Self-Sufficiency Matrix

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

AHSSD Unique Identifier:__________________ MM/YY for this administration of the matrix:__________________________

Domain

1

2

3

4

5

Homeless or threatened with
eviction.

In transitional, temporary or
substandard housing; and/or
current rent/mortgage
payment is unaffordable
(over 30% of income).

In stable housing that is
safe but only marginally
adequate.

Household is in safe,
adequate subsidized
housing.

No job.

Temporary, part-time or
seasonal; inadequate pay, no
benefits.

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

Employed full time with
adequate pay and
benefits.

No income.

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.

No food or means to prepare it.
Relies to a significant degree on
other sources of free or low-cost
food.

Household is on food stamps.

Can meet basic food needs,
but requires occasional
assistance.

Can meet basic food needs
without assistance.

Can choose to purchase
any food household
desires.

Child Care

Needs childcare, but none is
available/accessible and/or
child is not eligible.

Childcare is unreliable or
unaffordable, inadequate
supervision is a problem for
childcare that is available.

Affordable subsidized
childcare is available, but
limited.

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

Able to select quality
childcare of choice.

Children's
Education

One or more school-aged
children not enrolled in school.

One or more school-aged
children enrolled in school,
but not attending classes.

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.

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

Housing

Employment

Income

Food

Household is safe,
adequate, unsubsidized
housing.
Maintains permanent
employment with
adequate income and
benefits.
Income is sufficient, well
managed; has
discretionary income
and is able to save.

Literacy problems and/or no
high school diploma/GED are
serious barriers to employment.

Enrolled in literacy and/or
GED program and/or has
sufficient command of
English to where language is
not a barrier to employment.

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.

No medical coverage with
immediate need.

No medical coverage and
great difficulty accessing
medical care when needed.
Some household members
may be in poor health.

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

All members can get
medical care when
needed, but may strain
budget.

All members are
covered by affordable,
adequate health
insurance.

Life Skills

Unable to meet basic needs
such as hygiene, food, activities
of daily living.

Can meet a few but not all
needs of daily living without
assistance.

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

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

Able to provide beyond
basic needs of daily
living for self and
family.

Family /Social
Relations

Lack of necessary support form
family or friends; abuse (DV,
child) is present or there is
child neglect.

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 healthy/expanding
support network;
household is stable and
communication is
consistently open.

Adult
Education

Health Care
Coverage

Score

Participant
goal? (


)

Domain

1

2

3

4

5

Mobility

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.

Transportation is
generally accessible to
meet basic travel needs.

Transportation is readily
available and affordable;
car is adequately
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.

Some community
involvement (advisory
group, support group),
but has barriers such as
transportation, childcare
issues.

Actively involved in
community.

There are safety concerns
regarding parenting skills.

Parenting skills are minimal.

Parenting skills are apparent
but not adequate.

Parenting skills are
adequate.

Parenting skills are well
developed.

Current outstanding tickets or
warrants.

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

Fully compliant with
probation/parole terms.

Has successfully
completed
probation/parole within
past 12 months, no new
charges filed.

No active criminal
justice involvement in
more that 12 months
and/or no felony
criminal history.

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.

Minimal symptoms that
are expectable responses
to life stressors; only
slight impairment in
functioning.

Symptoms are absent or
rare; good or superior
functioning in wide
range of activities; no
more than every day
problems or concerns.

Substance
Abuse

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.

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.

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.

No drug use/alcohol
abuse in last 6 months.

Safety

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

Current level of safety is
minimally adequate; ongoing
safety planning is essential.

Environment is safe,
however, future of such
is uncertain; safety
planning is important.

Environment is
apparently safe and
stable.

Safe – rarely has acute or
chronic symptoms affecting
housing, employment, social
interactions, etc.

Building Capacity –
asymptomatic –
condition controlled by
services or medication

Thriving – no identified
disability.

Community
Involvement
Parenting
Skills
Legal

Mental
Health

Disabilities

Other:
(Optional)

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

Safety is
threatened/temporary
protection is available; level
of lethality is high.
Vulnerable – sometimes or
periodically has acute or
chronic symptoms affecting
housing, employment, social
interactions, etc.
Vulnerable

Safe

Building Capacity

Empowered

Score

Participant
goal? (


)