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(Opportunity for Interviewee to Explain their Situation in their Own Words)

“I will be asking you some questions today. First, I would like to ask you to tell me, in your words, what brings you and other party to mediation?” (Note: Elicit brief narrative about why the parties are in court/mediation.)


EXPLANATION ABOUT MEDIATION (RECOMMENDED BUT OPTIONAL) (Depending on What Information has Already Been Provided to the Parties)

“In family mediation, parties work together to try to make good decisions for themselves and the child/ren outside of court. Mediators do not take sides and do not decide for the parties how to settle their case. Rather, mediators assist the parties in exploring ways to resolve any disagreements in this confidential settlement process. Before the parties start mediation, they are asked to provide some information about their situation.”


“I am now going to ask you a series of questions about your relationship with [the other party]. We ask these kinds of questions of the parties who are the parents of the children in the case, or who are currently or were previously spouses or significant others. [If there are other parties in the case, say: These questions relate to [the other party’s name] and not the other parties in the case, but let us know if any of the other parties are doing the kinds of things we are asking about.]”

“Your responses to these questions will be confidential. They will NOT be shared with the court or [the other party]. Your responses will only be used to decide whether mediation would be appropriate in your case, and if so, how to conduct the mediation. However, in answering the questions below, please keep in mind that if I/we have reason to believe that a child has been subjected to abuse or neglect which has not previously been reported to Child Protective Services or an appropriate law enforcement agency, I/we [or the mediation program] will need to make a report to Child Protective Services or the appropriate law enforcement agency. [Add any other applicable disclosures about mandatory reporting in your jurisdiction.]”

“You may wonder about some of the questions you will now be asked, but it is helpful to think of this like a visit to the doctor’s office. There, you are often asked questions that may not seem important to you or may not seem to apply to you but are important to the doctor.”

“The questions you will be asked now are important for deciding what kind of mediation would work well for you and [the other party in this case], or if it would be better for you and [the other party in this case] not to mediate. So please answer the following questions to the best of your ability, knowing that this will be helpful.”

“In answering these questions, I am asking about things that [the other party in this case] may have done during a conflict, disagreement, fight, or in anger, or to scare you or hurt you, but NOT while joking around.”

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