1. Bus Station
2. Washington County Corrections
3. Muncey Melting Pot
4. Haven of Mercy
5. Salvation Army
6. Downtown Clinic
7. Homeless Camp
8. Good Shepherd Day Center
9. Living Water Shelter
10. Volunteers of America Office

Hello, my name is ________. I am with the Johnson City Coalition for the Homeless. We are interested in talking with homeless persons to find out more about their needs. I will pay you $3.00 to complete the survey. It will take us just 20 or 25 minutes to complete. The information that you give me will be used for research purposes only. I do not need to know your full name. I will not use the information in any way to harm you and it will not be used to keep you out of a shelter or any other service, which you may want and need. If you would like to take part in the survey I will give you a voucher at the end that you will use to collect your $3.00 at the Volunteers of America Center tonight between 6 and 7pm. I will give you a ticket that will allow you to ride the bus to and from the center. If you have any questions or problems before, during, or after the completion of the survey, you may call the numbers that are listed on the voucher. You may stop the interview at any time and you don't have to answer any questions that you don't want to answer. Are willing to be interviewed?

1. What is your first name? ______________
2. Are you homeless? (1) YES (skip to #3) (2) NO (ask 2a - 2c)

_____2a. Do you have control over the place you live? (1) YES (2) NO

_____2b. Have you ever been homeless? (1) YES (2) NO

IF YES, THEN:2b₂. How did you get housed again?

__________________________________________

_____2c. Do you worry about becoming homeless? (1) YES (2) NO

IF YES, THEN: 2c₂. Why do you think you might become homeless?

_____________________________________________________

Thank you for taking part in the survey.

Skip to the end and remind participants about how to get paid.

3. How long have you been homeless? ____Weeks ____Months ____Years
4. What caused you to be homeless?

1. Abuse by a family member
2. Drinking Problem
3. Drug Problem
4. Landlord kicked me out
5. Family kicked me out
6. Lost my job
7. No money for housing
8. Prefer current way of living
9. Other (specify)___________

1. Prior to this episode, have you been homeless before?

(1) YES (2) NO (Skip to #7)

2. IF YES, how many different times have you been homeless?__________
3. Do you have a permanent address in Johnson City where you get mail?

(1) YES (2) NO

4. During the past two years, have you been evicted or had to give up subsidized housing?

(1) YES (2) NO

5. IF YES, what was the reason? DO NOT READ LIST.

1. Loss of income
2. Unruly behavior
3. Criminal past
4. Poor payment history
5. Drug involvement
6. Other __________________

1. Has any agency ever assisted you with obtaining housing?

(1) YES (2) NO (Skip to #15)

2. IF YES, what agency helped you obtain housing in the past? DO NOT READ LIST. CIRCLE ALL THAT APPLY.

1. VA
2. Good Samaritan
3. Haven of Mercy
4. Salvation Army
5. Downtown Clinic
6. Volunteers of America
7. Interfaith Hospitality Network
8. Families First
9. OTHER_____________

1. What did they help you with? DO NOT READ LIST. CIRCLE ALL THAT APPLY.

1. Locating housing
2. Rental assistance
3. Housing deposit
4. Furnishings
5. Clearing credit record
6. Other____________

1. How long did you live in that housing?

1. Less than one month
2. One month to six months
3. Over six months to one year
4. Over one year to three years
5. More than three years

1. What was the main reason you lost that housing?

1. No money for rent
2. Evicted for reasons other than money
3. Didn’t like housing
4. Didn’t like area
5. Just wanted to move
6. Return to streets
7. Other__________________

1. Where did you grow up (city/county)? ________________________
2. Do you still have family/relatives there?

(1) YES (2) NO

3. Do you have relatives in the Johnson City area? (1) YES (2) NO
4. How long has it been since you got in touch with your family?

