Form PSH_Self-Assessmen PSH_Self-Assessment

Attachment 4: Permanent Supportive Housing (PSH) Self-Assessment

CABHI Evaluation - PSH Self-Assessment

1

Welcome to the Evaluation of SAMHSA’s Cooperative Agreements to Benefit
Homeless Individuals (CABHI) Program

OMB No. 0930-0339
Expiration Date: 1/31/2017

Public Burden Statement: An agency may not conduct or sponsor, and a person is not required to respond to, a collection
of information unless it displays a currently valid OMB control number. The OMB control number for this project is 09300339. Public reporting burden for this collection of information is estimated to average 40 minutes per respondent, per
year, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data
needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or
any other aspect of this collection of information, including suggestions for reducing this burden, to SAMHSA Reports
Clearance Officer, 5600 Fishers Lane, Room 15E57-B, Rockville, Maryland, 20857.

Permanent Supportive Housing (PSH) Self-Assessment

CABHI Evaluation - PSH Self-Assessment

2

Instructions

Welcome and thank you for taking time to complete the Permanent Supportive Housing (PSH) SelfAssessment Survey for the Evaluation of SAMHSA’s CABHI program. Please answer the questions
in this survey only about the CABHI project included in the invitation email you received, referred to
throughout this survey as the “SAMHSA Homeless project.”
Clicking "next" at the bottom of every page moves you to the next set of questions and saves your
answers to that page. Once you have begun the survey, you may go back and modify your
responses at any time. If you are unable to complete the survey, you can return to complete it at a
later date using the same link in the invitation email. The survey will continue where you left off.
Click "next" below to begin taking this survey!

CABHI Evaluation - PSH Self-Assessment

3

Respondent Information

We will start with questions about you and your agency's involvement with the SAMHSA Homeless project. 

2. Please select your SAMHSA Homeless project from the choices below.
Homeless Project Name with ID Number

6

SAMHSA Grantee 
Organization Name with ID 
Number

3. Which of the following best describes your role(s) in the SAMHSA Homeless project
(check all that apply)
Yes

No

Project Director

j
k
l
m
n

j
k
l
m
n

Project Coordinator

j
k
l
m
n

j
k
l
m
n

Program Manager

j
k
l
m
n

j
k
l
m
n

Local Evaluator

j
k
l
m
n

j
k
l
m
n

Housing Provider

j
k
l
m
n

j
k
l
m
n

Mental Health 

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Trauma Specialist

j
k
l
m
n

j
k
l
m
n

Case Manager

j
k
l
m
n

j
k
l
m
n

Benefits Specialist

j
k
l
m
n

j
k
l
m
n

Peer Specialist/Consumer

j
k
l
m
n

j
k
l
m
n

Housing Specialist

j
k
l
m
n

j
k
l
m
n

Vocational Specialist

j
k
l
m
n

j
k
l
m
n

Educational Specialist

j
k
l
m
n

j
k
l
m
n

Counselor/Treatment 
Provider/Supervisor
Substance Abuse 
Counselor/Treatment 
Provider/Supervisor
Integrated Treatment 
(Mental Health & 
Substance Abuse) 
Counselor/Treatment 
Provider/Supervisor

Other (please specify) 

4. Please write the name of your organization:

CABHI Evaluation - PSH Self-Assessment

4

5. Which of the following best describes your organization's role(s) in the SAMHSA
Homeless project. Please check all that apply (each row requires a "yes" or "no"
response).
Yes

No

Grantee agency

j
k
l
m
n

j
k
l
m
n

Administrative/Project 

j
k
l
m
n

j
k
l
m
n

Research/Evaluation

j
k
l
m
n

j
k
l
m
n

Substance abuse treatment 

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Shelter

j
k
l
m
n

j
k
l
m
n

Housing provider

j
k
l
m
n

j
k
l
m
n

Case management provider

j
k
l
m
n

j
k
l
m
n

Medical 

j
k
l
m
n

j
k
l
m
n

Benefits assistance provider

j
k
l
m
n

j
k
l
m
n

Education provider

j
k
l
m
n

j
k
l
m
n

Employment or job training 

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

coordination/Oversight

provider
Mental health treatment 
provider
Integrated treatment 
(mental health & substance 
abuse) provider

(primary/specialized) care 
provider

provider
Veterans Administration 
(VA) services provider
Justice/Criminal justice 
services provider
Child and family services 
provider
Other (please specify) 

6. How long has your organization been providing permanent supportive housing?
j Less than one year
k
l
m
n
j 1­2 years
k
l
m
n
j 3­4 years
k
l
m
n
j 5­6 years
k
l
m
n

j 7­10 years
k
l
m
n

j more than 10 years
k
l
m
n
j I don't know
k
l
m
n

CABHI Evaluation - PSH Self-Assessment

5

Grantee Project Section

Please answer the following questions based on the general practices across all PSH sites within your SAMHSA 
Homeless project. 

7. Do project participants have a choice among various housing models (e.g. clean and
sober, cooperative living, market rate housing, etc.)?
j Project participants choose the type of housing they prefer from a range of housing models.
k
l
m
n

j Project participants have a restricted choice of housing models (e.g. participants have only 2­3 options).
k
l
m
n

j Project participants are not given a choice of housing models and are assigned to one type of housing models.
k
l
m
n
j I don't know
k
l
m
n

j Other (please specify)
k
l
m
n

8. Do project participants have a choice of housing units?
j Project participants choose from 10 or more units.
k
l
m
n
j Project participants choose from 4­9 units.
k
l
m
n
j Project participants choose from 2­3 units
k
l
m
n

j Project participants are assigned to one unit only.
k
l
m
n
j I don't know.
k
l
m
n

9. Do project participants have a choice of the neighborhood where their apartment is
located?

j Yes
k
l
m
n
j No
k
l
m
n

j I don't know
k
l
m
n

10. When project participants first join the project, can they wait for the unit of their choice
without penalty?
j Yes, project participants can wait for the unit of their choice without risking discharge from the project or losing priority for services or units.
k
l
m
n
j Yes, project participants can wait for the unit of their choice, but they are allowed a set number of choices or a certain period of time 
k
l
m
n
before they lose priority on the list for units (e.g. 3 choices and then go to the bottom of the list). 

j No, project participants must accept the unit offered; no waiting for units is allowed. Prospective project participants who refuse the unit 
k
l
m
n
offered are not discharged from the project but go to the end of the waiting list. 

j No, project participants must accept the unit offered or be discharged from the project.
k
l
m
n
j I don't know.
k
l
m
n

CABHI Evaluation - PSH Self-Assessment

6

11. Can project participants control the composition of their households?
j Yes, project participants choose the members of their household or can choose to live alone.
k
l
m
n
j Yes, but project participants have limited choice of the members of their household.
k
l
m
n

j No, project participants must accept a predetermined household not of their choosing or only have the option to live alone.
k
l
m
n
j I don't know.
k
l
m
n

12. Please indicate the percentage of project participants that live in the following types of
housing arrangements
live in their own 

None

1­30%

31­60%

61­100%

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

independent 
apartment/duplex/house
live in a private bedroom 
but share other common 
areas (bathroom, kitchen, 
etc) with other project 
participants
share a bedroom with other 
project participants
live in other arrangements

CABHI Evaluation - PSH Self-Assessment

7

Grantee Project Section

13. Social and clinical services can be provided on­site (in project office space) or off­site
(in participant homes or other locations in the community). Which of the following best
describes where your project's social and clinical services are provided?
j Primarily off­site
k
l
m
n

j Equally off­site and on­site
k
l
m
n
j Primarily on­site
k
l
m
n
j I don't know
k
l
m
n

14. Is the project capable of delivering services at locations of participants' choosing?
j The project cannot deliver any services at locations of participants' choosing.
k
l
m
n
j The project can deliver some services at locations of participants' choosing.
k
l
m
n
j The project can deliver all services at locations of participants' choosing.
k
l
m
n
j I don't know.
k
l
m
n

15. To what degree is there separation between service providers and housing
management functions?

Service providers have the 

Strongly Disagree

Disagree

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Neither Agree nor 

Agree

Strongly Agree

I Don't Know

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Disagree

authority to collect rents, 
enforce lease requirements, 
initiate evictions, etc.
Service providers regularly 
provide services that 
overlap with housing 
management.
Housing management staff 
have the authority to 
provide social services.
Housing management staff 
regularly provide services 
that overlap with social 
service providers.
The same staff members 
perform both social service 
roles and housing 
management roles.

CABHI Evaluation - PSH Self-Assessment

8

16. Which of the following best describes the actions your project takes the first time
participants lose their housing?
j Participants are discharged from project services.
k
l
m
n

j Participants are discharged from services, and there are explicit criteria outlining options for re­enrollment.
k
l
m
n
j Participants continue to receive project services but may be discharged if they do not meet certain criteria.
k
l
m
n
j Participants continue to receive project services even if they lose housing.
k
l
m
n
j I don't know.
k
l
m
n
j NA
k
l
m
n

17. Please indicate the extent to which the following statements describe actions your
project takes with regard to project participants losing their housing.

Project does not offer 

Strongly Disagree

Disagree

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Neither Agree nor 

Agree

Strongly Agree

I Don't Know

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Disagree

participants a new housing 
unit nor assists with finding 
housing outside of the 
project.
Project does not offer 
participants a new unit but 
assists them to find their 
housing outside of the 
project.
Project offers participants a 
new unit but only if they 
meet readiness 
requirements, complete a 
period of time in more 
supervised housing, or the 
project has set limits on the 
number of relocations.
Project offers participants a 
new unit without requiring 
them to demonstrate 
housing readiness and has 
no set limits on the number 
of possible relocations.

CABHI Evaluation - PSH Self-Assessment

9

18. Please indicate the extent to which the following statements describe actions your
project takes when participants lose their housing more than once.
NA (participants 
Strongly 

Disagree

Disagree

Neither Agree 
nor Disagree

Agree

Strongly Agree

I Don't Know

are exited after 
losing housing 
the first time)

Participants are discharged 

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

from project services and do 
not have the option to re­
enroll.
Participants are discharged 
from services, and there are 
explicit criteria outlining 
options for re­enrollment.
Participants continue to 
receive project services but 
may be discharged if they do 
not meet certain criteria.
Participants continue to 
receive project services even 
if they lose housing.

19. Please indicate the extent to which the following statements describe participants'
status on eligibility lists when they lose housing.
Strongly 

Disagree

Disagree
Project participants can wait 

Neither Agree 
nor Disagree

N/A (participants 
Agree

Strongly Agree

I Don't Know

are not re­
housed)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

for another unit of their 
choice without risking 
discharge from the project or 
losing priority for services or 
housing.
Project participants can wait 
for another unit of their 
choice, but they are allowed 
a set number of choices or a 
certain period of time before 
they lose priority for services 
or housing.
Project participants must 
accept the first unit offered; 
no waiting for alternative 
units is allowed. Participants 
who refuse the unit offered 
are not discharged from the 
project but lose priority for 
services or housing.
Project participants must 
accept the unit offered or be 
discharged from the project.

CABHI Evaluation - PSH Self-Assessment

10

Grantee Project Section

20. Please indicate the percentage of project participants living in a building where...
fewer than 1/4 of units are 

None

1­30%

31­60%

61­100%

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

for people with special 
needs.
between 1/4 and 1/2 of all 
units are for people with 
special needs.
between 1/2 and 3/4 of all 
units are for people with 
special needs.
3/4 or more of all units are 
for people with special 
needs.
I don't know.

