SCREENINGANDINTAKEFORMS

For

DomesticViolenceEmergencyShelters

PreparedbyDeadriaBoyland

December2016

AcknowledgementsSpecialthankstoNewHopeDV/SAServices,YWCAYakima,NewBeginningsforBatteredWomenandtheirChildren,KingCounty,LowerValleyCrisis&SupportServices,YakimaCounty,EmergencySupportShelter,CowlitzCounty,LifeWire,KingCounty,YWCAofClarkCounty,YWCAofTacoma/PierceCounty,KoreanWomen’sAssociation,PierceCounty,CrisisSupportNetwork,PacificCounty,DomesticViolenceCenterofGreysHarborCounty,HealthFamiliesofClallamCounty,RoomOne,OkanoganCounty,HumanResponseNetwork,LewisCounty,whokindlymadetheirmaterialsavailabletousandwereuniformlygenerouswiththeirinsight.

Iwouldalsoliketothanktheadvisorygroupwhohelpeddesignthemodelformsanddevelopthequestionsforthescreeningandguidelines:BeckyJackson,NewBeginnings;ErinnGailey;Anne-MarieSchwerin,YWCAWallaWalla;KathrynCohenYWCAClarkCounty,DeidreEvansLifewireKingCounty,DebbieGonzalezNewHopeGrantCounty,AbigailMottYWCAYakima,StephanieBarrYWCAClarkCounty.

Lastbutnotleast,aspecialthankstothestaffattheWashingtonStateCoalitionagainstDomesticViolenceforsharingtheirexpertise.SpecialthankstoJudyChen,LeighHofheimer,BeccaCampbell,ReedForesterandKellyStarr.

ThisprojectwassupportedbythefundingfromtheWashingtonStateDepartmentofSocialandHealthServices.PointsofviewinthisdocumentarethoseoftheauthorsanddonotnecessarilyrepresenttheofficialpositionorpoliciesoftheWashingtonStateofDepartmentofSocialHealthServices.

IntroductionOneofthevaluesofouradvocacyworkistocontinuallyexamineandreevaluateourpracticesand exploreways to improve our services on behalf of survivors. Even though our advocacyprogramsofferaricharrayofservicesforsurvivorsbeyondemergencyshelter,formanypeople,“seekingshelter”isstillahighlyvisibleandcommonlyrecognizedoptionforhelp.Weknowthatshelterisnotenough.Weknowthatsurvivor’sneedsarecomplexandthatweoftendon’thavethecommunityresourcesthatwewant.Andyet,survivorstellusthatgettingthroughourdoorscanbeaconfusingandoverwhelmingexperience.Survivor-centeredadvocacypracticepushesustoquestionhowwearescreeningpeoplewhoareseekinghelpfromourprogramsandasksustothinkaboutthewaysweinadvertentlycreatebarrierstoourservices.Thisreportdescribesour findings and recommendations following an assessment of the screening and intakeprocessesof13domesticviolencesheltersand2community-baseddomesticviolenceprograms.

Thingstokeepinmind

Ø Screeningformsshouldbebrief,includestaffinstructionsandprompts,orframingintroductoryorexplanatorysentencesthathelpthecallerunderstandtheprocess.Additionally,screeningquestionsshouldbelimitedandfocusedon:thesurvivor’spriorities;understandingwhatthesurvivoridentifiesasriskstothemselvesortheirchildren;andthethreatsposedbytheabuserthatimpactsafetyforthecallerortheirchildren.

Ø ShelterScreeningsshouldleadwiththeintentiontoprovidesafetyandadvocacyservicesfor

individualsexperiencingarangeofabusivetacticsfromtheirpartner.

Ø Shelterscreeningsshoulddetermineeligibilitybasedonthesurvivor’sperceptionandunderstandingoftheriskstheyarefacingfromtheirabuser.Determinationofsheltereligibilityshouldgobeyondthelimitedlegaldefinitionsofdomesticviolencefoundinstatute.

Ø Bothshelterscreeningsandintakeformsshouldincludeexplanatoryinstructionsandguidelines

withpromptsthatguidetheadvocateandparticipantthroughtheprocessandexplainthepurposeofthequestions.

Ø Bothshelterscreeningsandintakeformsshouldincludestaffpromptsthatremindadvocatesto:

explainthepurposeofthequestions;describetheiradvocacyservices;provideinformationaboutaccommodations;offertimelyneededservices,offerbreaksduringtheprocessandcheckforunderstandingwiththeparticipant.

Ø Programsprovideongoingtrainingforstaff,volunteersandreliefworkersabouttheshelter

screeningandintaketobuildconsistencyandasharedunderstandingaboutthepurposeoftheseprocesses.

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EmergencyShelterScreeningforDomesticViolenceProgram

Tip:Pleasefamiliarizeyourselfwiththequestionsaheadoftime.Thisisatooltoassistyouinunderstandingtheneedsoftheparticipantsothatyouareequippedtoprovidetheappropriatesupport.“Areyousaferightnow?”�Yes�NoLanguageAccess“Ifneededwecanprovideabilingualadvocateorinterpreterforthiscall.”�Yes�No Language(s):_______________________________________________________Confidentialconversation“Whatyousharewithusoverthephoneandin-personisconfidential,andstayswithinthisprogramunlessyourequestotherwise.”Caller’sFirstName:_____________Phone#ifdisconnected(optional)(_____)_____-_______“Whatcityortownareyoucallingfrom?”___________________________________________

LISTEN

Narrative:“Canyousharewithmewhatpromptedyoutocallourprogramtoday?”Whenansweringasheltercallgenerallythisiswhatwehearfirst.“Doyouhaveanyshelterspace”or“Ineedshelter”Pleasebeawarethatthismaynotbethethingtheyneed.Youcanask“Tellmemoreaboutyourhousingsituation.”

