Loading...
HomeMy WebLinkAboutMINUTES - 05201997 - C86 TO: BOARD OF SUPERVISORS F&HS-05 ,� ,6E. •.oF Contra FROM: FAMILY AND HUMAN SERVICES COMMITTEE Costa County DATE: May 12, 1997 CITTA FOU GT SUBJECT: STATUS REPORT ON PROGRAMS FOR THE HOMELESS SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION RECOMMENDATIONS: 1. ESTABLISH a Continuum of Care Advisory Board as outlined in Dr. Brunner's attached report, except that four additional members are to be added, all of whom will initially be existing members of the Homeless Advisory Committee. 2. DIRECT the Health Services Director to recommend to the Family and Human Services Committee on June 9, 1997 in which categories the additional four seats should be placed. 3. INDICATE the intent of the Board of Supervisors to abolish the Homeless Advisory Committee at the time the appointments are made to the Continuum of Care Advisory Board. 4. DIRECT the Health Services Director to plan a suitable ceremony before the Board of Supervisors to express the Board's appreciation to the members of the Homeless Advisory Committee for their years of tireless and dedicated service to the homeless of this County. 5. AUTHORIZE the Health Services Director to pursue the process outlined in Dr. Brunner's attached report for recruiting applicants for the Continuum of Care Advisory Board, including REFER to the Internal Operations Committee the responsibility to recommend appointments for all seats to the Board of Supervisors by not later than September 9, 1997. CONTINUED ON ATTACHMENT: YES SIGNATURE: RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOAR OMMITTEE APPROVE OTHER SIGNATURES ACTION OF BOARD ON May 29, 1997 --APPROVED AS RECOMMENDED OTHER VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A TRUE -UNANIMOUS(ABSENT District i TTT ) AND CORRECT COPY OF AN ACTION TAKEN AYES: NOES: AND ENTERED ON THE MINUTES OF THE BOARD ABSENT: ni S tri cct TTT ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN. ATTESTED MAy 9n, 1917 Contact: PHIL BATCHELOR,CLERK OF THE BOARD OF cc: SUPERVISORS AND COUNTY ADMINISTRATOR See Page 3 BY �' DEPUTY F&HS-05 6. REQUEST the County Administrator to provide a recommendation to the Board of Supervisors regarding where the position of Homeless Program Coordinator should be placed organizationally within County government, if such a position were to be established and funded. 7. AUTHORIZE the Family and Human Services Committee: A. to meet on June 9, 1997, with the Executive Director and members of the Board of Directors of Center Point, the private non-profit organization headquartered in Marin County which is being recommended to the Board of Supervisors to take over the operation of the homeless shelters in Contra Costa County effective July 1, 1997, and B. to review the terms of the proposed contract between the County and Center Point, and C. to make a recommendation to the Board of Supervisors on June 17, 1997 regarding approving such a contract. 8. ACKNOWLEDGE the materials which are attached which were furnished to our Committee by Tom Fulton on behalf of the Northern California Family Center, which indicate the estimates of the numbers of homeless and runaway youth there are in this County and which notes the inadequacy of the resources which exist to assist these homeless and runaway youth. BACKGROUND: On February 4, 1997, the Board of Supervisors approved a report from our Committee which included a number of actions regarding the homeless programs in the County. The Health Services Director was asked to report to our Committee again in April, 1997. On May 12, 1997, our Committee met with the Public Health Director, Dr. Wendel Brunner, and members of his staff, along with members of the Homeless Advisory Committee, members of the Grand Jury, a representative from the County Counsel's Office, and other advocates for the homeless. Dr. Brunner presented the attached report to our Committee and reviewed it with us. The report is broken into four major areas: The first area is the formation of the Continuum of Care Advisory Board. The Board of Supervisors has already agreed in concept to the establishment of such an advisory board. It will be required by HUD as a condition of their grants to the County. We have tried to transition this advisory board from the Homeless Advisory Committee to the Continuum of Care Advisory Board by guaranteeing 11 seats to the most active current members of the Homeless Advisory Committee. As is reflected in the attached report, there was some dispute about the number of seats which should be reserved for members of the current Homeless Advisory Committee. We have resolved this dispute by adding four seats which will each initially be filled by members of the Homeless Advisory Committee. The staff's intent is to complete the recruitment, screening and ranking process by the end of July so -2- F&HS-05 the Internal Operations Committee can consider appointments to the new Continuum of Care Advisory Board at its August meeting. The second area is the decision to recommend a new contractor to operate the homeless shelters in the County. Dr. Brunner's report outlines the rather complete process which was followed in issuing RFP's for the operation of the County's homeless shelters. This process has resulted in the selection of a new contractor, Center Point, which is headquartered in Marin County. Staff is currently meeting with staff from Center Point to complete negotiations for the terms of the service plan which will form the basis of the contract which will be recommended to our Committee on June 9, 1997. We anticipate meeting with staff and Board members from Center Point on June 9, 1997 in Bay Point, and will make a firm recommendation to the Board on June 17, 1997 for a contract to operate the County's homeless shelters effective July 1, 1997. The third area is the funding of programs for the homeless in Contra Costa County. We are very pleased with the progress which has been made in obtaining additional HUD funds for homeless programs in this County. Dr. Brunner's report outlines the remarkable achievements which have been obtained in this regard. We are hopeful that staff will be equally successful in obtaining funding for programs for the coming fiscal year. The fourth and final area is that of homeless and runaway youth. Tom Fulton from the Northern California