OMB 0970-0564 [valid through 10/31/2024]
(Revised: 11/24/2021)
Instructions: The interviewer should explain to the minor that the interview is not mandatory and confirm that he/she is voluntarily participating in the interview without their attorney(s) present. The interviewer should also explain to the minor the monitor’s role, the purpose of the interview, and the use/role of an interpreter (if applicable). Explain the purpose of your visit in child friendly terms and answer any questions the UC has about ORR or your visit. Also, reassure minor to not be nervous if he/she is nervous about the interview and help the minor feel comfortable and relaxed. Allow minor to share something about themselves to help. Please see the "Introduction Prompt for UC Questionnaire" for additional guidance.
Questions in bold should be asked during the interview if possible. Other questions are optional prompts to assist the interviewer. These questions are NOT intended to be asked verbatim. Ask questions that help establish rapport. The UC monitor should ask individualized interview questions based upon the UC case file review and the circumstances of the inspection.
Name of witness present confirming minor volunteered to be interviewed without their attorney(s) present:____________________________________________
UC Name: |
A#: |
Date of Admission: |
Gender/Age: |
Date/Time of Interview: |
Country of Origin: |
Name of Evaluator: |
Name of Interpreter: |
Primary Language of UC: |
Language of Interview: |
Appropriately dressed? Yes No |
Appropriately groomed? Yes No |
Remind the minor: “I will be taking notes about what we will talk about today, so that I can remember everything you tell me. Sometimes I might need your help to make sure I get everything right.”
Introduction |
Notes |
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Admission/Orientation |
Notes |
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Education/School |
Notes |
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Medical |
Notes |
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Communication with Family |
Notes |
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Interpretation Services |
Notes |
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Meetings with CM Staff/Reunification |
Notes |
N/A
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Clinical Services |
Notes |
N/A
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Program Rules |
Notes |
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Reporting a Complaint or Abuse |
Notes |
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Safety |
Notes |
If safety of UC is a concern, please ask more questions to the UC. Some examples below may be helpful:
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Food/Snacks |
Notes |
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Recreation/Structured Leisure Activities |
Notes |
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Religious Services |
Notes |
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Conclusion |
Notes |
Re-explain that we will not say ‘who said what’ and will only share summary recommendations with program and ORR, unless there is something serious that needs to be elevated to leadership.
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File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Poole, Laura (ACF) (CTR) |
File Modified | 0000-00-00 |
File Created | 2023-08-18 |