____Weeks ____ Months _____Years

5. Who did you live with while growing up?

(1) Both Parents (2) Father (3) Mother (4) Relatives

(5) Other, _____________________

6. Where were you in birth order? (Read list if not clear)

1. Only child
2. Oldest
3. Middle
4. Youngest

1. What was your order of birth ____ of ____ children?
2. Was your family ever homeless while you were growing up?

(1) YES (2) NO

3. Were you ever in a foster care home?

(1) YES (2) NO (3) DON'T KNOW

4. IF YES, how many different foster care homes were you in?__________
5. Were you ever physically abused as a child?

(1) YES (2) NO (3) DECLINED TO ANSWER

6. Were you ever sexually abused as a child?

(1) YES (2) NO (3) DECLINED TO ANSWER

IF NO TO BOTH, GO TO QUESTION 28.

 

 

7. How long did the abuse last?

1. Less than one month
2. One month to one year
3. Over one year to five years
4. More than five years

1. How long have you lived in Johnson City? __Weeks __Months __Years
2. What was your most important reason for coming to Johnson City?

1. Born here
2. Family moved here
3. Job
4. Stranded
5. Traveling
6. Weather better
7. Education
8. Health care
9. VA Center
10. Other_________________

1. Do you plan to stay in Johnson City?

(1) YES (2) NO (3) DON'T KNOW

2. Are you a veteran? (1) YES (2) NO (Skip to #38)
3. Have you sought services at the VA? (1) YES (2) NO (Skip to #33a)
4. How often have you sought services at the VA?

1. Once or twice
2. Three or four times
3. More than four times

(Skip to #36)

1. How satisfied have you been with the help you have received from the VA? READ OPTIONS.

1. Very satisfied (Would go there again)
2. Somewhat satisfied (Might go there again)
3. Somewhat dissatisfied (Probably wouldn't go there again)
4. Very dissatisfied (Won't every go there again).

1. What was it about your experience that you found (satisfying/dissatisfying)?

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

2. Have you gotten help going to the VA domiciliary?

(1) YES (2) NO

3. Have you had recent care at a VA Medical facility?

(1) YES (2) NO

If YES, where? ___________________________________

 

NOW I AM GOING TO ASK YOU SOME PERSONAL QUESTIONS

4. What is your marital status? DO NOT READ LIST. PROBE IF NEEDED

1. Married
2. Single, never married
3. Separated
4. Divorced
5. Widow, widower

1. What is your sexual orientation? DO NOT READ THE LIST.

1. Heterosexual ("Straight")
2. Homosexual (gay; lesbian)
3. Bi-Sexual
4. Transgender
5. Declined to answer

1. Do you believe that your sexual orientation has prevented you from receiving the services you need (e.g., healthcare, housing)?

(1) YES (2) NO (Skip to question # 41)

40a. In what way?

______________________________________________________________

2. Do you have any children? (1) YES (2) NO
3. IF YES, how many children do you have? __________

IF RESPONDENT IS NOT MARRIED AND HAS NO CHILDREN, GO TO QUESTION 45.

4. IF RESPONENT HAS CHILDREN, what are their ages?

Child 1 ____ Child 2 ____ Child 3 ____ Child 4 ____

5. Is your family living with you now? (1) YES (2) NO
6. Have you stayed with friends or relatives during the past year?

(1) YES (2) NO

7. Where do you usually sleep at night?

1. Abandoned building
2. Car
3. With friend or relative
4. Hotel
5. Outside, camp out
6. Park
7. Public place
8. Shelter or mission
9. Street
10. Under a bridge
11. In a dumpster
12. Other__________________

1. How many people, including yourself, usually sleep there?________
2. On a scale from 1 to 10 how safe do you feel sleeping there?

1= Completely Unsafe 10 = Very Safe

3. Where do you usually get food?

1. Buy it (store or restaurant)
2. Food Stamps
3. Free meals from agencies or churches
4. Handouts
5. Relatives or friends
6. Scavenge (dumpsters or garbage cans)
7. Steal it
8. Other_________________

1. Where do you usually bathe?

1. Home of Friend/Family
2. Streams, rivers, etc.
3. Outside hose or faucet
4. Daycenter
5. Shelter
6. Public restrooms
7. Other__________________

1. Where do you launder your clothes?

1. Home of Friend/Family
2. Laundromat
3. Streams, rivers, etc.
4. Outside hose or faucet
5. Daycenter
6. Shelter
7. Public restrooms
8. Other_________________

