BIP Monitoring Form

Please complete the following report and submit to ICADV within one week of the review. Once you've submitted the form via this portal, please email Jessica (jmarcum@icadvinc.org) and/or Terri (tnoone@icadvinc.org) to inform them that it has been submitted. Any questions or concerns can be addressed to either Jess or Terri.

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* 1. Please provide the following details.

Name of Program:

Name(s) of Facilitator(s) Monitored:

Monitor's Name:

Monitor's Email:

Monitor's Phone Number:

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* 2. Date of Monitoring Review

Date

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* 3. Please check Yes or No in response to the following questions.
(Some of the questions will require you to obtain information prior to the group meeting or to ask the BIP for supplemental materials)

	Yes	No
The group size was a maximum of 18?	The group size was a maximum of 18? Yes	The group size was a maximum of 18? No
The group was facilitated by at least one ICADV approved provider?	The group was facilitated by at least one ICADV approved provider? Yes	The group was facilitated by at least one ICADV approved provider? No
Did the session last for 90 minutes or longer ?	Did the session last for 90 minutes or longer ? Yes	Did the session last for 90 minutes or longer ? No

If the group size was more than 18, what was the group size?

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* 4. The Provider addressed one or more of the following: (Please check all of the topics listed that apply.)

ICADV approved definition of violence

Dynamics of power and control

Socialization

Gender

Equality

Parenting after violence

Challenging beliefs that support abusive behavior

Relationship of violence to substance use (without implying causation)

Exploring realistic nonviolent alternatives

None of the above were present

Question Title

* 5. Please select the word that most accurately reflects your answer to the question. If the question is not applicable to the session being reviewed, indicate NA

