Surveys

Support Network Provider Survey

Organization___________________________________________

Position with the Organization

___ Front Line Worker

___Manager/Supervisor

___Volunteer

___Other:_____________

Phone _________________ Fax _________________

Where is the organization based? _______________________________

Which communities does it serve? _________________________________________________

Please note that for the purposes of this survey, the term ‘homeless’ not only applies to those with no shelter or living in emergency accommodation but also to those who may be at risk of becoming homeless. This may include those who are paying more than 50% of their gross income on rent, living in sub-standard or insecure conditions, ‘couch surfing’ from one house to another, doubling up with other households, those facing imminent eviction etc.

Please list the support and/or services that your organization provides that may relate to housing issues. Check all that apply:

_____	Emergency Shelter	_____	Mental Health Counselling
_____	Free Meals	_____	Drug/Alcohol Counselling
_____	Food Bank	_____	Treatment or Detox Centre
_____	Free Clothing	_____	Emergency Medical Services
_____	Job Counselling	_____	Parenting Support
_____	Financial Aid	_____	Crisis Counselling
_____	Victim’s Assistance	_____	Police/Law Enforcement
_____	Legal Assistance	_____	Literacy Services
_____	Domestic Violence Services	_____	Public Library
_____	Immigration Services	_____	Free Showers or laundry facilities
_____	Community Recreational Facilities	_____	Other, Please describe:_________________

If you checked any of the items above, please provide details of the services offered (e.g., hours of service, eligibility):

What service or help (whether you could provide it or not) do you think would be most valuable in improving the situation for the homeless or homeless at risk? (if you can identify more than one, please list them in priority)

1. ______________________________________________________

2. ______________________________________________________

3. ______________________________________________________

4. ______________________________________________________

5. ______________________________________________________

Do you target specific groups yes no

(If ‘yes’, describe) _________________________________________________

Do you keep statistics that may relate directly or indirectly to housing? yes no

(If ‘yes’, describe) _________________________________________________

How many homeless (or ‘homeless at risk’) people would you help in a typical month? (If no statistics kept, please provide a rough estimate)

During Summer_________ During Winter __________

Do you believe that the needs of the homeless or the number of homeless persons in the South Okanagan are:

Increasing?:_____

Staying the Same?:_____

Decreasing?:_____

Do you have any further comments about housing and homelessness in the region?

______________________________________________________________________

Desert Sun Counselling & Resource Centre

South Okanagan Homelessness Project

Participant Survey

All the information you provide will be both private and confidential.

WE WILL NOT USE YOUR NAME OR ANY OTHER IDENTIFYING INFORMATION

The information you provide will not affect any services you are currently using

If you are unable to or uncomfortable answering any of the questions, please move on

If you have any questions regarding this questionnaire, PLEASE CONTACT LEN GRANT at 250-498-2538

Basic Demographic Information

Age:

19 & Under:___

20 to 29:___

30 to 39:___

40 to 49:___

50 to 59:___

60 and Over:___

Gender:

Male:_____

Female:_____

Education (highest level achieved)

Grade School:_____

High School:_____

Diploma:_____

Degree:_____

Family or Marital Status

Single:_____

Married or Common Law:_____

Divorced or Separated:_____

Please describe your cultural or ethnic background:___________________________

Please indicate your first language:____________________

How long have you been living in the South Okanagan? (years):_________________

Housing History & Present Living Situation

What is your present living situation?

_____

On the street (e.g., abandoned building, tent, living on crown land)

_____

Couch surfing

_____

Shelter provided by church or religious group

_____

Car/vehicle

_____

Hotel

_____

Rooming House

_____

Rental

_____

Owner

_____

Other – please describe:________________________

How long have you been living in this situation? (months):_______

Do you consider yourself to be homeless (e.g., living on the street, couch surfing, in a shelter, or in a vehicle)?   Yes:_____   No:_____

Do you consider yourself to be at-risk of becoming homeless (living in accommodations that are temporary, or where there is an imminent risk of eviction)? Yes:_____   No:_____

