1 Preferred Communities Program Data Points

OMB control Number: 0970-0490; Expiration date: 1/31/2023

HHS/ACF Office of Refugee Resettlement

Preferred Communities Program

Data Points

Agency: Administration for Children and Families (ACF)/Office of Refugee Resettlement (ORR) Form: Preferred Communities (PC) Program – Program Data Points (PC-PDP)			Grantee Name: Grant Number: Grantee Point of Contact:			Reporting Period From: MM/DD/YYYY To: MM/DD/YYYY
Reporting: Submit this Data Points form at each semi-annual reporting period (April 30 and October 30) as well as annually, with cumulative totals, by November 30. Please use the SF-PPR (narrative report) to explain or highlight key program successes and challenges that cannot be adequately explained here.
PROGRAM INDICATORS
GOAL 1: HELPING VULNERABLE REFUGEES
Data Points by Population: ICM clients
Data Point	Description	Indicators					No. of ICM Clients Served
01	Totals – ICM Clients Served (Include only individuals receiving ICM or a combination of ICM and group programming. Clients receiving only group-based services or remote services are counted separately in this document.) (Totals – ICM clients served, continued)	Length of time in the U.S. at intake (totals by new ICM enrollees this period only) Total number of clients served during this period only (sum of c – e below) New enrollments Continuing clients (in first year of service) 2nd term clients (> one year of service) Total number of cases closed this period Total number of individuals concurrently enrolled in two ORR-funded case management programs (those for whom an exception has been granted; sum of h – k) Total enrolled in PC and Matching Grant Total enrolled in PC and Wilson Fish Total enrolled in PC and RSS Total enrolled in PC and other (list) Gender (totals by new enrollees only) Country of origin (list countries here and totals by new enrollees to the right) Country 1: ________________ Country 2: ________________ Country 3: ________________ Country 4: ________________ Country 5: ________________ Country 6: ________________ Country 7: ________________ Country 8: ________________ Country 9: ________________ Country 10: _______________ Category of ORR eligibility (totals by new enrollees only)					Less than one year: _______ 1 year to 5 years:_______ More than 5 years:_______ ________ ________ ________ ________ ________ ________ ________ _________ _________ _________ Female:_________ Male: __________ Unknown:__________ _________ _________ _________ _________ _________ _________ _________ _________ _________ _________ Refugees_______ Asylees _______ Cuban/Haitian entrants_______ Special Immigrant Visa (SIV) holders _______ Amerasians_______ Victims of Human Trafficking _______ Afghan Humanitarian Parolees________
02	Category of Primary Vulnerability at Intake (For individuals with more than one category of vulnerability, only mark the primary reason for enrollment; totals for this reporting period only)				First-time Enrollees		Re-Enrollees
		Minors (under 18) Young adults without parents Single-parent households Elderly refugees LGBT refugees HIV-positive refugees Refugees with Social/ Psychological conditions/Risk of suicide Substance Abusers Disabled or ill individuals Secondary migrants Survivors of Torture/Sexual and Gender-Based Violence Other			_____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____		_____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____
Data Points by Population: Remote and Underserved Areas Clients ONLY (fill out only if applicable)
03	Totals – Remote and Underserved Areas Clients only	Length of time in the U.S. at intake (totals by new ICM enrollees this period only) Total number of clients served during this period only (sum of ll – nn below) New enrollments Continuing clients Total number of cases closed this period Of these (nn.), total number of cases closed at 3 months (not needing service longer than 3 months) Total number of individuals concurrently enrolled in two ORR-funded case management programs (those for whom an exception has been granted; sum of oo – rr) Total enrolled in PC and Matching Grant Total enrolled in PC and Wilson Fish Total enrolled in PC and RSS Total enrolled in PC and other (list) Gender (totals by new enrollees only) Country of origin (totals by new enrollees only) Country 1: ________________ Country 2: ________________ Country 3: ________________ Country 4: ________________ Country 5: ________________ Country 6: ________________ Country 7: ________________ Country 8: ________________ Country 9: ________________ Country 10: _______________ Category of ORR eligibility (totals by new enrollees only)					Less than one year: _______ 1 year to 5 years:_______ More than 5 years:_______ ________ ________ ________ ________ ________ ________ _________ _________ _________ _________ Female:_________ Male: __________ Unknown:__________ _________ _________ _________ _________ _________ _________ _________ _________ _________ _________ Refugees_______ Asylees _______ Cuban/Haitian entrants_______ Special Immigrant Visa (SIV) holders_______ Amerasians_______ Victims of Human Trafficking _______ fff. Afghan Humanitarian Parolees ________
04	Category of Primary Vulnerability at Intake – Remote or Underserved Areas Clients (For individuals with more than one category of vulnerability, only mark the primary reason for enrollment; totals for this reporting period only)	Minors (under 18) Young adults without parents Single-parent households Elderly refugees LGBT refugees HIV-positive refugees Refugees with Social/ Psychological conditions/Risk of suicide Substance Abusers Disabled or ill individuals Secondary migrants Survivors of Torture/Sexual and Gender-Based Violence Other					________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________

ICM Client Assessment Indicators

05

Risk Domain & Assessment Criteria (at-risk; stable; thriving)

Totals for Clients at INTAKE in this reporting period

Totals for Clients who have reached 180 DAYS in this reporting period

Totals for clients who have reached 360 DAYS in this reporting period

At-Risk

Stable

Thriving

At-Risk

Stable

Thriving

At-Risk

Stable

Thriving

Housing (Risk of homelessness or eviction; adequate housing with occasional need for help with rent; no need of rent assistance)

