Appendix 2 :
A PROPOSAL OF CRITERIA FOR SEVERE SOCIAL EXCLUSION
Datasheet 1. Identification Datasheet 2. Financial Status Datasheet 3. Housing Status Datasheet 4. Social Integration Status Datasheet 5. Health Status Datasheet 6. Expression of Needs and Wishes
Datasheet 1
IDENTIFICATION (1/3)
1.1
1.0 1.1.a 1.1.b 1.1.c 1.1.d 1.1.e 1.1.f 1.1.g
Identity
identification number last name, first name
What are your first and last name? gender Are you male or female? date of birth When were you born? place of birth (town / country) What is your native town? If you were born outside France, what is your native country? nationality (French, European Union, from outside the European Union) What is your current nationality? native tongue(s) What is/are your native tongue(s)? French speaking skills (for those whose native tongue is not French) Do you speak French (yes/no)? How well do you speak French (basic, intermediate, advanced)?
Datasheet 1
IDENTIFICATION (2/3)
1.2
1.2.a
family circumstances
family status
What is your current family status?
1.2.b
single, married (officially or under common law), in a stable relationship, separated/divorced, widowed number of children (number of dependent children / number of non-dependent children) How many children do you have? How many children do you have the care of? maintenance of family ties (contact with family on a regular, occasionnal basis, no contact: for how long) Are you or do you keep in touch with your family (yes/no)? If you are, how often do you see your relatives (on a regular, occasional basis)? If you aren't, how long have you been out of touch?
1.2.c
Datasheet 1
IDENTIFICATION (3/3)
1.3
1.3.a 1.3.b
education level
schooling (yes/no)
Did you go to school (yes/no)? litteracy (yes/no) Can you read (yes/no)? Can you write (yes/no)? illitteracy (yes/no) Did you learn how to read (yes/no)? Did you learn how to write (yes/no)?
1.3.c
1.4
1.4.a 1.4.b 1.4.c
employment status and professional training
diploma(s)
What is your qualification? occupation What is your profession? training courses Have you had any formal training? (yes/no) If you have, what training courses did you take? work experience have you already worked? In what field? How long?
1.4.d
Datasheet 2
FINANCIAL STATUS (1/2)
2.1
2.1.a 2.1.b 2.1.c
work history
no employment history
Datasheet 2 If you have already been employed, how long did it last? FINANCIAL STATUS
current employment status (in the formal sector)
Have you ever been employed in the formal sector? (yes/no) employment history
(2/2)
Are you currently employed? (yes/no)
2.2 2.1.d
2.2.a
If you aren't, how long have you been unemployed? income alternative occupational status (alternative types of employment / informal sector) If you work in the informal sector, what kind of work do you do? (contract jobs, odd jobs) income derived from formal employment (wages, unemployment benefits…) + total earnings?
Do you earn a regular income from formal employment?
2.2.b
Can you tell how much you earn per month? income from activities in the informal sector ("stunts, odd jobs, casual work"…) + total earnings? Do you make an income out of other types of activities? Can you tell how much you earn per month? income from social benefits (RMIminimum income support, AAH disability benefits ASV old age benefits CAF child and family benefits , , ) Are you the recipient of social benefits? Can you tell how much you receive in social benefits each month? debts + how much? Are you in debt? (yes/no) if so, for what amount? total monthly income: Can you tell what last month's income was?
2.2.c
2.2.d
2.2.e
Datasheet 3
HOUSING STATUS (1/2)
3.1
3.1.a 3.1.b
address status
address status
Do you have an address? (yes/no) Type of address If you have an address, what type is it? (private accomodation, p.o.box, social housing...)
3.2
3.2.a
current living space or place
current accomodation status
3.2.b 3.2.c
Where are you currently living? (private accomodation, on the street, squat, temporary lodgings, shelter, social housing, etc.) town of residency(as stated by the individual concerned) Which town are you normally a resident of? homelessness status (living in a fixed spot in town or not ) + how long? Do you have a fixed living space/place on the street? (yes/no) How long have you been living on the street? squat + how long? How long have you been living in a squat? temporary accomodation (staying with a friend, with relatives,…) + how long? How long have you been living at a relative or friend's place? social housing + how long? How long have you been living in a social housing unit? How long are you going to stay there? private accomodation How long have you been living in a privately-owned housing unit?
