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YMCA $:tfn Vrsil Program Eva!u=-tion

Particip31ion in Program is:

Vohmtary __ Recommended __ Court Order -¥- Unknovm_
Age of ChildlChildren
Age 0-2
in
)(
p\Ck",m:
f. N\L\>.
~-~ . l- . , .--
9-11
12-14
Over 14
.;LQ!;)1-- c........~~. -~, .- -.' -.
.

~.>J,,\'\~~ M.,~\t\Q":>t~~'"'""'~ ~'-E'

"~""'\f'~\." r '~ ~'f"\1-M.bG;:n~
length ofr""" ChildlChiId,en in Program:
less than 3 months (
3 to 6 months
6-12 months
Over1Year. == {OVc....'<Z
"

Frequency of ScMces Utilized: -.

0""" a Wee!< -x:.... 't-\\.'" .l,. o'~
More tllen once a Week
Once a Month
Twice a Month

E.,~"'ions Qf Program Site (please theel< all that aooty)

Site p~es a safe ~rMronmcnt Va

Site oilers a variety of "?i"~ies and oppqrtunrties during \ _
vtsItallon ~l:; ~'r~~A-- ~()..~~
q,{5f~n~~.
Srte pro~. es ssee;';rvices with erible hours with day. erenirgs.
andWeef<endtimeframe. . nl'\'1v~.{\.~~O'\o"'4-
Sile offers services ~'IitI1the cosl belr1g1Jased'on amount of
income k::lO. . }-Jo \l~,\
J-..)o~~"
 Expectations of Program Involvement (PleaSe dled< all that apply)
i, I"fl Program invotvement win he!p increase the level of trust between Lnl'.~,
/.v~ PorcnVChild ~ ""'P'-..l-'~\\. <L~~..s.:s."'<:>
;V::0
contacl
Program In~nt
D"
\~ h$.ylOllld;~ency
Q ~~ ~~~"t
fo ParenVCnild
~~t>\.U'"
••

Program in men! win help enhance ParenVChild'relatklnship,

V G-
~
Program involvement will help aDProgram participants ~e - .

~ons of Slaff (pI"""" ched< aDthat apply)

IV ~__ Stall ~.ll help alt Prog",m
)JSL
participant1lto teel safe and comtort~ble
wile utifozmgSupelVised VlSitlMonllored Exchange Services "'€!:I
Stafl will be available to ""pelvise during designated appointment
~t"C..
\.

.J
J 0 ~mes h""~ l!Qo'\~~ltCJ
1[£__ Slaff will make referrals and recommendations for convnunlly
~ ••...
~~~ seMceS or therapeutic Interven1ion"-t(i\~~ ••.••••• I{'-ft~6 ~ !'tI
~ ~~ Staff will observe and record fnferae:tions of 811parties and report to C~
..., 'Q...<>2<:>'<"S the court such documenlation as "'lluested
= ~t<\~ ~ g<>.~~ ~ \i:(~ lr\.c~~
Unmet Expecla~ons of Program or Staff (Please ched< atl that apply)
I had hoped ..... •
_ Program involvement would guarant.ee a change in visitation st~tus•
_ Program invofvement would give affirmationlsupport to ~nf01'OO
opinions previousfy hctd
_ Program involvcment "'O\Ild alleviate (stop) conflict that inlliated
need for services ':'\ ~
_Other~~~
t-->I$<)\'=~ :w~""'v~
~_~\ ~t~'n\-\{t>V/\~
~sn,m~~~.
. 55Yr:= MW }i~~~;\Q/\~5~~*"
.
Overan: .Hm. would you rate your contact with the Safe vlSn Program?

_ tfoghly Satisfied _ Satiofted _ Unsatisfied '$- Highly Unsal"",ed

Overafl: How sare do you feel partie$ are during Supervised VisitslMonitored
Exchanges at lhe Safe Visll Program'

_Very Sale _Safe _Unsafe 'f... Very Unsafe

TharJi: YOU:OI your npu:. Evatuatiorls wm be revfcwed try s..-fc VISit Staff as part of 0lJf ~ffort to
~ rheP:Olj;IBr.l
end~. .

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