Vulnerability IndexServicePrioritizationDecisionAssistanceTool (VI-­‐SPDAT)

Prescreen for SingleAdults

GENERAL INFORMATION/CONSENT

Interviewer’sName / Agency
TEAMSTAFFVOLUNTEER
Date / Time / Location
Inwhatlanguagedoyoufeelbestabletoexpressyourself?
FirstName / LastName
Nickname / SocialSecurityNumber
Howoldareyou? / What’syourdateofbirth? / HasConsentedtoParticipate
YES NO
If60yearsorolder,thenscore1. / PrescreenScore
PRE-SCREENGENERALINFORMATIONSUBTOTAL

A. HISTORYOFHOUSING& HOMELESSNESS

QUESTIONS
If thepersonhas experienced twoor more cumulative years of homelessness, and/or
4+ episodes of homelessness, then score1. / RESPONSE / REFUSED / PrescreenScore
1. What is the total lengthof time youhave livedon the streets or in shelters? / 
2. In the past three years, howmany times have youbeenhousedand thenhomeless
again? / 
PRE-­‐SCREENHOUSINGANDHOMELESSNESS SUBTOTAL

SCRIPT:Iamgoingtoaskyousomequestionsaboutyourinteractionswithhealthandemergencyservices.Ifyouneedanyhelp figuringoutwhensixmonthsagowas,justletmeknow.

QUESTIONS
Ifthetotalnumberofinteractionsacrossquestions3,4,5,6and7isequaltoor greaterthan4,thenscore1. / RESPONSE / REFUSED / Prescreen
Score
3.Inthepastsixmonths,howmanytimeshaveyoubeentotheemergency department/room? / 
4.Inthepastsixmonths,howmanytimeshaveyouhadaninteractionwiththepolice? / 
5.Inthepastsixmonths,howmanytimeshaveyoubeentakentothehospitalinan ambulance? / 
6.Inthepastsixmonths,howmanytimeshaveyouusedacrisisservice,including distresscentersorsuicidepreventionhotlines? / 
7.Inthepastsixmonths,howmanytimeshaveyoubeenhospitalizedasanin-­‐patient, includinghospitalizationsinamentalhealthhospital? / 
IfYEStoquestions8or9,thenscore1. / YES / NO / REFUSED / Prescreen
Score
8.Haveyoubeenattackedorbeatenupsincebecominghomeless? /  /  / 
9.Threatenedtoortriedtoharmyourselforanyoneelseinthelastyear? /  /  / 
IfYEStoquestion10,thenscore1. / YES / NO / REFUSED / Prescreen
Score
10.Doyouhaveanylegalstuffgoingonrightnowthatmayresultinyoubeinglocked uporhavingtopayfines? /  /  / 
IfYEStoquestions11or12;ORifrespondentprovidesanyanswerOTHERTHAN
“Shelter”inquestion13,thenscore1. / YES / NO / REFUSED / Prescreen
Score
11.Doesanybodyforceortrickyoutodothingsthatyoudonotwanttodo? /  /  / 
12.Everdothingsthatmaybeconsideredtoberiskylikeexchangesexformoney,run drugsforsomeone,haveunprotectedsexwithsomeoneyoudon’treallyknow,sharea needle,oranythinglikethat? /  /  / 
13.Iamgoingtoreadtypesofplacespeoplesleep.Pleasetellmewhichonethatyou sleepatmostoften.(Checkonlyone.) / Shelter
Street,Sidewalkor
Doorway
Car,VanorRV
BusorSubway
Beach,RiverbedorPark
Other(SPECIFY):
PRE-­‐SCREENRISKSSUBTOTAL
QUESTIONS
IfYEStoquestion14orNOtoquestions15or16,score1. / YES / NO / REFUSED / Prescreen
Score
14.Isthereanybodythatthinksyouowethemmoney? /  /  / 
15.Doyouhaveanymoneycominginonaregularbasis,likeajoborgovernment benefitorevenworkingunderthetable,binningorbottlecollecting,sexwork,odd jobs,daylabor,oranythinglikethat? /  /  / 
16.Doyouhaveenoughmoneytomeetallofyourexpensesonamonthlybasis? /  /  / 
IfNOtoquestion17,score1. / YES / NO / REFUSED / Prescreen
Score
17.Doyouhaveplannedactivitieseachdayotherthanjustsurvivingthatbringyou happinessandfulfillment? /  /  / 
IfYEStoquestions18or19,score1. / YES / NO / REFUSED / Prescreen
Score
18.Doyouhaveanyfriends,familyorotherpeopleinyourlifeoutofconvenienceor necessity,butyoudonotliketheircompany? /  /  / 
19.Doanyfriends,familyorotherpeopleinyourlifeevertakeyourmoney,borrow cigarettes,useyourdrugs,drinkyouralcohol,orgetyoutodothingsyoureallydon’t wanttodo? /  /  / 
OBSERVEONLY.DONOTASK!IfYES,score1. / YES / NO / Prescreen
Score
20.Surveyor,doyoudetectsignsofpoorhygieneordailylivingskills? /  / 
PRE-­‐SCREENSOCIALIZATIONDAILYFUNCTIONSSUBTOTAL

