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CT HMIS Reporting Demo CoC - PATH(1169) CONNECTICUT
Provider For FY Beginning: For FY Ending: CT HMIS Reporting Demo CoC - PATH(1169) 1/1/12 6/12/12

Date Report Ran: 6/17/12

Table B: Persons Served

Responses B1. B2a. B2b. B2c. B2d. B3. B4. Persons Who are Homeless and have Serious Mental Illnesses Served by Federal and Matching PATH Funds and Other Sources. Persons Served by Federal PATH Funds -- Outreach Number of Outreach Contacts who Became Enrolled During the Year as PATH Clients Number of Outreach Contacts who Do Not Become Enrolled During the Year as PATH Clients. Number of Outreach Contacts (in Item B2c above) Not Enrolled Because They Have Been Found to be Ineligible: Persons Served by Federal PATH Funds -- Enrolled PATH Clients. Total Number of Persons Receiving Any Federal PATH-Supported Services During the Year. (Sum of b2c and B3) 2 2 1 1 1 1 2

Table C: Available Services

Key to Service Type: Key to Service Type: 1 = 100% PATH Funded 2 = Partially PATH-Funded 3 = Service Provided but not PATH-Funded 4 = Service Not Provided
Responses Ca. Ca1. Cb. Cb1. Cc. Cc1. Cd. Cd1. Ce. Ce1. Cf. Cf1. Cg. Outreach services: Number of Enrolled PATH Clients served by PATH-Funded Service. Screening and diagnostic treatment services: Number of Enrolled PATH Clients served by PATH-Funded Service. Habilitation and rehabilitation services: Number of Enrolled PATH Clients served by PATH-Funded Service. Community mental health services: Number of Enrolled PATH Clients served by PATH-Funded Service. Alcohol or drug treatment services: Number of Enrolled PATH Clients served by PATH-Funded Service. Staff training, including the training of individuals who work in shelters, MH clinics, SA programs, and other sites: Number of Enrolled PATH Clients served by PATH-Funded Service. Case management services: 4 0 4 0 4 0 4 0 4 0 4 0 4

Cg. Cg1. Ch. Ch1. Ci. Ci1. Cj. Cj1. Cj2. Cj21. Cj3. Cj31. Cj4. Cj41. Cj5. Cj51. Cj6. Cj61. Cj7. Cj71.

Case management services:

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4 0 4 0 4 0 4 0 4 0 4 0 4 0 4 0 4 0 4 0

Number of Enrolled PATH Clients served by PATH-Funded Service. Supportive and supervisory services in residential settings: Number of Enrolled PATH Clients served by PATH-Funded Service. Referrals for primary health services, job training, educational services, and relevant housing services: Number of Enrolled PATH Clients served by PATH-Funded Service. Housing services: 1. Minor renovation, expansion, and repair of housing: Number of Enrolled PATH Clients served by PATH-Funded Service. Housing services: 2. Planning of housing: Number of Enrolled PATH Clients served by PATH-Funded Service. Housing services: 3. The costs associated with matching eligible homeless individuals with appropriate housing situations: Number of Enrolled PATH Clients served by PATH-Funded Service. Housing services: 4. Technical assistance in applying for housing assistance: Number of Enrolled PATH Clients served by PATH-Funded Service. Housing services: 5. Improving the coordination of housing services: Number of Enrolled PATH Clients served by PATH-Funded Service. Housing services: 6. Security deposits: Number of Enrolled PATH Clients served by PATH-Funded Service. Housing services: 7. One-time rental payments to prevent eviction: Number of Enrolled PATH Clients served by PATH-Funded Service.

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Voluntary Outcome Measures
Voluntary Outcome Measure: 1. Housing (transitional, supportive, or permanent): CK1a. CK1b. Assisted Actual Voluntary Outcome Measure: 2. Income benefits: Ck2a. Ck2b. Assisted Actual Voluntary Outcome Measure: 3. Earned income (employment): Ck3a. Ck3b. Assisted Actual Voluntary Outcome Measure: 4. Medical insurance or coverage plans (Medicaid, Medicare, and/or state/local plans): Assisted Actual Voluntary Outcome Measure: 5. Primary medical care: Ck5a. Ck5b. Assisted Actual 1 1 0 0 1 1 0 0

Ck4a. Ck4b.

