Shelter/Transitional Housing by educaredc_1

DC’s First Stabilization Center

Location: 35 K Street NE | Hours of Operation: Walk-in available 24-7

What is it?

The Stabilization Center provides emergency crisis intervention, typically lasting 24–72 hours, for those experiencing substance use disorder. Services are provided to those who are 18 years and older and are free of charge with no insurance or residency requirements necessary.

The DC Stabilization Center offers:

Specialty care:

• Patients receive an individualized treatment plan based on an initial observation

• The center offers approved medication (buprenorphine) on the spot which, when combined with counseling, is effective in the treatment of opioid use disorders and can help some people sustain recovery

Empathetic care:

• Peer specialists trained in cultural competency work one-on-one with patients to navigate their recovery and refer them to appropriate long-term treatment options

• No one is ever turned away from services and services are provided in English and Spanish to support a wider group of individuals

• A team of on-site multidisciplinary care providers such as nurse practitioners, registered nurses, certified peers, recovery coaches, and patient care technicians will link the patient to resources that can help sustain their health after discharge, such as housing assistance, help with filling out paperwork, or help with reinstating insurance

A safe space and environment to recover:

• The facility features recliners or patient beds in a comfortable, quiet, private setting to begin the stabilization process

• Patients can lock personal items in a secure locker during the intake process

• Patients are closely monitored by medical professionals and staff throughout the course of the stabilization process, including medical screenings and observations

Pathway to long-term recovery:

• Patients receive referrals and placements into long-term treatment options

• Individuals are connected to ongoing substance use disorder treatment at one of the 29 DBH-certified provider locations across DC in all eight wards

What are the benefits of the stabilization center?

• Provides relief for hospital emergency rooms and emergency psychiatric centers

• Offers a cost-effective and time-effective alternative to ER visits for intoxication

• Individuals who receive care at the Stabilization Center can get connected to long-term care and other resources and programs that support recovery

• Gets people the “right care, right now” and prevents escalation to other harmful or dangerous behaviors

• Increases the chance that the intoxicated individual will be open to receiving care

Mayor Muriel Bowser

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Office of Disability RightsOffice of Disability Rights

Office of Disability Rights

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Office Hours

Monday to Friday, 8:45 am to 4:45 pm, except District holidays

Connect With Us

441 4th Street, NW, Suite 729 North, Washington, DC 20001

Phone: (202) 724-5055

Fax: (202) 727-9484

TTY: (202) 727-3363

Email: odr@dc.gov

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Housing Resources and Emergency Shelter

Department of Housing and Community Development (DHCD)

1800 Martin Luther King Avenue, SE, Washington, DC 20020

Phone: (202) 442-7200

Fax: (202) 645-6727

TTY: 711

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Email:dhcd@dc.gov

Hours: Monday to Friday, 8:15 am to 4:45 pm, except District holidays

DC Housing Authority (DCHA)

1133 North Capitol Street, NE

Washington, DC 20002

Phone: (202) 535-1000

TTY users may call DC Relay at (202) 855-1234.

Hours: Monday to Friday, 8:30 am to 4:30 pm

The District of Columbia public housing portfolio consists of more than 8,000 apartment or townhome units in 56 properties owned and managed by the District of Columbia Housing Authority (DCHA). DCHA serves as the landlord for close to 20,000 residents who call public housing home.

Public housing units provide very low-income families, seniors and persons with disabilities with the financial assistance they need to live in affordable rental homes. There are income requirements for public housing and priority is given to those who are in greatest need. Contact the DC Housing Authority for more information.

Pathways to Housing

101 Q Street Northeast

Washington, DC 20002

Phone: (202) 529-2972

Fax: (202) 529-2976

Pathways to Housing provides independent housing with case management and other needed community services to individuals who are homeless, diagnosed with significant behavioral health issues and have a steady source of income.

Phyllis Wheatley YWCA

901 Rhode Island Avenue, NW

Washington, DC 20001

Phone: (202) 667-9100

Fax: (202) 319-3595

Private furnished rooms are available for adults 18 and over. The kitchen, bath and laundry are shared. Room rates are $490, $550, and $600 per month. $10 membership fee, $25 application fee, and $100 security deposit are required.

Missionaries of Charity, Queen of Peace

3310 Wheeler Road, SE

Washington, DC 20032

Phone: (202) 562-6890 or (202) 562-5157

Housing provided for pregnant women and their children under the age of 3. Women are required to leave 6 weeks postdelivery of the infant. In person interview is part of the application process. Women under 18 must have parental consent.

Virginia Williams Family Resource Center (VWFRC)

920-A Rhode Island Avenue, NE

Washington, DC 20018

Phone: (202) 526-0017 or (202) 526-1833

Intake services provided to District of Columbia homeless families. The following documents are required at the intake interview: picture identification, social security card, a birth certificate for each family member, statement of income (SSI,

TANF eligibility, W-2 form or paystub) writ of eviction, or statement of homelessness if living temporarily with relative or friend. The VWFRC is open from 8 am till 5 pm. Services are provided on a first come first served basis.

