VICTIMS SERVICES QUARTERLY REPORT FORM COMMUNITY BASED PROGRAMS. Table 1 - New Cases Referred to VSU and New Persons Assisted

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1 VICTIMS SERVICES QUARTERLY REPORT FORM COMMUNITY BASED PROGRAMS Year: indicate the four digits of the year. Instructions for Completion April 1, 2010 Quarter: victim services information is collected on a quarterly rather than monthly basis. Circle the appropriate quarter being completed. (e.g., January, February, March is indicated as J-F-M) Organization Name: the name of the organization Program Name: name of the program funded through Victims of Crime Fund and being reported on through this form Agency Code: Victims Services will assign and provide your program with an agency code. Table 1 - New Cases Referred to VSU and New Persons Assisted 1. Under New Cases, record ONLY the number of new cases referred to your program during this quarter. Each case is considered one incident, even though it may involve several offences. In these situations, record the most serious offence (e.g., a violent criminal code offence is the most serious). 2. Under Referral Source, indicate whether the victim was referred to the program by police; non-police or self. Note: only one referral source can be selected per case. The total number of police referrals added to non-police or self referral total must equal the total number of new cases. Explanation of Referral Source : Police Referral - from police members, police services or; police-based victim service units. Non-Police or Self Referral - from a victim, Crown Prosecutor, Alberta Child and Youth Services, community agency; hospital; medical employee; counselor; social worker; friend; family; neighbour; co-worker or other. 3. Under New Persons Assisted, record the number of people assisted (adults/children [under 18]) as a result of New Cases. Do not record persons assisted that were also assisted during previous quarters unless it is regarding a different new case.

2 Explanation of Type of Incident (Table I): A - Criminal Code - Violent: is a crime against a person, and includes incidents listed in the schedule below. B - Criminal Code - Non-violent: is a crime involving property, and includes, but is not limited to: arson, forgery, fraud, theft, public mischief and possession of property obtained by crime. C - Offence - Non-criminal: is an offence that does not fall under the Criminal Code of Canada, such as an offence under the Traffic Safety Act, or another provincial or federal law. D - Assistance Provided Where an Offence Has Not Occurred: involves assisting with missing persons, sudden death, notifying next-of-kin, motor vehicle collisions, fire, suicide, and other tragedies. Please Note: charges to DO NOT have to be laid for the classification of crime types. Classify the victim you are assisting by the crime that was committed against them. For example, all domestic violence files, with or without charges, are to be considered Criminal Code Violent Schedule of Serious and Violent Criminal Code Offences* Serious and violent crimes are crimes against persons that: result in death; cause serious physical or emotional injury; include violence, intimidation or criminal harassment/stalking within a domestic relationship; and/or cause harm to a child or a vulnerable adult. Criminal Code Section Crime 65 taking part in a riot 76 hijacking of aircraft 77 endangering safety of aircraft in flight 78 taking on board a civilian aircraft offensive weapons or explosive substances 80 failure to take reasonable care in respect of explosives where death or bodily harm results 81(1) intentionally causing death or bodily harm by explosive substance 86(2) careless use of firearm 151 sexual interference 152 invitation to sexual touching 153 sexual exploitation 155 incest 160 bestiality 162 voyeurism child pornography 170 parent or guardian procuring sexual activity luring a child 173 indecent acts 212 procuring 215 failure to provide necessities 218 abandoning child

3 220 causing death by criminal negligence 221 causing bodily harm by criminal negligence 235 murder 236 manslaughter 239 attempted murder 244 causing bodily harm with intent 245 administering noxious substance 246 overcoming resistance to commission of offence 247 setting traps likely to cause death or bodily harm 248 interfering with transportation facilities 262 impeding attempt to save life 264 criminal harassment/stalking 267 assault causing bodily harm; assault with a weapon 268 aggravated assault 269 unlawfully causing bodily harm torture 270 assaulting a peace officer 271 sexual assault 272 sexual assault with a weapon, threats to a third party or causing bodily harm 273 aggravated sexual assault removal of child from Canada for sexual purpose 279 kidnapping / illegal confinement trafficking in persons hostage taking 280 abduction of person under abduction of person under robbery 346 extortion 423 intimidation intimidation of justice system participant 430(2) mischief causing actual danger to life 433 arson *Source: Victims of Crime Protocol - Roles and Responsibilities Table 2 Caseload Totals This table provides a method for capturing the caseload your program worked with during the quarter, in addition to the new cases opened and accounted for in table 1. Follow the plus and minus indicators to complete the table. Potential clients are those for whom a file has not been opened but who have been provided information of some kind by your program. These potential clients do not get included in the caseload total number. Table 3 - New and Ongoing Cases: Units of Service Provided Indicate the type of assistance your program provided for all cases (i.e., new cases reported this quarter, ongoing cases reported in previous quarters and other other in this case would be the same as potential clients from previous table or just information calls that were responded to). This is a count of units of service delivery.

