QUESTIONS Prescreen If YES to question 14 or NO to questions 15 or 16, score 1. YES NO REFUSED Score 14. Is there anybody that thinks you owe them money?    15. Do you have any money coming in on a regular basis, like a job or government    benefit or even working under the table, binning or bottle collecting, sex work, odd jobs, day labor, or anything like that? 16. Do you have enough to meet all of your expenses on a monthly basis?    Prescreen If NO to question 17, score 1. YES NO REFUSED Score 17. Do you have planned activities each day other than just surviving that bring you    happiness and fulfillment? Prescreen If YES to questions 18 or 19, score 1. YES NO REFUSED Score 18. Do you have any friends, family or other people in your life out of convenience or    necessity, but you do not like their company? 19. Do any friends, family or other people in your life ever take your money, borrow    cigarettes, use your drugs, drink your alcohol, or get you to do things you really don’t want to do? YES NO Prescreen OBSERVE ONLY. DO NOT ASK! If YES, score 1.   20. Surveyor, do you detect of poor hygiene or daily living skills? SOCIALIZATION & DAILY FUNCTIONS SUBTOTAL
QUESTIONS If YES to question 14 or NO to questions 15 or 16, score 1. YES NO REFUSED Prescreen Score 14. Is there anybody that thinks you owe them money?    15. Do you have any money coming in on a regular basis, like a job or government benefit or even working under the table, binning or bottle collecting, sex work, odd jobs, day labor, or anything like that?    16. Do you have enough to meet all of your expenses on a monthly basis?    If NO to question 17, score 1. YES NO REFUSED Prescreen Score 17. Do you have planned activities each day other than just surviving that bring you happiness and fulfillment?    If YES to questions 18 or 19, score 1. YES NO REFUSED Prescreen Score 18. Do you have any friends, family or other people in your life out of convenience or necessity, but you do not like their company?    19. Do any friends, family or other people in your life ever take your money, borrow cigarettes, use your drugs, drink your alcohol, or get you to do things you really don’t want to do?    OBSERVE ONLY. DO NOT ASK! If YES, score 1. YES NO Prescreen 20. Surveyor, do you detect of poor hygiene or daily living skills?   SOCIALIZATION & DAILY FUNCTIONS SUBTOTAL
Vi-Spdat-for-single-adults.docx