Evaluation of the Collaborative Initiative to Help End Chronic Homelessness (CICH)
National Performance Outcomes Assessment

An Evaluation of an Initiative to Improve Coordination and Service Delivery of Homeless Services Networks

Appendix A:
Network Participation Survey

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Agency ID [Entry Field]

Interviewer ID [Entry Field]

Date of Survey [Entry Field]

Agency Name [Entry Field]

Agency Representative [Entry Field]

Phone Number [Entry Field]

Sequence Number 1 = Baseline, 2 = Year 1, 3 = Year 2, 4 = Year 3, 5 = Other (Specify: ___________)

  1. For which component(s) of the Chronic Homelessness Initiative is this agency/organization responsible? (Code ‘0’ or ‘1’ for each item below)
    1. Lead agency [0 = No 1 = Yes]
    2. Permanent housing service provider [0 = No 1 = Yes]
    3. Primary health care services provider [0 = No 1 = Yes]
    4. Mental health services provider [0 = No 1 = Yes]
    5. Substance abuse treatment provider [0 = No 1 = Yes]
    6. Veteran service provider (VA or community provider) [0 = No 1 = Yes]
    7. Other service provider (e.g., partnering agency) [0 = No 1 = Yes]
  2. SKIP QUESTIONS 2-3 FOR YEARS 1-3
  3. SKIP QUESTIONS 2-3 FOR YEARS 1-3
  4. About how many agencies/organizations are involved in the CHI network? [Entry Field, Code Don’t Know = ’99’]
  5. How often does the CHI network meet, on average?
    1. = More Than Weekly
    2. = Weekly
    3. = Twice/month
    4. = Monthly,
    5. = Bi-monthly
    6. = Quarterly
    7. = Bi-annually
    8. = Annually
    9. = DK
  6. Does the CHI network have a formal committee structure? [Entry Field 0 = No, 1 = Yes, 9 = DK (If ‘No’ or ‘DK’, SKIP to Q10)
  7. Please specify the names of a few committees.
    1. Name: [Entry Field]
    2. Name: [Entry Field]
    3. Name: [Entry Field]
  8. How effective are these committees in accomplishing the goals of the CHI network? [Entry Field, 0 = Not at all, 1 = A little, 2 = Somewhat, 3 = Very, 9 = DK]
  9. Are consumers on these committees? [Entry Field, 0 = No, 1 = Yes, 9 = DK]
  10. Sometimes there are critical individuals without whom the network would not be sustainable. Are there key leaders without whom the network
    1. Would not have been established? [Entry Field, 0 = No, 1 = Yes, 9 = DK]
    2. Would not continue to function at its current high level? [Entry Field, 0 = No, 1 = Yes, 9 = DK ]
    3. Please name up to two of these key individuals [Entry Field 1] [Entry Field 2]
  11. To what extent has each of the following agencies been actively involved with the CHI network during the past year? (0 = Not at all 1 = A little bit 2 = Somewhat involved 3 = Very involved 9 = DK)
    1. Public housing authority (PHA) [Entry Field]
    2. Social Security Administration (SSA) [Entry Field]
    3. City or county welfare/general assistance office [Entry Field]
    4. Soup kitchens [Entry Field]
    5. Vocational rehabilitation agencies [Entry Field]
    6. Law enforcement [Entry Field]
    7. Faith based organizations [Entry Field]
    8. Private businesses [Entry Field]
    9. Primary health care services provider [Entry Field]
    10. Mental health services provider [Entry Field]
    11. Substance abuse treatment provider [Entry Field]
    12. Veteran service provider [Entry Field]
  12. Is there a local governmental agency responsible for the care of homeless persons in your community? [Entry Fireld, 0 = No, 1 = Yes, 9 = DK, (If ‘No’ or ‘DK’, SKIP to Q13)
  13. To what extent does (do) the provider(s) in the CHI Network considered together now provide each of the following types of housing for homeless people through the use of either CHI funding or non-CHI funding? [Entry Field, 0 = Not at all, 1 = A little, 2 = Somewhat, 3 = A lot, 9 = DK]
    1. Emergency shelter [Entry Field]
    2. Transitional housing [Entry Field]
    3. Affordable housing without services [Entry Field]
    4. Permanent supported housing (i.e., housing with significant supportive services) [Entry Field]
  14. In recent years has there been a change in emphasis in the type of housing provided by the agencies participating in the CHI network? [Entry Field] 0 = No, 1 = Yes, 9 = DK, (If ‘No’ or ‘DK’, SKIP to Q16)
  15. How has the emphasis changed for each of the following types of housing (i.e., housing emphasized less, same, or more)?