4 Example: If in the JFM quarter your program opened a new case file for a victim and attended court 4 times in January, 2 times in February and 1 time in March, record this as 7 units of court accompaniment in the New cases this quarter column. If your program then attended court with the same victim 1 time in April and 1 time in June, indicate this as 2 units of service for court accompaniment on the AMJ quarterly report in the Ongoing cases from previous quarters column. Explanation of Type of Services Provided : Client Contacts actual contacts with victim (not attempted contacts) Collateral contacts on behalf of clients contacts your program makes with other service providers regarding the services and supports to a victim on your caseload Information - providing information about the status of the case and criminal justice proceedings, the criminal justice system in general, and other information and resources that can assist a victim of crime Referral - providing a victim with information about community resources and the name, phone number or address of a community agency or resource that can provide further assistance or support appropriate to the victim s circumstances. Emotional Support - providing practical assistance and emotional support to a victim of crime in person or via the phone (not counseling) Assistance with form completion providing victims with assistance in completing necessary forms or documents related to the justice system process Court Orientation - orientation of a victim to the court process, explaining and assisting the victim to understand the process Court Preparation preparing the victim for court proceedings, may include physical tour of court house/court room, or via video/dvd or online tools Court Accompaniment attending court with the victim as a support and resource person during the victims required attendance at proceedings related to their case Emergency Protection Orders assisting victims to obtain EPO s, completing documents required for EPO s, or assisting with confirmation of EPO s Safety Planning discussing and preparing safety plan tools and resources with victims for their use Risk Assessments discussing or participating in risk assessments with the victim or as part of a risk assessment team Other specify what the other includes, create additional others for each type of service provided not categorized on the list

5 Table 4 New and Ongoing Cases: Type of Activity and Hours Contributed 1. Volunteer Hours: record all volunteer hours contributed by your program volunteers as they relate to the delivery of the service covered by the program being reported on. Board member hours are the inclusive hours of the Board of Directors of your organization even if your program operates in a multiservice organization. Descriptions of types of activities that can and cannot be included is listed below: On-call hours in which services were provided to victims can be included (these hours should be recorded in the Type of Activity row that best reflects the on-call service provided and not under Other ). This DOES NOT include crisis telephone line hours or on call hours where the volunteer was not supporting a victim. Court Room support should include all three court related categories from above as a collective total as well as activities related to EPO s. Community Development/Relationship Building includes the hours program staff or volunteers invest in building community in which to deliver services. Training received by volunteers (e.g. advocate training; in-service; guest speakers). Please note, all training provided by your program to other organizations should be included in Table VI, not here. Meetings attended by Advocates/Board Members and Coordinator (excluding paid staff time). 2. (Optional) Paid Hours: record all paid hours in which the Coordinator and/or support staff (administrative, court-support worker; Aboriginal liaison, etc.) provided services to victims or administered the program. As this is an optional item, the Solicitor General and Ministry of Public Security does not track these hours. Table 5 Volunteer and Staffing Resources Record the number of positions related to the program being reported on, including those that are funded through the Victims of Crime Fund Grant as well as any other sources of funding. DO NOT include all the positions of your organization unless they are directly related to the program being reported on. In number of persons column please include the total number of persons in that capacity (coordinator, staff etc.) related to the program funded by VOCF. In the part time and full time columns, indicate what portion of an Full Time Equivalent each position works. For example: Paid Staff Type of Position Number of Part-time Full-time Persons Coordinator(s) 1 1 Program Staff Administrative Support 2 1 Manager/Supervisory Position(s) 1.2 Other* (please describe) Other* (please describe)

6 Table 6 - Professional Development/Training Taken by Program Staff List all professional development and training taken by the Program Coordinator or other paid staffing positions within the Program during the quarter being reported on. Table 7 - Professional Development/Training Taken by Program Volunteers List all professional development and training taken by the program volunteers associated with the program being reported on for the quarter being reported on. Table 8 Public Education/Awareness or Training Provided by Your Program Identify any public education, awareness or training provided to other organizations, groups or individuals by your program, including training to schools, community agencies, etc for the quarter being reported on. However, training for program volunteers is not included here unless the trainees are volunteers from a different program. Table 9 Victim Information Statistics Request for Restitution: List the total number of Request for Restitution forms provided to victims; completed by an eligible victim and returned to the police service for review; and the number of forms forwarded to the Crown s Office for that quarter. They are to be recorded based on the three crime type categories provided in the table. Note: Programs should establish local procedures with their police service and local VSU to determine the number of Requests for Restitution provided to victims by the VSU or the police service that were returned by the victim to the police and then forwarded to the Crown. Victim Impact Statement: Record the number of Victim Impact Statement (VIS) packages distributed in this quarter to victims and the number of notification forms sent to the Clerk of the Court and the Crown s Office (after a charge has been laid) to indicate the victim s intent to complete a VIS and whether they wish to read it aloud in court. For each VIS package provided, indicate the specific crime for which it was provided (i.e assault, attempted homicide etc. See table of crime types on page 2). Please provide a count of the number of Financial Benefits Applications that were mailed or given in-person to victims in the quarter being reported on. Please provide a count of the number of What victims of crime can expect from the criminal justice system Victims of Crime Protocol books that you provided to victims in the quarter being reported on.

7 Report Submission: The Quarterly Report Form must be signed by the person responsible for the program (supervisor, manager, coordinator etc.) after the report has been reviewed and the information is verified as correct. When submitting the report to Victims Services, please submit one copy, either by mail, fax or (do not submit multiple copies). If the form is submitted by please include in the covering the following attestation: I, (name of the person responsible for signing the report) attest that the information contained in this report for (name of the program being reported on) for the months of (months covered by the reporting period) is accurate to the best of my knowledge. Name of Person responsible for signing the report Position/Job Title Name of Program Contact Number The report is due on the 15 th of the month following the end of the quarter. Please see report form for additional submission information.