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ORR-4 Outcomes Report Form Instructions
Unaccompanied Refugee Minors (URM) Program
Office of Refugee Resettlement
What is the ORR-4 Report?
• An annual progress and outcome report for minors and youth in the URM Program.
• Provides information on education, personal functioning of youth, and family reunification.
• Provides information on transition to adulthood services and outcomes similar to information tracked on
other foster youth and former foster youth, via the National Youth in Transition Database.
• Aids the Office of Refugee Resettlement (ORR) to assess the youths’ progress toward adulthood. Also
meets reporting requirements of the Immigration and Nationality Act (8 U.S.C. 1522(d)).
• Assists ORR in understanding program effectiveness and broader planning for the URM Program.
Note 1: Failure to provide these reports may result in delay, suspension, or termination of grant support.
Note 2: “URM,” “minor,” or “youth” in the ORR-4 Report Form and Instructions refers to both children under the
age of 18 and youth over the age of 18 who are receiving or have received placement, services, and/or benefits
funded by ORR.
Who completes and submits the ORR-4 Report?
• The URM provider completes the report form in the URM module of ORR’s Refugee Arrivals Data System
(RADS).
• Once the report form is completed, the URM provider submits it to the State Agency.
• The State Agency then reviews the report and submits it to ORR.
How is the ORR-4 Report structured? There are seven sections in the report form.
• Section I: Report Action
• Section II: Identifying Data
• Section III: Education and Personal Functioning of the Youth
• Section IV: Family Reunification
• Section V: Transition to Adulthood Services
• Section VI: Outcomes
• Section VII: Report Submission Authority
What are the types of ORR-4 Reports and when are they due?
• Annual Outcomes Report: completed for current URM clients who are receiving ORR-funded services.
• Follow-up Annual Report: completed for former URM clients who are 17 to 21 years old and who
terminated all ORR-funded services and benefits after the age of 17.
• Both types of ORR-4 Reports are due annually on the anniversary of the initial placement date, up until
the youth’s 21st birthday.
PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: Through this information collection,
the Administration for Children and Families (ACF) is gathering data on youth served through the Unaccompanied Refugee Minors
Program including their location, status, and progress. Public reporting burden for this collection of information is estimated to average .5
hours for respondents from state agencies, 1 hour for respondents from provider agencies, and .5 hours for youth participants, 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 (8 U.S.C. 1522(d)). 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 Paperwork Reduction Act of 1995, unless it displays a currently valid
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How do I begin a new ORR-4 Report in RADS?
• Log in to the URM database using your registered User ID and Password.
o If you do not have a registered User ID and Password, please contact your state agency.
• Under the URM menu, navigate to Cases, then select “Search.” Search for the case using youth’s
identifying criteria. ORR suggests searching by either Alien Number or Case ID, as there are often youth
with the same or similar names in the database.
• Click “Edit,” then select “ORR-4” at the bottom. Finally, select “New ORR-4 Form.”
• Begin at Section I: Report Action. Follow instructions below.
Reminders:
• Consult the instructions when you are unsure of what information is to be reported. The instructions can
be found under the dropdown menu on the “Help” tab in RADS.
• If a change is needed to the data on the URM Child Information screen, contact ORR at
• RADS uses controls and auto-population functions. Review data for accuracy prior to submitting to ORR.
SECTION I: REPORT ACTION
Select the type of report:
1. Annual Outcomes Report. This report is submitted for all current clients that are receiving ORR-funded
placement, services, and/or benefits. For URMs who are younger than 17, Sections I, II, III, IV, and VII
are required. Sections V and VI are also required for URMs ages 17-21.
2. Follow-up Annual Report. This report is only for former URM clients who are 17 to 21 years old and who
have terminated all ORR-funded services/benefits after age 17. Only Sections VI and VII are required.
Date data was collected: Enter the month, day, and year that the outcome data was collected from the youth for
Section VI. The age will auto-populate based on the youth’s date of birth.
