Form 1 SOT Program Data Points Form

Office of Refugee Resettlement (ORR) Services for Survivors of Torture (SOT) Program Data Points (PDP) and Performance Progress Reports (PPR)

Instrument 1. SOT Program Data Points Form FY23

Program Data Points Form (PDPs)

OMB: 0970-0599

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OMB NO: 0970-XXXX

EXPIRATION DATE: XX/XX/XXXX

ACF Office of Refugee Resettlement: Services for Survivors of Torture

Program Data Points Form


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


Form: Survivors of Torture – Program Data Points (SOT-PDP)

Grantee 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 each year of the project period. Please use the narrative report to explain or highlight key program indicators and illustrate changes in outcome indicators. See the Program Data Points User Guide for more information: https://healtorture.org/content/office-refugee-resettlement

PROGRAM INDICATORS1

Data Point

Description

Indicators

No. of Clients Served

Data Validation Checks

01a

Active Caseload:


Client count during reporting period


New primary

New secondary

Continuing primary

Continuing secondary


TOTAL ACTIVE CLIENT COUNT


_____

_____

_____

_____


_____



Please double check your math when adding up all new and continuing clients in the line indicating the total active client count.

01b

Closed Caseload:


Client count during reporting period


New primary

New secondary

Continuing primary

Continuing secondary


TOTAL CLOSED CASE COUNT



_____

_____

_____

_____


_____



Please double check your math when adding up all new and continuing clients in the line indicating the total closed case count.

02

Age when first subjected to torture



(Primary survivors only)


Under 5 years

5 – 17 years

18 – 44 years

45 – 64 years

65 years and over


TOTAL


_____

_____

_____

_____

_____


_____


Add the number of new primary and continuing primary clients from DP01a to get the total number of active primary survivors:


01a. New primary: ______ + 01a. Continuing primary: ______ = _______


The total number of active primary survivors should be equal to the total ages reported to the left. If this is not the case, please check your entries for DP02.


Total number of active primary survivors = ______


Total reported for DP02 = ______


Data Point

Description

Indicators

No. of Clients Served

Data Validation Checks

03


Type of torture suffered



(Primary survivors only)


Asphyxiation

Beating

Burning

Deprivation

Electrical

Forced postures

Gender-based violence

Kidnapping and disappearances

Rape and sexual torture

Sensory stress

Severe humiliation

Threats and psychological torture

Witnessing torture of others

Wounding/maiming

Other:

Please specify_________________


TOTAL



_____

_____

_____

_____

_____

_____

_____

_____

_____

_____

_____

_____

_____

_____


_____


_____



Compare the total number of active primary survivors to the total number of types of torture reported to the left:


Total active primary survivors = ______


Total types of torture from DP03 = ______


The total number of types of torture from DP03 should be greater than or equal to the total number of active primary survivors. If this is not the case, please go back and check your entries for DP03.

04


Reason for torture



(Primary survivors only)



Breakdown of authority/terror by non- state actors

Ethnicity

Nationality

Religion

Social group

Clan/Tribe

Gender

Gender identity

Sexual orientation

Sociopolitical activism

Other:

Please specify_________________


TOTAL



_____


_____

_____

_____

_____

_____

_____

_____

_____

_____


_____



_____



Compare the total number of active primary survivors to the total number of reasons for torture reported to the left:


Total active primary survivors = ______


Total reasons for torture from DP04 = ______


The total number of reasons for torture from DP04 should be greater than or equal to the total number of active primary survivors. If this is not the case, please go back and check your entries for DP04.



Data Point

Description

Indicators

No. of Clients Served

Data Validation Checks

05

Country where torture occurred



(Primary survivors only)


Country 1:

Country 2:

Country 3:

Country 4: …


Unknown


(Report all countries)


TOTAL



_____

_____

_____

_____




_____


_____



Compare the total number of active primary survivors to the total number of countries reported to the left:


Total active primary survivors = ______


Total countries from DP05 = ______


The total number of countries from DP05 should be greater than or equal to the total number of active primary survivors. If this is not the case, please go back and check your entries for DP05.


06

Client goal(s) at intake


Behavioral

Housing

Interpersonal/Social

Legal

Occupational/Educational

Physical/Medical


TOTAL



_____

_____

_____

_____

_____

_____


_____



Compare the total number of active clients (primary and secondary) from DP01a to the total number of goals reported to the left:


Total active clients from DP01a = ______


Total goals from DP06 = ______


The total number of goals from DP06 should be greater than or equal to the total number of active clients (primary and secondary). If this is not the case, please go back and check your entries for DP06.


07

Gender



Female

Male

X (unspecified or another gender identity)


TOTAL



_____

_____

_____


_____



Compare the total number of active clients (primary and secondary) from DP01a to the total number of genders reported to the left:


Total active clients from DP01a = ______


Total genders from DP07 = ______


The total number of genders from DP07 should be equal to the total number of active clients. If this is not the case, please go back and check your entries for DP07.



Data Point

Description

Indicators

No. of Clients Served

Data Validation Checks

08

Immigration category/status

at intake


Afghan Humanitarian Parolee

Asylee (include derivatives)

Asylum Applicant

Refugee (include derivatives)

Special Immigrant Juvenile (SIJ)

Special Immigrant Visa Holder (SIV)

Lawful Permanent Resident (LPR)

Former refugee (include derivatives)

Former asylee (include derivatives)

Other former: Please specify___________

U.S. Citizen

Former refugee (include derivatives)

Former asylee (include derivatives)

Other former: Please specify___________

U.S. born citizen

Ukrainian Humanitarian Parolee

Undocumented

Unknown

Other at intake:

Please specify______________________


TOTAL


_____

_____

_____

_____

_____

_____


_____

_____

_____


_____

____

____

_____

_____

_____

____


_____







_____



Compare the total number of active clients (primary and secondary) from DP01a to the total number of categories/statuses reported to the left:


Total active clients from DP01a = ______


Total categories/statuses from DP08 = ______


For the lines labeled “Lawful Permanent Resident (LPR)” and “U.S. Citizen,” please enter the subtotal of the lines below (former refugee, former asylee, other former, U.S. born citizen). When checking the total for immigration categories/statuses, be careful not to double count the LPR and U.S. Citizen subtotals and the categories beneath it.


The total number of categories/statuses from DP08 should be
equal to the total number of active clients. If this is not the case, please go back and check your entries for DP08.


09

Age at intake


Under 5 years

5 – 17 years

18 – 44 years

45 – 64 years

65 years and over


TOTAL



_____

_____

_____

_____

_____


_____



Compare the total number of active clients (primary and secondary) served from DP01a to the total number of ages reported to the left:


Total active clients from DP01a = ______


Total ages from DP09 = ______


The total number of ages from DP09 should be equal to the total number of active clients. If this is not the case, please go back and check your entries for D09.




Data Point

Description

Indicators

No. of Clients Served

Data Validation Checks

10

Education prior to arrival


(For clients > 18 years of age at intake)



Less than 1 year

1-4 years

5-8 years

9-12 years

13-16 years

More than 16 years


TOTAL



_____

_____

_____

_____

_____

_____


____



Add the following age categories together from DP09:


18 – 44 years = ______


45 – 64 years = ______


65 years and over = ______


This gives you the total number of clients 18 years at intake = ______


Compare the total number of clients ≥ 18 years of age at intake to the total from DP10 to the left.


Total number of clients ≥ 18 years at intake = ______


Total education from DP10 = ______


The total reported in DP10 should be equal to the total number of clients 18 years or older at intake. If this is not the case, please go back and check your entries for D10.

11

Employment in the U.S. at intake


(For clients > 18 years of age at intake)



No work authorization

Unemployed and not seeking employment (e.g., students, elderly, disabled, and primary caregivers)

Unemployed, work authorized, and seeking employment

Employed with work authorization (PT/FT)


TOTAL



_____

_____



_____


_____


_____



Compare the total number of clients 18 years of age at intake calculated above to the total number of employment categories reported to the left:


Total clients 18 years of age at intake = ______


Total employment categories from DP11 = ______


The total number employment categories from DP11 should be equal to the total number of clients ≥ 18 years of age at intake. If this is not the case, please go back and check your entries for DP11.


12

Length of time in the U.S. at intake



Less than one year

1-5 years

More than 5 years

Unknown


TOTAL



_____

_____

_____

_____


_____



Compare the total number of active clients (primary and secondary) served from DP01a to the total number of categories reported to the left:


Total active clients from DP01a = ______


Total length of time in the U.S. at intake from DP12 = ______


The total number of categories from DP12 should be equal to the total number of active clients. If this is not the case, please go back and check your entries for DP12.



Data Point

Description

Indicators

No. of Clients Served

Data Validation Checks

13

Country of origin


Country 1:

Country 2:

Country 3:

Country 4: …


(Report all countries)


TOTAL



_____

_____

_____

_____



_____



Compare the total number of active clients (primary and secondary) from DP01a to the total number of countries reported to the left:


Total active clients from DP01a = ______


Total countries from DP13 = ______


The total number of countries from DP13 should be equal to the total number of active clients. If this is not the case, please go back and check your entries for DP13.


14

Ethnicity


Ethnicity 1:

Ethnicity 2:

Ethnicity 3:

Ethnicity 4: ….


Unknown


(Report all ethnicities)


TOTAL


_____

_____

_____

_____


_____




_____



Compare the total number of active clients (primary and secondary) from DP01a to the total number of ethnicities reported to the left:


Total active clients from DP01a = ______


Total ethnicities from DP14 = ______


The total number of ethnicities from DP14 should be equal to the total number of active clients. If this is not the case, please go back and check your entries for DP14.


15

Religion


Buddhism

Christianity

Hinduism

Islam

Judaism

None

Unknown

Other:

Please specify______________________


TOTAL


_____

_____

_____

_____

_____

_____

_____

_____


_____



Compare the total number of active clients (primary and secondary) from DP01a to the total number of religions reported to the left:


Total active clients from DP01a = ______


Total religions from DP15 = ______


The total number of religions from DP15 should be equal to the total number of active clients. If this is not the case, please go back and check your entries for DP15.




Data Point

Description

Indicators

No. of Clients Served

Data Validation Checks

16

Languages used


Language 1:

Language 2:

Language 3:

Language 4: …


(Report all languages used)


TOTAL



_____

_____

_____

_____




_____



Compare the total number of active clients (primary and secondary) from DP01a to the total number of languages reported to the left:


Total active clients from DP01a = ______


Total languages from DP16 = ______


The total number of languages from DP16 should be equal to the total number of active clients. If this is not the case, please go back and check your entries for DP16.


17

Clients served by service category


Behavioral

Housing

Interpersonal/Social

Legal

Occupational/Educational

Physical/Medical


TOTAL



_____

_____

_____

_____

_____

_____


_____



Compare the total number of active clients (primary and secondary) from DP01a to the total number of service categories reported to the left:


Total active clients from DP01a = ______


Total service categories from DP17 = ______


The total number of service categories from DP17 should be greater than or equal to the total number of active clients. If this is not the case, please go back and check your entries for DP17.


18

Professionals/community members trained under SOT


Community

Education

Interpretation/translation

Law Enforcement

Legal

Medical

Mental health

Social work

Other:

Please specify:______________________



_____

_____

_____

_____

_____

_____

_____

_____


_____



There are no data validation checks for this data point.



Data Point

Description

Indicators

No. of Clients Served

Data Validation Checks

19

Pro bono professional service hours donated to SOT program



Administrative, managerial, and other professional services

Accounting, development, and grant writing

Information technology and research

Interpretation/Translation

Legal

Medical services

Mental health services

Social services

Other:

Please specify:______________________



Number of hours


_____

_____

_____

_____

_____

_____

_____

_____


_____



There are no data validation checks for this data point.



OUTCOME INDICATORS2

  • Indicate the tool from which you have derived the client-level data you are reporting here in the aggregate:

SOT-PWI-S Our Program Tool Case File Review Other: Please specify

  • Complete all the boxes for each data point below to show aggregate changes in the level of need.

