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Assessment Instrument Copyright 1985, 1988 Contributed by Jacquelyn C. Campbell, Ph.D., RN, FAAN Dear Colleague: Here is a copy of the Danger Assessment Instrument which you may duplicate in any quantity desired for use with battered women. In exchange, I would appreciate your sharing with me the results of any research (raw or coded date) which is done with the instrument and/or an approximate number of women with whom the instrument was used, a description of their demographics, their mean score, and the setting in which the data was collected. Please send this information within the next year. I would also be grateful for comments (positive and negative), and suggestions for improvement from battered women themselves, advocates, and professionals who are involved in its use. Finally, I ask that you please correspond with me prior to altering the instrument in any way. Sincerely, Jacquelyn C. Campbell, Ph.D., RN, FAAN Anna D. Wolf Endowed Professor Associate Dean for Doctoral Education Programs and Research jcampbel@son.jhmi.edu (410) 955-2778 Fax: (410) 614-8285 Copyright 1985, 1988
Using the calendar, please mark the approximate dates during the past year when you were beaten by your husband or partner. Write on that date how bad the incident was according to the following scale:
1. Slapping, pushing; no injuries and/or lasting pain 2. Punching, kicking; bruises, cuts, and/or continuing pain 3. "Beating up"; severe contusions, burns, broken bones 4. Threat to use weapon; head injury, internal injury, permanent injury 5. Use of weapon; wounds from weapon
(If any of the descriptions for the higher number apply, use the higher number.)
Mark Yes or No for each of the following. ("He" refers to your husband, partner, ex-husband, ex-partner, or whoever is currently physically hurting you.)
____ 1. Has the physical violence increased in frequency over the past year? ____ 2. Has the physical violence increased in severity over the past year and/or has a weapon or threat from a weapon ever been used? ____ 3. Does he ever try to choke you? ____ 4. Is there a gun in the house? ____ 5. Has he ever forced you to have sex when you did not wish to do so? ____ 6. Does he use drugs? By drugs, I mean "uppers" or amphetamines, speed, angel dust, cocaine, "crack", street drugs or mixtures. ____ 7. Does he threaten to kill you and/or do you believe he is capable of killing you? ____ 8. Is he drunk every day or almost every day? (In terms of quantity of alcohol.) ____ 9. Does he control most or all of the your daily activities? For instance: does he tell you who you can be friends with, how much money you can take with you shopping, or when you can take the car? (If he tries, but you do not let him, check here: ____) ____ 10. Have you ever been beaten by him while you were pregnant? (If you have never been pregnant by him, check here: ____) ____ 11. Is he violently and constantly jealous of you? (For instance, does he say "If I can't have you, no one can.") ____ 12. Have you ever threatened or tried to commit suicide? ____ 13. Has he ever threatened or tried to commit suicide? ____ 14. Is he violent toward your children? ____ 15. Is he violent outside of the home? | |||||||||||||
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