DC Emergency Shelter Hotline

United Planning Organization (UPO)

Phone: (202) 399-7093

Toll Free: (800) 535-7252

This is a gate keeping and transportation service for District residents seeking homeless shelter services. UPO manages hourly totals of the number of shelter beds available for both singles and families. UPO operates hypothermia vans that respond to individuals and families in need of immediate shelter during the winter months.

Covenant House

2001 Mississippi Avenue, SE

Washington, DC 20020

Phone: (202) 610-9632 or (202) 561-3850

This structured living program is for homeless District residents between the ages of 18 to 21. The program is designed so that participants may live independently with stability.

Hope and a Home

1439 R Street, NW

Washington, DC 20009

Phone: (202) 387-7091

Fax: (202) 387-7097

This program offers transitional housing for homeless families.

Latin American Youth Center (LAYC)

3031 Fifteenth Street, NW

Washington, DC 20009

Phone: (202) 319-2621

Fax: (202) 797-1502

Emergency shelter provided for young men and women in foster care or who are homeless or in immediate danger of becoming homeless and seeking a transitional independent living program for young adults. Services are available to young adults regardless of cultural or ethnic background.

Housing Counseling Services Incorporated

2410 Seventeenth Street, NW

Washington, DC 20009

Phone: (202) 667-2681

Fax: (202) 667-0862

This agency provides independent living and emergency housing assistance for persons and their families with HIV /AIDS in the District of Columbia.

District Alliance for Safe Housing Incorporated (DASH)

Post Office Box 91730

Washington DC 20090

Phone: (202) 462-3274 +

Fax: (202) 269-0528

The District Alliance for Safe Housing Incorporated (DASH) was founded in 2006 to provide relief to survivors of domestic and sexual violence, through emergency and long-term safe housing, and innovative homelessness prevention services.

My Sister’s Place

Post Office Box 29596

Washington, DC 20017

Hotline: (202) 529-5991

Phone: (202) 520-5261

Fax: (202) 529-5984

Domestic violence shelter for women and children (boys must be under the age of 12). Meals, employment guidance, and legal service referrals are provided to families.

Courtney’s House

Post Office Box 12054

Washington, DC 20005

Toll Free 24-Hour Hotline: (888) 261-3665

Outreach, protection and support for children and minors who are victims of domestic sex trafficking in the greater DC area. A safe group house is provided for girls between the ages of 12 to 17.

Different Avenues

1419 V Street Northwest

Washington, DC 20011

Phone: (202) 829-2103

Fax: (202) 839-2104

This agency provides a Drop in Center with healthcare, legal services, substance abuse treatment, and housing support for gay, lesbian, bisexual and transgender (GLBT) who are homeless or in insecure housing.

William Booth, Founder

Brian Peddle, General

Commissioner Kenneth G. Hodder, National Commander

Commissioner Willis Howell, Territorial Commander

Lt. Colonel Allan Hofer, Divisional Commander

Major Mark A. Woodcock, National Capital Area Commander

Major Rhea Dawn Woodcock, National Capital Area Commander

THESALVATIONARMY’S TURNINGPOINTCENTERFORWOMENANDCHILDREN

2022APPLICANTREFERRAL

REFERRALCHECKLIST

DearProvider:

Usethischecklistasaguidetoensureyourreferralpacketiscomplete.Completedreferrals, alongwiththischecklistandallrequiredattachmentsareduetoTurningPointCenterProgram DirectorpriortotheselectionofanIntakeInformationSessionDate. WhenanIntake Informationdateisselected,thepotentialcandidatewillberesponsiblefor RSVP’ingfor attendanceattheinformationsession.Nolast-minutereferralorRSVP’swillbeaccepted withoutprioracknowledgementandapprovaloftheProgramDirector. Referredapplicants shouldarriveearlyontheschedule IntakeInformationSessionDaytoensuretheirreferralhas beenreviewedpriortosessionstarttime. Nochildrenovertheageof6monthsareallowedat theIntakeInformationsessions andfollow-upwillbegiventothereferringrepresentative regardingtheirapplicant’snextsteps. PleasenoteduetoCOVID-19allin-personhasbeen suspendedtovirtualZoommodel.

