HMIS Agency/Program Setup

Agency Legal Name*

Agency Acronym (if applicable)

Point of Contact

One point of contact for the agency involving HMIS work is required, preferably the Executive Director or equivalent.

Name*

Email*

Agency Information

Domestic Violence Agency?*

Yes

No

Unsure

When is HMIS access needed/when would you like to *

CAHP Participation

Coordinated Assessment and Housing Placement (CAHP), represents standardized access and assessment for all individuals experiencing homelessness within the District of Columbia, whether that homelessness includes any combination of emergency shelter, transitional housing or locations outdoors not meant for human habitation. Individuals receive referrals for housing (permanent supportive housing, targeted affordable housing, rapid rehousing, transitional housing, and other housing options) based on acuity of service needs (including medical vulnerability, mental health needs, substance use issues and other risk factors) and length of homelessness. The CAHP system also facilitates connections to services and temporary housing to meet immediate needs, in addition to helping individuals explore housing options outside of the CAHP system when possible.

Is your agency interested in participating in CAHP*

Yes

No

Do you have a contract for providing services to persons experiencing or formerly experiencing homelessness in Washington, DC that include requirements to participate in HMIS? If so, please check which agencies you have this contract with.*

If you have none, please choose "Not Applicable"

Select or enter value

What is your organization's mission? - CAHP*

How many staff provide direct services and/or case management to end clients' experience of homelessness at your agency?*

Do not include staff who will serve as Agency Admin. Per DC HMIS Policies and Procedures, agencies must have at least one staff member to serve as Agency Admin and at least one other staff member eligible to use HMIS.

Do you have at least one staff member dedicated to the HMIS Agency Administrator Role to provide oversight for data entry and quality?*

More information about the Agency Administrator role can be found at: https://community-partnership.org/resource/hmis-agency-administrator-guides-and-videos/

Select or enter value

Do you have at least one staff member dedicated to the CAHP liaison role?*

This individual(s) will serve as the main point of contact for referral and matching processes for your program. This can be the same person as the Agency Administrator.

Select or enter value

Please estimate the number of clients your agency serves per month.*

Please estimate the number of clients experiencing homelessness your agency serves per month.*

Please include clients of all ages, regardless of family or veteran status. To be counted, clients' experience must meet the definition of literal homelessness (i.e., staying outside, in shelter, or in some place not meant for human habitation, such as a car or abandoned building).

Please estimate the number of YOUTH clients experiencing homelessness your agency serves per month.*

To be counted, clients' experience must meet the definition of literal homelessness (i.e., staying outside, in shelter, or in some place not meant for human habitation, such as a car or abandoned building).

Please estimate the number of SINGLE ADULT clients experiencing homelessness your agency serves per month.*

To be counted, clients' experience must meet the definition of literal homelessness (i.e., staying outside, in shelter, or in some place not meant for human habitation, such as a car or abandoned building).

Please estimate the number of VETERAN clients experiencing homelessness your agency serves per month.*

To be counted, clients' experience must meet the definition of literal homelessness (i.e., staying outside, in shelter, or in some place not meant for human habitation, such as a car or abandoned building).

Please estimate the number of FAMILY clients experiencing homelessness your agency serves per month.*

To be counted, clients' experience must meet the definition of literal homelessness (i.e., staying outside, in shelter, or in some place not meant for human habitation, such as a car or abandoned building).

Are you currently using data system(s) to track delivery and use of services?*

Yes

No

In progress

Please select how your organization intends to engage with appropriate CAHP Subsystems:*

Check all that apply

Complete SPDAT assessments. Purpose: to determine client vulnerabilities/receive a recommendation for housing interventions to appropriately address client needs and to help prioritize clients for housing resources through CAHP matching processes

Record service engagements in HMIS. Purpose: to determine which clients are actively engaging the homeless services system and to help prioritize clients for housing resources through CAHP matching processes

Attend CAHP matching meetings. Purpose: to provide information about clients my organization is engaging

Attend CAHP matching meetings. Purpose: to receive referrals to my housing program(s) (transitional housing, rapid rehousing, permanent supportive housing)

Coordinate with appropriate CAHP Coordinators to provide information about clients my organization is engaging offline. Purpose: to prepare the CAHP Coordinator if clients are reviewed during CAHP matching meetings

Coordinate with appropriate CAHP Coordinators regarding vacancies offline. Purpose: to receive referrals to my housing program(s) (transitional housing, rapid rehousing, permanent supportive housing)

Have information about services offered through your organization published on the CAHP website and distributed to other CAHP participating providers. Purpose: to receive direct referrals to any services and programs that accept direct referrals

Any additional information we need to know about your organization's interest in CAHP?

Name of Agency*

If your agency does not appear in this list please contact HMIS@community-partnership.org

Name of Program*

Address of Program (including zip code)*

Type of Address Provided*

Select or enter value

Program's Point of Contact Name*

This is the person we will contact with any questions about the program including but not limited to vacancies, grant information, and CAHP participation.

Program's Point of Contact email address*

Date program began serving clients/will begin service*

Domestic Violence Program?*

Yes

No

Unsure

Population Served*

Select or enter value

Program Type*

Select or enter value

If Federally funded, grant identifier

Grant Start Date*

Availability of shelter*

Select or enter value

Bed Type*

Select or enter value

For single individuals programs, number of beds

For Family programs, number of units

For Family programs, average household size

Housing Type*

Select or enter value

Number of Beds/units for Chronically Homeless Veterans*

Number of beds/units for Youth (18-24) veterans*

Number of beds/units for any other veterans*

Number of beds/units for Chronically Homeless Youth*

Number of beds/units for any other Youth*

Number of beds/units for any other Chronically Homeless people*

Non-dedicated beds/units*