SlideShare a Scribd company logo
1 of 1
Download to read offline
Abuse Assessment Screen
This tool may be used to quickly screen for domestic violence. Prior to use the
agency should have record-keeping and confidentiality standards that ensure
against disclosure of participant information and maximize participant safety.
Instructions: Circle Yes or No for each question.
1.    Have you ever been emotionally or physically abused by your partner or someone
important to you?   YES          NO

2.   Within the last year, have you been hit, slapped, kicked or otherwise physically hurt by
someone?    YES             NO
If YES, by whom? (Circle all that apply)
Husband         Ex-Husband          Boyfriend          Stranger    Other     Multiple
Total no. of times ___________

3.     (If applicable): Since you’ve been pregnant, have you been slapped, kicked or otherwise
physically hurt by someone? YES              NO
If YES, by whom? (Circle all that apply)
Husband         Ex-Husband          Boyfriend          Stranger    Other     Multiple
Total no. of times ___________

4. Within the last year, has anyone forced you to have sexual activities?
If YES, by whom? (Circle all that apply)
Husband         Ex-Husband          Boyfriend          Stranger    Other     Multiple
Total no. of times ___________

5. Are you afraid of your partner or anyone you listed above?
YES            NO             Multiple (please list)

Developer: Judith McFarlane, Barbara Parker, Karen Soeken, and Linda Bulloc
Copyright (c) 1992, American Medical Association. All rights reserved. Journal of the American
Medical Association, 1992, 267, 3176-78.
Administration method: Provide a private and confidential setting. Inform each woman
that all women attending this service are being assessed for abuse. Read the Abuse Assessment
Screen (AAS) questions to the woman.
Scoring procedures: If any questions on the screen are answered affirmatively, the AAS is
considered positive for abuse (Weiss, Ernst, Cham, & Nick, 2003).
Follow-up procedures: At a minimum, all agencies should offer women with positive
screens referral sources and legal options (Soeken et al. 1998).

SHARE Study Handout                                                         January 2012

More Related Content

What's hot

The role of exercise in medicine
The role of exercise in medicineThe role of exercise in medicine
The role of exercise in medicine
Nursing Hi Nursing
 
Overview of Health Promotion
Overview of Health PromotionOverview of Health Promotion
Overview of Health Promotion
JHU Nursing
 
Information education and communication and behavioural changes communication
Information education and communication and behavioural changes communicationInformation education and communication and behavioural changes communication
Information education and communication and behavioural changes communication
AkanshaJohn1
 

What's hot (20)

Evolution of community medicine
Evolution of community medicineEvolution of community medicine
Evolution of community medicine
 
The social context of public health
The social context of public healthThe social context of public health
The social context of public health
 
Introduction to Social and Behaviour Change communication (SBCC)
Introduction to Social and Behaviour Change communication (SBCC)Introduction to Social and Behaviour Change communication (SBCC)
Introduction to Social and Behaviour Change communication (SBCC)
 
Principles of primary health care
Principles of primary health carePrinciples of primary health care
Principles of primary health care
 
Health promotion
Health promotionHealth promotion
Health promotion
 
Delivery System of Family Welfare Program in India
Delivery System of Family Welfare Program in IndiaDelivery System of Family Welfare Program in India
Delivery System of Family Welfare Program in India
 
02 1 principles of history taking and physical examination
02 1 principles  of  history  taking  and  physical  examination02 1 principles  of  history  taking  and  physical  examination
02 1 principles of history taking and physical examination
 
Building Health Equity: The Role of Public Health
Building Health Equity: The Role of Public Health Building Health Equity: The Role of Public Health
Building Health Equity: The Role of Public Health
 
High impact interventions in rmnch+a(mch)part
High impact interventions in rmnch+a(mch)partHigh impact interventions in rmnch+a(mch)part
High impact interventions in rmnch+a(mch)part
 
Communicable & non communicable diseases
Communicable & non communicable diseasesCommunicable & non communicable diseases
Communicable & non communicable diseases
 
The role of exercise in medicine
The role of exercise in medicineThe role of exercise in medicine
The role of exercise in medicine
 
Overview of Health Promotion
Overview of Health PromotionOverview of Health Promotion
Overview of Health Promotion
 
Evolution of concept of health promotion
Evolution of concept of health promotionEvolution of concept of health promotion
Evolution of concept of health promotion
 