SECTION II: IDENTIFYING DATA
Date of Birth and Gender will auto-populate from the ORR-3 Initial Placement Report.
SECTION III: EDUCATION and PERSONAL FUNCTIONING of the YOUTH
1. Education Information
a. Most Recent Education and Grade Level, if applicable.
• Regular Mainstream School
o Includes public, private, and charter schools.
o Select the most recent education level completed by the youth that was assigned by the
school.
o Example: For a youth currently in the 11
th
grade, “10
th
grade” is the most recent grade level
completed.
• Alternative to High School
o An educational establishment with non-mainstream curriculum and methods for students
working towards a high school equivalent credential.
Office of Management and Budget (OMB) control number. The OMB # is 0970-0034 and the expiration date is 11/30/2026. If you have
any comments on this collection of information, please contact Anne Mullooly at [email protected].
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o Select the most recent education level completed by the youth that was assigned by the
educational entity.
o Dual-credit program: Select if youth is working on high school completion while also enrolled
as a community college student.
Note: If the youth completed mainstream or alternative high school in the reporting period and is now
enrolled in a vocational or post-secondary educational program, do not complete the most recent
education level completed. Rather, select from the remaining options in this section to report on the
youth’s most recent education in the reporting period.
• GED program: Select if the youth was enrolled, even if not completed yet.
o General Educational Development, or GED, is offered either in person or online to obtain a
certificate that indicates a level of knowledge equivalent to a high school graduate.
• Trade/Vocational program: Select if the youth was enrolled, even if not completed yet.
o A specific skill, vocation, or technique-building program that offers a certificate when a youth
completes the program.
o Examples include electrician, massage therapy, culinary arts, cosmetology, auto mechanics,
building trades, nursing, computer technician, and other current or emerging employment
sectors.
• Job Corps/Job Corps equivalent: Select if the youth was enrolled, even if not completed yet.
o Job Corps is a free or low-cost residential education and job training program for young
adults ages 16–24.
o Job Corps typically offers career planning, on-the-job training, job placement, residential
housing, food service, driver’s education, health and dental care, a basic living allowance,
and clothing allowance.
• Post-secondary education: Select if youth has a high school diploma or GED certificate and has
taken classes at a 2- or 4-year College or University.
• Not in school: Select if youth was not in school in the reporting period.
Note: Provide additional information about the youth’s education/grade level in the text box, if necessary.
b. Youth is receiving English Language Learner (ELL) support.
• Check the appropriate box: “Yes” or “No.”
• ELL can be provided by public schools, religious organizations, colleges, after-school programs,
or private tutors.
2. Caseworker/Provider Assessment
Assess the youth’s functioning in the following domains, using the 5-point scale provided. Provide
explanation on any impediments to the youth’s progressive development in the areas, or actions detailed
in the youth’s plan to support improvement in these areas.
Scale: 1 for poor, 2 for below average, 3 for average, 4 for above average, 5 for excellent.
Assessment domains:
• English Language Skill
• Education (other than English)
• Social Adjustment
o Youth’s ability and skills to cope with standards and values of American society.
• Health Condition
o Includes both medical and dental health.
• Mental Health
o Youth’s cognitive, behavioral, and emotional wellbeing that affect their daily life,
relationships, and functioning.
• Preservation of Ethnic and Religious Heritage
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o Youth’s preserving, valuing, and expressing of their culture, language, ethnic activities, or
holidays.
• Readiness to Live Independently
o Youth’s ability and skills to provide for their needs and manage all aspects of their lives
(e.g., school, job, finances, interpersonal relationships, self-care).
Note: While URM youth come from a wide variety of cultural and educational backgrounds, assessment
of URM youth should be based on the age-appropriate functioning level of their peers in the general
population/community. ORR acknowledges the subjective nature of this assessment but is interested in
tracking how youth functioning progresses throughout their duration of care in the URM program. For
additional guidance and examples on assessing youth functioning, please see Addendum at the
end of these Instructions.