	Always	Frequently	Sometimes	Seldom	Never	Not Applicable
Did the provider lead the group in a way that allowed all voices to be heard?	Did the provider lead the group in a way that allowed all voices to be heard? Always	Did the provider lead the group in a way that allowed all voices to be heard? Frequently	Did the provider lead the group in a way that allowed all voices to be heard? Sometimes	Did the provider lead the group in a way that allowed all voices to be heard? Seldom	Did the provider lead the group in a way that allowed all voices to be heard? Never	Did the provider lead the group in a way that allowed all voices to be heard? Not Applicable
Did the provider confront participant’s statements that minimized, denied, or justified abusive behavior?	Did the provider confront participant’s statements that minimized, denied, or justified abusive behavior? Always	Did the provider confront participant’s statements that minimized, denied, or justified abusive behavior? Frequently	Did the provider confront participant’s statements that minimized, denied, or justified abusive behavior? Sometimes	Did the provider confront participant’s statements that minimized, denied, or justified abusive behavior? Seldom	Did the provider confront participant’s statements that minimized, denied, or justified abusive behavior? Never	Did the provider confront participant’s statements that minimized, denied, or justified abusive behavior? Not Applicable
Did the provider allow substance abuse and/or addictions to be an excuse for abusive behavior?	Did the provider allow substance abuse and/or addictions to be an excuse for abusive behavior? Always	Did the provider allow substance abuse and/or addictions to be an excuse for abusive behavior? Frequently	Did the provider allow substance abuse and/or addictions to be an excuse for abusive behavior? Sometimes	Did the provider allow substance abuse and/or addictions to be an excuse for abusive behavior? Seldom	Did the provider allow substance abuse and/or addictions to be an excuse for abusive behavior? Never	Did the provider allow substance abuse and/or addictions to be an excuse for abusive behavior? Not Applicable
Did the provider address inappropriate laughter and jokes?	Did the provider address inappropriate laughter and jokes? Always	Did the provider address inappropriate laughter and jokes? Frequently	Did the provider address inappropriate laughter and jokes? Sometimes	Did the provider address inappropriate laughter and jokes? Seldom	Did the provider address inappropriate laughter and jokes? Never	Did the provider address inappropriate laughter and jokes? Not Applicable
Did the provider avoid teaching gradual containment and/or de-escalation of violence as appropriate tools for ending abusive behavior?	Did the provider avoid teaching gradual containment and/or de-escalation of violence as appropriate tools for ending abusive behavior? Always	Did the provider avoid teaching gradual containment and/or de-escalation of violence as appropriate tools for ending abusive behavior? Frequently	Did the provider avoid teaching gradual containment and/or de-escalation of violence as appropriate tools for ending abusive behavior? Sometimes	Did the provider avoid teaching gradual containment and/or de-escalation of violence as appropriate tools for ending abusive behavior? Seldom	Did the provider avoid teaching gradual containment and/or de-escalation of violence as appropriate tools for ending abusive behavior? Never	Did the provider avoid teaching gradual containment and/or de-escalation of violence as appropriate tools for ending abusive behavior? Not Applicable
Did the provider make remarks that let participants off the hook?	Did the provider make remarks that let participants off the hook? Always	Did the provider make remarks that let participants off the hook? Frequently	Did the provider make remarks that let participants off the hook? Sometimes	Did the provider make remarks that let participants off the hook? Seldom	Did the provider make remarks that let participants off the hook? Never	Did the provider make remarks that let participants off the hook? Not Applicable
Did the provider refrain from using confidential victim information or information that could increase the victims risk of harm?	Did the provider refrain from using confidential victim information or information that could increase the victims risk of harm? Always	Did the provider refrain from using confidential victim information or information that could increase the victims risk of harm? Frequently	Did the provider refrain from using confidential victim information or information that could increase the victims risk of harm? Sometimes	Did the provider refrain from using confidential victim information or information that could increase the victims risk of harm? Seldom	Did the provider refrain from using confidential victim information or information that could increase the victims risk of harm? Never	Did the provider refrain from using confidential victim information or information that could increase the victims risk of harm? Not Applicable
Did the provider ask participants to use proper names, not slang or other personal references (e.g.” my wife”) when referencing and/or discussing others?	Did the provider ask participants to use proper names, not slang or other personal references (e.g.” my wife”) when referencing and/or discussing others? Always	Did the provider ask participants to use proper names, not slang or other personal references (e.g.” my wife”) when referencing and/or discussing others? Frequently	Did the provider ask participants to use proper names, not slang or other personal references (e.g.” my wife”) when referencing and/or discussing others? Sometimes	Did the provider ask participants to use proper names, not slang or other personal references (e.g.” my wife”) when referencing and/or discussing others? Seldom	Did the provider ask participants to use proper names, not slang or other personal references (e.g.” my wife”) when referencing and/or discussing others? Never	Did the provider ask participants to use proper names, not slang or other personal references (e.g.” my wife”) when referencing and/or discussing others? Not Applicable
Did the provider confront sexist, racist, ageist and homophobic comments?	Did the provider confront sexist, racist, ageist and homophobic comments? Always	Did the provider confront sexist, racist, ageist and homophobic comments? Frequently	Did the provider confront sexist, racist, ageist and homophobic comments? Sometimes	Did the provider confront sexist, racist, ageist and homophobic comments? Seldom	Did the provider confront sexist, racist, ageist and homophobic comments? Never	Did the provider confront sexist, racist, ageist and homophobic comments? Not Applicable
Did the provider successfully avoid teaching anger control and/or impulse control as a way of ending abusive behavior?	Did the provider successfully avoid teaching anger control and/or impulse control as a way of ending abusive behavior? Always	Did the provider successfully avoid teaching anger control and/or impulse control as a way of ending abusive behavior? Frequently	Did the provider successfully avoid teaching anger control and/or impulse control as a way of ending abusive behavior? Sometimes	Did the provider successfully avoid teaching anger control and/or impulse control as a way of ending abusive behavior? Seldom	Did the provider successfully avoid teaching anger control and/or impulse control as a way of ending abusive behavior? Never	Did the provider successfully avoid teaching anger control and/or impulse control as a way of ending abusive behavior? Not Applicable
