Wisconsin Safe Exchange
& Supervised Visitation Guidelines
Referrals & Screening
This guideline presents an overview and suggestions for developing safe exchange and supervised
visitation (SEV) policies and practices pertaining referrals and screening. While each of these topics is
peripheral to the actual safe exchange or supervised visitation, the manner in which these procedures are
conducted can have a significant impact on the short and long-term success of the service(s) provided to
“Referrals” includes requests for individual and family services made by community and
government agencies staff and individuals to an SEV provider (incoming) as well as when SEV staff
recommend individual and family service recipients seek services with other agencies (outgoing).
Referrals can be court-ordered/mandated, “strongly encouraged” or voluntary. Court-ordered referrals
can include verification of participation and, sometimes, some degree of professional evaluation of
The screening process determines the “fit” between the needs of the family members requesting
services (voluntary or court-ordered) and the services available. Screening includes assessing the risk of
SEV services further traumatizing the child or battered/abused parent
This guideline will expand on each of these concepts as they pertain to initiating or enhancing SEV
services. Core concepts covered include:
1. Wisconsin Safe Exchange & Visitation survey results (pp.2-3)
2. Key considerations for SEV services providers: (pp.3-6)
3. Safety and other considerations (pg.6)
4. Wisconsin SEV Consulting Committee recommendations (pg.7)
5. Summary on referrals and screening (pg.8)
6. Resources on referrals and screening (pp.8-9)
In situations where children have been abused or
traumatized by a visiting parent, the SEV provider serves as
the only line of protection for that child.
Children depend upon the “system” to get it right on their
Wisconsin Safe SEV Survey Results for Referrals & Screening
Referral sources contributed significant those agencies providing SEV services is the
information to the overall context of the court order. Concerns for child safety thread
statewide assessment. One hundred twenty-six throughout the many layers of government and
actual/potential referral sources participated. private service providers. However, there
Probation and parole and law enforcement were appear to be very few policies or practices that
particularly interested in accessing SEV services connect the safety of children to: a) the presence
if they existed and wanting of domestic violence in the
Agency (N=127) No. Resp. % Resp. home; b) the impact of a
services established in their
Probation & Parole 53 41.7% battering or sexually abusive
area. Connections between
Law Enforcement 28 22.2% parent on the children or
existing SEV providers,
domestic violence and sexual Social Services 22 17.5% other parent; or c) the ability
abuse service agencies, child DV/SA Services 13 10.3% of the battering/abusive
protective services, family Other 10 7.9% parent to prevent the other
court, criminal court, family Total 126 100.% parent from caring for
mediators, etc. are loose, if children. In summary,
existent at all. Most SEV services lack multi- substantial opportunity exists to build multi-
disciplinary consulting committees (advisory disciplinary, interagency partnerships to address
committees). If SEV services do exist, they are the child exchange and visitation needs of
not typically well known or understood by the families where domestic violence and sexual
other agencies providing services to families abuse exist. The limited interagency
where violence, abuse or neglect are present. communication, awareness and established
policy create significant challenges for referring
Approximately twelve non-social service and screening.
agencies provided safe exchange or structured
supervised visitation services throughout the One referral source wrote the following
state; all appear to have participated in the regarding barriers to SEV collaborations:
assessment survey. Many county social service …just an overall unfamiliarity of the program
agencies subcontract with local individuals to and services offered, coupled with differing views of
provide supervised visitation when needed (five domestic violence and what should be done about
survey respondents). Few agencies exist that certain situations. It is very difficult when two people
have facilities or services designed to address in a professional situation working with an offender
the multiple needs of families in need of SEV or victim are not on the same page as to the goals
services. and objectives that need to be accomplished. Even
more frustrating is when each person is not aware of
Currently, the most common connection the other person’s role in the process.
between agencies referring for SEV services and
Survey information gathered pertaining to referrals focused primarily on the interaction between
referral agencies and SEV providers. SEV received referrals most often from judges (62%) and guardian
ad litem’s (54%). Referrals originated mostly from court involvement (restraining order) and a history of
convictions of domestic violence or parent to child violence. Probation and parole, law enforcement and
social service agencies had the highest survey response rates, yet made the fewest referrals to SEV
providers. Domestic violence and sexual abuse victim services agencies are not significant referral
sources. SEV providers generally do not participate in Coordinated Community Response Teams (DV or
SA) which limits their referral base.