Listen Support Provide

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SUPPORT

Welcomingstatement:“I’msorrythishappenedtoyou,andyoudon’tdeservetobetreatedthisway.Ihopewewillbeabletoprovideyouwiththeresourcesyouneedandifnot,guideyouintherightdirection.”Ourprogramwelcomeseveryone–andweopenourdoorstoindividualswhoreachouttousfromdifferentcultures,raceandethnicities,fromavarietyofreligiousbackgrounds,folkswithdiversegenderidentitiesandsexualorientations,folkswithhiddenorvisibledisabilities,folkswhohavesubstanceusechallenges,folkswithmoneyornomoney–justliketheworldaroundus.”Non-ShelterHousingoptions:Offertheseifappropriate.�Offerassistancetostayinownhome�Financialassistance�IfcallerwantstostayinhomelinkthemtohousingadvocateoracommunityadvocateProceedwithScreening:Thisiswhenyoudecideiftheparticipantiseligibleforyourprogramservices.�Yes“Iwouldliketoofferyouaspaceinourshelterprogram.”�Nospace�NoDV/IPV�Other_____________________________Iftheparticipantisnoteligibleforyourservices,remembertosafetyplanwithcaller.

PROVIDE

MeetingtheParticipant’sNeeds“I’mgladwe’regoingtobeabletoprovidespaceforyouatourshelter.ThereareafewthingsIwouldliketoshareoraskyouabout,inordertotrytomeetyourneedsandprovideyouwithappropriatesupport.”Thenextfewquestionsaretohelpmeunderstandhowtohelpyou.Yourresponseswon’tpreventyoufromgettingservices.”(Optional)UnpublicizedLocation“Ourprogramisinanunpublicizedlocation,andourintentistokeepthelocationprivate.Wewilltalkabitlaterabouthowtogethere.”Whatshouldyouexpectfromourprogram?Providebriefoverviewofthingspeopleshouldknowaheadoftime(e.g.,accessibility,lengthofstay,communal/non-communallivingandsharedspaces(e.g.,sharedbathrooms,bedrooms,kitchen),basicaccommodations(e.g.,food,financialassistance.)Diversity“Wehavediversepeoplelivingandworkinghere.Thereareusuallyalotofdifferentagesofchildren,anddifferentreligions,languages,andcultures,racesandethnicities,andincludinglesbian,gay,bisexualandtransgenderpeople.Everyoneistryingtostaysafeandgetalong.Isthissomethingthatwillworkforyou?Doyouhaveanyquestions?”

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Children“Doyouhaveanychildrenthatwillbeaccompanyingyou?”�Yes�No“Whataretheirages?”________________“Anychildrenaboveage18?”__________________Animals“Manypeoplehaveafamilypet.Doyouhaveanyspecialpetsthatotherfamily/friendscanhelpyoucarefor?”�Yes�No“HowMany?Whatkind?”__________________Accessibility“Thisprogramhasstairs,hallways,andsharedspaces(describethephysicallayout).Doyouhaveanyaccessneedsthatmightlimityouwhengettingaround,forexample,usingthekitchenorthelaundryapplianceseasily,anythingelse?Doyouhaveanyconcernsorhesitationsaboutusingourprogram?”Doyouoryourchildrenhaveanyaccessneedsororspecialneedssothatwecansupportyou?�Yes�No(Ifyes,briefnotes)____________________________________________________Medical“Doyouhaveanymedicalconcernsyouwouldlikeforustoknowabout?”�Yes�No(Ifyes,briefnotes)______________________________________________________________“Ifyouhaveanyprescribedmedicationsthatyouwillneedduringyourstay,pleasebringthemwithyou.”Substances“AlotofpeopleItalktomentionthatusingalcoholorotherdrugsissometimesawaytheyhavecopedwithviolence.Thisisreallynormal.Haveyouparticipatedinusingdrugsoralcoholinthelast24to48hours?”Howcanwesupportyou?______________________________________________________________________________Whenwasthelasttimeyouusedinthelast24hours?_________________________________(Ifyes)“Howcanwesupportyouonyourarrival?”____________________________________CulturalandReligiousorDietaryNeeds“Isthereanythingelseyou’dliketotellmesowecandotowelcomeyou?Doyouhavespecificculturalandreligiousneeds?____________________________Doyouhavespecificdietaryrestrictions?_________________________TransportationtotheShelter“Howdoyouplantogettoourprogram?”(circle)CarBusFriendFamily(TIP:Iftheparticipantgetsaridetotheshelterandyoudidnotknowmakearrangementspriortothemcomingtotheshelter,donotthemscreenout--makeaplanwiththeminstead.)Arrivaltime___:___AMPM(TIP:Lettheparticipantknowhowlongyoucanholdaspaceforthem.Beclearthatyoumighthavetogivethespaceawayiftheydon’tarrivebytheagreededupontime).

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Iscallerstillinterestedincomingtoshelter?�Yes�NoIfnot,why:�Didnotfinishscreening�Other________________________________________Aretheyinterestedinotherservices?�Yes�No_____________________________________Whatreferralsdidyouoffer?Legaladvocacy,supportgroup,communityadvocacy,housingsupport,children’sadvocacy,mobileadvocacysupport.______________________________________________________________________________Safetyplanning:Safetyplanningisanongoingconversationwithasurvivorandmayormaynotbeaformalorwrittenplan.Safetyplanningstrategiesshouldberelevanttothesurvivors’priorities,decisionsandrisks.Theplanningprocessshouldbedynamicandflexibletomeetthesurvivors’changingcircumstances.Davies,J.DomesticViolenceAdvocacy:ComplexLives/DifficultChoices,2,secondedition,2014

Thankyouforyourpatiencewithallthesequestions.Nowit’syourturn,doyouhaveanyquestionsforme?____________________________________________________________________________________________________________________________________________________________

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EmergencyShelterScreeningGuidelinesforDomesticViolenceProgram

LISTEN

“Areyousaferightnow?” Whenacallercontactsyourprogram,oneofthefirstthingsyoushouldaskisiftheyareindanger(forexample,istheabusivepersonisintheroom,home/building,outside,makingitdifficultforcallertospeakfreelyorleave.)Ifso,nowisthetimetofindwaystooffersupport.