Family study
Family studyFamily study
Family study
 
Information education and communication and behavioural changes communication
Information education and communication and behavioural changes communicationInformation education and communication and behavioural changes communication
Information education and communication and behavioural changes communication
 
Chapter four health communication
Chapter four  health communicationChapter four  health communication
Chapter four health communication
 
Population Health
Population HealthPopulation Health
Population Health
 
IDSP- Dr. Dharmendra Gahwai
IDSP- Dr. Dharmendra GahwaiIDSP- Dr. Dharmendra Gahwai
IDSP- Dr. Dharmendra Gahwai
 
HEALTH FOR ALL
HEALTH FOR ALLHEALTH FOR ALL
HEALTH FOR ALL
 
Health promotion
Health promotionHealth promotion
Health promotion
 

Similar to 1.3 Abuse Assessment Screen

2010 april violence_tool_kit
2010 april violence_tool_kit2010 april violence_tool_kit
2010 april violence_tool_kit
guest9f4018
 
Module – 7 CASE STUDYQUESTIONS1. Why are the data tha.docx
Module – 7 CASE STUDYQUESTIONS1. Why are the data tha.docxModule – 7 CASE STUDYQUESTIONS1. Why are the data tha.docx
Module – 7 CASE STUDYQUESTIONS1. Why are the data tha.docx
moirarandell
 
SEXUAL HARASSMENT AT WORKPLACE
SEXUAL HARASSMENT  AT WORKPLACESEXUAL HARASSMENT  AT WORKPLACE
SEXUAL HARASSMENT AT WORKPLACE
OJO SUNDAY
 
Pl 2 ethics_020713_rev
Pl 2 ethics_020713_revPl 2 ethics_020713_rev
Pl 2 ethics_020713_rev
ngiunta
 
APD SUD by Rand L. Kannenberg
APD SUD by Rand L. KannenbergAPD SUD by Rand L. Kannenberg
APD SUD by Rand L. Kannenberg
Rand Kannenberg
 
Presentation 3 mdr ethics wb-2011
Presentation 3 mdr ethics wb-2011Presentation 3 mdr ethics wb-2011
Presentation 3 mdr ethics wb-2011
Prabir Chatterjee
 

Similar to 1.3 Abuse Assessment Screen (20)

Hv medical
Hv medicalHv medical
Hv medical
 
The Brick Wall
The  Brick  WallThe  Brick  Wall
The Brick Wall
 
Harassment2
Harassment2Harassment2
Harassment2
 
Developing, Delivering, & Teaching Evidence-Based Domestic Violence & Sexual ...
Developing, Delivering, & Teaching Evidence-Based Domestic Violence & Sexual ...Developing, Delivering, & Teaching Evidence-Based Domestic Violence & Sexual ...
Developing, Delivering, & Teaching Evidence-Based Domestic Violence & Sexual ...
 
healthy relationships
healthy relationshipshealthy relationships
healthy relationships
 
2010 april violence_tool_kit
2010 april violence_tool_kit2010 april violence_tool_kit
2010 april violence_tool_kit
 
Navigating the Criminal Justice System within a Support Group
Navigating the Criminal Justice System within a Support GroupNavigating the Criminal Justice System within a Support Group
Navigating the Criminal Justice System within a Support Group
 
Applied dev. powerpoint
Applied dev. powerpointApplied dev. powerpoint
Applied dev. powerpoint
 
Group_Proposal_2016
Group_Proposal_2016Group_Proposal_2016
Group_Proposal_2016
 
Chapter 4 – Steps in Ethical Decision Making.pptx
Chapter 4 – Steps in Ethical Decision Making.pptxChapter 4 – Steps in Ethical Decision Making.pptx
Chapter 4 – Steps in Ethical Decision Making.pptx
 
Module – 7 CASE STUDYQUESTIONS1. Why are the data tha.docx
Module – 7 CASE STUDYQUESTIONS1. Why are the data tha.docxModule – 7 CASE STUDYQUESTIONS1. Why are the data tha.docx
Module – 7 CASE STUDYQUESTIONS1. Why are the data tha.docx
 
