WAHRS QUARTERLY DATA REPORT
SUBMIT TO JOLI GUENTHER; 2318 EAST DAYTON STREET, MADISON, WI 53704
Program
Name: ________________________________
City:
______________________________
Person
Completing This Report: ___________________
Report
Period: _____________________________________
1.
Number youth seen individually, and/or with family member(s)* ______
(new/re-opened cases; do not include continued)
______ New
______ Reopen (new contact after case has been closed)
Locale Breakdown (total
should = 1 above)- Indicate the numbers of youth served that come from:
a.
___________County (ies) served by your program.
b. ___________Other served counties in
c. ___________Unserved counties in
d. ___________Other states.
*
The total of a, b, c, and d must equal #1.
2. Number of
clients seen face to face with problems related, at least in part, to the
effects of W-2 sanctions. ________
3.
Race (youth may identify
American Indian or Alaskan Native
with
more than Asian
one
race)
Black or African American
White
Native Hawaiian or Other Pacific Islander
_______
Not Provided
4.
Ethnicity (total should =
Not Hispanic or Latino
1 above)
Hispanic or Latino
Not Provided
5.
Gender (total should = Male
1
above)
Female
6.
Runaway Status (# and %)
At Home
Runaway
Throwaway
Homeless
Emancipated
J.J. Placement
Child Welfare Placement
Other
7.
Youth Issues Identified
(# and %) Physical
Abuse/Assault
Sexual Abuse/Assault
Alcohol and Other Drug Abuse
Emotional Abuse
Neglect
Family Dynamics
Sexual Orientation/Gender Identity
School/Educational
Housing Issues
Unemployment
Mental Health Issues
Health Issues
Physical
Disability
Mental Disability
Other
8. Discharge status of youth
seen face-to-face (total should equal #1).
a. ______Youth returned home
b. ______Youth was placed in a safe alternative (other than home)
c. ______Youth returned to the street or unknown destination
9. Number of
new youth seen in counseling groups* _________
Do not
include youth counted in #1
10.
_______Total # of families that received face-to-face counseling.
11. ________Total # of face-to-face counseling sessions.
12._______ Number
of youth sheltered
13. _______Total number of telephone contacts.
________Initial Counseling
Calls
________Follow up Counseling
Calls
________Information and
Referral Calls
14.
______
Number of Volunteers recruited
15.
_______Number
of volunteer hours donated directly to your program.
16.
_______
Number of youth provided intensive off-site
services (through schools, community centers, etc.)
17.
Number
of individuals reached through community/school presentations
___________ Youth
____________ Adults/Community Members
The following questions apply to programs providing
formal street outreach to runaway and homeless youth and youth at risk.
18. _______Total
number of street outreach contacts. (may be duplicated)
19. _______Total
number of youth in #18 who were provided more intensive street based services
(unduplicated).