Stress/Safety

Afraid

Friends/Family

Emergency Plan

• What stresses do you have in your relationship with your partner?
• How do you handle disaggrements?
• Do you feel safe in your relationship with (name spouse/partner)?
• Should I be concerned for your safety?
• Are there situations in which you feel afraid?
• Have you ever been threatened or abused?
• Has your partner forced you to have sexual intercourse that you did not want?
• If postive reponses to items above: Ask "Are your friends/family aware that this is happening?"
• If negative responses to items above: Ask "Do you think you could tell them if it did happen? Would they help you?"
• Do you have a safe place to go in an emergency situation?
• If you are in danger now, would you like me to help you find a shelter?
• Would you like to talk with a social worker/counselor to help you develop a plan?