Diversion Questionnaire
Client Name
*
First Name
Last Name
CT Case #
Where did client sleep last night?
Is this a safe place they could potentially stay longer?
What other housing options are available for the next few days or weeks?
Even if there is an option outside of shelter that is only available for a short time, it's worth exploring if this housing resource can be used.
(If staying in someone else's housing) What issues exist with you remaining in your current housing situation?
Can these issues be resolved with coaching, mediation, financial assistance, etc?
(If coming from their own unit) Is it possible/safe to stay in your current housing unit? What resources would you need to do that?
If the family could stay in their current housing with some assistance, what resources are available for a prevention-oriented solution?
In terms of housing, have you tried other things in the past? What were these and how did they work for you? What other things have you considered doing?
Could be living with family members, friends, income-based housing, etc.
What is preventing you from using one of those solutions?
Would any of the above solutions help in the short-term while working towards long-term housing and stability?
Is diversion possible for client?
Yes
No
What is the diversion plan?
Does the client need additional support?
Outreach Follow-up
Transitional Housing/Emergency Shelter
No
Follow-up details:
Best way and time to follow-up? In which specific areas are follow-up needed?
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