    GOALS AND FOCUS

  16. Which of the following goals are most important for the CHI network? Next most… (Code 1-5, with most important = ‘1’ and least important = ‘5’)
    1. Obtain grant funding from the Chronic Homelessness Initiative [Entry Field]
    2. Obtain grant funding from other sources [Entry Field]
    3. Establish partnerships among homeless service providers to better coordinate care across agencies [Entry Field]
    4. Develop an integrated system of care for persons who are homeless [Entry Field]
    5. Develop systematic plans to end or substantially reduce the prevalence of chronic homelessness in our community [Entry Field]


    PLANNING

  17. Did the CHI network conduct the following planning activities focused on ending chronic homelessness during the past year or were they involved in such activities as part of a larger coalition?
    1. Developed a mission statement [Entry Field] 0 = No, 1 = Yes, 9 = DK
    2. Identified goals for training staff [Entry Field] 0 = No, 1 = Yes, 9 = DK
    3. Used quantitative methodology to determine the prevalence and/or unmet needs of homeless people [Entry Field] 0 = No, 1 = Yes, 9 = DK
    4. Conducted an inventory of available housing and supportive services for homeless people [Entry Field] 0 = No, 1 = Yes, 9 = DK


    MANAGEMENT

  18. How well does the CHI network work together to…
    1. Identify barriers or bottlenecks in delivery of housing and services to homeless people? [Entry Field] 0 = Not at all, 1 = A little, 2 = Somewhat, 3 = Very well, 9 = DK
    2. Understand the reasons for these problems? [Entry Field] 0 = Not at all, 1 = A little, 2 = Somewhat, 3 = Very well, 9 = DK
    3. Fix or improve these problems? [Entry Field] 0 = Not at all, 1 = A little, 2 = Somewhat, 3 = Very well, 9 = DK
    4. Address individual client service needs? [Entry Field] 0 = Not at all, 1 = A little, 2 = Somewhat, 3 = Very well, 9 = DK
  19. Do you currently have a way of identifying the characteristics of the people served by the CHI network? [Entry Field] 0 = No, 1 = Yes, 9 = DK, (If ‘No’ or ‘DK’, SKIP to Q21)
  20. Does the system provide information on client characteristics…?
  21. Do you currently have a way of identifying the housing and services
    delivered by the CHI network? [Entry Field] 0 = No 1 = Yes 9 = DK, (If ‘No’ or ‘DK’, SKIP to Q23)
  22. Does the system provide data on housing and services delivered …?
    1. In real-time, used by clinicians in the delivery of services [Entry Field] 0 = No, 1 = Yes, 9 = DK
      In the form of aggregated periodic summaries [Entry Field] 0 = No, 1 = Yes, 9 = DK
      As individual client data [Entry Field] 0 = No, 1 = Yes, 9 = DK
      Through an inter-agency management information system [Entry Field] 0 = No, 1 = Yes, 9 = DK
  23. Do you currently have a way of determining the client outcomes of clients served by the CHI network? [Entry Field] 0 = No, 1 = Yes, 9 = DK, (If ‘No’ or ‘DK’, SKIP to Q25)
  24. Does the system provide data on client outcomes …?
    1. In real-time, used by clinicians in the delivery of services [Entry Field] 0 = No, 1 = Yes, 9 = DK
    2. In the form of aggregated periodic summaries [Entry Field] 0 = No, 1 = Yes, 9 = DK
    3. As individual client data [Entry Field] 0 = No, 1 = Yes, 9 = DK
    4. Through an inter-agency management information system[Entry Field] 0 = No, 1 = Yes, 9 = DK
  25. Is there a CHI network management information system [Entry Field] 0 = Neither planned for nor currently in use, 1 = Being planned for or developed, 2 = Being used by some network members, 3 = Being used by most network members, 4 = Being used by all network members, 5 = Other [Entry Field](If ‘No’ or ‘DK’ or ‘1’, SKIP to Q27), 6 = DK
  26. To what extent has the management information system been used for each of the following purposes?
    1. To identify malfunctioning processes of the service delivery system for homeless people [Entry Field] 0 = Not at all, 1 = A little, 2 = Somewhat, 3 = Very effectively, 9 = DK
    2. To understand causes of these malfunctioning processes [Entry Field] 0 = Not at all, 1 = A little, 2 = Somewhat, 3 = Very effectively, 9 = DK
    3. To fix or improve these malfunctioning processes [Entry Field] 0 = Not at all, 1 = A little, 2 = Somewhat, 3 = Very effectively, 9 = DK
    4. To address individual client service needs [Entry Field] 0 = Not at all, 1 = A little, 2 = Somewhat, 3 = Very effectively, 9 = DK


