If you are looking for a mental health street outreach initial contact worksheet, you’re probably working in homeless services or other other behavioral health programs with the community. Such worksheets are a written framework used when homeless and mental health workers first meet with people who are experiencing homelessness and have mental health problems. It can instigate trust, evaluate immediate needs and ensure safety, and provide referrals to services such as housing, treatment or crisis support. Though there is no general public template (because they are often customized by the individual agency and typically contain private information that cannot be shared), these worksheets can be found throughout programs such as PATH (Projects for Assistance in Transition from Homelessness) and local homeless outreach teams. In this guide, we’ll show you what they’re for, what they should include, and how you can make or modify your own to use with your team.
Mental Health Street Outreach Initial Contact Worksheet: What Is It?
A mental health street outreach initial contact worksheet is a worksheet that the outreach worker completes at or immediately following first contact with an unsheltered individual demonstrating signs of mentally ill and/or crisis. It’s for use in street-based settings (for example, encampments, parks, under bridges) where formal intake is not possible.
The goal is to:
- Just document so you are on a safe side Do not even send all the basic information as to avoid burdening the doughadd with any kind of request for work.
- Identify risk factors that need to be urgently addressed (e.g., suicidal ideation, medical care).
- Record engagement details for follow-up.
- Adhere to funding guidelines (e.g., SAMHSA for PATH programs) and to HMIS (Homeless Management Information System) data entry.
These instruments promote trauma-informed, person-centered interviewing with an emphasis on establishing rapport rather than asking a rigid series of questions. And efforts such as LA County’s HOME teams, MHALA outreach or PATH engagement providers use similar forms to follow on contacts from street-encounter through enrollment.
Why Use an Initial Contact Worksheet in Street Outreach?
Street-based mental health outreach is hard people may not trust, and could be in crisis, or lack access to services. A worksheet provides:
- Uniformity: Guarantees that all laborers gather necessary information.
- Security: Assists in estimating risks for the customer and team.
- Efficacy: Measures change (e.g., from homelessness to housing).
- Responsibility: supports grant reporting (eg PATH would want data from first contact).
- Harm Reduction: Emphasizes Reduce the harms associated with drug use through accepting and voluntary care within the goal that people who use drugs can access care without fear of legal repercussion.
Studies reveal that clients who are street-contacted often have more complex needs, so structured but flexible notes are imperative.
Elements of a General Initial Contact Worksheet
For Worksheet You know and love the programs in PATH, HUD-funded outreach, as well as local teams A solid worksheet contains:
- Date, Time and Site: For follow-up and safety.
- Info about the workers: Name, team, contact info.
- Client Identifier: Name as preferred, aliases, estimated age, gender/pronouns (restratin full demographics if trust is low).
- Prioritized Needs: Symptoms of mental health, substance use and physical health, risk in the moment (e.g., suicidal concerns or exposure).
- Notes on Engagement: Summary of conversation, client response (eg accepted water/snacks, declined services)
- Services offered/provided: Basic needs (food, hygiene), referrals, crisis intervention.
- 12Post-consultation plan: Next actions, follow up (date).
- Consent/ROI Notes: Oral consent to share data or photos (where appropriate).
- Safety Evaluation: For employee and client.
By 1-2 pages—stick to what is significant so they don’t tune out.
Sample Street Outreach Initial Contact Worksheet for Mental Health
Here’s a basic responsive script (customize for your agency and in compliance with HIPAA):
Agency Name: __
Initial Contact Worksheet
Date/Time: _ Location: ________________
Outreach Worker(s): __
Individual’s Preferred Name/Alias: __
Approx. Age: _ Gender/Pronouns: __________________________
Description (for identification): __
Observed Mental Health/Substance Use Indicators: ( ) Crisis in appearance ( ) Thoughts disorganized ( ) Observed substance use ( ) Other: __
Immediate Risks/Needs: ( ) Medical emergency ( ) Suicidal/homicidal thoughts or intentions ( )Insufficient food/clothing; exposure to elements (X) Other immediate risks None
Communication Summary: Client disposition: Friendly / Cautious / Not open to communication Products offered/accepted: _ Subject matters discuss in chat session: _
Services/Referrals Offered: ( )Basic needs (food/hygiene) ( )Crisis hotline info( )Housing referral ( )Mental health resources ( )Other: __
Client Response: Yes / Maybe / No Oral consent for future contact: Yes/No
Follow-Up Plan: Re-contact in _ days status at this location / Refer to team
Worker Notes/Safety Concerns: __
This template rests on typical outreach advice—feel free to adjust with whatever branding and legal constraints attend your program.
How to Use the Worksheet
- Establish Trust First: Provide support (water, snacks) before you start asking questions.
- Be Open: Some of the fields do not have to be filled in upon your first contact.
- Trauma-Informed: Ask open-ended questions; honor no.
- Documentation Time: Finish privately after contact.
- Training: Pair with resources such as PATH videos on initial engagement.
Digital OptionsSome teams are utilizing apps for HMIS integration.
More Templates and Training Resources
- PATH Programs: Please refer to your State PATH Coordinator for manual/forms (such as data from first contact information is needed).
- HUD/ESG Guidance: Street Outreach Documentation Standards: REF NOT DISM-CAF 4.
- Training Videos Look up “PATH Street Outreach Video Series” on YouTube (Episode 1 focuses on initial contact).
- Local Agencies: Contact teams like MHALA, LA DMH HOME, or your CoC for common tools.
Final Thoughts: Empowering Effective Outreach
The mental health street outreach initial contact worksheet is about more than paperwork: It’s a lifeline to support for vulnerable people. With thoughtful, uniform tools, outreach teams can reach out safely, document accurately and get people into mental health, housing and recovery services.
If you’re building one for your own program, use the example above to get started and customize it as necessary. For agency specific forms, refer to your local homeless coalitions or PATH providers. Combined, these actions help to make a tangible impact on community mental health. Stay safe out there!
