Self-Sufficiency Matrix

AHSSD Unique Identifier:

Domain

Housing

Employment

Income

Food

MM/YY for this administration of the matrix:

1
Homeless or threatened with
eviction.

No job.

No income.
No food or means to prepare it.
Relies to a significant degree on
other sources of free or low-cost
food.
Needs childcare, but none is
available/ accessible and/or
child is not eligible.

2

Household is safe,
adequate, unsubsidized
housing.

Employed full time;
inadequate pay; few or no
benefits.

Employed full time
with adequate pay
and benefits.

Inadequate income and/or
spontaneous or inappropriate
spending.

Can meet basic needs with
subsidy; appropriate
spending.

Can meet basic needs
and manage debt
without assistance.

Can meet basic food needs, but
requires occasional assistance.

Can meet basic food
needs without
assistance.

Maintains permanent
employment with
adequate income and
benefits.
Income is sufficient, well
managed; has
discretionary income
and is able to save.
Can choose to purchase
any food household
desires.

Affordable subsidized
childcare is available, but
limited.

Reliable, affordable
childcare is available,
no need for subsidies.

Able to select quality
childcare of choice.

Enrolled in school, but one or
more children only
occasionally attending
classes.

Enrolled in school and
attending classes most
of the time.

All school-aged children
enrolled and attending
on a regular basis.

Household is on food stamps
(for example, SNAP).

Adult
Education

Life Skills

Family
/Social
Relations

Unable to meet basic needs such
as hygiene, food, activities of
daily living.
Lack of necessary support form
family or friends; abuse (DV,
child) is present or there is child
neglect.

5

Household is in
safe, adequate
subsidized
housing.

Enrolled in literacy and/or
Literacy problems and/or no high GED program and/or has
school diploma/GED are serious sufficient command of
English to where language is
barriers to employment.
not a barrier to employment.

No medical coverage with
immediate need.

4

In stable housing that is
safe but only marginally
adequate.

Children's
Education

Health
Care
Coverage

3

In transitional, temporary or
substandard housing; and/or
current rent/mortgage
payment is unaffordable
(over 30% of income).
Temporary, part-time or
seasonal; inadequate pay, no
benefits.

Childcare is unreliable or
unaffordable, inadequate
supervision is a problem for
childcare that is available.
One or more school-aged children One or more school-aged
not enrolled in school.
children enrolled in school,
but not attending classes.

Child Care

Client consented to sharing
de-identified self-sufficiency
matrix data for the
evaluation: Yes No

Has high school
diploma/GED.

Needs additional
education/training to
improve employment
situation and/or to
resolve literacy
problems to where
they are able to
function effectively in
society.
All members can get
medical care when
needed, but may strain
budget.

No medical coverage and
great difficulty accessing
medical care when needed.
Some household members
may be in poor health.
Can meet a few but not all
needs of daily living without
assistance.

Some members (e.g. Children)
have medical coverage.

Can meet most but not all
daily living needs without
assistance.

Able to meet all basic
needs of daily living
without assistance.

Family/friends may be
supportive, but lack ability or
resources to help; family
members do not relate well
with one another; potential
for abuse or neglect.

Some support from
family/friends; family
members acknowledge and
seek to change negative
behaviors; are learning to
communicate and support.

Strong support
from family or
friends.
Household
members
support each
other’s efforts.

Has completed
education/training
needed to become
employable. No literacy
problems.

All members are
covered by affordable,
adequate health
insurance.
Able to provide beyond
basic needs of daily
living for self and
family.
Has healthy/expanding
support network;
household is stable and
communication is
consistently open.

Participant
Score
(1-5, N/A) goal? (✓)

Domain

Mobility

Community
Involvement
Parenting
Skills

Legal

Mental
Health

Substance
Abuse

Safety

Disabilities
Other:

(Optional)

1

2

3

No access to transportation,
public or private; may have car
that is inoperable.

Transportation is available,
but unreliable, unpredictable,
unaffordable; may have care
but no insurance, license, etc.

Transportation is available and
reliable, but limited and/or
inconvenient; drivers are
licensed and minimally
insured.

Not applicable due to crisis
situation; in “survival” mode.

Socially isolated and/or no
social skills and/or lacks
motivation to become
involved.

Lacks knowledge of ways to
become involved.

There are safety concerns
regarding parenting skills.

Parenting skills are minimal.

Parenting skills are apparent
but not adequate.

Current outstanding tickets or
warrants.

Current charges/trial
pending, noncompliance with
probation/parole.

Fully compliant with
probation/parole terms.

Danger to self or others;
recurring suicidal ideation;
experiencing severe difficulty in
day-to-day life due to
psychological problems.

Recurrent mental health
symptoms that may affect
behavior, but not a danger to
self/others; persistent
problems with functioning
due to mental health
symptoms.

Mild symptoms may be
present but are transient; only
moderate difficulty in
functioning due to mental
health problems.

Meets criteria for severe
abuse/dependence; resulting
problems so severe that
institutional living or
hospitalization may be
necessary.

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.

Home or residence is not safe;
immediate level of lethality is
extremely high; possible CPS
involvement.

Safety is
threatened/temporary
protection is available; level
of lethality is high.

In crisis – acute or chronic
symptoms affecting housing,
employment, social interactions,
etc.
In Crisis

Vulnerable – sometimes or
periodically has acute or
chronic symptoms affecting
housing, employment, social
interactions, etc.
Vulnerable

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.
Current level of safety is
minimally adequate; ongoing
safety planning is essential.
Safe – rarely has acute or
chronic symptoms affecting
housing, employment, social
interactions, etc.
Safe

4
Transportation is
generally accessible to
meet basic travel
needs.
Some community
involvement (advisory
group, support group),
but has barriers such
as transportation,
childcare
issues.
Parenting skills are
adequate.
Has successfully
completed
probation/parole
within past 12
months, no new
charges filed.
Minimal symptoms
that are expectable
responses to life
stressors; only slight
impairment in
functioning.
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.
Environment is safe,
however, future of
such is uncertain;
safety
planning is important.
Building Capacity –
asymptomatic –
condition controlled by
services or medication
Building Capacity

5
Transportation is readily
available and affordable;
car is adequately
insured.

Actively involved in
community.

Parenting skills are well
developed.
No active criminal
justice involvement in
more that 12 months
and/or no felony
criminal history.
Symptoms are absent or
rare; good or superior
functioning in wide
range of activities; no
more than every day
problems or concerns.

No drug use/alcohol
abuse in last 6 months.

Environment is
apparently safe and
stable.

Thriving – no identified
disability.
Empowered

Score
(1-5, N/A)

Participant
goal? (✓)