1 1

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Table D: Demographics
D1ea. Numbers Reported are Actual Less than 13 years: 13-17 years: 18-34 years: 35-49 years: 50-64 years: 65-74 years: 75 years and older: Unknown: 0 0 0 1 0 0 0 0

Unduplicated Count (All) D1a. D1b. D1c. D1d. D1e. D1f. D1g. D1h. D2ea.

Gender: Numbers Reported are - Actual D2a. D2b. D2c. Male Female Unknown 1 0 0

D3ea.

Race / Tehnicity: Numbers Reported are Actual D3a. D3b. D3c. D3d. D3e. D3f. D3g. D3h. American Indian or Alaska Native Asian Black or African American Hispanic or Latino Native Hawaiian or Other Pacific Islander White Two or More Races Unknown 0 1 1 0 0 0 0 0

D4ea.

Principal Mental Illness Diagnosis: Numbers Reported are Actual D4a. D4b. D4c. D4d. D4e. D4f. Schizophrenia and Related Disorders Other Psychotic Disorders Affective Disorders Personality Disorders Other Serious Mental Illness Unknown or Undiagnosed Mental Illness 0 0 0 1 0 0

D5ea.

Co-occurring Substance Use Disorders: Numbers Reported are - Actual D5a. D5b. D5c. Co-Occurring Substance Use Disorders No Co-Occurring Substance Use Disorders Unknown If Substance Use Disorder 1 0 0

D6ea.

Veteran Status: Numbers Reported are Actual D6a. D6b. D6c. Veteran Non-Veteran Unknown 0 1 0

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D6c. D7ea. Unknown 0 Housing Status (at first contact): Numbers Reported are Actual Outdoors (e.g., street, abandoned or D7a. public building, automobile) 0 D7b. D7c. D7d. D7e. D7f. D7g. D7h. D7i. Short term shelter Long term shelter. Own or someone else's apartment, room, or house Hotel, SRO, boarding house Halfway house, residential treatment program Institution (psychiatric or other hospital, nursing home, etc.) Jail or correctional facility Other 0 0 0 0 0 0 0 0

D8ea.

D7j. Unknown 0 Length of Time Living Outdoors or in Short Term Shelter at First Contact: Numbers Reported are Actual D8a. D8b. D8c. D8d. D8e. D8f. Less than 2 days Two to 30 days 31-90 days 91 days to 1 year Over 1 year Unknown 0 0 1 0 0 0

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Needs Review? X X X X X X OK Reason for ineligbility? X X X X X Ineligible X Age at Entry OK OK OK OK OK OK OK Homeless ness Status OK X X X X X OK Length outdoors / shelter OK OK OK OK OK OK OK Has co-occur ring OK OK OK OK OK OK OK Principal MI OK OK OK OK OK OK OK

Client ID 37319 184232 184234 184235 184980 184981 184982

Is Elligible? X Eligible Eligible X X Ineligible Eligible

Entry ID 232653 237878 240643 237884 240651 240652 240656

Entry Date 4/10/12 5/23/12 1/12/12 4/23/12 6/1/12 3/1/12 6/1/12

Exit Date Ongoing 6/23/12 Ongoing 6/12/12 6/12/12 3/1/12 Ongoing

Gender OK OK X OK X OK OK

Veteran OK OK OK OK OK OK OK

P. Race OK OK X OK X OK OK

S. Race OK OK None None None None None

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Comments: Only clients with correct Housing/Homeless Status, Path Enrollment and a Path Type program entry are listed below. Services Voluntary Outcomes

Client ID 184982

Ca No

Cb No

Cc No

Cd No

Ce No

Cf No

Cg No

Ch No

Ci No

Cj1 No

Cj2 No

Cj3 No

Cj4 No

Cj5 No

Cj6 No

Cj7 No

Ck1a Ck1b Ck2a Ck2b Ck3a Ck3b Ck4a Ck4b Ck5a Ck5b No No Yes Yes No No Yes Yes Yes Yes