1. Areyouinterestedincalling911?2. CanImakethecallforyou?3. Canyougosomeplacesafeandcallusback?4. Arethereotherfolksclosebytoaskforhelp?

LanguageAccess“Wecanprovideabilingualadvocateorinterpreterforthiscall.”

IfthecallerisbilingualorLimitedEnglishSpeaking,followyourprogram’sprocedurestoofferinterpreterservices.Don’tassumesomeonewhospeaksfunctionalEnglishwillbeabletounderstandyournuances,especiallyforsafetyplanningorspecialneeds.

Confidentialconversation“Whatyousharewithusoverthephoneandin-personisconfidential,andstayswithinthisprogramunlessyourequestotherwise.”

Domesticviolenceandsexualassaultprogramsarerequiredtokeepprogramparticipants’information(oralandwrittencommunications)confidentialunlesstheyrequestotherwise.Youcannotconfirmordenythattheyhaveevercalledyourprogram.

“Whatcityortownareyoucallingfrom?”“Ineedshelter.”Pleasebeawarethatthismaynotbethethingtheyneed.

EnsurethecallerisintendingtocallyourDVshelterprogram,andnotonewithasimilarnameinanothercounty/state.

“Canyousharewithmewhatpromptedyoutocallourprogramtoday?”Whenansweringasheltercallgenerallythisiswhatwehearfirst.“Doyouhaveanyshelterspace”or“Ineedshelter”Pleasebeawarethatthismaynotbethethingtheyneed.Youcanask“Tellmemoreaboutyourhousingsituation.”

Listenforwhatthecallerisexperiencingthatpromptedthiscalltoday:• WhataretheurgentneedsthathavesurfacedduetotheDV

situationtoday?• Patterns–howlonghasthisbeengoingon?• Safetyandwell-being–whataretheirconcernsforthemselves,

children,andothers?Iftheydiscloselittleornothing,thecallermightbeminimizingtheabuse,orhasverylittletrustwithsharingpersonalinformation,orcan’tspeakfreely.Tip:Phrasestogetclarificationwithoutbeingjudgmental:• “I’msorry,couldyourepeatthelastsentence?”• “I’malittleunclearaboutthesequenceofevents.”• “Canyousharewithmeagainyourmajorconcernsatthistime?”

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SUPP

ORT

Welcomingstatement:“I’msorrythishappenedtoyou,andyoudon’tdeservetobetreatedthisway.Ihopewewillbeabletoprovideyouwiththeresourcesyouneedandifnot,guideyouintherightdirection.”Ourprogramwelcomeseveryone–andweopenourdoorstoindividualswhoreachouttousfromdifferentcultures,raceandethnicities,fromavarietyofreligiousbackgrounds,folkswithdiversegenderidentitiesandsexualorientations,folkswithhiddenorvisibledisabilities,folkswhohavesubstanceusechallenges,folkswithmoneyornomoney–justliketheworldaroundus.”

Offerawelcomingstatementwhichsignalstothecallerthattheywillbesupportedandcanraisecomplicatedconcernswithyou.Withoutmakinganypromises,sayyouwilldoyourbesttoprovidethemwithappropriateresourcesbasedonwhatyouhaveheard.Acknowledgethatyoulistenedtowhatthecallerhassharedandthatit’snottheirfault.

Non-ShelterHousingoptions:Offertheseifappropriate.

�Offerassistancetostayinownhome�Financialassistanceifavailable�Ifcallerwantstostayinthehomethiswouldbeagreatopportunitytolinkthemtoamobileadvocate.Mobileadvocatesandprogramadvocatesoftenmeetparticipantslocally.Ifyourprogramcanofferfinancialassistanceforhousingandprovideadvocacythatsupportspeoplemovingintohousinginsteadofcomingtoshelter,thisisthetimetoengageinthisconversation.(Forexample:changinglocks,helpadvocatingwithlandlord,evictionprevention,first/lastmonth’srent,movingtoanotherunit,relocation,etc.).

ProceedwithScreening Makethedecisionaboutofferingthecalleraspaceinyourshelterprogram.Theirtimeisvaluable,andtheyneedtoknowiftheyshouldlookelsewhere.Remembertoleantowardsscreeningin,notout.

“Iwouldliketoofferyouaspaceinourshelterprogram.”

Don’tassumetheparticipanthasdecidedtocometoyourprogram.Bepreparedtoanswersomeoftheirquestionsanddon’tbesurprisediftheysay,“nothankyou.”Theygettodecide.

SafetyPlanning-IfCallerisn’tcomingtoshelter

Engagecallerinsafetyplanningregardlessofwhatoptiontheychoose.

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PROVIDE

MeetingTheParticipantsNeeds“I’mgladwe’regoingtobeabletoprovidespaceforyouatourshelter.ThereareafewthingsIwouldliketoshareoraskyouabout,inordertotrytomeetyourneedsandprovideyouwithappropriatesupport.Thenextfewquestionsaretohelpmeunderstandhowtohelpyou.Yourresponseswon’tpreventyoufromgettingservices.”

Ifthecallerdecidestocometoyourprogram,letthemknowyouhaveinformationtoshare,andyouhaveafewmorequestions,tohelpyouhelpthemontheirarrival.Thesequestionsshouldnotpreventthemfromgettingservices.

(Optional)UnpublicizedLocation“Ourprogramisinanunpublicizedlocation,andourintentistokeepthelocationprivate.Wewilltalkabitlaterabouthowtogethere.”

Ifyourshelterhasavalueonkeepingthelocationundisclosedorprivate,besuretoexplainthat.(Rememberthatlegalobligationstokeepingconfidentialityappliestousasadvocates,nottolocations,participants,orresidents.)

