Silence Hurts
Alcohol Abuse and Violence Against Women
Supplements
Spouse Abuse Risk Assessment
NAME __________ DATE ____________
| RISK FACTORS | LOW (L) | MODERATE (M) | HIGH (H) | COMMENTS |
|---|---|---|---|---|
| History of Abuse | No prior reports or injuries | Prior minor injuries | Subsequent incident or serious injury | |
| Substance Abuse | None | Some use, non-contributing factor | Significant use, contributing factor | |
| Extent of physical injury | No medical treatment needed | Minor physical injuries or treatment | Major physical injury or hospitalization/injury during pregnancy | |
| Use of weapons | None | Weapons available, not used | Weapons used, or threat to use | |
| Emotional maltreatment | None/infrequent | Frequent/chronic | Threats of death or serious injury/stalking | |
| Location of children | Known/no risk | Known/minimal risk | Unknown, or with perpetrator | |
| Forced sex | No evidence or allegation | Allegation with no evidence | Evidence of forced sex | |
| Family stressors | None | Minimal | Multiple | |
| Location of perpetrator | Known, no access to victim | Known, access to victim | Unknown, or at large | |
| Assault history | None | Infrequent/occasional episodes | Frequent/chronic episodes | |
| Fear of perpetrator | None | Minimal | Significant | |
| Safety Plan | Appropriate | Vague | None |
Source:
"Safety and Sobriety: Best Practices in Domestic Violence and Substance Abuse, Domestic Violence/Substance Abuse Interdisciplinary Task Force of the Illinois Department of Human Services, July 2000.








