STAR Program Data Point Form

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Program Data Points (PDP) Form 
OFFICE OF REFUGEE RESETTLEMENT
Division of Refugee Health
Support for Trauma-Affected Refugees (STAR) 

Agency: Administration for Children and Families (ACF)/Office of Refugee Resettlement (ORR)

Form: Support for Trauma-Affected Refugees (STAR)
Grant Recipient Name: 

Grant Number:

Point of Contact:  
Reporting Period
From: 
MM/DD/YYYY               
To: 
MM/DD/YYYY
Reporting: Submit annual program data with the second semi-annual report (PPR) each year of the project period. Please use the narrative portion of the PPR to explain or highlight key program indicators and illustrate trends in outcome indicators. Please see the PDP User Guide for more information.


PAPERWORK REDUCTION ACT (PRA) OF 1995 (Public Law 104-13) STATEMENT OF PUBLIC BURDEN:  The purpose of this information collection is to measure how the STAR program is achieving the goal of sustained psychosocial well-being of ORR-eligible clients whose experience of trauma is impeding their ability to function effectively at home, school, work and/or in social settings. Public reporting burden for this collection of information is estimated to average 3 hours per grantee, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information.  This collection of information is required to retain a benefit (Immigration and Nationality Act (INA)).  An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the PRA of 1995, unless it displays a currently valid OMB control number. If you have any comments on this collection of information, please contact Maggie Barnard at [email protected]. 





Assessment Area 1: Core Service Delivery
Section 1: Client Demographics 

Enter aggregate data for indicators 1-15 for all new and continuing clients served during the reporting period.

1a. Client count
                           ___New client
                           ___Continuing client
                           ___Closed client

1b. Family composition (aggregate):
___ Family unit enrolled in STAR
___ Single enrollment from a family unit
___ Single

2. Client language of preference (aggregate):
___ Language 1:
___ Language 2:
___ Language 3:
___ Language 4: …

3. Employment status in the U.S. at intake (aggregate):
___ Unemployed and not seeking employment 
___ Unemployed and seeking employment
___ Employed part-time
___ Employed full-time

4. Immigration category/status at intake (aggregate):
___ Afghan Humanitarian Parolee
___ Afghan Individual with SI/SQ Parole (aka Afghan Special Immigrant Parolee) 
___ Afghan Individual with Special Immigrant Conditional Permanent Residence (SI CPR)
___ Amerasian
___ Asylee 
___ Cuban and Haitian Entrant
___ Iraqi and Afghan Special Immigrant Visa Holder (SIV)
___ Legal Permanent Resident (LPR)
___ Refugee 
___ Special Immigrant Juvenile (SIJ)
___ Ukrainian Humanitarian Parolee
___ Victim of human trafficking
___ Other at intake: 
                ___ Please specify________________

5. Length of time in the U.S. at intake:
___ <1 year
___ 1-2 years
___ 3-5 years

6. Type of trauma exposure (aggregate - include all that apply):
               ___  Physical violence
               ___  Psychological violence
___ Sexual violence
___ Deprivation of basic needs
___ Forced labor
___ Domestic violence/abuse
___ Harm, or threats to harm, committed against a person(s) based on actual or perceived sex, or other related characteristics
___ Threats
___ Kidnapping or disappearances
___ Environmental/community exposure
___ Other




Section 2: Client Demographics and Outcomes

    7.  Age at intake:
___Under 5 years 
___5 – 17 years
___18 – 24 years
___25 - 44 years 
___45 – 64 years 
___65 years and over

    8. Sex:
___Female
___Male

    9. Country of origin (select one):
___Country 1:
___Country 2:
___Country 3:
___Country 4:

    10. Activities/services client received to date:

 MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT
___Individual therapy
___Family therapy
___Group therapy
___Family-strengthening interventions
___Support groups 
___Other: Specify______

PHYSICAL HEALTH
___Medical services
___Other: Specify______


SOCIOECONOMIC
___Childcare services
___Emergency assistance
___Employment services
___Housing services 
___Vocation/education 
___Other: Specify_____



Section 2: Individual Client Demographics and Outcomes (cont.):
Safety & Wellness Benchmarks


ORR requires quarterly assessments of each client using the Safety & Wellness Benchmarks. Enter the average score across all enrolled clients. 
        ◦ Indicate clients average Safety & Wellness Benchmarks score at intake and most recent assessment. If the client has not been enrolled long enough to receive a second assessment, please do not add a score for them. For continuing clients, use their intake score from when they entered the program, and their most recent score during this reporting period. Assess all enrolled clients quarterly and/or at case closure, whichever is sooner.
        ◦ For adults (ages 18+): Include Mental Health, Relationship Safety, and Self-Efficacy score
        ◦ For children and youth (under age 18): Include Mental Health and Relationship Safety score
        ◦ Calculate the ‘average score change’ by calculating each individual’s score change, then averaging the sum.

11a. Mental Health
Score at Intake:___

Most Recent Score (most recent quarter or case closure ): ___

Average score change from Intake to Most Recent Score____
11b. Relationship Safety
Score at Intake :___

Most Recent Score (most recent quarter or case closure): ___


        Average score change from Intake to Most Recent Score____
11c. Self-Efficacy – adults only
Score at Intake :___

Most Recent Score: ___

       Average score change from Intake to Most Recent Score____
Assessment Area 2: Capacity Building
Complete Assessment Area 2: Capacity Building data points 12-13 using aggregate data for the reporting period.
12. Professional training areas for staff 
___ Interpretation/translation
___ Mental health
___ Physical/Medical health
___ Social services
___ Family-specific interventions
___ Other: Specify_____

    13. Community-facing trainings (by profession/audience type)
___ Community (general)
___ Educators
___ Interpreters/translators
___ Law enforcement
___ Medical providers
___ Mental health providers
___ Social workers (non-clinical)
___ Other: Please specify:_______________