Thisreferralpacketcontainsthefollowing:

 PartI,Referrer’sInformation

 PartII,FamilyInformation

 PartIII,Applicant’sStatementofUnderstanding(Program),signedanddated

 PartIV,Applicant’sStatementofUnderstanding(ReleaseofInformation),signedand dated

 PartV,Referrer’sStatementofUnderstanding,signedanddated

RSVP’stotheIntakeInformationSessionscanbeemailedto Ncvncc.tpc@uss.salvationarmy.org AnyquestionsonthereferralorapplicationprocesscanbedirectedtotheOfficeAdministrator viatelephoneat(202)250-7720

PARTI:Referrer’sInformation

NameofPersonCompletingReferral:

William Booth, Founder

Brian Peddle, General

Commissioner Kenneth G. Hodder, National Commander

Commissioner Willis Howell, Territorial Commander

Lt. Colonel Allan Hofer, Divisional Commander

Major Mark A. Woodcock, National Capital Area Commander

Major Rhea Dawn Woodcock, National Capital Area Commander

PositionorTitle: ___________________________________________________________________________

ReferringAgency: ___________________________________________________________________________

DateCompleted: _______________

Referrer’sEmail:

Referrer’sPhoneNumber: ___________________

Dateyoubeganworkingwithapplicant: ______________________

Willthisapplicantreceiveon-goingservicesifacceptedintoTurningPointCenter: ______

Ifyes,pleaseexplain:

PARTII:FamilyInformation (tobecompletedbypersonmakingthereferral)

PleaseanswerthefollowingquestionsforthefamilyyouarereferringtoTurningPoint.

Onaseparateattachment,pleaseanswertheFamilyHistoryquestionsbelow.Besuretoputthe questionnumberandcorrespondinglabelforeachanswer,beginningwith1.Family’sHousing History,andsoon.Theattachmentmustlistandcontainallitemsfrom1through16. Ifanitem isnotapplicablewrite“Applicantdenies_______”PleaseDONOTwriteN/A. Ifanyitemis missingtheapplicationwillnotbeaccepted.

William Booth, Founder

Brian Peddle, General

Commissioner Kenneth G. Hodder, National Commander

Commissioner Willis Howell, Territorial Commander

Lt. Colonel Allan Hofer, Divisional Commander

Major Mark A. Woodcock, National Capital Area Commander

Major Rhea Dawn Woodcock, National Capital Area Commander

FAMILYHISTORY

1. Family’sHousingHistory.Brieflydescribetheapplicant’sfamilyhousinghistory, includinghousingstabilityandthereasonforcurrenthomelessness;hastheapplicant everhadhernameonlease?Hassheeverbeenevicted?

2. Children’sInformation.Foreachchildinthefamily,providename,ageanddescription ofcurrentstatus(e.g.schoolordaycareenrollment,fostercare/kinshipcareplacement, etc.);iftheapplicantispregnant,indicateduedate.

3. Education.Whatistheapplicant’shighestgradecompleted?Listanyothertrainingor educationalprogramsattended,includingdatesattendedandcompletiondates, certificatesearned,etc.

4. EmploymentHistory. Describetheapplicant’sworkhistoryandexperience. Listjobs held,includingdatesofemployment,averagehoursperweekworked,salary,etc.Ifnot currentlyemployed,includereasonsunemployed.

5. CurrentWages/Income. Pleaseindicatewhethertheapplicanthasorreceivesverifiable incomeatthistime.Verifiableincomeisdefinedasoneormoreofthefollowing:TANF, SSI/SSDI,EmploymentWages,orChildSupport.Istheclientcurrentlyemployed?

6. MedicalInformation. Listanycurrentmedicalconditionsforapplicantorchildren, includingon-goingtreatment.

7. LegalIssues. Describeanycurrentorpastinvolvementwiththecriminaljusticesystem inanycapacitybyapplicant,children’sfather(s),etc.andcurrentstatusofcase/situation.

8. SupportSystems/SignificantRelationships.Listsignificantrelationshipsthatexistfor theapplicantandhowtheymightimpacttheapplicant’sprogressintheprogram.

9. HistoryofAbuse. Describeanyinformationaboutsexual,physical,and/orverbalabuse withinthefamily(applicantand/orchildren)includinganyinvolvementwiththechild welfare/fostercaresystem,domesticviolenceservices,etc.

10.SubstanceUse/AbuseHistory. Describeanycurrentand/orpastsubstanceuseand/or treatment,participationinNA/AA,etc.;includecurrentcleantimeandrecoveryinfoif relevant.Applicantswithadrughistory,mustprovesixmonthcleantime.

William Booth, Founder

Brian Peddle, General

Commissioner Kenneth G. Hodder, National Commander

Commissioner Willis Howell, Territorial Commander

Lt. Colonel Allan Hofer, Divisional Commander

Major Mark A. Woodcock, National Capital Area Commander

Major Rhea Dawn Woodcock, National Capital Area Commander

11. MentalHealthHistory. Describeanycurrentandpastmentalhealthconditions, diagnosesorconcernsfortheapplicantand/orchildren;provideinfoonconnection to/participationinanyMentalHealthservices,inpatientoroutpatienttreatment,etc., includingtreatmentdates/timeframes.

12. CurrentFamilyFunctioning. Describetheapplicant’sabilitytofunctionindailyliving, includingsuccessesinestablishingandachievinggoals,aswellcopingmechanismswhen confrontedwithdisappointmentsand/orcrises.

