Form 1 Preferred Communities Program Data Points

Generic Performance Progress Report

PC Program Data Points FY18_Oct 2021 update

Preferred Communities Program Data Points

OMB: 0970-0490

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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)

  1. Length of time in the U.S. at intake (totals by new ICM enrollees this period only)








  1. Total number of clients served during this period only (sum of c – e below)


  1. New enrollments


  1. Continuing clients (in first year of service)


  1. 2nd term clients (> one year of service)


  1. Total number of cases closed this period


  1. 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)

  2. Total enrolled in PC and Matching Grant


  1. Total enrolled in PC and Wilson Fish

  2. Total enrolled in PC and RSS

  3. Total enrolled in PC and other (list)



  1. Gender (totals by new enrollees only)







Country of origin (list countries here and totals by new enrollees to the right)

  1. Country 1: ________________

  2. Country 2: ________________

  3. Country 3: ________________

  4. Country 4: ________________

  5. Country 5: ________________

  6. Country 6: ________________

  7. Country 7: ________________

  8. Country 8: ________________

  9. Country 9: ________________

  10. Country 10: _______________



  1. Category of ORR eligibility (totals by new enrollees only)

  1. Less than one year: _______


  1. 1 year to 5 years:_______


  1. More than 5 years:_______



  1. ________


  1. ________


  1. ________


  1. ________


  1. ________




  1. ________


  1. ________


  1. _________

  2. _________

  3. _________



  1. Female:_________


  1. Male: __________


  1. Unknown:__________





  1. _________

  2. _________

  3. _________

  4. _________

  5. _________

  6. _________

  7. _________

  8. _________

  9. _________

  10. _________



  1. Refugees_______

  1. Asylees _______

  1. Cuban/Haitian entrants_______

  1. Special Immigrant Visa (SIV) holders _______

  1. Amerasians_______

  1. Victims of Human Trafficking _______

  1. 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

  1. Minors (under 18)

  2. Young adults without parents

  3. Single-parent households

  4. Elderly refugees

  5. LGBT refugees

  6. HIV-positive refugees

  7. Refugees with Social/ Psychological conditions/Risk of suicide

  8. Substance Abusers

  9. Disabled or ill individuals

  10. Secondary migrants

  11. Survivors of Torture/Sexual and Gender-Based Violence

  12. Other



  1. _____


  1. _____


  1. _____

  2. _____

  3. _____


  1. _____





  1. _____

  2. _____


  1. _____

  2. _____


  1. _____



  1. _____


  1. _____


  1. _____


  1. _____

  2. _____

  3. _____


  1. _____





  1. _____

  2. _____


  1. _____

  2. _____


  1. _____



  1. _____


Data Points by Population: Remote and Underserved Areas Clients ONLY (fill out only if applicable)

03

Totals – Remote and Underserved Areas Clients only

  1. Length of time in the U.S. at intake (totals by new ICM enrollees this period only)








  1. Total number of clients served during this period only (sum of ll – nn below)


  1. New enrollments


  1. Continuing clients


  1. Total number of cases closed this period


  1. Of these (nn.), total number of cases closed at 3 months (not needing service longer than 3 months)


  1. 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)


  1. Total enrolled in PC and Matching Grant

  2. Total enrolled in PC and Wilson Fish

  3. Total enrolled in PC and RSS

  4. Total enrolled in PC and other (list)



  1. Gender (totals by new enrollees only)









Country of origin (totals by new enrollees only)


  1. Country 1: ________________

  2. Country 2: ________________

  3. Country 3: ________________

  4. Country 4: ________________

  5. Country 5: ________________

  6. Country 6: ________________

  7. Country 7: ________________

  8. Country 8: ________________

  9. Country 9: ________________

  10. Country 10: _______________



  1. Category of ORR eligibility (totals by new enrollees only)

  1. Less than one year: _______


  1. 1 year to 5 years:_______


  1. More than 5 years:_______



  1. ________


  1. ________


  1. ________


  1. ________



  1. ________




  1. ________



  1. _________

  2. _________

  3. _________

  4. _________



  1. Female:_________


  1. Male: __________


  1. Unknown:__________







  1. _________

  2. _________

  3. _________

  4. _________

  5. _________

  6. _________

  7. _________

  8. _________

  9. _________

  10. _________



  1. Refugees_______

  1. Asylees _______

  1. Cuban/Haitian entrants_______

  1. Special Immigrant Visa (SIV) holders_______

  1. Amerasians_______

  1. 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)


