Baseline - U-turn

Baseline - U-turn

Baseline captured on

Interviewer name

Who captured the baseline?

Location of Interview

Organisation/ Service Provider

Program

Client Name

Does the client currently have an ID document?

1a. Where did you sleep last night?

Street address / local landmark

City

Suburb

Other Suburb

1b. What type of accommodation did you sleep in last night?

Primary accommodation

Name of Shelter

other accommodation

1c. Where were you sleeping before you came to the area?

Previous Street address/ Landmark

(If applicable)

1d. Where did you live before you became a rough sleeper?

Suburb originally from

2a. How long have you been a rough sleeper?

Time spent living on the street

When was the first night that you spent on the street?

3a. Before you moved to the streets the FIRST time did you stay in an institution?

3b. Before you moved to the streets this CURRENT time did you stay in an institution?

Institution before current on streets?

4. Why did you move to the streets the FIRST time?

Tick all that apply

Poverty

Left looking for work or other opportunities

Violence at home

Substance use at home

Neglect / lack of support

Breakdown of relationship

Family lost home we were staying in

Discharged from an institution

Other (specify)

Specify other reason why moved to streets the first time

5. Why do you remain on the streets?

Tick all that apply

No family support/Parents died

Substance use

Gangsterism

Came out of prison with nowhere to go

Lost house/ Repossessed

I have nowhere to go

Behavioural health / mental health issue

Unemployed / lost job / no income

I can't leave my child/ partner on the streets

I feel people I live with now are my family

Living on Street by Choice

Other (Please specify)

Please specify other reason, why living on the streets

6. What are your main sources of income

Tick all that apply

AD hoc employment

Donations at traffic light

Employment (full/part-time)

NGOs or EPWP

Friends/family

Income from tourists

Government grant

Income from residents or households

Park Cars

Recycling

Selling drugs

Sex Worker

Other sources of income

Other main source of income

7a. Have you been assisted previously to leave rough sleeping but ended up back on the streets?

If yes, what support did you receive? [Tick all that apply]

Daytime services / service centre

Safe space placement

Shelter placement

In-patient rehab programme

Bus ticket home

Family reunification

Psychiatric institution

Work programme

Other (specify)

Other previous assistance

8. What is your highest level of education?

Prompt: what is the last standard/ grade you passed in school?

9. Would you like any assistance to leave the streets?

Would like assistance to leave strreets

If yes, what assistance do you need?

Other Assistance

Confidentiality Statement Signed

Any other relevant information given

Recommended next steps?

U-turn Contact Id

On submission, a U-turn Baseline and a Service Delivery is created for the Programme you selected above