Appendix C—Instruments

Center for Substance Abuse Treatment

Appendix C—Instruments

This appendix reproduces the following tools:

Abuse Assessment Screen (in English and Spanish)
Danger Assessment
Psychological Maltreatment of Women Inventory (PMWI)
Revised Conflict Tactics Scale (CTS2)

Although these instruments have been used extensively in research settings, they have not been validated as clinical tools; nor do they have instructions for scoring. The PMWI and the CTS2, in particular, were designed as research tools, not clinical tools, and do not have cutting scores (the score beyond which a person has a problem). All the instruments in this appendix can, however, serve to open dialogue with a client, elicit information, promote discussion, and help evaluate a program.

Abuse Assessment Screen (English Version)

Table

Abuse Assessment Screen (English Version).

Encuesta Sobre El Maltrato (Spanish Version)

Table

Encuesta Sobre El Maltrato (Spanish Version).

Danger Assessment

Several risk factors have been associated with homicides (murders) of both batterers and battered women in research conducted after the murders have taken place. We cannot predict what will happen in your case, but we would like you to be aware of the danger of homicide in situations of severe battering and for you to see how many of the risk factors apply to your situation.

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 (if any of the descriptions for the higher number apply, use the higher number):

Slapping, pushing; no injuries and/or lasting pain
Punching, kicking; bruises, cuts, and/or continuing pain
"Beating up"; severe contusions, burns, broken bones
Threat to use weapon; head injury, internal injury, permanent injury
Use of weapon; wounds from weapon

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.)

Thank you. Please talk to your nurse, advocate, or counselor about what the Danger Assessment means in terms of your situation.

Danger Assessment

Table

Danger Assessment.

Please share with the author the results of any research (raw or coded data) that 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 data were collected. Please send this information within the next year. Also please send comments (positive and negative) and suggestions for improvement from battered women themselves, advocates, and professionals who are involved in its use.

Sources:

Campbell, J. Nursing assessment for risk of homicide in battered women. Advances in Nursing Science 8:36-51, 1986.

Campbell, J.C. Prediction of homicide of and by battered women. In: Campbell, J.C., ed. Assessing Dangerousness. Violence by Sexual Offenders, Batterers, and Child Abusers. Thousand Oaks, CA: Sage Publications, Inc., 1995.

The Psychological Maltreatment Of Women Inventory (PMWI)

The PMWI is a 58-item test designed to measure the extent and nature of abuse toward women in a relationship. The questionnaire below is given to women survivors of abuse. The version for male perpetrators includes identical behaviors but reverses the pronouns and direction of abuse.

Women's Scale Items

Table

Women's Scale Items.

The Revised Conflict Tactics Scale (CTS2) (for Couples)

Copyrights

The Revised Conflict Tactics Scale (CTS2) is copyrighted by the test authors and may be reproduced only with their express permission. Permission will be granted on the basis of completing a one-page permission form and signing a user agreement. The agreement commits the user to either (1) carry out and publish, or make available to the test authors, psychometric analyses, including frequency distribution, mean, standard deviation, and alpha coefficient of reliability for each scale; or (2) provide the test authors with the raw data for each subject tested in a form that will enable the test authors to compute these statistics, together with as much demographic information as possible for each subject. The test authors agree to only use this information for psychometric analyses and to acknowledge the source of the data. The user providing the information retains the sole right to use the data for substantive purposes. Copies of the permission form and user agreement are available from Western Psychological Services. Copyright was formerly held by Murray A. Straus, Family Research Laboratory, University of New Hampshire.

All versions of the Revised Conflict Tactics Scales, except the new short form of the CTS2 are on the website http://pubpages.unh.edu/~mas2 The full-length CTS2 is in the appendix to paper CTS15, the CTSPC is in paper CTS17, and adult-recall/child-report versions are in paper CTS24. Many other articles on the CTS, including detailed scoring instructions (paper CTS28), can be downloaded from this website. Please note that permission to reproduce these instruments must be obtained from Western Psychological Services (see below).

WESTERN PSYCHOLOGICAL SERVICES (WPS) is the publisher of all versions of the Revised Conflict Tactics Scales (CTS2 and CTSPC). They provide copies on “Autoscore" forms. These forms permit easy manual scoring of the CTS. They can be ordered from WPS web site using a credit card [www.wpspublish.com] or through the Customer Service Department (phone 1-800-648-8857; FAX 310-478-2061; email custsvc@wpspublish.com).