Family Center presented our Committee with the attached information regarding the needs of homeless and runaway youths. We readily admit that this is an area in which we need to devote more time and attention. We are providing here the information which was shared with our Committee. We will review this information in more detail in the future and will provide a further report to the full Board at a later date. cc: County Administrator Health Services Director Public Health Director Brenda Blasingame, Homeless Program Manager, HSD Sara Hoffman, Senior Deputy County Administrator -3- YOUTH OUTREACH PROGRAM for RUNAWAY AND HOMELESS YOUTH and Their Families NORTHERN CALIFORNIA FAMILY CENTER IN THE DAY CALL(510)370-1990 EXT 2# AT NIGHT CALL 1 800-718-4357 sE L Contra Costa County Health Services Department - '' - -= —�' • Public Health Division p Administrative Offices x�, 3��„ ® •` 597 Center Avenue,Suite 200 Martinez,California 94553 Phone: (510)313-6712 osT`4`COUPZ G Fax:(510)313-6721 E-Mail:wbrunner@hsd.co.contra-costa.ca.us TO: Family & Human Services Committee Supervisor Mark DeSaulnier, District 4 Supervisor Donna Gerber, District 2 FROM: Wendel Brunner, M.D. E".�� / Director of Public Health DATE: May 8, 1997 SUBJECT: STATUS REPORT ON THE COUNTY HOMELESS PROGRAMS Development of the Homeless Continuum of Care Advisory Board As requested by the Board of Supervisors, we have developed a Homeless Continuum of Care Advisory Board (COCB) which consist of 21 members from 10 categories. The structure of the Board is consistent with what we expect to be required by HUD to receive future HUD funding for homeless services. The membership of the COCB is indicated in the chart below. Ex-officio members: a representative from the County Mental Health Division, Community Substance Abuse Services, Department of Social Services, and the County Homeless Program. CONTINUUM OF CARE ADVISORY BOARD Area of Representation Total Number of Seats Number of Vacancies Term of Office Open Consumers-Current or Former 3 2- 1 Seat for HAC 1 Year Advocates 2 1 - 1 Seat for HAC 2 Years Citizens-At-Large 2 2 2 Years Agency Representatives 3 All Seats for HAC 3 Years Voluntary Organizations 2 2 2 Years Faith Community 2 All Seats for HAC 3 Years Business 2 2 2 Years County 2 2 3 Years Cities 3 3 3 Years Family & Human Services Committee Supervisors DeSaulnier/Gerber May 8, 1997 Page 2 Seven of the COCB seats are set aside for current Homeless Advisory Committee (HAC) members, as directed by the Family&Human Services Committee and the Board of Supervisors. This overlap will ensure continuity with the existing Homeless Advisory Committee, and tap into the extensive expertise and experience that exists in the current HAC membership. The Homeless Advisory Committee is not in agreement with the number of seats specifically identified for HAC. HAC would like to see at least half of the seats on the COCB go to current HAC members. The Health Services Department believes that overlap of current HAC members with COCB membership is important to the formation of the new Board, but we also believe that it is essential to open up the recruitment process to the community and general public, to offer the opportunity for interested citizens who have not yet been involved in HAC to participate in the new Board. Members of HAC are encouraged to apply for open seats in the COCB, and the final composition may include more than seven HAC members. Recruitment for COCB members has involved mailing over 160 application packets to each of the cities, municipal advisory committees, police departments, members of the Board of Supervisors, community based organizations including the Homeless Advisory Committee and the Public and Environmental Health Advisory Board, and interested individuals. We will also be seeking applicants through notices in the newspapers and community newsletters. We have established a deadline of June 6, 1997 for the return of the applications. A committee including members of HAC will review the applications, interview applicants, and prepare recommendations for memberships to be submitted to the Internal Operations Committee during the month of August. Selection of Homeless Shelter Program Operator After an extensive bidding and review process,the Contra Costa County Health Services Department has selected Center Point, a predominantly Marin based community non-profit, to operate the county's homeless shelters. Four agencies responded to the Request for Proposal--Shelter, Inc., Center Point, St. Vincent de Paul, and Catholic Charities. Center Point was selected after a panel of eight people (including Homeless Advisory Committee members and one homeless expert from outside the county) reviewed the applications, made site visits, interviewed the applicants, and provided recommendations to the Health Services Department. The Health Services Department then made additional site visits to Shelter, Inc. and Center Point and did extensive reference checks before making the selection. Center Point has been providing drug treatment and medical services in Marin and throughout the Bay Area since 1971, including adult, adolescent, and perinatal treatment programs. Among their services is administration of the six county case management program for California parolees (BASN), including Contra Costa. Center Point is involved in the Hamilton Base conversion to a homeless services site, and the Executive Director is the co-chair of the Marin County Housing and Services Committee. Thirty four percent(34%) of Center Point's current clients in all programs are homeless, and many are residents of Contra Costa. Center Point has experience in providing entry level emergency services, and stabilization and support services to individuals with multiple issues. The current shelter operator, Shelter, Inc., was organized 10 years ago when there were almost no dedicated services for the homeless in Contra Costa County. The staff and Board members of Shelter, Inc. have played a major role in the development and expansion of the homeless continuum of care, and in increasing HUD funding to Contra Costa County. In recent years Shelter, Inc. has particularly expanded the opportunities for transitional and low-cost housing in Contra Costa, and Family & Human Services Committee Supervisors DeSaulnier/Gerber May 8, 1997 Page 3 homeless