Whatshouldyouexpectfromourprogram?Providebriefoverviewofthingspeopleshouldknowaheadoftime

Mostpeoplehavenoideawhattoexpect,orhaveonlyheardofshelteronTV.Describe:• Accessibility(stairs,etc.–seealsobelow)• Lengthofstay(ifanylimits)• Communal/non-communallivingandsharedspaces(e.g.,

sharedbathrooms,bedrooms,kitchen)• Basicaccommodations(food,financialassistance,etc.)• Whatelse?

Diversity“Wehaveverydiversepeoplestayinghereandworkinghere.Thereareusuallyalotofdifferentagesofchildren,anddifferentreligions,languages,andcultureshere,includinglesbian/gay/bisexual/transgenderpeople.Everyoneistryingtostaysafeandgetalong.Isthissomethingthatwillworkforyou?Doyouhaveanyquestions?”

Manypeopleareawareofdiversityintheirdailylivesbutdon’tlivewiththewiderangeofdifferentlifestyles,cultures,andespecially,somanychildrenona24/7basis.Informthecalleraboutthisinawaythatassumesgoodwill.It’sOKifpeopledon’tlikeXgroup;thequestionis,cantheyagreetogetalongonatemporarybasisinshelter?Invitethemtoaskquestions.TIP:ifyou’rehavingadifficulttimeexplainingthis,theywillhaveadifficulttimeunderstandingit.Getclearbeforeyouhavethisconversation.

Children“Doyouhaveanychildrenthatwillbeaccompanyingyou?”“Whataretheirages?”(Anychildrenaboveage18?)

Donotscreenoutforteens,olderteenboys,olderchildren.Thepurposeofthisquestionistomeettheirneeds(forexample,wouldtheolderchildrenprefertobetheirownclient)?

Animals“Manypeoplehaveafamilypet.Doyouhaveanyspecialpetsthatotherfamily/friendscanhelpyoucarefor?”

• Makesureyouhaveaplaninplaceifyoudonotaccommodatepets.

• Ifyoucanaccommodatepetshaveyourplaninplace.

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PROVIDE

Accessibility“Doyouoryourchildrenhaveanyphysicallimitationsorspecialneedssothatwecansupportyou?Forexample,…”

Fillinasneeded-wehavestairs;bathtubsbutnoshowers;peoplestayinghereneedtobeabletocareforthemselvesandtheirchildren.

Medical“Doyouhaveanymedicalconcernsyouwouldlikeforustoknowabout?”

Sometimestraumaandsuddenchangecantriggerunderlyingmedicalconcerns,suchasasthmaorpanicattacks.Ifthecallerisexperiencingorhasahistoryofmedicalissues,thisisthetimetotalkwiththemaboutaccesstomedication.

“Ifyouhaveanyprescribedmedicationsthatyouwillneedduringyourstay,pleasebringthemwithyou.”

Doesyourprogramofferassistancewithmedications?Thisisagoodtimetohavethisdiscussionwithyourstaffbeforethecallerarrives.

Substances“AlotofpeopleItalktomentionthatusingalcoholorotherdrugsissometimesawaytheyhavecopedwithviolence.Thisisreallynormal.Haveyouparticipatedinusingdrugsoralcoholinthelast24to48hours?”Howcanwesupportyou?“Howmanydrinkshaveyouhadinthelast24hours?”“Howcanwesupportyouonyourarrival?”

Usingalcoholorotherdrugspriortocallingyourprogramshouldnotpreventsomeonefromgettingin.Ifthisisopenfordiscussionnowisthetimetoask:• Whendidyoulastuse?• Whatwasyourdrugofchoice?

Letthemknowthatyouwanttodoyourbesttosupportthemandofferoptionswhiletheyareinyourprogram.

CulturalorReligious,orDietary“Isthereanythingelseyou’dliketotellmesowecanwelcomeyou?Forexample,culturalorreligiousneeds,ordietaryrestrictions?”

Thingstoconsider:• Aroomthatfaceseast• Dishesthathavenotbeenusedtocookmeat• Candles-batteryoperated

Transportation“Howdoyouplantogettoourprogram?”

TIP:Ifyourshelterisinanunpublicizedlocation,donotscreenoutforgettingaridetoshelter,makeaplanwiththeminstead.

Arrivaltime

TIP:Whendoyoudecidetogivethespaceawaytosomeoneelse?Sharethisinfowithcaller.Don’tassumethatthecallerisknowledgeableabouthowtogettoyourprogram.Theymightaskfolksfordirections,getaride,oraskforyourhelp.Bepreparedtooffersuggestionstoassistintheirarrival.Onceacallerhassecuredaspacegivethemtimetogathertheirbelongings.THINK..canyoupackinonehour?Twohours?Bepreparedtodiscussarrivaltimesandwhatyourcut-offtimeisforaNOSHOW.

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PROVIDE

Iscallerstillinterestedincomingtoshelter?(Ifnot,whatreferralsdidyouoffer?)

Referralsshouldbegivenwhenpossible.Thecallercouldchangetheirmindaboutcomingtoyourprogramandthiscanprovidethemwithoptionsforfuturedecisions.• Legalservices• Supportgroups• Mobileadvocacy

Incompletescreening Ifthescreeningwasnotcompletemakeanoteofthatand

why.Thishelpsthenextadvocatesupportthiscalleriftheydecidetocallbackinafewdays,weeks,ormonth.

Safetyplanning:Engagecallerinthinkingthroughhowtheyandtheirchildrencanstaysafebetweennowandwhentheygettoshelter.

Tailorthistotheirlifestyle,schedule,school,work,etc.andwhatmakessensetothem.Thesurvivorknowsbest.Consideraspecificplanpriortocomingtoshelterandtailoringitafterthearrivalofthecaller.Safetyplanningisanongoingconversationwithasurvivorandmayormaynotbeaformalorwrittenplan.Safetyplanningstrategiesshouldberelevanttothesurvivors’priorities,decisionsandrisks.Theplanningprocessshouldbedynamicandflexibletomeetthesurvivors’changingcircumstances.Davies,J.DomesticViolenceAdvocacy:ComplexLives/DifficultChoices,2,secondedition,2014.