13.BenefitsofProgram. DescribehowyouthinkthisfamilywillbenefitfromtheTurning Pointprogram.

14.Barriers.Identifyandexplainpotentialbarriersfacedbythisfamilytoprogresstoward goalsandsuccessintheprogram.

15.FamilyStrengths. Describethestrengthsthatthisfamilyhastohelpthemachievetheir goals.

16.OtherRelevant Information.Provideanyotherrelevantinformationabouttheapplicant and/orchildren.

William Booth, Founder

Brian Peddle, General

Commissioner Kenneth G. Hodder, National Commander

Commissioner Willis Howell, Territorial Commander

Lt. Colonel Allan Hofer, Divisional Commander

Major Mark A. Woodcock, National Capital Area Commander

Major Rhea Dawn Woodcock, National Capital Area Commander

APPLICANTONLY

PARTIII:Applicant’sSignedStatementofUnderstanding.Reviewthefollowingwithapplicant. Besuretheyinitialeachitembelow,andthensignanddate.Thereferralwillnotbeaccepted withouttheapplicantsinitialsandsignature.

____ Iwillbebetweentheagesof18and24asofNewResidentOrientation.

____ Ihave1to4children,orifpregnant,willhavenomorethan4childrenaftergivingbirth.

____ IfIdonothavechildren,IcanprovideverificationfrommydoctorthatIampregnant.

____ IfIhaveahistoryofsubstanceabuse,Icandocumentatleast6monthscleantime.

____ IfIhaveahistoryofmentalillness,Icandocumentconnectiontomentalhealthservices andcompliancewithtreatmentrecommendationsforatleast6months.

____ IunderstandthatthisreferralisjustthefirststepintheApplicationProcessandthatIam notofficiallyacceptedintotheprogramuntilIcompleteallstepsoftheApplicationPhase, includingattendinganIntakeInformationSessiontolearnmoreabouttheprogramrequirements, attending2interviews(ifselectedtobeinterviewed),providingallnecessarydocumentationand feesifacceptedintotheprogram,andattendingaNewResidentOrientation.

____ IunderstandthatTurningPointisnotjustlow-income/incomebased housing. I understanditisaprogramfirstwithmandatoryprogramcomponents,includingcurfew andeveningclasses,whichwillnotbewaivedforanyreason,includingevening employment,school,and/orothereveningobligations.

SignatureofApplicant Date

William Booth, Founder

Brian Peddle, General

Commissioner Kenneth G. Hodder, National Commander

Commissioner Willis Howell, Territorial Commander

Lt. Colonel Allan Hofer, Divisional Commander

Major Mark A. Woodcock, National Capital Area Commander

Major Rhea Dawn Woodcock, National Capital Area Commander

REFERRER/PROVIDERONLY

PARTIV:Referrer’sSignedStatementofUnderstanding.Reviewandinitialeachitembelow, thensignanddate.

____ IunderstandthatreferralsreceivedbyTurningPointafterthestateddeadlinewillnotbe considered.

____ Iunderstandthatreferralsthathavequestionsleftunansweredoraremissinganyrequired attachmentswillnotbeconsidered.

____ TurningPointstaffwillbeginreviewingreferralsandapplicationsafterthe1st Intake InformationSession.IfIsubmitacompletedreferralandtheapplicantprovidedallofthe documentsneededtocompletetheirapplication,IunderstandthatTurningPointwillnotifyme within3businessdays.

____ Iunderstandthatduetothevolumeofapplicationsreceived,TurningPointstaffwill notnotifymeifthereferralorapplicantapplicationisincompleteorthatmyreferral was notaccepted.

____ IunderstandthatifIhavenotheardfromTurningPointwithin3businessdaysoftheirlast IntakeInformationSessions,ImayfollowupwithTurningPointstafftofindoutwhy.

SignatureofPersonMakingReferral

Date

William Booth, Founder

Brian Peddle, General

Commissioner Kenneth G. Hodder, National Commander

Commissioner Willis Howell, Territorial Commander

Lt. Colonel Allan Hofer, Divisional Commander

Major Mark A. Woodcock, National Capital Area Commander

Major Rhea Dawn Woodcock, National Capital Area Commander

**PLEASEGIVETHIS PAGETOAPPLICANT**

WHATAREYOURRIGHTS?

RighttoRequestYourProtectedHealthInformation:

Youhavetherighttolookatyourowninformationandtogetacopyofthatinformation.Please note that exceptions may apply as provided by law. (The law requires us to keep the original record.)Thisincludesyourclientrecord,yourservices/referralrecord,andotherrecordsweuse tomakedecisions about your care.To requestyour information, call orwrite to yourTurning Point case managerorTPProgramDirector.

