VSL VSL Test Initial Test of the VSL through a Web Browser VSW Name(Required) Case First Name and Last Name(Required) District(Required)District 1 – BiddefordDistrict 1 – SanfordDistrict 2 – PortlandDistrict 2 – BrunswickDistrict 3 – AuburnDistrict 3 – WiltonDistrict 3 – NorwayDistrict 4 – RocklandDistrict 4 – BelfastDistrict 4 – DamariscottaDistrict 5 – AugustaDistrict 5 – SkowheganParticipant Visiting(Required) Credible Number(Required) Date(Required) MM slash DD slash YYYY FVP – Pre-Visit Meeting FVP – Pre-Visit Meeting Duration FVP Post-visit Meeting FVP – Post-visit meeting Duration FVP – Supervised Visit FVP – Supervised Visit Duration FVP – Monitored Visit FVP – Monitored Visit Duration FVP – Transportation to Visits (Child Present) FVP – Transportation to Visits (Child Present) Duration FVP – Transportation from Visits (Child Present) FVP – Transportation from Visits (Child Present) Duration FVP – Collateral Contact FVP – Collateral Contact Duration FVP – DOC (Documentation) specific to Visit FVP – DOC (Documentation) specific to Visit Duration Katahdin Documentation Entry- Duration: 3 minutesFVP – Time WAIT for Scheduled Visits FVP – Time WAIT for Scheduled Visits Duration FVP – FTM (Family Team Meeting) FVP – FTM (Family Team Meeting) Duration FVP – Court FVP – Court Duration FVP – No Show FVP – No Show FVP – No Show 30 Min Sched = 30 Min 1 Hr Sched = 1 Hr 1.5 Hr Sched = 1 Hr 15 Min 2 Hr Sched = 1 Hr 30 Min 3 Hr Sched = 2 Hr 4 Hr Sched = 2 Hr 30 Min Other FVP – Cancelation less than 24 hours FVP – Cancelation less than 24 hours FVP – Cancelation less than 24 Hours 30 Min Sched = 30 Min 1 Hr Sched = 1 Hr 1.5 Hr Sched = 1 Hr 15 Min 2 Hr Sched = 1 Hr 30 Min 3 Hr Sched = 2 Hr 4 Hr Sched = 2 Hr 30 Min Other Transportation Time (Scheduled time with client present) Note: Transportation will be paid as half the time entered aboveFVP – Cancelation more than 24 hours FVP – Cancelation more than 24 hours Duration FVP – Visitation Terminated FVP – Visitation Terminated FVP – Visitation Suspended FVP – Visitation Suspended FVP – Disregarded Referal FVP – Disregarded Referal FVP – Safety Intervention Used FVP – Safety Intervention Used Number of Safety Interventions Used: Collateral Contact Family Visitation ProgramCase Name Contact Date MM slash DD slash YYYY Katahdin Number Duration Narrative Supportive Visitation NarrativeKatahdin Case Number Date of Visitation MM slash DD slash YYYY Agency Case ID Number Full Name (first and last) of All Visit Participants Agency Scheduled Start Time Hours : Minutes AM PM AM/PM Scheduled End Time Hours : Minutes AM PM AM/PM Reason Visitation did not occur: Cannot Locate Illness No Show Scheduling Conflict Transportation Issues Weather Other Actual Start Time Hours : Minutes AM PM AM/PM Actual End Time Hours : Minutes AM PM AM/PM Location Visit Supervisor (VSW) Level of Supervision Supervised Unsupervised Monitored Number of Check-Ins: Describe the interactions between visitors and children (start and end of the visit. Please include name of Adults and Children in attendance):Engagement between visitors and children (throughout the visit):Number of TEACHING PROMPTS: Describe the teaching prompts:Describe the INTERVENTIONS needed:Nurturing Parenting info provided to parent(s):Pre-visit planning discussion:Post Visit Feedback:If the visit was terminated, explain the circumstances resulting in termination:Notes regarding any additional communication with parents outside the actual visit:Future visit recommendations:Describe any unmet needs that should be communicated to DHHSNOTE: This visit occurred in a structured and protected environment and thus should not be used in isolation when assessing the appropriateness of future access of custody arrangements.New information about the parents and/or children that may be helpful for future visits: