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Tools and Policy Guidance Previous Page

Through guidance and resources from Futures Without Violence and the work of Virginia's Project Connect pilot sites, a number of model policies, forms and tools have been developed for family planning clinics, home visiting programs and domestic violence programs implementing on-site health services and/or assessment for reproductive coercion at shelter intake. Many of these tools have been tested in programs throughout the state and are modifiable so that they can be used in a variety of communities.

Family Planning/Reproductive Health

Addressing Intimate Partner Violence, Reproductive and Sexual Coercion: A Guide for Obstetric, Gynecologic and Reproductive Health Care Settings

Birth Control Education Handout

Hanging Out or Hooking Up: Clinical Guidelines on Responding to Adolescent Relationship Abuse: An Integrated Approach to Prevention and Intervention

Sample Memorandum of Agreement Between Family Planning and Domestic Violence Programs

Home Visiting

Protocol for Home Visiting/Visitation Guidelines

Relationship Assessment Tool (English)

Relationship Assessmetn Tool (Spanish)

Relationship Assessment Tool Instructions

Safety Plan and Instructions (English)

Safety Plan and Instructions (Spanish)

Sample Memorandum of Agreement Between Home Visiting and Domestic Violence Programs

Shelter- Based Health Services

Health Care Information Sheet

Health Referral Form for On-Site Clinics

Health Screening Tool for On-Site Clinics

Model Shelter Intake Form (Brief)

Model Shelter Intake Form (Full)


Last Updated: 03-21-2014

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