Right to Request Amendmentof ProtectedHealth Information youbelieveisErroneousor Incomplete:

If you examine your protected health information and believe that some of the information is wrong or incomplete, you may ask us to amend your record. To ask us to amend your client information, submit a written request to your Turning Point case manager or TP Program Director.

Right

GetaListofCertainDisclosuresofYourMedicalInformation:

You have the right to request a list of the disclosures we make of your protected health information. If you would like to receive such a list, submit awritten request to yourTurning PointcasemanagerortheTPProgramDirector.Wewillprovidethefirstlisttoyoufree,butwe may charge you for any additional lists you request during the same year. We will tell you in advancewhatthislistwillcost.

RighttoRequestRestrictionsonHowThisSalvationArmyWillUseorDiscloseYour MedicalInformationforProgramParticipation: YouhavetherighttoaskusNOTto makeusesordisclosuresofyourinformationtoprovideservices/referralsto you.Wearenot requiredto agreeto your request,but ifwedo agree, wewillcomplywith thatagreement. If youwant to request a restriction,write totheTurningPointProgramDirectoranddescribe yourrequestindetail.

William Booth, Founder

Brian Peddle, General

Commissioner Kenneth G. Hodder, National Commander

Commissioner Willis Howell, Territorial Commander

Lt. Colonel Allan Hofer, Divisional Commander

Major Mark A. Woodcock, National Capital Area Commander

Major Rhea Dawn Woodcock, National Capital Area Commander

**PLEASEGIVETHIS PAGETOAPPLICANT**

RighttoRequestConfidentialCommunications:

Youhavetherighttoaskustocommunicatewithyouinawaythatyoufeelismoreconfidential. For example, you can ask us not to call your home, but to communicate only by mail. To do this, please discuss this with your case manager. You can also ask to speak with your case worker(s)inprivateoutsidethepresenceofotherclients.

CHANGESTOTHISNOTICE:

From time to time, we may change our practices concerning how we use or disclose client information or how we will implement client rights concerning their information. We reserve the right to change this Notice and to make the provisions in our new notice effective for all protected health information we maintain. If we change these practices, we will publish a revised Notice of Privacy Practices. You can get a copy of our current Notice of Privacy Practices at any time at this Salvation Army facility or by requesting one from your case manager.

William Booth, Founder

Brian Peddle, General

Commissioner Kenneth G. Hodder, National Commander

Commissioner Willis Howell, Territorial Commander

Lt. Colonel Allan Hofer, Divisional Commander

Major Mark A. Woodcock, National Capital Area Commander

Major Rhea Dawn Woodcock, National Capital Area Commander

**PLEASEGIVETHIS PAGETOAPPLICANT**

DOYOUHAVECONCERNSOR COMPLAINTS?

Please tell us about any problems or concerns you have with your Privacy Rights or how The Salvation Army’s Turning Center uses or discloses your protected health information. If you haveaconcern,pleasecontactyourcasemanagerortheTurningPointProgramDirector.

IfforsomereasonTheSalvationArmycannotresolveyourconcern,youmayalsofileacomplaint withtheFederalGovernment.

DepartmentofHealthand HumanServices

200IndependenceAve SW

Washington,DC,20201

P:(202)696-6775

Wewillnotpenalizeyouorretaliateagainstyouinanywayforfiling acomplaintwiththeFederalGovernment.

William Booth, Founder

Brian Peddle, General

Commissioner Kenneth G. Hodder, National Commander

Commissioner Willis Howell, Territorial Commander

Lt. Colonel Allan Hofer, Divisional Commander

Major Mark A. Woodcock, National Capital Area Commander

Major Rhea Dawn Woodcock, National Capital Area Commander

DOYOUHAVEQUESTIONS?

This Salvation Army is required by law to give you this Notice and to follow the terms of the Notice that is currently in effect. If you have any questions about this Notice or have further questions about how this Salvation Army may use and disclose your protected health information, pleasecontacttheTurningPointProgramDirector.

TurningPointProgramDirector 1434HarvardStreet,NW Washington,DC 20009 (202) 250-7721-Phone

TheSalvationArmyDivisionalHeadquarters 2626PennsylvaniaAvenue,NW,Washington,DC20037

P:(202)756-2600

TheSalvationArmy SouthernTerritorial Headquarters 1424Northeast Expressway,Atlanta,GA 30329

P:(404)728-1300

William Booth, Founder

Brian Peddle, General

Commissioner Kenneth G. Hodder, National Commander

Commissioner Willis Howell, Territorial Commander

Lt. Colonel Allan Hofer, Divisional Commander

Major Mark A. Woodcock, National Capital Area Commander

Major Rhea Dawn Woodcock, National Capital Area Commander

**PLEASEGIVETHIS PAGETOAPPLICANT**

ClientRightsandResponsibilities

AsaclientofTheSalvationArmy’sTurningPointCenter,youhavetheright:

 To be treated with courtesy and respect and to be free from mental and physicalabuse.