prevention services. The expansion of the continuum of services for homeless persons in Contra Costa over the last several years has allowed community agencies to specialize in different aspects of the homeless continuum of care. The addition of Center Point strengthens the continuum in Contra Costa, and adds expertise in direct services to individuals with some of the most difficult problems of homelessness. Shelter, Inc., its employees, and Board of Directors are to be commended for their commitment to the homeless and to the provision of emergency shelter services in the county. During the past four years, Shelter, Inc. has operated the shelter program with limited funding and under intense public scrutiny when there was no other agency willing to provide these services. Status of HUD Assistance Funding FY 1996 The County submitted a Consolidated Application to HUD for McKinney Homeless Assistance FY 96 funding in June of 1996. In September, we received notification that the three top ranked proposals would be funded at$1,656,195. In early March, 1997 we received word from HUD that an additional three proposals would be funded,resulting in an additional $1,523,093 in funding for our County. Only seven additional projects nationwide were funded and three were in Contra Cosa. This success speaks to the strength of our Continuum of Care planning process, our Plan, and our collaborative efforts. The programs funded are: Moving Out of Violent Environments (MOVE) $ 284,478 Battered Women's Alternative GRIP Resource Center $ 486,045 Greater Richmond Interfaith Program Family Employment Resources & Services Together(FERST) $ 885,672 St. Vincent de Paul Transitional Housing Partnership Program $ 505,373 Shelter, Inc. Contra Costa County Shelter Plus Care Program $ 446,520 Housing Authority of the County of Contra Costa Money Management Program $ 571,200 Rubicon Programs TOTAL $3,179,288 Each of the proposals was required to complete a second submittal with complete budget and match information and HUD has completed its review and issued contracts to all of the programs. The first two are up and running and a Program Manager has just been hired for the FERST Program. These programs each address high priority needs identified in the County's Continuum of Care Plan and they are funded for three years. Family & Human Services Committee Supervisors DeSaulnier/Gerber May 8, 1997 Page 4 Preparation for FY `97 HUD Homeless Assistance Funding HUD released the Notice of Funds Available (NOFA) on April 8,with applications due to HUD on July 31. Funding is available for Supportive Housing Programs (SHP), Shelter Plus Care, and Section 8 Moderate Rehabilitation with regulations similar to last year. Our application must address the needs identified in our County's Continuum of Care Plan, and extensive collaboration and coordination is required to be awarded funding. Five or six of the existing programs in the county must also apply for renewal funding (for one to three years) in this current funding cycle. The renewal funding will come out of the current HUD allocation, which will diminish funding available for new programs to address existing gaps and priorities in our service continuum. Our Continuum of Care Homeless Plan emphasizes as the top priority the maintenance of the existing continuum, and renewal funding for current programs will be a priority. We will again submit one Consolidated Application for Contra Costa County with all proposals prioritized for funding. We will be following the successful process developed last year to gather proposals and prioritize them for our Consolidated Application. Two Continuum of Care coordination meetings have already been held with the Ad Hoc Task Force and providers of homeless services and housing. Letters of Intent(LOI's) are due May 15 for preliminary review and ranking prior to the development of full proposals for the HUD application. A ranking sub- committee will be selected at the next Continuum of Care coordination meeting on May 19 to review and rank all LOI's and work with the highest ranked projects on the development of their applications. A timeline has been developed to guide us through the 90 day process. HOMELESS AND RUNAWAY YOUTH There are almost no services in Contra Costa for homeless and runaway youth who are outside of the criminal justice or children's protective services systems. The Northern California Family Center has a homeless youth program,but it is not yet well developed. HAC and other organizations have identified homeless and runaway youth as a major gap in Contra Costa County's Homeless Continuum of Care services. A Homeless and Runaway Youth Committee has formed consisting of County agencies and community based organizations to assess the need for services for homeless youth, and to develop programs to meet those needs. The Committee has met with other Bay Area agencies involved in the Homeless Youth 101 Project and has gathered information about the Federal Runaway and Homeless Youth Program (RHY) application from Health and Human Services (HHS). Three applications are being submitted from Contra Costa County to HHS, and another application may be prepared for the current HUD funding cycle. There is a great need for developing these services in Contra Costa County,and a good potential for developing funding for these services from the Federal government, Contra Costa cities, and community foundations. WB:ah May 12, 1997 To: Family and Services Advisory Committee From: Northern California Family Center Regarding: Estimates of the number of Runaways in Contra Costa County Attached are estimates of the number of runaways in Contra Costa County. In June 1995, the Northern California Family Center surveyed eight Police Departments and discovered a reporting rate of 1,685 status offenders for a population of 413,000 people or 0.41% of the surveyed population. With a total population of 860,000 this projects to 3,526 status offenders annually in Contra Costa County.' Based upon the Federal Register'there are 1.3 million runaways in the U.S. 1.3 million runaways/260 million for the general population = 0.50% of the total population. 