Have you been homeless at any time in the past two years? Yes:_____   No:_____

Do you consider your housing to be sub-standard or unsafe? Yes:_____   No:_____

If you are renting or living in a rooming house, please indicate if there are problems with any of the following:

Appliances:_____

Utilities:_____

Maintenance:_____

Difficult Landlord:_____

If you have been unable to access stable shelter, please indicate which of the factors below have contributed (Mark all that applies):

_____

Lack knowledge of places to stay

_____

Disability

_____

Low or no income

_____

Credit Record

_____

Your choice

_____

Tenant record (bad or no references)

_____

Lack of supports or assistance

_____

Gender

_____

Can’t afford the damage deposit

_____

Drug or Alcohol Use

_____

Can’t afford rent

_____

Pets

_____

Lack of affordable housing

_____

Smoking

_____

Sexual Orientation

_____

Age

_____

Ethnic or cultural background

_____

Other, Describe:________________

Health Care

Do you have a valid Health Care Card or Health Care Number? Yes:_____   No:_____

Are you receiving treatment/counselling for physical or mental health concerns? Yes:_____   No:_____

Are you currently taking any prescription medication?   Yes:_____   No:_____

If yes, have you been able to consistently access and pay for your prescription medication?

All of the time:___

Most of the time:____

Some of the time:____

Rarely or never:____

In comparison to other people your age, how would you rate your overall level of health?

Excellent:___

Above Average:___

Average:___

Below Average:___

Poor:___

What is the most frequent way you access health care services?

Family Physician:_____

Walk-in Health Clinic:_____

Emergency Ward:_____

Employment & Income

What is your current employment status?

_____

Unemployed

_____

Full Time Employed

_____

Casually Employed

_____

Self Employed

_____

Part time employed

_____

Retired

_____

Seasonally Employed

If you are employed, how long have you been continuously employed? _____

If you are part time/casually employed, how many hours do you work per week on average? _____

If you have been unable to maintain stable employment or full time employment, please indicate which of the following factors have contributed:

_____

No available jobs

_____

Lack of required equipment or tools

_____

Don’t have skills

_____

Lack of documentation or qualifications

_____

Don’t have experience

_____

Mental Health problems

_____

Poor health

_____

Too old to work

_____

Substance abuse

_____

Lack of Job search skills

_____

Lack of Transportation

_____

Lack of proper clothing or attire

_____

Other – Please describe:____________________________________

Please indicate what your current sources of income are:

_____

Employment

_____

Underground Economy (cash work)

_____

Self Employment

_____

Pension

_____

BC Benefits

_____

Disability Benefits

_____

Employment Insurance

_____

Other, Please Describe:__________________

What would you estimate your average monthly income to be?

$0 to $500:____

$500 to $1000:___

$1000 to $1500:____

More than $1500:____

How many adults does this income support (including yourself)? _____

How many children does this income support? _____

Approximately what percentage of your monthly income is spent on housing? ______

Accessing Community Resources

Please indicate which of the following community resources you have accessed in the past six months:

_____

Emergency Shelter

_____

Mental Health Counselling

_____

Free Meals

_____

Drug/Alcohol Counselling

_____

Food Bank

_____

Treatment or Detox Centre

_____

Free Clothing

_____

Emergency Medical Services

_____

Job Counselling

_____

Parenting Support

_____

Financial Aid

_____

Crisis Counselling

_____

Victim’s Assistance

_____

Police/Law Enforcement

_____

Legal Assistance

_____

Literacy Services

_____

Domestic Violence Services

_____

Public Library

_____

Immigration Services

_____

Free Showers or laundry facilities

_____

Community Recreational Facilities

_____

Other, Please describe:_________________

What service or help do you think would be most valuable in improving your situation? (if you can identify more than one, please list them in priority)

1. ______________________________________________________

2. ______________________________________________________

3. ______________________________________________________

4. ______________________________________________________

5. ______________________________________________________

Is there anything else you would like us to know about you or your situation?

Participants in this survey are being identified through the contact we have with persons such as yourself. Can you think of anyone who may be homeless or at risk of homelessness who might be interested in participating in this survey?

(DO NOT include answers to this question on the survey document)