any additional information that you would like us to know about the data submitted.

Shape286 (If you have any information that could be helpful in understanding the data you have submitted in this report, please answer this question. For example, if you submitted two different progress reports for the same reporting period, you may explain how the data was apportioned to each report; or if you funded staff but did not report any corresponding services you may explain why; or if you did not use program funds to support either staff or activities during the reporting period, please explain how program funds were used, if

you have not already done so.)

Page 30.


Public Reporting Burden

Paperwork Reduction Act Notice. Under the Paperwork Reduction Act, a person is not required to respond to a col- lection of information unless it displays a currently valid OMB control number. We try to create forms and instruc- tions that are accurate, can be easily understood, and which impose the least possible burden on you to provide us with information. The estimated average time to complete and file this form is 60 minutes per form. If you have comments regarding the accuracy of this estimate, or suggestions for making this form simpler, you can write to the Office on Violence Against Women, U.S. Department of Justice, 800 K Street, NW, Washington, DC 20531.



Supervised Visitation Program Semi-Annual Progress Report 20 Office on Violence Against Women

Describe your goals and objectives, as outlined in your grant proposal, or as revised - Question #39



Goals/Objectives












Key Activities


Back to Instructions

Status












Comments











Goals/Objectives

Back to Instructions

Status

Shape287 Shape288










Key Activities












Comments








Supervised Visitation Program Semi-Annual Progress Report • 21 • Office on Violence Against Women

Describe your goals and objectives, as outlined in your grant proposal, or as revised - Question #39(cont. 1)




Goals/Objectives












Key Activities

Back to Instructions

Status











Comments











Goals/Objectives

Back to Instructions

Status

Shape289 Shape290











Key Activities












Comments

Describe your goals and objectives, as outlined in your grant proposal, or as revised - Question #39 (cont. 2)




Goals/Objectives












Key Activities

Back to Instructions

Status












Comments











Goals/Objectives

Back to Instructions

Status

Shape291 Shape292











Key Activities












Comments







Supervised Visitation Program Semi-Annual Progress Report • 23 • Office on Violence Against Women



Shape293 Back to Instructions

OMB Clearance # 1122-0009 Expiration Date: 06/30/2011

OMB Clearance # 1121-0279 Expiration Date: 07/31/2004

Shape294 Shape295 What do you see as the most significant areas of remaining need, with regard to improving services to vic- tims/survivors of sexual assault, domestic violence, dating violence, and stalking, increasing the safety of families and enhancing community response (including offender accountability for both batterers and sex offenders?) - Question #40


































































Supervised Visitation Program Semi-Annual Progress Report 24 Office on Violence Against Women



Shape296 Back to Instructions

OMB Clearance # 1122-0009 Expiration Date: 06/30/2011


OMB Clearance # 1121-0279 Expiration Date: 07/31/2004

Shape297 Shape298 What do you see as the most significant areas of remaining need, with regard to improving services to vic- tims/survivors of sexual assault, domestic violence, dating violence, and stalking, increasing the safety of families and enhancing community response (including offender accountability for both batterers and sex offenders?) - Question #40 (cont.)


































































Supervised Visitation Program Semi-Annual Progress Report 25 Office on Violence Against Women

Shape299 Shape300 Bae to Instructions

Expiration Date: 06/30/2011

Shape301 What has the Supervised Visitation Program funding allowed you to do that you could not do prior to receiv­ ing this funding? - Question #41





































































Supervised Visitation Program Semi-Annual Progress Report 26 Office on Violence Against Women

lcBack to Instructions]

Expiration Date: 06/30/2011

Shape302 What has the Supervised Visitation Program funding allowed you to do that you could not do prior to receiv­ ing this funding? - Question #41 (cont.)





































































Supervised Visitation Program Semi-Annual Progress Report 27 Office on Violence Against Women

L Bacldo Instructions]

Expiration Date: 06/30/2011

Shape304 Provide any additional information that you would like us to know about your Supervised Visitation Program grant and/or the effectiveness of your grant. - Question #42





































































Supervised Visitation Program Semi-Annual Progress Report 28 Office on Violence Against Women

I Bae to Instructions]

Expiration Date: 06/30/2011

Shape306 Provide any additiona l information that you would like us to know about your Supervised Visitation Program grant and/or the effectiveness of your grant. - Question #42 (cont.)





































































Supervised Visitation Program Semi-Annual Progress Report 29 Office on Violence Against Women

Shape307 Bae!< to Instructions]

Expiration Date: 06/30/2011

Shape308 Provide a ny additional information that you would like us to know about the data submitted. - Question #43





































































Supervised Visitation Program Semi-Annua I Progress Report 30 Office on Violence Against Women

lcBack to Instructions]

Provide a ny additional information that you would like us to know about the data submitted.

(cont.)


- Question #43

Shape309



































































Supervised Visitation Program Semi-Annual Progress Report 31 Office on Violence Against Women




Shape310 Validate

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