2015 Employee presentation
2015 Employee presentation2015 Employee presentation
2015 Employee presentation
 
SEXUAL HARASSMENT AT WORKPLACE
SEXUAL HARASSMENT  AT WORKPLACESEXUAL HARASSMENT  AT WORKPLACE
SEXUAL HARASSMENT AT WORKPLACE
 
Pl 2 ethics_020713_rev
Pl 2 ethics_020713_revPl 2 ethics_020713_rev
Pl 2 ethics_020713_rev
 
APD SUD by Rand L. Kannenberg
APD SUD by Rand L. KannenbergAPD SUD by Rand L. Kannenberg
APD SUD by Rand L. Kannenberg
 
Risk assessment safety plans 101
Risk assessment safety plans 101Risk assessment safety plans 101
Risk assessment safety plans 101
 
Evaluating Social Marketing Campaigns
Evaluating Social Marketing CampaignsEvaluating Social Marketing Campaigns
Evaluating Social Marketing Campaigns
 
Evaluating Social Marketing Campaigns
Evaluating Social Marketing CampaignsEvaluating Social Marketing Campaigns
Evaluating Social Marketing Campaigns
 
Recovery Coaching for Sex Addicts
Recovery Coaching for Sex AddictsRecovery Coaching for Sex Addicts
Recovery Coaching for Sex Addicts
 
Presentation 3 mdr ethics wb-2011
Presentation 3 mdr ethics wb-2011Presentation 3 mdr ethics wb-2011
Presentation 3 mdr ethics wb-2011
 

More from National Alliance to End Homelessness

Retooling Transitional Housing: Steps for Implementing Changes to Your Program
Retooling Transitional Housing: Steps for Implementing Changes to Your ProgramRetooling Transitional Housing: Steps for Implementing Changes to Your Program
Retooling Transitional Housing: Steps for Implementing Changes to Your Program
National Alliance to End Homelessness
 
2.13 Matters of State: Advancing Policy Priorities in State Capitals
2.13 Matters of State:  Advancing Policy  Priorities in State Capitals2.13 Matters of State:  Advancing Policy  Priorities in State Capitals
2.13 Matters of State: Advancing Policy Priorities in State Capitals
National Alliance to End Homelessness
 

More from National Alliance to End Homelessness (20)

Jacksonville, Florida by Carl Falconer
Jacksonville, Florida by Carl FalconerJacksonville, Florida by Carl Falconer
Jacksonville, Florida by Carl Falconer
 
Ending Veteran Homelessness - Cynthia Nagendra
Ending Veteran Homelessness - Cynthia NagendraEnding Veteran Homelessness - Cynthia Nagendra
Ending Veteran Homelessness - Cynthia Nagendra
 
Housing First and Youth
Housing First  and YouthHousing First  and Youth
Housing First and Youth
 
6.2 Successful Strategies for Implementing Rapid Re-Housing for Youth
6.2 Successful Strategies for Implementing Rapid Re-Housing for Youth6.2 Successful Strategies for Implementing Rapid Re-Housing for Youth
6.2 Successful Strategies for Implementing Rapid Re-Housing for Youth
 
Frontline Practice within Housing First Programs
Frontline Practice within Housing First ProgramsFrontline Practice within Housing First Programs
Frontline Practice within Housing First Programs
 
Rapid Re-Housing with DV Survivors: Approaches that Work
Rapid Re-Housing with DV Survivors: Approaches that WorkRapid Re-Housing with DV Survivors: Approaches that Work
Rapid Re-Housing with DV Survivors: Approaches that Work
 
Non-chronic Adult Homelessness: Background and Opportunities
Non-chronic Adult Homelessness: Background and OpportunitiesNon-chronic Adult Homelessness: Background and Opportunities
Non-chronic Adult Homelessness: Background and Opportunities
 
California’s Approach for Implementing the Federal Fostering Connections to...
California’s Approach for  Implementing the Federal Fostering  Connections to...California’s Approach for  Implementing the Federal Fostering  Connections to...
California’s Approach for Implementing the Federal Fostering Connections to...
 
Health Care Reform: What’s in it for Homeless Families and Youth?
Health Care Reform: What’s in it for Homeless Families and Youth?Health Care Reform: What’s in it for Homeless Families and Youth?
Health Care Reform: What’s in it for Homeless Families and Youth?
 