NotetoAdvocate Reviewallrelevantoptionstothecaller’ssituationincasethereissomethingotherthanshelterthatmayworkbetterforthem.

Anyquestionsforthecaller? Thankyouforyourpatiencewithallthesequestions.Nowit’syourturn,doyouhaveanyquestionsforme?

Questionsnotonthisfrom:Toomanyquestionsallatoncecanbeoverwhelming.Ifyoudonotseeanumberofquestionsonthisformthatyounormallyask,pleaseconsiderputtingthesequestionsonanoptionalformforthemtofilloutandgivebacktoyoulaterorconnectwiththeparticipantsatalatertime.

Consideralternativestoaskingalotofquestionsonyourforms.Additionalquestions,liketheonesbelow,canbeonahandoutthatparticipantsfilloutontheirowntimeandreturntoyou.

• Courtorder• Werethepoliceinvolved?• Veteranormilitarystatus• Otheradditionaldemographics• Additionalneedsofchildren-canthisinformationbe

collectedwiththechildren’sadvocate?• Areyouduplicatingyourquestionsbetweendifferent

advocatepositions?• Couldtherebebettercoordinationbetweenforms

andreducetheduplicativedatacollection?Bottomline:Participantsshouldnothavetoanswerthesamequestionoverandoveragain.

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EmergencyShelterIntake

Name__________________________Date______________Interpreter_______________________CellNumber______________________LastAddress_______________________________________City_________________________State_________________ZipCode:__________________ProgramID#DateofBirth

Tip:Pleasefamiliarizeyourselfwiththeintakequestionsaheadoftime.Thisisatooltoassistyouinunderstandingtheneedsoftheparticipantsothatyouareequippedtoprovidetheappropriatesupport.Welcomingstatement:“Ihopewewillbeabletoprovideyouwiththeresourcesyouneedandifnot,guideyouintherightdirection.Ourprogramwelcomeseveryone–andweopenourdoorstoindividualswhoreachouttousfromdifferentcultures,raceandethnicities,fromavarietyofreligiousbackgrounds,folkswithdiversegenderidentitiesandsexualorientations,folkswithhiddenorvisibledisabilities,folkswhohavesubstanceusechallenges,folkswithmoneyornomoney–justliketheworldaroundus.”Tip:Wheneverpossible,beforeyoubeginthepaperwork,taketheparticipants(includingchildren)onatourofyourprogram.Providethemwithanopportunitytogetacquaintedwithanunfamiliarplace.Sharethehighlightsofyourprogrambeforeyougettothepersonalquestionsonyourform.Thisallowsfolktimetogetcomfortableandappreciatethegoalofyourprogram.AccessibilityandCommunalFacilitiesThisprogramhasstairs,hallways,andsharedspaces(describethephysicallayout).Didyounoticeanythingonourtourthatmightpreventyoufromgettingaround,usingthekitchenorthelaundryapplianceseasily,anythingelse?Doyouhaveanyconcernsorhesitationsaboutusingourprogram?Doyouhaveanyaccessneedsthatweshouldknowabout?qNoqYes,Pleasedescribe_______________________________________________________________

Introductionsandoverviewofyour

program

Gettingtoknowyoubetter

Wewanttodoourbesttosupportyou

Introductionsandoverviewofyourprogram

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Tip:Shiftingtheconversation–sharingthestory“Thenextquestionisfocusedonsharingwhatbroughtyoutoourprogram.Pleasetakeyourtimeandfeelfreetostopifyouneedtotakeabreak.Pleasesharewhateveryoufeelcomfortablewith,allyouranswersarevoluntary.Wekeepthisinformationconfidentialandwedon’tshareitwithanyonewithoutyourpermission.Except,ifyoutellusthatyouwanttohurtyourselforsomeoneelse,oryoutellusthatyourchildhasdirectlyexperiencedabuse.”Iknowthisisadifficulttimeforyou,andwhenyoufeelcomfortable,Iamreadytohearabouttheeventsthatledyoutocallourprogram.Bes

Tip:Oncetrusthasbeenestablished,andbecausewewanttoprovidethebestadvocacyservices,itmaybehelpfultoknowhowapersonidentifiestheirgenderandsexualorientation.Remindparticipantstosharewhatevertheyfeelcomfortablewith,alltheiranswersarevoluntary.Makeawelcomingspaceforallpeopleofallgendersandsexualorientations.Openthedoorforadvocacyafterintake.Whatisyourgenderidentity?___________________________________________________qFemaleqMaleqTransgenderqGendernon-conformingqSomethingelseyouwouldliketoshare_________________________________________Canyousharewhatyourrelationshipiswiththepersonwhoisharmingyou?qSpouseqBoyfriend/GirlfriendqEx-Boyfriend/Ex-GirlfriendqPartnerqOtherrelationship________Tip:Timetocheck-inandlettheparticipantknowthatyoubeaskingthemtodescribetheirexperienceoflivingwithabuse.Lettheparticipantknowthatyouarehappytotakeabreakandreturntothisconversation.Canyoudescribeyourexperienceofabuse?EmotionalAbuse:__________________________________________________________________ PhysicalAbuse:____________________________________________________________________

