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Domestic abuse service user questionnaire
We are asking you to complete this short form, about your experience of contacting agencies about any domestic abuse you have experienced. Your responses will help us to improve our services to meet your needs.
As well as asking you about services, we have included a few questions about you, because we want to know that our services are inclusive and open to everyone who wants to use them.
We will treat any information you provide as confidential but will be used for research and statistical purposes.
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About you
How would you describe your gender?
Choose
Female
Male
Female Transgender
Male Transgender
Gender Queer
Rather not say
Other
Age group
Choose
16 - 25
26 - 35
36 - 45
46 - 55
56 - 65
66 +
Rather not say
How would you describe your ethnicity?
Choose one option that best describes your ethnic group or background
Choose
English/Welsh/Scottish/Northern Irish/British
Black British
Irish
Gypsy or Irish Traveller
Any other White background, please describe
White and Black Caribbean
White and Black African
White and Asian
Indian
Pakistani
Bangladeshi
Chinese
African
Caribbean
Arab
European
How would you describe your sexual identity?
Choose
Straight/ Heterosexual
Gay
Lesbian
Bisexual
Asexual
Rather not say
Other
What is your religion?
Choose
No religion
Christian (including Church of England, Catholic, Protestant and all other Christian denominations)
Buddhist
Hindu
Jewish
Muslim
Sikh
About the Domestic Abuse
What type of domestic violence or abuse did you/are you experiencing?
Please tick all the types you have experienced
Physical (hurting you in anyway physically)
Financial (not letting you have access to money/ taking all the money/ making you pay for everything/ making you account for all money spent/ going into debt because of the abuse/running up debt in your name)
Emotional & psychological (Making you feel bad/ name calling/ isolation/ taking away you self esteem and confidence/ accusing you of having affairs/ threats to hurt you or someone close to you/denying or blaming someone or something else fro the abuse)
Sexual (rape, Revenge Porn, sexual name calling, putting emotional pressure on you for sex)
Forced marriage (physical or emotional pressure to marry/ taking you overseas to marry/ consequences if you refuse marriage/ feeling like you have to say yes for your family)
So called 'honour' based violence(Not allowed to divorce/ forced to divorce/ called too westernised/told you are bringing shame to the family/ more than one person involved/ religion and culture used to restrict your actions)
Stalking (following you, sending texts/email/messages when asked not to)
Coercive Control (Unreasonable and non-negotiable demands, isolating a person from their friends and family, depriving them of their basic needs, monitoring their time & activities)
What area did you live in when you experienced the abuse?
Please tick the local authority, who you pay your council tax to
Bolton
Bury
Manchester
Oldham
Rochdale
Salford
Stockport
Tameside
Trafford
Wigan
Other:
When did you experience the violence or abuse?
Choose
It's still happening
Less than six months ago
Less than a year ago
More than a year ago
More than two years ago
About the agencies
Which agencies have you been in contact with?
please tick all the agencies that you have had contacted with in relation to the domestic abuse etc.
Police (999 call out, front office staff, Domestic Violence Unit , PCSO)
Housing (Housing association)
Health (GP, Hospital, Midwife, Dentist)
Childrens Social Services
Legal (e.g. solicitor)
Adult Social Services
Greater Manchester Women's Domestic Abuse Helpline
Other domestic abuse helpline
Local domestic abuse service
Saheli
Manchester Women's Aid
LGBT Foundation
YPSF
Broken Rainbow
IDVA
Relate
None
Other:
If you had no contact with agencies, why not?
Your answer
When you had involvement with the agencies, how did that come about?
I rang for help
Someone else rang for help (friend, neighbor or family)
An agency that has become involved becuse of police call out
An agency became involved because of children
Safeguarding concerns
When you called initially, what help were looking for?
If you called the agency yourself what was it you were hoping to get from the call?
Emergency help (police call out due to attack, ambulance call out due to injury)
Moving away from the abuse, looking for refuge
Housing advice (wanting to find out if abuser can be removed)
Financial advice
Emotional support
Safety advice
Child contact
Immigration advice
Group work
Not applicable
Other:
Which of the services that you contacted did you feel was most helpful ?
You might have had contact with a range of people or services and we are interested in who you found most helpful, Please write the name of the agency
Your answer
What was your experience of this agency?
eg: did they have a good attitude, offered emotional support, gave helpful advice, practical help, felt safer
Your answer
We are interested in your experience of the support you have been offered by this service.
please tick any of these that you feel apply
I have a greater knowledge of domestic abuse
The service has enabled me to deal with education or employment issues
The service has enabled me to deal with legal issues
The service has enabled me to deal with housing problems
The service has enabled me to deal with finances or benefits issues
The service has enabled me to deal with other practical needs
I have been supported to access other services where needed
The service listened to me and believed me
The service treated me with respect
Staff at the service have been respectful of my identity (e.g. my gender, race, age, sexual orientation, disability, faith)
The service was knowledgeable and competent
The service made me feel safe to talk about my experiences of abuse and violence
I have been given choices about the support I receive
Other:
Overall, do you feel that your life has improved as a result of your contact with services?
Choose
Yes
No
Stayed the same
What could have made things better?
eg: other services offered, quicker response for support, easier to access
Your answer
Which of the services that you contacted did you feel could have been improved?
You might have had contact with a range of people or services and we are interested in which service you felt could have improved their service, Please write the name of the agency
Your answer
What was your experience of this agency?
Poor attuitdude, poor advice, abusive response (e.g. racist or homophobic language), action taken was unhelpful or put you at risk
Your answer
Overall, do you feel that your life has improved as a result of your contact with services?
Choose
Yes
No
Stayed the same
What could have made things better?
eg: other services offered, quicker response for support
Your answer
We are interested in finding out about barriers that prevent people experiencing domestic abuse in seeking help
Fear of children being taken away
Fear of further abuse or violence/ reprisals
Losing control of what happens
Fear of not being believed
Not wanting other people to find out about the abuse
Fear of unknown
Immigration status being threatened
No Recourse to Public Funds (NRPF)
Are there any other comments that you want to make about your experience of domestic abuse and the agencies involved?
Your answer
Thank you for taking the time to complete this form.
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