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Table of contents

Purpose Of The Transition Home Survey
Section 1 — Facility Profile As Of Noon (date)
Section 2 — Resident Profile As Of Noon On (date)
Section 3 — Departures And Turn-aways: Midnight To Noon On (date)
Section 4 — Services For Non-residents And Ex-residents
Section 5 — Annual Information
Section 6 — Issues And Challenges

Statistics Canada is prohibited by law from publishing any statistics which would divulge information obtained from this survey that relates to any identifiable business, institution or individual without the previous written consent of that business, institution or individual. The data reported on this questionnaire will be treated in confidence, used for statistical purposes and published in aggregate form only. The confidentiality provisions of the Statistics Act are not affected by either the Access to Information Act or any other Legislation.

Confidential when completed.

Collected under authority of the Statistics Act, Revised Statutes of Canada, 1985, Chapter S19.

Please make any corrections to the address label here:

Name of contact person
Name of organization
Postal Address
City
Province/Territory
Postal Code

Purpose Of The Transition Home Survey

The purpose of the Transition Home Survey is to collect data on residential services for abused women and their children during the previous 12 months of operation, as well as to provide a one-day "snapshot" of the clientele being served on a specific date. The Transition Home Survey is distributed across Canada to all residential agencies serving women victims of family violence. While participation in this survey is voluntary, your co-operation is important to ensure that the information collected in this survey is as accurate and as comprehensive as possible. The information collected will be useful to service providers, non-profit organizations and governments in developing programs, policies and services for abused women and their children.

Please Read The Attached Guidebook For Instructions and Definitions Before Completing The Questionnaire.

Section 1 — Facility Profile As Of Noon (date)

Facility:

1. Please indicate which best describes your facility (Check only one. If there is more than one facility, for example a transition house and a second stage house, please complete two questionnaires.)

(Refer to Guidebook for definitions)

  • Transition House
  • Second Stage Housing
  • Safe Home Network
  • Satellite
  • Women's Emergency Centre
  • Emergency Shelter
  • Rural Family Violence Prevention Centres (Alberta only)
  • Interim Housing (Manitoba only)
  • Family Resource Centre (Ontario only, residential)
  • Other (please specify)

2. What is the total number of beds within your facility? (Count each bed, child's bed and crib.  Do not count emergency beds [e.g. cots, sofas, sleeping bags, etc.] unless funded or licensed).

  • number of beds:

Area:

3. Please indicate the area(s) your facility serves (Check all that apply). (Refer to Guidebook for definitions)

  • Urban/suburban (1,000 or more people)
  • Rural/Village (less than 1,000 people)
  • Reserve

4. Is your facility owned or operated by a band council? (Band council refers to a group of representatives elected by the on-reserve residents of the community.)

  • Owned by a band council?
    • Yes
    • No
  • Operated by a band council?
    • Yes
    • No

5. Is your facility located on a reserve? (Refer to Guidebook for definitions)

  • Yes
  • No

Services:

6. Please indicate all services your facility provides on a regular basis to residents, non-residents and ex-residents. If your facility does not distinguish between non-residents and ex-residents please use the non-resident category. Please indicate all services provided by Other Agencies to residents of your facility. (Answer residents, non-residents, ex-residents and/or Other Agencies for each or answer not applicable if these do not apply.) (Refer to Guidebook for definitions)

A) Services for Women

  • Individual short-term counselling
  • Individual long-term counselling
  • Group counselling
  • Family counselling programs (includes mother, child(ren) and partner)
  • Safety planning or protection planning
  • Addiction counselling (e.g. information or support)
  • Crisis telephone line (staffed 24 hour line)
  • Medical services (e.g. information or support)
  • Mental health services (e.g. information or support)
  • Legal services (e.g. information or support, paralegal services)
  • Financial assistance or welfare (e.g. information or support)
  • Life skills (e.g. banking, groceries, day-to-day management)
  • Job training or employment search
  • Parenting skills
  • Housing referral
  • Culturally sensitive services for Aboriginal women
  • Culturally sensitive services for ethno-cultural and visible minority women
  • Lesbian sensitive services
  • Services for women with disabilities
  • Recreation services
  • Advocacy on behalf of women
  • Transportation/accompaniment (e.g., transportation to the shelter, to court)
  • Specialized services for older women (55+)
  • Other services for women (please specify)

B) Services for Children

  • Individual counselling
  • Group counselling or support
  • Programs for child witnesses or victims of abuse (e.g. play therapy)
  • Culturally sensitive services for Aboriginal children
  • Culturally sensitive services for ethno-cultural and visible minority children
  • School classes or tutoring for children
  • Child protection or family services
  • Supervising visiting for non-resident parent
  • Baby-sitting services
  • Outdoor recreation spaces for children
  • Indoor recreation spaces for children
  • Temporary placement of children without parents
  • Other services for children (please specify)

C) Services for Abusive Partners

  • Treatment or counselling services
  • Other (please specify)

D) General Services

  • Information
  • Public education or prevention
  • Outreach programs
  • Advocacy
  • Political or social action (e.g. writing letters to politicians, marches, protesting)
  • Help with pet accommodation
  • Food bank
  • Clothing items
  • Furniture items
  • Other (please specify)

7. Are there any services that are currently needed but not offered or not offered at the level required to meet the needs of the residents, former residents or non-residents your facility serves?  If so, please indicate the most important of these services (up to 3).

Accessibility:

8. In what languages can your facility provide services? Include languages that staff, volunteers or others who can speak to verbally communicate when providing services. (Check all that apply) (Refer to Guidebook for definitions)

  • English
  • French
  • Arabic
  • Chinese (Mandarin, Cantonese, Hakka)
  • Cree
  • Dutch
  • German
  • Greek
  • Inuktitut
  • Italian
  • Ojibway
  • Polish
  • Portuguese
  • Punjabi
  • Spanish
  • Tagalog (Pilipino)
  • Ukrainian
  • Vietnamese
  • Urdu
  • Persian (Farsi)
  • Russian
  • Hindi
  • Other languages(s) (please specify):

9. Is at least one of your building entrances wheelchair accessible? (e.g. access ramps, street-level entrances, automatic or easy-to open doors, etc.)

  • Yes
  • No (Go to Question 12)

10. Are any bedrooms within your facility wheelchair accessible? (e.g. widened doorways, automatic or easy-to-open doors, etc.)

  • Yes
  • No

11. Are any bathrooms within your facility wheelchair accessible? (e.g. widened doorways, grab bars, automatic or easy-to-open doors, etc.)

  • Yes
  • No

12. Does your facility have services for people who are deaf or hearing impaired, such as: (answer yes or no for each)

  • TTY/TDD? (Teletypewriter, Telephone Device for Deaf)
  • Sign language communication or interpretation?
  • Other services? (please specify)

13. Does your facility have services for people who are blind or visually impaired, such as: (answer yes or no for each)

  • Braille reading materials?
  • Large print reading materials?
  • Other services? (please specify)

Male Youth:

14. How does your facility handle the admission of male youth? (Check only one)

  • Male youth are automatically admitted up to an age limit (Go to Question 15)
  • Male youth may be admitted up to an age limit, but each case is reviewed individually before deciding whether or not to admit.  (Go to Question 15)
  • There is no age limit, but each case is reviewed individually before deciding whether or not to admit. (Go to Question 16)
  • Not applicable (facility does not accept any children). (Go to Question 18)

15. What is the age limit? (please indicate age)

16. Does your facility refer male youth elsewhere?

  • Yes
  • No (Go to Question 18)

17. To whom or to what type of organization does your facility refer male youth? (Check all that apply)

  • Youth shelter
  • Social services or child protection services
  • Family service centre
  • Youth centre
  • Family or friends
  • Other type of organization (please specify)

Section 2 — Resident Profile As Of Noon On (date)

The purpose of Section 2 is to obtain a one-day snapshot of the clientele being served on a particular day in the year (i.e., (date)).  Appreciating that a number of residents to whom space has been assigned may be temporarily absent on (date), please include all admitted residents when completing the following questions including those who are temporarily absent.

18. For each adult woman residing in your facility as of noon on (date), please indicate the reason(s) she came to your facility (number). Count all the reasons that apply.For example, a woman suffering physical abuse, financial abuse and threats who is also experiencing mental health problems would be counted once in each of the 4 corresponding categories. Answer with a number for each of the following categories. Please ensure that only the women are counted. Do not count the children in this question.

  • Physical abuse
  • Sexual abuse
  • Financial abuse
  • Emotional/Psychological abuse
  • Threats
  • Harassment
  • Protection of her child(ren):
    • Physical abuse
    • Sexual abuse
    • Threats
    • Psychological abuse
    • Neglect
    • Witnessing abuse of mother
  • Other abuse (please specify)
  • Housing problems
    • Housing emergency ( e.g. had to leave last home because of eviction or damage caused by fire, flood or natural disaster)
    • Unable to find affordable housing
    • Short-term housing problem (e.g. on list for subsidized housing or waiting to move but unable to secure housing in the meantime)
  • Mental health problems
  • Drug and alcohol addiction
  • Other (please specify)
  • Reason unknown/Don't know

Number of residents (Women, Children, Total) as of noon on (date). (Count each woman and child only ONCE).

19. Of the total number of residents in your facility as of noon on (date), how many women and accompanying children were there primarily because of ABUSE? (Enter "0" if there were none.)

  • Women
  • Children
  • Total

20. Of the total number of residents in your facility as of noon on (date), how many women and accompanying children were there primarily for reasons OTHER THAN ABUSE (e.g. housing problem)? (Enter "0" if there were none.)

  • Women
  • Children
  • Total

21. Please indicate the TOTAL number of women and children who were residing in your facility as of noon (date). (Enter "0" if there were none.)

  • Women
  • Children
  • Total

22. What were the referral sources for each woman? (Count as many referral sources as apply for each woman)

  • Self-referred only
  • Family/friend
  • Ministry for Children and Families
  • Ministry of Human Resources
  • Other Ministry
  • House resident (current or former)
  • Hospital, doctor, nurse, other health care practitioner or hospital social worker
  • Clergy, minister of religion
  • Police or RCMP
  • Other Transition House
  • Aboriginal or First Nations organization or reserve
  • Other community agency
  • Other
  • Don't know/no data
  • TOTAL

23. Of the women residents in the facility as of noon on (date)

  • a) How many had been there before? (If number of repeat residents equals ZERO, go to Question 24).
  • b) How many women have been there:
    • 1 time in the last 12 months?
    • 2 to 4 times in the last 12 months?
    • 5 times or more in the last 12 months?
  • c) How many women have stayed in the facility in the last 12 months for an unknown number of times?
  • d) How many women have stayed in the facility before, but it has been more than 12 months since their last stay?
  • e) Total (Should equal number of women in Question 23 a)

Questions 24 to 26 apply only to people who are residing in your facility as of noon april 15, 2010 and came primarily because of abuse (see question 19)

Characteristics:

24. As of noon on (date), indicate the number of residents from abusive situations in each of the following age groups: (Count each woman and child only once)

A) Age categories of women (number of women for each of the following age categories)

  • 15-19 years
  • 20-24 years
  • 25-29 years
  • 30-34 years
  • 35-44 years
  • 45-54 years
  • 55-64 years
  • 65 years +
  • Age unknown
  • Total Women (Should equal total number of women in Question 19).

Age categories of accompanying children (number of female and male children):

  • Under 1 year
  • 1-4 years
  • 5-9 years
  • 10-12 years
  • 13-15 years
  • 16-18 years
  • 19-24 years
  • 25-29 years
  • Age unknown
  • Total Children (Should equal total number of children in Question 19).

B) As of noon on (date), indicate the number of women (Count each woman only once) (Refer to Guidebook for definition)

  • Who were admitted with their children
  • Who were admitted without their children
  • Who have no children or parenting responsibilities
  • Facility doesn't know if they have children or parenting responsibilities
  • Total (Should equal total number of women in Question 19)

C) As of noon on (date), indicate the number of residents with a disability.

  • Women
  • Children
  • Total residents with a disability  (If total residents with a disability equals ZERO, go to Question 25)
  • Don't know (Go to Question 25)

D) As of noon on (date), indicate the number of residents with: (Count each woman and each child as often as applies, if more than one disability. Include residents with permanent and temporary physical disabilities (e.g., someone on crutches due to a broken leg)) (Answer in number for women and children)

  • Mobility disabilities
  • Visual disabilities
  • Hearing disabilities
  • Other disabilities (please specify):
  • Don't know

Relationship to abuser:

25. As of noon on (date), please indicate the number of women residents by the relationship with the abuser. (Count each woman only once. Do not include children)

  • Spouse (legally married)
  • Common-law partner
  • Ex-spouse
  • Ex-common-law partner
  • Dating relationship (couples who do not live together)
  • Ex-dating relationship
  • Relative (parent, child, other)
  • Friend or acquaintance
  • Caregiver (a non-relative responsible for taking care of the victim full or part-time — Caregivers who are also relatives should be categorized as "relative")
  • Authority figure (teacher, professor, employer, person in a position of trust)
  • Other (please specify)
  • Don't know
  • Total (Should equal total number of women in Question 19)

Involvement of the criminal justice system in the most recent abusive situation:

This question refers to the most recent abusive situation for which the woman was admitted to your facility. It DOES NOT refer to previous incidents of abuse for which the police may have been involved.

26. As of noon on (date), please answer the following questions in relation to the involvement of the criminal justice system for the most recent abusive situation of each woman (Enter "0" if there were none.)

In how many cases: (answer in numbers for: Yes, No, Don't know and Total*)

  • Was the incident reported to police?
  • Were charges laid against the abuser (e.g. by the woman, police or Crown)?
  • Was an order obtained for the abuser to stay away (peace bond, restraining order, undertaking to keep the peace and have good conduct, conditions of probation,  emergency intervention order, emergency protection order, victim's assistance order, order to abstain from persistently following a person about from place to place, etc.)?

*Total (Should equal total number of women in Question 19)

Section 3 – Departures And Turn-aways: Midnight To Noon On (date)

Questions 27 to 30 apply to Departures and Turnaways that occurred between midnight and noon on (date).

Departures (Refer to Guidebook for definitions)

27. How many women and children (number) departed from your facility between midnight and noon on (date)?

  • Women
  • Children
  • Total Departures (If total departures equal ZERO, Go to Question 29).

28. Upon departure where did the women go? This question refers to departures (number) between midnight and noon on (date) (Count each woman only once. Do not count the children in this question).

  • Returned to spouse/common-law partner
  • Returned home without spouse/common-law partner
  • Second stage housing
  • Another emergency shelter
  • Out of province/territory shelter
  • New accommodation without spouse/common-law partner
  • Living with friends or relatives
  • Hospital
  • Residential services (e.g. group home, hostel, detox centre, addictions rehabilitation centre or other adult care facility)
  • Other (please specify):
  • Unknown
  • Total (Should equal number of women in Question 27)

Turn-aways:

29. How many women and children (number) were turned away from your facility between midnight and noon on (date)?

  • Women
  • Children
  • Total Turn-aways (If total turn-aways equals ZERO, Go to Question 31).

30. Please list the reason(s) women and children were turned away. (Check all that apply)

  • Shelter was full
  • Alcohol and drug issues
  • Mental health issues
  • Transportation issue (e.g., no transportation to get to facility)
  • Accessibility issues (e.g., not wheelchair accessible)
  • Language barrier
  • Under age without parent
  • Non-admit or caution list
  • Other (please specify)

Section 4 — Services For Non-residents And Ex-residents

The purpose of Section 4 is to obtain information on contacts for assistance from non-residents and ex-residents. Question 31 deals with contacts on the day of (date) and contacts for an average month.

31. Please report the number of phone, letter, e-mail, fax, walk-in or other contacts received from non-residents and ex-residents for housing related and non-housing related needs (for both: Contacts on (date) and Contacts for an average month.) This includes outreach services. (Enter "0" if there were none. Count each contact for assistance) (Refer to Guidebook for definitions)

  • Housing related (e.g. crisis, needs housing because of abuse; housing problem; non-abuse; etc.)
  • Other (non-housing related) (e.g. crisis, needs medical help; general information; emotional support; etc.)
  • TOTAL

Outreach work: (Refer To Guidebook For Definitions)

32. How many hours per week are dedicated to doing outreach? (Please note, if there are 3 staff each doing 20 hours of outreach work per week this would equal 60 hours. Include paid staff, volunteers and others.)

  • Number of hours per week

Section 5 — Annual Information

The purpose of Section 5 is to obtain annual information on admissions and physical repairs and improvements for your residential facility. This information is to be provided for a 12-month fiscal period, for example, April 1, 2009 to March 31, 2010.

A. Reference Period: Please specify the 12-month period used in providing information for Section (format DD / MM / YYYY).

  • From:
  • To:

33. Please indicate the total number of admissions during the reference period.  (Enter "0" if there were none.) (Refer to Guidebook for definitions.)

  • Number of women
  • Number of children
  • Total admissions

B. Adult Males:

Questions 34 to 38 refer to adult men, 15 years of age and over, who were admitted to a facility with or without their dependent children.  (DO NOT include adult men who were admitted with a parent.)

34. Does your facility have a policy on admitting adult men (15 years and over) with or without children? (Check only one)

  • Policy allows adult men to be admitted
  • Policy does not allow adult men to be admitted (Go to Part C- Physical repairs or improvements).
  • There is no facility policy on admitting adult men

35. During the reference period (for example, between April 1, 2009 and March 31, 2010), how many adult men were admitted to your facility? (If no men were admitted, enter "0" and go to Part C- Physical repairs or improvements)

  • Number of men

36. During the reference period, were any adult men admitted for reasons of abuse?

37. During the reference period, how many adult men (number) were admitted to your facility for reasons of abuse? (If no men were admitted, enter "0" and go to Part C. Physical repairs or improvements)

  • Number of men

38. During the reference period, of those adult men admitted for reasons of abuse, how many (number) were victims of spousal violence? (If no men were admitted, enter "0")

  • Number of men

C. Physical repairs or improvements:

The purpose of Questions 39 to 42 is to collect information on physical repairs or improvements that have been made to your facility during the reference period (for example, between April 1, 2009 and March 31, 2010).  In this section, do not include funds received from Canada Mortgage and Housing Corporation (CMHC) for the construction of new units.