0.50% of 870,000 =4,350 runaways in Contra Costa County. Since these estimates are reasonably close and independent in terms of their method, we thing that they reflect a good start in estimating the total number of youth who run away in the county each year. Our estimates about the daily average number who are runaways who are out of their homes ranges from about ten to as many as thirty on any given day. The estimate as to the number of youth who will receive services is considerably less. This is based upon the practical placement levels conducted by Sherman House.' The practical placement with this population is really where current investigations and studies should be today. We have just begun to use the attached RHYMIS' forms and hope to provide reports from this data base as it is developed. We support research in this area, but we believe that the existing system has clearly demonstrated a need. This need for Basic Services should not be secondary to conducting another need survey. If this occurs, then another 450 to 750 youth who would otherwise seek services will continue to receive no direct assistance from the County in 1997-8. '. Please see the attached memo to the Youth Crisis Consortium dated June 12, 1995. '. The April 10th, 1997 Federal Register p. 10965 3. The Contra Costa Juvenile Corrections Master Plan,1990,p.58 identified the total number of referrals of runaway/status offender referrals to 625 children county wide in 1989-90. Of these 450 youths were placed for an average of 3 nights each 4. The Runaway and Homeless Youth Management Information System which is part of the Federal Tracking System and now part of the information currently being gathered by the Northern California Family Center. If you are interested in the incidents of youth who run as recorded from the school system, please see our attached review of contact with runaways in the schools.' ' This is based on an attached questionnaire circulated to over 4,000 students in 11 schools. 483 youth identified themselves as runaways as some point. This means that about 11.9%of High School students ran away. 1 � June 12 , 1995 To: Members of the Youth Crisis Consortium From: Tom Fulton, N.C.F.C. Regarding: Police Department Questionnaire On May 25, 1995 we sent a questionnaire to many of the Police Departments in Contra Costa in order to assess the degree of occurrence of runaways in each of the cities of the county as well as to determine whether we would be able to establish a cooperative relationship to develop foster family support servic- es . Not all of the departments have yet responded, and so a more complete report will be forthcoming, but I thought I should share some of the preliminary results with you. The following table shows some of our answers: #4 #3 #7 City Will They % of # Runaways City Cooperate? Total in a Year Population Pop. 1 ) Antioch Yes 0. 30% 240 75 ,000 2) San Pablo Yes 0. 470 123 26 ,000 3 ) Hercules Yes 0. 30% 60 20 ,000 4 ) Concord Yes 0. 40% 460 115,000 5) Martinez Yes 0. 68% 240 35,000 G ) Clayton Yes 0. 12% 12 10 ,000 7) Richmond Yes 0. 55% 500 90, 000 8) San Ramon Yes 0. 12% 50 42 ,000 Totals 1,685 413 ,000 County Average/Total 0. 41% 860,000 Projected County Total 3 ,526 Runaways NORTHERN CALIFORNIA FAMILY CENTER 2244 PACHECO BLVD MARTINEZ, CA 94553-1968 FAX 370-1993 PHONE 370-1990 Police Department Status Offender Questionnaire as of May 25, 1995 .Lt. Jim Alcorn Concord Police Department Juvenile Bureau OR 1950 Parkside Drive Concord, CA 94520 OFFICE TELEPHONE: 671-3020 YOU ARE PROBABLY AWARE THAT STATUS OFFENDERS OR "601'S" ARE CHILDREN UNDER 18 , WHICH ARE RUNNING AWAY, TRUANT, OR OUT OF PARENTAL CONTROL. ( 1) Does your Department maintain statistical records on Status Offenders or for any of these classifications? [ ] YES, [ ] NO. ;/ " ./7617"✓ 01V 7 p 10 vAI .'t i-✓.F+Yf, iv L? . .r t.'? 0, tl✓G ( 2) If you know, or can refer to your records, please estimate the number of Status Offenders-which you encounter in a Month, O V Year. ( 3 ) Of these status offenders, approximately how many are RUNAWAYS in a Month, 4Y16 Year? The number or "Missing Children" reported in 1994 was le) Y (4 ) If the Northern California Family Center is able to certify crisis foster homes in your area, would you be interested refering runaway children to these homes for short term. placement? .�Q YES [ ] NO ( 5) Can you suggest a city newsletter or other media approach which the Northern California Family Center might use to announce our need for foster family recruits? %Adi' C/7-y v' POA4,�,Lal r7 C oA.s:A e--r, !',e',a ov A fl' ' 6 71- 71 7.?_ (6) If you coordinate your work with Runaways through a local organization or community based service provider(s) ,' - please write their name and phone number here: Contact Person: Organization: Phone Number: Other: (7) Approximately how many people live in the city or area"which- you serve? 1Zj _.o r) o people. (8) Do you have any sugestions about how to coordinate our services with yours? in0�;�.'.L6 &Ss*<!% /`�1%G:f�tl.e�7 '.�t� !°� ttite°/�f+E�i'9 tiil:i�r lsr�'a'C? /i �'Uaf"1 2'0 A1r4"7e>y�iR' In.e< f n LA'r !.v ,V J F 'yw• ,'r�ml3.�. 1���)rd� c�__ yf�T` h7 (9) Can you recommend .a Community Based Service. Program which you believe could assist the Northern California Family Center in providing coordin- ated therapy for Drug and/or Alcohol Abuse for runaways. Contact Person 1j7?'1 ..r'r�d.Fc,7"6C ? Organization: Arlr_ +1-1 C c?,,r/XaI¢r Phone Number 6 7f"-/Ertl Other: ( 10) What percentage of Runaways, which you encounter, do you estimate have a drug and/or alcohol abuse problem? -_ZC2 % ( 11) What percentage of Runaways do you. estimate speak Spanish? o Signature Date Northern California Family Center STARLIGHT PROGRAM WE NEED TO KNOW WHAT YOU KNOW ABOUT HOMELESSNESS & RUNAWAYS: 1 .) Whom do you think of, when you think of the homelessness? 2) Do you know someone who has run away from home? ❑ Yes ❑ No 3) Have you ever runaway or been homeless? ❑ Yes ❑ No 4) If you ran away, did you: ❑ Stay with another family member ❑ Stay with a friend; ❑ Stay in a Shelter: Which City? ❑ Stay on the Street: Which City For Days. 5) Where do runaway kids stay or hang out in your neighborhood? Location: Street? & Cross Street ? 6) Other Comments: DEMOGRAPHICS: 1 ) You go to: (School) in (City). 