Homeless Home Case Study

Participant: ____________________________________________ Staff: _____________________________________________
Current Living Situation
Chronic Homelessness Homeless Place not meant for Habitation Unstably housed
Stably housed Institutional Situation (such as jail, hospitals or treatment facility/detox center) Emergency Shelter

Safe Haven Transitional or Permanent Housing

Comments________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Does the participant receive …show more content…
Yes No
Comments _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Did the participant note any changes in income (both cash and noncash), medical insurance or housing situation?
Yes No
Comments _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Please review the list below and circle the topics that the participant stated that they had been able to maintain or increase or is looking in to creating goals to obtain at the present time.

Maintaining housing Increasing life skills Going to school Increasing employment skills Saving money Increasing …show more content…
1 3
2 4
Barriers Did the participant express any barriers in the process?
1 3
2 4
Review • Achieved • Progress Made • No Progress Review date:
Comments:

#2 Action Steps What action steps did the Participant do to maintain or increase the above skills/ relationships Target Date Date/Progress
1

2 3 4 5 Referrals & Support What referrals or support systems did the Participant note helpful in assisting them.
1 3
2 4
Strengths What strengths (internal or environmental) did they believe that they used or developed to meet the action steps above?
1 3
2 4
Barriers Did the participant express any barriers in the process?
1 3
2 4
Review • Achieved • Progress Made • No Progress Review date:
Comments:

#3 Action Steps What action steps did the Participant do to maintain or increase the above skills/ relationships Target Date Date/Progress
1

2 3 4 5 Referrals & Support What referrals or support systems did the Participant note helpful in assisting them.
1 3
2 4
Strengths What strengths (internal or environmental) did they believe that they used or developed to meet the action steps