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Overview

These sample questions are designed to give you a better idea of the kinds of things to ask your clients about their relationships when screening for domestic violence, sexual assault and stalking. As you open a dialogue with your clients, questions will come up and clarifications will be needed. These questions are not intended to be a script or a screening instrument. The spaces are meant to encourage you to identify and use appropriate language when screening—language that recognizes spouses, partners, boyfriends/girlfriends, personal care attendants and family members as the potential abuser, perpetrator or stalker. In addition, the list is not meant to be comprehensive. Once you have opened up a dialogue with someone you are working with, you can begin to address some of the following questions:

Sample Questions

  • Do you feel that ___________ treats you well? Is there anything that goes on at home that makes you feel afraid or uncomfortable?
  • How does ___________ react to your disability/being Deaf in private?
  • Has ___________ ever hurt or threatened you or your children? Has ___________ ever put his/her hands on you against your will or forced you to do something you did not want to do?
  • Does ___________ ever threaten to take away your children or say you are a bad parent because of your disability?
  • Does ___________ do things that take away your independence?
  • Does ___________ try to control your communication with others or change what you are trying to say?
  • Has ___________ ever taken or broken your cane/ walker/ wheelchair/ respirator/ TTY/ pager/ screen reader/ other adaptive equipment?
  • Has ___________ ever hurt your pets or destroyed your clothing, objects in your home, or something which you especially cared about? Does ___________ throw or break objects in the home during arguments?
  • Does ___________ withhold money from you when you need it?
  • Does ___________ alter your organizational systems for money or paperwork to deliberately confuse you?
  • Does ___________ have legal control over your money or your decisions? What happens if you disagree with him/ her about his/ her decisions?
  • Does ___________ prevent you from using resources and support that you need to be independent? Does _____________ keep you from accessing any services or organizations?
  • Has ___________ refused to give you medication, kept you from taking your medication or given you too much or too little medication?
  • Has ___________ ever forced you to have sex or made you do things during sex that make you feel uncomfortable?
  • Has ___________ ever used or threatened to use a weapon against you?
  • Does ___________ abuse drugs or alcohol? Does ___________ ever demand that you use them?