Resources
Samples From the Pilot Sites
Samples From the Pilot Sites
This section includes resources that SafePlace and its subgrantees—the three pilot sites—used while implementing a multidisciplinary response to crime victims with disabilities. Adapt these samples for your own use as you develop your community's response.
- Sample Privacy Certificate (PDF, 122 kb)
- Sample Confidentiality Agreement (PDF, 11 kb)
- Sample Consent Forms
- Focus Groups (PDF, 23 kb)
- Focus Groups Attended by Persons With Intellectual Disabilities (PDF, 12 kb)
- Individual Interviews (PDF, 17 kb)
- Individual Interviews of Persons With Intellectual Disabilities (PDF, 12 kb)
- Sample Community Needs Assessment Plan (PDF, 23 kb)
- Sample Protocol for Individual Interviews, Focus Groups, and Community Meetings (PDF, 44 kb)
- Sample Script for Setting Up Interviews and Focus Groups (PDF, 19 kb)
- Sample Focus Group and Individual Interview Questions
- Persons With Disabilities (PDF, 12 kb)
- Disability Service Providers (PDF, 12 kb)
- Victim Services Staff (PDF, 13 kb)
- Sample Surveys
- Disability Service Providers (PDF, 13 kb)
- Law Enforcement Staff (PDF, 14 kb)
- Victim and Disability Service Providers and Law Enforcement Staff (PDF, 16 kb)
- Sample Needs Assessment Recruitment Flier: Persons With Disabilities (PDF, 36 kb)
- Sample Community Needs Assessment Report (PDF, 15 kb)
- Sample Strategic Plan (PDF, 47 kb)
- Sample Fact Sheet (PDF, 49 kb)
- Sample Class Guidelines for Persons With Intellectual Disabilities (PDF, 10 kb)
- Template Plan for Tracking Reports of Crime (PDF, 64 kb)
- Sample Plan for Tracking Crimes Against Persons With Disabilities (PDF, 22 kb)
- Sample Evaluation Plan (PDF, 24 kb)
- Sample Pre- and Post-Tests
- Persons With Disabilities (PDF, 10 kb)
- Victim Service Providers (PDF, 11 kb)
- All Service Providers (PDF, 27 kb)
- Sample Training Evaluation for Service Providers and Law Enforcement Staff (PDF, 39 kb)
- Sample Followup Survey for Disability Service Providers (PDF, 26 kb)
- Sample Class Evaluation for Persons With Intellectual Disabilities (PDF, 26 kb)