Gettingtoknowyouhelpsourprogramsupportyoubetter

Wewanttodoourbesttosupportyou

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SexualAbuse:______________________________________________________________________ Othertactics:______________________________________________________________________Wewouldliketogettoknowyourchildren.Canyousharetheirnamesandanyparticularneedsthatwecansupportyouwith?Name Gender DateofBirth Age Hasyourpartnereverharmedyourchildren?qNoqYes Pleasedescribe:________________________________________________________________Canyousharehowyourchildrenwereharmed? qNoqYes Pleasedescribe:________________________________________________________________Whatisyourbiggestconcernforyourchildrenrightnow? qNoqYes Pleasedescribe:________________________________________________________________Experiencingabusecanbeextremelydifficulttolivewithandsometimesitcanleadtopeopleharmingthemselvestoeasethepain.Haveyoueverthoughtaboutharmingyourself?qNoqYes Pleasedescribe:________________________________________________________________Haveyoueverdoneanythingtohurtyourself?qNoqYes Pleasedescribe:________________________________________________________________ Whileyouarewithus,ifyouarefeelinglikeyoumightwanttoharmyourselfwouldbewillingtotalktostaff?Couldyoufindastaffpersonandsharehowwecansupportyou?__________________________________________________________________________________________Manypeopleexperiencingabuseusealcoholorotherdrugstohelpthemcope.Weareheretosupportyouandcanconnectyoutoresourcesthatmatchyourneeds.Isthissomethingthatyouwouldlikehelpwith?qNoqYesHowcanwesupportyou?_________________________________________________________Thismaynotbeaconcernforyounow,howeverweleteveryoneknowthatwecantalkwithyouaboutarangeofbirthcontroloptionsincludingemergencycontraception.Wouldyoulikemoreinformationaboutthis?qNoqYesPleasedescribe:_______________________________________________________________Tip:Lettheparticipantknowthatthenextsetofquestionsfocusonwhattheymayneedtobecomfortableinthisspaceandincludessomedemographicquestions.Remindparticipantsthattheanswersarevoluntaryandyoucanreturntothematalatertime.

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Manypeoplehavebeenprescribedmedicationtotakedaily.Ifyouneedhelpwithrefillingaprescription,wecanassistyouwiththat.Doyouoryourchildrenhaveanyconcernsabouthealthormedicalrelatedissuesthatyouwouldliketoaddress?qNoqYesPleasedescribe:_______________________________________________________Areyouoryourchildrenonanymedicationthatstaffshouldbeawareof?qNoqYesPleasedescribe:___________________________________________________________________________Doyouhaveanyculturalorreligiousneeds?qNoqYesPleasedescribe:____________________________________________________________________________Doyouhaveanydietaryrestrictions?qNoqYesPleasedescribe:________________________________________________________________________(Ifthereareanyfoodallergies,remindfolksthatthekitchenisasharedspaceandwecanproblem-solvethistogether.)Canyousharewhatspecificcultural,ethnicgroupsorcommunitiesyouidentifywith?Race:�AfricanAmerican �Asian �NativeAmerican �AlaskaNative �PacificIslander �White �Multiracial �Other_______ Ethnicity:�Non-Hispanic/Non-Latino �Hispanic/Latino �Other__________Canyousharewhatisyourmainsourceofincome?qTANF__________IfnotonTANF,eligible?__________qSSI__________qWorker’sCompensation__________qNone qUnknown qEmployment__________qVeteran’sDisability__________qGA___________qUnabletoWork____________________qOther:____________HasparticipanteverreceivedinformationonapplyingforTANF?____________*IfNOTonTANFandpossiblyeligible,giveinformationNOWonhowtoapply.Ourprogramworkswithinourcommunitytoconnectyoutoservicestosupportyouandyourfamily.Let’sdiscusssomeoftheseprogramsandseeifyoumightbeinterestedintheirservices.qEmployment/VocationalCounselingorTraining qDrug/AlcoholCounselingqLegalAdvocacy qFood/Clothing qLGTBQSupportqCourtAdvocacy qChildcare/RespiteCare qSexualabuse/AssaultSupportqInterpreterServices qEducation qCulturallyAppropriateServicesqShelter qESL qReligiousCommunityqHousing qAddressConfidentialityProgram qPeerGroupSupportqFinancialAssistance qHealthcare/Medication qNoParticipantServicesNeeded qTransportation qParenting-Support qOtherqDVEducation qMentalHealthSupport qUnknown

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EmergencyContactInformation__________________________________(Incaseofanemergencyisthereanyoneyouwouldlikeforustocontact?)SafetyPlanning Safetyplanningisanongoingconversationwithasurvivorandmayormaynotbeaformalorwrittenplan.Safetyplanningstrategiesshouldberelevanttothesurvivors’priorities,decisionsandrisks.Theplanningprocessshouldbedynamicandflexibletomeetthesurvivors’changingcircumstances.Davies,J.DomesticViolenceAdvocacy:ComplexLives/DifficultChoices,2,secondedition,2014

__________________________________________________________________________________________________________________________________________________________________Thanksforyourpatiencewithallthesequestions.Nowitisyourturn,doyouhaveanyquestionsforme?__________________________________________________________________________________________________________________________________________________________________________

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EmergencyShelterIntakeGuidelines

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overview

Name,DateInterpreter,Cell,Lastaddress,City,ProgramID#,DateofBirth

Mostofthisinformationwillbeonthescreeningsoifyoucan,pulltheinformationfromthereratherthanrepeatingthequestions.

Tip:Pleasefamiliarizeyourselfwiththeintakequestionsaheadoftime.Thisisatooltoassistyouinunderstandingtheneedsoftheparticipantsothatyouareequippedtoprovidetheappropriatesupport.Welcomingstatement:Createastatementthatworksforyourprogram

“Ihopewewillbeabletoprovideyouwiththeresourcesyouneedandifnot,guideyouintherightdirection.Ourprogramwelcomeseveryone–andweopenourdoorstoindividualswhoreachouttousfromdifferentcultures,raceandethnicities,fromavarietyofreligiousbackgrounds,folkswithdiversegenderidentitiesandsexualorientations,folkswithhiddenorvisibledisabilities,folkswhohavesubstanceusechallenges,folkswithmoneyornomoney–justliketheworldaroundus.”

