NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.
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.)
Name:_________________________
Date:__________________________
Review Dates:____________________
________________________
Personalized Safety Plan
| The following steps represent my plan for increasing my safety and preparing in advance for the possibility for further violence. Although I do not have control over my partner's violence, I do have a choice about how to respond to him/her and how to best get myself and my children to safety. | |
| Step 1: Safety during a violent incident. Women cannot always avoid violent incidents. In order to increase safety, battered women may use a variety of strategies. | |
| I can use some or all of the following strategies: | |
| A. | If I decide to leave, I will ______________________. (Practice how to get out safely. What doors, windows, elevators, stairwells, or fire escapes would you use?) |
| B. | I can keep my purse and car keys ready and put them (place) ____________________ in order to leave quickly. |
| C. | I can tell ____________________ about the violence and request they call the police if they hear suspicious noises coming from my house.
I can also tell ___________________________________ about the violence and request they call the police if they hear suspicious noises coming from my house. |
| D. | I can teach my children how to use the telephone to contact the police and the fire department. |
| E. | I will use __________________________ as my code word with my children or my friends so they can call for help. |
| F. | If I have to leave my home, I will go ___________________________. (Decide this even if you don't think there will be a next time.)
If I cannot go to the location above, then I can go to _____________________________ or _______________________. |
| G. | I can also teach some of these strategies to some/all of my children. |
| H. | When I expect we are going to have an argument, I will try to move to a space that is lowest risk, such as _______________________________________________. (Try to avoid arguments in the bathroom, garage, kitchens, near weapons or in rooms without access to an outside door.) |
| I. | I will use my judgment and intuition. If the situation is very serious, I can give my partner what he/she wants to calm him/her down. I have to protect myself until I/we are out of danger. |
| Step 2: Safety when preparing to leave. Battered women frequently leave the residence they share with the battering partner. Leaving must be done with a careful plan in order to increase safety. Batterers often strike back when they believe that a battered woman is leaving a relationship. | |
| I can use some or all of the following safety strategies: | |
| A. | I will leave money and an extra set of keys with ____________________ so I can leave quickly. |
| B. | I will keep copies of important documents or keys at ___________________________. |
| C. | I will open a savings account by ______________________ (date), to increase my independence. |
| D. | Other things I can do to increase my independence include: ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ |
| E. | The domestic violence program's hotline number is ________________________. I can seek shelter by calling this hotline. |
| F. | I can keep change for phone calls on me at all times. I understand that if I use my telephone credit card, the following month the telephone bill will tell my batterer those numbers that I called after I left. To keep my telephone communications confidential, I must either use coins or I might get a friend to permit me to use their telephone credit card for a limited time when I first leave. |
| G. | I will check with ___________________ and ___________________ to see who would be able to let me stay with them or lend me some money. |
| H. | I can leave extra clothes with _____________________________________________. |
| I. | I will sit down and review my safety plan every ____________________________ in order to plan the safest way to leave the residence. ____________________________ (domestic violence advocate or friend) has agreed to help me review this plan. |
| J. | I will rehearse my escape plan and, as appropriate, practice it with my children. |
| Step 3: Safety in my own residence. There are many things that a woman can do to increase her safety in her own residence. It may impossible to do everything at once, but safety measures can be added step by step. | |
| Safety measures I can use include: | |
| A. | I can change the locks on my doors and windows as soon as possible. |
| B. | I can replace wooden doors with steel/metal doors. |
| C. | I can install security systems including additional locks, window bars, poles to wedge against doors, an electronic system, etc. |
| D. | I can purchase rope ladders to be used for escape from second floor windows. |
| E. | I can install smoke detectors and purchase fire extinguishers for each floor in my house/apartment. |
| F. | I can install an outside lighting system that lights up when a person is coming close to my house. |
| G. | I will teach my children how to use the telephone to make a collect call to me and to (friend/minister/other) in the event that my partner takes the children. |
| H. | I will tell people who take care of my children which people have permission to pick up my children and that my partner is not permitted to do so.
The people I will inform about pick-up permission include ___________________________________________________________ (school), _____________________________________________________ (day care staff), ________________________________________________________ (babysitter), _____________________________________________ (Sunday school teacher), __________________________________________________________ (teacher), _______________________________________________________ and (others). |
| I. | I can inform ________________________________________________ (neighbor), ________________________________ (pastor), and _________________________ (friend) that my partner no longer resides with me and they should call the police if he is observed near my residence. |
| Step 4: Safety with a protection order. Many batterers obey protection orders, but one can never be sure which violent partner will obey and which will violate protection orders. I recognize that I may need to ask the police and the courts to enforce my protection order. | |
| The following are some steps that I can take to help the enforcement of my protection order: | |
| A. | I will keep my protection order _________________________ (location). (Always keep it on or near your person. If you change purses, that's the first thing that should go in.) |
| B. | I will give my protection order to police departments in the community where I work, in those communities where I usually visit family or friends, and in the community where I live. |
| C. | There should be a county registry of protection orders that all police departments can call to confirm a protection order. I can check to make sure that my order is in the registry. The telephone number for the county registry of protection orders is __________________. |
| D. | For further safety, if I often visit other counties in my state, I might file my protection order with the court in those counties. I will register my protection order in the following counties: __________________, __________________________, and _________________________. |
| E. | I can call the local domestic violence program if I am not sure about B, C, or D above or if I have some problem with my protection order. |