2) You are (years), in the (grade) ❑ Male ❑ Female 3) Your are: ❑ Caucasian ❑ African American ❑ Hispanic ❑ Asian/Pacific Islander ❑ Native American ❑ Other. DETACH HERE IF YOU WANT THE ABOVE INFORMATION CONFIDENTIAL ------------------------------------------------------------- VOLUNTEER INFORMATION: I want to volunteer to help runaway and homeless youth. NAME: STREET ADDRESS: CITY: ZIP: PHONE: SCHOOL I can participate: ❑ WEEKLY, ❑ MONTHLY, ❑ ONCE IN MY LIFE, ❑ OTHER. I can come to ❑ Martinez, ❑ Walnut Creek ❑ Other I can come between am/pm and am/pm I am interested in: ❑ Public Relations/Newsletter ❑ Concert: Role Playing, Equipment Help, Other ❑ Fundraising/Concessions ❑ Student Coordination Thanks for your help! Northern California Family Center Review of Self-Reporting of Runaway Activity 1995-7 Total Run- # Aways Number of % of Date Organization/School Youth Surveyed Runaways Runaways 10/21/95 CASA in Pleasant Hill, Benefit 300 - 11/12/95 Christ The King School 40 11/21-2/95 Salesian High School 800 465 33 7% Total Student/Patent Contact for the Quarter 840 465 January - March 1996 Q - 2 1/10/96 Miramonte 1100 583 62 11 % 1/12/96 Moreau , 1300 888 94 10.5% 1/26/96 Sycamore Valley School 80 2/2/96 Sacramento Nat'l Self Esteem Assoc. 30 2/12/96 St. Mary's 700 2/20/96 Los Lomas 1300 399 36 9.0% 2/22/96 Clayton Valley High 300 148 19 12.8% 3/3/96 St. Raymonds School Youth Group 40 3/7/96 Liberty High 1200 447 65 14.5% 3/13/96 S. F. State Graduate School 70 3/30/96 Christian Youth Rally-Parents Group 40 3/30/96 Christian Youth Rally-Student Group 3000 Total Student/Parent Contact for the Quarter 9160 2,465 276 April - June 1996 Q - 3 4/1-9/96 Sigma High-Pinot 40 40 20 50% 4/6/96 Broadway Plaza, Walnut Creek 100 4/24/96 St. Joes Youth Group 100 4/25/96 Johnny Loves Benefit 150 4/30/96 Olympic Continuation 300 120 37 31% 5/4 - 5/96 St. Joes Church 3000 5/6 - 7/96 St. Joes School 300 150 15 10% 5/22/96 County Wide Youth Commission 30 5/23/96 Pleasant Hill Park and Rec. Benifit Total Student/Parent Contact for the Quarter 4020 310 72 Total Student/Parent Contact for the YTD 14020 310 346 Total Run- # Aways Number of % of Date Organization/School Youth Surveyed Runaways Runaways Oct -Dec 1996 Q - 4 9/28/96 Pinole High Continuation 300 20 6 30.0% 10/15/96 Alhambra High School 1,200 371 55 14.8% Total for the Quarter 1,500 391 61 2/15/97 Pittsburg High School 2,000 398 41 12.0% Totals 17,220 4,029 483 11.98% 0 a O '14'00 IL 1�0 tit Hog ,� cd CA cd U oc m ^ap.m ~p` a qia o r7 p° y "gi 0 � � W �� o a o Q �p ^�� a �i• °�N•,o°e�c H 07 :a p UVV � a v oo � AEnWr7� A Ilia-i I I y y A ` ooA •t cn x g CAN w �W 1-4 to N � � O D p W my � .° E m � d a•U RHY MIS YOUTH PROFILE OMB NO: 0970-0123 Lj PAI2 :Y . i' IT' `H D► 1VIfGRA 'HIS For each youth served by the program, complete this form at, or soon after, intake. It records basic information about the youth and his or her household. To complete the form, circle the code or place check marks in the boxes below that best answer each question. For questions without coded responses, write the appropriate responses in the space provided. YOUTH CHARACTERISTICS 1. Agency ID: 2. Youth ID: I 3. Intake Date: / / 4. Date of Birth: 5. Gender: (Circle one) Female Male 6. How does the youth describe himself or herself using these census categories?(Circle one) a. American Indian or Alaskan Native b. Asian or Pacific Islander c. Black, not of Hispanic Origin d. Hispanic e. White, not of Hispanic Origin 7a.Would services be delivered more effectively in a language other than English? (Circle one) Yes No b. In what language(s)does the youth communicate? (Check all that apply) 0 An American Indian or Alaskan Native Language 0 An Asian or Pacific Island Language 0 English 0 Sign 0 Spanish 0 Other 8. Is the youth a refugee? (Circle one) Yes No 9. Marital Status: (Circle one) 10. Is the youth pregnant,or is a female pregnant by youth? (Circle one) a. Single,Never Married b. Single,Living with Partner a. Yes c. Married b. No d. Other c. Do Not Know 11. How many children does the youth have? RHY MIS 02-08 Version 3.0 Page 1 of 16 RHY MIS YOUTH PROFILE ONM NO: 0970-0123 PART I Y!0►UTH.DEMOGRAPHICS (continued) 12. School Program Last Attended: (Circle one) 13. School Status: (Circle one) a. ElenvMiddle/High School a. Attending School Regularly b. GED b. Graduated High School c. Vocational c. Completed GED d. Special Education d. Attending School Irregularly/Extended Truancy e. Altemative/Homebound Program e. Dropped Out f Post-Secondary f. Suspended g. College g. Expelled h. Not Applicable h. School Not in Session i. Do Not Know i. Do Not Know 14. Last Grade Completed: (Circle one) a. Grade 5 or less g. Grade 11 b. Grade 6 h. Grade 12 c. Grade 7 i. 1-3 Years of College d. Grade 8 j. 4 or More Years of College e. Grade 9 k. Other Post-Secondary Training f. Grade 10 1. School Program Not Graded LIVING SITUATION: 15. Youth's Legal Residence: a. County b. Zip - 16. Estimate the number of living situations in which youth has resided in the last month: 17. Last Living Situation of Youth: (Circle one) a. .Parent/Legal Guardian Home j. Job Corps s. Residential Treatment b. other Parent's Home k. Basic Center t. Mental Hospital c. Relative's Home 1. Homeless Family Center u. Correctional Institute/ d. Friend's Home m. Living Independently Detention Center e. Other Adult's Home n. On the Run v. Other Institution f Foster Home o. On the Street w. Other Temporary Shelter g. Group Home p. In Squat x. Military h. Transitional Living Program q. Educational Institute y. Other i. Independent Living Program r. Drug Treatment Center z. Do Not Know 18. Primary Living Situation for Past Year: (Circle one) a. Parent/Legal Guardian Home j. Job Corps s. Residential Treatment b. other Parent's Home k. Basic Center t. Mental Hospital c. Relative's Home 1. Homeless Family Center u. Correctional Institute/ d. Friend's Home m. Living Independently Detention Center e. Other Adult's Home n. On the Run v. Other Institution f Foster Home o. On the Street w. Other Temporary Shelter g. Group Home p. In Squat x. Military h. Transitional Living Program q. Educational Institute y. Other i. Independent Living Program r. Drug Treatment Center z. Do Not Know RHY MIS 02-08 Version 3.0 Page 2 of 16 RHY MIS YOUTH PROFILE OMB NO: 0970-0123 PARTI YOUTH DEMOGRAPHICS (continued) HOUSEHOLD SITUATION: 19a. Employment Status of the Youth: (Circle one) b. Is the youth's father figure employed? (Circle one) a. Full Time(Over 35 Hours) a. Yes b. Part Time b. No c. Volunteer c. Do Not Know d. Seasonal/Sporadic d. Not Applicable e. Not Employed,Looking for work f. Not