21. Please indicate the percentage of project participants...
None

1­30%

31­60%

61­100%

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Living in other settings.

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

I don't know.

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Living in private market 
housing.
Living in housing units 
owned by mental health, 
behavioral health, or non­
profit agencies.
Living in housing units 
owned by local public 
housing authorities.

22. How many distinct neighborhoods do you utilize to house project participants?
j 1 neighborhood.
k
l
m
n

j 2­4 neighborhoods.
k
l
m
n

j 5­10 neighborhoods.
k
l
m
n

j 11­15 neighborhoods.
k
l
m
n

j 16 or more neighborhoods.
k
l
m
n
j I don't know.
k
l
m
n

23. Are project participants the primary authors of their service plans at project entry?

j Yes
k
l
m
n
j No
k
l
m
n

j I don't know
k
l
m
n

CABHI Evaluation - PSH Self-Assessment

11

24. Are project participants offered the opportunity to modify their service plans (i.e.
selection of services) on an ongoing basis?

j Yes
k
l
m
n
j No
k
l
m
n

j I don't know
k
l
m
n

25. Which of the following best describes the choice of services project participants have
on an ongoing basis (excluding case management)?
j Project participants may choose from an array of services including the option of no services.
k
l
m
n

j Project participants may choose from an array of services, but choosing no services is not an option.
k
l
m
n
j Project participants must participate in services selected by staff.
k
l
m
n
j I don't know.
k
l
m
n

26. Which of the following best describes the array of available services (i.e. service mix) to
meet project participants' changing needs and preferences?
j Service mix is highly flexible and the type, location, intensity, and frequency can be adapted.
k
l
m
n
j Service mix is somewhat flexible and variations can occur at project participant request.
k
l
m
n

j Service mix cannot be adapted to meet project participants' changing needs and preferences.
k
l
m
n
j I don't know.
k
l
m
n

27. Which of the following best describes participants' involvement in the design and
provision of project services?
j Significant participant control of services exists.
k
l
m
n

j Some participant input into into services exists (e.g. participant advisory board).
k
l
m
n
j No participant input; project is staff­controlled.
k
l
m
n
j I don't know.
k
l
m
n

28. What is the average caseload of the project's case managers who provide support
services?
j No more than 15 project participants to each full­time equivalent (FTE) case manager.
k
l
m
n
j 16­25 project participants to each FTE case manager.
k
l
m
n
j 26­35 project participants to each FTE case manager.
k
l
m
n

j 36 or more project participants to each FTE case manager.
k
l
m
n
j I don't know.
k
l
m
n
j NA
k
l
m
n

CABHI Evaluation - PSH Self-Assessment

12

29. What is the participant/staff ratio the project typically maintains for doctors and/or
nurse practitioners?
j No doctors and/or nurse practitioners are available within the project
k
l
m
n
j 150 or more participants per 1 FTE staff
k
l
m
n
j 100­149 participants per 1 FTE staff
k
l
m
n
j 76­99 participants per 1 FTE staff
k
l
m
n

j 75 or fewer participants per 1 FTE staff
k
l
m
n
j I don't know
k
l
m
n

30. When a participant first enrolls in the project, is there a policy regarding the minimum
number of face­to­face contacts the participant is required to have with project staff?
j No minimum requirement
k
l
m
n

j Yes, there is a minimum requirement.
k
l
m
n
j I don't know
k
l
m
n

31. What is the average number of monthly face­to­face contacts participants have with
project staff?
j Fewer than 1
k
l
m
n
j 1
k
l
m
n

j 2­3
k
l
m
n
j 4­5
k
l
m
n
j 6+
k
l
m
n

j I don't know
k
l
m
n

32. How often do project staff meet to plan and review services for participants?
j Less than one day per month
k
l
m
n
j 1 day per month
k
l
m
n

j 2­3 days per month
k
l
m
n
j 1 day per week
k
l
m
n

j 2­3 days per week
k
l
m
n

j At least 4 days per week
k
l
m
n
j I don't know
k
l
m
n

CABHI Evaluation - PSH Self-Assessment

13

Grantee Project Section

Please indicate whether the following types of input into project operations and policies are available to participants. 

33. The project has a formal grievance process for participants to express concerns or
dissatisfaction.
j Agree
k
l
m
n

j Disagree
k
l
m
n

j I don't know
k
l
m
n

34. The project routinely offers opportunities for participant feedback (e.g. in a community
meeting, survey, etc.).
j Agree
k
l
m
n

j Disagree
k
l
m
n

j I don't know
k
l
m
n

35. The project routinely includes participants on planning and implementation
committees.
j Agree
k
l
m
n

j Disagree
k
l
m
n

j I don't know
k
l
m
n

36. The project employs persons with experiences of substance abuse and/or mental
health issues in regular staff positions.
j Agree
k
l
m
n

j Disagree
k
l
m
n

j I don't know
k
l
m
n

37. The project employs persons with experiences of substance abuse and/or mental
health issues as peer specialists.
j Agree
k
l
m
n

j Disagree
k
l
m
n

j I don't know
k
l
m
n

38. Participants are included on a governing body.
j Agree
k
l
m
n

j Disagree
k
l
m
n

j I don't know
k
l
m
n

CABHI Evaluation - PSH Self-Assessment

14

39. Which of the following statements best reflect the times that services are available to
project participants?
j Services are available 24/7.
k
l
m
n

j Services are available on flexible schedules, but not 24/7.
k
l
m
n

j Services are available during regular business hours Monday­Friday, with some weekend availability.
k
l
m
n

j Services are available during regular business hours Monday through Friday with no weekend availability.
k
l
m
n
j I don't know
k
l
m
n

40. Are behavioral health services team­based?
j Yes ­ all behavioral health services, including psychiatric services, are provided through a team within the project.
k
l
m
n
j Mostly ­ all behavioral health services except psychiatric services are provided through a team within the project.
k
l
m
n

j No ­ individual service providers are primarily responsible for behavioral health services, but specialists are routinely consulted.
k
l
m
n
j No ­ the primary responsibility for behavioral health services falls to one provider.
k
l
m
n
j I don't know.
k
l
m
n

CABHI Evaluation - PSH Self-Assessment

15

Behavioral Health Team Module

The following questions are about the team­based behavioral health services your SAMHSA Homeless project provides. 
These questions are based on the ACT model philosophy and standards. 

