Domestic Violence Assessment Questions (Fritsch, rev. 2005) ººººººººººººººººº

Victim ººººººººººººººº

_____ Restricted or isolated from family or friends?

_____ Activities monitored?

_____ Accused of being interested in or with other partners?

_____ Fear for self, children, family, others, animals?

_____ Under stress? How affecting victim’s life?

_____ Injuries or complaints of pain?

_____ Ever thought of harming or killing self?

Demeaning/Abusive Acts ººººººººººººººº

_____ Describe how treated. (i.e., victim, children, others, animals).

_____ How has abusive behavior changed over time?

_____ Describe the most recent incidents of abuse or threats?

_____ Children witness (see, hear) incidents or attempt to intervene?

_____ Children involved in victim’s abuse?

_____ Witnesses to incidents? Other evidence e.g., cards, phone messages left, etc.?

_____ How victim and children stay safe during and after incidents?

_____ Law enforcement called? How often? Actions taken? Court action? Outcomes?

Perpetrator ººººººººººººººº

_____ Use or threats to use firearms or other weapons?

_____ Access to firearms or other weapons?

_____ Obsessive or stalking behavior?

_____ Strangulation behavior?

_____ Sex ‘forced’ or ‘coerced’ or used as ‘apology’ after abusive incident? Pornography?

_____ Ever threatened, scared, or harmed the well-being of children?

_____ Ever threatened to take custody of, hide, abduct or kill the children?

_____ Abused or witnessed abuse of mother as child?

______ Ever harmed or threatened harm to animals?

_____ Uses or abuses alcohol or drugs? (including prescription drugs)

_____ Depressed or suspicious (paranoid) of others?

_____ Ever under care of mental health? Currently?

_____ Assaulted or threatened others?

_____ Experienced significant or recent deaths/other ‘losses’? Personal risk-taking behavior?

_____ History of family suicide or mental health problems? Symbolic days/events?

_____ Threaten to take hostage(s), seriously harm, kill, or commit suicide?

_____ Aware of victim’s disclosure? Of any plans to separate or seek legal intervention?

Victim Safety ººººººººººººººº

_____ Safety plans for self and children, if any? Remind to practice and update regularly!

_____ Advise and refer to local protection/legal agencies? Currently involved?

_____ Need for emergency shelter services?

_____ Advised: purpose of reporting & the voluntary, confidential services of DCBS.

_____ Need for other protection (e.g., change locks, caller ID, cell/analog phone, etc.)?

_____ Given written materials related to domestic violence and safety planning?