Preble Street TCM Service Plan

MAINEHOUSING HOUSING STABILITY PLAN (HSP) OR PLAN OF CARE (POC)

Date: ______

HOUSING STABILITY PLANS MUST BE REVIEWED AND UPDATED AT LEAST EVERY 30 DAYS AND REWRITTEN AT LEAST EVERY 90 DAYS.

Review Type: Initial HSP/POC (or update) 30 Day 60 Day 90 Day

Next Review Date: ______Next Update: ______

Head of Household (HOH): ______Other Household members: ______

Navigator/Case Worker: ______Phone: ______Email: ______

Thinking about your income, housing, health (physical, mental, social), transportation, educational and legal needs, what resources do you need to achieve permanent housing stability? ______------Navigator Use for STEP Clients Only:

3, 6 and 9 Month Review Documentation (attach to HSP):

-DHHS Release of Information

-Income Verification

Recommendation to continue STEP (every 90 days): YES NO If no, please provide documentation supporting the discontinuation of STEP Comments: ______

1 ______

______Navigator Signature & Date

2  Health Needs & 90 Day Goal: ______

Strengths to achieve goal: ______

Barriers to achieve goal: ______

Presenting problem: Long Term Goals:  No health insurance  Obtain health insurance  Need Physician  Consistent Medical Care  Need Dentist  Sobriety  Have health problems  Emotional stability  Substance Use Short term Goals:  Need Mental Health services  Apply for MaineCare  ______ Find a PCP  ______ Find a dentist  ______ Resolve health problems

 ______ Reduce substance use  ______ Enter treatment/detox  Access MH services  ______  ______ Target Date: ______ ______  ______ Navigator/Case Worker Responsibilities (connection to mainstream resources): ______

Household Responsibilities and Activities: ______30 Day Update: ______60 Day Update:

3 ______90 Day Update (were goals achieved why or why not, next steps): ______

Date Achieved or Discontinued: ______

 Educational Needs & 90 Day Goal: Highest level of education______

Presenting problem: Long Term Goal  Need more schooling to become employable  Get GED  Reading ability  Achieve HS Diploma  Learning disability______ College/Tech School  Other______Short term Goals  Other______ Tutoring  Other______ Take GED Tests  Other______ Enroll In School  ______Target Date: ______

Navigator/Case Worker Responsibilities (connection to mainstream resources): ______

Household Responsibilities and Activities: ______30 Day Update: ______4 ______60 Day Update: ______90 Day Update (were goals achieved why or why not, next steps): ______

 Social Needs & 90 Day Goal: ______

Presenting problem: Long Term Goal  Family______ Stable Relationships  Partner______ Stable Social Supports  Friends______Short term Goals  Other______ Re-engage with family  Other______ Re-engage with partner  Other______ Develop Social Supports  ______ ______Target Date: ______ ______

5 Navigator/Case Worker Responsibilities (connection to mainstream resources): ______

Household Responsibilities and Activities: ______30 Day Update: ______60 Day Update: ______90 Day Update (were goals achieved why or why not, next steps): ______

 Housing Needs & 90 Day Goal: ______

Presenting problem: current living situation Long Term Goal  Shelter  Stable housing  Couch Surfing Short term Goals 6  Place unsuitable for human habitation  Secure Subsidies  Unstable Housing  Transitional Housing  Hotel/Motel  SRO  Pending eviction/loss of housing  Return Home to Family  Left program, jail, foster care, other ______ Enter Residential Program  Kicked out of/left home  ______ Other______

Target Date: ______

Household Responsibilities and Activities: ______

30 Day Update: ______

60 Day Update: ______90 Day Update (were goals achieved why or why not, next steps): ______

 Financial Needs & 90 Day Goal ______

7 ______

Presenting problem: Long Term Goal  Unemployed  Stable Employment  Under Employed  Stable Income  Lack Skills/Training Short term Goals  No work Experience  Vocational Training  Negative Work History  Part Time Job  No Income/Unemployable  Gain Experience  Other______ Apply for Entitlements  Volunteer Target Date: ______ ______

8  Transportation Needs & 90 Day Goal: ______

Presenting problem: Long Term Goal  No transportation  Stable form of transportation  ______Short term Goals  ______ Access public transportation  ______ Access ride for medical appointments  Maintain personal vehicle  ______Target Date: ______ ______

9 ______

 Legal Needs & 90 Day Goal: ______

Presenting problem: Long Term Goal  ______ ______Short term Goals  ______ ______ ______ ______ ______ ______

Target Date: ______

10 ______

 Other ______: ______

Presenting problem: Long Term Goal  ______ ______Short term Goals  ______ ______ ______

11  ______ ______ ______Target Date: ______

EXIT PLANNING: Maintaining Permanent Housing

Long-Term resources that will be helpful and/or necessary to maintaining housing: ______

12 If my housing becomes unstable, I will contact: ______

The above Housing Stability Plan/Plan of Care was developed in partnership with my Navigator/Case Worker. I understand that each action item listed above will support my efforts in securing permanent housing. I agree to work on this plan in partnership with my Navigator/Case Worker. I will update my Navigator/Case Worker as I complete the above goals. I will also communicate with any challenges I experience and understand my Navigator/Case Worker can offer me support as need.

Initial (or Update) Housing Stability Plan/Plan of Care:

Head of Household Signature ______Date ______

Navigator/Case Worker Signature______Date ______

30 Day Review:

Navigator /Case Worker Signature ______Date ______

60 Day Review:

Navigator /Case Worker Signature ______Date ______

90 Day Review:

Head of Household Signature ______Date ______

Navigator Signature/Case Worker______Date ______

 Collateral Contact – Sharing information between staff and with outside agencies will take place if helpful to the client in achieving continuity of care, coordination of services, and the most appropriate mix of services for the client.