Employed g. Never Employed h. Do Not Know C. Is the youth's mother figure employed? (Circle one) d. Is the youth's spouse/partner employed? (Circle one) a. Yes a. Yes b. No b. No c. Do Not Know c. Do Not Know d. Not Applicable d. Not Applicable 20. Have any of the youth's household members run away or been thrown away? (Circle one) a. Yes b. No c. Do Not Know d. Not Applicable 21. Youth's Household Members: PLACE A NUMBER in the box to indicate the quantity of each member type that resides in the youth's household. HOUSEHOLD MEMBER TYPE FEMALE MALE ❑ Biological Mother ❑ Biological Father ❑ Adoptive Mother ❑ Adoptive Father ❑ Step-Mother ❑ Step-Father ❑ Foster Mother ❑ Foster Father ❑ Parent's Partner ❑ Parent's Partner ❑ Youth's Spouse/Partner ❑ Youth's Spouse/Partner ❑ Aunt ❑ Uncle ❑ Grandmother ❑ Grandfather ❑ Sister ❑ Brother ❑ Step/Half-Sister ❑ Step/Half-Brother ❑ Youth's Daughter ❑ Youth's Son ❑ Other: Relative ❑ Other: Relative ❑ Other:Non-Relative ❑ Other: Non-Relative RHY MIS 02-08 Version 3.0 Page 3 of 16 RHY MIS YOUTH PROFILE OMB NO: 0970-0123 PARTI: YQU'T;H DEM©GRAPHICS(continued) 22a. Is youth and/or someone in the household receiving unearned income? a. Yes b. No c. Do Not Know d. Not Applicable b. If yes, what type of unearned income? (Check all that apply) A. Income Maintenance C. Nutritional Assistance 0 Foster Care 0 Women,Infants, and Children 0 Supplemental Security Income 0 Food Stamps 0 AFDC Other 0 Welfare(not AFDC) . Unemployment Compensation D. Medical Assistance 0 State Allowances 0 Medicaid 0 Other 0 Medicare 0 State Program for Disease/Disabilities B. Housing Services 0 Other 0 Temporary Housing/Shelter 0 Federal Low-Income E. Community Center 0 Other Low-Income Housing 0 Religious Affiliation Other 0 Other 23. Who are the youth's legal guardians? (Circle one or two,as applicable) FEMALE Male OTHER a. Biological Mother k. Biological Father u. Child Welfare/DSS b. Adoptive Mother 1. Adoptive Father v. Juvenile Justice/DJS c. Step-Mother m. Step-Father w. Self d. Foster Mother n. Foster Father x. Do Not Know e. Parent's Partner o. Parent's Partner f Youth's Spouse/Partner p. Youth's Spouse/Partner g. Aunt q. Uncle h. Grandmother r. Grandfather i. Sister s. Brother j. Other t. Other REFERRAL: 24. Who referred the youth to the agency? (Circle one) a. Self Referral k. School Staff b. Parent's/Legal Guardian 1. Street Outreach c. Foster Parent m. Religious Organization d. Other Relative n. Other Agency Program e. Other Youth o. Other Youth Services Agency f. Other Adult p. Other Organization g. Child Welfare/CPS q. National Switchboard h. Safe Place r. Other Hotline i. Law Enforcement/Police s. Do Not Know j. Juvenile Justice RHY MIS 02-08 Version 3.0 Page 4 of 16 RHY MIS YOUTH PROFILE OMs NO: 0970-0123 PART I YOUTH:DEMOGRAPHICS tanhnued REFERRAL(continued): 25. Where did the youth hear about agency? (Check all that apply) Q Referral Source(Item 24) 0 Street Outreach Public Media ED Public Presentations Other Youth Other Forms of Promotional Materials School Q Other RUNAWAY AND HOMELESS YOUTH STATUS: 26. Status of youth at intake: (Circle one) a. At Home e. Emancipated b. Runaway f. Juvenile Justice Placement c. Throwaway g. Child Welfare Placement d. Homeless h. Other NOTE: If the youth is not currently runaway,throwaway,or homeless, skip to Question 30. 27. 1 How long has the youth been a runaway,throwaway or homeless? (Circle one) a. Overnight g. 22-28 days b. 1 day h. 29-56 days c. 2-4 days i. More than 56 days d. 5-7 days , j. Do Not Know e. 8-14 days k. Not Applicable f. 15-21 days 28. Distance of Household from Program: (Circle one) a. Less than 1 Mile e. 51-100 Miles b. 1-10 Miles f. More than 100 Miles c. 11-20 Miles g. Not Applicable d. 21-50 Miles 29. Location of Household Relative to the Program: (Circle one) a. In same Community e. In Different State b. In Same Metropolitan Area f. In Different Country c. In Same Rural Community g. Not Applicable d. Elsewhere in Same State 30. Previous Runaway Information: a. How many times has the youth runaway? a b. Of these runaway episodes,how many resulted in receipt of services from this agency? c. Of these runaway episodes,how many resulted in receipt of services from another agency? RHY MIS 02-08 Version 3.0 Page 5 of 16 RHY•MIS YOUTH PROFILE 097 09700--01122 3 PART I OPTIONAL CONTACT INFORMATION This form is provided to allow service providers to record important identifying information and contacts for the youth being served. This information is optional and will NOT be included with the quarterly data submission. Agency ID: Youth ID: Date: YOUTH'S INFORMATION 1. Youth's Name: Alias Name: Address: City: State: Zip Code: - County: Telephone No.: SCHOOL INFORMATION 2. School Name: Address: City: State: Zip Code: - County: Telephone No.: Fax No.: OPTIONAL IDENTIFICATION NUMBERS 3. Case No.: 4. Social Security No.: 5. Medicaid No.: 6. CPS No.: 7. Other(specify): HEALTH INSURANCE INFORMATION 8. Insurance Company: Insurance No.: Group No.: Telephone No: RHY MIS 02-08 Version 3.0 Page 6 of 16 RHY MIS YOUTH PROFILE DUB NO: 0970-0123 PART II jij OPTIONAL.CQNTACT�NFORATION (Continued) 9. Notes: CONTACT INFORMATION RELATIONSHIP OF CONTACT TO YOUTH a. Parent g. Social Worker b. Grandparent h. Mental Health Therapist 10.Contacts: c. Sibling i. School Counselor d. Other Adult Relative j. Employer a. Relation: (Enter Code) e. Legal Guardian k Other L Probation Officer First Name: Last Name: Address: City: State: Zip Code: - County: Telephone No.: b. Relation: (Enter Code) F First Name: Last Name: Address: City: State: Zip Code: County: Telephone No.: c. Relation: (Enter Code) ❑ First Name: Last Name: Address: City: State: Zip Code: - County: Telephone No.: RHY MIS 02-08 Version 3.0 Page 7 of 16 RHY MIS YOUTH PROFILE OUB NO: 09 -0123 PART I : XOUTH'S ISS[ E5 This form is designed to record information about issues facing runaway and homeless youth. The form should be filled out by a staff member at intake after meeting with the youth and possibly the family. The form should be reviewed and updated at exit or at three month intervals following with the intake date. This review and update will ensure that any additional insight into the youth's problems gained during his or her services will be recorded. 