41. What percentage of participants have had face­to­face contact with at least 3 different
project staff members in the last month?
j Less than 20%
k
l
m
n
j 20­49%
k
l
m
n
j 50­79%
k
l
m
n

j 80% or more
k
l
m
n
j I don't know
k
l
m
n

CABHI Evaluation - PSH Self-Assessment

16

Behavioral Health Team Module

Please indicate whether or not the project uses its organizational project or team meetings for the following: 

42. Conduct a clinically­relevant review of participants with whom you've had contact in
the past 24 hours.

j Yes
k
l
m
n
j No
k
l
m
n

j I don't know
k
l
m
n

j NA ­ the project does not hold organizational project (or team) meetings.
k
l
m
n

43. Conduct a review of participants' long­term goals of all participants on a regularly
scheduled basis.

j Yes
k
l
m
n
j No
k
l
m
n

j I don't know
k
l
m
n

j NA ­ the project does not hold organizational project (or team) meetings.
k
l
m
n

44. Develop a staff schedule based on participant schedules and emerging needs.

j Yes
k
l
m
n
j No
k
l
m
n

j I don't know
k
l
m
n

j NA ­ the project does not hold organizational project or team meetings.
k
l
m
n

45. Discuss the need for proactive contact with participants to prevent future crises.

j Yes
k
l
m
n
j No
k
l
m
n

j I don't know
k
l
m
n

j NA ­ the project does not hold organizational project (or team) meetings.
k
l
m
n

46. Review previous staff assignments for follow­through.

j Yes
k
l
m
n
j No
k
l
m
n

j I don't know
k
l
m
n

j NA ­ the project does not hold organizational project (or team) meetings.
k
l
m
n

CABHI Evaluation - PSH Self-Assessment

17

Service Philosophy Module

The following questions are about your organization's service philosophy. If your project includes more than one PSH site, 
please answer based on the site used by most participants in the past year or the typical housing placement. 

47. For participants with psychiatric disabilities, which of the following best describes the
requirements to take medication or participate in psychiatric treatment?
j All participants with psychiatric disabilities are required to take medication and/or participate in psychiatric treatment.
k
l
m
n

j Most participants with psychiatric disabilities are required to take medication and/or participate in psychiatric treatment but exceptions are 
k
l
m
n
made. 

j Participants with psychiatric disabilities who have not achieved symptom stability are required to take medication and/or participate in 
k
l
m
n
psychiatric treatment. 

j Participants with psychiatric disabilities are not required to take medication and/or participate in treatment.
k
l
m
n
j I don't know.
k
l
m
n
j NA
k
l
m
n

48. For project participants with substance use disorders, which of the following best
describes the requirement to participate in substance use treatment?
j All participants with substance use disorders, regardless of current use or abstinence, are required to participate in substance use 
k
l
m
n
treatment. 

j Participants with substance use disorders who have not achieved a specified period of abstinence must participate in substance use 
k
l
m
n
treatment. 

j Participants who are currently using substances must participate in substance use treatment.
k
l
m
n

j Participants with substance use disorders are not required to participate in substance use treatment.
k
l
m
n
j I don't know.
k
l
m
n
j NA
k
l
m
n

49. Does the project utilize a harm reduction approach to substance use?
j Participants are required to abstain from alcohol and/or drugs at all times.
k
l
m
n

j Participants are required to abstain from alcohol and/or drugs while they are in their residence.
k
l
m
n

j Participants are not required to abstain from alcohol and/or drugs, but staff work with participants to achieve abstinence.
k
l
m
n

j Participants are not required to abstain from alcohol and/or drugs and staff work with participants to reduce the negative consequences of 
k
l
m
n
use and/or utilize appropriate stage­matched interventions. 

j I don't know.
k
l
m
n
j NA
k
l
m
n

CABHI Evaluation - PSH Self-Assessment

18

Service Philosophy Module

Please indicate whether the following actions are used with participants who are difficult to engage in services. 

50. The project pursues discharge after a certain number of attempts.

j Yes
k
l
m
n

j Sometimes
k
l
m
n
j No
k
l
m
n

j I don't know
k
l
m
n

51. The project withdraws contact for a period of time, then attempts re­engagement.

j Yes
k
l
m
n

j Sometimes
k
l
m
n
j No
k
l
m
n

j I don't know
k
l
m
n

52. The project uses therapeutic limit­setting as necessary.

j Yes
k
l
m
n

j Sometimes
k
l
m
n
j No
k
l
m
n

j I don't know
k
l
m
n

53. The project uses motivational intervention to build rapport as necessary (e.g. taking
the participant out for lunch without pressure to engage in treatment).

j Yes
k
l
m
n

j Sometimes
k
l
m
n
j No
k
l
m
n

j I don't know
k
l
m
n

CABHI Evaluation - PSH Self-Assessment

19

Service Philosophy Module

Please indicate whether the following activities are used to promote adherence to a treatment plan. 

