Supporting People Gwent Needs Mapping Exercise (GNME) Form - April 2017 to March 2018

This questionnaire is used to help plan housing-related support services for vulnerable people in Gwent and for equality monitoring purposes. If you have completed a GNME form before you do not need to complete one again unless your support needs have changed.  Please note, this is not an application for services and will not be used to meet individual needs.

Initial information

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Your details

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Homelessness

10. Are you homeless now?
 
11. Are you threatened with homelessness?
 
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13. If you are homeless or threatened with homelessness, please give reason(s) why:
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14. Access to Health Services: if you are homeless and are NOT registered with any of the following, please indicate the services you need
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15. If you were in hospital in last 12 months, did housing or support needs delay your discharge?
 

Support and Housing

There may be a number of reasons that you need support. Please select your first (most important), second (if applicable) and third (if applicable) areas of support from the drop down lists below.

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19. Do you currently have: (select any that apply)
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21. What type of accommodation do you want/think you'll need in the future? (please select only one)
 
 
 
 
 
 
 
 
 
22. Please tell us about any support you are currently receiving, or feel you need, to help you obtain accommodation or remain living in your home:
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  Help with feeling safe (e.g. developing routines that improve safety; accessing community alarms or warden services)    
  Help with contributing to the safety/well-being of self and others (e.g. reducing anti-social behaviour;  identifying problems with alcohol or drug use)    
  Support to manage accommodation (e.g. help with the homelessness process; understanding of tenancy agreements/meeting tenancy obligations)    
  Support to manage relationships (e.g. establishing contact and building relationships with other people; accessing mediation/advocacy services)    
  Help to feel part of the community (e.g. developing hobbies/interests and improved life skills; improving self-confidence in social settings)    
  Support to manage money (e.g. accessing benefits/debt or other advice; making regular bill payments or setting up direct debits)    
  Help to engage in education/learning (e.g. identifying educational aspirations and career plans; accessing services that provide skills training to improve literacy and numeracy)    
  Support to engage in employment/voluntary work (e.g. accessing work experience or volunteering advice; developing a CV/preparing for work)    
  Help to be physically healthy (e.g. managing health conditions in line with specialist advice; accessing mobility equipment, aids and adaptations)    
  Support with mental health (e.g. managing mental health conditions in line with specialist advice; accessing relevant support groups/organisations)    
  Help with leading a healthy and active lifestyle (e.g. shopping for/ planning and preparing meals independently; accessing leisure/fitness services/facilities)    
23. Please select any diagnosed mental health issues you have:
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24. How long do you think you need support for?
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Equality Monitoring (completion of this section is optional)

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