Tip:Wheneverpossible,beforeyoubeginthepaperwork,taketheparticipants(includingchildren)onatourofyourprogram.Providethemwithanopportunitytogetacquaintedwithanunfamiliarplace.Sharethehighlightsofyourprogrambeforeyougettothepersonalquestionsonyourform.Thisallowsfolktimetogetcomfortableandappreciatethegoalofyourprogram.Explainthegoalofyourprogramandhowyouplantosupporttheparticipant(caution:toomuchorganizationaldetailmaybeunnecessaryatthistime).Shareifyouprovide24-houradvocacycoverage,legaladvocacyservices,and/orhousingspecialists.Doyouallowsmokingaroundthefacility?Canfamilymembersvisit?Thinkaboutthemostimportantthingssomeoneneedstoknowupfront.AccessibilityandCommunalFacilitiesDoyouhaveanyaccessneedsthatweshouldknowabout?

Thinkhowpeopleusethespace–whatdopeopleneedtofunctionsuccessfullyinyourfacility.Providingatouroftheprogramgivesyoutheopportunitytoengagewiththeparticipantwhilewalkingaround.Youalsohavetheopportunitytoseeiftheyarestrugglingtomaneuverinyourfacilityormayhaveotheraccessneeds(i.e.,lowvisionandneedtomarkthesettingsonthemicrowaveorstove).Makesuretoinquireaboutthechildrenandtheirabilitytogetaroundoranyotheraccessneed.

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Gettingtokno

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Tip:Shiftingtheconversation–sharingthestory“Thenextquestionisfocusedonsharingwhatbroughtyoutoourprogram.Pleasetakeyourtimeandfeelfreetostopifyouneedtotakeabreak.Pleasesharewhateveryoufeelcomfortablewith,allyouranswersarevoluntary.Wekeepthisinformationconfidentialandwedon’tshareitwithanyonewithoutyourpermission.Except,ifyoutellusthatyouwanttohurtyourselforsomeoneelse,oryoutellusthatyourchildhasdirectlyexperiencedabuse.”Byusingthislanguage,youaresharing:1. Thetransitiontoanewsetofquestions.2. Acknowledgmentthatitisokayforparticipantstotakecareofthemselves,and3. Theparticipantisguidingtheconversation.“Iknowthisisadifficulttimeforyou,andwhenyoufeelcomfortable,Iamreadytohearabouttheeventsthatledyoutocallourprogram?”

Thewayyouaskthisquestionisimportanttobuildingaconnectionandtrustwiththeparticipant.Invitingtheparticipant“toshare”ratherthanmakingthemfeelliketheyhavenochoice.Usephraseslike:“canyoushare”or“whenyoufeelcomfortable,let’sbegin.”Avoidingphraseslike“tellmewhathappenedwhenyouwereabused”or“tellmethedetailsabouttherecentincident.”

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Tip:Oncetrusthasbeenestablished,andbecausewewanttoprovidethebestadvocacyservices,itmaybehelpfultoknowhowapersonidentifiestheirgender.Remindparticipantstosharewhatevertheyfeelcomfortablewith,alltheiranswersarevoluntary.Gender–Whatisyourgenderidentity?• Female• Male• Transgender• Gendernon-conforming• Somethingelseyouwouldliketoshare?

Don’tassumeyouknowthegenderoftheprogramparticipant.Oriftheyidentifywithagenderthatistheoneyouthink.

Canyousharewhatyourrelationshipiswiththepersonharmingyou?• Spouse• Girlfriendor(Ex)• Boyfriendor(Ex)• Partner• Otherrelationship?

Noticehowtheparticipantdescribestheirrelationship,usethesamelanguage.Refrainfromcallingtheirpartner“yourabuser,yourbattererortheperpetrator.”

Tip:Timetocheck-inandlettheparticipantknowthatyoubeaskingthemtodescribetheirexperienceoflivingwithabuse.Lettheparticipantknowthatyouarehappytotakeabreakandreturntothisconversation.Canyoudescribeyourexperienceofabuse?• Emotionalabuse• Physicalabuse• SexualAbuse• Othertactics

Mostpeoplelivingwithabusehaveexperienceddifferenttypesofbehaviorslike:threats,putdownsphysicalorsexualabuse,restrictingaccesstomoney,usingadisabilityagainstyou,usingthechildrenagainstyou,interferingwithbirthcontrolanddecisionsaroundfamilyplanning

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Wewouldliketogettoknowyourchildren.Canyousharetheirnamesandanyparticularneedsthatwecansupportyouwith?• Hasyourpartnereverharmedyour

children?• Canyousharehowyourchildrenwere

harmed?• Whatisyourbiggestconcernforthe

childrenrightnow?

Theintentofthesequestionsistolaythefoundationforworkingwiththeparticipantonhowtobestsupportthechild(ren).Weknowthatremovingachild(ren)fromafamiliarspacetoanunfamiliarplaceandchangingroutinesisoftenconfusingandupsetting.

Experiencingdomesticviolencecanbeextremelydifficulttolivewithandsometimesitcanleadtopeopleharmingthemselvestoeasethepain.• Haveyoueverthoughtaboutharming

yourself?• Haveyoueverdoneanythingtohurt

yourself?• “Whileyouarewithus,ifyouarefeeling

likeyoumightwanttoharmyourselfwouldbewillingtotalktostaff?Couldyoufindastaffpersonandsharehowwecansupportyou?”

“Experiencingdomesticviolencecanbeextremelydifficulttolivewithandsometimesitcanleadtopeopleharmingthemselvestoeasethepain.”“Whileyouarewithus,ifyouarefeelinglikeyoumightwanttoharmyourselfwouldyoubewillingtotalktostaff?”ForinformationcheckoutthiswebinarontheWSCADVwebsite--SuicideAssessmentandInterventionWebinarbySueEastgard.https://wscadv.org/resources/suicide-assessment-and-intervention-webinar/

Manypeopleexperiencingdomesticviolenceusealcoholorotherdrugstohelpthemcope.Weareheretosupportyouandcanconnectyoutoresourcesthatmatchyourneeds.Issomethingthatyouwouldlikehelpwith?

Theintenthereistooffersupportifneeded,nottopunishpeopleormakethemfeelbadaboutusing.Usingsubstancesshouldnotbeareasontoasksomeonetoleaveyourprogram.