Data Point

Description

Level of Need

END

1

In Crisis

2

Vulnerable

3

Stable

4

Safe

20.a

New Clients

Legal (Immigration)

S T A R T

1

In Crisis

N=





2

Vulnerable

N=





3

Stable

N=





4

Safe

N=






Data Point


Description


Level of Need

END

1

In Crisis

2

Vulnerable

3

Stable

4

Safe






20.b

Continuing Clients






Legal (Immigration)






S T A R T

1

In Crisis


N=





2

Vulnerable

N=





3

Stable

N=





4

Safe

N=






Data Point

Description

Level of Need

END

1

In Crisis

2

Vulnerable

3

Stable

4

Safe







21.a

New Clients







Housing







S T A R T

1

In Crisis

N=





2

Vulnerable

N=





3

Stable

N=





4

Safe

N=





Data Point

Description

Level of Need

END

1

In Crisis

2

Vulnerable

3

Stable

4

Safe






21.b

Continuing Clients






Housing





S T A R T

1

In Crisis

N=





2

Vulnerable

N=





3

Stable

N=





4

Safe

N=







Data Point

Description

Level of Need

END

1

In Crisis

2

Vulnerable

3

Stable

4

Safe







22.a

New Clients







Employment







S T A R T

1

In Crisis

N=





2

Vulnerable

N=





3

Stable

N=





4

Safe

N=





Data Point

Description

Level of Need

END

1

In Crisis

2

Vulnerable

3

Stable

4

Safe






22.b

Continuing Clients






Employment





S T A R T

1

In Crisis

N=





2

Vulnerable

N=





3

Stable

N=





4

Safe

N=








Data Point


Description


Level of Need

END

1

In Crisis

2

Vulnerable

3

Stable

4

Safe






23.a

New Clients






Physical

Health





S

T

A

R

T

1

In Crisis

N=





2

Vulnerable

N=





3

Stable

N=





4

Safe

N=












23.b

Continuing Clients








Physical

Health


Level of Need

END

1

In Crisis

2

Vulnerable

3

Stable

4

Safe





S T A R T

1

In Crisis

N=





2

Vulnerable

N=





3

Stable

N=





4

Safe

N=








Data Point


Description


Level of Need

END

1

In Crisis

2

Vulnerable

3

Stable

4

Safe






24.a

New Clients






Mental

Health





S T A R T

1

In Crisis

N=





2

Vulnerable

N=





3

Stable

N=





4

Safe

N=













24.b

Continuing Clients









Mental

Health

Level of Need

END

1

In Crisis

2

Vulnerable

3

Stable

4

Safe






S T A R T

1

In Crisis

N=





2

Vulnerable

N=





3

Stable

N=





4

Safe

N=







Data Point

Description

Level of Need

END

1

In Crisis

2

Vulnerable

3

Stable

4

Safe






25.a

New Clients






Access to community resources





S T A R T

1

In Crisis

N=





2

Vulnerable

N=





3

Stable

N=





4

Safe

N=













25.b

Continuing Clients









Access to community resources

Level of Need

END

1

In Crisis

2

Vulnerable

3

Stable

4

Safe






S T A R T

1

In Crisis

N=





2

Vulnerable

N=





3

Stable

N=





4

Safe

N=







Data Point

Description

Level of Need

END

1

In Crisis

2

Vulnerable

3

Stable

4

Safe






26.a

New Clients






U.S.-Based

Support Systems





S T A R T

1

In Crisis

N=





2

Vulnerable

N=





3

Stable

N=





4

Safe

N=













26.b

Continuing Clients









U.S.-Based

Support Systems

Level of Need

END

1

In Crisis

2

Vulnerable

3

Stable

4

Safe






S T A R T

1

In Crisis

N=





2

Vulnerable

N=





3

Stable

N=





4

Safe

N=






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


The purpose of this information collection is to collect demographic, programmatic, and outcome data in order to learn more about the population being served, the types of services they receive, and the effectiveness of those services. Public reporting burden for this collection of information is estimated to average 6 hours per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. This is a mandatory collection of information (Funding Announcement: HHS-2022-ACF-ORR-ZT-0051). This collection of information is required to retain a benefit (Torture Victims Relief Act of 1998, Pub. L. 105-320). If you have any comments on this collection of information, please contact the Administration for Children and Families, Office of Refugee Resettlement, Division of Refugee Health, 330 C Street, SW, 5th Floor, Washington, DC 20201 or email drh-rmh-team@acf.hhs.gov. 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. The OMB number and expiration date for this collection are OMB #: 0970-XXXX, Exp: XX/XX/XXXX.

1 Refer to the Program Data Points User Guide for all definitions

2 Use the Survivor of Torture Psychosocial Well-being Index (Short Version) (SOT-PWI-S) © 2016 Hodges-Wu & Zajicek-Farber to aggregate the data for these indicators. (See User Guide, Appendix A)

Program Data Points pg. 1

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