Learning from you

You are completing this feedback because at some point you have been involved in an abusive relationship and have caused harm to someone else.  

Reliving this can be traumatic and there are also some questions in here about your past experiences that you might find difficult to answer.  If you do not feel comfortable answering certain questions please leave them blank. Do not feel that you have to complete every answer, any information at all is invaluable in helping to improve services and prevent further domestic abuse and so if you need to leave some questions out to protect yourself from emotional distress then please do so.

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* 1. Please indicate whether you think you were the abusive person or whether you think there was abuse from both people in the relationship?

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* 2. Were you abusive towards a partner/ex-partner or family member?

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* 3. Were they male or female?

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* 4. Did you identify yourself as a person causing harm prior to any intervention?

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* 5. Did you receive support to address your behaviour and attitudes?  

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* 6. What type of harm did you cause?

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* 7. How do you feel about what you did?

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* 8. What do you think about the words abuser/perpetrator to describe someone who has caused harm in a relationship?

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* 9. What is your opinion of the support you received?

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* 10. How could the support you received be improved?

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* 11. Were you issued a warning notice about the use of SmartWater?

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* 12. What do you think could be done to prevent people being abusive?

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* 13. Did you have children at the time of the abuse (your own children and step-children)?

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* 14. If you answered Yes to Q13 can you explain what impact your behaviour had on the children?

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* 15. Did you experience any type of trauma or abuse as a child? 
As mentioned above, this can be difficult to think about and answer.  It is really important that we understand the impact of trauma on people but if you do not feel comfortable answering please leave this question blank.

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* 16. If you answered yes to the last question, what impact do you think this had on you?

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* 17. What support do you think could have helped at the time?

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* 18. Have you experienced trauma as an adult that has had a negative impact on you?

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* 19. If you could give someone who is being abusive some advice to change their behaviour what would it be?

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* 20. What is your age?

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* 21. What is your gender

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* 22. Do you consider yourself to be transgender?

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* 23. Which ward to you live in?

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* 24. Which race/ethnicity best describes you? (Please choose only one.)

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* 25. Do you identify with any of the following religions? (Please select all that apply.)

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