SECTION IV: FAMILY REUNIFICATION
1. The youth has a permanency plan. Indicate whether the youth has a permanency plan by selecting “Yes”
or “No.” Youth may not have a permanency plan if over the age of 18, or if emancipated from foster care
and receiving only ORR-funded services or benefits. If response was “Yes”, proceed to 1.a.
a. The youth’s most recent primary permanency goal. Select primary permanency goal from the
following options. When there are concurrent permanency goals, report only primary goal.
• Adoption
• Guardianship
• Reunification
• Another Planned Permanent Living Arrangement (APPLA)
• Permanent Placement with Fit and Willing Relative (PPFWR)
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2. Family reunification efforts in the reporting period
a. Parents or relatives in the U.S. have been (re-)assessed for reunification. Indicate whether parents or
relatives in the U.S. have been assessed, in the reporting period, for reunification by selecting “Yes”
or “No.”
b. There have been significant developments in reunification efforts. Indicate if there have been
significant developments, in the reporting period, in family reunification efforts with parents or
relatives in the U.S., by selecting “Yes” or “No.” Describe efforts and significant developments in the
reporting period.
• Do not report on reunification efforts by the UC program, but report reunification assessment only
after the youth has entered the URM program.
c. There has been a decision to not reunify the youth with a parent or relative. Indicate if there has been
a decision, in the reporting period, to not reunify a youth with a parent or relative in the U.S., who has
been assessed for reunification, by selecting “Yes” or “No.” If “Yes,” explain any decisions for not
reunifying youth. If the youth has no relatives in the U.S. or relatives in the U.S. were not assessed
as permanency resources in the past 12 months, select “No.”
• When providing information on relationships, please be specific if possible; for example, aunt,
grandfather, cousin. If the relationship is not clear to the youth and URM provider agency,
indicate ‘female family member,’ or ‘male family member.’
3. There have been family tracing efforts with parents or relatives in other countries for the purpose of
reunification. Indicate if there have been family tracing efforts with parents or relatives in other countries
for the purpose of reunification, by selecting “Yes” or “No.” If “Yes,” please describe tracing efforts.
• Include contact with siblings or relatives who are adults and could potentially serve as caregivers.
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On rare occasions, if a youth is placed permanently with a fit and willing relative in the U.S.
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SECTION V: TRANSITION TO ADULTHOOD SERVICES
This section must be completed for youth who are in care and are ages 17 or older. This section should be
completed based on the URM provider agency’s knowledge of services provided to the youth during the reporting
period.
1. Youth’s residence: Enter the address of the youth’s residence.
2. Service Types: Select “Yes” or “No” reflective of youth receipt of each of the following services, a - q.
a. Youth remains in foster care
• Indicate whether the youth was in foster care under the placement and care responsibility of the
state, county, or URM provider agency.
• Placement includes but is not limited to foster family homes, therapeutic foster homes, group
homes, supervised-independent living, and residential treatment facilities.
b. Post-adjudication juvenile probation
• Indicate whether the youth was found guilty by a judge of committing a delinquent act and is/was
receiving post-adjudication juvenile probation services.
c. Special education
• Services specifically designed to meet the unique needs of a child with a disability.
d. Independent living needs assessment
• A systematic procedure to identify a youth’s basic skills, emotional and social capabilities,
strengths, and needs to match the youth with appropriate independent living services.
• May also address knowledge of basic living skills, job readiness, money management abilities,
decision-making skills, goal setting, task completion, and transitional living needs.
e. Academic support
• Includes services designed to help a youth complete high school or obtain a General Educational
Development (GED).
• Examples: academic counseling; preparation for a GED, including assistance in applying for or
studying for a GED exam; tutoring; study skills training; literacy training; and help accessing
educational resources.
f. Post-secondary educational support
• Includes services designed to help a youth enter or complete post-secondary education.
