BEHAVIORAL HEALTH ADMINISTRATION

Catonsville, MD 21228

Permanent Supportive Housing Implementation Self-Assessment

When filling out the self-assessment make sure you have several sources of evidence to be able to illustrate the reasoning for the score provided in the self-assessment. When the fidelity monitors come to visit the PSH team to conduct the fidelity review they will be looking at multiple source of evidence to calculate a score in each of the dimensions. Please note any special circumstances that would decrease your score in any of the dimensions based on rules and regulations outside of the PSH team’s control.

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DIMENSIONS / Score
  1. Choice of housing:
PSH worker provides housing options based on consumer preferences, financial means andwait for housing of choice, based on housing voucher.
(Housing options examples: private landlord, sober housing, and housing with or w/o roommate.)
Source of Evidence: Agency documents, including the following: Intake forms; Intake procedures; Eligibility or admission criteria; Program descriptions; assessments; contact notes.
  1. Separation of housing and services:
PSH team directly provides services to the tenant.
(Linkage examples: There is a distinct separation from the landlord and PSH team.)
Source of Evidence: Agency documents, including the following: Intake forms; Intake procedures; Eligibility or admission criteria; Program descriptions and Leases. Documentation of organizational structure; Policies and procedures; MOUs/MOAs between organizations orfunctions; and Program descriptions
  1. Decent, safe, and affordable housing:
PSH worker seeks affordable, decent and safe housing.
(Affordability, Decent & Safe examples: pays 30% or less of income towards rent and utilities. Meets HUD housing quality standards.)
Source of Evidence: Agency documents, including the following: Documentation of rents/program payments; Policies and procedures related to housing subsidies; Program descriptions; rent calculation tool, Housing Inspections andrelated records.
  1. Housing integration:
PSH worker seeks housing options that are integrated.
(Integrated Examples: Less than 25% of all housing units are set aside for tenants meeting disability criteria.)
Source of Evidence: Agency documents, including the following: Documentation of physical location ofhousing units; Documentation of proximity to other housing units reserved for people with disabilities; and Program descriptions.
  1. Rights of tenancy:
PSH worker seeks housing with full legal rights of tenancy according to local landlord/tenant laws and tenancy is not contingent on program compliance.
(Rights of tenancy Examples: Lease w/o stipulated attachments to a program for supports.)
Source of Evidence: Agency documents, including the following: Leases, occupancy agreements, lease addendums or special provision clauses, house rules, program rules, etc.; and Program descriptions.
  1. Access to housing:
PSH worker works with all eligible tenants regardless of housing readiness and ensures consumers have full control over who has access to his/her unit.
(Access Example: PSH worker doesn’t have keys to tenants home. Permanent Supportive Housing must beresponsive to the needs of all people with disabilities.)
Source of Evidence: Agency documents, including the following: Leases, occupancy agreements, lease addendums or special provision clauses, house rules, program rules, etc.; and Program descriptions.
  1. Flexible, Voluntary, Services:
PSH worker seeks to ensure services are customized and consumer driven, and accessible.
(Customized Examples: Tenants are offered a range of services and have the opportunity to modify services as needed.)
Source of Evidence: Agency documents, including the following: Team meeting notes or minutes; job descriptions; other documentation of team approach; Person Centered treatment plans; Program descriptions;Program intake forms, intake interview forms; Consumer discharge procedures, especially involuntary discharge procedures; contact notes; assessments; Program Policy and Consumer Rights.

Sources of Evidence and Comments for Scoring of Dimensions

DIMENSIONS / Documentation of Sources of Evidence and Comments
(If additional space is needed please complete on a separate sheet)
1.Choice of housing / ______
2.Separation of housing and services / ______
3.Decent, safe, and affordable housing / ______
4.Housing integration / ______
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5.Rights of tenancy / ______
6.Access to housing / ______
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7.Flexible, Voluntary, Services / ______

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DHMH #4787 (Revised June 29, 2017)