1. Where do you get money?

1. Handouts
2. Plasma center
3. Relatives
4. Work
5. Churches or missions
6. Government assistance (specify)____________
7. Other_______________

1. IF GOVT. ASSISTANCE, Do you have a payee other than yourself?

(1) YES (2) NO (Skip to # 55)

2. If payee, is he/ she a

1. Friend
2. Relative
3. Agency Employee
4. Other,____________________________________

1. What is your approximate weekly income?

1. $0
2. $1-$50
3. $51-$100
4. $101-$200
5. $200-$300
6. $310 or more
7. Declined to answer

1. During the past two years, have you received any government benefits, such as SSI, Food stamps, Temporary Assistance to Families (AFDC) or Tenncare?

(1) YES (2) NO (Skip to #58) (3) DECLINED TO ANSWER

2. During the past two years, have you lost any government benefits such as SSI, Food stamps, Temporary Assistance to families (AFDC) or Tenncare?

(1) YES (2) NO (3) DECLINED TO ANSWER

3. What is your usual line of work? ________________
4. What kinds of work have you done in the past year?_________________
5. Do you have a job now? (1) YES (2) NO

If YES, GO TO QUESTION 62.

6. IF NO, Why aren’t you working now?

1. Alcoholism
2. Don’t want to
3. Got fired
4. Got sick
5. Disabled
6. No transportation
7. Nobody will hire me
8. Other _______________

1. How do you find work or find out who is hiring?

1. State employment office (Job service)
2. Newspaper
3. Word of mouth
4. Other________________________

1. Do you need job training? (1) YES (2) NO
2. IF YES, what kind of job training?____________________________________
3. Have you ever used a computer?

(1) YES (2) NO (Skip to #67)

4. IF YES, when was the last time?

1. Within the last month
2. Between one month and six months ago
3. Over six months to one year ago
4. Over a year ago

1. How do you consider your health at this time?

(1) Excellent (2) Good (3) Fair (4) Poor

2. IF FAIR OR POOR, "What condition causes your health to be that way?"

Specify__________________________________________________________

3. While being homeless, have you ever had:

1. Pneumonia
2. Foot/Feet problems
3. Personal accidents injuries (breaks, lacerations)
4. Epilepsy/Seizures
5. Breathing, ear, or throat problems
6. (For women only) Been pregnant while homeless
7. Dental Problems
8. Tuberculosis
9. Eye Problems
10. Heart problems
11. Headaches (severe)
12. Skin problems (lice, scabies, etc.)
13. Other,______________
14. None of the above
15. Don’t know

1. Have you been in the hospital since being homeless?

(1) YES (2) NO

IF NO, GO TO QUESTION #73.

2. IF YES, what hospital? DO NOT READ LIST. CIRCLE THOSE USED.

1. Johnson City Medical Center Hospital
2. Veterans Affairs Medical Center
3. Northside
4. Watauga Area Mental Health Center
5. Woodridge Hospital
6. Johnson City Eye and Ear Hospital
7. Other__________________

1. Why did you have to go to the hospital? SPECIFY IN SPACE BELOW.

________________________________________________________

 

 

 

 

 

 

 

 

2. If you have a health or medical problem not requiring hospitalization, where do you go?

1. Johnson City Downtown Clinic
2. Washington County Health Department
3. Emergency Room at Johnson City Medical Center
4. Emergency Room at Northside Hospital
5. A family physician (private practice)
6. Other________________________

1. Have you ever asked for health care and been refused?

(1) YES (2) NO

2. How long has it been since your eyes were examined?_____________
3. Do you need to wear glasses? (1) YES (2) NO (Skip to #78)
4. IF YES, where do you get glasses?_____________________________
5. Many people have stress-related problems. Have you ever been treated for nerves or other emotional or mental problems?

Specify with "behavioral health" if necessary.