    SKIP QUESTIONS 27-31 FOR YEARS 1-3


    CONNECTIVENESS AND INTEGRATION

  27. During the past year, to what extent has your agency participated in the following activities with each member of the CHI network? Note that all your responses will be confidential. (Code each line below 0-5. The letters above each column refer to the agencies listed in Q27. Read questions 32-45 for each agency, beginning with the first column and ending with the last column. Code rows under your agency column ‘4’.) 0 = None, 1 = A little, 2 = Some, 3 = A lot, 4 = N/a (own agency), 5 = DK
    Agencies
    A B C D E F G H I


    SERVICE DELIVERY LEVEL

  28. Send clients to or receive homeless clients from this agency [Entry Field] A, [Entry Field] B, [Entry Field] C, [Entry Field] D, [Entry Field] E, [Entry Field] F, [Entry Field] G, [Entry Field] H, [Entry Field] I
  29. Co-locate staff and/or services in the same location with this agency [Entry Field] A, [Entry Field] B, [Entry Field] C, [Entry Field] D, [Entry Field] E, [Entry Field] F, [Entry Field] G, [Entry Field] H, [Entry Field] I
  30. Cooperate in serving clients [Entry Field] A, [Entry Field] B, [Entry Field] C, [Entry Field] D, [Entry Field] E, [Entry Field] F, [Entry Field] G, [Entry Field] H, [Entry Field] I
  31. Communicate clearly with this agency in serving clients [Entry Field] A,[Entry Field] B, [Entry Field] C, [Entry Field] D, [Entry Field] E, [Entry Field] F, [Entry Field] G, [Entry Field] H, [Entry Field] I
  32. Agree on goals with this agency for serving clients [Entry Field] A, [Entry Field] B, [Entry Field] C, [Entry Field] D, [Entry Field] E, [Entry Field] F, [Entry Field] G, [Entry Field] H, [Entry Field] I


    LEADERSHIP LEVEL

  33. Send funds to this agency [Entry Field] A, [Entry Field] B, [Entry Field] C,[Entry Field] D, [Entry Field] E, [Entry Field] F, [Entry Field] G, [Entry Field] H,[Entry Field] I
  34. Influence flow of funds to agency [Entry Field] A, [Entry Field] B,[Entry Field] C, [Entry Field] D, [Entry Field] E, [Entry Field] F, [Entry Field] G, [Entry Field] H, [Entry Field] I
  35. Receive funds from this agency [Entry Field] A, [Entry Field] B, [Entry Field] C, [Entry Field] D, [Entry Field] E, [Entry Field] F, [Entry Field] G, [Entry Field] H, [Entry Field] I
  36. To what extent does this agency influence the flow of funds to you [Entry Field] A, [Entry Field] B, [Entry Field] C, [Entry Field] D, [Entry Field] E,[Entry Field] F, [Entry Field] G, [Entry Field] H, [Entry Field] I
  37. Share data systems with this agency for assessing needs & delivering services [Entry Field] A, [Entry Field] B, [Entry Field] C, [Entry Field] D,[Entry Field] E, [Entry Field] F, [Entry Field] G, [Entry Field] H, [Entry Field] I
  38. Cooperate with this agency in planning [Entry Field] A, [Entry Field] B,[Entry Field] C, [Entry Field] D, [Entry Field] E, [Entry Field] F, [Entry Field] G, [Entry Field] H, [Entry Field] I
  39. Communicate clearly with this agency in planning [Entry Field] A, [Entry Field] B, [Entry Field] C, [Entry Field] D, [Entry Field] E, [Entry Field] F, [Entry Field] G, [Entry Field] H, [Entry Field] I


