Substance Abuse Treatment
and Domestic Violence
Appendix C -- Instruments
This appendix reproduces the following tools:
- Abuse Assessment Screen (in English and Spanish)
- Danger Assessment
- Psychological Maltreatment of Women Inventory (PMWI)
- Revised Conflict Tactics Scale (CTS2)
Although these instruments have been used extensively in research settings,
they have not been validated as clinical tools; nor do they have instructions
for scoring. The PMWI and the CTS2, in particular, were designed as research
tools, not clinical tools, and do not have cutting scores (the score beyond
which a person has a problem). All the instruments in this appendix can,
however, serve to open dialogue with a client, elicit information, promote
discussion, and help evaluate a program.
Abuse Assessment Screen(English
Version)
| 1. |
WITHIN THE LAST YEAR, have you been hit,
slapped, kicked, or otherwise physically hurt by someone? |
YES |
NO |
|
If YES, by
whom?____________________________________ |
|
|
|
Total number of times
________________________________ |
|
|
| 2. |
SINCE YOU'VE BEEN PREGNANT, have you
been hit, slapped, kicked, or otherwise physically hurt by someone? |
YES |
NO |
|
If YES, by whom?
____________________________________ |
|
|
|
Total number of times
________________________________ |
|
|
|
MARK THE AREA OF INJURY ON THE BODY MAP,
SCORE EACH INCIDENT ACCORDING TO THE FOLLOWING SCALE:
|
|
SCORE |
|
1 = Threats of abuse including use of a weapon
|
|
_______ |
|
2 = Slapping, pushing; no injuries and/or
lasting pain |
|
_______ |
|
3 = Punching, kicking, bruises, cuts and/or
continuing pain |
|
_______ |
|
4 = Beating up, severe contusions, burns,
broken bones |
|
_______ |
|
5 = Head injury, internal injury, permanent
injury |
|
_______ |
|
6 = Use of weapon; wound from weapon |
|
_______ |
|
If any of the descriptions for the higher
number apply, use the higher number. |
|
|
| 3. |
WITHIN THE LAST YEAR, has anyone forced
you to have sexual activities? |
YES |
NO |
|
If YES, by whom?
___________________________________ |
|
|
| Developed by the Nursing Research Consortium on Violence and
Abuse. |
| Reproduced with permission from J. McFarlane B. Parker
(1994). Abuse During Pregnancy: A Protocol for Prevention and
Intervention. White Plains, NY: The March of Dimes Birth Defects
Foundation, pp. 22-23. |
Encuesta Sobre El Maltrato (Spanish
Version)
| 1. |
DURANTE EL LTIMO A O, fu golpeada,
bofeteada, pateada, o lastimada fisicamente de alguna otra manera por
alguien? |
SI |
NO |
|
Si la respuesta es "SI" por
quien(es)?___________________ |
|
|
|
Cuantas
veces?______________________________________ |
|
|
| 2. |
DESDE QUE SALIO EMBARAZADA, ha sido
golpeada, bofeteada, pateada, o lastimada fisicamente de alguna otra
manera por alguien?__________________________________ |
SI |
NO |
|
Si la respuesta es "SI" por quien(es)?
___________________ |
|
|
|
Cuantas
veces?______________________________________ |
|
|
|
EN EL DIAGRAMA ANAT MICO, MARQUE LAS PARTES
DE SU CUERPO QUE HAN SIDO LASTIMADAS. VALORE CADA INCIDENTE USANDO LAS
SIGUIENTE ESCALA:
|
|
GRADO |
|
1 = Amenazas de maltrato que incluyen el uso de
un arma |
|
_______ |
|
2 = Bofeteadas, permanentel ompujones sin
lesiones fisicas o dolor permanente |
|
_______ |
|
3 = Moquestos, patadas, moretones, heridas y/o
dolor continuo |
|
_______ |
|
4 = Molida a palos, contusiones severas,
quemaduras, fracturas de huesos |
|
_______ |
|
5 = Heridas en la cabeza, lesiones internas,
lesiones permanentes |
|
_______ |
|
6 = Uso de armas, herida por arma |
|
_______ |
|
Si cualquiera de las situaciones valora un
numero alto en la escala, selo. |
|
|
| 3. |
DURANTE EL LTIMO A O, fu forzada a tener
relaciones sexuales? |
SI |
NO |
|
Si la respuesta es "SI" por
quien(es)_____________________ |
|
|
|
Cuantas
veces?______________________________________ |
|
|
Source: The National Clearinghouse for Alcohol and Drug Information
DHHS Publication No. (SMA) 97-3163
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