MY SISTER’S House

Emergency Screening

Emergency Screenings may be conducted in the following situations:

Downtown Rising Drop-offs

When a City Employee brings an individual for emergency shelter.

Extreme Weather

Temperatures at or below 35 degrees, extreme heat, hurricanes, or other environmental disasters.

Other Extreme Situations

As specifically approved by your supervisor.

"(Required)*" indicates required fields

1Initial

2Safety/Legal

3Health

4Guidelines

5Decision

Initial Questions

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Client ID(Required)*

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Lastbeddate

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Today

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Days since last bed stay(Required)*

The applicant was a client within the last 30 days.

Staff Member Performing Prescreening(Required)*

First Last

This is a previous client.
Make sure you don’t write over their name with a new client.

Applicant Name(Required)*

What is your first and last name?

First Middle Last

Applicant Name(Required)*

What is your first and last name?

First Middle Last

Reason for Emergency Screening(Required)*

Emergency Weather

Mercy Care Recuperative Program

Other – With Supervisor Approval

Phone(Required)*

What’s a good contact number to reach you at? (If the client doesn’t have a phone, check the box below).

Client doesn't have phone

Client doesn’t have phone

SMS/Text Opt-In

I agree to receive text messages (SMS) from Atlanta Mission regarding important updates, appointments, and other operational information related to the services provided to me.

Do you have an email address you can share with us? We would use it to send you follow-up information.

Birthdate(Required)*

Client refused to provide birthdate

Yes

*Applicant is not qualified – Refused Birthdate(Required)*

The applicant refused to provide their birthdate. For security and identification purposes, all incoming clients must provide a birthdate. Please select End Interview and press next.

End Interview

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Age(Required)*

*Applicant is not qualified – Unaccompanied minor(Required)*

The applicant is an unaccompanied minor. We cannot provide shelter to unaccompanied minors at Restoration House. Please offer prayer, end the interview, and provide the listed referrals to the applicant.

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End Interview

Gender(Required)*

According to the applicant‘s Government-Issued ID

Male

Female

*Applicant is not qualified – Male applying to My Sister's House(Required)*

The applicant is male. We cannot provide shelter to men at My Sister’s House. Please select “End Interview” and press next.

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End Interview

What is your race?(Required)*

American Indian/Alaskan Native

Asian

Black or African American

Native Hawaiian/Pacific Islander

White

I don’t know

I refuse to answer

What is your ethnicity?(Required)*

Are you a veteran?(Required)*

Yes

I refuse to answer

I don’t know

, with this interview, I am trying to get an idea of what is currently going on in your life, so I will be asking some questions to guide that process. I encourage you to be as open and upfront with the information as possible.

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Count of Active Bans

*The applicant currently has an active ban. We cannot accept a previous client with an active ban. Press next.

Children

Do you have any children that would be staying with you?(Required)*

Yes

Do you have custody of the children?(Required)*

Yes

*Applicant is not qualified – Applicant does not have custody(Required)*

The applicant does not have custody of their children. We cannot provide shelter to individuals without custody of children in their care. Please select “End Interview” and press next.

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End Interview

How many children are you seeking shelter for?(Required)*

Please enter a number from 1 to 10.

*Should this applicant be referred out due to a lack of capacity for the number of children?(Required)*

If the applicant has more than 5 children in custody, she may need to be referred out. If one or two of the children are under 2, a crib can be added to the room increasing capacity to 7. If the children are young enough, we can sleep two children to a bed. Evaluate capacity and if we cannot serve them, please select “Yes” and press next.

Yes

Child 1 Name(Required)*

First Last

Child 1 Gender(Required)*

Female

Male

Child 1 Birthdate(Required)*

Child 2 Name(Required)*

First Last

Child 2 Gender(Required)*

Female

Male

Child 2 Birthdate(Required)*

Child 3 Name(Required)*

First Last

Child 3 Gender(Required)*

Female

Male

Child 3 Birthdate(Required)*

Child 4 Name(Required)*

First Last

Child 4 Gender(Required)*

Female

Male

Child 4 Birthdate(Required)*

Child 5 Name(Required)*

First Last

Child 5 Gender(Required)*

Female

Male

Child 5 Birthdate(Required)*

Child 6 Name(Required)*

First Last

Child 6 Gender(Required)*

Female

Male

Child 6 Birthdate(Required)*

Child 7 Name(Required)*

First Last

Child 7 Gender(Required)*

Female

Male

Child 7 Birthdate(Required)*

Child 8 Name(Required)*

First Last

Child 8 Gender(Required)*

Female

Male

Child 8 Birthdate(Required)*

Child 9 Name(Required)*

First Last

Child 9 Gender(Required)*

Female

Male

Child 9 Birthdate(Required)*

Child 10 Name(Required)*

First Last

Child 10 Gender(Required)*

Female

Male

Child 10 Birthdate(Required)*

*End Interview?

Only check if you are denying the applicant.

