[Do not ask in front of a child 3 or older or in front of partner] “From speaking to families, I have learned that violence in the home is common and now I ask all families about violence in the home. Do you have any concerns about violence in your home?”
Do you sometimes find you need to slap or hit your child?
Yes/No
Thinking about the past three months
Have you and a partner fought a lot?
Yes/No
Has a partner threatened, shoved, hit or kicked you or hurt you physically in any way?
Yes/No
In general, how would you describe your relationship with your spouse/partner?
No tension
Some tension
A lot of tension
Not applicable
Do you and your partner work out arguments with:
No difficulty
Some difficulty
Great difficulty
Not applicable
University of San Francisco California