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.