54. Requiring urine screening

j Yes
k
l
m
n

j Sometimes
k
l
m
n
j No
k
l
m
n

j I don't know
k
l
m
n
j NA
k
l
m
n

55. Paying participants to take medication

j Yes
k
l
m
n

j Sometimes
k
l
m
n
j No
k
l
m
n

j I don't know
k
l
m
n
j NA
k
l
m
n

56. Requiring daily visits with project staff

j Yes
k
l
m
n

j Sometimes
k
l
m
n
j No
k
l
m
n

j I don't know
k
l
m
n
j NA
k
l
m
n

57. Withholding of participants' income/allowance

j Yes
k
l
m
n

j Sometimes
k
l
m
n
j No
k
l
m
n

j I don't know
k
l
m
n
j NA
k
l
m
n

CABHI Evaluation - PSH Self-Assessment

20

58. Withholding participants' services

j Yes
k
l
m
n

j Sometimes
k
l
m
n
j No
k
l
m
n

j I don't know
k
l
m
n
j NA
k
l
m
n

59. Withholding participants' housing

j Yes
k
l
m
n

j Sometimes
k
l
m
n
j No
k
l
m
n

j I don't know
k
l
m
n
j NA
k
l
m
n

60. Engaging in bargaining or quid pro quo (e.g. "I'll help you find furniture if you can
show me one week of sobriety")

j Yes
k
l
m
n

j Sometimes
k
l
m
n
j No
k
l
m
n

j I don't know
k
l
m
n
j NA
k
l
m
n

CABHI Evaluation - PSH Self-Assessment

21

Service Philosophy Module

Please indicate whether the following components are included in a participant's treatment plan and follow­up. 

61. Goals that are chosen by staff or set by the project

j Yes
k
l
m
n

j Sometimes
k
l
m
n
j No
k
l
m
n

j I don't know
k
l
m
n
j NA
k
l
m
n

62. Goals that are chosen by staff with input from the participant

j Yes
k
l
m
n

j Sometimes
k
l
m
n
j No
k
l
m
n

j I don't know
k
l
m
n
j NA
k
l
m
n

63. Goals that are chosen by the participant with input from staff

j Yes
k
l
m
n

j Sometimes
k
l
m
n
j No
k
l
m
n

j I don't know
k
l
m
n
j NA
k
l
m
n

64. Goals related to participant strengths

j Yes
k
l
m
n

j Sometimes
k
l
m
n
j No
k
l
m
n

j I don't know
k
l
m
n
j NA
k
l
m
n

CABHI Evaluation - PSH Self-Assessment

22

65. Strategies for overcoming barriers to successful goal attainment

j Yes
k
l
m
n

j Sometimes
k
l
m
n
j No
k
l
m
n

j I don't know
k
l
m
n
j NA
k
l
m
n

66. Actions that both participants and project staff will take to meet goals

j Yes
k
l
m
n

j Sometimes
k
l
m
n
j No
k
l
m
n

j I don't know
k
l
m
n
j NA
k
l
m
n

CABHI Evaluation - PSH Self-Assessment

23

Service Philosophy Module

67. Does the project adjust or provide a step­down approach to services with the intention
of fostering independence and self­determination?
j No
k
l
m
n

j Yes
k
l
m
n

j I don't know
k
l
m
n

68. Does your project primarily offer single­site apartments (e.g. 2 or more apartments
within a building reserved for the target population) or scattered­site apartments (e.g.
apartments that are located in different buildings and/or neighborhoods)?
j 80% or more of housing offered is single­site
k
l
m
n

j More than 50% but less than 80% of housing offered is single­site
k
l
m
n
j Housing is about 50% single­site and 50% scattered­site
k
l
m
n

j More than 50% but less than 80% of housing offered is scattered­site
k
l
m
n
j 80% or more of housing offered is scattered­site
k
l
m
n

j I don’t know
k
l
m
n

CABHI Evaluation - PSH Self-Assessment

24

Permanent Supportive Housing Sites: Scattered­Site Housing

Please answer the following questions about the typical scattered­site housing placements within your SAMHSA 
Homeless project.  

69. On average, how much of their income do project participants pay for housing?
j 30% or less.
k
l
m
n
j 31­40%.
k
l
m
n
j 41­50%.
k
l
m
n

j More than 50%.
k
l
m
n
j I don't know.
k
l
m
n

j NA ­ project participants do not pay for housing.
k
l
m
n

70. What percentage of housing units rented by project participants meet the Department
of Housing and Urban Development's Housing Quality Standards (HQS)?
j 76­100%
k
l
m
n
j 50­75%
k
l
m
n

j Fewer than 50%
k
l
m
n

j Housing does not meet HQS.
k
l
m
n

j Housing is not assessed for HQS.
k
l
m
n
j I don't know.
k
l
m
n

71. Do project participants have full legal rights to tenancy?

j Yes
k
l
m
n
j No
k
l
m
n

j I don't know
k
l
m
n

CABHI Evaluation - PSH Self-Assessment

25

Permanent Supportive Housing Sites: Scattered­Site Housing

Please answer the following questions about requirements project participants must meet to GAIN ACCESS to 
permanent housing. 

72. Are project participants required to complete a period of time in transitional housing or
outpatient, inpatient, or residential treatment to gain access to permanent housing?

j Yes
k
l
m
n
j No
k
l
m
n

j I don't know
k
l
m
n

73. Are project participants required to attain sobriety or abstinence from alcohol and/or
drugs to gain access to permanent housing?

j Yes
k
l
m
n
j No
k
l
m
n

j I don't know
k
l
m
n
j NA
k
l
m
n

74. Are project participants required to comply with medication to gain access to
permanent housing?

j Yes
k
l
m
n
j No
k
l
m
n

j I don't know
k
l
m
n
j NA
k
l
m
n

75. Are project participants required to demonstrate psychiatric symptom stability to gain
access to permanent housing?

j Yes
k
l
m
n
j No
k
l
m
n

j I don't know
k
l
m
n
j NA
k
l
m
n

CABHI Evaluation - PSH Self-Assessment

26

76. Are project participants required to show willingness to comply with a treatment plan
that addresses sobriety, abstinence, and/or medication compliance to gain access to
permanent housing?

