DV Core Competencies Worksheet
  Please complete and submit this Worksheet in order to successfully meet the requirements of this Module.
  Please be advised that your responses here will be confidential.  However, in order to assist in that effort, please follow the instructions below closely.  
  Also, be sure to click on the "SUBMIT" Button at the bottom of this Worksheet after you have completed all items, and before you exit this page so that your Response will be counted.
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  Please respond to the following items Truthfully and Thoughtfully.
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Email *
Please type in the first 3 letters of your first name.   *
Please type in the first 3 letters of your last name.   *
What year were you born?   *
Date of this Session related to this Worksheet?  (If there was no Session, please just put in today's date): *
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Time of the Session related to this Worksheet?  (If there was no Session, please just put in today's date): *
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Which type of Session did you do that relates directly to this Worksheet? *
Where do you usually attend Sessions? *
Please Note: The DVOMB Core Competencies are a Mandatory Requirement for DV Offenders in Colorado.  The State Agency that manages DV Offender Treatment mandates that every DV Offender be required to master the following Core Competencies before he or she can be successfully discharged from DV Offender Treatment.  PLEASE CAREFULLY READ the Instructions Below:
  Please read each one of the DVOMB Core Competencies (below), and underneath each one, please describe what this Core Competency means to you in terms of how it could relate to you never again having DV-Type Thinking, DV-Type Feelings, DV-Type Behavior or a DV-Related Offense.  How could this Core Competency Help PREVENT DV?  Whatever you do, DO NOT write "N/A or Not Applicable or None, or Does not Apply to me, or Never did this...." underneath any of these Core Competencies as listed below.  What you need to do here is to demonstrate by your answers how each one of these Core Competencies below has been mastered by you, regardless of the nature of your DV-Related Offense; or how your DV Offense relates to the Core Competency.
PLEASE CAREFULLY READ the Instructions Below:
  Please read each one of the DVOMB Core Competencies (below), and underneath each one, please describe what this Core Competency means to you in terms of how it could relate to you never again having DV-Type Thinking, DV-Type Feelings, DV-Type Behavior or a DV-Related Offense.  In other words, how could this Core Competency Help PREVENT DV?
  Whatever you do, DO NOT put a check-mark or write "N/A or Not Applicable or None, or Does not Apply to me, or Never did this.... ,or I understand this Competency" on this list below.  
  Instead, what you need to do here is to demonstrate by your answers how each one of these Core Competencies below has been mastered by you, regardless of the nature of your DV-Related Offense; or how your DV Offense relates to the Core Competency.
  And this can be done by write just a couple of sentences under each one that demonstrates: A) That you understand what this Competency is about; and (B) That you are capable of using this Core Competency in your Relationships.
 