Did the provider engage participants in dialogue that illustrated the participant’s duty not to victimize others as they were/may have been victimized themselves in the past?	Did the provider engage participants in dialogue that illustrated the participant’s duty not to victimize others as they were/may have been victimized themselves in the past? Always	Did the provider engage participants in dialogue that illustrated the participant’s duty not to victimize others as they were/may have been victimized themselves in the past? Frequently	Did the provider engage participants in dialogue that illustrated the participant’s duty not to victimize others as they were/may have been victimized themselves in the past? Sometimes	Did the provider engage participants in dialogue that illustrated the participant’s duty not to victimize others as they were/may have been victimized themselves in the past? Seldom	Did the provider engage participants in dialogue that illustrated the participant’s duty not to victimize others as they were/may have been victimized themselves in the past? Never	Did the provider engage participants in dialogue that illustrated the participant’s duty not to victimize others as they were/may have been victimized themselves in the past? Not Applicable
Did the provider use dialogue that was considerate of participant’s thoughts and feelings?	Did the provider use dialogue that was considerate of participant’s thoughts and feelings? Always	Did the provider use dialogue that was considerate of participant’s thoughts and feelings? Frequently	Did the provider use dialogue that was considerate of participant’s thoughts and feelings? Sometimes	Did the provider use dialogue that was considerate of participant’s thoughts and feelings? Seldom	Did the provider use dialogue that was considerate of participant’s thoughts and feelings? Never	Did the provider use dialogue that was considerate of participant’s thoughts and feelings? Not Applicable
Did the provider speak in a clear, understandable language?	Did the provider speak in a clear, understandable language? Always	Did the provider speak in a clear, understandable language? Frequently	Did the provider speak in a clear, understandable language? Sometimes	Did the provider speak in a clear, understandable language? Seldom	Did the provider speak in a clear, understandable language? Never	Did the provider speak in a clear, understandable language? Not Applicable
Did the provider confront veiled or direct threats of violence?	Did the provider confront veiled or direct threats of violence? Always	Did the provider confront veiled or direct threats of violence? Frequently	Did the provider confront veiled or direct threats of violence? Sometimes	Did the provider confront veiled or direct threats of violence? Seldom	Did the provider confront veiled or direct threats of violence? Never	Did the provider confront veiled or direct threats of violence? Not Applicable
Did the provider challenge blame shifting?	Did the provider challenge blame shifting? Always	Did the provider challenge blame shifting? Frequently	Did the provider challenge blame shifting? Sometimes	Did the provider challenge blame shifting? Seldom	Did the provider challenge blame shifting? Never	Did the provider challenge blame shifting? Not Applicable
Did the provider address participants justifying or excusing abusive behavior based on what the “victim did”?	Did the provider address participants justifying or excusing abusive behavior based on what the “victim did”? Always	Did the provider address participants justifying or excusing abusive behavior based on what the “victim did”? Frequently	Did the provider address participants justifying or excusing abusive behavior based on what the “victim did”? Sometimes	Did the provider address participants justifying or excusing abusive behavior based on what the “victim did”? Seldom	Did the provider address participants justifying or excusing abusive behavior based on what the “victim did”? Never	Did the provider address participants justifying or excusing abusive behavior based on what the “victim did”? Not Applicable
Did the provider follow the curriculum plan?	Did the provider follow the curriculum plan? Always	Did the provider follow the curriculum plan? Frequently	Did the provider follow the curriculum plan? Sometimes	Did the provider follow the curriculum plan? Seldom	Did the provider follow the curriculum plan? Never	Did the provider follow the curriculum plan? Not Applicable
Did the provider allow, “feeling angry” as an excuse or cause for abusive behavior?	Did the provider allow, “feeling angry” as an excuse or cause for abusive behavior? Always	Did the provider allow, “feeling angry” as an excuse or cause for abusive behavior? Frequently	Did the provider allow, “feeling angry” as an excuse or cause for abusive behavior? Sometimes	Did the provider allow, “feeling angry” as an excuse or cause for abusive behavior? Seldom	Did the provider allow, “feeling angry” as an excuse or cause for abusive behavior? Never	Did the provider allow, “feeling angry” as an excuse or cause for abusive behavior? Not Applicable
Did the provider maintain a respectful atmosphere throughout the group?	Did the provider maintain a respectful atmosphere throughout the group? Always	Did the provider maintain a respectful atmosphere throughout the group? Frequently	Did the provider maintain a respectful atmosphere throughout the group? Sometimes	Did the provider maintain a respectful atmosphere throughout the group? Seldom	Did the provider maintain a respectful atmosphere throughout the group? Never	Did the provider maintain a respectful atmosphere throughout the group? Not Applicable
Did the group rules and process observed in the education groups have victim safety as a priority?	Did the group rules and process observed in the education groups have victim safety as a priority? Always	Did the group rules and process observed in the education groups have victim safety as a priority? Frequently	Did the group rules and process observed in the education groups have victim safety as a priority? Sometimes	Did the group rules and process observed in the education groups have victim safety as a priority? Seldom	Did the group rules and process observed in the education groups have victim safety as a priority? Never	Did the group rules and process observed in the education groups have victim safety as a priority? Not Applicable
Did the provider clearly present abuse as behavior attempting to gain power and control over another person?	Did the provider clearly present abuse as behavior attempting to gain power and control over another person? Always	Did the provider clearly present abuse as behavior attempting to gain power and control over another person? Frequently	Did the provider clearly present abuse as behavior attempting to gain power and control over another person? Sometimes	Did the provider clearly present abuse as behavior attempting to gain power and control over another person? Seldom	Did the provider clearly present abuse as behavior attempting to gain power and control over another person? Never	Did the provider clearly present abuse as behavior attempting to gain power and control over another person? Not Applicable
Did the provider keep responsibility for abusive behavior on participants?	Did the provider keep responsibility for abusive behavior on participants? Always	Did the provider keep responsibility for abusive behavior on participants? Frequently	Did the provider keep responsibility for abusive behavior on participants? Sometimes	Did the provider keep responsibility for abusive behavior on participants? Seldom	Did the provider keep responsibility for abusive behavior on participants? Never	Did the provider keep responsibility for abusive behavior on participants? Not Applicable

