1. Are you afraid of anyone in your family? |
1. Are you afraid of anyone in your family? |
05 * |
IN * |
1. Are you afraid of anyone in your family? |
05 * |
IN * |
2. Has anyone close to you tried to hurt you or harm you
recently? |
2. Has anyone close to you tried to hurt you or harm you
recently? |
05 * |
PA |
2. Has anyone close tried to hurt or mistreat you recently? |
02 |
PA |
3. Has anyone close to you called you names or put you down or
made you feel bad recently? |
3. Has anyone close to you called you names or put you down or
made you feel bad recently? |
05 * |
IN |
3. Has anyone close to you verbally offended you, put you down
or made you feel bad recently? |
03 |
PA |
4. Do you have enough privacy at home? |
4. Do you have enough privacy at home? |
05 * |
IN |
4. Do you have enough privacy inside your home? |
05 |
PA |
5. Do you trust most of the people in your family? |
5. Do you trust most of the people in your family? |
05 * |
IN |
5. Do you trust most of the people in your family? |
05 |
PA |
6. Can you take your own medication and get around by
yourself? |
6. Can you take your own medication and get around by
yourself? |
05 * |
PA * |
6. Can you control your own medication and take care of you on
your own? |
02 * |
PA |
7. Are you sad or lonely often? |
7. Are you sad or lonely often? |
05 * |
PA * |
7. Do you often get sad or lonely? |
04 |
PA * |
8. Do you feel that nobody wants you around? |
8. Do you feel that nobody wants you around? |
05 * |
IN |
8. Do you feel that no one wants you around? |
04 |
IN |
9. Do you feel uncomfortable with anyone in your family? |
9. Do you feel uncomfortable with anyone in your family? |
05 * |
IN |
9. Do you feel uncomfortable with anyone from your family? |
05 |
PA |
10. Does someone in your family make you stay in bed or tell you
you’re sick when you know you’re not? |
10. Does someone in your family make you stay in bed or tell you
you’re sick when you know you’re not? |
05 * |
IN |
10. Does anyone in your family make you stay in bed or say that
you’re sick when know you’re not? |
05 * |
PA |
11. Has anyone forced you to do things you didn’t want to
do? |
11. Has anyone forced you to do things you didn’t want to
do? |
05 * |
IN |
11. Has anyone forced you to do things you didn’t want to
do? |
05 * |
PA |
12. Has anyone taken things that belong to you without your
OK? |
12. Has anyone taken things that belong to you without your
OK? |
05 * |
IN * |
12. Has anyone taken things that belong to you without your
permission? |
05 |
IN |