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Thismaynotbeaconcernforyounow,howeverweleteveryoneknowthatwecantalkwithyouaboutarangeofbirthcontroloptionsincludingemergencycontraception.Wouldyoulikemoreinformationaboutthis?

Thereareoptionsforfolkswhothinktheymightbepregnantandaretryingtodecideaboutthislifechangingdecision.EmergencyContraceptionworksbestwithinthreedaysofintercourseandcanpreventpregnancy.(Somefolkshavethisonsiteifnot,PlanBisavailableonstoreshelvesortheinternetatAfterpill.com.Weknowthatmanysurvivorstalkaboutthewaystheirpartnerinterferedwiththeirbirthcontrolordidn’trespecttheirdecisionsaroundfamilyplanning.TheWSCADVwebsite’sReproductiveJusticepagehasinformationaboutbasicformsofbirthcontrolthatarelesslikelytobefeltbyapartner.InformationaboutteenrightsaroundaccesstobirthcontrolandparentalnotificationinWA.Informationabouthowemergencycontraceptionworksandwhereyoucangetit(ifyourprogramdoesnothaveitasaresource).

Tip:Lettheparticipantknowthatthenextsetofquestionsfocusonwhattheymayneedtobecomfortableinthisspaceandincludessomedemographicquestions.Remindparticipantsthattheanswersarevoluntaryandyoucanreturntothematalatertime.Manypeoplehavebeenprescribedmedicationtotakedaily.Ifyouneedhelpwithrefillingaprescription,wecanassistyouwiththat.Doyouoryourchildrenhaveanyconcernsabouthealthormedicalrelatedissuesthatyouwouldliketoaddress?• Areyouoryourchildrenonany

medicationthatstaffshouldbeawareof?

Askingaboutgeneralhealthconcernshelpsyouidentifythesupportthataparticipantortheirchild(ren)mightneed.Askingaboutprescriptionsisnotanopportunityforyoutodeterminewhatmedicationtheyaretaking;butrather,iftheyhaveenoughtolastforseveraldays.Doesyourprogramprovideapersonallockboxforthemtousewhileintheprogram?Canyourefillmedsquicklyifneeded?

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Doyouhaveanyculturalorreligiousneeds,ordietaryrestrictions?Canyousharewhatspecificcultural,ethnicgroupsorcommunitiesyouidentifywith?

Participantsappreciateyoureffortstoidentifytheirculturalorreligiousneedswhichwillhelpthemhaveapositiveexperienceinyourprogram.Additionally,knowingaparticipant’sdietaryneedscanhelpyoufullysupportthem.Forexample:• Allergiestonuts,soy,eggs,dairy,gluten,

wheat,etc.• Can’tcookwithequipmentthathasbeenused

forcookingmeat.Supportingaparticipant’sculturalandreligiousneedssendsamessagethatyourprogramiswelcomingtoall.Ifpossible,knowingthisinformationaheadoftimecanhelpyoupreparefortheirarrivalandincreaseaparticipant’scomfort.

“Financialstabilityisanimportantpartofsurvival.Ourprogramcanreferyoutofinancialresourcesintheareaifneeded.Canyousharewhatisthemainsourceofyourincome?“

Weknowthathavingasourceofincomeiscritical.Weaskthisquestionsothatifyouneedassistancewecanprovideyouwithinformation.

Ourprogramworkswithinourcommunitytoconnectyoutoservicestosupportyouandyourfamily.Let’sdiscusssomeoftheseprogramsandseeifyoumightbeinterestedintheirservices.

Thisisagreatwaytouncovertheservicestheparticipantmayhavealreadytappedintoandprovideefficientcoordinationandcollaboratewithexistingsupports.And,theparticipantmaywantadditionalinformationorclarificationabouthowtoaccessotherresources.

EmergencyContactInformation Thisinformationshouldonlybeusedinextremeemergenciesandwiththeparticipant’spermission.Theparticipantgetstodecidewhatconstitutesanemergency.Thisinformationisnottobeusedtotrytolocatesomeoneiftheydonotreturntoyourprogramafterafewdays.Wearenotdetectivesandparticipationinourprogramisvoluntary!

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SafetyPlanning Safetyplanningisanongoingconversationwithasurvivorandmayormaynotbeaformalorwrittenplan.Safetyplanningstrategiesshouldberelevanttothesurvivors’priorities,decisionsandrisks.Theplanningprocessshouldbedynamicandflexibletomeetthesurvivors’changingcircumstances.Davies,J.DomesticViolenceAdvocacy:ComplexLives/DifficultChoices,2,secondedition,2014.

Thanksforyourpatiencewithallthesequestions.Nowitisyourturn,doyouhaveanyquestionsforme?

Thisisatimetolistencloselytotheparticipant’sneedsandquestions.Listenforwhytheneeds,questionsandrequestsareimportanttotheparticipant.

QuestionsNOTonthisfrom:Toomanyquestionscanbeoverwhelming.Ifyoudonotseeanumberofquestionsonthisformthatyounormallyaskpleaseconsiderputtingthesequestionsonanoptionalformfortheparticipanttofilloutandreturntoyou.Or,considernotaskingthequestionsandaskyourself–isthisreallynecessary–orareyouaskingthequestionbecauseyouhavealwaysaskedthisquestionandnoonerememberswhy,ortellsyou“wehavealwaysdoneitthisway.”

Consideralternativestoaskingalotofquestionsonyourforms.Additionalquestions,liketheonesbelow,canbeonahandoutthatparticipantsfilloutontheirowntimeandreturnedtoyou.

• Courtorder• Werethepoliceinvolved?• Veteranormilitarystatus• Otheradditionaldemographics• Additionalneedsofchildren-canthis

informationbecollectedwiththechildren’sadvocate?

• Areyouduplicatingyourquestionsbetweendifferentadvocatepositions?

• Couldtherebebettercoordinationbetweenformsandreducetheduplicativedatacollection?

Bottomline:Participantsshouldnothavetoanswerthesamequestionoverandoveragain.