Region 16 Homeless Housing Programs

Balance of State Continuum of Care
Homeless Planning Region 16

The Community Action Commission of Fayette County, in partnership with homeless planning Region 16, presents the Coordinated Entry process on this page.  The purpose of this page is to serve as a starting point for any individuals and service providers seeking information on how to access the homeless crisis response system in Clinton, Fayette, Highland, Pickaway, and Ross Counties.  Please continue to visit this website for details and updates.

These programs serve all households regardless of race, color, national origin, religion, sexual orientation, gender identification, age, familial status, or disability.

Community Resources for the Homeless & At-Risk

Region 16 Housing Inventory Chart 2017
Available Housing List
Fayette County Community Resource
Fayette County Private Landlord List
Highland County Resource Guide 2021
School Homeless Liaison Contact Information
Pickaway County Specific Resources
Ross County Specific Resources

Customer Satisfaction Survey 2021

Region 16 Management & Structure

Bylaws & Operating Procedures
Regional Committees & Membership Rosters

Program Policies & Notices

CACFC IDOR Plan 4.2020

HMIS Data Privacy Notice 2.2019
Region 16 Coordinated Entry Plan CURRENT
Region 16 RRH Policies & Procedures CURRENT
Region 16 HP Policies and Procedures COVID revised 1.2021
Region 16 PSH Policies & Procedures
Case Closeout and Termination of Assistance
Domestic Violence Policy
Region16 Grievance Packet CURRENT-To be posted in office and can be provided to clients enrolled in housing programs.

Access Points in Region 16

Clinton County:

Clinton County Services for the Homeless- 36 Gallup Street, Wilmington, Ohio 45177; 937.382.7058

Highland County:

Highland County Homeless Shelter- 145 Homestead Avenue, Hillsboro, Ohio 45133; 937.393.0634

Fayette County:

Brick House Emergency Shelter- 320 North Hinde St, Washington C.H., Ohio 43160; 740.333.7580
Community Action- 1400 U.S. Route 22 NW, Washington C.H., Ohio 43160; 740.335.7282
Fayette Landing- 719 Rawlings St., Washington C.H., Ohio 43160; 740.895.6742 or 740.620.9016
Peace House- DV project- 1400 U.S. Route 22 NW, Washington C.H., Ohio 43160; 740.505.0090

Pickaway County:

Pickaway County Community Action- 469 East Ohio Street, Circleville, Ohio 43113; 740.477.1655

Ross County:

Community Action: 250 North Woodbridge Avenue, Chillicothe, Ohio 45601; 740.702.7222
Seeds of Hope: 75 North Paint Street, Chillicothe, Ohio 45601; 740.774.1200

Diversion Assessment- (completed by Access Point)

HMIS-Diversion-Form-8.31.21 This form is completed by the Access Point for the Head of Household (HOH) ONLY. If Diversion is NOT successful, this form must be included in the CE File.
Data Release UNIVERSAL– This is completed for the HOH ONLY by the Access Point. In-Person Consent Form or Verbal Consent Form are both provided, use accordingly.
*If the household is NOT diverted, the Diversion Assessment MUST BE PRESENT in the Coordinated Entry File.
Coronavirus Vaccination Questions and Symptom Screening Tool 2.10.21 (1)-This form is to be used during the Diversion Assessment. Information collected is entered into HMIS. Use this form until further notice. (effective 3-17-2020)

DV Diversion Addendum Forms


Coordinated Entry (CE) File- (completed by Access Point)

The Coordinated Entry (CE) File is the common file shared among ALL Homeless Service Providers in the region & is required to be completed for ALL referrals.

          1. CE-Checklist UNIVERSAL-This form is to track required documents needed for the CE File. When completed, referral to Homeless Provider can be sent.
          2. HMIS-Diversion-Form-8.31.21– This was completed by Access Point during the Diversion Assessment & must be included in the CE File.
          3. Referral for ES/RRH/PSH (as applicable)- Will be completed & printed off of HMIS by Access Point when the SPDAT is completed & HOH provides verification of homelessness to Access Point
          4. Regional-Universal-Release-Form This form must be completed by Access Point.
          5. Diversion Data Release Forms – This form was completed for the HOH during the Diversion. If children are present in the HH, they MUST BE ADDED NOW.
          6. Homeless-Status-Documentation UNIVERSAL– This form must be completed by Access Point & be accompanied with verification of homelessness.
          7. HMIS Intake Form All Programs – Completed in HMIS by the AP through Unsheltered & MUST be printed from HMIS & placed in file. Blank pdf copies are available on COHHIO’s website.
          8. HMIS Intake Form ES SH Oct 2019 – Completed in HMIS by ES. MUST be printed from HMIS & placed in file. Blank pdf copies are available on COHHIO’s website.
          9. Income Verification Forms– These forms must be completed by Access Point & be accompanied with required income documents if applicable.
          10. Copies of the entire HH’s Personal Identifying Information.
          11. PSH-Forms Update 2019 ONLY completed by Access Point when referring HH to PSH
        1. Printable VISPDAT- **TO BE USED DURING THE HMIS BLACKOUT 7-19 thru 8-3-2021!!**
        2. Single VISPDAT:VI-SPDAT-V3-Single-Adults-fillable
        3. Family VISPDAT: VI-F-SPDAT-V3-Families-fillable
        4. TAY VISPDAT: TAY-VI-SPDAT-v1.0-US-Fillable-Amended-July-13-2015
        5. These links provide a printable version of the various VI-SPDAT’S. Emergency Shelter’s MUST complete the VI-SPDAT within 5-8 days of HH enrollment into their homeless emergency shelter program & maintain a signed copy of the completed VI-SPDAT in the HH’s file. All referrals require the completed VI-SPDAT score, which is provided through HMIS when completing referral. All SDPAT’s must be completed within 5-8 days of ES entry, with the exception of TAY, Unsheltered & those with prior homelessness which can be done day they present.

      DV CE Addendum Forms

      PH Action Plan Worksheet
      PH Goal Planning Worksheet
      PH Enrollment Verification

      Emergency Transitional Housing (ETH) Forms

      Rapid Re-Housing (RRH)s