• Examples: classes for test preparation; counseling about college; information about financial aid
and scholarships; help completing college or loan applications; or tutoring while in college.
g. Career preparation
• Includes services that focus on developing a youth’s ability to find, apply for, and retain
appropriate employment.
• Examples:
o Vocational and career assessment (e.g., career exploration and planning, guidance in setting
and assessing vocational and career interests and skills, and help in matching interests and
abilities with vocational goals)
o Job seeking and job placement support (e.g., identifying potential employers, writing
resumes, completing job applications, developing interview skills, job shadowing, receiving
job referrals, using career resource libraries, understanding employee benefits coverage, and
securing work permits)
o Retention support and job coaching (e.g., learning how to work with employers and other
employees, understanding workplace values such as timeliness and appearance, and
understanding authority and customer relationships)
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h. Employment programs/vocational training
• Includes apprenticeships, internships, occupational/trade programs, or summer employment
programs.
• Examples: electrician, massage therapy, culinary arts, cosmetology, auto mechanics, building
trades, nursing, computer technician, and other current or emerging employment sectors.
• Does not include summer or after-school jobs secured by the youth alone.
i. Budget & financial management
• Includes training and practice in the following areas: living within a budget; opening and using a
checking and savings account; balancing a checkbook; developing consumer awareness and
smart shopping skills; accessing information about credit, loans, and taxes; and filling out tax
forms.
j. Housing education & home management training
• Housing education includes assistance or training in locating and maintaining housing (e.g., filling
out a rental application and acquiring a lease, handling security deposits and utilities,
understanding practices for keeping a healthy and safe home, understanding tenants’ rights and
responsibilities, and handling landlord complaints).
• Home management includes instruction in food preparation, laundry, housekeeping, living
cooperatively, meal planning, grocery shopping, and basic maintenance and repairs.
k. Health education & risk prevention
• Includes information about mental health and self-care, hygiene, nutrition, fitness and exercise,
personal safety and situational awareness, emergency preparedness, and first aid; medical and
dental care benefits, health care resources and insurance, prenatal care and maintaining
personal medical records; education and information about sexual development and sexuality,
pregnancy prevention and family planning, and prevention of sexually transmitted diseases and
AIDS; substance abuse prevention and intervention.
• Does not include the youth’s actual receipt of direct medical care or substance abuse treatment.
l. Family support & healthy marriage education
• Includes education and information about safe and stable families, healthy marriages, spousal
communication, parenting, responsible fatherhood, childcare skills, teen parenting, and domestic
and family violence prevention.
m. Mentoring
• Refers to when youth has been matched with a screened and trained adult for a one-on-one
relationship that involves the two meeting on a regular basis.
• Can be short-term, but it may also support the development of a long-term relationship.
• While youth often are connected to adult role models through school, work, or family, this service
category only includes a mentor relationship that has been facilitated, paid for, or provided by the
state or URM provider agency.
n. Supervised independent living
• May not be supervised 24 hours a day, but an agency or adult is responsible and accountable for
the youth’s wellbeing and safety.
• May continue to receive case management services.
• May be given increased responsibilities to manage own living arrangement (e.g., paying bills,
assuming leases, working with a landlord).
o. Room & board financial assistance
• Includes payment that is paid for or provided by the state or URM provider agency for room and
board, including rent deposits, utilities, and other assistance.
p. Education financial assistance
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• Includes assistance that is paid for or provided by the state or URM provider agency for
education or training.
• Examples: allowances to purchase textbooks, uniforms, computers, and other educational
supplies; tuition assistance; scholarships; payment for educational preparation and support
services (e.g., tutoring); payment for GED and other educational tests; and vouchers for
vocational education.
q. Other financial assistance
• Includes any other payments that are not mentioned above and made or provided by the state or
URM provider agency to help the youth live independently. List type of financial assistance.
