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1.

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* 1. Name of the Organization I work/volunteer for:

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* 2. Our community has a plan to end homelessness within a defined period of time.

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* 3. Our plan is consistent with or can be aligned with the HEARTH Act and the Federal Strategic Plan to Prevent and End Homelessness.

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* 4. I believe my community has a comprehensive and effective discharge plan.

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* 5. Our community uses a universal process and/or tool at intake that helps us assess the most appropriate resources for the consumer's needs.

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* 6. In my opinion, the intake process is used the same way by all organizations in my community that serve the same type of consumers, e.g., families.

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* 7. Our community has a periodic review process to evaluate our targeting strategy as well as the overall assessment and resource allocation process.

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* 8. Consumers are prioritized for housing, financial assistance, and services based on their needs.

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* 9. Please answer the following questions as they pertain to housing consumers (unless otherwise indicated, you should assume the question is being asked about your organization).

  Yes No Unsure
Choices are provided to consumers about where they can be housed based on their preferences and income.
Housing needs are assessed within 24 hours of a consumer’s entry into any community shelter.
Most consumers are successfully supported in keeping their housing.
The community has an updated listing of available affordable housing units within its boundaries.
The community has staff dedicated specifically to providing housing location services to consumers.
Consumers receive thorough orientation to their new building and neighborhood.

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* 10. Please answer these additional questions about housing consumers (unless otherwise indicated, you should assume the question is being asked about your organization).

  Strongly Disagree Disagree Neither Agree nor Disagree Agree Strongly Agree
Consumers are helped to find housing that is acceptable to them and suitable for their needs.
Whenever possible, our community employs strategies that prevent people from losing their housing and diverts them away from needing shelter or other housing assistance.
The community has sufficient rapid re-housing resources in place that assist consumers in being re-housed quickly (<45 days) should they become homeless.
The community has been successful engaging landlords and finding new ones who are amenable to housing formerly homeless people.
We have an adequate supply of affordable permanent and permanent supportive housing in our community that can accommodate each person's place in the life cycle with the needed level of support.
Community wide, landlords are actively supported through regular communication and checking to ensure rent is paid on time and in full each month.
Newly housed consumers have access to suitable furniture in good and functional condition.
Newly housed consumers have access to other daily living essential such as bedding, dishes, cleaning supplies, food staples, shower curtains, etc.

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* 11. Please answer the following questions pertaining to your qualifications, training and expertise.

  Strongly Disagree Disagree Neither Agree nor Disagree Agree Strongly Agree
I am knowledgeable of the essential elements of diversion/prevention programs.
I am knowledgeable of the essential elements of rapid re-housing programs.
I am knowledgeable of the essential elements of permanent supportive housing programs.
I understand the Stages of Change and how the various stages apply to my work with consumers.
I comprehensively understand strength-based support strategies.
I am comprehensively trained in conflict resolution and de-escalation.
I am comprehensively trained in active listening.
I am comprehensively trained in Motivational Interviewing.
I am comprehensively trained in data storage and rules of disclosure including legal requirements pertaining to confidentiality and privacy.
I am comprehensively trained and/or have experience to address life changes, including: new partner, return of children, relationship break-up, etc.
I have an understanding of cognitive impairments such as brain injuries, Fetal Alcohol Spectrum Disorders, severe and persistent mental illness,etc.
I have a strong understanding of the effects of trauma.
I have a strong understanding of the impact and behaviors associated with sexual abuse.
I have expertise in how to access and navigate income supports and benefits systems.
I have expertise in other community services available to the consumers with whom I work.
I have a strong understanding of poverty, social stigmatization, discrimination and social justice.
I have received appropriate cultural competency training.
The need and practice of self-care is understood and practiced by all team members with whom I work.

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* 12. I do not attempt to provide services that I am unqualified or untrained to deliver.

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* 13. There are appropriate staff to consumer ratios in my organization for the type of work that we deliver.

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* 14. Our organization supports and participates in joint meetings/case conferences regarding specific consumers to coordinate our efforts with other service providers in our community.

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* 15. I strive to help consumers connect with other resources, services and organizations to best meet their needs.

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* 16. Our community uses HMIS to assist with case planning.

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* 17. As a community, we routinely reflect on data from either our HMIS or other case management software to understand who we are serving and not serving well and make adjustments to our service delivery.

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* 18. In our community, consumers who are entering or already engaged in a crisis are quickly identified and assisted.

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* 19. Our community separates crisis responses from longer-term support or case management responses.

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* 20. Services are distributed across the community so consumers can effectively access services in different locations.

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* 21. Programs and services have been implemented that respect and serve the needs of identified sub-populations, including: survivors of domestic violence, veterans, youth, seniors, immigrants, etc.

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* 22. The services we offer the clients we serve—either in-house or through direct referrals to other services in the community—include the following: (check all the services that apply)

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* 23. My community has an effective, integrated network of practice and I am an active part of it.

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* 24. Service benchmarks are in place throughout our organization.

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* 25. Services are monitored against predetermined service benchmarks at least once per quarter.

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* 26. I believe that I am accountable for helping consumers and my organization achieve pre-determined outcomes.

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* 27. We use a methodological approach to collect information from consumers regarding their impressions of our programs and services.

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* 28. Our system is responsive to feedback from consumers.

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