Email hidden; Javascript is required.
All questions below are REQUIRED except for some follow-up questions that are marked "Recommended but optional"
A. Did [the other party in this case] ever (whether or not while living with you)...
0
0
0
0
0
0
Please remember that all questions concern things that [the other party] ever, whether or not while living with you, may have done during a conflict, disagreement, or fight, or in anger, or to scare or hurt you, but NOT while joking around.
0
0
0
0
0
0
0
0
0
0
0
Now consider the questions you just answered, or similar kinds of things:
0
0
0
0
MASIC-S QUESTIONS-SECTION 2
If “Yes” to any of the items in Section 1 above, then Section 2 is REQUIRED.
If “No” to all questions in Section 1, then you may skip to Section 3. However, according to your clinical judgment, you may also complete Section 2.
0
0
0
0
MASIC-S QUESTIONS-SECTION 3
RECOMMENDED BUT OPTIONAL
Do you have any of the following concerns about [the other party]?
0
0
0
0
0
Ask all parties the following question (regardless of whether Sections 2 and/or 3 were completed)
"As a reminder, mediation is a confidential settlement process that takes place outside of court. Mediation may happen with the parties communicating directly with each other in the presence of the mediator, or with each party meeting privately with the mediator and communicating with the other party or parties through the mediator. [At this point the screener should explain how mediation is done in their program.]
Not all cases, however, go through the mediation process. I [or the mediation program] will determine whether mediation will take place in your case, and if mediation will take place, how it will be conducted. I have a few more questions to help make these decisions."
0
0
Email hidden; Javascript is required.
All questions below are REQUIRED except for some follow-up questions that are marked "Recommended but optional"
A. Did [the other party in this case] ever (whether or not while living with you)...
1
1
1
0
0
0
Please remember that all questions concern things that [the other party] ever, whether or not while living with you, may have done during a conflict, disagreement, or fight, or in anger, or to scare or hurt you, but NOT while joking around.
1
1
1
1
1
1
here is more detail
0
0
0
0
0
Now consider the questions you just answered, or similar kinds of things:
1
0
more detail
1
even more detail
0
MASIC-S QUESTIONS-SECTION 2
If “Yes” to any of the items in Section 1 above, then Section 2 is REQUIRED.
If “No” to all questions in Section 1, then you may skip to Section 3. However, according to your clinical judgment, you may also complete Section 2.
0
0
0
0
MASIC-S QUESTIONS-SECTION 3
RECOMMENDED BUT OPTIONAL
Do you have any of the following concerns about [the other party]?
0
0
0
0
0
Ask all parties the following question (regardless of whether Sections 2 and/or 3 were completed)
"As a reminder, mediation is a confidential settlement process that takes place outside of court. Mediation may happen with the parties communicating directly with each other in the presence of the mediator, or with each party meeting privately with the mediator and communicating with the other party or parties through the mediator. [At this point the screener should explain how mediation is done in their program.]
Not all cases, however, go through the mediation process. I [or the mediation program] will determine whether mediation will take place in your case, and if mediation will take place, how it will be conducted. I have a few more questions to help make these decisions."
0
0
Email hidden; Javascript is required.
All questions below are REQUIRED except for some follow-up questions that are marked "Recommended but optional"
A. Did [the other party in this case] ever (whether or not while living with you)...
1
1
0
0
0
1
this was bad
Please remember that all questions concern things that [the other party] ever, whether or not while living with you, may have done during a conflict, disagreement, or fight, or in anger, or to scare or hurt you, but NOT while joking around.
0
0
0
0
0
0
0
0
0
0
0
Now consider the questions you just answered, or similar kinds of things:
0
0
0
0
MASIC-S QUESTIONS-SECTION 2
If “Yes” to any of the items in Section 1 above, then Section 2 is REQUIRED.
If “No” to all questions in Section 1, then you may skip to Section 3. However, according to your clinical judgment, you may also complete Section 2.
