VISPDAT – Family

6. How long has it been since you lived in a permanent stable housing?

7. In the last three years, how many times have you been homeless?

A) Received healthcare at an emergency department/room?

B) Taken an ambulance to the hospital?

C) Been hospitalized as an inpatient?

D) Used a crisis service, including sexual assault crisis, mental health crisis, family/intimate violence, distress centers and suicide prevention hotlines?

E) Talked to police because you witnessed a crime, were the victim of a crime, or the alleged perpetrator of a crime or because the police told you that you must move along?

F) Stayed one or more nights in a holding cell, jail, or prison, whether that was a short-term stay like the drunk tank, a longer stay for a more serious offense, or anything in between?

9. Have you been attacked or beaten up since you've become homeless?

10. Have you threatened to or tried to harm yourself or anyone else in the last year?

11. Do you have any legal stuff going on right now that may result in you being locked up, having to pay fines, or that make it more difficult to rent a place to live?

12. Does anybody force or trick you to do things that you do not want to do?

13. Do you ever do things that may be considered to be risky like exchange sex for money, run drugs for someone, have unprotected sex with someone you don't know, share a needle, or anything like that?

14. Is there any person, past landlord, business, bookie, dealer, or government group like the IRS that thinks you owe them money?

15. Do you get any money from the government, a pension, an inheritance, working under the table, a regular job, or anything like that?

16. Do everyone in your family have planned activities, other than just surviving, that makes you feel happy and fulfilled?

17. Is everyone in your family currently able to take care of basic needs like bathing, changing clothes, using a restroom, getting food and clean water and other things like that?

18. Is your family's current homelessness in any way caused by a relationship that broke down, an unhealthy or abusive relationship, or because other family or friends caused you to become evicted?

19. Has your family ever had to leave an apartment, shelter program, or other place you were staying because of the physical health of you or anyone in your family?

20. Do you or anyone in your family have any chronic issues with your liver, kidneys, stomach, lungs or heart?

21. If there was space available in a program that specifically assists people that lived with HIV or AIDS, would that be of interest to you or anyone in your family?

22. Does anyone in your family have any physical disabilities that would limit the type of housing you could access, or would make it hard to live independently because you'd need help?

23. When someone your family is sick or not feeling well, do you avoid getting medical help?

24. Has drinking or drug use led you or anyone in your family led your family to being kicked out of an apartment or program where you were staying in the past?

25. Will drinking or drug use make it difficult for you to stay housed or afford your housing?

27. Do you or anyone in your family have any mental health or brain issues that would make it hard for your family to live independently because help would be needed?

28. If the family answered Yes to ANY Physical Health questions 19 through 23, AND Yes to ANY Substance Use questions 24 through 25, AND Yes to ANY Mental Health questions 26 through 27:

a) Does any single member of your household have a medical condition, mental health concerns, and experience with problematic substance use?

29. Are there any medications that a doctor said you or anyone in your family should be taking that, for whatever reason, that you are not taking?

30. Are there any medications like painkillers that you or anyone in your family don't take the way the doctor prescribed or where you sell the medication?

31. Has your family's current period of homelessness been caused by an experience of emotional, physical, psychological, sexual, or other type of abuse, or by any other trauma you have experienced?

Section VI: Family Unit:

32. Are there any children that have been removed from the family by a child protection service within the last 180 days?

33. Do you have any family legal issues that are being resolved in court or need to be resolved in court that would impact your housing or who may live within your housing?

34. In the last 180 days have any children lived with family or friends because of your homelessness or housing situation?

35. Has any child in the family experienced abuse or trauma in the last 180 days?

36. IF THERE ARE SCHOOL AGED CHILDREN: Do your children attend school more often than not each week?

37. Have the members of your family changed in the last 180 days, due to things like divorce, your kids coming back to live with you, someone leaving for military service or incarceration, a relative moving in, or anything like that?

38. Do you anticipate any other adults or children coming to live with you within the first 180 days of being housed?

39. Do you have two or more planned activities each week as a family such as outings to parks, going to the library, visiting other family, watching a family movie, or anything like that?

36. 40. After school, or on weekends or days when there isn't school, is the total time children spend each day where there are no interactions with you or another responsible adult ...

A. 3 or more hours per day for children aged 13 or older?

B. 2 or more hours per day for children aged 12 or younger?

41. IF THERE ARE CHILDREN BOTH 12 AND UNDER & 13 AND OVER:

A. Do your older kids spend 2 or more hours on a typical day helping their younger siblings(s) with things like getting ready for school, helping with homework, making them dinner, bathing them, or anything like that?