(1) YES (2) NO (3) DECLINED TO ANSWER

IF NO OR DECLINED, SKIP TO #88

6. Did you get treatment in… READ LIST. CIRCLE ONE

1. Doctor’s office
2. Hospital
3. Mental Health Center
4. Other (specify)_______

1. If IN HOSPITAL, About how long were you in the hospital?

1. Less than a month
2. (02) 1-6 months
3. (03) 7-12 months
4. 1-5 years
5. 6-10 years
6. More than 10 years
7. Other (specify amount of time)________________

1. Did you feel that you were ready to leave the hospital?

(1) YES (2) NO

 

2. Where did you live when you got out of the hospital?

1. Home
2. Relatives
3. Friends
4. Group home/halfway house
5. Boarding house
6. Jail
7. Street
8. Other_____________

1. When you left the hospital, was any follow-up medicine or treatment recommended?

(1) YES (2) NO (Skip to #88)

2. How long has it been since your last treatment?

1. 1 month or less
2. 2-6 years
3. 7-12 months
4. 1-5 years
5. More than 5 years
6. Don't know, Can't remember

1. Were you given medicine to treat your behavioral or mental health?

(1) YES (2) NO

If NO, GO TO QUESTION 88.

2. If YES, are you taking it now? (1) YES (2) NO
3. If NO, why not? DO NOT READ LIST. CIRCLE ALL ANSWERS.

1. Can’t afford it
2. Lost it
3. Don’t like how it makes me feel.
4. Transportation problem
5. Prescription ran out
6. Other (specify)___________

1. Have you ever been to Watuaga Area Mental Health Center?

(1) YES (2) NO

2. Are you currently being seen at the mental health center? (1) YES (2) NO
3. IF NO, why did you stop going? _____________________________________
4. How would you say your behavioral or mental health is now?

1. I don’t know
2. Good
3. Bad

1. IF BAD, how do you feel?_____________________________
2. Do you drink? (1) YES (2) NO (3) DECLINED TO ANSWER

IF NO OR DECLINED TO ANSWER, SKIP TO #96

3. Do you think you ever drink too much? (1) YES (2) NO
4. IF YES, how often would you say you drink too much?

1. Couple of times a year.
2. Couple of times a month.
3. Couple of times a week.
4. Daily.

1. Do you ever use drugs? (1) YES (2) NO
2. Have you ever gotten treatment for an alcohol or drug problem?

(1) YES (2) NO (Skip to #100)

3. IF YES, Where did you get treatment?

_________________________________________________________

 

 

 

 

 

 

 

 

4. How many times did you get treatment?

1. 1
2. 2
3. 3-5
4. 6-10
5. More

1. Do you ever worry about getting HIV (AIDS)? (1) YES (2) NO
2. Have you ever been tested for HIV (AIDS)? (1) YES (2) NO
3. IF NO, Are you afraid of being tested? (1) YES (2) NO
4. Has anyone ever committed a crime against you since you have been homeless in Johnson City? (1) YES (2) NO
5. IF YES, What kind of crime? (specify)______________________________
6. While homeless, have you ever been sexually assaulted?

(1) YES (2) NO (3) DECLINED TO ANSWER

IF NO OR DECLINED TO ANSWER, GO TO QUESTION 109

7. IF YES, how many times?

(1) Once (2) More than once

8. Was it a man or a woman who assaulted you?

(1) same sex person (2) opposite sex person (3) Both

9. Did you know this person? (1) YES (2) NO
10. Have you ever spent time in jail? (1) YES (2) NO
11. How long ago were you in jail?

1. less than one month
2. One month to six months
3. Over six months to one year
4. Over one year to three years
5. Three years or more

1. How long were you in jail? _____________________________________
2. IF TIME SERVED IN PRISON, Where did you go when you were released from jail the last time? DO NOT READ LIST

1. Home
2. Relatives
3. Group home/Half-way house
4. Jail
5. Shelter
6. Street
7. Other,_______________

1. Have you ever spent time in a juvenile justice center or youth correction facility? (1) YES (2) NO
2. While homeless, have you ever engaged in illegal activity to support yourself?

(1) YES (2) NO (3) DECLINED TO ANSWER

 

NOW I HAVE SOME GENERAL QUESTIONS.

