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A Global Response to Elder Abuse - page 69 / 149

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PAGE 54

RELATIONSHIP WITH CHILDREN

12. Do you have any children? Yes p No p N/A p R/A p

If "No" go to question 14.

If "Yes" how many?

Explore the relationship between the subject and the child(ren). If there are any problems, with whom?

Please list relationship:

A:

B:

C:

D:

Describe any problems:

13. Does any child have any specific health problem or emotional problem (include illness, handicap, alcohol or drug or gambling addiction, or mental illness)?

Yes p

No p

N/A p

R/A p

If "Yes", explain:

If "Yes", describe the impact that it has had on you:

Does this person live with you? Yes p No p N/A p R/A p

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