1. Agency ID: 2. Youth ID: 3. Intake Date: 4. Issues presented by Youth: (Check all that apply) NOTE: A response under each category is not necessary. The responses should reflect the youth's and staff members'perceptions. A. HOUSEHOLD DYNAMICS: D.PSYCHOLOGICAL ISSUES: ❑ Relationship with Father Figure ❑ Relationship with Mother Figure ❑ Youth Depressed ❑ Relationship with Parent Partner ❑ Youth Suicidal ❑ Relationship between Parent Figures Poor Self Image ❑ Youths Sexuality/Behavior with Spouse/Partner ❑ ❑ s Sexual Orientation Relationship with Foster/Group Home Member ❑ Youth ❑ ❑ Parent Figures Sexuality/Behavior Relationship with Other Household Member ❑ Parent Figure's Sexual Orientation ❑ No Parental Figure ❑ Youth Unsupervised ❑ Searching for Biological Parent El Divorced Family ❑ Racial/Ethnic Identity [:] Loss and Grief Issues of Youth 1:1 Blended Family ❑ Abandonment ❑ Youth Wants to Live with Other Parent ❑ Other ❑ Suicidal Friend(s)of Youth ❑ Suicidal Family Member(s) B.HOUSING ISSUES• ❑ Witnessed Violent Crime ❑ Youth Homeless ❑ Crime Victim ❑ Family Homeless ❑ Mental Health Problem of Family Member ❑ Youth Rejected From Homeless Shelter ❑ Other ❑ Custody Change ❑ Chose to Leave Previous Residence E.HEALTH ISSUES• ❑ Forced to Leave Previous Residence ❑ Youth Has/Suspects Sexually Transmitted Disease ❑ Legally Evicted From Previous Residence 0 Youth Has/Suspects HIV/AIDS Infection ❑ Other ❑ Family Planning C. SCHOOL/EDUCATION ISSUES: ❑ Pregnancy ❑ Bad Grades ❑ Eating Disorder ❑ Illiteracy ❑ Youth Physically Challenged ❑ Learning Disability ❑ Youth Not Appropriately Using Medication ❑ Cannot Get Along with Teachers ❑ Health Problem of Family Member ❑ Poor School Attendance/Truancy ❑ Other Chronic Health Problem of Youth ❑ Dropped Out ❑ Other Current Health Problem of Youth ❑ Suspended ❑ Expelled F.YOUTH HAVING TROUBLE GETTING SERVICES: ❑ Other ❑ Child Protective Services ❑ Social Services Q Alcohol and Other Drug Treatment Program ❑ Day Care ❑ Education Program ❑ Other RHY MIS 02-08 Version 3.0 Page 8 of 16 YOUTH PROFILE OMB NO: 0970-0123 PrT : GUTS ISSUES "cant�nued HYSICAL ABUSE/ASSAULT: K SOCIALIZATION ISSUES:(con't) By Father Figure ❑ Violent Youth Behavior ❑ By Mother Figure ❑ Gang Involvement by Youth ❑ By Parent's Partner ❑ Cult Involvement ❑ By Spouse/Partner ❑ Survival Sex ❑ By Foster/Group Home Member ❑ Prostitution ❑ By Other Household Member ❑ Selling Drugs ❑ By Other Non-Household Member ❑ Other ❑ Domestic Violence ❑ Youth Assaulting Other L.NEGLECT: ❑ Other ❑ By Father Figure ❑ By Mother Figure H. SEXUAL ABUSE/ASSAULT: ❑ By Parent's Partner 0 By Father Figure ❑ By Spouse/Partner ❑ By Mother Figure ❑ By Foster/Group Home Member ❑ By Parent's Partner ❑ By Other Household Member ❑ By Spouse/Partner ❑ Youth Neglecting Child ❑ By Foster/Group Home Member ❑ Youth Neglecting Spouse/Partner ❑ By Other Household Member ❑ Other ❑ By Other Non-Household Member ❑ Youth Assaulting Other M.INVOLVEMENT WITH JUSTICE SYSTEM: ❑ Other ❑ Youth Charged with Misdemeanor ❑ Youth Charged with Felony I.EMOTIONAL ABUSE: ❑ Alcohol or Other Drug ❑ By Father Figure Possession/Distribution (Youth) ❑ By Mother Figure ❑ Drug Possession/Distribution(Parent Figure) ❑ Youth on Probation/Suspended Sentence El By Parent's Partner Status Offense ❑ By Spouse/Partner ❑ ❑ By Foster/Group Home Member ❑ Use of Guns/Weapons ❑ Youth on Parole ❑ By Other Household Member ❑ By Other Non-Household Member [3 Youth in Need of Supervision E3 Youth Abusing Household Member Household Member Involvement ❑ Other ❑ Spouse/Partner ❑ Immigration/Naturalization J.ALCOHOL AND OTHER DRUG ABUSE: ❑ Other ❑ Substance Abuse by Household Member N. UNEMPLOYMENT: ❑ Substance Abuse by Spouse/Partner ❑ Father Figure ❑ Substance Abuse by Youth ❑ Other ❑ Mother Figure ❑ Parent's Partner K SOCIALIZATION ISSUES: ❑ Spouse/Partner ❑ Lack of Social Skills ❑ Youth Unemployment ❑ Problem With Peers ❑ Other 5a. Has the youth contemplated suicide? (Circle one) Yes No If Yes: b. Estimate the number of times youth has attempted suicide (Enter zero if none): c. Number of times the youth has been hospitalized after suicide attempts(Enter zero if none): RHY MIS 02-08 Version 3.0 Page 9 of 16 RHY MIS YOUTH PROFILE: oMB: 0970-0123 . FART ASS . SMEl�A A'�ODR FO A'Tl�d1'�T Complete this form at intake for each youth served who has indicated a problem with alcohol, tobacco, or other drugs. 1. Agency ID: 2. Youth ID: 3. Intake Date: 4. On How Many Occasions(if any)Has Youth: NUMBER OF OCCASIONS AGE AT FIRST USE Never 11 or 12- 15- 18 or Tried 1-2 3-9 10-29 30+ younger 14 17 older A) Smoked Cigarettes ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 1) In the youth's lifetime: ❑ ❑ ❑ ❑ ❑ 2) During the past 6 months: B) Used Smokeless Tobacco (chewing tobacco, snuff) ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 1) In the youth's lifetime: ❑ ❑ ❑ ❑ ❑ 2) During the past 6 months: C) Had Beer,Wine(other than for religious use)or Wine Coolers ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 1) In the youth's lifetime: ❑ ❑ ❑ ❑ ❑ 2) During the past 6 months: D) Had Liquor(such as rum, vodka,or whiskey) ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 1) In the youth's lifetime: ❑ ❑ ❑ ❑ ❑ 2) During the past 6 months: E) Had Five or More Servings of any Alcohol on the Same Occasion ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 1) In the youth's lifetime: ❑ ❑ ❑ ❑ ❑ 2) During the past 6 months: F) Used Inhalants(glue,paint, rush,cleaning fluids, gasoline) ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 1) In the youth's lifetime: ❑ ❑ ❑ ❑ ❑ 2) During the past 6 months: G) Used Over-the-Counter Drugs (diet pills,No-Doz,caffeine) Above the Recommended Dosage ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 1) In the youth's lifetime: ❑ ❑ ❑ ❑ ❑ 2) During the past 6 months: RHY MIS 02-08 Version 3.0 Page 10 of 16 RHY MIS YOUTH PROFILE OMB: 0970-0123 .. PART IV ASSESSMENT• AT.* IN 't)RMATION contmr�ed . 