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Wayne County Children's Advocacy Center
1761 Beall Avenue
Wooster, Ohio 44691


RE: Family Justice Center Survey

Dear Wayne County Resident:

The Wayne County Family Justice Center Task Force is attempting to assess the prevalence of domestic violence within Wayne County. We are also looking at the services that are currently available to individuals, families, and children and how effective they are in addressing the issue of domestic violence. We hope to identify areas that need attention, and strengthen service delivery to the community.

Domestic violence and emotional abuse are behaviors used by one person in a relationship to control the other. Partners may be married or not married; heterosexual, gay, or lesbian; living together, separated or dating.

Examples of domestic violence include:

actual or threatened physical harm
withholding money
sexual assault/unwanted or forced sexual activity
stalking
intimidation
keeping a partner from contacting their family or friends
stopping a partner from getting or keeping a job
emotional/verbal abuse
name-calling or put downs
*(Domesticviolence.org, 2010)

Please complete the survey below. Your responses will help our evaluation. Most people are able to complete the survey in less than ten minutes. Your response and any comments will be treated with the utmost confidentiality.

Sincerely,

Members of the Wayne County Family Justice Center Task Force

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* 1. Gender

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* 2. Age

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* 3. Please select all that apply
Race:

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* 4. Please select all that apply
Ethnicity:

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* 5. Please select all that apply
Religion:

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* 6. Relationship Status

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* 7. Domestic violence and emotional abuse are behaviors used by one person in a relationship to control the other. Please answer the following questions related to domestic violence.

  Yes No Not sure
Someone close to me is/has been a victim of domestic violence.
I am/was a victim of domestic violence.
My children have been witness to domestic violence.
My children are/have been victims of domestic violence.
I am/have been involved with children services or adult protective services because of domestic violence.
I have reported domestic violence to the police.
I have not reported domestic violence to the police.

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* 8. Resources
Please answer the following questions related to domestic violence services.

  Strongly Agree Agree Neutral Disagree Strongly Disagree N/A
I know where to go to get help for domestic violence.
If you and/or your child(ren) were in need of services as a victim(s) of domestic violence, they were easily accessible.
I am satisfied with the resources available to help me.
I am satisfied with the way my situation was handled.

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* 9. How many places did you need to contact or go to in order to meet yours and/or your family's needs?

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* 10. Please list the names of the places you contacted, if applicable.

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