4B_ Individualized Housing Stabilization Plan
To Be Completed By:
Navigator
When Completed:
Day 5 of Shelter
Client Name (First, MI, Last)
Goal No.
Linked to Treatment Recommendation No.
1
☐
Start Date
Target Completion Date
DA
☐
DA Update
☐
1
Client CSP No.
Date Plan Initiated
Psychiatric Evaluation
☐ Other: Intake Packet for
Housing
from form dated
☐
Crisis Intervention Plan
Adjusted Target Date
Reason for Adjustment
State Goal Below in Collaboration with Client
Obtain housing and address factors that threaten housing stability, and address any lifestyle issues in order promote long-term housing stability.
Desired Results in Client’s Words
“ client’s own words here”
Client has reviewed?
☐
☐
Yes
No
Client agrees?
☐
☐
Yes
No
Client Initials
Strengths and How They Will be Used to Meet this Goal
Client is motivated to complete housing applications, motivated and willing to work with Navigator Program to secure housing.
Skills/Knowledge Needed
Knowledge of benefits issues that threaten housing stability; gather community resources needed to maintain housing.
Natural/Community Supports Needed
Community resources and referrals for funding for housing, affordable housing unit, support services to maintain independent housing.
Objective
No. 1
Start Date
Secure income to support housing unit; Find and obtain an affordable housing unit and facilitate transition from
homeless shelter to independent housing; Complete all needed referrals for services to address barriers that will
impede independent housing which includes management of mental health symptoms.
Anticipated Duration
Housing Obtainment Interventions
Specify
Frequency
Person or Agency
Responsible
Target Date
Completion Date
Complete intake and with Navigator Program staff, establish
prioritized needs to address barriers to access housing, complete all
activities needed for ongoing process to obtain housing.
Complete Individualized Housing Stabilization Plan with Navigator
Program and obtain necessary transportation, support group
meetings, leisure opportunities and or other community resources.
If indicate, follow-up with Mental Health Referral and complete
Diagnostic mental health assessment and any/all other mental
health services needed including health assessment, medication
evaluation by psychiatrist, compliance with all prescribed
medications and attendance of all follow up appointments and
individual counseling.
Objective
No. 2
Connect client with resources to promote long-term housing stability, Address benefits issues that threaten housing
stability; gather community resources needed to maintain housing.
Start Date
Anticipate Duration
Client Agrees To:
Complete intake and application process with Navigator Program Staff, attend all appointments, and follow up with all referrals made by Navigator
Program Listed Below:
Specify
Person or Agency
Housing Stabilization Interventions
Target Date
Completion Date
Frequency
Responsible
Signature Section
Page 1 of 2
Release Date: April 1, 2015
4B_ Individualized Housing Stabilization Plan
To Be Completed By:
Navigator
When Completed:
Day 5 of Shelter
Client Signature
Was client provided copy of Individualized Service Plan?
☐ Yes, client received copy.
☐ No, client did not want copy.
Date
Client Initials to Confirm
Parent/Guardian Signature (if applicable)
Date
Provider Signature/Credentials
Date
Supervisor Signature/Credentials (if applicable)
Date
Page 2 of 2
Release Date: April 1, 2015