j Yes
k
l
m
n
j No
k
l
m
n

j I don't know
k
l
m
n
j NA
k
l
m
n

77. Are project participants required to agree to face­to­face visits with staff to gain access
to permanent housing?

j Yes
k
l
m
n
j No
k
l
m
n

j I don't know
k
l
m
n

78. Are project participants required to meet responsibilities of a standard lease to gain
access to permanent housing?

j Yes
k
l
m
n
j No
k
l
m
n

j I don't know
k
l
m
n

79. Are project participants required to demonstrate housing readiness to gain access to
permanent housing?
j No ­ project participants have access to housing with no requirements to demonstrate readiness (other than provisions in a standard lease).
k
l
m
n
j Somewhat ­ project participants have access to housing with minimal readiness requirements, such as engagement with case 
k
l
m
n
management. 

j Yes ­ to qualify for housing, project participants must meet requirements such as sobriety, medication compliance, or willingness to 
k
l
m
n
comply with program rules; OR participants must first successfully complete a period of time in another program, such as transitional housing. 

j I don't know.
k
l
m
n

CABHI Evaluation - PSH Self-Assessment

27

Permanent Supportive Housing Sites: Scattered­Site Housing

Please answer the following questions about the requirements project participants must meet to STAY IN permanent 
housing. 

80. Are project participants required to maintain sobriety or abstinence from alcohol and/or
drugs in order to stay in permanent housing?
j Yes, this requirement is included in the lease or occupancy agreement
k
l
m
n

j Yes, but this requirement is not included in the lease or occupancy agreement
k
l
m
n
j No
k
l
m
n

j I don't know
k
l
m
n
j NA
k
l
m
n

81. Are project participants required to comply with medication in order to stay in
permanent housing?
j Yes, this requirement is included in the lease or occupancy agreement
k
l
m
n

j Yes, but this requirement is not included in the lease or occupancy agreement
k
l
m
n
j No
k
l
m
n

j I don't know
k
l
m
n
j NA
k
l
m
n

82. Are project participants required to demonstrate psychiatric symptom stability in order
to stay in permanent housing?
j Yes, this requirement is included in the lease or occupancy agreement
k
l
m
n

j Yes, but this requirement is not included in the lease or occupancy agreement
k
l
m
n
j No
k
l
m
n

j I don't know
k
l
m
n
j NA
k
l
m
n

83. Are project participants required to comply with treatment plan and/or participate in
formal treatment activities (e.g. attend groups, see a psychiatrist, etc.) in order to stay in
permanent housing?
j Yes, this requirement is included in the lease or occupancy agreement
k
l
m
n

j Yes, but this requirement is not included in the lease or occupancy agreement
k
l
m
n
j No
k
l
m
n

j I don't know
k
l
m
n
j NA
k
l
m
n

CABHI Evaluation - PSH Self-Assessment

28

84. Are project participants required to have face­to­face visits with staff in order to stay in
permanent housing?
j Yes, this requirement is included in the lease or occupancy agreement
k
l
m
n

j Yes, but this requirement is not included in the lease or occupancy agreement
k
l
m
n
j No
k
l
m
n

j I don't know
k
l
m
n
j NA
k
l
m
n

85. Are project participants required to meet responsibilities of a standard lease in order to
stay in permanent housing?
j Yes, this requirement is included in the lease or occupancy agreement
k
l
m
n

j Yes, but this requirement is not included in the lease or occupancy agreement
k
l
m
n
j No
k
l
m
n

j I don't know
k
l
m
n
j NA
k
l
m
n

CABHI Evaluation - PSH Self-Assessment

29

Permanent Supportive Housing: Scattered­Site

86. Is ongoing tenancy/voucher issuance contingent on compliance with project
provisions?
j No ­ not contingent in any way on compliance with project or treatment participation (e.g. sobriety or medication compliance).
k
l
m
n

j No ­ project rules require participating in ongoing services, but failure to comply with this requirement does not lead to eviction/revoked 
k
l
m
n
voucher. 

j Yes ­ tenancy/voucher is revoked based on noncompliance with the project or failure to participate in treatment (e.g. not maintaining 
k
l
m
n
sobriety or keeping to a required medical regimen). 

j I don't know.
k
l
m
n

87. Is housing tenure permanent with no actual or expected time limits (other than those
defined under a standard lease or occupancy agreement)?
j No ­ there are rigid time limits on the length of stay in housing such that participants are expected to move by a certain date or time or 
k
l
m
n
the housing is considered emergency, short­term, or transitional. 

j No ­ there are standardized time limits on housing tenure such that participants are expected to move when standardized criteria are met.
k
l
m
n

j Somewhat ­ there are individual time limits on housing tenure such that participants can stay as long as necessary but are expected to 
k
l
m
n
move when certain criteria are met. 

j Yes ­ there are no expected time limits on housing tenure, although the lease agreement may need to be renewed periodically.
k
l
m
n
j I don't know.
k
l
m
n

88. Is participation in project services permanent with no actual or expected time limits?
j No ­ there are rigid time limits on the length of participation in project services such that participants are expected to exit the project by a 
k
l
m
n
certain date or time. 

j No ­ there are standardized time limits on participation in project services such that participants are expected to exit the project when 
k
l
m
n
standardized criteria are met. 

j Somewhat ­ there are individual time limits on participation in project services such that participants can stay as long as necessary but are 
k
l
m
n
expected to exit the project when certain criteria are met. 

j Yes ­ there are no expected time limits on participation in project services.
k
l
m
n
j I don't know.
k
l
m
n

CABHI Evaluation - PSH Self-Assessment

30

89. Please indicate which population your project serves and whether priorities are given
for certain participant characteristics.
Project serves, gives 
Project will serve this 
population

