DHS/CMHP/A&D 60-Housing - Josephine County, Oregon



Exhibit A&D 60-Housing

____________ County

I. SERVICE DESCRIPTION

Housing Assistance Services are services intended to assist individuals, who are in recovery from substance abuse, in locating and paying for housing designated as “alcohol and drug free” as defined in ORS 90.243 or approved by the County Alcohol and Drug Abuse Program Manager. Individuals who receive assistance may be living with other family members (e.g. where a parent is re-assuming custody of one or more children).

Housing Assistance Services include:

• Rental assistance in the form of cash payments made on behalf of individuals recovering from substance abuse to cover all or a portion of the monthly rent and utilities and may include payment of associated move-in costs, such as cleaning and security deposits; and

• Housing coordination services to assist individuals recovering from substance abuse in locating suitable housing, equipping the housing unit, providing assistance with housing maintenance and referrals to other resources.

II. PERFORMANCE STANDARDS

All individuals receiving Housing Assistance Services (A&D 60-Housing Services) funded through this Agreement must reside in County, be in recovery from substance abuse and be enrolled in a verifiable program of substance abuse recovery.

The expenditure of financial assistance awarded for this special project must result in the delivery of at least (insert #) total months of rental assistance to at least (insert #) different individuals in recovery[; and in the delivery of housing coordination services to at least (insert #) different individuals in recovery].

III. SPECIAL REPORTING REQUIREMENTS

For each calendar quarter (or portion thereof) during the period for which financial assistance is awarded under this Agreement for Housing Assistance Services , County shall submit written quarterly progress reports on the delivery of Housing Assistance Services not later than 30 days after the end of the quarter. Reports should be substantially in the format described in Exhibit A&D 60-Housing-1 attached hereto, and incorporated herein by this reference, and sent to:

Department of Human Services

Addictions and Mental Health Division

Attention: Housing Specialist

500 Summer Street N.E. E86

Salem, OR 97301-1118

IV. FINANCIAL ASSISTANCE CALCULATION AND DISBURSEMENT PROCEDURES

A. Calculation of Financial Assistance. Department will provide financial assistance to County for Housing Assistance Services identified in a particular line of the Financial Assistance Award in an amount equal to the amount of cash assistance actually paid by County on behalf of the individuals for rent assistance, as described above, plus the costs incurred by County in providing housing coordination services, under that line of the Financial Assistance Award during the period specified in that line, subject to the following

1. Total Department financial assistance for all Housing Assistance Services delivered under a particular line of the Financial Assistance Award shall not exceed the total funds awarded for Housing Assistance Services as specified in that line of Financial Assistance Award.

2. Department is not obligated to provide financial assistance for any Housing Assistance Services that are not properly reported to the Department in the quarterly reports described above.

3. Department will not provide financial assistance, under this Agreement, for more than 12 months of Housing Assistance Services for any particular individual unless approved in advance and in writing by the Department.

4. Department will not provide financial assistance, under this Agreement, for Housing Assistance Services delivered during a particular year, in an amount averaging more than (insert amount) per individual per month for both rental assistance and housing coordination services.

B. Disbursement of Financial Assistance. Unless a different disbursement method is specified in that line of the Financial Assistance Award, Department will disburse the funds awarded for Housing Assistance Services in a particular line of the Financial Assistance Award to County in substantially equal monthly allotments during the period specified in that line of the Financial Assistance Award, subject to the following.

1. Department may, at its discretion, reduce the monthly allotments based on under delivery of services identified through the required quarterly reports.

2. Department may, at its discretion, adjust monthly allotments to meet cash flow requirements for continued delivery of Housing Assistance Services.

3. Department may at its discretion, adjust monthly allotments to reflect changes in the funds awarded for Housing Assistance Services on that line of the Financial Assistance Award as a result of a amendments to the Financial Assistance Award.

C. Agreement Settlement. Agreement Settlement will reconcile any discrepancies that may have occurred during the term of this Agreement between actual Department disbursements of funds awarded for Housing Assistance Services under a particular line of the Financial Assistance Award and amounts due for such services based on the cash assistance paid on behalf of the individuals for rent assistance and costs incurred by County for housing coordination services under that line of the Financial Assistance Award during the period specified in that line, as properly reported in the quarterly reports described above.

EXHIBIT A&D 60-Housing-1

ADDICTIONS AND MENTAL HEALTH DIVISION

500 Summer Street NE E-86

Salem OR 97301-1118

Effective Date: 7/1/07

Quarterly Report

Individuals with Alcohol and Drug Abuse Problems

(Housing Assistance Services - RFGP #458)

General Instructions

Purpose. The quarterly reports tracks data pertaining to rent assistance and housing coordination services received by clients in Alcohol and Drug Free Housing (ADFH), funded under RFGP 458. This report will provide descriptive and quantitative information for the purposes of program evaluation and planning.

Applicability. County must complete this report for each quarter in which ADFH funding is utilized.

Organization of the Report. The quarterly report is organized in the following manner:

Part 1: Summary. This section of the report provides an overview of the activities carried out, problems encountered and actions taken.

Part 2. Data Worksheet. This worksheet provides information on the characteristics of the individuals assisted by this program. A worksheet needed to complete this report is included.

Part 3. Utilization Summary. This section of the report provides information on the characteristics of persons assisted by this program.

Part 4. Financial Information. This section of the report is to be completed by all Counties receiving funding under RFGP 458.

Final Assembly of Report. After the entire report is assembled, please number every page sequentially. Mark any questions that do not apply to your project with “N/A” for not applicable.

Filing Requirements. The information in this package must be submitted to: The Addictions and Mental Health Division 30 days after the end of each quarter.

Reporting period: January to March Due date: April 30

April to June Due date: July 30

July to September Due date: October 30

October to December Due date: January 30

Housing for Alcohol and Drug Abuse Individuals

Quarterly Report

|County |Contracted Provider |Reporting Period (month/year) |

| |(if applicable) | |

| | |from: to: |

|I hereby certify that all the information stated in this report is true and accurate. |

|Name & Title of Person who can answer questions about this report |Phone: (include area code) |

| | |

| | |

| |Fax #: (include area code) |

|Address |E-mail address: |

| | |

| | |

| | |

|Signature of County Official Date |Name & Title of County Official |

| | |

| | |

| | |

| | |

| |E-mail address: |

Part 1 Summary.

Describe on a page(s) attached to this report.

Exhibit A - Program Overview.

Please briefly describe the activities carried out during this quarter. List your specific objectives and briefly describe your success in meeting those objectives.

Exhibit B - Challenges

Please briefly describe any problems or difficulties that were encountered and what actions were taken to address those issues.

Part 3. Utilization Summary.

1. Projected Level of Individuals to be Served. In the table below, enter the number of individuals to be served at a given point in time.

|Projected Level | |

| | |

|Individuals to receive rental assistance at a point in time | |

|Individuals to receive housing coordination services at a point in time. | |

2. Persons Assisted with Housing Services. In the tables below, enter the number of persons who received rental assistance and or housing coordination services funded by RFGP 458 during this quarter.

|Rental Assistance | |

| |Total Number of Individual’s Served |

|a. Number on the first day of quarter | |

|Date:___________ | |

|b. Number who enrolled in the program during the quarter | |

|c. Number who left the program during the quarter | |

|d. Number in the program on the last day of the quarter | |

|(a+b-c=d) Date:_____________ | |

|Housing Coordination Services | |

| |Total Number of Individual’s Served |

|a. Number on the first day of quarter | |

|Date:___________ | |

|b. Number who enrolled in the program during the quarter | |

|c. Number who left the program during the quarter | |

|d. Number in the program on the last day of the quarter | |

|(a+b-c=d) Date:_____________ | |

3. Rental Assistance Utilization.

| |# of Rent Months |Average Rent |Average Months of |# of Individuals |

| | |Assistance |Assistance | |

|Biennial Capacity | | | | |

|Use through ________________ | | | | |

|(end date of last quarter) | | | | |

|Use- Current Quarter | | | | |

|____________ through ___________ | | | | |

Part 4. Financial Information.

This exhibit provides information about available funds and expenditures. Expenditures are amounts spent for eligible activities. Do not include other sources or in-kind items, such as the value of services or materials provided by volunteers.

