Lisa Gray / Supervised contact form

ABN: 41 680 336 991 Phone: 0416 017 383 Email: hello@lisagray.com.au If there is a question that is 'required' and doesn't apply to you please type 'not applicable' or 'N/A'. If left unanswered the form will not submit.

Personal Information

Email

Legal Representatives Name and Firm

If there is not a legal representative type N/A

Email

Legal Representatives Name and Firm

if there is not a legal representative type N/A

Number Of Children To Be Supervised

Child's Relationship To The Person Being Supervised

How Long Since The Child/ren Have Seen The Supervised Parent:

How Long Since The Child/ren Have Spoken (phone contact) With The Supervised Parent:

Gender

Independent Children’s Legal Representative:

Medical information / Special needs:

Behavioural Notes/concerns:

Gender

Independent Children’s Legal Representative:

Medical information / Special needs:

Behavioural Notes/concerns:

Gender

Independent Children’s Legal Representative:

Medical information / Special needs:

Behavioural Notes/concerns:

Requested Supervised Visitation Details

Family Name

Start Date

List All Dates

Finish Date (Or Ongoing)

Contact Start And Finish Time (excluding transport)

Transport To And From Venue Required? Please Specify Child Seat Required?

Contact Venue/s

List Attendees

Outline The Reason You Require A Service

(eg difficulties with current arrangements, family violence, child safety)

Are there any past/current sexual abuse allegations

Additional Information For Adult Requiring Supervison

Are You Required To Complete Any Of The Following

Other

Intake And Service Agreement

COASTAL CHILDREN’S CONTACT SERVICE is designed to provide a safe, supervised environment for children to spend time with the parent they do not live with or to facilitate the transfer of children from one parent to another, in circumstances where parents are not able to manage their own parenting time arrangements. We provide an outreach service where supervised contact or interactive supervised contact arrangements between parents and children occur in the community or in the home. We are here to support you and your children through this time of transition with a priority on the children’s experience. We require both parents/carers to enter into this agreement with Coastal Children’s Contact Service and complete and sign the Application Form. This client agreement will inform you about using this service. Supervisors are highly qualified and skilled professionals with expertise in supervised contact and who have undergone specific training. Professions they come from are counselling, early childhood education and community welfare. Supervisors will monitor conversations and observe all interactions between the children, parents and others. Supervisors will accompany children everywhere including bathrooms. The child must always be in sight and within hearing of the supervisor. The supervisors are highly competent in managing any challenging, volatile or emergency situations. A comprehensive report of the visit will be documented and securely stored and may be provided under subpoena to the Family Court or other agencies in specific circumstances. Home visit risk assessments will be undertaken prior to intake and/or supervised contact/handover. Parents/carers or additional visitors agree not to come to the contact visit, handover or communicate with supervisors under the influence of drugs or alcohol. Visits may be cancelled if this agreement is compromised or if a parent/carer or visitor behaves in a manner which is highly emotional or aggressive. Copies of new orders/agreements/variations of orders/apprehended violence orders are required with application form. Court matters are not permitted to be discussed with children or supervisors. It is important parents/carers or visitors do not disparage the other parent or family members in front of child/ren. Photographic cameras may be used for personal keepsakes during a supervised visit (with consent). The entire visit should not be recorded and may result in a termination of service. Parents/carers are required to notify Coastal Children’s Contact Service at least 48 hours prior to a booked service. Failure to provide notice will result in full payment of the booked service. Families can be excluded from service when it is assessed that providing service would pose a risk to the children, parents, significant others or supervisors. The intake assessment process provides a means to determine the appropriateness of the service for the family and the level of safety risk associated with providing the service. Supervisors cannot legally physically restrain a visiting parent from removing a child/ren from a contact visit even if this is against the party’s agreement or an order of a court. In the event a child/ren is removed a supervisor will contact the police. Unless a criminal offence has been committed police may not have the legal authority to stop a visiting parent from absconding with the child/ren.

Information

The following information on roles and responsibilities is intended to provide information and roles for the parties. In providing this information, Coastal Children’s Contact Services seeks that the parties agree upon all agreements associated with the contact visits.

The Role Of The Contact Supervisor

• Stay Neutral and Impartial at all times • Monitoring conversations between the children, parent and others by always been in the close proximity to the child/ren and parent and making notes • Accompanying parents and children everywhere, including bathrooms • Supervised transport is available upon request. Supervisor’s and child/ren being supervised at the contact visit, are not permitted to travel in the vehicle of the person/s being supervised. • Ensuring Safety, Wellbeing and welfare of the child/ren at all times. However, there is an expectation that the parent having contact with the child/ren takes responsibility for managing the child/ren’s behaviour during the visit. • Guiding & Assisting parents with the care of children when they are not responding to the child/ren’s needs/safety. • Providing Feedback and maintaining confidentiality to the primary carer that is appropriate and relevant to the child/ren’s care • Directing primary carer and parent questions/requests to the relevant person/legal representative • Support parents and children to facilitate a positive and safe interaction • Preparing and Reporting about the supervised visit including date, time, attendees, conversations, interactions and behaviours displayed by the children and discipline techniques implemented. Such reports can be used in court. We will intervene immediately in the event of inappropriate/unsafe conduct and terminate the contact visit and return the child/ren to their parent/carer if necessary.