  1. Minors (under 18)

  2. Young adults without parents

  3. Single-parent households

  4. Elderly refugees

  5. LGBT refugees

  6. HIV-positive refugees

  7. Refugees with Social/ Psychological conditions/Risk of suicide

  8. Substance Abusers

  9. Disabled or ill individuals

  10. Secondary migrants

  11. Survivors of Torture/Sexual and Gender-Based Violence

  12. Other


  1. ________

  2. ________

  3. ________

  4. ________

  5. ________

  6. ________



  1. ________

  2. ________

  3. ________

  4. ________


  1. ________


  1. ________




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:

  1. % of clients moved from at-risk to stable in 1 or more domains

  2. % of clients moved from stable to thriving in 1 or more domains

At 360 days:

  1. % of clients moved from at-risk to stable in 1 or more domains

  2. % of clients moved from stable to thriving in 1 or more domains


For re-enrollees

At 180 days:

  1. % of re-enrollees moved from at-risk to stable in 1 or more domains

  2. % of re-enrollees moved from stable to thriving in 1 or more domains

At 360 days:

  1. % of re-enrollees moved from at-risk to stable in 1 or more domains

  2. % of re-enrollees moved from stable to thriving in 1 or more domains

_________________________________________________

First-Year Enrollees:

  1. Total number of clients who reached all goals of their self-sufficiency plan


  1. Percentage of caseload who reached all goals of their self-sufficiency plan


Second-Year Enrollees:

  1. Total number of clients who reached all goals of their self-sufficiency plan


  1. Percentage of caseload who reached all goals of their self-sufficiency plan




  1. ________


  1. ________



  1. ________



  1. ________




  1. ________


  1. ________



  1. ________


  1. ________






  1. ________



  1. ________


  1. ________



  1. ________

07

Client Progress: Remote and Underserved Areas Clients

Remote and underserved clients only

At 3 months:

  1. Percentage of remote/underserved areas clients who moved from at-risk to stable in one or more assessment categories from intake to 3 months


  1. 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:

  1. Percentage of remote/underserved areas clients who moved from at-risk to stable in one or more assessment categories by case closure


  1. Percentage of remote/underserved areas clients who moved from stable to thriving in one or more assessment categories by case closure




  1. ________





  1. ________





  1. _________





  1. _________





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)

  1. Number of clients participating in extended cultural orientation as their main group activity

  2. Number of clients in specific support groups (list totals for each)

    1. Art therapy

    2. Music therapy

    3. Gender-based support groups

    4. Cultural/ethnic support groups

    5. Youth support groups

    6. Other (list)____________



  1. Number of clients whose self-sufficiency scores improved by at least 50% at end of group services


  1. Number of clients whose scores show no significant improvement (49% or less) and referred to ICM at end of group services




















  1. ________


  1. ________

  1. ______

  2. ______

  3. ______


  1. ______

  2. ______

  3. ______





  1. ________





  1. ________




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




Data Point

Description

Indicators

No. Clients Served




09

Program Services and Components









  1. Average frequency of case worker interaction per ICM client (give totals by # of affiliates reporting for each category of frequency)


  1. 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)


  1. Total number of hours of interpretation provided


  1. Total number of client referrals and linkages


  1. Total number of clients provided with Emergency Financial Assistance (EFA)


  1. Total number of clients provided with immigration status services this reporting period (includes LPR and naturalization assistance)


  1. Weekly:

  1. Bi-weekly:

  1. Monthly:

















  1. _______



  1. _______



  1. _______




  1. _______




  1. _______



Volunteer and Community Engagement



10

Outreach and Dissemination


  1. New providers/partnerships this reporting period (list)

  2. Medical service provider

  3. Legal service provider

  4. Educational organization

  5. Local/state government entity

  6. Faith-based group

  7. Other (list) __________



  1. Number of community outreach hours this reporting period




  1. _______

  2. _______

  3. _______

  4. _______

  5. _______

  1. p. ______________



  1. _______




11

Volunteer Engagement and Hours Contributed by Pro Bono Service


  1. Number of new volunteers engaged this reporting period


  1. Number of new mentor-client matches this reporting period


  1. Total number of volunteers who served this reporting period


  1. Total number of volunteer hours donated


w. Major volunteer activities (list):






  1. Other resources generated (cash, in-kind, etc.)





  1. ______



  1. ______


  1. _______



  1. _______



  1. _______________

___________________

___________________

___________________




  1. _______________

___________________

___________________

___________________






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.


An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.








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