 To be treated in a manner that respects your dignity and privacy and promotes your autonomy.

 To be fully informed about client services provided to you and to be told who will be providingtheclientservices.

 Togiveorrefuseconsenttotheprovisionofanycommunityservice.

 To raise concerns or recommend changes in connection with the community services provided to you and in connection with policies and decisions that affect your interests, to the service provider, government officials or any other person, without fear of interference,coercion,discriminationorreprisal.

 To expect all communication and records pertaining to your service to be treated as confidentialandprotectedtotheextentrequiredbylaw.Allinformationaboutaclient and the client's family that is obtained by our staff in carrying out case management tasks shall be held in the strictest confidence. Information may be released to other professionals and agenciesonly with written permission from you oryourguardian. This release shall detail what information is to be disclosed, to whom, and in what time frame. Please note there are very limited exceptions in which we may be required to release your information without your written permission. These exceptionswillbe fullyexplainedtoyou.

 ToreceiveanoticeofourPrivacyPracticesandtohavethemexplainedtoyou.

 To be aware of the relationship the case management agency has with other community partnersthatmayimpactyourservices.

William Booth, Founder

Brian Peddle, General

Commissioner Kenneth G. Hodder, National Commander

Commissioner Willis Howell, Territorial Commander

Lt. Colonel Allan Hofer, Divisional Commander

Major Mark A. Woodcock, National Capital Area Commander

Major Rhea Dawn Woodcock, National Capital Area Commander

YourOptions:

 Youmusttakeanactiveandparticipatoryroleinyourowncasemanagement.You should notify our staff if: you have changed contact information, you are unable to meet an agreeduponappointmenttime,youareunabletofulfillyourowntasks/goals of your case management plan. Failure to do so may lead to a suspension of services. If youfeelthatanyofthese rights havebeen violatedyou shouldcontact TheSalvationArmy NationalCapitalAreaCommanderat(202)756-2600 or call The Salvation Army Southern Southern Territorial Headquarters at (404) 728-1300.

William Booth, Founder

Brian Peddle, General

Commissioner Kenneth G. Hodder, National Commander

Commissioner Willis Howell, Territorial Commander

Lt. Colonel Allan Hofer, Divisional Commander

Major Mark A. Woodcock, National Capital Area Commander

Major Rhea Dawn Woodcock, National Capital Area Commander

CLIENTCONSENTTOTHERELEASEOFCONFIDENTIALINFORMATION

INSTRUCTIONS

Signing and returning this form authorizes The Salvation Army’s Turning PointCenter to share personal information, including mental health, substance abuse, communicable diseases, and/or HIV/AIDS- related information, collected about you or your family with other service and voluntary organizations participating in your case management. The Salvation Army’sTurningPointCenter needs to share this informationinordertocoordinate available services and assistance. The Salvation Army’s Turning Point Center and its community partners are committed to respecting your privacy and will use your information solely forthepurposeofcoordinatingandprovidingassistance.

With the exception of certain limited circumstances, it is the policy of The Salvation Army notto releaseinformationaboutindividualorfamilyassistance,orotherpersonalinformation obtained through the provision of social services, without the written consent of the individual or family. Therefore, we need your written consent to share this information and assist you or your family with obtaining the services in the most expeditious and least cumbersome manner. You will receiveTheSalvationArmyNoticeofPrivacyPracticesprior tosigningthisconsent.

CONSENTANDRELEASE

I, _, hereby authorize The Salvation Army’s Turning Point Center to share my information in its possession, including but not limited to my name, address, Protected Health Information, other personal information, including mental health, substance abuse, communicable diseases, and/or HIV/AIDS-related information, related to my situation and the type of assistance I am receiving with other services and voluntary organizations participating in mycaseinordertocoordinateavailable servicesandassistance.IacknowledgethatIhavebeen provided The Salvation Army Notice of Privacy Practices and a list of all organizations that may have access to my information andhavebeeninformedthatifIwishtolimitorrefusetheRelease ofInformation,Ihavehad theopportunitytodoso.

I understand that I may revoke this consent at any time by contacting The Salvation Army’s Turning Point Center, except when action has already been taken to obtain and/or release such information to organizations participatinginmycasemanagement.Mysignatureonthis releaseindicatesthatIhavereadthe above, or had it read to me, and I understand the terms and conditions. I have also had the opportunity to ask any questions. I am also signing this release on behalf of my children that are undertheageofeighteen(18).