Retooling Transitional Housing: Steps for Implementing Changes to Your Program
Retooling Transitional Housing: Steps for Implementing Changes to Your ProgramRetooling Transitional Housing: Steps for Implementing Changes to Your Program
Retooling Transitional Housing: Steps for Implementing Changes to Your Program
 
The Fusion Project
The Fusion ProjectThe Fusion Project
The Fusion Project
 
Building Education and Employment Supports for Homeless LGBTQ Youth
Building Education and Employment Supports for Homeless LGBTQ YouthBuilding Education and Employment Supports for Homeless LGBTQ Youth
Building Education and Employment Supports for Homeless LGBTQ Youth
 
Housing Choice Vouchers: Funding Outlook and Impact on Ending Homelessness
Housing Choice Vouchers: Funding Outlook and Impact on Ending HomelessnessHousing Choice Vouchers: Funding Outlook and Impact on Ending Homelessness
Housing Choice Vouchers: Funding Outlook and Impact on Ending Homelessness
 
Family Reunification Pilot, Alameda County, CA
Family Reunification Pilot, Alameda County, CAFamily Reunification Pilot, Alameda County, CA
Family Reunification Pilot, Alameda County, CA
 
Avenues for Homeless Youth
Avenues for Homeless YouthAvenues for Homeless Youth
Avenues for Homeless Youth
 
Retooling Transitional Housing: Moving to New Models
Retooling Transitional Housing: Moving to New ModelsRetooling Transitional Housing: Moving to New Models
Retooling Transitional Housing: Moving to New Models
 
Improving Homeless Assistance Through Learning Collaboratives
Improving Homeless Assistance Through Learning CollaborativesImproving Homeless Assistance Through Learning Collaboratives
Improving Homeless Assistance Through Learning Collaboratives
 
2.13 Matters of State: Advancing Policy Priorities in State Capitals
2.13 Matters of State:  Advancing Policy  Priorities in State Capitals2.13 Matters of State:  Advancing Policy  Priorities in State Capitals
2.13 Matters of State: Advancing Policy Priorities in State Capitals
 
Shelter diversion
Shelter diversionShelter diversion
Shelter diversion
 
Evaluating Philadelphia’s Rapid Re-Housing Impacts on Housing Stability and I...
Evaluating Philadelphia’s Rapid Re-Housing Impacts on Housing Stability and I...Evaluating Philadelphia’s Rapid Re-Housing Impacts on Housing Stability and I...
Evaluating Philadelphia’s Rapid Re-Housing Impacts on Housing Stability and I...
 

1.3 Abuse Assessment Screen

  • 1. Abuse Assessment Screen This tool may be used to quickly screen for domestic violence. Prior to use the agency should have record-keeping and confidentiality standards that ensure against disclosure of participant information and maximize participant safety. Instructions: Circle Yes or No for each question. 1. Have you ever been emotionally or physically abused by your partner or someone important to you? YES NO 2. Within the last year, have you been hit, slapped, kicked or otherwise physically hurt by someone? YES NO If YES, by whom? (Circle all that apply) Husband Ex-Husband Boyfriend Stranger Other Multiple Total no. of times ___________ 3. (If applicable): Since you’ve been pregnant, have you been slapped, kicked or otherwise physically hurt by someone? YES NO If YES, by whom? (Circle all that apply) Husband Ex-Husband Boyfriend Stranger Other Multiple Total no. of times ___________ 4. Within the last year, has anyone forced you to have sexual activities? If YES, by whom? (Circle all that apply) Husband Ex-Husband Boyfriend Stranger Other Multiple Total no. of times ___________ 5. Are you afraid of your partner or anyone you listed above? YES NO Multiple (please list) Developer: Judith McFarlane, Barbara Parker, Karen Soeken, and Linda Bulloc Copyright (c) 1992, American Medical Association. All rights reserved. Journal of the American Medical Association, 1992, 267, 3176-78. Administration method: Provide a private and confidential setting. Inform each woman that all women attending this service are being assessed for abuse. Read the Abuse Assessment Screen (AAS) questions to the woman. Scoring procedures: If any questions on the screen are answered affirmatively, the AAS is considered positive for abuse (Weiss, Ernst, Cham, & Nick, 2003). Follow-up procedures: At a minimum, all agencies should offer women with positive screens referral sources and legal options (Soeken et al. 1998). SHARE Study Handout January 2012