Projects serves AND 

priority for admission, 

gives priority for 

AND participant MUST 

admission

have this characteristic 

Project does not serve 
this population

I don't know

to enter program
Participants who 

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

demonstrate a high level of 
housing instability/chronic 
homelessness
Participants who have a 
criminal justice record 
including those who are 
currently on 
probation/parole/court 
mandate
Participants who are 
actively using substances, 
including alcohol and/or 
illicit drugs
Participants who do not 
engage in any mental 
health or substance 
treatment services
Participants who 
demonstrate instability of 
mental health symptoms

90. Do project participants have control of staff entry into their units?
j Yes ­ service staff may not enter the unit unless project participants invite them.
k
l
m
n

j Sometimes ­ service staff may enter the unit uninvited only under specific circumstances agreed on in advance.
k
l
m
n
j Sometimes ­ service staff may enter the unit uninvited only in a crisis.
k
l
m
n

j No ­ service staff has free access to housing units, including making unannounced visits.
k
l
m
n
j I don't know.
k
l
m
n

91. Participants move from project enrollment to permanent housing in the following time
period:
j Within 2 weeks
k
l
m
n

j More than 2 weeks but within 1 month
k
l
m
n

j More than 1 month but within 3 months
k
l
m
n

j More than 3 months but within 6 months
k
l
m
n
j More than 6 months but within 1 year
k
l
m
n
j More than 1 year
k
l
m
n
j I don't know
k
l
m
n

CABHI Evaluation - PSH Self-Assessment

31

92. Is at least 80% of housing offered to participants in the form of scattered­site housing?

j Yes
k
l
m
n

j No, less than 80% is scattered­site housing, and at least 20% is single­site housing
k
l
m
n

CABHI Evaluation - PSH Self-Assessment

32

Permanent Supportive Housing Site: Single­Site Housing

The following questions are about the single­site PSH used by your SAMHSA Homeless project. If your project includes 
more than one PSH site, please answer based on the site used by most participants in the past year. 

93. How many single­site permanent supportive housing locations are used by your
project?
j 1
k
l
m
n

j 2­3
k
l
m
n
j 4­5
k
l
m
n

j 6 or more
k
l
m
n

j I don’t know
k
l
m
n

94. On average, how much of their income do project participants pay for housing?
j 30% or less.
k
l
m
n
j 31­40%.
k
l
m
n
j 41­50%.
k
l
m
n

j More than 50%.
k
l
m
n
j I don't know.
k
l
m
n

j NA ­ project participants do not pay for housing.
k
l
m
n

95. What percentage of housing units rented by project participants meet the Department
of Housing and Urban Development's Housing Quality Standards (HQS)?
j 76­100%
k
l
m
n
j 50­75%
k
l
m
n

j Fewer than 50%
k
l
m
n

j Housing does not meet HQS.
k
l
m
n

j Housing is not assessed for HQS.
k
l
m
n
j I don't know.
k
l
m
n

96. Do project participants have full legal rights to tenancy?

j Yes
k
l
m
n
j No
k
l
m
n

j I don't know
k
l
m
n
j NA
k
l
m
n

CABHI Evaluation - PSH Self-Assessment

33

Permanent Supportive Housing Site: Single­Site Housing

Please answer the following questions about requirements project participants must meet to GAIN ACCESS to 
permanent housing. 

97. Are project participants required to complete a period of time in transitional housing or
outpatient, inpatient, or residential treatment to gain access to permanent housing?

j Yes
k
l
m
n
j No
k
l
m
n

j I don't know
k
l
m
n

98. Are project participants required to attain sobriety or abstinence from alcohol and/or
drugs to gain access to permanent housing?

j Yes
k
l
m
n
j No
k
l
m
n

j I don't know
k
l
m
n
j NA
k
l
m
n

99. Are project participants required to comply with medication to gain access to
permanent housing?

j Yes
k
l
m
n
j No
k
l
m
n

j I don't know
k
l
m
n
j NA
k
l
m
n

100. Are project participants required to demonstrate psychiatric symptom stability to gain
access to permanent housing?

j Yes
k
l
m
n
j No
k
l
m
n

j I don't know
k
l
m
n
j NA
k
l
m
n

CABHI Evaluation - PSH Self-Assessment

34

101. Are project participants required to show willingness to comply with a treatment plan
that addresses sobriety, abstinence, and/or medication compliance to gain access to
permanent housing?

j Yes
k
l
m
n
j No
k
l
m
n

j I don't know
k
l
m
n
j NA
k
l
m
n

102. Are project participants required to agree to face­to­face visits with staff to gain
access to permanent housing?

j Yes
k
l
m
n
j No
k
l
m
n

j I don't know
k
l
m
n

103. Are project participants required to meet responsibilities of a standard lease to gain
access to permanent housing?

j Yes
k
l
m
n
j No
k
l
m
n

j I don't know
k
l
m
n

104. Are project participants required to demonstrate housing readiness to gain access to
units?
j No ­ project participants have access to housing with no requirements to demonstrate readiness (other than provisions in a standard lease).
k
l
m
n
j Somewhat ­ project participants have access to housing with minimal readiness requirements, such as engagement with case 
k
l
m
n
management. 

j Yes ­ to qualify for housing, project participants must meet requirements such as sobriety, medication compliance, or willingness to 
k
l
m
n
comply with program rules; OR participants must first successfully complete a period of time in another program (such as transitional housing). 

j I don't know.
k
l
m
n

CABHI Evaluation - PSH Self-Assessment

35

Permanent Supportive Housing: Single­Site

Please answer the following questions about the requirements project participants must meet to STAY IN permanent 
housing. 