William Booth, Founder

Brian Peddle, General

Commissioner Kenneth G. Hodder, National Commander

Commissioner Willis Howell, Territorial Commander

Lt. Colonel Allan Hofer, Divisional Commander

Major Mark A. Woodcock, National Capital Area Commander

Major Rhea Dawn Woodcock, National Capital Area Commander

TheSalvationArmy-TurningPointCenterforWomenandChildren

APPROVEDAGENCYTORECEIVEINFORMATON DATE

PURPOSEFORRELEASE

SIGNATUREHEADOFHOUSEHOLD DATE

SIGNATURESALVATIONARMYTURNINGPOINTSTAFF DATE

William Booth, Founder

Brian Peddle, General

Commissioner Kenneth G. Hodder, National Commander

Commissioner Willis Howell, Territorial Commander

Lt. Colonel Allan Hofer, Divisional Commander

Major Mark A. Woodcock, National Capital Area Commander

Major Rhea Dawn Woodcock, National Capital Area Commander

CLIENTCONSENTTOTHERELEASEOFPROTECTEDHEALTH INFORMATION

INSTRUCTIONS

Signing and returning this form authorizes The Salvation Army’s Turning Point Center to share personal information, including protected health information, collected about you or your family with other service and voluntary organizations participating in your case management. The Salvation Army’sTurningPointCenter needs to share this information in ordertocoordinateavailableservicesandassistance.TheSalvation Army and its community partners are committed to respecting your privacy and will use your informationsolelyfor thepurposeofcoordinatingandprovidingassistance.

With the exception of certain limited circumstances, it is the policy of The Salvation Army notto releaseinformationaboutindividualorfamilyassistance,orotherpersonalinformation obtained through the provision of social services, without the written consent of the individual or family. Therefore, we need your written consent to share this information and assist you or your family with obtaining the services in the most expeditious and least cumbersome manner. You will receive The Salvation Army’s Notice of Privacy Practices priortosigningthisconsent.

CONSENTANDRELEASE

I, _, hereby authorize The Salvation Army’s TurningPointCenter to share my information in its possession, including but not limited to my name, address, protected health information, other personal information related to my situation and the type of assistance I am receiving with other services and voluntary organizations participating in my case in order to coordinate available services and assistance. I acknowledge that I have been provided The SalvationArmyNoticeofPrivacy Practicesandalistofallorganizationsthatmayhaveaccessto myinformationandhavebeen informedthatifIwishtolimitorrefusethereleaseofinformation,I havehadtheopportunity todoso.

I understand that I may revoke this consent at any time by contacting The Salvation Army’s Turning Point Center except when action has already been taken to obtain and/or release

William Booth, Founder

Brian Peddle, General

Commissioner Kenneth G. Hodder, National Commander

Commissioner Willis Howell, Territorial Commander

Lt. Colonel Allan Hofer, Divisional Commander

Major Mark A. Woodcock, National Capital Area Commander

Major Rhea Dawn Woodcock, National Capital Area Commander

such information to organizations participatinginmycasemanagement.Mysignatureonthis releaseindicatesthatIhavereadthe above, or had it read to me, and I understand the terms and conditions. I have also had the opportunity to ask any questions. I am also signing this release on behalf of my children that are undertheageofeighteen(18).

TheSalvationArmy-TurningPointCenterforWomenandChildren APPROVEDAGENCYTORECEIVEINFORMATON DATE

CoordinationofCare/ApplicationforTransitionalHousing PURPOSEFORRELEASE

SIGNATUREHEADOFHOUSEHOLD DATE

SIGNATURESALVATIONARMYTURNINGPOINTSTAFF DATE

William Booth, Founder

Brian Peddle, General

Commissioner Kenneth G. Hodder, National Commander

Commissioner Willis Howell, Territorial Commander

Lt. Colonel Allan Hofer, Divisional Commander

Major Mark A. Woodcock, National Capital Area Commander

Major Rhea Dawn Woodcock, National Capital Area Commander

TheSalvationArmy–TurningPointCenterforWomenandChildren

Address:1434HarvardStreet,NWSuiteA

Referrer’sProgramName:

City:

ZipCode:

TSAStaffName:HeatherCampbell

State:

Telephone:

I understand people seek help from The Salvation Army when they have special needs which may range fromfairlysimple to painfully difficult. I further understand that this commitment to confidentiality is essential for the delivery of services to be effective and that there must be trust that the Turning Point Center hold the information confidential.

I understand that the fact that an individual is or has been a participant in a Salvation Army program should not be disclosed outside the Salvation Army unit, except when allowable or required by law. I further agree that I will not disclose any information about individuals receivingSalvationArmyTurningPointservicesoutsideof theorganization withoutinformed, written consent from the Turning Point programparticipant, unless obligated to do so by law. I also understand that this consent is not mandatory as a condition to receive services and that

William Booth, Founder

Brian Peddle, General

Commissioner Kenneth G. Hodder, National Commander

Commissioner Willis Howell, Territorial Commander

Lt. Colonel Allan Hofer, Divisional Commander

Major Mark A. Woodcock, National Capital Area Commander

Major Rhea Dawn Woodcock, National Capital Area Commander

the client has the righttorefuse,limitorrevokeconsentatanytime.