3. What do you find the most helpful thing to do when you have a problem?

___________________________________________________________

___________________________________________________________

4. How (where) do you usually spend the day?

___________________________________________________________

5. Is it easier to live on the streets alone or as part of a group?

(1) Alone (2) Part of a group

6. How many different cities have you been in during the past year?

Record specific number______________

7. In what year were you born?

RECORD LAST TWO DIGITS________

8. How many years of school did you complete? CIRCLE

01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 GED grammar school high school college-tech grad school

9. Have you ever been denied housing because of past criminal behavior?

(1) YES (2) NO

10. Do you have TennCare?

(1) YES (2) NO

11. What forms of transportation do you use?

1. Own Car
2. City Buses
3. Walk
4. Hitch-hike/Thumb
5. Friend’s car
6. TennCare provided transportation
7. Other__________________

1. Do you have a valid driver’s license? (1) YES (2) NO
2. Do you have a social security card? (1) YES (2) NO
3. Have you enrolled in Families First? (1) YES (2) NO (Skip to 129)
4. What year did you enroll in Families First? _________
5. Have you ever been removed from Families First for non-compliance?

(1) YES (2) NO

6. Do you ever stay in shelters? (1) YES (2) NO
7. IF NO, Why not?_________________________________________________

________________________________________________________________

8. IF YES, What is the most difficult thing about living in a shelter?

________________________________________________________________

________________________________________________________________

 

Many of the local agencies and shelters have programs that are supposed to help people to get out of being homeless.

9. Have you used any of these programs? (1) YES (2) NO

 

 

 

 

 

 

 

10. I am going to read you a list of services and programs in the area; please tell me if you have heard about the service, if you have ever used it, and if you needed to, if you would go there again.

Heard of Use Go Again

Haven of Mercy ______ ______ ______

Salvation Army ______ ______ ______

Fishes and Loaves—West Main Street ______ ______ ______

Employment Security Office ______ ______ ______

Alcoholics Anonymous ______ ______ ______

Watauga Mental Health Center ______ ______ ______

Tenn. Depart. of Vocational Rehab. ______ ______ ______

Washington County Health Depart. ______ ______ ______

Washington County Dept. Human Services ______ ______ ______

Food Stamp Service ______ ______ ______

Red Cross ______ ______ ______

Johnson City Medical Center ______ ______ ______

VA Homeless Outreach Program ______ ______ ______

Veterans Organizations ______ ______ ______

Vet Center ______ ______ ______

Good Samaritan Ministries ______ ______ ______

• Melting Pot ______ ______ ______
• Good Shepherd Day Center ______ ______ ______

Downtown Clinic ______ ______ ______

Volunteers of America ______ ______ ______

Living Water Shelter ______ ______ ______

Interfaith Hospitality Network ______ ______ ______

Other (specify and list on lines below)

_______________________________ ______ ______ ______

_______________________________ ______ ______ ______

_______________________________ ______ ______ ______

1. We are concerned about what you need while you are homeless that local agencies might be able to offer you. Please tell me the kinds of things you think that homeless people need. DO NOT READ LIST. WRITE IN THOSE NOT ON THE LIST. PROBE IF NECESSARY.

1. Alcohol/drug rehabilitation
2. Bathrooms and showers
3. Clothing
4. Counseling
5. Daytime place to stay
6. Job
7. Food
8. Housing
9. Medicine
10. Medical attention/doctor
11. Place to store things
12. Don’t know

1. What would help you get out of homelessness?

 

2. Race ASK ONLY IF NOT OBVIOUS

(1) White

(2) Black

(3) Other _____________________________

3. Is there anything about being homeless that we haven’t asked that you think we should know?

 

 

 

Thank you very much for completing this interview. All your answers are confidential and there is no way to identify you from your answers.

4. Do you have any other comments about the things we’ve talked about?

 

 

We are finished, thank you again.

 

Remind them of how to get the money and let them know when and where other homeless persons can take part in the survey if they know of anyone else who might be interested. Offer them brochures on local agencies and services.

 

COMPLETE AFTER THE INTERVIEW IS OVER.

5. Gender of respondent (1) MALE (2) FEMALE
6. Do you feel the answers given are valid

(1) YES (2) NO

7. Do you feel the respondent has mental health problems?

(1) YES (2) NO

8. Was the respondent sober?

COMMENTS:____________________________________________________________

________________________________________________________________________