Wisconsin SEV Guidelines Page 2 of 9 Referrals & Screening
Some communities that actually had SEV services reported their services being highly underutilized.
It would be helpful to determine why this is happening—perhaps agency credibility, lack of community
awareness, hours of operation, lack of “system” collaboration, etc. could be hindering referrals.
In general, too few services are available for too limited of hours of operation to meet the need
identified by the referral sources. As a result, courts are relying on family members, law enforcement,
social services agencies, and public sites (fast food restaurants and convenience stores) to provide some
degree of “safety” for most exchanges and supervised visits. This survey did not make specific
connections between referral sources and service providers. However, the following questions arise from
the comments provided by referral sources:
◊ Does the SEV service provider have a community consulting (advisory) committee, including critical referral
sources, to guide and advocate for its services?
◊ Has sufficient communication occurred between the SEV provider and outside agencies to build relationships
and core understanding of services offered?
◊ Does the SEV service do what it says it is doing and do it well (community credibility)?
◊ Have memorandum of understanding been developed between referral sources and SEV provider(s)?
Focus group participants offered suggestions and concerns pertaining to referrals. They expressed
frustration with the limited services available versus the need, and in their lack of inclusion in the referral
process when applicable. They were reluctant to participate because of uncertainty regarding
confidentiality, feeling judged, afraid of losing what little control they had over their family and that
things would get worse with intervention instead of better. Immigrant or undocumented families were
reluctant to follow-through or request services because of language barriers, uncertainties regarding
confidentiality, and concerns over INS reporting and possible deportation. Limited availability of
services often results in escalation of already volatile situations and non-participation.
◊ I stopped using SEV services because there were too many referral sources to contend with.
◊ Limit the written information during referral process.
◊ Include and support family members in accessing referral agencies.
◊ Have trained, neutral bilingual staff available to assist families.
The Wisconsin study did not directly devalued, and often retaliated against when they
address screening families for domestic violence tried to state a case to prevent their child from
or sexual abuse, nor risk. The study did not having visitation or access to the other
review practices for screening referrals to SEV (battering/abusive) parent. Some “victim”
services providers. Essentially SEV agencies parents lost child placement and custody while
indicated they felt obligated to provide services trying to prevent the abusive parent from having
for all referred families. access. Some victims returned to living with the
abuser to prevent the batterer/abuser from
Social service agencies have a set of criteria having 1:1 time with the child (ren).
to follow in assessing risk and safety that is
different from the criteria used by domestic The children’s focus group participants did
violence and sexual abuse advocacy agencies. not wish to have contact with their
Very few communities have come to battering/abusive parents. Their wishes were
philosophical consensus or agreement on best mostly ignored. This was particularly true for
practice regarding screening. Yet, there is the young girls. One parent suggested:
consensus on the need to keep the children safe. …a team should make the decision – social
worker, parent, kids, GAL, etc. They should
Focus group members felt helpless, send their recommendations to the judge.
Wisconsin SEV Guidelines Page 3 of 9 Referrals & Screening
Essentially, SEV services in Wisconsin are have been observed and documented. Very few
so limited that screening is rarely considered. communities in Wisconsin offer the range of
Screening infers layers of services and supports services needed to accommodate meaningful
available to accommodate the varying needs of screening and referral. Very few communities
families referred for services. It also infers that have the interagency relationships or agreements
professionals connected to family court are in place to work with families in meeting their
willing to deny batterers/abusers access to their needs.
children until changes in attitudes and behavior
Key Considerations for SEV Services Providers
Incoming and outgoing referrals are ongoing occurrences within the SEV setting. Both types of
referrals infer strong interagency partnerships, awareness of available services (the parameters for
acceptance into any given program), and family members’ signed releases of information for all involved
agencies. Ideally, family members will have a choice and a voice in determining and accessing services.
Community limitations pertaining to available resources will normally compromise the choice, hopefully,
not the voice.
