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Ner & children 5. Person was part of nonfamily group 6. Other: 3. Referral by mental health agency or provider How responsive was the person to contact? 1. Talked briefly; did not want to talk further 2. Would talk but not interested in services 3. Interested in basic services (food, clothing) 4. Self-referral 5. Other 4. Interested in referral to non-PATH program 5. Interested in outreach services 6. Other: GOAL: Interviewer s Name: Duration of Contact: 5 min Date: 10 min 15 min 30 mi.

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