PERMISSION TO PRINT COPIES. If you need to print the CTS for computer scoring, you must first arrange with Susan Dunn Weinberg of WPS [email: weinberg@wpspublish.com] for licensing and royalty payments for the number of copies you need.

RESEARCH AND EDUCATIONAL DISCOUNTS. WPS offers discounts for scholarly research and training. Contact Susan Dunn Weinberg (Weinberg@wpspublish.com). http://www.wpspublish.com/inetpub4/wo020302.htm#Comment:%20Research%Dicounts

The Revised Conflict Tactics Scale (CTS2) (for Couples)

Table

The Revised Conflict Tactics Scale (CTS2) (for Couples).

Scoring

The principles for scoring the CTS2 have been previously described in the CTS1 manual (Straus, 1995) and in Straus and Gelles (1990). Therefore, only the most basic aspects of scoring are presented here. The reader is referred to these other sources for further information.

The CTS2 is scored by adding the response number (i.e., the number of times something happened) midpoint for each category chosen by the participant. Categories 0, 1, and 2 do not have midpoints, and responses for these categories are scored 0, 1, and 2, respectively. For Category 3 (3-5 times), the midpoint is 4; for Category 4 (6-10 times), the midpoint is 8; and for Category 5 (11-20 times), it is 15. The assigned scores for responses to Categories 3, 4, and 5 are, respectively, 4, 8 , and 15. For Category 6 responses (20 times in the past year), the authors recommend assigning a score of 25.

Responses for Category 7 ("Not in the past year, but it did happen before") may be used in two ways: (1) When scores for the previous year are desired (the usual use of the CTS2), Category 7 is assigned a score of 0; and (2) to obtain a relationship prevalence measure of physical assault (i.e., Did an assault ever occur?), respondents who answer 1-7 are assigned a score of 1 ("yes").

When the CTS2 is used for research with any type of sample except cases known to be violent (e.g., men in a batterer treatment program), the test authors recommend that two variables be created for the physical assault, sexual coercion, and physical injury scales: a prevalence variable and a chronicity variable. The prevalence variable is a 0-or-1 dichotomy, with a score of 1 assigned if one or more of the acts in the scale occurred. The chronicity variable is the number of times the act(s) in the scale occurred among those who engaged in at least one of the acts in the scale. If the CTS2 is used with a person (or group member) who is known to be violent, separate prevalence and chronicity variables are not required because prevalence is already known.

Source

Straus, M.A.; Hamby, S.L.; Boney-McCoy, S.; and Sugarman, D.B. The Revised Conflict Tactics Scale (CTS2): Development and preliminary psychometric data. Journal of Family Issues 17(3):283-316, 1996.

References

Straus, M.A. Manual for the Conflict Tactics Scales. Durham, NH: Family Research Laboratory, University of New Hampshire, 1995.

Straus, M.A., and Gelles, R.J. Physical Violence in American Families: Risk Factors and Adaptations to Violence in 8,145 Families. New Brunswick, NJ: Transaction Publishing, 1990.

Publication Details

Copyright

Publisher

Substance Abuse and Mental Health Services Administration (US), Rockville (MD)

NLM Citation

Center for Substance Abuse Treatment. Substance Abuse Treatment and Domestic Violence. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 1997. (Treatment Improvement Protocol (TIP) Series, No. 25.) Appendix C—Instruments.

Abuse Assessment Screen (English Version)

1.	WITHIN THE LAST YEAR, have you been hit, slapped, kicked, or otherwise physically hurt by someone?	YES	NO
	If YES, by whom?____________________________________
	Total number of times ________________________________
2.	SINCE YOU'VE BEEN PREGNANT, have you been hit, slapped, kicked, or otherwise physically hurt by someone?	YES	NO
	If YES, by whom? ____________________________________
	Total number of times ________________________________
	MARK THE AREA OF INJURY ON THE BODY MAP, SCORE EACH INCIDENT ACCORDING TO THE FOLLOWING SCALE:		SCORE
	1 = Threats of abuse including use of a weapon		_______
	2 = Slapping, pushing; no injuries and/or lasting pain		_______
	3 = Punching, kicking, bruises, cuts and/or continuing pain		_______
	4 = Beating up, severe contusions, burns, broken bones		_______
	5 = Head injury, internal injury, permanent injury		_______
	6 = Use of weapon; wound from weapon		_______
	If any of the descriptions for the higher number apply, use the higher number.
3.	WITHIN THE LAST YEAR, has anyone forced you to have sexual activities?	YES	NO
	If YES, by whom? ___________________________________
Developed by the Nursing Research Consortium on Violence and Abuse.
Reproduced with permission from J. McFarlane & B. Parker (1994). Abuse During Pregnancy: A Protocol for Prevention and Intervention. White Plains, NY: The March of Dimes Birth Defects Foundation, pp. 22-23.

