Study participants baseline interview

SHIPS
Page 1

Baseline Interview: Housing History
Record ID.

__________________________________

Baseline Interview: Housing History
(Please repeat the reminder below if it has not been provided during this interview session.)
Reminder about resources to help you cope with distress.  
When you enrolled in this study, you were provided with a list of resources to help you cope
with negative feelings and reactions to these interviews.  These resources can also help you
with other problems in your life not related to the study.
If you do not remember receiving this information, we will provide it to you immediately
following this interview.
Interview prompt:
"Now I'll ask you a few questions about where you've lived."
Think about your whole life. Which of these places
have you ever stayed in?

How old were you the first time you stayed in one of
the places you selected?
If you added up all of the time in your life that you
have lived in the places selected in (1), is it more
than a year?
How many years?

How many months?

05/01/2024 12:09pm

Temporary or emergency shelter
Outside on the street, park, or beach
Abandoned building
Garage or shed not meant for living in.
Indoor public place (all-night theater,
restaurant, train/bus station)
Car, truck, van, or RV
Bus, subway, or train
None of these
(Select all that apply.)

__________________________________
Yes
No

__________________________________
(including fractions of years)

__________________________________
(Enter number from 0 to 12.)

projectredcap.org

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Where were you living immediately before living in
PATH permanent supportive housing?

Temporary or emergency shelter
Outside on the street, park, or beach
Abandoned building
Garage or shed not meant for living in.
Indoor public place (all-night theater,
restaurant, train/bus station)
Car, truck, van, or RV
Bus, subway, or train
None of these
(Select all that apply.)

Current Housing
Have you lived in PATH permanent supportive housing
for more than a year?
How many years?

How many months?

Are you currently living in your supportive housing
unit?

Yes
No

__________________________________
(including fractions of years)

__________________________________
(Enter number from 0 to 12.)
Yes
No
Prefer not to answer

Since you first moved into housing with PATH, please
indicate any other place you have slept for at least
one night:

Someone else's apartment or home
In a shelter, emergency, temporary housing
Hotel/motel provided by an agency
Outside on the street, park, or beach
Tent or makeshift shelter
In a bus station, train station, airport
Abandoned building
In a vehicle (car, van, RV, truck)
An institution, hospital, or facility
None of these
(Select all the apply.)

What type of institution, hospital, or facility did
you stay in?

Hospital
Substance abuse treatment, detox, or recovery
center/rehab
Jail, prison, or juvenile detention facility
Foster home or group home
Long-term care facility, nursing home, or Board
and Care
(Select all that apply.)

If you stayed in more than one place, where did you
stay the most?

05/01/2024 12:09pm

I did not stay in more than one place
Someone else's apartment or home
In a shelter, emergency, temporary housing,
Hotel/motel provided by an agency
Outside on the street, park, or beach
Tent or makeshift shelter
In a bus station, train station, airport
Abandoned building
In a vehicle (car, van, RV, truck)
An institution, hospital, or facility

projectredcap.org