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* 6. Please select the word(s) that most closely reflect your reaction to the following statement;
"On behalf of women and children, I left this session's monitoring feeling..."

Safe / Respected

Confused

Concerned

Wanting Corrective Action to Be taken

BIP Monitoring Form

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* 1. Please provide the following details.

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* 2. Date of Monitoring Review

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* 3. Please check Yes or No in response to the following questions.
(Some of the questions will require you to obtain information prior to the group meeting or to ask the BIP for supplemental materials)

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* 4. The Provider addressed one or more of the following: (Please check all of the topics listed that apply.)

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* 5. Please select the word that most accurately reflects your answer to the question. If the question is not applicable to the session being reviewed, indicate NA

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* 6. Please select the word(s) that most closely reflect your reaction to the following statement;
"On behalf of women and children, I left this session's monitoring feeling..."

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* 7. Additional comments regarding the group process following the curriculum:

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* 8. Additional comments regarding the provider's technique:

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* 9. Additional comments regarding the provider's focus of responsibility on participants:

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* 10. Additional comments regarding the provider's awareness of safety issues for partner and family:

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* 11. Additional comments in general:

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* 1. Please provide the following details.

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* 2. Date of Monitoring Review

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* 3. Please check Yes or No in response to the following questions.(Some of the questions will require you to obtain information prior to the group meeting or to ask the BIP for supplemental materials)

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* 4. The Provider addressed one or more of the following: (Please check all of the topics listed that apply.)

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* 5. Please select the word that most accurately reflects your answer to the question. If the question is not applicable to the session being reviewed, indicate NA

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* 6. Please select the word(s) that most closely reflect your reaction to the following statement;"On behalf of women and children, I left this session's monitoring feeling..."

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* 7. Additional comments regarding the group process following the curriculum:

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* 8. Additional comments regarding the provider's technique:

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* 9. Additional comments regarding the provider's focus of responsibility on participants:

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* 10. Additional comments regarding the provider's awareness of safety issues for partner and family:

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* 11. Additional comments in general:

* 3. Please check Yes or No in response to the following questions.
(Some of the questions will require you to obtain information prior to the group meeting or to ask the BIP for supplemental materials)

* 6. Please select the word(s) that most closely reflect your reaction to the following statement;
"On behalf of women and children, I left this session's monitoring feeling..."