3.2.d 3.2.e 3.2.f
3.2.g
Datasheet 3
HOUSING STATUS (2/2)
3.3
3.3.a
housing possibilities
home ownership status
Do you own a home? (yes/no)
3.3.b
If you don't, have you ever owned one? (yes/no) lodger status / possibility of renting accomodation Do you rent a home? (yes/no) If you don't, have you ever rented one? (yes/no) other possibilities for accomodation Have you ever stayed in a social housing unit or an emergency shelter? (yes/no)
3.3.c
Do you have a place to sleep in if you want to (staying with relatives, friends, in a shelter)? (yes/no
Datasheet 4
SOCIAL INTEGRATION STATUS (1/2)
4.1
4.1.a 4.1.b
occupations
activities outside working
Do you have activities outside formal or casual work ? (need to relate to other people, seeking refuge from or trying to forget problems, motivation for such activities
out of habbit, trying not to lose all bearings)
What is your motivation for this activity?
4.2
4.2.a 4.2.b
social interaction status
community / neighbourhood work or activitieskeeping up or not keeping up personal relationships / individual level ( )
Do you interact with people in your neighbourhood or on your block? (yes/no) social services assistance (going or not going to social aid structures / institutional level) Do you receive any help from social services? (yes/no) which ones? Do you receive assistance in any way? (yes/no) If you do, where do you get help from? (neighbours / social services / relatives / other)
Datasheet 4
SOCIAL INTEGRATION STATUS (2/2)
4.3
4.3.a
administrative status
documentation
Do you have any identity documents? (yes/no)
4.3.b
if you don't, have you ever had any identity documents? validity of documents If you have documents, are these documents valid? (yes / no / not known)
4.4
4.4.a
rights
rights awareness
Do you know if you are entitled to social aid or benefits? (yes/no)
4.4.b
if you are, what kind of aid or benefits are you entitled to? rights history status Have you ever been the recipient of social aid or benefits? (yes/no) If you have, what kind of aid or benefits did you receive? If you haven't, give the reasons for not accessing aid or benefits (lack of motivation, undocumented, not entitled) current rights status Are you currently receiving social aid or benefits in any way? If you are, what kind of aid or social benefits are you receiving? if you aren't, give reasons for not receiving any (no longer entitled, not entitled, undocumented, no application) application for rights Did you act on your own the last time you applied for social benefits or was it with the help of social services?
4.4.c
4.4.d
Datasheet 5
HEALTH STATUS (1/2)
5.1
5.1.a
health and personal hygiene
access to shower facilities
Is there a place where you can shower on a regular basis? (yes/no)
5.2
5.2.a 5.2.b
health status
Self-appraisal
How would you describe your current health? (good, bad, no answer) health concerns Are you concerned with, or even simply interested in your health? (yes/no)
5.3
5.3.a
medical tracking
last medical check-up
when was the last time you saw a doctor? (regardless of the medical facility)
5.4
5.4.a
addiction status
addictions
Do you suffer from any kind of addiction? (yes/no) If you do, what substance(s) are you addicted to?
Datasheet 5
HEALTH STATUS (2/2)
5.5
5.5.a
access to medical care
type of medical facilities accessed
To what type of medical facility did you last turn for medical aid? (people's dispensary, NOG, hospital, other facility) Give the reasons for not visiting any medical facility?
5.6
5.6.a
type(s) of medical care provided
Types of condition or health problems treated
What was the reason that made you seek medical aid the last time you had health problems? (wounds, pain, tooth trouble, stomach trouble, rehydration, refeeding, chronic condition, temporary health problem, other)
5.7
5.7.a 5.7.b 5.7.c 5.7.d
health insurance status
social security status
Do you have a social security number? (yes/no) CMU (French universal health insurance program) Are you entitled to CMU care? (yes/no) AME (French state medical aid program) Are you entitled to AME care? (yes/no) health insurance history : in case of no health insurance : Have you ever had medical insurance? If you have, why are you currently without any? (no longer entitled, no application, other) If you haven't, give the reasons for not having any (not entitled, lack of information, no application, other)
Datasheet 6
EXPRESSION OF NEEDS AND WISHES
6.1
6.1.a
prioritisation of needs
needs (accomodation, food, clothing, medical care, social care, psychological assistance, work, nothin
What would you say is your most urgent need right now? What other current pressing needs can you think of?
6.2
6.2.a
expression of wishes
voices/does not voice wishes
Are there things you would like to change in your life? (yes/no) If there are, what are these things?