| F. | I will inform my employer, my minister, my closest friend and ___________________ and _____________________ that I have a protection order in effect. |
| G. | If my partner destroys my protection order, I can get another copy from the courthouse by going to [the office] located at __________________________ |
| H. | If my partner violates the protection order, I can call the police and report a violation, contact my attorney, call my advocate, and/or advise the court of the violation. |
| I. | If the police do not help, I can contact my advocate or attorney and will file a complaint with the chief of the police department. |
| J. | I can also file a private criminal complaint with the district justice in the jurisdiction where the violation occurred or with the district attorney. I can charge my battering partner with a violation of the protection order and all the crimes that he commits in violating the order. I can call the domestic violence advocate to help me with this. |
| Step 5: Safety on the job and in public. Each battered woman must decide if and when she will tell others that her partner has battered her and that she may be at continued risk. Friends, family and coworkers can help to protect women. Each woman should consider carefully which people to invite to help secure her safety. | |
| I might do any or all of the following: | |
| A. | I can inform my boss, the security supervisor and _____________________________ at work of my situation. |
| B. | I can ask ________________________________________ to help screen my telephone calls at work. |
| C. | When leaving work, I can _______________________________________________. |
| D. | When driving home if problems occur, I can _________________________________. |
| E. | If I use public transit, I can ______________________________________________. |
| F. | I can use different grocery stores and shopping malls to conduct my business and shop at hours that are different than those when residing with my battering partner. |
| G. | I can use a different bank and take care of my banking at hours different from those I used when residing with my battering partner. |
| H. | I can also __________________________________________________________. |
| Step 6: Safety and drug or alcohol use. Most people in this culture use alcohol. Many use mood-altering drugs. Much of this use is legal and some is not. The legal outcomes of using illegal drugs can be very hard on a battered woman, may hurt her relationship with her children and put her at a disadvantage in other legal actions with her battering partner. Therefore, women should carefully consider the potential cost of the use of illegal drugs. But beyond this, the use of any alcohol or other drugs can reduce a woman's awareness and ability to act quickly to protect herself from her battering partner. Furthermore, the use of alcohol or other drugs by the batterer may give him/her an excuse to use violence. Therefore, in the context of drug or alcohol use, a woman needs to make specific safety plans. | |
| If drug or alcohol use has occurred in my relationship with the battering partner, I can enhance my safety by some or all of the following: | |
| A. | If I am going to use, I can do so in a safe place and with people who understand the risk of violence and are committed to my safety. |
| B. | I can also _______________________________________________________. |
| C. | If my partner is using, I can _______________________________________. |
| D. | I might also _____________________________________________________. |
| E. | To safeguard my children, I might _________________________________ and _________________________. |
| Step 7: Safety and my emotional health. The experience of being battered and verbally degraded by partners is usually exhausting and emotionally draining. The process of building a new life for myself takes much courage and incredible energy. | |
| To conserve my emotional energy and resources and to avoid hard emotional times, I can do some of the following: | |
| A. | If I feel down and ready to return to a potentially abusive situation, I can ______________________________. |
| B. | When I have to communicate with my partner in person or by telephone, I can _________________________________________________________. |
| C. | I can try to use "I can . . ." statements with myself and to be assertive with others. |
| D. | I can tell myself, "____________________________________________" whenever I feel others are trying to control or abuse me. |
| E. | I can read ___________________________ to help me feel stronger. |
| F. | I can call ______________________________, ______________________________ and _______________________________ as other resources to be of support to me. |
| G. | Other things I can do to help me feel stronger are _______________________, ____________________, and __________________________________. |
| H. | I can attend workshops and support groups at the domestic violence program or __________________________________, __________________________ , or _________________________________ to gain support and strengthen my relationships with other people. |
| Step 8: Items to take when leaving. When women leave partners, it is important to take certain items with them. Beyond this, women sometimes give an extra copy of papers and an extra set of clothing to a friend just in case they have to leave quickly. | |
| Items with asterisks on the following list are the most important to take. If there is time, the other items might be taken, or stored outside the home. | |
| These items might best be placed in one location, so that if we have to leave in a hurry, I can grab them quickly. | |
| When I leave, I should take: | |
| * | Identification for myself |
| * | Children's birth certificates |
| * | My birth certificate |
| * | Social Security cards |
| * | School and vaccination records |
| * | Money |
| * | Checkbook, ATM (Automatic Teller Machine) card |
| * | Credit cards |
| * | Keys-house/car/office |
| * | Driver's license and registration |
| * | Medications |
| Welfare identification | |
| Work permits | |
| Green card | |
| Passport(s) | |
| Divorce papers | |
| Medical records-for all family members | |
| Lease/rental agreement, house deed, mortgage payment book | |
| Bank books | |
| Insurance papers | |
| Small saleable objects | |
| Address book | |
| Pictures | |
| Jewelry | |
| Children's favorite toys and/or blankets | |
| Items of special sentimental value | |
Telephone Numbers I Need to Know
| Police department-home | ________________________ |
| Police department-school | ________________________ |
| Police department-work | ________________________ |
| Battered women's program | ________________________ |
| County registry of protection orders | ________________________ |
| Work number | ________________________ |
| Supervisor's home number | ________________________ |
| Minister | ________________________ |
| Other | ________________________ |
Reproduced with permission from Barbara Hart and Jane Stuehling, Pennsylvania Coalition Against Domestic Violence, Harrisburg, Pennsylvania, 1992.
Adapted from "Personalized Safety Plan," Office of the City Attorney, City of San Diego, California, April 1990.
- Appendix D—Sample Personalized Safety Plan For Domestic Violence Survivors - Sub...Appendix D—Sample Personalized Safety Plan For Domestic Violence Survivors - Substance Abuse Treatment and Domestic Violence
- Autosomal dominant nonsyndromic hearing loss 68Autosomal dominant nonsyndromic hearing loss 68MedGen
- C4225240[conceptid] (1)MedGen
Your browsing activity is empty.
Activity recording is turned off.
See more...