5. Has the youth ever used illicit drugs? (Circle one) Yes No If no,skip to question 6. On How Many Occasions(if any)Has the Youth: NUMBER OF OCCASIONS AGE AT FIRST USE Never 11 or 12- 15- 18 or Tried 1-2 3-9 10-29 30+ younger 14 17 older H) Used Marijuana/Hashish 1) In the youth's lifetime: ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 2) During the past 6 months: ❑ ❑ ❑ ❑ ❑ I) Used Cocaine(exclude use of Crack) 1) In the youth's lifetime: ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 2) During the past 6 months: ❑ ❑ ❑ ❑ ❑ J) Smoked Crack Cocaine (rock) 1) In the youth's lifetime: ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ r 2) During the past 6 months: ❑ ❑ ❑ ❑ ❑ w Has the Youth Ever: K) Taken Steroids Yes No P) Used Two or More Drugs Yes No on the Same Occasion L) Taken Stimulants(such as Yes No (exclude alcohol and tobacco) Prescription Diet Pills,Uppers, Speed,ice) Q) Used Alcohol and Yes No Marijuana on the Same M)Taken Depressants(such as Yes No Occasion valium,quaaludes) R) Used a Needle to Inject Yes No N) Taken Narcotice(such as Yes No Cocaine,Heroin,or heroin/smack,codeine, Illicit Drug morphine,dilaudid) O) Taken Hallucinogens(such as Yes No PCP/angel dust,LSD/acid, mescaline,mushrooms,ecstasy) 6. Has the Youth Ever Been Asked to Sell Drugs? (circle one) Yes No 7. Has the Youth Ever Sold Drugs? (circle one) Yes No RHY MIS 02-08 Version 3.0 Page 11 of 16 RHY MIS YOUTH PROFILE olviB NO:0970-0123 ... PART N ASSESSMENTS ATOD INFORMATIONT(+contIuued) 8. How Was the Youth First Influenced to Use: Other Through Never Parent Household Selling Tried Figures Member Friends It Other A) Alcohol ❑ ❑ ❑ ❑ ❑ ❑ B) Drugs ❑ ❑ ❑ ❑ ❑ ❑ 9. Household Members' Substance Use: Drug Use Alcohol Abuse Yes No N/A Yes No N/A A) Mother Figure ❑ ❑ ❑ ❑ ❑ ❑ B) Father Figure ❑ ❑ ❑ ❑ ❑ ❑ Q Spouse/Partner ❑ ❑ ❑ ❑ ❑ ❑ D) Other Significant Person [-1 El ❑ ❑ ❑ ❑ RHY MIS 02-08 Version 3.0 Page 12 of 16 OMB NO: RHY MIS YOUTH PROFILE 0970-0123 PART Y. :SERYICS .TO YOUTH . . Part V, Services to Youth,records information on services provided to youth either directly or through referral while the youth is on active caseload. One form will be completed for each program in which the youth has been admitted. A staff member should complete this form at the youth's exit from each program. 1. Agency ID: 2. Youth ID: 3. Intake Date: 4. Other individuals Participating in Services:PLACE A NUMBER in the Box to indicate the quantity of each person participating in services. FEMALE MALE ❑ Biological Mother ❑ Biological Father ❑ Adoptive Mother ❑ Adoptive Father ❑ Step-Mother ❑ Step-Mother ❑ Foster Mother ❑ Foster Mother ❑ Parent's Partner ❑ Parent's Partner ❑ Youth's Spouse/Partner ❑ Youth's Spouse/Partner ❑ Aunt ❑ Uncle ❑ Grandmother ❑ Grandfather ❑ Sister ❑ Brother ❑ Step/Half-Sister ❑ Step/Half-Brother ❑ Youth's Daughter ❑ Youth's Son ❑ Other Relative ❑ Other Relative ❑ Non-Relative ❑ Non-Relative 5. Primary Method of Payment Services: (Circle One) a. No Charge b. Youth/Youth's Family c. Social Welfare Agency d. Juvenile Justice Agency e. Other RHY MIS 02-08 Version 3.0 Page 13 of 16 OMB NO: RHY MIS YOUTH PROFILE 0970-0123 I'A SiG5'TO Yt�U"1` (contenued) 6. Services Received by Youth: check all that apply. Leave blank if service was not received by the youth. Itis not necessary to provide a response under each category. Categories A and B provide space to record number of hours of service received. Referral Made, Referral Made, This Coordinating Services Status Enter A. Counseling/Therapy Agency Agency Provided Unknown Other Service Hours Crisis Intervention 0 0 0 0 0 Individual(Youth) 0 0 0 0 0 Individual(Parent) 0 0 0 0 0 Family 0 0 0 0 0 Home-Based 0 0 0 0 0 Group(Youth) 0 0 0 0 Group(Parent) 0 [3 0 0 0 Outdoor Adventure/Challenge 0 0 0 0 0 Peer(Youth) 0 0 0 0 0 Expressive/Art 0 0 0 0 0 Mediation 0 0 0 0 0 Other 0 0 0 0 B. Youth Education Assessment 0 0 D D Tutoring D 0 0 O 0 Alternative Education O 0 0 0 0 GED Prep/Test 0 0 0 0 0 Vocational Training 0 0 0 0 0 Other 0 0 0 D 0 C. Life Skills Training Estimated Hours Service: This Referral Made, Referral Made, Agency Coordinating Services Status Formal Informal Agency Provided Unknown Other Communication Skills 0 0 0 0 0 0 Assertiveness D 0 0 D 0 0 Conflict Resolution 0 ID 0 0 D 0 Goal Setting/Life Planning 0 0 0 0 0 0 Budgeting 0 0 0 0 C] 0 Employment 0 0 0 0 Consumerism 0 0 0 0 0 0 Hygiene 0 0 0 0 0 0 Sex Education 0 0 0 0 0 0 Parenting Skills 0 0 0 0 0 0 Nutrition 0 0 0 0 0 0 Leisure Skills 0 0 0 0 0 0 Household Management 0 0 0 0 0 0 Other 0 0 0 D O 0 RHY MIS 02-08 Version 3.0 Page 14 of 16 RHY MIS YOUTH PROFILE 0170103 09700--0123 -' SERVICES TU Y4VTH (conttttte ) 6. Services Received by Youth(Continued): (Check all that apply) Referral Made, Referral Made, This Coordinating Services Status Agency Agency Provided Unknown Other D. Phone Services Crisis Counseling 0 0 0 0 0 Information and Referral 0 0 0 0 0 Advocacy 0 0 0 0 Other 0 0 0 0 E. Basic Support Services Food 0 0 0 0 Clothing 0 0 0 0 0 Emergency Shelter 0 0 0 0 0 Transportation 0 0 0 0 0 Other D D D O 0 F. Health Care General Medical 0 0 0 Dental D D D D D Psychological or Psychiatric 0 0 0 0 0 Substance Abuse Assessment 0 0 0 0 D Alcohol and Other Drug Treatment 0 0 0 0 Eating Disorder 0 0 0 0 Gynecological D D 0 D D Pre-Natal 0 0 0 0 HIV/AIDS Related 0 0 0 0 Other 0 0 0 0 0 G. Alcohol and Other Drug Prevention Education/Information 0 0 Postive Peer Leadership 0 0 0 113 0 Alternative Activities/Recreation 0 0 0 0 0 Refusal Skills 0 0 0 0 Substance Abuse Screening 0 D 0 0 D Other D 0 D H. Alternative Housing Other Youth Shelter 0 0 0 0 0 Foster Home 0 O D 1:3 0 Host Home 0 D D 111 D Group Home 0 0 0 O O Transitional Living Program 0 0 0 0 0 Independent Living Program 0 0 0 0 0 Job Corps(Residential) 0 0 D 0 0 Residential Treatment 0 0 0 0 Other 0 D D 0 D RHY MIS 02-08 Version 3.0 Page 15 of 16 RHY MIS YOUTH PROFILE -'OMB 90: 0970-0123 PART SERYIE$TU YOUTHcont><nered) 6. Services Received by Youth(Continued): (Check all that apply) Referral Made, Referral Made, This Coordinating Services Status Agency Agency Provided Unknown Other L Legal Services To the Youth 0 0 0 0 0 To the Family 0 0 0 O 0 J. Recreational Activities Organized Sports Activities 0 0 0 0 0 Arts and Crafts 0 0 0 0 0 Field Trips 0 0 0 0 0 Other 0 0 0 0 K Support Groups Alcoholics Anonymous 0 0 Narcotics/Cocaine Anonymous 0 0 0 0 0 Alateen 0 0 0 0 0 Alanon 0 C] O 0 0 Spiritual 0 0 0 0 0 Other O O 0 0 L. Employment Career Counseling 0 0 0 0 0 Job Training 0 0 0 0 0 Employability Training 0 0 0 0 0 Employment Referral/Placement 0 0 0 0 0 Job Corps(Non-Residential) Q 0 0 0 0 Other 0 0 0 0 M. Area Services Outreach Services Promotional/Inst.Materials 0 0 0 0 0 Language Assistance Services 0 0 0 0 0 Respite Care O 0 0 0 0 Community Educational Events 0 0 0 0 0 Training/Consultation 0 0 0 0 Other 0 0 0 0 0 RHY MIS 02-08 Version 3.0 Page 16 of 16