Homeless Assessment Tool

Homeless Assessment Tool
Client Name
Client Name
First Name
Last Name
Interviewer Name
Interviewer Name
First Name
Last Name

Introduction

Interviewer Note: Before beginning the assessment, please review these key points:

  • Verify as much information as possible in HMIS.
  • Check the person’s immigration status. Coordinated Entry can only serve people who are United States citizens.
  • If a Homeless Assessment Tool (HAT) was completed in the last 6 months, please use that score unless some other life-changing event has occurred in the person’s life.
  • If they have identification, use it to answer the age question. You can also verify their date of birth in HMIS and confirm it with them.
  • Answer the household size and income questions as much as possible from HMIS and confirm it with them.
  • Look for any existing documented disability information in HMIS.
  • Remember that the person does not need documentation of a disabling condition to answer “yes” on the disability questions, however, they may need it later to obtain additional resources.
  • View our HAT Resources Page for relevant contact information and fact sheets.

Interviewer Says: Thank you for meeting with me today. I’m here to help connect you with housing and resources that best meet your needs.

I’ll be asking questions about your housing situation, health, well-being, and any support you may need. Some questions may feel personal or difficult. The more I understand your situation, the better I can help identify the housing assistance you may qualify for. The assessment usually takes about 15 minutes.

If you’re not comfortable answering a question, you can say “pass,” and we can come back to it later if you’d like. Your information is kept confidential in a secure database and is only shared with people who need it to help coordinate your services.

Before we begin, is there anything I can do to help you feel more comfortable? Do you have any questions or concerns? Are you ready to get started?

Getting to Know You

Interviewer Says: Lets get started with some easy questions. Then we’ll move to questions that help find out if there are things that might put you at risk more than others.

1) Would you rather have these questions asked in another language (i.e. Spanish)?
Interviewer Note: Please stop the assessment and provide interpretation services before preceding.
2) Do you have any identification?
Interviewer Note: If they have identification, please take the age information from there to answer question #3. If they do not, check HMIS and see if their date of birth is listed there and confirm with them that it is correct.
Interviewer Note: Look up the person’s age, if available
Prefers not to answer how old are you
Interviewer Note: Consider a referral to Center for Youth (585-271-7670).
A) Were you ever homeless as a child (under age 18)?
B) Have you ever been in foster care or entered the foster care system?
Prefers not to answer current monthly household income
Prefers not to answer how many people are moving into permanent housing
6) Do you require a 3-bedroom unit or larger based on your household size?
7) Do you have reliable childcare so you can attend appointments and search for housing?
8) In the last year, have you stayed in a place like a car, a park, the sidewalk, or an abandoned building, a place where people don’t typically stay?
9) Has there ever been a time when you felt pressured to do something you didn’t want to do just to have a place to stay?

Disabilities

Interviewer Note: HUD defines disability as one or more of the following: physical, mental or emotional impairment, post-traumatic stress disorder, brain injury or a chronic physical illness that:

  • Is expected to be long-continuing or of indefinite duration AND
  • Substantially impedes the person’s ability to live independently AND
  • Could be improved by more suitable housing

Interviewer Says: It’s important to note that this next section of questions is not only about you but relates to any member of your household who lives with you. Documentation is not needed at this time but may be needed in the future to obtain certain resources.

10) Has a medical provider told you or any member of your household that you have a terminal medical condition, meaning that you may need more support, like hospice or end-of-life planning in the next 12 months?
Interviewer Note: After you finish the assessment please ask if they need more support and referrals like those mentioned above.
11) Do you or any member of your household have any chronic health issues, which could include but are not limited to heart disease, cancer, diabetes, stroke, HIV/AIDS, or arthritis?
12) Do you or any member of the household have a disabling condition which limits the ability to complete daily functions?
Please refer to this disability definition for more details.
A) Please select the relevant condition(s).
Select all that apply.
Interviewer Note: If they have disability documentation, enter it into HMIS now.
13) Do you or any member of your household have a physical disability that limits your access to housing? (i.e., require a handicap-accessible with ramps, hard-of-hearing doorbells and alarm systems, or railings, etc.)
14) Has your substance misuse ever affected your housing or your relationship with others?
15) Has there been any mental health or behavioral health issues that have affected your housing or your relationships with others?

General Personal Vulnerabilities

Interviewer Says: These questions are to find out what would make finding housing easier for you.

16) Do you need help with taking care of yourself (for example: bathing, changing clothes, using a restroom, making meals, and other things like that)?
17) Are you pregnant or have you had a baby in the last 3 months?
18) Do you ever need help reading and/or understanding paperwork or mail?
19) Do you have a GED or Diploma?
20) In the last 2 years have you ever been asked to leave your housing or been legally evicted?
21) Have you ever lost your housing due to criminal activity in your household?
22) In the past 6 months, have you felt unsafe where you were living (due to issues like neighbor or family conflict, or gang violence)?

Interactions with the Criminal Justice System

Interviewer Says: This next question is about any past involvement with the legal system. I understand this question may feel uncomfortable, but it helps us determine which housing options and resources may be available to you.

23) Have you ever been convicted of a crime?

Interviewer Note: Check the sex offender registry after the client has left the interviewer room and note the results in the Coordinated Entry Prioritization List Application.
https://www.criminaljustice.ny.gov/SomsSUBDirectory/search_index.jsp

Domestic Violence

Interviewer Says: There are only two questions left, and they may be difficult to answer. Please take your time and share only what you feel comfortable sharing. While you’re not required to answer, any information you provide can help ensure the assessment is as complete as possible and support connecting you with appropriate services and resources.

24) In the last 60 days, have you or any household member been threatened, physically harmed, or subject to verbal, mental, or physical abuse by someone they live with?
25) Are you or anyone in your household afraid of someone knowing where you live (like someone threatening your life or stalking you)?

Interviewer Says:  Thank you for your time. Would you like any additional support or resources regarding any of the things I asked you about today? Do you have any questions or concerns after completing the assessment? Are there any questions that you would like to go back to?

Please remember that this assessment is not a guarantee that you will receive a referral for housing placement, and that you should continue to search for other housing options in the community.