*If a score is unknown or not applicable, leave it blank.
SELF-SUFFICIENCY MATRIX SCORE
DOMAIN Income
1 No income
Employment No job
Housing
Food
Homeless or threatened with eviction
No food or means to prepare it. Relies to a significant degree on other sources of free or low-cost food
2
3
Can meet basic needs and Income is sufficient, well manage debt without assistance managed; has discretionary income and is able to save
Temporary, part-time or seasonal; inadequate pay, no benefits
Employed full time; inadequate pay; few or no benefits
Employed full time with adequate pay and benefits
In transitional, temporary or substandard housing; and/or current rent/mortgage payment is unaffordable (over 30% of income) Household is on food stamps
In stable housing that is safe but Household is in safe, adequate only marginally adequate subsidized housing
Household is safe, adequate, unsubsidized housing
Can meet basic food needs, but Can meet basic food needs requires occasional assistance without assistance
Can choose to purchase any food household desires
Needs childcare, but none is Childcare is unreliable or available/accessible and/or child unaffordable, inadequate is not eligible supervision is a problem for childcare that is available
Children’s Education
One or more eligible children not All eligible children enrolled in Enrolled in school, but one or enrolled in school school, but one or more children more children only occasionally not attending classes attending classes
Adult Education
Literacy problems and/or no high Enrolled in literacy and/or GED school diploma/GED are serious program and/or has sufficient barriers to employment command of English to where language is not a barrier to employment Current outstanding tickets or warrants or other serious unresolved legal issues
Health Care No medical coverage with immediate need
Life Skills
5
Can meet basic needs with subsidy; appropriate spending
Childcare
Legal
4
Inadequate income and/or spontaneous or inappropriate spending
Affordable subsidized childcare is available, but limited
Maintains permanent employment with adequate income and benefits
Reliable, affordable childcare is Able to select quality childcare available, no need for subsidies of choice
Enrolled in school and attending All eligible children enrolled and classes most of the time attending on a regular basis and making progress
Has high school diploma/GED Needs additional but may also suffer from literacy education/training to improve problems employment situation and/or to resolve literacy problems to where they are able to function effectively in society
Current charges/trial pending; noncompliance with probation/parole; legal issues impacting housing qualifications
Fully compliant with Has successfully completed probation/parole terms; past non- probation/parole within past 12 violent felony convictions; months, no new charges filed; working on plan to resolve other resolved other legal issues legal issues No medical coverage and great Some members (e.g. children) All members can get medical difficulty accessing medical care covered, but adults may lack care when needed, but may when needed. Some household coverage strain budget members may be in poor health
Unable to meet basic needs Can meet a few but not all basic Can meet most but not all basic Able to meet all basic needs of such as hygiene, food, activities needs of daily living without needs of daily living without daily living without assistance of daily living assistance assistance
Has completed education/training needed to become employable. No literacy problems
No active legal issues in more than 12 months and/or no felony/significant legal/criminal history All members are covered by affordable, adequate health insurance
Able to provide beyond basic needs of daily living for self and family
1
*If a score is unknown or not applicable, leave it blank.
SELF-SUFFICIENCY MATRIX SCORE
DOMAIN 1 Mental Health Danger to self or others;
3
4
5
Mild symptoms may be present but are transient; only moderate difficulty in functioning due to mental health problems
Minimal symptoms that are expectable responses to life stressors; only slight impairment in functioning
Symptoms are absent or rare; good or superior functioning in wide range of activities; no more than every day problems or concerns
Use within last 6 months; evidence of persistent or recurrent social, occupational, emotional or physical problems related to use (such as disruptive behavior or housing problems); problems have persisted for at least one month Lack of necessary support from Family/friends may be Some support from family or friends and/or abuse supportive, but lack ability or family/friends; family members (DV, child) is present or there is resources to help; family acknowledge and seek to child neglect members do not relate well with change negative behaviors; are one another; potential for abuse learning to communicate and or neglect support
Client has used during last 6 months, but no evidence of persistent or recurrent social, occupational, emotional, or physical problems related to use; no evidence of recurrent dangerous use
No drug use/alcohol abuse in last 6 months
Strong support from family or friends. Household members support each other’s efforts
Has healthy/expanding support network; household is stable and communication is consistently open
No access to transportation, public or private; may have car that is inoperable
Transportation (including bus) is Transportation is readily generally accessible to meet available and affordable; car is basic travel needs adequately insured
recurring suicidal ideation; experiencing severe difficulty in day-to-day life due to psychological problems
Substance Abuse
Family Relations
Mobility
Meets criteria for severe abuse/dependence; resulting problems so severe that institutional living or hospitalization may be necessary
Community Not applicable due to crisis Involvement situation; in “survival” mode
Safety
Home or residence is not safe, lethality is high
Parenting Skills
Parenting skills are lacking and there is no extended family support
2 Recurrent mental health symptoms that may affect behavior, but not a danger to self/others; persistent problems with functioning due to mental health symptoms
Meets criteria for dependence; preoccupation with use and/or obtaining drugs/alcohol; withdrawal or withdrawal avoidance behaviors evident; use results in avoidance or neglect of essential life activities
Transportation is available (including bus), but unreliable, unpredictable, unaffordable; may have car but no insurance, license, etc.
Transportation is available (including bus) and reliable, but limited and/or inconvenient; drivers are licensed and minimally insured
Socially isolated and/or no social Lacks knowledge of ways to skills and/or lacks motivation to become involved or new to become involved community
Safety is threatened, temporary protection is available, lethality is high Parenting skills are minimal and there is limited extended family support
Some community involvement Actively involved in community (church, advisory group, support group), but has barriers such as transportation, childcare issues
Safety is minimally adequate, safety planning is essential
Home is safe, however, future is Home is apparently safe and uncertain, safety planning is stable important Parenting skills are apparent but Parenting skills are adequate Parenting skills are well not adequate developed
2