SECTION VI: OUTCOMES
The questions in this section are designed to collection information on current and former URM clients ages 17
and older. This includes youth receiving placement services (e.g., foster care), youth receiving ORR-funded
services/benefits only (e.g., Education and Training Vouchers), and youth who terminated from the program after
age 17 and are no longer receiving any ORR-funded services/benefits. Responses are not based on the URM
provider’s assessment of the youth’s outcomes. Rather, responses should be based on the perception and self-
report of the youth when surveyed by the URM provider staff. To assist in accurate data collection, URM
providers may tweak the questions in their conversations with youth based on how services and benefits are
labeled or defined in their respective states. If the provider, based on their knowledge, believes the youth did not
answer correctly or misunderstood the question, the provider may consider asking a follow-up clarifying question.
1. Outcomes reporting status. Select the most appropriate option that represents the youth’s participation,
or lack thereof, in the outcome data collection.
a. Youth participated. The youth participated in the outcome data collection, either fully or partially.
b. Youth declined. The youth was successfully located and invited to participate but declined to take
part in the outcome data collection.
c. Incapacitated. The youth has a permanent or temporary mental or physical condition that prevented
them from participating in the outcome data collection.
d. Incarcerated. The youth was unable to participate in the outcome data collection because of their
incarceration.
e. Runaway/missing. The youth is known to have run away or is missing from their foster care
placement.
f. Unable to locate or invite. The state or URM provider agency could not locate a youth who is not in
foster care or otherwise invite such a youth’s participation.
g. Death. The youth died prior to their participation in the outcome data collection.
2. Date of outcome data collection. Date will auto-populate from Section I.
3. Foster care status. Indicate whether the youth is in foster care under the placement and care
responsibility of the state, county, or URM provider agency by selecting ‘‘Yes’’ or ‘‘No.” Includes, but is
not limited to, placement in foster family homes, group homes, and residential treatment facilities.
For items 4-26, select “Yes” if given outcome description is applicable, based on the youth’s self-report.
Otherwise, select “No.” Additionally, select “Declined” if the youth declined to participate in the outcome data
collection, or “Don’t Know” (items 21-26 only) when the youth did not know an answer.
4. Current full-time employment
• Select “Yes” if the youth is employed at least 35 hours per week in one or multiple jobs as of the date
of the outcome data collection.
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5. Current part-time employment
• Select “Yes” if the youth is employed between 1 and 34 hours per week in one or multiple jobs as of
the date of the outcome data collection.
6. Employment-related skills
• Select “Yes” if the youth completed an apprenticeship, internship, or other on-the-job training, either
paid or unpaid, in the past year.
• The experience must help the youth acquire employment-related skills, e.g., specific trade skills such
as carpentry or auto mechanics, or office skills such as word processing or use of office equipment.
7. Social Security
• Select “Yes” if the youth is receiving Supplemental Security Income (SSI) or Social Security Disability
Insurance (SSDI), either directly or as a dependent beneficiary as of the date of the outcome data
collection.
• SSI payments are made to eligible low-income persons with disabilities.
• SSDI payments are made to persons with a certain amount of work history who become disabled.
8. Educational aid
• Select “Yes” if the youth is using a scholarship, voucher (including Education or Training Vouchers
pursuant to section 477(h)(2) of the Social Security Act), grant, stipend, student loan, or other type of
educational financial aid to cover educational expenses as of the date of the outcome data collection.
• Scholarships, grants, and stipends are funds awarded for spending on expenses related to gaining an
education.
• Student loan is a government-guaranteed, low-interest loan for students in post-secondary education.
9. Public financial assistance
• Select “Yes” if the youth is receiving ongoing cash welfare payments from the government to cover
some of their basic needs, as of the date of the outcome data collection.
• Does not include government payments or subsidies for specific purposes, such as unemployment
insurance, childcare subsidies, education assistance, food stamps, or housing assistance.
10. Public food assistance
• Select “Yes” if the youth is receiving assistance in any form (e.g., government-sponsored checks,
coupons, or debit cards) to buy eligible food at authorized stores, as of the date of the outcome data
collection.
