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questionnaire

Safe Speak and other groups are working to improve the support we can offer young people affected by domestic abuse.

To do this we need to know how big the problem is in Derbyshire. You can help us by filling in this questionnaire. We want the views of all young people, so fill it in even if domestic abuse does not affect you personally.

The questionnaire is anonymous, so nobody can link your answers to you.

If you need help about domestic abuse or another issue, contact one of the groups or sites on the Help page on this site

1 How old are you?
 
2 Are you…
  Male Female
3 Town or area of Derbyshire you live in
 
4 Had you heard of domestic abuse before you read this info?
  Yes No
5 Did you know what domestic abuse meant before you read the info on this site?
  Yes No
Where did you find out about it?
6 Do you feel safe at home?
  Yes No
Why?
Why?
7 Do you feel safe in your neighbourhood?
  Yes No
Why?
Why?
8 Has domestic abuse ever happened in your home?
(Remember this questionnaire is anonymous)
  Yes No
Go to question 9

Tick if someone in your home has... (you can tick more than one)

Deliberately hurt another, by hitting, slapping, kicking, burning or some other physical way
Done stuff that makes another person at home feel threatened or scared
Regularly used put downs or name calling towards another person
Threatened to hurt one of the children to get their way
Made someone do sexual stuff they didn't want, like touching or rape or watching pornography

Tick if someone in your home has... (you can tick more than one)
Heard domestic abuse in your home
Seen domestic abuse in your home

9 Do you know anyone who has experienced domestic abuse?(Remember this questionnaire is anonymous)
  Yes No
Go to question 12

Tick whether this was... (you can tick more than one)

You
One of your parents or your step-parent
Other member of your family
A friend
A neighbour
A person not in this list

10 What abuse was happening in this person’s home?
 

Deliberately hurt another, by hitting, slapping, kicking, burning or some other physical way
Did stuff that made another person at home feel threatened or scared
Regularly used put downs or name calling towards another person
Threatened to hurt one of the children to get their way
Threatened to hurt a pet to get their way
Made someone do sexual stuff they didn't want,like touching or rape or watching pornography

Tick if someone you know has…(you can tick more than one)
Heard domestic abuse in their home
Seen domestic abuse in their home

11 If you or someone you know has experienced domestic abuse, did anyone try to get help?
  Yes No
Go to question 12

Tick if this was...

Phoneline offering info and advice
 Phoneline offering listening and support
Website offering info
On-line counselling or support
Someone to talk to that they knew well, like a relative or friend
Someone else to talk to, like a teacher or another adult
A counsellor to meet with face-to-face
Leaflets offering info
Other - please say what...
12 What kind of help do you think is most useful for people who have experienced domestic abuse? (You can tick more than one box)
 

Phoneline offering info and advice
Phoneline offering listening and support
Website offering info
On-line counselling or support
Someone to talk to that they knew well, like a relative or friend
Someone else to talk to, like a teacher or another adult
A counsellor to meet with face-to-face
Leaflets offering info
Other - please say what...

13 If you were experiencing domestic abuse, what do you think might stop you asking for help?
 
14 What would you do if a friend or relation was experiencing domestic abuse?
 
15 Any other comments you want to make?
 

Thanks for filling this in. Remember there are many ways to get support and more information about domestic abuse. Lots are listed on the Help page on this site. Please click the send button…

Development of this site has been funded by: BBC Children in Need and the Local Network Fund as part of Safe Speak’s work to raise awareness of Domestic Abuse.
Produced with the support of the Domestic Abuse Support Service