Encuesta Sobre El Maltrato (Spanish Version)

1.	DURANTE EL ÚLTIMO AÑO, fuÉ golpeada, bofeteada, pateada, o lastimada fisicamente de alguna otra manera por alguien?	SI	NO
	Si la respuesta es "SI" por quien(es)?___________________
	Cuantas veces?______________________________________
2.	DESDE QUE SALIO EMBARAZADA, ha sido golpeada, bofeteada, pateada, o lastimada fisicamente de alguna otra manera por alguien?__________________________________	SI	NO
	Si la respuesta es "SI" por quien(es)? ___________________
	Cuantas veces?______________________________________
	EN EL DIAGRAMA ANATÓMICO, MARQUE LAS PARTES DE SU CUERPO QUE HAN SIDO LASTIMADAS. VALORE CADA INCIDENTE USANDO LAS SIGUIENTE ESCALA:		GRADO
	1 = Amenazas de maltrato que incluyen el uso de un arma		_______
	2 = Bofeteadas, permanentel ompujones sin lesiones fisicas o dolor permanente		_______
	3 = Moquestos, patadas, moretones, heridas y/o dolor continuo		_______
	4 = Molida a palos, contusiones severas, quemaduras, fracturas de huesos		_______
	5 = Heridas en la cabeza, lesiones internas, lesiones permanentes		_______
	6 = Uso de armas, herida por arma		_______
	Si cualquiera de las situaciones valora un numero alto en la escala, Úselo.
3.	DURANTE EL ÚLTIMO AÑO, fuÉ forzada a tener relaciones sexuales?	SI	NO
	Si la respuesta es "SI" por quien(es)_____________________
	Cuantas veces?______________________________________

Danger Assessment

Danger Assessment
_______	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 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?
_______		Total "Yes" Answers

Women's Scale Items

Women's Scale Items
How often, if at all, did the behavior described in each item occur in the past six months (never, rarely, sometimes, frequently, or very frequently)?
1.	My partner put down my physical appearance.
2.	My partner insulted me or shamed me in front of others.
3.	My partner treated me like I was stupid.
4.	My partner was insensitive to my feelings.
5.	My partner told me I couldn't manage or take care of myself without him.
6.	My partner put down my care of the children.
7.	My partner criticized the way I took care of the house.
8.	My partner said something to spite me.
9.	My partner brought up something from the past to hurt me.
10.	My partner called me names.
11.	My partner swore at me.
12.	My partner yelled and screamed at me.
13.	My partner treated me like an inferior.
14.	My partner sulked or refused to talk about a problem.
15.	My partner stomped out of the house or yard during a disagreement.
16.	My partner gave me the silent treatment, or acted as if I wasn't there.
17.	My partner withheld affection from me.
18.	My partner did not let me talk about my feelings.
19.	My partner was insensitive to my sexual needs and desires.
20.	My partner demanded obedience to his whims.
21.	My partner became upset if dinner, housework, or laundry was not done when he thought it should be.
22.	My partner acted like I was his personal servant.
23.	My partner did not do a fair share of household tasks.
24.	My partner did not do a fair share of child care.
25.	My partner ordered me around.
26.	My partner monitored my time and made me account for where I was.
27.	My partner was stingy in giving me money to run our home.
28.	My partner acted irresponsibly with our financial resources.
29.	My partner did not contribute enough to supporting our family.
30.	My partner used our money or made important financial decisions without talking to me about it.
31.	My partner kept me from getting medical care that I needed.
32.	My partner was jealous or suspicious of my friends.
33.	My partner was jealous of other men.
34.	My partner did not want me to go to school or other self-improvement activities.
35.	My partner did not want me to socialize with my female friends.
36.	My partner accused me of having an affair with another man.
37.	My partner demanded that I stay home and take care of the children.
38.	My partner tried to keep me from seeing or talking to my family.
39.	My partner interfered in my relationships with other family members.
40.	My partner tried to keep me from doing things to help myself.
41.	My partner restricted my use of the car.
42.	My partner restricted my use of the telephone.
43.	My partner did not allow me to go out of the house when I wanted to go.
44.	My partner refused to let me work outside of the home.
45.	My partner told me my feelings were irrational or crazy.
46.	My partner blamed me for his problems.
47.	My partner tried to turn our family, friends, and children against me.
48.	My partner blamed me for causing his violent behavior.
49.	My partner tried to make me feel like I was crazy.
50.	My partner's moods changed radically, from calm to angry, or vice versa.
51.	My partner blamed me when he was upset about something, even when it had nothing to do with me.
52.	My partner tried to convince my friends, family, or children that I was crazy.
53.	My partner threatened to hurt himself if I left him.
54.	My partner threatened to hurt himself if I didn't do what he wanted me to do.
55.	My partner threatened to have an affair with someone else.
56.	My partner threatened to leave the relationship.
57.	My partner threatened to take the children away from me.
58.	My partner threatened to have me committed to a mental institution.

