screening tools

These screening tools are intended for professional assessments. If you have specific questions about these tools or would like additional information, please contact us (336) 722-8173.

Screening Tools for Domestic Violence

The Partner Violence Screen:
	Have you been hit, slapped, kicked, punched or otherwise physically hurt by someone within the past year?
	Are you in a relationship with a person who threatens or physically hurts you?
	Is there a partner from a previous relationship who is making you feel unsafe now?

Adapted from Feldhaus KM, Koziol-McLain J, Amsbury HL, Norton IM, Lowenstein SR, Abbott JT.Department of Emergency Medicine, Denver Health Medical Center, CO 80204, USA. JAMA. 1997 May 7;277(17):1400-1.

The SAFE Model

Stress and Safety
	Do you feel safe in your relationship?
	What happens when you and your partner disagree?

Afraid or Abused
	Have you or your children ever been physically threatened or abused?
	Have you ever been forced to have sexual intercourse?

Friend or Family Awareness
	Are your friends or family aware of what is happening?
	Would they support and help you?

Emergency Escape Plan
	Are you in danger now? Would you like to go to a shelter or talk with someone?
	Do you have a place where you and your children could go in an emergency?

JAMA. 1993 May 12;269(18):2367. Asking about domestic violence: SAFE questions. Ashur ML.

Validated Abuse Assessment Tools

Excerpted from National Consensus Guidelines on Identifying and Responding to Domestic Violence Victimization in Health Care Settings, produced by the Family Violence Prevention Fund

Downloadable Validated Abuse Assessment Tool