  In short, all you really need to do is to simply try to write a sentence with the primary Competency Terms in the Sentence.
  For example, if I was completing a Sentence related to the Personal Change Plan Competency, I could write: "My Personal Change Plan essentially includes themes such as ways to prevent Domestic Violence in my future."
A.   Elimination of Abusive Behavior  _______1. Offender commits to the elimination of abusive behavior:  _______2. Eliminates the use of physical intimidation, psychological cruelty, or coercion toward one’s partner or children. *
B.   Demonstration of Change  _______1. Offender demonstrates change by working on the comprehensive personal change plan:  _______2. Begins implementing portions of the personal change plan;  _______3. Accepts that working on abuse related issues and monitoring them is an ongoing process;  _______4. Begins designing an Aftercare Plan;  _______5. Completes an Aftercare Plan and is prepared to implement this plan after discharge from treatment *
C.   Personal Change Plan _______1. Offender completes a comprehensive Personal Change Plan: _______2. Reflects the level of treatment and has been reviewed and approved by the MTT; _______3. Driven by the offender’s risk and level of treatment *
D.   Empathy  _______1.  Offender development of empathy: Recognizes and verbalizes the effects of one’s actions on one’s partner/victim; _______2.  Recognizes and verbalizes the effects on children and other secondary and tertiary victims such as neighbors, family, friends, and professionals; _______3.  Offers helpful, compassionate response to others without turning attention back on self *
E.   Responsibility _______1. Offender accepts full responsibility for the offense and abusive history; _______2. Discloses the history of physical and psychological abuse toward the offender’s victim(s) and children; _______3. Overcomes the denial and minimization that accompany abusive behavior; _______4. Makes increasing disclosures over time; _______5. Accepts responsibility for the impact of one’s abusive behavior on secondary, tertiary victims and the community; _______6. Recognizes that abusive behavior is unacceptable (abuse wrong-no excuses or justifications-no blaming) *
F.   Understanding of offense, pattern of power and control, cultural context _______1. Offender identifies and progressively reduces pattern of power and control behaviors, beliefs, and attitudes of entitlement: _______2. Recognizes that the violence was made possible by a larger context of the offender’s behaviors and attitudes; _______3. Identifies the specific forms of day-to-day abuse and control, such as isolation that have been utilized, as well as the underlying outlook and excuses that drove those behaviors; _______4. Demonstrate behaviors, attitudes and beliefs congruent with equality and respect in personal relationship *
G.   Offender Accountability _______1. Accepts responsibility for one’s abusive behaviors, _______2. Accepts the consequences of those abusive behaviors, _______3. Actively works to repair the harm, and prevent future abusive behavior; _______4.  Taking corrective actions to foster safety and health for the victim   *
--- A.   Recognizes and eliminates all minimizations of abusive behavior and without prompts identifies one’s own abusive behaviors   *
--- B.   Demonstrates full ownership for his/her actions and accepts the consequences of these actions: The offender demonstrates an understanding of patterns for past abusive actions and acknowledges the need to plan for future self-management and further agrees to create the structure that makes accountability possible   *
--- C.  The offender accepts that their partner or former partner and their children may continue to challenge them regarding past or current behaviors.  Should they behave abusively in the future, they consider it their responsibility to report those behaviors honestly to their friends and relatives, to their probation officer, and to others who will hold them accountable   *
H.     _______ Consequences and Choice  _______1. Offender accepts that one’s behavior has, and should have, consequences;    _______2. Identifies the consequences of one’s own behavior and challenges distorted thinking and understands    that consequences are a result of one’s actions or choices.  _______3.  The offender makes decisions based on recognition of potential consequences;  _______4. Recognizes that the abusive behavior was a choice, intentional and goal-oriented   *
I.    Offender participation and cooperation in treatment:  _______1. Participates openly in treatment (e.g. processing personal feelings, providing constructive feedback, identifying one’s own abusive patterns,  _______2. Completes homework assignments,  _______3.  Presents letter of accountability,  _______4.  Demonstrates responsibility by attending treatment as required by the Treatment Plan *
J.    Offender ability to define types of domestic violence _______1.  Defines controlling behavior and all types of domestic violence e.g. (a) physical, b) emotional, c) sexual, d) psychological, e) animal abuse, f) property, g) financial, h) isolation & jealousy, i) male privilege, j) intimidation,  &  k) coercion and threats. _______2.  Identifies in detail the specific types of DV engaged in, and the destructive impact of that behavior on the offender’s partner and children; _______3. Demonstrates cognitive understanding of the types of domestic violence as evidenced by giving example and accurately label situations; defines continuum of behavior from healthy to abusive *
K.  Offender understanding, identification and management of one’s personal pattern of violence _______1.  Acknowledges past/present violent/controlling/abusive behavior; _______2. Explores motivations; _______3. Understands learned pattern of violence and can explain it to others; _______4. Disrupts pattern of violence prior to occurrence of behavior *
