Strategies To Respond to Intimate Violence Effectively (STRIVE)

CUES Practitioner Implementation Log

Please complete this log following each CUES conversation you have with a program participant.

“CUES” stands for “confidentiality,” “universal education + empowerment,” and “support.” A CUES conversation is a one-on-one interaction with a program participant about IPV that uses the following structure and incorporates the CUES safety card:

• C - disclose any limits to confidentiality

• UE - provide universal education on complicated relationships, discuss healthy and unhealthy relationships, and encourage the participant to share the information with a friend

• S - offer support and resources related to IPV

1. What is today’s date?

2. What is the participant’s STRIVE ID number?

3. This conversation took place:

   • In person

   • On a phone call

   • On a video call

4. Did you provide the participant with…

   • Information about limits of confidentiality? (Y/N)

   • General information about healthy relationships? (Y/N)

   • [If answered “in person” to Q3]: Two copies of the safety card?

   • [If answered “on a phone call” or “on a video call” to Q3]: A link to the virtual safety card?

5. Did the participant indicate that they are currently in an intimate relationship or romantic relationship? (Y/N)

   • [IF YES]: Did the participant disclose the presence of physical violence, emotional abuse, or controlling behavior within their relationship? (Y/N)

   • [IF YES]:

     1. Did you provide the participant with a referral to your domestic violence partner agency? (Y/N)

     2. Did you provide the participant with a referral to another agency?

        1. [IF YES]: Agency name:

6. Did the participant disclose ongoing physical violence, emotional abuse, or controlling behavior within a coparenting relationship or from a former romantic partner?

   • [IF YES]

   • Did you provide the participant with a referral to your domestic violence partner agency? (Y/N)

   • Did you provide the participant with a referral to another agency?

     1. [IF YES]: Agency name:

The Paperwork Reduction Act Statement: The described collection of information is voluntary and will be used to better understand approaches to preventing and addressing intimate partner violence in HMRF programs. Public reporting burden for the described collection is estimated to average 2 minutes/log. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB control number for the described collection is 0970-0531 and it expires on 09/30/2025.