    BOTH SERVICE DELIVERY & LEADERSHIP LEVELS

  40. Send information to or receive information from this agency for coordination, control, planning, or evaluation [Entry Field] A, [Entry Field] B, [Entry Field] C, [Entry Field] D, [Entry Field] E, [Entry Field] F, [Entry Field] G, [Entry Field] H, [Entry Field] I
  41. Have written documents (e.g., MOUs) or flow charts specifying working relationship with this agency [Entry Field] A, [Entry Field] B, [Entry Field] C, [Entry Field] D, [Entry Field] E, [Entry Field] F, [Entry Field] G, [Entry Field] H, [Entry Field] I
  42. Trust this agency [Entry Field] A, [Entry Field] B, [Entry Field] C,[Entry Field] D, [Entry Field] E, [Entry Field] F, [Entry Field] G, [Entry Field] H,[Entry Field] I
  43. Respect this agency [Entry Field] A, [Entry Field] B, [Entry Field] C,[Entry Field] D, [Entry Field] E, [Entry Field] F, [Entry Field] G, [Entry Field] H, [Entry Field] I


    STRATEGIES TO IMPROVE SYSTEM INTEGRATION

  44. To what extent are the following strategies to improve the integration of services for chronically homeless individuals currently in place either within the CHI network or through its involvement in a larger coalition? Note that in this question we are asking about structures that currently exist either within the CHI or within the larger community.


    PRACTICES

  45. To what extent are the following services provided as part of the Chronic Homeless Initiative or available to its clients?
  46. Is there a specific effort to coordinate substance abuse and mental health services as part of the CHI network?
    1. Within an integrated team [Entry Field] 0 = Not at all, 1 = A little, 2 = Somewhat, 3 = A lot, 9 = DK
    2. Between distinct substance abuse and mental health agencies [Entry Field] 0 = Not at all, 1 = A little, 2 = Somewhat, 3 = A lot, 9 = DK


    LARGER HOMELESS COALITION

    These last few questions are about the overarching coalition(s) with which the Chronic Homelessness Initiative agencies has been involved during the past year.

  47. Is there a Department of Housing and Urban Development continuum of
    care currently operating in your community? [Entry Field] 0 = No, 1 = Yes, 9 = DK
  48. Have the agencies participating in the Chronic Homelessness Initiative been
    part of one or more broader homelessness coalitions during the past year, including a HUD continuum of care)? [Entry Field] 0 = No, 1 = Yes, 9 = DK (If ‘No’, END interview.)
  49. What is the name of the homelessness coalition most strongly associated with the Chronic Homelessness Initiative during the past year? [Entry Field]
  50. How important has this coalition been in the development of the Chronic Homelessness Initiative application? [Entry Field] 0 = Not at all, 1 = A little, 2 = Somewhat, 3 = Very, 9 = DK
  51. How important will (is) this coalition be to the implementation of the Chronic Homelessness Initiative? [Entry Field] 0 = Not at all, 1 = A little, 2 = Somewhat, 3 = Very, 9 = DK
  52. To what extent does it provide financial or in-kind resources for the implementation of the Chronic Homelessness Initiative? [Entry Field] 0 = Not at all, 1 = A little, 2 = Somewhat, 3 = A lot, 9 = DK
  53. How influential will (is) the coalition be in shaping the goals of the Chronic Homelessness Initiative? [Entry Field] 0 = Not at all, 1 = A little, 2 = Somewhat, 3 = Very, 9 = DK
  54. How important will (are) the institutional and political support provided by the coalition be for theimplementation of the Chronic Homelessness Initiative? [Entry Field] 0 = Not at all, 1 = A little, 2 = Somewhat, 3 = Very, 9 = DK


This concludes the interview. Thank you for your time. We will contact you in about 12 months to schedule a time for our next interview. Do you have any questions you would like to ask me before we say goodbye? [Answer any questions.] Alright, then, I look forward to talking with you next year. Goodbye.


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