1. RFGP 458 Expenditures (totals by eligible activity) for quarter ending ______________.

| |$ |

|a. Expenditures for housing coordination services | |

| |$ |

|b. Expenditures for rental assistance | |

| |$ |

|c. Total Expenditures for this quarter | |

Comments/Explanation:______________________________________________________________________________________________________________________________________________________________________________________________________________________

2. Summary of RFGP 458 Expenditures

| |Remaining Balance |

|a. Total Funds Available for Biennium |$ |

|(_____________ to ________________) | |

|b. Total Funds Spent as of Last Quarter |$ |

|(period ending _______________) | |

|c. Balance (a-b) |$ |

|d. Total Funds Spent Current Quarter |$ |

|(period ending _______________) | |

|e. Balance (c-d) |$ |

Instructions and Codes for Data Worksheet

This section will assist you in filling out the worksheet found on the next pages. The numbers in the columns reference the items described below to the questions on the worksheet. Please Note: In the case of a household with 2 or more enrolled clients each additional client should be listed separately.

1. ID code.

Please assign an ID code for each qualified individual. Keep a key in your records that identifies the individual for each ID code. The ID code is used to protect the confidentiality of the individual; please do not use the individuals name or other reference that could easily reveal the individual’s identity.

2. Enroll Date.

Enter the date the individual entered the program. Usually this will be the date the individual’s ADF rental assistance was started or housing coordination services began.

3. Single or Family.

Enter the appropriate family status. Use (S) for single individual and (F) for family or (M) for multi-person household. If the person being assisted is a member of a family but you are only providing services to this individual consider this person as single (i.e. rest of family lives elsewhere).

4. If family, No. of Children.

If you answered, (F) to question 3 enter the number of children residing in the household. In order to avoid counting children more than once, the children in families with more than one adult participating should be reported with the adult that is the head of household. Use N/A for the adult who is not the head of household.

5. Single Parent Household.

Enter appropriate letter if single parent household. Use (N) for No and (Y) for Yes.

6. Education.

Enter number of years of school completed or if the individual received their GED at enrollment.

7. Gender.

Enter appropriate letter for gender. Use (F) for Female and (M) for Male.

Instructions and Codes for Data Worksheet

Continued

8. Ethnicity.

Enter appropriate letter for ethnicity.

a. American Indian or Alaska Native

b. Asian or Pacific Islander

c. Black or African-American

d. Hispanic or Latino

e. White

f. Multi-racial/other

9. Age

Enter the age of the individual at enrollment.

10. Substance Use.

Enter the appropriate letter for substance use at enrollment or prior to enrollment.

a. Alcohol abuse only

b. Drug abuse only

c. Both alcohol and drug abuse

11. Initial Source of Income/Benefits.

Enter all types of income/benefits the individual is receiving at enrollment.

a. Supplemental Security Income (SSI)

b. Social Security Disability (SSDI)

c. Social Security (SS)

d. General public assistance

e. Temporary Aid to Needy Families (TANF)

f. Child support

g. Veterans benefits

h. Employment wages

i. Unemployment benefits

j. Medicare

k. Medicaid

l. Food stamps

m. Other (please specify)

n. No financial resources

o. Unknown

12. Amount of Income/Benefits.

Enter the amount of gross monthly income the individual is receiving at the time of enrollment (include food stamps).

Instructions and Codes for Data Worksheet

Continued

13. Prior Living Situation.

Enter the category that best describes the individual's most recent living situation prior to receiving services.

a. Jail or prison

b. Temporarily living with relative or friend

c. Subsidized house or apartment

d. Rental house or apartment (no subsidy)

e. Psychiatric hospital

f. Alcohol and drug residential treatment facility

g. Other hospital or inpatient medical facility

h. Alcohol and drug free transitional housing

i. Participant-owned housing

j. Homeless from the streets

k. Homeless shelter

l. Other group home

m. Other/describe in comment

14. Referral Source.

Enter the category that best describes who referred the individual to your agency.

a. Parole/probation/community corrections

b. Relative or friend

c. Court system

d. Community mental health provider

e. Psychiatric hospital

f. Alcohol and drug residential treatment facility

g. Other hospital or inpatient medical facility

h. Outpatient substance abuse treatment provider

i. Physician or outpatient healthcare provider

j. Self-referral

k. Shelters/homeless provider

l. Religious or faith-based organizations

m. Social service agency

n. Other /describe in comments

15. Housing Coordination Services.

Enter appropriate letter if Housing Coordination Services were received. Use (N) for No and (Y) for Yes.

