NEWPORT CITY COUNCIL

HOUSING SUPPORT OUTCOMES QUESTIONNAIRE 2022/2023

To be completed for ALL service users when support starts, support is reviewed and when support ends

Scheme Information

Q1	Support Provider and scheme name - please select one from the list below

Q2	Length of time support is provided in this service

Q3	Type of scheme

Service User Information

Q4	Service user reference code - first 3 letters of surname, date of birth and gender with no separators (/), e.g. smi010103m

Q5	Main support need

Q6	Second support need

Q7	Third support need

Please select which Outcomes information you are completing for your service user for this 6 month collection period:

Start outcomes

Review outcomes

End outcomes

Q9	Date support started (dd/mm/yy) (Required even if this submission is for review or end of support)

Q10	Review date (must be between 01/04/22 and 31/03/23)

Q11	Date support ended (must be between 01/04/22 and 31/03/23)

Outcomes

Promoting Personal and Community Safety

Q13

Have any of the following prevented progression for the service user

Barriers

Beyond the control of the provider

Non-engagement

Provider unable to meet needs/risk

Still working towards support outcomes

Q15

Have any of the following prevented progression for the service user

Barriers

Beyond the control of the provider

Non-engagement

Provider unable to meet needs/risk

Still working towards support outcomes

Promoting Independence and Control

Q17

Have any of the following prevented progression for the service user

Barriers

Beyond the control of the provider

Non-engagement

Provider unable to meet needs/risk

Still working towards support outcomes

Q19

Have any of the following prevented progression for the service user

Barriers

Beyond the control of the provider

Non-engagement

Provider unable to meet needs/risk

Still working towards support outcomes

Q21

Have any of the following prevented progression for the service user

Barriers

Beyond the control of the provider

Non-engagement

Provider unable to meet needs/risk

Still working towards support outcomes

Promoting Economic Progress and Financial Control

Q23

Have any of the following prevented progression for the service user

Barriers

Beyond the control of the provider

Non-engagement

Provider unable to meet needs/risk

Still working towards support outcomes

Q25

Have any of the following prevented progression for the service user

Barriers

Beyond the control of the provider

Non-engagement

Provider unable to meet needs/risk

Still working towards support outcomes

Q27

Have any of the following prevented progression for the service user

Barriers

Beyond the control of the provider

Non-engagement

Provider unable to meet needs/risk

Still working towards support outcomes

Promoting Health and Wellbeing

Q29

Have any of the following prevented progression for the service user

Barriers

Beyond the control of the provider

Non-engagement

Provider unable to meet needs/risk

Still working towards support outcomes

Q31

Have any of the following prevented progression for the service user

Barriers

Beyond the control of the provider

Non-engagement

Provider unable to meet needs/risk

Still working towards support outcomes

Q33

Have any of the following prevented progression for the service user

Barriers

Beyond the control of the provider

Non-engagement

Provider unable to meet needs/risk

Still working towards support outcomes

End of Support Information

Q34

Was support ending planned?

Yes

Q35	Reason for support ending

	For "other" reason, please specify

Homelessness Status

Q36

Homelessness status at start of support

Homeless

At threat of homelessness within 56 days

In interim accommodation

Need support to remain in own home

Q37

Homelessness status at end of support

Maintaining stable accommodation independently (6 months+)

Need support to remain in own home

In interim accommodation

At threat of homelessness within 56 days

Homeless

Completion Details

Q38	Name of person completing questionnaire

Q39	Email address

Q40	Date of submission (today's date) (dd/mm/yyyy)