SUPERVISED VISITATION

OBSERVATION SUMMARY

CASE NAME: / CASE ID#:
DATE OF VISIT: / TIME OF VISIT: / LOCATION:
PARTICIPANTS: / VISIT SUPERVISOR:

Next Scheduled Visit:

OBSERVATIONS / MOTHER (P1) / FATHER (P2) / NOTES
Yes
(+1) / No
(-1) / N/A / Yes
(+1) / No
(-1) / N/A
PARENT’S STATUS AT VISIT
Appearance includes appropriate dress, hygiene, etc.
Sober demeanor
Appears stable and oriented to time and place
Arrives on time
Remains for entire visit
COMMUNICATION SKILLS
Uses child friendly language
Is attentive to child’s statements without ignoring or changing what the child says
Demonstrates sensitivity to the child’s feelings
Provides emotional, verbal and non-verbal support without hostility or distraction and responds to child’s cues
Engages child in appropriate discussions (does not seek reassurances or “quiz” child about his/her feelings or the situation)
PHYSICAL SPACE & INTIMACY NEEDS
Respects child’s physical space (appropriate displays of affection; does not force contact, hugs, kisses, etc.)
Maintains safe and comfortable interaction with child overall (no threatening, intimidating, intrusive behavior)
Understands need to join with child’s play or let child initiate play (neither over nor under-involved)
OBSERVATIONS / MOTHER (P1) / FATHER (P2) / NOTES
YES
(+1) / NO
(-1) / N/A / YES
(+1) / NO
(-1) / N/A
CONFLICT MANAGEMENT
Sets age appropriate behavior limits
Uses positive reinforcement and tries to educate child through non-punitive discipline (vs. use of negative terms, cursing, criticizing, etc.)
Handles child’s anger and frustrations and seeks to calm the child rather than escalate conflict
Has the goal of mutual enjoyment of the interaction
Provides appropriate modeling and is not argumentative or manipulative
UNDERSTANDING OF CHILD’S DEVELOPMENTAL STAGE
Has reasonable expectations of child’s abilities provides care appropriate for developmental stage (diaper changes, appropriate snacks, assists with dressing, etc)
Greets and separates from child appropriately
Provides age appropriate activities, comforts, reassures, nurtures and encourages the child
Understands impact of adult behavior on child (makes no promises that can’t be kept, is mindful of safety, etc.)
INTERACTION SCORE (Y- N = score)
Subtract total N from total Y to calculate score / Total Y / Total N / score / Total Y / Total N / score
CHECK (X) ifNeed for intervention orSAFETY CONCERNS AROSE DURING VISIT (Explain what happened, how staff handled it & how participants reacted)
Overall impression of the visit (Include indicators of the child’s comfort level and demeanor)

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DCF 2013