DO NOT INCLUDE REGULAR MAINTENANCE WHEN RESPONDING TO THESE QUESTIONS. Regular maintenance refers to painting, repairing leaky faucets, furnace cleaning, etc.

39. Have any physical repairs or improvements (e.g., new roof, flooring, windows, floor tiles, plumbing fixtures) been made to your facility during the reference period?

  • Yes
  • No  (Go to Question 43)

40. What types of physical repairs or improvements have been made to your facility during the reference period? (Check all that apply)

Major physical repairs or improvements refers to defective plumbing or electrical wiring, structural repairs to walls, floors or ceilings, etc. In other words, there is a legal necessity to make these repairs so that your facility is in accordance with municipal building codes.  These repairs are deemed essential for safety reasons and for meeting municipal standards.

Minor physical repairs or improvements refers to missing or loose floor tiles, bricks or shingles, defective steps, railing or siding, etc.

Structural improvements refers to improvements not required for safety reasons or meeting municipal standards, such as making rooms wheelchair accessible, adding a new security system, adding ramps, adding an outside play area for children, creating a ventilated inside smoking area.

  • Major
  • Minor
  • Structural Improvements

41. How were the physical repairs or improvements made during the reference period funded? (Check all that apply)

  • Shelter enhancement program (CMHC)
  • Other federal department funding
  • Provincial or Territorial government funding
  • Joint Federal/Provincial/Territorial agreement funding
  • Regional/Municipal government funding
  • Fundraising
  • Donations
  • Other (please specify)
  • Don't know

42. How much did the physical repairs or improvements made during the reference period cost? (Indicate cost in dollars - If the exact cost is not available please provide an accurate estimate).

  • Exact
  • Estimate
  • Don't know

43. Within the next five years, do you anticipate necessary physical repairs or improvements to your facility? (Check all that apply)

Major physical repairs or improvements refers to defective plumbing or electrical wiring, structural repairs to walls, floors or ceilings, etc. In other words, there is a legal necessity to make these repairs so that your facility is in accordance with municipal building codes. These repairs are deemed essential for safety reasons and for meeting municipal standards.

Minor physical repairs or improvements refers to missing or loose floor tiles, bricks or shingles, defective steps, railing or siding, etc.

Structural improvements refers to improvements not required for safety reasons or meeting municipal standards, such as making rooms wheelchair accessible, adding a new security system, adding ramps, adding an outside play area for children, creating a ventilated inside smoking area.

  • Major
  • Minor
  • Structural Improvements

44. Within the next five years, from which of the following do you anticipate funding for these necessary physical repairs or improvements? (Check all that apply)

  • Shelter enhancement program (CMHC)
  • Other federal department funding
  • Provincial or Territorial government funding
  • Joint Federal/Provincial/Territorial agreement funding
  • Regional/Municipal government funding
  • Fundraising
  • Donations
  • Other (please specify)
  • Don't know

Section 6 – Issues And Challenges

45.

  • A) What would you identify as the top three issues or challenges facing your facility in the upcoming year? (Refer to Guidebook for definition)
  • B) What would you identify as the top three issues or challenges for the women and children using your facility in the upcoming year? (Refer to Guidebook for definition).

Interdepartmental Agreements

In order to reduce response burden and to provide consistent statistics, Statistics Canada has entered into data sharing agreements under Section 12 of the Statistics Act with the Public Health Agency of Canada and the Canada Mortgage and Housing Corporation. The information we provide to these agencies will be kept confidential and used only for statistical purposes. Under Section 12 of the Statistics Act, you may refuse to share your information with the agencies listed above by writing to the Chief Statistician and returning your letter of objection along with the completed questionnaire in the enclosed return envelope.

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Comments

Thank you for taking the time to complete this questionnaire. Please keep a copy of the completed questionnaire in the event that Statistics Canada contacts you for clarification of information given. National, provincial and territorial fact sheets for this survey are available for free.  It is hoped that the information will assist us in better understanding the services available within the community to address the needs of victims of abuse. Should you have any comments or questions regarding the questionnaire or the survey itself, please do not hesitate to contact us at 1-800-387-0479. The following space is provided for those of you who would prefer to write down your comments. Please print carefully.

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