Part 1
Name:
Date:
The following steps are my plan for increasing my saftey and preparing to protect myself in case of further abuse. Although I can't control my abuser's violence, I do have a choice about how I respond and how I get to saftey.
To increase my saftey, I can do (some or any of) the following:
- When I have to talk to my abuser in person, I can
- When I talk to my abuser on the phone, I can
- I will makeup a "code word" for my family, teachers, or friends, so they know when to call help for me. My code word is
- When I feel a fight coming on, I will try to move to a place that is lowest risk for getting hurt, such as _______________ (at school), _______________ (at home), or _______________ (in public).
- I have the right to be safe when I am out with friends.
- I can ask my parents or other family memvers to screen my calls and visitors. I have the right to not receive harassing phone calls.
- I can keep change for phone calls with me at all times. I can call any of the following people for I ride if I need to:
- If I have ended the relationship, I can tell the following people and ask them to call the police if they see my abuser bothering me.
teacher:
friend:
relative:
Part 2
I will decide for myself if and when I will tell others that I have been abused, or that I am still at risk. Friends, family, co-workers, and school personnel can help protect me, if they know what is happening, and how they can help.
- I can tell my teacher, co-workers, boss, or a friend about my situation. I feel safe telling:
- I can ask _______________ or _______________ to help screen my phone calls at home or work.
- When leaving work or school, I can:
- When walking, riding or driving home, if problems occur, I can:
- If I use the school bus or public transportation, I can:
- I can take a different route or change the time I leave when I walk if I think my abuser will follow me.
- I can also:
For Myself:
- If I feel down, I can talk to sources of support, like friends, neighbors, a teacher, youth minister, or crisis line. The people and numbers I can call include:
- I can attend a support group for teens who have been abused. Support groups are held:
- Other things I can do to make myself feel better:
Telephone Numbers I Need to Know:
- Police Department:
- Sheriffs Department:
- Domestic Violence/Sexual Assault Program:
- Clergy Person:
- Attorney:
- Probation Officer:
- Other:
- Other:
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