NEWPORT CITY COUNCIL

SUPPORTING PEOPLE OUTCOMES QUESTIONNAIRE 2019

To be completed for ALL service users at start of support, at review of support and at end of support

Scheme Information

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

2.	Length of time support is provided in this service

3.	Type of scheme

Service User Information

4.	Service user reference code - first 3 letters of surname, date of birth and gender with no separators (/), e.g. smi010190m

5.	Main support need

6.	Second support need

7.	Third support need

Please select which Outcomes information you are completing for a service user - start, review or end:

Started support this collection period

Is being reviewed during this collection period

Ended support this collection period

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

10.	Review date (must be between 01/01/19 and 31/12/19)

11.	Date support ended (must be between 01/01/19 and 31/12/19)

OUTCOMES

Promoting Personal and Community Safety

13.

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

14.

Outcome 2: Contributing to the safety and well-being of themselves and of others

Not relevant to service user

step 1

step 2

step 3

step 4

step 5

15.

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

16.

Outcome 3: Managing accommodation

Not relevant to service user

step 1

step 2

step 3

step 4

step 5

17.

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

18.

Outcome 4: Managing relationships

Not relevant to service user

step 1

step 2

step 3

step 4

step 5

19.

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

20.

Outcome 5: Feeling part of the community

Not relevant to service user

step 1

step 2

step 3

step 4

step 5

21.

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

23.

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

24.

Outcome 7: Engaging in education/learning

Not relevant to service user

step 1

step 2

step 3

step 4

step 5

25.

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

26.

Outcome 8: Engaged in employment/voluntary work

Not relevant to service user

step 1

step 2

step 3

step 4

step 5

27.

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

28.

Outcome 9: Physically healthy

Not relevant to service user

step 1

step 2

step 3

step 4

step 5

29.

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

31.

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

32.

Outcome 11: Leading a healthy and active lifestyle

Not relevant to service user

step 1

step 2

step 3

step 4

step 5

33.

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

34.

Was support ending planned?

Yes

35.	Reason for support ending

	For "other" reason, please specify

Homelessness Status

36.

Homelessness status at start of support

Homeless

At threat of homelessness within 56 days

In interim accommodation

Need support to remain in own home

37.

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

38.	Name of person completing questionnaire

39.	Date of completion (dd/mm/yy)