D.WELLNESS

QUESTIONS
IfDoesNotGoForCare,score1. / RESPONSE / Prescreen
Score
21.Wheredoyouusuallygoforhealthcareorwhenyou’renotfeelingwell? / Hospital
Clinic
VA
Other(specify)
Doesnotgoforcare
ForEACHYESresponseinquestions22through25(MedicalConditions),score1.
Doyouhavenow,haveyoueverhad,orhasahealthcareproviderevertoldyou thatyouhaveanyofthefollowingmedicalconditions: / YES / NO / REFUSED / Medical
Conditions
22.Kidneydisease/EndStageRenalDiseaseorDialysis /  /  / 
23.Historyoffrostbite,Hypothermia,orImmersionFoot /  /  / 
24.Liverdisease,Cirrhosis,orEnd-­‐StageLiverDisease /  /  / 
25.HIV+/AIDS /  /  / 
IfYEStoanyoftheconditionsinquestions26to34,thenmark“X”inOtherMedical
Conditioncolumn. / YES / NO / REFUSED / Other Medical Conditions
26.HistoryofHeatStroke/HeatExhaustion /  /  / 
27.Heartdisease,Arrhythmia,orIrregularHeartbeat /  /  / 
28.Emphysema /  /  / 
29.Diabetes /  /  / 
30.Asthma /  /  / 
31.Cancer /  /  / 
32.HepatitisC /  /  / 
33.Tuberculosis /  /  / 
OBSERVATIONONLY–DONOTASK:
34.Surveyor,doyouobservesignsorsymptomsofaserioushealthcondition? /  / 
IfanyresponseisYESinquestions35through41,score1intheSubstanceUse column. / YES / NO / REFUSED / Substance
Use
35.Haveyoueverhadproblematicdrugoralcoholuse,abuseddrugsoralcohol,or toldyoudo? /  /  / 
36.Haveyouconsumedalcoholand/ordrugsalmosteverydayoreverydayforthe pastmonth? /  /  / 
37.Haveyoueverusedinjectiondrugsorshotsinthelastsixmonths? /  /  / 
38.Haveyoueverbeentreatedfordrugoralcoholproblemsandreturnedtodrinking orusingdrugs? /  /  / 
39.Haveyouusednon-­‐beveragealcohollikecoughsyrup,mouthwash,rubbing alcohol,cookingwine,oranythinglikethatinthepastsixmonths? /  /  / 
40.Haveyoublackedoutbecauseofyouralcoholordruguseinthepastmonth? /  /  / 
OBSERVATIONONLY–DONOTASK:
41.Surveyor,doyouobservesignsorsymptomsorproblematicalcoholordrug abuse? /  / 
IfanyresponseisYESinquestions42through48,score1intheMentalHealth
Column. / YES / NO / REFUSED / Mental
Health
42.Everbeentakentoahospitalagainstyourwillforamentalhealthreason? /  /  / 
43.Gonetotheemergencyroombecauseyouweren’tfeeling100%wellemotionally orbecauseofyournerves? /  /  / 
44.Spokenwithapsychiatrist,psychologistorothermentalhealthprofessionalinthe lastsixmonthsbecauseofyourmentalhealth–whetherthatwasvoluntaryor becausesomeoneinsistedthatyoudoso? /  /  / 
45.Hadaseriousbraininjuryorheadtrauma? /  /  / 
46.Everbeentoldyouhavealearningdisabilityordevelopmentaldisability? /  /  / 
47.Doyouhaveanyproblemsconcentratingand/orrememberingthings? /  /  / 
OBSERVATIONONLY–DONOTASK:
48.Surveyor,doyoudetectsignsorsymptomsofsevere,persistentmentalillnessor severelycompromisedcognitivefunctioning? /  / 
IftheSubstanceUsescoreis1ANDtheMentalHealthscoreis1ANDtheMedicalConditionscoreisatleasta1
ORanX,thenscore1additionalpointfortri-­‐morbidity. / Tri-­‐Morbidity
IfYEStoquestion49,score1. / YES / NO / REFUSED / Prescreen
Score
49.Haveyouhadanymedicinesprescribedtoyoubyadoctorthatyoudonottake, sell,hadstolen,misplaced,orwheretheprescriptionswereneverfilled? /  /  / 
IfYEStoquestion50,score1. / YES / NO / REFUSED / Prescreen
Score
50.YesorNo–Haveyouexperiencedanyemotional,physical,psychological,sexual orothertypeofabuseortraumainyourlifewhichyouhavenotsoughthelpfor, and/orwhichhascausedyourhomelessness? /  /  / 
PRE-­‐SCREENWELLNESSSUBTOTAL