End Interview

Safety

Domestic violence refers to fleeing from someone. For us, if it is within 30 days of leaving the abuser then we will refer elsewhere, particularly if the abuser is located in Georgia. There need to be no recent attempts to contact/harm the client as well within the last 30 days as well. Our address is well known and we do not have security that could protect them or our other clients and children on campus if an abuser came here.

Are you fleeing from someone? (Required)*

Yes

Are you in immediate danger?(Required)*

Yes

*Applicant is not qualified – Applicant in immediate danger(Required)*

Applicant is in immediate danger of abuse or being stalked cannot be accepted. Please select “End Interview” and press next.

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End Interview

Are you willing to not tell the person you're fleeing from that you are coming here?(Required)*

If the applicant answers yes, let them know that if their abuser or stalker shows up here looking for them, they will be referred to a Domestic Violence shelter for their own safety and the safety of the community.

Yes

*Applicant is not qualified – Applicant would share location with abuser/stalker(Required)*

Applicants planning to share their location with their abuser or stalker cannot be accepted. Please select “End Interview” and press next.

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End Interview

Safety Notes

Legal History

Have you been charged with any violent crimes?(Required)*

Yes

Can you tell me more about the violent crime?(Required)*

*Does the violent crime prevent entrance into Atlanta Mission?(Required)*

Applicants who are convicted of an armed crime or aggravated assault within the last 5 years, murder at any point in their lives, fire setting at any point in their lives, or rape at any point in their lives should be referred out to other partners.

Yes

You’ve recommended that the applicant be referred out rather than continuing the interview. Please press next.

Search for in the National Sex Offender Registry.

Search the National Sex Offender Registry

*Are you a sex offender?(Required)*

Yes

The applicant is a registered sex offender. We cannot provide shelter to a registered sex offender. Please press next.

Is the applicant intoxicated or under the influence?(Required)*

Yes

The applicant is intoxicated or under the influence. We cannot provide shelter to an applicant who is currently intoxicated or under the influence. Please press next.

Please let the applicant know they may not use drugs or alcohol on or off the property or be intoxicated on the property.

*End Interview?

Only check if you are denying the applicant.

End Interview

Physical Health

Are they able to stand, sit, walk, etc without assistance?(Required)*

Yes

The applicant cannot stand, sit, or walk without assistance. We cannot provide a cot to someone unable to sit down and stand up. Please press next.

Physical Health Notes

Mental/Behavioral Health

Does the applicant's mental health appear to be stabilized?(Required)*

Evaluate whether they seem to be a threat to self or others, if they can comprehend instructions, are aware of their current state, and what their agitation level is. If they do not appear to be stabilized or aware, you could ask them, “Do you know where you are?”

Yes

The applicant has unstabilized mental health issues. We cannot provide shelter to an applicant with severe unstabilized mental health. Please press next.

Mental/Behavioral Health Notes

COVID-19

Have you been diagnosed with or been exposed to anyone with coronavirus in the past 14 days?(Required)*

Yes

*Applicant is not qualified – Applicant has exposure, diagnosis, or symptoms of COVID-19(Required)*

We cannot currently serve applicants diagnosed with or exposed to COVID-19. We also cannot serve applicants with current symptoms of COVID-19. Please let them know they will need to wait 14 days before rescreening and will need to have proof of a negative covid test before coming in. Please select “End Interview” and press next.

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End Interview

TB

Do you have a cough that has lasted for 3 weeks or more?(Required)*

Yes

Have you had contact with person(s) with chronic cough recently?(Required)*

Yes

Have you lost weight without explanation during the past month?(Required)*

Yes

Have you coughed up blood in the past month?(Required)*

Yes

Have you been more tired than usual over the past month?(Required)*

Yes

Have you had fevers almost daily for more than one week?(Required)*

Yes

Have you sweated so much during the night that you've soaked your sheets or clothing during the past month?(Required)*

Yes

Do you have children with any of the above symptoms?(Required)*

Yes

*End Interview?

Only check if you are denying the applicant.

End Interview

Guidelines

Now, I’m going to read you our guidelines and confirm that you agree to abide by them.

Atlanta Mission strives to maintain a safe community. As a result, all clients are expected to uphold the following safety guidelines at all times:

We highly encourage you to participate in services to get all you can out of your stay with us, however, you do have the option of leaving between 8:00 am-7:00 pm daily. You must have an approval in order to leave campus outside of those times.

Do you agree to abide by our guidelines?(Required)*

Yes

*Applicant is not qualified – Refusal to abide by guidelines(Required)*

We cannot serve applicants who refuse to participate in our services and abide by our guidelines. Please select “End Interview” and press next.

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End Interview

*End Interview?

Only check if you are denying the applicant.

End Interview

Closing Tasks

General Notes

Intake Decision(Required)*

Planned to accept the applicant?

If so, you have not answered all required questions.

Press the Previous button and unselect “End Interview” or the Disqualifying question and finish the interview.