Instructions and Codes for Data Worksheet

Continued

16. If Yes, to question 15 please Specify.

Enter all services received by the individual.

a. Housing placement/referral

b. Life skills development (budget mgmt, housekeeping, parent training etc.)

c. Conflict resolution/problem solving assistance

d. Employment assistance (job training, resume writing, interviewing skills, etc)

e. Recovery support

f. Education assistance

g. Case management

h. Assisted with accessing childcare

i. Assisted with accessing mental health services

j. Assisted with accessing health care services

k. Other/describe in comments

17. Date Assistance Ended.

Enter the date the individual’s assistance ended. Usually this will be the date the individual’s rental assistance was discontinued or housing coordination services terminated.

18. Reason for Discontinuation of Services.

Enter the primary reason why the individual’s rental assistance or housing coordination was discontinued.

a. Non payment of rent

b. Criminal activity/destruction of property/violence

c. Non Compliance with rules/regulations of program

d. Needs could not be met by program

e. Reached maximum time allowed in program

f. Successful-met treatment goals

g. Life changing circumstances

h. Left for alternative housing opportunity

i. Moved out without notice

j. Client no longer needed housing assistance but is continuing treatment

k. Other/describe in comments

Instructions and Codes for Data Worksheet

Continued

19. Destination.

Enter the destination of the individuals leaving the program.

a. Jail/Prison

b. Temporarily moved in with relative or friend

c. Subsidized house or apartment

d. Rental House or apartment (no subsidy)

e. Psychiatric hospital

f. Client entered inpatient alcohol and drug residential treatment facility

g. Other hospital or medical inpatient facility

h. Client remaining in same housing unit

i. Participants-owned housing

j. Non-housing (street, car, park, bus station, etc.)

k. Unknown

l. Other group home

m. Other/describe in comments

20. Sources of Income/Benefits at Exit

Enter all types of income/benefits the individual is receiving at departure.

a. Supplemental Security Income (SSI)

b. Social Security Disability (SSDI)

c. Social Security (SS)

d. General public assistance

e. Temporary Aid to Needy Families (TANF)

f. Child support

g. Veterans benefits

h. Employment wages

i. Unemployment benefits

j. Medicare

k. Medicaid

l. Food stamps

m. Other/describe in comments

n. No Financial Resources

o. Unknown

21. Amount of Income/Benefits.

Enter the amount of gross monthly income the individual is receiving at the time of departure (include food stamps).

Instructions and Codes for Data Worksheet

Continued

Enter number of years of school completed or if the individual received their GED at enrollment. 22. Outcomes Achieved.

Enter all outcomes achieved by the individual at the time of departure.

a. Clean and sober

b. Relapse

c. Stable, permanent housing

d. Re-united with family/children

e. Employment

f. Education

g. Other/describe in comments

23. Special Needs.

Enter all the letters that best describe the special needs of the individual at enrollment.

a. Mental illness

b. HIV/AIDS or related disease

c. Medical condition (e.g. diabetes, respiratory difficulties)

d. Development disability

e. Physical disability

f. Domestic violence

g. Legal issues

h. Criminal justice system involvement

i. Other/describe in comments

j. No special needs

24. Rent Subsidy Amount.

Enter the amount of subsidy provided for every month of the quarter. If no rental assistance was provided enter 0. To get an accurate count for total months of rental assistance provided to a family with more than one adult participating you should split the rental assistance amount between the two individuals.

25. Comments. Use this space for describing “other” responses and additional description

or explanation.

Part 2. Data Summary Individuals with Alcohol and Drug Abuse Problems From: _________ To:_________

(date) (date)

|1. |2. |3. |4. |5 |

|ID code |Enroll |(S) Single or |If family, |Single |

| |Date |(F) Family or |No. of |Parent |

| | |(M) Multi-person |children |Household |

| | | | |(Y/N) |

| | | |$ |$ |$ | |

| | | |$ |$ |$ | |

| | | |$ |$ |$ | |

| | | |$ |$ |$ | |

| | | |$ |$ |$ | |

| | | |$ |$ |$ | |

| | | |$ |$ |$ | |

| | | |$ |$ |$ | |

| | | |$ |$ |$ | |

| | | |$ |$ |$ | |

| | | |$ |$ |$ | |

| | | |$ |$ |$ | |

| | | |$ |$ |$ | |

| | | |$ |$ |$ | |

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