SCORINGSUMMARY

DOMAIN / SUBTOTAL / IfthePre-­‐ScreenTotalisequaltoorgreaterthan10, theindividualisrecommendedforaPermanent SupportiveHousing/HousingFirstAssessment.
IfthePre-­‐ScreenTotalis5,6,7,8or9,theindividualis recommendedforaRapidRe-­‐HousingAssessment.
IfthePre-­‐ScreenTotalis0,1,2,3or4,theindividualis notrecommendedforaHousingandSupport Assessmentatthistime.
GENERALINFORMATION
A.HISTORYOFHOUSINGANDHOMELESSNESS
B.RISKS
C.SOCIALIZATIONANDDAILYFUNCTIONS
D.WELLNESS
PRE-­‐SCREENTOTAL

FinallyI’dliketoaskyousomequestionstohelpusbetterunderstandhomelessnessandimprovehousingandsupport services.

Whatisyourgender? / MaleFemaleTransgenderOther
DeclinetoState
HaveyoueverservedintheUSMilitary? / YesNoRefused
Ifyes,whichwar/wareradidyouservein? / KoreanWar(June1950-­‐January1955)
VietnamEra(August1964-­‐April1975)
PostVietnam(May1975-­‐July1991)
PersianGulfEra(August1991-­‐Present)
Afghanistan(2001-­‐Present)
Iraq(2003-­‐Present)
Other(Specify)
Refused
Ifyes,whatwasthecharacterofyourdischarge? / HonorableOtherthanHonorable
BadConductDishonorableRefused
Whatisyourcitizenshipstatus? / CitizenLegalResidentUndocumented
Refused
Wheredidyoulivepriortobecominghomeless? / Thiscity
Thisregion
OtherpartoftheState
Somewhereelse
(specify)______
Haveyoueverbeeninfostercare? / YesNoRefused
Haveyoueverbeeninjail? / YesNoRefused
Haveyoueverbeeninprison? / YesNoRefused
Doyouhaveapermanentphysicaldisabilitythatlimitsyourmobility? [i.e.,wheelchair,amputation,unabletoclimbstairs]? / YesNoRefused
Whatkindofhealthinsurancedoyouhave,ifany?(checkallthatapply) / MedicaidMedicareVAPrivate
Insurance
NoneOther(specify):______
Onaregularday,whereisiteasiesttofindyouandwhattimeofdayis easiesttodoso?
Isthereaphonenumberand/oremailwheresomeonecangetintouch withyouorleaveyouamessage?
Ok,nowI’dliketotakeyourpicture.MayIdoso? / YesNoRefused