Denial Reason(Required)*

Select the reason that was denied entry

Take the Client’s Photo for Identification

1. Make sure the Logitech webcam is plugged in.
2. Open the Camera App on your laptop.
3. Aim the Logitech camera at the new client.
4. Click the take photo button in the Camera App.
5. After the screening is completed, upload the file to the client’s files in Salesforce.

How can I pray for you?

, thank you for your interest in staying at Atlanta Mission. Due to the information you shared, , we are unable to serve you within our facility at this time.

Because we are unable to help, there may be another facility that could better assist you, I will send that information to your email/phone.

Is there anything I could be praying for you?

Referrals(Required)*

Salvation Army: 404-486-2700. 469 Marietta Street Atlanta, GA 30313.

Gateway: (404) 215-6600. 275 Pryor Street SW Atlanta, GA 30303. They are a men’s shelter but they do referrals for other shelters as well as a housing assessment. Some shelters actually require their referral.

City of Refuge: (404) 952-1201. 1300 Joseph E. Boone Blvd NW, Atlanta, GA 30314.

Calvary Refuge: (404) 361-5309. 4265 Thurman Rd, Forest Park, GA 30297. They will provide up to 21 nights of shelter. They can take older boys.

Must Ministries: (770) 426-7667. 55 Elizabeth Church Rd, Marietta, GA 30060.

The Donna Center for Women: (770) 558-9490.

Buckhead Christian Ministry: While enrolled in their program, clients receive rent and utility assistance for 12 months. Their services are for those who work. https://buckheadchristianministry.org/request-help/

Lost and Found: (678) 856-7825. They accept ages 13-25. 24/7 phone hotline.

Covenant House: (404) 589-0163. 1559 Johnson Road NW, Atlanta, GA 30318. They accept ages 18-24.

Nicholas House: (404) 622-0793. 830 Boulevard SE, Atlanta, GA 30312. For families only. Requires a referral from Gateway.

Hagar’s House: (404) 687-3500 (number for coordinated entry for shelter). For families only. Up to 90 days.

Drake House: (844) 249-8367. 10500 Clara Drive Roswell, GA 30075. Mothers with children.

Homestretch Roswell: (770) 642-9185 Ext. 112. Applicant must be employed full-time – documented with pay stubs showing at least 37.5 hours worked per week. Have custody of minor child(children) in residence.

Family Promise: (770) 609-5407. Requires vehicle and at least one minor child.

Sheltering Grace: (678) 337-7858. 797 Roswell St NE, Marietta, GA 30060. Pregnant women with no other children.

Our House: (404) 522-6056. 173 Boulevard Northeast Atlanta, GA 30312. Up to six months of housing for families with newborns under twelve months of age.

Zaban Paradies Center: (404) 872-2915. 1605 Peachtree Rd NW, Atlanta, GA 30309. Shelter for Couples.

JC Freedom House: Requires- (ID, social, birth certificate, proof of circumstances). Able to pay $350 per month or 30% of income, whichever is greater. Single women, no kids. https://www.jcfreedomhouse.com/housing-application.

Rebekah’s Tent: (404) 873-3147. Cold Weather Shelter. November-April.

PADV (Partnership against Domestic Violence): (404) 873-1766, They do an assessment over the phone with you and they work with a network of shelters to find placement. You need to be as honest as possible about what happened. The more active the situation/threat the more DV shelters you are eligible for.

Shepherd’s Rest Ministries: (770) 443-5213

Share House: (770) 949-0626 (main), (770) 489-7513 (crisis)

Women’s Resource Center to End Domestic Violence: (404) 370-7670 (main), (404) 688-9436 (crisis)

GA Coalition against DV (GCADV): 1-800-334-2836, Decatur office number: (404) 209-0280.

Atlanta Recovery Center: 404-577-3352.

Free Rehab Centers: 1-888-501-8982.

Mary Hall Freedom Village: (770) 642-5500. 8995 Roswell Rd, Sandy Springs, GA 30350.

St. Jude Recovery Center: (404) 874-2224. 139 Renaissance Pkwy NE, Atlanta, GA 30308.

Right Side Up: (678) 736-5918. 2815 Clearview Pl #100, Atlanta, GA 30340.

Gilgal: 404-305-8007.

Mercy Care: (Medication Resource), (678) 843-8600, 424 Decatur St SE.

Good Samaritan: (Medication Resource), (404) 523-6571, 1015 Donald Lee Hollowell Pkwy NW.

CAPN (Community Advanced Practiced Nurses): (Housing Resources for those with a behavioral health diagnosis and have experienced at least a year of homelessness), (404) 658-1500, 173 Boulevard NE, Atlanta, GA 30312.

PATH (Operates through Mercy Care): (Housing Resources for those with a behavioral health diagnosis and have experienced at least a year of homelessness), (678) 843-8600, 424 Decatur St SE, Atlanta, GA 30312.

The Shepherd’s Inn (Atlanta Mission’s Men’s Shelter): https://atlantamission.org/shepherds-inn/#admission

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