The Revised Conflict Tactics Scale (CTS2) (for Couples)

Relationship Behaviors
No matter how well a couple gets along, there are times when they disagree, get annoyed with the other person, want different things from each other, or just have spats or fights because they are in a bad mood, are tired, or for some other reason. Couples also have many different ways of trying to settle their differences. This is a list of things that might happen when you have differences. Please circle how many times you did each of these things in the past year, and how many times your partner did them in the past year. If you or your partner did not do one of these things in the past year, but it happened before that, circle "7."
How often did this happen?
1 = Once in the past year		5 = 11-20 times in the past year
2 = Twice in the past year		6 = More than 20 times in the past year
3 = 3-5 times in the past year		7 = Not in the past year, but it did happen before
4 = 6-10 times in the past year		0 = This has never happened
1.	I showed my partner I cared even though we disagreed.	1 2 3 4 5 6	7 0
2.	My partner showed care for me even though we disagreed.	1 2 3 4 5 6	7 0
3.	I explained my side of a disagreement to my partner.	1 2 3 4 5 6	7 0
4.	My partner explained his or her side of a disagreement to me.	1 2 3 4 5 6	7 0
5.	I insulted or swore at my partner.	1 2 3 4 5 6	7 0
6.	My partner did this to me.	1 2 3 4 5 6	7 0
7.	I threw something at my partner that could hurt.	1 2 3 4 5 6	7 0
8.	My partner did this to me.	1 2 3 4 5 6	7 0
9.	I twisted my partner's arm or hair.	1 2 3 4 5 6	7 0
10.	My partner did this to me.	1 2 3 4 5 6	7 0
11.	I had a sprain, bruise, or small cut because of a fight with my partner.	1 2 3 4 5 6	7 0
12.	My partner had a sprain, bruise, or small cut because of a fight with me.	1 2 3 4 5 6	7 0
13.	I showed respect for my partner's feelings about an issue.	1 2 3 4 5 6	7 0
14.	My partner showed respect for my feelings about an issue.	1 2 3 4 5 6	7 0
15.	I made my partner have sex without a condom.	1 2 3 4 5 6	7 0
16.	My partner did this to me.	1 2 3 4 5 6	7 0
17.	I pushed or shoved my partner.	1 2 3 4 5 6	7 0
18.	My partner did this to me.	1 2 3 4 5 6	7 0
19.	I used force (like hitting, holding down, or using a weapon) to make my partner have oral or anal sex.	1 2 3 4 5 6	7 0
20.	My partner did this to me.	1 2 3 4 5 6	7 0
21.	I used a knife or gun on my partner.	1 2 3 4 5 6	7 0
22.	My partner did this to me.	1 2 3 4 5 6	7 0
23.	I passed out from being hit on the head by my partner in a fight.	1 2 3 4 5 6	7 0
24.	My partner passed out from being hit on the head in a fight with me.	1 2 3 4 5 6	7 0
25.	I called my partner fat or ugly.	1 2 3 4 5 6	7 0
26.	My partner called me fat or ugly.	1 2 3 4 5 6	7 0
27.	I punched or hit my partner with something that could hurt.	1 2 3 4 5 6	7 0
28.	My partner did this to me.	1 2 3 4 5 6	7 0
29.	I destroyed something belonging to my partner.	1 2 3 4 5 6	7 0
30.	My partner did this to me.	1 2 3 4 5 6	7 0
31.	I went to a doctor because of a fight with my partner.	1 2 3 4 5 6	7 0
32.	My partner went to a doctor because of a fight with me.	1 2 3 4 5 6	7 0
33.	I choked my partner.	1 2 3 4 5 6	7 0
34.	My partner did this to me.	1 2 3 4 5 6	7 0
35.	I shouted or yelled at my partner.	1 2 3 4 5 6	7 0
36.	My partner did this to me.	1 2 3 4 5 6	7 0
37.	I slammed my partner against a wall.	1 2 3 4 5 6	7 0
38.	My partner did this to me.	1 2 3 4 5 6	7 0
39.	I said I was sure we could work out a problem.	1 2 3 4 5 6	7 0
40.	My partner was sure we could work it out.	1 2 3 4 5 6	7 0
41.	I needed to see a doctor because of a fight with my partner, but I didn't.	1 2 3 4 5 6	7 0
42.	My partner needed to see a doctor because of a fight with me, but didn't.	1 2 3 4 5 6	7 0
43.	I beat up my partner.	1 2 3 4 5 6	7 0
44.	My partner did this to me.	1 2 3 4 5 6	7 0
45.	I grabbed my partner.	1 2 3 4 5 6	7 0
46.	My partner did this to me.	1 2 3 4 5 6	7 0
47.	I used force (like hitting, holding down, or using a weapon) to make my partner have sex.	1 2 3 4 5 6	7 0
48.	My partner did this to me.	1 2 3 4 5 6	7 0
49.	I stomped out of the room or house or yard during a disagreement.	1 2 3 4 5 6	7 0
50.	My partner did this to me.	1 2 3 4 5 6	7 0
51.	I insisted on sex when my partner did not want to (but did not use physical force).	1 2 3 4 5 6	7 0
52.	My partner did this to me.	1 2 3 4 5 6	7 0
53.	I slapped my partner.	1 2 3 4 5 6	7 0
54.	My partner did this to me.	1 2 3 4 5 6	7 0
55.	I had a broken bone from a fight with my partner.	1 2 3 4 5 6	7 0
56.	My partner had a broken bone from a fight with me.	1 2 3 4 5 6	7 0
57.	I used threats to make my partner have oral or anal sex.	1 2 3 4 5 6	7 0
58.	My partner did this to me.	1 2 3 4 5 6	7 0
59.	I suggested a compromise to a disagreement.	1 2 3 4 5 6	7 0
60.	My partner did this to me.	1 2 3 4 5 6	7 0
61.	I burned or scalded my partner on purpose.	1 2 3 4 5 6	7 0
62.	My partner did this to me.	1 2 3 4 5 6	7 0
63.	I insisted my partner have oral or anal sex (but did not use physical force).	1 2 3 4 5 6	7 0
64.	My partner did this to me.	1 2 3 4 5 6	7 0
65.	I accused my partner of being a lousy lover.	1 2 3 4 5 6	7 0
66.	My partner accused me of this.	1 2 3 4 5 6	7 0
67.	I did something to spite my partner.	1 2 3 4 5 6	7 0
68.	My partner did this to me.	1 2 3 4 5 6	7 0
69.	I threatened to hit or throw something at my partner.	1 2 3 4 5 6	7 0
70.	My partner did this to me.	1 2 3 4 5 6	7 0
71.	I felt physical pain that still hurt the next day because of a fight with my partner.	1 2 3 4 5 6	7 0
72.	My partner still felt physical pain the next day because of a fight we had.	1 2 3 4 5 6	7 0
73.	I kicked my partner.	1 2 3 4 5 6	7 0
74.	My partner did this to me.	1 2 3 4 5 6	7 0
75.	I used threats to make my partner have sex.	1 2 3 4 5 6	7 0
76.	My partner did this to me.	1 2 3 4 5 6	7 0
77.	I agreed to try a solution to a disagreement my partner suggested.	1 2 3 4 5 6	7 0
78.	My partner agreed to try a solution I suggested.	1 2 3 4 5 6	7 0