Begin developing your program’s referral policies and guidelines by reviewing your agency’s
mission, philosophy, target audience and scope of services you wish to provide. Consider the following
1. What does a family need/want from the referral process?
2. What does the SEV provider want from the referral process?
3. What does the referring agency want from the referral process?
4. What expectations and outcomes does the court have in making the referral?
The answers to these questions require conversations with numerous people. Identify families likely
to access SEV services and ask them what information they would need to know to seek out SEV services
(self-refer). Identify local probable referral sources and ask them what information they would need in
order to refer a family for services. Consider developing an interagency memorandum of understanding
(MOU) if one has not already been proposed. Interagency partnerships that support families in ending the
violence in their lives must share a common understanding of domestic violence and sexual abuse and the
impact on family function. This includes a shared understanding of the tactics used by battering/abusive
persons to control other family members and others (including service providers). MOU’s Guidelines for
accepting and making referrals should be included in the MOU. Clarifying referral policies and
guidelines will reduce frustrations and misunderstandings for everyone involved. Include the following
topics in your discussions:
◊ Where will a majority of the referrals come from? Do you have consensus on confidentiality and documentation
◊ What are other potential referral sources?
◊ What are the differences between court –ordered, agency-referred, and self-referred cases?
◊ Be prepared to meet the cultural and language needs of referred families. What interagency partnerships are
◊ Develop an open relationship with the court. Be clear in sharing your agency’s mission, guidelines, restrictions
Wisconsin SEV Guidelines Page 4 of 9 Referrals & Screening
and boundaries. Be open and flexible to addressing concerns that arise without compromising the safety of adult
and child victims.
◊ Work with the court system to establish a positive, supportive presence in the courtroom. Strive to be present for
all order for protection hearings to connect with families. SEV staff can introduce themselves to the petitioners
and respondents, explain the services offered, and make initial appointments with both parties to schedule
◊ Develop relationships with a wide variety of service providers to help family make connections and transitions for
other services. Have a resource area in the visitation room that includes informational brochures, books,
videos, and other resource information.
◊ Encourage other agencies to meet families at the SEV facility when it is in the best interest of family to do so.
Offer space for families to enhance their web of supportive services.
SEV agencies have an opportunity to reduce a family’s isolation, and support the family in meeting
their needs by connecting family members with other service providers and community members. All
outgoing referrals require verbal and written consent of the family member involved. Encourage family
members to “take charge” of their situation by coaching them in making the contact with the referral. If
needed, “bridge” the referral by arranging a face-to-face meeting.
SEV staff should be well aware of the services available in the community, have current information
on accessibility (does this agency have a waiting list?) and have a general idea of how to access the
service. In some instances, SEV providers can create wrap-around services within their agency to
support families as they transition into stability, ultimately reducing their need for services: i.e. mentor
programs, transportation, assist with childcare, household chores, etc.
Post-SEV services follow-up can provide extended support to families and “keep the door open” for
future help, perhaps preventing future abusive situations from occurring. Seek feedback from families on
what SEV services most helped or hindered their family. What changes would they recommend?
Currently, most referrals for SEV services originate through either criminal or family court. These
court-ordered cases bring with them judgments regarding parents’ treatment of their children and each
other. Court-ordered requests for services may be made without knowing the depth of extenuating
circumstances related to that family’s experiences. System players may not be aware of the prevalence of
domestic violence and sexual abuse in divorcing families or in families presenting with child abuse and
neglect. Routine screening for the presence of domestic violence and sexual abuse is seldom done. In
addition, it is often difficult to ascertain the depth of abuse present during court proceedings because
many batterers/abusers present as model citizens outside of their homes. Battered women and children
are often reluctant to disclose abuse in the family court setting, particularly if there has been no DV/SA
intervention. The reluctance to disclose DV/SA is particularly strong where immigration concerns are
part of the family’s story. Traumatized adult victims can present as depressed, irrational, or “unfit”
before a court.
This presents a challenge to the concept of screening in determining if a referral for SEV services is
merited at all. Many court officials have had limited exposure and training on the family dynamics of
domestic violence and sexual abuse and the impact of those dynamics on children. Court system
personnel make referrals for exchange and visitation unaware of the potential for re-victimization of
renewed trauma for the child. Some court officials may not be willing to deny parental access to children.
Parent’s “access” rights often overlook the child’s need for protection and safety.
