DV Alternative Treatment & Containment Plan

Domestic Violence Alternative Treatment & Containment Plan - Variance Request

When an Approved Provider is faced with barriers to implementing the Standards for Treatment with Court Ordered Domestic Violence Offenders,he/she may submit a proposal to the Application Review Committee (ARC).
Provider Name*

First NameLast Name
1. Please provide an overview of the unusual circumstance including why compliance with a specific Standard is not achievable. (Cite the specific standard)*
2. A design for the proposed variation on the Standards. This design shall address the following:
a. Victim safety-*
b. Offender containment-*
c. Offender ongoing assessment, including risk assessment-*
d. Time frame for this variation-*
e. Written verification that MTT consensus has been obtained for this proposal (Treatment Victim Advocate Documentation)*

Cancelof
e. Written verification that MTT consensus has been obtained for this proposal (Supervising Officer Documentation) *

Cancelof
DVOMB Staff and at least one ARC member will perform an initial review of the request. If the request is acceptable, they will authorize temporary/preliminary acceptance of the plan with stipulations that the ARC will conduct the final review. If the request is not acceptable, the ARC member and the Staff will work with the Provider to come up with an acceptable solution OR, if needed, bring the request to the next ARC meeting. The request will then be fully reviewed by the ARC at its next meeting. The ARC will review the Preliminary acceptance and provide any needed stipulations to strengthen the plan. The ARC will create a plan for periodic review of the request. The provider will be notified expediently and in writing.

The Committee has the authority to set forth specific program conditions during the time frame of the Alternative Treatment and Containment Plan. This may include requiring the provider to submit periodic documentation to the DVOMB regarding how the Alternative Plan is working identifying any benefits and or challenges.
Signature*

Clear
Date*

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Date
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Domestic Violence Alternative Treatment & Containment Plan - Variance Request