Supervised Parent

• Plan and be on time for the visit, notify any changes 48 hours prior to contact • Be calm and positive during the visit. • Do not discuss court matters with supervisors, child/ren or others. • Do not engage the supervisor or your child/ren in negative discussions about other persons. • Manage your child/ren’s behaviours in a positive manner during the contact visit. • Supervision is provided to the person names in the court orders or others named on the intake form. • Will pay for all entry fees and any other related costs for the contact supervisor. • Provide child/ren with lunch/food/snacks and drinks that are healthy. No lollies or chocolate permitted in the contact visits.

Contact Visit Guidelines

Contact visits may not proceed or be terminated in the following circumstances: • Any agreed persons are under the influence of drugs or alcohol • The agreed arrangements and not complied • Any person’s behaviour inappropriately emotional state, such as highly agitated, aggressive or abusive. • Child/ren are inappropriately disciplined, threatened or abusive. • Any negative discussion regarding the other parent, extended family or the court. • Any aggressive or abusive behaviours towards the supervisor.

Proceeding With Application

• Both parties are made aware of your intention/application to use Coastal Children’s Contact Services and are provided with relevant documentation. All parties will be required to complete and sign the Service Agreement and Referral Form. Once the signed documentation is received from both parties/parents and referral can progress to an intake assessment interview. Intake Assessment Interviews are compulsory and will be conducted with both parents prior to commencing any of our services. The aim of the interview is to: • To identify supervision needs. • To exchange important information between the parties and this service so that each can make an informed decision. This includes details of the purpose, duration, any limitations of the visits, as well as the costs of the service. • To understand the nature and extent of any risk. • To assess whether the proposed arrangement are in the best interest of the child/ren. • To evaluate whether the service has the capacity and resources to provide the type of supervision required.

Suspending Or Ceasing Service

Supervisors may decide to suspend or cease providing service in circumstances where: • In the view of the supervisor the visit is too stressful or traumatic or the child/ren. • In the view of the supervisor cannot effectively address the safety requirements or other issues involved. • There is undue demand on Coastal Children’s Contact Services resources. • One or both parties have failed to comply with the terms and conditions of the service.

Confidentiality And Privacy

• All client files are confidential and kept in a locked facility. All files are kept for 7 years according to DHS policies and are then destroyed. Supervisors are Mandatory reporters of child abuse which binds supervisors to report the matter to the Department of Human Services under the Child, Youth and Family Act 2005 section 162, Mandatory Reporting is confidential between Coastal Children’s Contact Service and the Department of Human Services.

Invoicing

All tax invoices may include the following details: • Date, day & time • Name of the supervised parent • Invoices are charged to the person nominated on the court order or parenting agreement. • Family Orientation & Intake Assessment • 15 min either side of contact or handover • The fee for service • Travel & kilometre charges for transportation • Court preparation & attendance fees • Compilation fees of final report for family court / lawyers / parents • The amount owing

Agreement To Be Signed

• I agree that all information provided in this form is correct and any changes will need to be approved by both parties in writing to Coastal Children’s Contact Services. • I agree to be appropriate in my conduct and communication with supervisors at all times and agree to follow any directions from staff. • I will not attend contact visits, handover or communicate with supervisors under the influence of drugs or alcohol. • I agree that breaching this agreement can result in the termination of my family’s use of this service and recorded in a report. • I will finalise my payment responsibility for the visit at least 72 hours prior to contact and provide a receipt payment by email to hello@lisagray.com.au. When the service arrangement has been finalised, the accounts department will issue an invoice to you. Payment is accepted by bank deposit or internet transfer. • CCCS require internet transfers to be in advance of the scheduled service to allow for the funds to arrive in the account. For visits scheduled on a Saturday or Sunday, payment is required no later than the Thursday prior; by 5pm. Payment in advance will ensure the booking is confirmed and ready to proceed. • I understand that charges that occur on the day of the visit may include vehicle mileage, venue entry fees, parking etc. Additional charges may be billed after the contact visit these will be invoiced. When making your payment please reference with either child/family name, invoice number or some other reference number so we can clearly identify your payment and allocate to your account. To the fullest extent permitted by law, the Indemnity covers, but is not limited to, any liability arising out of, or as a direct or indirect consequence of any harm, loss, damage bodily injury or death sustained by myself, my child/ren and any attendee as a result of participation in the activities (including transportation of children/attendees to and from activities), or being present at premises utilised for the purpose of contact supervisory services or handovers.

Client Consent

Authorise the Coastal Children’s Contact Service to obtain/exchange information with internal/external services in order to assist with my application to the service.

Responsibility Agreement

Person(s) responsible for payment of the service:

Percentage (or amount) of responsibility:

All costs are payable prior to scheduled contact or other services.

I (you) are financially responsible for this service, agree to the following: • I agree to pay the costs invoiced to me by Coastal Children’s Contact Services at least 72 hours prior to each contact service. If less than 48 hour’s notice of cancellation or in the event of non-attendance, the contact fees must be paid. • Refunds are not issued if contact time is terminated due to breach of service agreement or if children are non-compliant with attendance after supervisors have taken all practical measure to encourage and support children to participate in a visit. • I agree to notify office personnel by email/phone when payment has been made. Failure to make payment on time may result in a visit been delayed, cancelled or postponed. • I am aware that in the event I fail to pay my account all contact supervision services will cease and legal action will be undertaken.

To get started please fill out the form of the service you need.

Lisa Gray