It is therefore prudent to presume that many of the cases that are referred for SEV services (due to
Wisconsin SEV Guidelines Page 5 of 9 Referrals & Screening
child abuse and neglect or contentious divorces) have not been pre-screened for the presence of domestic
violence or sexual abuse. Even when there are allegations of DV/SA, victims are often not believed or
their concerns are minimized. In some courts, attorneys may introduce Parental Alienation Syndrome as
a component of the family dynamic. This controversial syndrome, developed by Richard Gardner, is
directed primarily against mothers whose children who do not wish to have contact with the father or
father figure in the family. It presumes child allegations of abuse (primarily sexual abuse-incest) have
been “programmed” in the child by the mother as a ploy to deny the father access to the child. This topic
merits further research and familiarity by those providing SEV services, court personnel, and other
referral sources (see resource list, pg.9).
The minimization or lack of disclosure of the extent of abuse present (either physical or sexual) can
result in mandated safe exchange or supervised visitation services that are questionable, at best.
Rhetorically, would the court system ever demand that a rape victim have weekly visits with his/her
rapist? Yet, court systems routinely order children to have visitations with parents or parent figures
(usually fathers or father figures) where allegations of incest have occurred. Children often have not been
asked about their situation, have not disclosed, or have disclosed and recanted, partly because the risk for
rejection or retaliation from parents or other family members is too great and other reasons (McDonald,
1998; Dalton, 1999). Yet, regardless of the degree of abuse children have witnessed or experienced, most
still love and want to have some form of relationship with their parent.
In situations where children who have been abused or traumatized by a parent are referred for
visitation, the SEV provider serves as the only line of protection for that child. The SEV screening
process must provide a means to sort through the various truths and design a plan of action that respects
the court order and does its best to protect the child and victimized parent from further victimization or
trauma. Consider “screening” to be timely at any or all of the following junctures.
Screening prior to referral or denied based on new information received through
the orientation process. Ideally, the SEV provider
Social services, the family court officials, court has attained sufficient credibility and the trust of
mediator, district attorney, probation & parole, etc, other agencies to “screen out” or not accept
have knowledge of family history including domestic referrals. “Child-focused” guidelines will allow SEV
violence or sexual abuse. This information is agencies to block visits where the child refuses to
documented and passed onto the SEV provider. One visit or shows indication of further traumatization
of these sources identifies serious abuse potential and because of the proposed visit.
recommends neither visitation or exchange occurs
Screening at each contact with the
until a court-approved treatment program is
Screening as part of This level of screening monitors follow-through on
intake/orientation policies and guidelines establish for each family as
part of their orientation and family plan. Behaviors
SEV agency intake and orientation interview includes that decrease safety for any participant are
questions on safety and perceived risk to both the confronted. Sometimes visits end early on a given
non-offending parent and child (ren). (See WI SEV day because of endangering behaviors. Family plans
guideline on Intake) SEV services may be modified may need modification.
Safety and Other Considerations
Most families will be court-ordered to use SEV services and may not be happy about it. Understand
the post-separation escalation of violence, manipulation, and the probability of stalking and harassment
and their impact on family members. Keep all SEV staff, law enforcement back-up, and referral sources
alert to high-risk cases. Create strategies for supporting families when extra help is needed, and for
Wisconsin SEV Guidelines Page 6 of 9 Referrals & Screening
intervening if a critical incident should arise.
Many families in need of SEV services also have limited resources. Limited access to transportation,
isolation from friends and family members, limited access to laundry facilities, back rent due, eviction
notices, utility turn-offs, water disconnects, etc. may also be part of the family’s “picture”. It is important
to understand the role these “other” situations play in a parent’s ability to change behaviors, comply with
service expectations, or even be on time. Make referrals to other area agencies that specialize in helping
families address other presenting concerns. Be sensitive to when agency (external) expectations become
overwhelming to a family and are causing trauma. Note that many families will “recover” without
external intervention when the violence or abuse is no longer present. SEV services providers must ask--
What role is our SEV agency playing in ending exposure to the violence or abuse? What role does our
agency play in the family healing process?
WI SEV Consulting Committee Recommendations
The Wisconsin Consulting Committee overwhelming supports a proactive, respectful and strengths-
based approach when creating policies, procedures and practices surrounding the topics of referral and
screening. “Best practice” in Wisconsin, will incorporate these ideals.