 L.  Offender understanding of intergenerational effects of violence; _______1.  Identifies and recognizes past victimization, its origin, its type and impact; _______2. Recognizes the impact of witnessed violence; acknowledges that one’s upbringing has influenced current behaviors; _______3. Develops and implements as a plan to distance oneself from violent traditional tendencies, as well as cultural roles. (Examples: Homework assignments such as the Genogram, violence autobiography and timeline. *
M.  Offender understanding and use of appropriate communication skills: _______1. Demonstrates non-abusive communication skills that include how to respond respectfully to the offender’s partner’s grievances _______2. How to initiate and treat one’s partner as an equal; _______3. Demonstrates an understanding of the difference between assertive, passive, passive aggressive, and aggressive communication, _______4. Makes appropriate choices in expressing emotions; _______5. Demonstrates appropriate active listening skills *
 N.  Offender understanding and use of “time-outs” and Stop-Breathe-Focus _______1.  Recognizes the need for “time-outs” and/or other appropriate self-management skills; _______2.  Understands and practices all components of the time-out; _______3. Demonstrates and is open to feedback regarding the use of time-outs in therapy   *
O.  Offender recognition of financial abuse and management of financial responsibility _______1.  Consistently meets financial responsibilities such as treatment fees, child support, maintenance, court fees, and restitution;  the MTT may choose to require the offender to provide documentation that demonstrates financial responsibilities are being met; _______2. Maintains legitimate employment, unless verifiably or medically unable to work *
P.  Violence and Abuse _______1. Offender eliminates all forms of violence and abuse _______2.  The offender does not engage in further acts of abuse and commits no new DV offenses or violent offenses against persons or animals. *
Q.   Weapons _______1. Offender prohibited from purchasing, possessing, or using firearms or ammunition: _______2. An exception may be made if there is a specific court order allowing this – must provide written proof – treatment provider must address safety plan/storage etc. *
R.   Identification and challenge of cognitive distortions _______1. Offender identifies and challenges cognitive distortions that play a role in the offender’s violence _______2. Offender demonstrates an understanding of distorted view of self, others, and relationships (e.g. gender role stereotyping, misattribution of power and responsibility, sexual entitlement   *
S.  Offender understanding and demonstration of responsible parenting: _______1. Consistently fulfills all applicable parenting responsibilities such as cooperating with the child/children’s other parent regarding issues related to parenting, _______2. follows established parenting plan and appropriately uses parenting time including the safety and care of the child/children; _______3. Demonstrates an understanding that abuse during pregnancy may present a higher risk to the victim and unborn child.  _______4. The offender demonstrates sensitivity to the victim’s needs (physical, emotional, psychological, medical, financial, sexual, social, during pregnancy; _______5. Demonstrates appropriate interaction with the children and partner in a co-parenting or step-parenting situation *
T.  Offender identification of pro-social and/or community support and demonstration of the ability to utilize the support in an appropriate manner (sponsor, support person, etc. not the victim) *
U.  Offender’s consistent compliance with any psychiatric and medical recommendations for medication that may enhance the offender’s ability to benefit from treatment and/or reduce the offender’s risk of re-offense. *
 V.  Offender’s consistent compliance with any alcohol or substance abuse evaluation and treatment that may enhance the offender’s ability to benefit from treatment and/or reduce the offender’s risk of re-offense *
_______ DV Autobiography *
_______ Personal Change Plan *
_______ Aftercare Plan *
_______Statement of Responsibility *
_______ Personal Mission Statement *
_______ Commitment Statement/Elimination of Abusive Behavior *
How Helpful is Learning about the DVOMB Core Competencies going to be for you in your efforts to prevent DV in your life? *
Not very helpful at all.
Very helpful.
How Negatively or Positively has this DV Treatment impacted your Life? *
A Lot More Negatively than Positively Impacted.
A Lot More Positively than Negatively Impacted

Assistance for Emergencies and Crises and Disclaimer:

  Please acknowledge below that you understand that your responses to Dr. B's Online Surveys, Questionnaires, and/or Worksheets are NOT Monitored on a daily or a consistent basis and that if you have a Mental Health-Related or DV-Related Emergency or Crisis; or if you need to communicate with Dr. B. in a timely fashion, that this Online form is NOT the way to do it and Dr. B. cannot be responsible for receiving any timely communications via this platform.  

  If you are having a Medical Emergency, please dial 911, and/or go to the nearest Emergency Room. 

  If you are having a Mental Health Emergency or Crisis, please dial the Suicide Crisis Lifeline at 988. 

  Or, you can contact their CHAT Service at Lifeline Chat.

  Or, if needed, you may Text HOME to 741741 free 24/7, to contact the Crisis Text Line for any Crisis so that you can Text with a Trained Crisis Counselor.

  If you are a client of Dr. B's and you are in Crisis, please call him at 719-671-7793 (24/7).

  Otherwise, If you feel a need to communicate something to Dr. B. that is not a Crisis or an Emergency, please feel free to email him at nepeht@gmail.com.  Or you may Text Dr. B. at 719-671-7793. 

  Please acknowledge below that you have received this information and that you understand its contents.

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