Coordinated Access Survey

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* 1. What type of Organization do you represent?

Non-Profit

For-Profit

Government

Individual

Other

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* 2. Does your Organization receive any funding through the CoC?

Yes

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* 3. What Population do you serve? (Check all the apply)

Literal Homeless

Youth (18-24)

Domestic Violence Victims

Unaccompanied Youth (17 and under)

Other

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* 4. What Counties do you serve? (Check all that apply)

Hernando

Lake

Citrus

Sumter

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* 5. Please rate the following in order of priority (1 being highest and 5 being lowest)

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* 6. Select Two of the following you feel should be given priority over the others

Chronic Homeless (individual with a disabling condition who has either experienced homelessness for 12 months or loner or has had 4 or more episodes in the past 3 years.)

Those at Risk of being homeless

Elderly

Those fleeing Domestic Violence

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* 7. Select TWO of the following you feel should be given priority over the others

Length of time homeless

Substance abuse issues

Mental Health Issues

Length of time of the By Name List

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* 8. Select THREE of the following you feel should be given priority over the others

Tri-morbidity (co-occurring disorder (psychiatric, substance abuse) with a chronic medical condition

Current Palliative Health Care

Acuity (Mental acuity is sharpness of the mind. Things considered in determining a person's mental acuity are memory, focus, concentration, and understanding)

Physical/Chronic Health Issues

Pregnancy in family

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* 9. Select TWO of the following you feel should be given priority over the others

Sheltered (Emergency or Transitional Shelter)

Unsheltered

Length of time in CoC

Working current reunification case plan

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* 10. High utilizer of Mental Health facility Select ONE of the following you feel should be given priority over the others

High utilizer of Mental Health facility

High utilizer of Correctional facility

Hugh utilizer of Community Drop in Centers

High utilizer of Substance Abuse Treatment facility