In practical terms, implement language changes that reduce the agency to service recipient power
imbalance within the SEV agency and extends the service recipient’s voice to be heard throughout the
system. For example, replace “intake” with “orientation”; “interview” with “information gathering”;
“client information” with “family information”; “client” with “participant”. This change in focus may be
very difficult to implement throughout a system that is based on hierarchal power and control over
people’s lives. It may be difficult to “sell” the strength-based assumption that most parents want to be
good parents, particularly in situations where incest and abuse are present. Balance the strength-based
ideals with a public that expects intervention agencies to protect citizens from harm and hold perpetrators
of crime accountable.
The task is daunting at best. Therefore, it is critical that SEV agencies take a leadership role in
bringing community members together to discuss the foundation of beliefs, practices, and expected
outcomes of SEV efforts, at the beginning of providing services, and as an ongoing practice.
The WI SEV Consulting Committee recommendations for referrals and screening depends on
building and maintaining open communication, trust and professional boundaries between all system
players. It also involves all system players knowing what the options are for families in need of SEV
services, the parameters for utilizing those services and making appropriate referrals. Local consulting
(advisory) committees of SEV programs should think through and develop protocols for the following
◊ Identify the parameters and limitations of services referrals have no court jurisdiction. How effective
available in the community. What other options are signed agreements? What happens when SEV
exist for families not appropriate for SEV referral? participants breech voluntary agreements? (i.e.
child abduction when there are no court orders in
◊ Develop a strategy that authorizes SEV program place)
staff to deny and recommend services.
◊ Develop communication protocols between
◊ Develop, revise and utilize memorandum of referral sources and SEV services providers.
understanding between agencies regarding pre- Clarify what kinds of information will be
screening, referrals, and non-acceptance of exchanged. What releases will be needed from
families into SEV services. family members? What information will letters to
◊ Discuss the difficulties surrounding self-referrals the court system include? Do any agency staff
for safe exchange and supervised visitation. Self- members have “privilege?”
Wisconsin SEV Guidelines Page 7 of 9 Referrals & Screening
◊ Who will determine the length and depth of SEV ◊ Be prepared to address instances of
services provided? SEV services providers should revictimization or questionable ethics or practices
have control over the scheduling of services. Avoid within the local community on behalf of or in
having the court or private attorneys determine partnership with the families accessing services.
SEV services schedules.
Summary on Referrals and Screening
Early in the development of SEV services, establish a consulting (advisory) committee to discuss and
develop consensus on how referrals (incoming and outgoing) and screening will be handled. It is vital for
SEV services providers to bring to the discussion a clear understanding of the impact and prevalence of
domestic violence and sexual abuse in families referred for services. SEV providers must be well
informed on the topics and eager to share this information with other system players. It is also vital to
encourage the other players to bring their concerns and perspectives to the table. Develop clear, open
communications and realistic expectations between SEV service providers, referral agencies, and family
participants. Support these expectations with quality research on best practice.
Children depend upon the “system” to get it right on their behalf.
Resources on SEV Referrals and Screening
ASSESSING RISK FACTORS FOR INTIMATE PARTNER HOMICIDE
Campbell, Jacquelyn C., Daniel Webster, Jane Koziol-McLain, et al, National Institute of Justice
ASSESSING RISK TO CHILDREN FROM BATTERERS
Lundy Bancroft and Jay G. Silverman, MINCAVA Electronic Clearinghouse Document Library
BUILDING BRIDGES BETWEEN DOMESTIC VIOLENCE ORGANIZATIONS AND CHILD PROTECTIVE SERVICES
SPEARS, L.; http://www.vaw.umn.edu/FinalDocuments/dvcps.asp
CHILD PROTECTION IN FAMILIES EXPERIENCING DOMESTIC VIOLENCE: CHILD ABUSE AND NEGLECT USER
H. Lien Bragg, Office on Child Abuse & Neglect, U.S. Department of Health & Family Services , 2003,
CHILDREN OF DOMESTIC VIOLENCE: SPECIAL CHALLENGES IN CUSTODY AND VISITATION DISPUTE
Jaffe, Peter. 1995, In J. Carter, B. Hart, and C. Heisler (Eds.). Domestic Violence and Children: Resolving
Custody and Visitation Disputes. San Francisco, CA: The Family Violence Prevention Fund
COLLABORATING FOR WOMEN & CHILD SAFETY TRAINING CURRICULUM
Minnesota Rural Project for Women and Child Safety, Annelies K. Hagemeister, et al, 2003.