Food security (Significant reliance on food banks; occasional need of food assistance; no need of food assistance)

Finances (Income & Employment) (Unemployment; occasional employment; regular employment)

Financial Management (Inability to manage assistance or income to meet needs; occasional ability to form and stay within budget; regular ability to meet needs and work on savings)

Mental Health (Significantly limited ability to perform daily functions, and unwillingness or inability to access mental healthcare services; somewhat impaired ability to function daily and to access/participate in mental healthcare services; no impairment in performance of daily functions and/or in active treatment for identified mental health need)

Navigation of Physical Healthcare Systems (Limited/no access to or understanding of healthcare; occasional need for help with access to care; independent management of condition and medications)

Transportation (No access to transportation; limited access to transportation; regular and independent means of transportation)

Linkages to Benefit Systems (SSI & food stamps) (Limited/no access to or understanding of benefits; occasional need of help with access to benefits; independent access to and understanding of benefits systems)

English Language Education (ELE) (No access to/participation in ELE; regular attendance and participation in ELE; no need for ELE)

Family Wellness (Wellness= absence of violence, child endangerment, and substance abuse) (Family is experiencing one or more elements; family is addressing wellness issues; family is not experiencing any of these elements)

Social Adjustment & Interaction/ Integration (Isolated or not adjusting to resettlement; learning coping skills & building social relationships; adapting to resettlement and actively engaged with family, community and/ school

Immigration Status (In need of assistance with LPR at enrollment; not in need of assistance with LPR at enrollment; on track to naturalization at closure)

06

Client Progress: ICM clients

ICM Clients only For first-time enrollees At 180 days: % of clients moved from at-risk to stable in 1 or more domains % of clients moved from stable to thriving in 1 or more domains At 360 days: % of clients moved from at-risk to stable in 1 or more domains % of clients moved from stable to thriving in 1 or more domains For re-enrollees At 180 days: % of re-enrollees moved from at-risk to stable in 1 or more domains % of re-enrollees moved from stable to thriving in 1 or more domains At 360 days: % of re-enrollees moved from at-risk to stable in 1 or more domains % of re-enrollees moved from stable to thriving in 1 or more domains _________________________________________________ First-Year Enrollees: Total number of clients who reached all goals of their self-sufficiency plan Percentage of caseload who reached all goals of their self-sufficiency plan Second-Year Enrollees: Total number of clients who reached all goals of their self-sufficiency plan Percentage of caseload who reached all goals of their self-sufficiency plan

________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________

07

Client Progress: Remote and Underserved Areas Clients

Remote and underserved clients only At 3 months: Percentage of remote/underserved areas clients who moved from at-risk to stable in one or more assessment categories from intake to 3 months Percentage of remote/underserved areas clients who moved from stable to thriving in one or more assessment categories from intake to 3 months At Case Closure, if longer than 3 months: Percentage of remote/underserved areas clients who moved from at-risk to stable in one or more assessment categories by case closure Percentage of remote/underserved areas clients who moved from stable to thriving in one or more assessment categories by case closure

________ ________ _________ _________

INDICATORS FOR PARTICIPANTS ENROLLED SOLELY IN GROUP ACTIVITIES (non-ICM clients only)

Data Point

Description

Indicators

No. Clients Served

08

Client Progress in Group Activities (Non-ICM clients only)

Total number of clients enrolled solely in group activities (sum a – b) Number of clients participating in extended cultural orientation as their main group activity Number of clients in specific support groups (list totals for each) Art therapy Music therapy Gender-based support groups Cultural/ethnic support groups Youth support groups Other (list)____________ Number of clients whose self-sufficiency scores improved by at least 50% at end of group services Number of clients whose scores show no significant improvement (49% or less) and referred to ICM at end of group services

________ ________ ______ ______ ______ ______ ______ ______ ________ ________

GOAL 2: PROGRAMMING AND ORGANIZATIONAL CAPACITY BUILDING (Supporting Refugee Service Providers)

Data Point

Description

Indicators

No. Clients Served

09

Program Services and Components

Average frequency of case worker interaction per ICM client (give totals by # of affiliates reporting for each category of frequency) Total number of hours of specialized case management provided (representing one of these program focuses: health and medical services/case management, social adjustment services, mental health services, services for vulnerable LGBT clients, services for single mothers and women-at-risk, services for elderly refugees, services for youth, services for survivors of torture and trauma, services for clients in underserved/areas/unanticipated arrivals and secondary migrants, remote/underserved areas clients) Total number of hours of interpretation provided Total number of client referrals and linkages Total number of clients provided with Emergency Financial Assistance (EFA) Total number of clients provided with immigration status services this reporting period (includes LPR and naturalization assistance)

Weekly: Bi-weekly: Monthly: _______ _______ _______ _______ _______

Volunteer and Community Engagement

10

Outreach and Dissemination

New providers/partnerships this reporting period (list) Medical service provider Legal service provider Educational organization Local/state government entity Faith-based group Other (list) __________ Number of community outreach hours this reporting period

_______ _______ _______ _______ _______ p. ______________ _______

11

Volunteer Engagement and Hours Contributed by Pro Bono Service

Number of new volunteers engaged this reporting period Number of new mentor-client matches this reporting period Total number of volunteers who served this reporting period Total number of volunteer hours donated w. Major volunteer activities (list): Other resources generated (cash, in-kind, etc.)

______ ______ _______ _______ _______________ ___________________ ___________________ ___________________ _______________ ___________________ ___________________ ___________________

THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13)

Public reporting burden for this collection of information is estimated to average 5 hours per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information.

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