105. Are project participants required to maintain sobriety or abstinence from alcohol
and/or drugs to stay in permanent housing?
j Yes, this requirement is included in the lease or occupancy agreement
k
l
m
n

j Yes, but this requirement is not included in the lease or occupancy agreement
k
l
m
n
j No
k
l
m
n

j I don't know
k
l
m
n
j NA
k
l
m
n

106. Are project participants required to comply with medication in order to stay in
permanent housing?
j Yes, this requirement is included in the lease or occupancy agreement
k
l
m
n

j Yes, but this requirement is not included in the lease or occupancy agreement
k
l
m
n
j No
k
l
m
n

j I don't know
k
l
m
n
j NA
k
l
m
n

107. Are project participants required to demonstrate psychiatric symptom stability in
order to stay in permanent housing?
j Yes, this requirement is included in the lease or occupancy agreement
k
l
m
n

j Yes, but this requirement is not included in the lease or occupancy agreement
k
l
m
n
j No
k
l
m
n

j I don't know
k
l
m
n
j NA
k
l
m
n

108. Are project participants required to comply with a treatment plan and/or participate in
formal treatment activities (e.g. attend groups, see a psychiatrist, etc.) in order to stay in
permanent housing?
j Yes, this requirement is included in the lease or occupancy agreement
k
l
m
n

j Yes, but this requirement is not included in the lease or occupancy agreement
k
l
m
n
j No
k
l
m
n

j I don't know
k
l
m
n
j NA
k
l
m
n

CABHI Evaluation - PSH Self-Assessment

36

109. Are project participants required to have face­to­face visits with staff in order to stay
in permanent housing?
j Yes, this requirement is included in the lease or occupancy agreement
k
l
m
n

j Yes, but this requirement is not included in the lease or occupancy agreement
k
l
m
n
j No
k
l
m
n

j I don't know
k
l
m
n

110. Are project participants required to meet responsibilities of a standard lease in order
to stay in permanent housing?
j Yes, this requirement is included in the lease or occupancy agreement
k
l
m
n

j Yes, but this requirement is not included in the lease or occupancy agreement
k
l
m
n
j No
k
l
m
n

j I don't know
k
l
m
n

CABHI Evaluation - PSH Self-Assessment

37

Permanent Supportive Housing: Single­Site

111. Is ongoing tenancy/voucher issuance contingent on compliance with project
provisions?
j No ­ not contingent in any way on compliance with project or treatment participation (e.g. sobriety or medication compliance).
k
l
m
n

j No ­ project rules require participating in ongoing services, but failure to comply with this requirement does not lead to eviction/revoked 
k
l
m
n
voucher. 

j Yes ­ tenancy/voucher is revoked based on noncompliance with the project or failure to participate in treatment (e.g. not maintaining 
k
l
m
n
sobriety or keeping to a required medical regimen). 

j I don't know.
k
l
m
n

112. Is housing tenure permanent with no actual or expected time limits other than those
defined under a standard lease or occupancy agreement?
j No ­ there are rigid time limits on the length of stay in housing such that participants are expected to move by a certain date or time or 
k
l
m
n
the housing is considered emergency, short­term, or transitional. 

j No ­ there are standardized time limits on housing tenure such that participants are expected to move when standardized criteria are met.
k
l
m
n

j Somewhat ­ there are individual time limits on housing tenure such that participants can stay as long as necessary but are expected to 
k
l
m
n
move when certain criteria are met. 

j Yes ­ there are no expected time limits on housing tenure, although the lease agreement may need to be renewed periodically.
k
l
m
n
j I don't know.
k
l
m
n

113. Is participation in project services permanent with no actual or expected time limits?
j No ­ there are rigid time limits on the length of participation in project services such that participants are expected to exit the project by a 
k
l
m
n
certain date or time. 

j No ­ there are standardized time limits on participation in project services such that participants are expected to exit the project when 
k
l
m
n
standardized criteria are met. 

j Somewhat ­ there are individual time limits on participation in project services such that participants can stay as long as necessary but are 
k
l
m
n
expected to exit the project when certain criteria are met. 

j Yes ­ there are no expected time limits on participation in project services.
k
l
m
n
j I don't know.
k
l
m
n

CABHI Evaluation - PSH Self-Assessment

38

114. Please indicate which population your project serves and whether priorities are given
for certain participant characteristics.
Project serves, gives 
Project will serve this 
population

Projects serves AND 

priority for admission, 

gives priority for 

AND participant MUST 

admission

have this characteristic 

Project does not serve 
this population

I don't know

to enter program
Participants who 

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

demonstrate a high level of 
housing instability/chronic 
homelessness
Participants who have a 
criminal justice record 
including those who are 
currently on 
probation/parole/court 
mandate
Participants who are 
actively using substances, 
including alcohol and/or 
illicit drugs
Participants who do not 
engage in any mental 
health or substance 
treatment services
Participants who 
demonstrate instability of 
mental health symptoms

115. Do project participants have control of staff entry into their units?
j Yes ­ service staff may not enter the unit unless project participants invite them.
k
l
m
n

j Sometimes ­ service staff may enter the unit uninvited only under specific circumstances agreed on in advance.
k
l
m
n
j Sometimes ­ service staff may enter the unit uninvited only in a crisis.
k
l
m
n

j No ­ service staff has free access to housing units, including making unannounced visits.
k
l
m
n
j I don't know.
k
l
m
n

116. Participants move from project enrollment into permanent housing in the following
time period:
j Within 2 weeks
k
l
m
n

j More than 2 weeks but within 1 month
k
l
m
n

j More than 1 month but within 3 months
k
l
m
n

j More than 3 months but within 6 months
k
l
m
n
j More than 6 months but within 1 year
k
l
m
n
j More than 1 year
k
l
m
n
j I don't know
k
l
m
n

CABHI Evaluation - PSH Self-Assessment

39

Last Question

This is the last section of the survey and only has one question. 

117. Thank you for taking time to participate in this survey! Would you like to receive a
summary of results of the analysis?

j Yes
k
l
m
n
j No
k
l
m
n

CABHI Evaluation - PSH Self-Assessment

40