DULUTH FAMILY VISITATION CENTER
Orientation manual and selected forms are available through the Wisconsin SEV Resource Center,
EXPANDING SOLUTIONS FOR DOMESTIC VIOLENCE AND POVERTY: WHAT BATTERED WOMEN WITH ABUSED
CHILDREN NEED FROM THEIR ADVOCATES
Schecter, Susan: http://www.mincava.umn.edu/documents/expandin/expandin.html
ISSUES AND DILEMMAS IN FAMILY VIOLENCE
American Psychological Association Presidential Task Force on Violence and the Family, American
Psychological Association, 1998 http://www.apa.org/pi/pii/issues/homepage.html
THE LEGAL SYSTEM’S RESPONSE TO CHILDREN EXPOSED TO DV
Lemon, Nancy. A description of case law, as well as innovative court and law enforcement programs, that
Wisconsin SEV Guidelines Page 8 of 9 Referrals & Screening
address the effects of domestic violence on children. http://www.futureofchildren.org/usr_doc/vol9no3Art5.pdf
THE MYTH OF EPIDEMIC FALSE ALLEGATION OF SEXUAL ABUSE CASES
Merrilyn McDonald, Court Review, Spring 1998. http://www.omsys.com/mmcd/courtrev.htm#Rcr20236
NAVIGATING CUSTODY & VISITATION IN CASES WITH DOMESTIC VIOLENCE: A JUDGE'S GUIDE
Clare Dalton, LLM, Leslie Drozd, PhD, and Judge Frances Wong, National Council of Juvenile and Family
Court Judges, 2004. http://www.ncjfcj.org/images/stories/dept/fvd/pdf/complete_guide_read-only.pdf
POVERTY, WELFARE AND BATTERED WOMEN: WHAT DOES THE RESEARCH TELL US?
Lyon, E. http://www.mincava.umn.edu/documents/welfare/welfare.pdf
TRAPPED IN POVERTY/TRAPPED BY ABUSE – NEW EVIDENCE DOCUMENTING THE RELATIONSHIP BETWEEN
DOMESTIC VIOLENCE AND WELFARE
Raphael, Jody: http://www.ssw.umich.edu/trapped/pubs_trapped.pdf
Safe Havens: Supervised Visitation and Safe Exchange Grant Programs Technical Assistance Provider.
WHEN PARADIGMS COLLIDE: PROTECTING BATTERED PARENTS AND THEIR CHILDREN IN THE FAMILY COURT
Claire Dalton, 37 Fam. & Conciliation Courts Rev. 273, 1999. http://cyber.law.harvard.edu/vaw00/dalton.html
WISCONSIN SEV RESOURCE CENTER
Hosts examples of forms in use from a variety of agencies through the country. Online and hard copy resource
center administered through the Children’s Trust Fund of Wisconsin. HTTP://WCTF.STATE.WI.US
WISCONSIN COALITION AGAINST SEXUAL ASSAULT
Sexual abuse technical assistance, 600 Williamson St. Ste N-2, Madison WI 53703, www.wcasa.org
WISCONSIN COALITION AGAINST DOMESTIC VIOLENCE
Domestic violence technical assistance, 307 S. Patterson St #1, Madison WI 53703, www.wcadv.org
The Wisconsin Safe Exchange and Supervised Visitation Project was initiated by Wisconsin Office of
Justice Assistance and funded through the Federal Violence Against Women Act Safe Havens initiative.
An interdisciplinary statewide consulting committee has guided the process from its beginning in May
2003. Initial project facilitation and product development was completed by Kieffer Consulting and
Facilitation, LLC., Strum Wisconsin. Additional partners in SEV project development include Wisconsin
Children’s Trust Fund, Wisconsin Coalition Against Domestic Violence, Wisconsin Coalition Against
Sexual Assault, Wisconsin Department of Justice – Office of Crime Victim Services, and Wisconsin
Department of Health and Family Services.
Wisconsin Safe Exchange and Supervised Visitation Project purpose:
• To assess status of SEV services available to families experiencing domestic violence and/or sexual
• To develop guidelines for developing and sustaining new SEV services Statewide.
• To develop a sustainable network that provides technical assistance and support to SEV services
Access SEV information online through HTTP://WCTF.STATE.WI.US
Wisconsin SEV Guidelines Page 9 of 9 Referrals & Screening