I agree that before I disclose any client information to outside organizations, I have obtained written consent from the client, identifying what information is being disclosed, the person or agency whom it will be disclosed, the purpose of the disclosure and the date upon which the clients’ consent expires. Any information disclosed by me about a client must be factual information, not informal counselor notes and/or casual observations. I further agree to treat any information received by me from another organization regarding a client with the same considerationandstandardsoutlinedhere.

IagreethatifIhaveanydoubtaboutwhetherclientinformationshouldbedisclosed,Iwillseek advice from my supervisor, Corps Officer, Area Commander, Divisional Headquarters and/or TerritorialHeadquarters.

I further certify that I have been informed of my obligations related to Health Insurance Portability and Accountability Act Final Privacy Rule, 45 CFR Parts 164.306(a)(4) and 164.308(a), Health Information Technology for Economic and Clinical Health Act, any applicablefederalorstatelawspertainingtoconfidentiality and have received copies of this Salvation Army location’s Notice of Privacy Practices and have read The Salvation Army Policy and Guidelines on Confidentiality and the Protection of Personal Privacy (Minute No. 058B),theNationalCodeofConduct&Ethics,SocialServiceCodeofEthics(MinuteNo. PL041), Non- Discrimination in Programs and Delivery of Services (Minute No. PL042), IT PoliciesandProcedures(MinuteNo. 011A)andUseofLotusNotes(MinuteNo.046C)which are attached to this agreement and fully understand my obligationsunderthatpolicy.

William Booth, Founder

Brian Peddle, General

Commissioner Kenneth G. Hodder, National Commander

Commissioner Willis Howell, Territorial Commander

Lt. Colonel Allan Hofer, Divisional Commander

Major Mark A. Woodcock, National Capital Area Commander

Major Rhea Dawn Woodcock, National Capital Area Commander

Please initial at each line and sign at the bottom of this page.

Ihavereadandunderstandthisagreementandunderstandanyadditionalapplicable HC policies andlawsrelatedtoclientconfidentiality.

HC clientconfidentialityisnotbreached.

IunderstandthattheinformationIreceivefromaclientmayonlybeusedtothe extent HC necessarytoperformmyjobandnoneother.

IunderstandthatImustmaketheappropriatestaffawareofanybreachin HC confidentialityas soonasIamawareithasoccurred.

TurningPointStaffSignature:

Print/TypeName:HeatherCampbell

Date:

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EDUCARE DC, A HEAD START PROVIDER, IS MORE THAN JUST A DAYCARE OR CHILDCARE PROGRAM WE ARE YOUR PARTNER FOR PREPARING YOUR CHILD FOR SUCCESS IN SCHOOL AND LIFE. SAFE, FUN, AND CHALLENGING, EDUCARE UNLEASHES YOUR CHILD’S CURIOSITY TO BUILD A LIFETIME LOVE OF LEARNING PROVIDING THE HIGHEST QUALITY CARE AND EDUCATION TO FAMILIES.

PARKSIDE: 640 ANACOSTIA AVE. NE | WASHINGTON, DC 20019 | 202-727-5604 IDEA: 4501 LEE ST. NE | WASHINGTON, DC 2001

Shelter/Transitional Housing

FAMILY RESOURCE HUB

is Virginia Williams Family Resource Center?

What Services are Offered at VWFRC?

Who is Considered Homeless ?

Where Do I Go If I’m In Need of Homeless Services?

When Can I Go to VWFRC?

Shelters Shelters

In Washington DC In Washington DC

WOMAN AND CHILDREN

TRANSITIONAL/ SUPPORTIVE HOUSING

HOMELESS SHELTERS

Shelters Shelters

In Washington DC In Washington DC

TRANSITIONAL/ SUPPORTIVE HOUSING

HOMELESS SHELTERS

Shelters Shelters

In Washington DC In Washington DC

YOUTH ONLY

TRANSITIONAL/ SUPPORTIVE HOUSING

HOMELESS SHELTERS

Shelters Shelters

In Washington DC In Washington DC

DC’s First Stabilization Center

What is it?

Office of Disability RightsOffice of Disability Rights

THESALVATIONARMY’S TURNINGPOINTCENTERFORWOMENANDCHILDREN

2022APPLICANTREFERRAL

REFERRALCHECKLIST

FAMILYHISTORY

APPLICANTONLY

REFERRER/PROVIDERONLY

WHATAREYOURRIGHTS?

Right

GetaListofCertainDisclosuresofYourMedicalInformation:

RighttoRequestConfidentialCommunications:

CHANGESTOTHISNOTICE:

DOYOUHAVECONCERNSOR COMPLAINTS?

DOYOUHAVEQUESTIONS?

ClientRightsandResponsibilities

YourOptions:

INSTRUCTIONS

CONSENTANDRELEASE

CLIENTCONSENTTOTHERELEASEOFPROTECTEDHEALTH INFORMATION

INSTRUCTIONS

CONSENTANDRELEASE