1 STAR Program Data Point Form

OMB Control Number: 0970-0490

Expiration date: 03/31/2026

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 15 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 Margaret.Barnard@acf.hhs.gov.

In immediate response to priorities of the current administration, this form has been updated with the following changes prior to approval by the Office of Management and Budget (OMB), as required by the Paperwork Reduction Act (PRA) of 1995 (44. USC. 3501 et seq.). The PRA requires that agencies obtain OMB approval before requesting information from the public, and OMB review and approval for most changes to an approved information. ACF is working to process these changes through OMB to come into compliance with the PRA but has implemented changes to the OMB-approved form to ensure compliance with the following Executive Orders: Executive Order(s) 14168 and/or 14151, 14173, 14224. Other than these changes, this form is approved under OMB #: 0970-0490.

Assessment Area 1: Core Service Delivery

Section 1: Aggregate Client Demographics

Enter aggregate data for indicators 1-7 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: Individual Client Demographics and Outcomes

Complete data points 7-13 for EACH enrolled client

7. Date client enrolled in STAR Program: __________________________

7. Date client case closed (if applicable): __________________________

7. Age at intake (Select one):

• Under 5 years

• 5 – 17 years

• 18 – 24 years

• 25 - 44 years

• 45 – 64 years

• 65 years and over

7. Sex (Select one):

• Female

• Male

7. Country of origin (select one):

• Country 1:

• Country 2:

• Country 3:

• Country 4:

7. Activities/services client received to date (select all that apply):

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 score for EACH client in the following categories.

• Indicate the client’s Safety & Wellness Benchmarks score at intake and during their most recent assessment. If the client has not been enrolled long enough to receive a second assessment, please leave ‘most recent score’ blank. 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+): Enter the client’s Mental Health, Relationship Safety, and Self-Efficacy score

• For children and youth (under age 18): Enter the client’s Mental Health and Relationship Safety score
  
  

13a. Mental Health

Score at Intake (select one):

1

1.5

2

2.5

3

3.5

4

Not enough information

Most Recent Score (most recent quarter or case closure – select one):

1

1.5

2

2.5

3

3.5

4

Not enough information

13b. Relationship Safety

Score at Intake (select one):

1

1.5

2

2.5

3

3.5

4

Not enough information

Most Recent Score (most recent quarter or case closure – select one):

1

1.5

2

2.5

3

3.5

4

Not enough information

13c. Self-Efficacy – adults only

Score at Intake (select one):

1

1.5

2

2.5

3

3.5

4

Not enough information

Most Recent Score (most recent quarter or case closure – select one):

1

1.5

2

2.5

3

3.5

4

Not enough information

Assessment Area 2: Capacity Building

Complete Assessment Area 2: Capacity Building data points 14-15using aggregate data for the reporting period.

14. Professional training areas for staff

___ Interpretation/translation

___ Mental health

___ Physical/Medical health

___ Social services

___ Family-specific interventions

___ Other: Specify_____

15. 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:_______________