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SUPERVISED
VISITATION
PROFESSIONAL PROVIDER
ANNUAL RENEWAL APPLICATION/ELIGIBILITY FO
R
INCLUSION
ON
LIST
h. I am able to speak the language of the minor(s) and parent I am supervising or
will provide a neutral interpreter over 18 years of age who is able to do so.
i. I agree to adhere strictly to and enforce each Court order regarding supervised
visitation.
3. I have met the requirements for 24 hours of training as specified in California Family Code
Section 3200.5 and California Standards of Judicial Administration 5.20.
4. I have completed eight (8) hours of training within the last year in the areas specified
below, with at least two hours dedicated to Issues Relating to Substance Abuse, Child
Abuse, Sexual Abuse & Domestic Violence (item j below). (Provide details in (a) through
(k) below)
a. The Role of a Professional Provider: Hours completed _____
b. Child Abuse Reporting Laws: Hours completed _____
c. Recordkeeping Procedures: Hours completed _____
d. Screening, Monitoring, and Termination of Visitation: Hours completed _____
e. Developmental Needs of Children: Hours completed _____
f. Legal Responsibilities and Obligations of a Provider: Hours completed _____
g. Cultural Sensitivity: Hours completed _____
h. Conflicts of Interest: Hours completed _____
i. Confidentiality: Hours completed _____
j. Issues Relating to Substance Abuse, Child Abuse, Sexual Abuse & Domestic Violence:
Hours completed _____
k. Basic Knowledge of Family & Juvenile Law: Hours completed _____
5. I agree to meet all safety and security procedures, have the ratio of children to provider as
described in the Standards of Judicial Administration 5.20(h) and/or specific Court order,
have no conflict of interest, maintain and disclose records as described in the Standards of
Judicial Administration 5.20(j), abide by confidentiality standards as described in the
Standards of Judicial Administration 5.20(k), and, additionally, meet all the Standards as
set forth in Standards of Judicial Administration 5.20.
6. I agree to have reviewed and comply with the six (6) Guiding Principles of the United States
Department of Justice, Office on Violence Against Women (“OVW”) Safe Havens:
Supervised Visitation and Safe Exchange Grant Program, as listed in detail below:
i. Principle I, Equal Regard for the Safety of Child(ren) and Adult Victims: Visitation
centers should consider as their highest priority the safety of child(ren) and adult
victims and should treat both with equal regard.
ii. Principle II, Valuing Multiculturalism and Diversity: Visitation centers should be
responsive to the background, circumstances, and cultures of their community and
the families they serve.
iii. Principle III, Incorporating an Understanding of Domestic Violence into Center
Services: Visitation centers should demonstrate a comprehensive understanding of
the nature, dynamics, and impact of domestic violence and incorporate that
understanding into their services.
iv. Principle IV, Respectful and Fair Interaction: Visitation centers should treat every
individual using their services with respect and fairness, while taking into account the
abuse that has occurred within the family.
v. Principle V, Community Collaboration: Visitation centers should seek to operate
within a community collaborative which has as its goal to centralize safety of
child(ren) and adult victims and hold batterers accountable. The community
collaborative will strive (1) to ensure a holistic response to each family member’s
