SOMB Request For Standards Variance

SOMB Request for Standards Variance- Juvenile

When an Approved Provider wishes to provide treatment/evaluation/polygraph services that do not meet the requirements of the Juvenile Standards, they may submit this request to the Sex Offender Management Board (SOMB). Please refer to the SOMB Standards Variance Process Policy Statement for further information related to completing this Request for Standards Variance Form. All Requests for Standards Variance shall be submitted to the SOMB/ARC prior to providing treatment that does not meet the requirements of the Juvenile Standards. Standards variances will only be granted in extraordinary circumstances.
Provider Name*

First NameLast Name
Juvenile Provider Approved Statuses (Select All That Apply)*

Full Operating Treatment ProviderAssociate Treatment ProviderFull Operating EvaluatorAssociate EvaluatorClinical SupervisorAssociate Polygraph ExaminerFull Operating Polygraph ExaminerDD/IDOther
1. Please input Client's Index Offense and Date of Adjudication.*
2. Please input Client's current length of time in treatment*
3. Why are you requesting this Standards variance? Please identify specific barriers to compliance with the Juvenile Standards.*
4. List the Standard and Standard number for which you are requesting a variance.*
5. Describe the proposed variance from the Standard listed above.*
6. Describe how the proposed variance addresses victim safety.*
7. Describe how the proposed variance addresses community safety.*
8. Describe how the proposed variance complies with the Guiding Principles.*
9. Describe how supervision will be maintained.*
10. Describe the time frame for the use of the proposed variance.*
Providers must collaborate with all members of the MDT. Letters of support or concern are required to be submitted with the variance from each of the following. (See numbers 11 through 15).

*Note: If a provider is unable or unwilling to provide a letter regarding this request, please attach documentation of the attempt to gather the information or how any known information was incorporated into the variance request.
11. Written verification that MDT consensus has been obtained for this proposal (Victim Representative - may include a letter from the victim)*

Cancelof
12. Written verification that MDT consensus has been obtained for this proposal (Defense Counsel) *

Cancelof
13. Written verification that MDT consensus has been obtained for this proposal (Prosecuting Attorney)*

Cancelof
14. Written verification that MDT consensus has been obtained for this proposal (Probation Officer)*

Cancelof
15. Written verification that MDT consensus has been obtained for this proposal (Juvenile/Parent/Caregiver)

Cancelof
SOMB Staff will perform an initial review of the request. If the request is not acceptable, the Staff will work with the Provider to modify and address any questions or concerns. The ARC will then review the Standards Variance Request. If the request is acceptable and does not pose a safety risk, the ARC may authorize preliminary approval of the Variance Request. A review of the approved Variance Request will be scheduled and presented at the SOMB. Variances that are not granted preliminary approval by the ARC will be scheduled for formal review by the Board at the next meeting. If approved, the ARC will ratify the Standards Variance Request and create a plan for conducting periodic reviews and any necessary documentation required for those reviews. The Provider will be notified in writing of the decision to approve or deny the variance.

The SOMB has the authority to set forth specific program conditions during the time frame of the proposed variation. This may include requiring the provider to submit to periodic documentation to the SOMB regarding how the Standard variation is working, identifying any benefits and/or challenges. Variances are intended to be temporary and shall not exceed a period of two years.
Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty:

SOMB Request for Standards Variance- Juvenile