0
0
0
0
MASIC-S QUESTIONS-SECTION 3
RECOMMENDED BUT OPTIONAL
Do you have any of the following concerns about [the other party]?
0
0
0
0
0
Ask all parties the following question (regardless of whether Sections 2 and/or 3 were completed)
"As a reminder, mediation is a confidential settlement process that takes place outside of court. Mediation may happen with the parties communicating directly with each other in the presence of the mediator, or with each party meeting privately with the mediator and communicating with the other party or parties through the mediator. [At this point the screener should explain how mediation is done in their program.]
Not all cases, however, go through the mediation process. I [or the mediation program] will determine whether mediation will take place in your case, and if mediation will take place, how it will be conducted. I have a few more questions to help make these decisions."
0
0
Email hidden; Javascript is required.
All questions below are REQUIRED except for some follow-up questions that are marked "Recommended but optional"
A. Did [the other party in this case] ever (whether or not while living with you)...
1
1
1
0
0
0
Please remember that all questions concern things that [the other party] ever, whether or not while living with you, may have done during a conflict, disagreement, or fight, or in anger, or to scare or hurt you, but NOT while joking around.
0
0
0
0
0
0
0
0
0
0
0
Now consider the questions you just answered, or similar kinds of things:
0
0
0
0
MASIC-S QUESTIONS-SECTION 2
If “Yes” to any of the items in Section 1 above, then Section 2 is REQUIRED.
If “No” to all questions in Section 1, then you may skip to Section 3. However, according to your clinical judgment, you may also complete Section 2.
0
0
0
0
MASIC-S QUESTIONS-SECTION 3
RECOMMENDED BUT OPTIONAL
Do you have any of the following concerns about [the other party]?
0
0
0
0
0
Ask all parties the following question (regardless of whether Sections 2 and/or 3 were completed)
"As a reminder, mediation is a confidential settlement process that takes place outside of court. Mediation may happen with the parties communicating directly with each other in the presence of the mediator, or with each party meeting privately with the mediator and communicating with the other party or parties through the mediator. [At this point the screener should explain how mediation is done in their program.]
Not all cases, however, go through the mediation process. I [or the mediation program] will determine whether mediation will take place in your case, and if mediation will take place, how it will be conducted. I have a few more questions to help make these decisions."
0
0
All questions below are REQUIRED except for some follow-up questions that are marked "Recommended but optional"
A. Did [the other party in this case] ever (whether or not while living with you)...
Yes
Yes
No
Yes
he threatened to hit my neice
Yes
No
Please remember that all questions concern things that [the other party] ever, whether or not while living with you, may have done during a conflict, disagreement, or fight, or in anger, or to scare or hurt you, but NOT while joking around.
No
No
No
Don't Know
Yes
No
No
No
No
No
Yes
he put spyware on my computer
Now consider the questions you just answered, or similar kinds of things:
No
No
No
No
MASIC-S QUESTIONS-SECTION 2
If “Yes” to any of the items in Section 1 above, then Section 2 is REQUIRED.
If “No” to all questions in Section 1, then you may skip to Section 3. However, according to your clinical judgment, you may also complete Section 2.
No
Yes
No
No
MASIC-S QUESTIONS-SECTION 3
RECOMMENDED BUT OPTIONAL
Do you have any of the following concerns about [the other party]?
No
No
No
Yes
jaywalking
No
Ask all parties the following question (regardless of whether Sections 2 and/or 3 were completed)
"As a reminder, mediation is a confidential settlement process that takes place outside of court. Mediation may happen with the parties communicating directly with each other in the presence of the mediator, or with each party meeting privately with the mediator and communicating with the other party or parties through the mediator. [At this point the screener should explain how mediation is done in their program.]
Not all cases, however, go through the mediation process. I [or the mediation program] will determine whether mediation will take place in your case, and if mediation will take place, how it will be conducted. I have a few more questions to help make these decisions."
No
No