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 DurationFVP Post-visit Meeting FVP – Post-visit meeting DurationFVP – Supervised Visit FVP – Supervised Visit DurationFVP – Monitored Visit FVP – Monitored Visit DurationFVP – Transportation to Visits (Child Present) FVP – Transportation to Visits (Child Present) DurationFVP – Transportation from Visits (Child Present) FVP – Transportation from Visits (Child Present) DurationFVP – Collateral Contact FVP – Collateral Contact DurationFVP – DOC (Documentation) specific to Visit FVP – DOC (Documentation) specific to Visit DurationKatahdin Documentation Entry- Duration: 3 minutesFVP – Time WAIT for Scheduled Visits FVP – Time WAIT for Scheduled Visits DurationFVP – FTM (Family Team Meeting) FVP – FTM (Family Team Meeting) DurationFVP – Court FVP – Court DurationFVP – 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 DurationFVP – 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 NameContact Date MM slash DD slash YYYY Katahdin NumberDurationNarrativeSupportive Visitation NarrativeKatahdin Case NumberDate of Visitation MM slash DD slash YYYY Agency Case ID NumberFull Name (first and last) of All Visit ParticipantsAgencyScheduled 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 LocationVisit 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: