Clinical Templates and Resources

Intimate Partner Violence Questionnaire

1.Women Abuse Screening Tool (WAST): here, here 

The WAST screening tool is well-utilized, is significant and valid tool with high reliability and internal consistency.

2. SAFE: here

SAFE screening questionnaire uses a simple 4-question assessment that providers can utilize at a point of care to screen for violence. Questioning proceeds from open questions to more focused questions that help foster a therapeutic physician-patient relationship which builds the trust required for disclosure.

3. Canadian Centers for Disease Control: Intimate Partner Violence and Sexual Violence Victimization Assessment Instruments for Use in Healthcare Settings:  here 

This document is a compilation of existing tools for assessing intimate partner violence (IPV) and sexual violence (SV) victimization (defined below) in clinical/healthcare settings.The purpose of this compilation of assessment instruments is: 1) to provide practitioners and clinicians with the most current inventory of assessment tools for determining IPV and/or SV victimization and 2) to supply information on the psychometric properties of these instruments, when available, to inform decisions about which instruments are most appropriate for use with a given population. This document should serve as a guide to aid in the selection of assessment instruments for use in health care settings to identify victims requiring additional services. This identification can help practitioners make appropriate referrals for both victims and perpetrators

  1. Ontario College of Family Physicians Screening : here

The Ontario College of Family Physicians provides facilitator notes for educating further physicians and care providers in screening for violence.

5. Trauma Informed Practice Guide: here

The Trauma-Informed Practice (TIP) Guide was developed collaboratively to support the application of trauma-informed principles into practice and policy, by clinics, agencies and groups assisting clients with mental health and substance use concerns in British Columbia.

Clinical Templates

1.Children Protection Body Map: here

A child protection body map is used to record information about physical injuries to a child, particularly if it is felt that the injury is non-accidental or thought to be following a pattern. The body map provides a visual record of physical abuse and helps professionals to work together when deciding whether there is a safeguarding concern.

2. SOGC Intimate Partner Violence Consensus Statement – Appendix A-E including environmental checklist, Body Map, Screening questionnaires: here

Objective: To provide health care providers with a summary of current knowledge on intimate partner violence (IPV) and to propose recommendations for best practices. To provide tools and resources to support interventions. Aims to optimizing provider skills in assessing for intimate partner violence (IPV) and responding to disclosure, promoting institutional and community coordination in a public health approach, and improving safety and health for all women.

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