Risk_Assessment_012016Community Housing Support Services Program Risk Assessment Matrix
Family Name:
Program Name:
Date(s) of
Evaluation and Process Used (EDSP questionnaire or intake questions):
Issue / Assistance Needed
Score on Intake
Score at Exit
Score at 90 days
Score at 180
days
Score at 9 months
Score at 12 months
1 – In Crisis
2 – Vulnerable
3 – Safe
4 – Building Capacity
5 – Empowered
Income
No income.
Inadequate income
and/or spontaneous or inappropriate spending
Can meet basic needs with subsidy; appropriate spending
Can meet basic needs and manage debt without assistance
Income is sufficient,
well managed; has discretionary income and is able to save.
Employment
No job.
Temporary, part-time or seasonal; inadequate pay, no benefits.
Employed full time;
inadequate pay; few or no benefits
Employed full time with adequate pay and benefits
Maintains permanent employment with adequate income and benefits.
Conflict Resolution (other
than legal)
Unable to get along with others or resolve disputes; often engages in violent or threatening behavior.
Unable to get along with others or resolve disputes;
occasionally engages in threatening behavior.
Able to resolve disputes in a nonviolent manner; does not engage in threatening or violent behavior.
Able to get along with others; has
resolved past conflicts and/or has not been involved in any disputes for more than 6 months.
Able to get along with others and build new, conflict-free, relationships; no violent or
threatening behavior in more than 12 months.
Food
No food or means to prepare it. Relies to a significant degree on other sources of free or low-cost food.
Household
is on food stamps.
Can meet basic food needs, but requires occasional assistance.
Can meet basic food needs without assistance.
Can choose to purchase any food household desires.
Childcare
Needs childcare, but none is available/accessible and/or child is not eligible
Childcare is unreliable or unaffordable, inadequate supervision is a problem for childcare
that is available.
Affordable subsidized childcare is available, but limited.
Reliable, affordable childcare is available, no need for subsidies.
Able to select quality childcare
of choice.
Children’s Education
One or more eligible children not enrolled in school.
One or more eligible children enrolled in school, but not attending classes.
Enrolled
in school, but one or more children only occasionally attending classes.
Enrolled in school and attending classes most of the time.
All eligible children enrolled and attending on
a regular basis.
Adult Education
Literacy problems and/or no high school diploma/GED are serious barriers to employment.
Enrolled in literacy and/or GED program
and/or has sufficient command of English to where language is not a barrier to employment.
Has high school diploma/GED.
Needs additional education/training to improve employment situation
and/or resolve literacy problems to where they are able to function effectively in society.
Has completed education/training needed to become employable. No literacy problems.
Legal
Current outstanding tickets or warrants.
Current charges/trial pending, noncompliance with probation/parole.
Fully compliant with probation/parole terms.
Has successfully completed
probation/parole within the past 12 months, no new charges pending.
No felony criminal history and/or no active criminal justice involvement in more than 12 months.
Healthcare
No medical coverage with immediate need.
No medical coverage and great difficulty accessing medical care when needed. Some household members in poor health.
Some members (e.g. Children)
receiving Medicaid
All members can get medical care when needed, but may strain budget.
All members are covered by affordable, adequate health insurance.
Life Skills
Unable
to meet basic needs such as hygiene, food, activities of daily living.
Can meet a few but not all needs of daily living without assistance.
Can meet most but not all daily living needs
without assistance.
Able to meet all basic needs of daily living without assistance.
Able to provide beyond basic needs of daily living for self and family.
Mental Health
Dang
er to self or others; recurring suicidal ideation; experiencing severe difficulty in day-to-day life due to psychological problems.
Recurrent mental health symptoms that may effect
behavior, but not a danger to self/others; persistent problems with functioning due to mental health symptoms.
Mild symptoms may be present but are transient; only moderate difficulty
in functioning due to mental health problems.
Minimal symptoms that are expectable responses to life stressors; only slight impairment in functioning.
Symptoms are absent or rare;
good or superior functioning in wide range of activities; no more than every day problems or concerns.
Substance Abuse
Meets criteria for severe abuse/dependence; resulting problems so severe that institutional living or hospitalization may be necessary.
Meets criteria
for dependence; preoccupation with use and/or obtaining drugs/alcohol; withdrawal of withdrawal/avoidance
Persistent use. Evidence of persistent or recurrent social, occupational,
emotional, or physical problems related to use (such as disruptive behavior or housing problems); problems have persisted for at least one month.
Recent use, but no evidence of persistent
or recurrent social, occupational, emotional, or physical problems related to use; no evidence of recurrent dangerous use; and / or consistent engagement in a sobriety program.
No history
or a demonstrated, long-term commitment to sobriety, including long-term engagement in sobriety programs.
Social Network
Lack of necessary support from family or
friends; and/or presence of abuse.
No abuse present. Family/friends may be supportive, but lack ability or resources to help; family members do not relate well with one another; potential
for abuse or neglect.
Some support from family/friends; family members acknowledge and seek to change negative behaviors; are learning to communicate and support.
Strong support from
family or friends. Household members support each other’s efforts.
Has healthy/expanding support network; household is stable and communication is consistently open.
Mobility
No access to transportation, public or private; may have car that is inoperable.
Transportation is available, but unreliable, unpredictable, unaffordable; may have car but no insurance,
license, etc.
Transportation is available and reliable, but limited and/or inconvenient; drivers are licensed and minimally insured.
Transportation is generally accessible to meet
basic travel needs.
Transportation is readily available and affordable; car is adequately insured.
Community Involvement
Not applicable due to crisis situation;
in “survival” mode.
Socially isolated and/or no social skills and/or lacks motivation to become involved.
No community involvement. Lacks knowledge of ways to become involved and/or
barriers to participation exist.
Some community involvement (advisory group, support group), but has barriers such as transportation, childcare issues.
Actively involved in community.
Housing
Homeless or threatened with eviction.
In transition, temporary or substandard housing; and/or current rent/mortgage payment is unaffordable (over 30% of income.)
In
stable housing that is safe but only marginally adequate.
Household is in safe, adequate, subsidized housing.
Household is in safe, adequate, unsubsidized housing.
Safety
Home or residence is not safe; immediate level of lethality is extremely high; possible CPS involvement
Safety is threatened/temporary protection is available;
level of lethality is high
Current level of safety is minimally adequate; ongoing safety planning is essential
Environment is safe, however, future of such is uncertain; safety planning
is important
Environment is apparently safe and stable
Parenting Skills
There are safety concerns regarding parenting skills
Parenting skills are minimal
Parenting
skills are apparent but not adequate
Parenting skills are adequate
Parenting skills are well developed