Are you worried that the place you are living now is making you sick? (has mold, bugs/rodents, water leaks, not enough heat) |
Housing quality |
Are you worried that in the next 2 months, you may not have a safe or stable place to live? (eviction, being kicked out, homelessness) |
Housing instability |
In the last 12 months, did you worry that your food could run out before you got money to buy more? |
Food insecurity |
In the last 12 months, has lack of transportation kept you from medical appointments or getting your medications? |
Health travel |
In the last 12 months, did you have to skip buying medications or going to doctor’s appointments to save money? |
Health cost |
In the past 12 months, has the electric, gas, oil, or water company threatened to shut off services to your home? |
Utilities cost |
Are you finding it hard to get along with a partner, spouse, or family members? |
Getting along |
Do you need help getting child care or care for an elderly or sick adult? |
Care need |
Do you need legal help? (child/family services, immigration, housing discrimination, domestic issues, etc)? |
Legal |
Does anyone in your life hurt you, threaten you, frighten you or make you feel unsafe? |
Interpersonal violence |