The SAFE questionnaire is based on a mnemonic for screening a patient for domestic violence. This can help identify patients who may require further evaluation.
Components:
(1) S = stress and safety (items 1 and 2)
(2) A = afraid or abused (items 3 and 4)
(3) F = friends and family (items 5 and 6)
(4) E = emergency escape (items 7 and 8)
Questions to identify possible abuse: 1 to 4
Questions about resources and support: 5 to 8
where:
• I rephrased the second questions for implementation to: "Do you feel safe when you disagree or argue with your significant other?"
• I split the seventh question into 2: "Are you in danger now?" and "Would you like to go to a shelter or talk with someone?"
Interpretation:
• One or more affirmative answers in the first group should prompt further questions.
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