• Includes public food assistance through the Special Supplemental Nutrition Program for Women,
Infants, and Children (WIC) and Supplemental Nutrition Assistance Program (SNAP).
11. Public housing assistance
• Select “Yes” if the youth is living in government-funded public housing or receiving a government-
funded housing voucher to pay for part of their housing costs, as of the date of the outcome data
collection.
• Does not include room and board payments funded through the State Chafee Program.
12. Other financial support
• Select “Yes” if youth is receiving any other periodic and/or significant financial resources or support
from another source not listed in the elements described in elements 8-11 of this section, as of the
date of outcome data collection.
• Includes payments from a spouse or family member (biological, foster, or adoptive), child support that
the youth receives, or funds from a legal settlement.
• Does not include occasional gifts, such as birthday or graduation checks or small donations of food or
personal incidentals, childcare subsidies, child support for a youth’s child, or other financial support
that does not benefit the youth directly in supporting himself or herself.
13. Highest educational certification received. Select only ONE from the following options:
a. A GED is a certificate a student receives if they have passed a high school equivalency test.
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b. A high school diploma is a diploma awarded for the completion of high school. This can include
just high school completion, as well.
c. A vocational certificate is a document stating that a person has received education or training that
qualifies them for a particular job, e.g., auto mechanics or cosmetology.
d. A vocational license is a document that indicates that the state or local government recognizes an
individual as a qualified professional in a particular trade or business.
e. An associate’s degree is generally a 2-year degree from a community college.
f. A bachelor’s degree is a 4-year degree from a college or university.
g. A higher degree indicates a graduate degree, such as a master’s degree or a Juris Doctor (J.D.).
h. None of the above means that the youth has not received any of the above educational
certifications.
14. Current enrollment and attendance
• Select “Yes” if the youth is currently enrolled in and attending high school, GED classes, or post-
secondary vocational training or college, as of the date of the outcome data collection.
• A youth is still considered enrolled in and attending school if the youth would otherwise be enrolled in
and attending a school that is currently out of session (e.g., summer break.)
15. Connection to adult
• Select “Yes” if, as of the date of the outcome data collection, the youth knows an adult who they can
go to for advice or guidance when there is a decision to make or a problem to solve, or for
companionship when celebrating personal achievements.
• The adult must be easily accessible to the youth either by telephone or in person. This can include
but is not limited to adult relatives, parents, or foster parents. The definition excludes spouses,
partners, boyfriends or girlfriends, and current caseworkers.
16. Homelessness
• Select “Yes” if the youth had no regular or adequate place to live, in the past year.
• Examples: lived in a car or on the street or staying in a homeless or other temporary shelter.
17. Substance abuse referral
• Select “Yes” if the youth was referred for an alcohol or drug abuse assessment or counseling.
• Includes either a self-referral or referral by a social worker, school staff, physician, mental health
worker, foster parent, or another adult.
18. Incarceration
• Select “Yes” if the youth was confined in a jail, prison, correctional facility, or juvenile or community
detention facility in connection with allegedly committing a crime (misdemeanor or felony), in the past
year.
19. Children
• Select “Yes” if the youth has given birth herself, or the youth has fathered any children who were
born.
• This refers to biological parenthood only.
20. Marriage at child’s birth
• Select “Yes” if the youth was married at the time of the child’s birth.
• Do not include Common Law Marriages or customary marriages, which did not result in
documentation of the marriage recognized by the state or country of residence at the time of the
marriage.
21. Medicaid
• Select “Yes” if the youth is enrolled in Medicaid, a medical assistance program supported by the
Federal and State government under title XIX of the Social Security Act, as of the date of the outcome
data collection.
22. Other health insurance coverage
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• Select “Yes” if the youth has a third-party payer (other than Medicaid) for all or part of the costs of
medical care, mental health care, and/or prescription drugs.
• Includes group coverage offered by employers, schools or associations, an individual health plan,
self-employed plans, inclusion in a parent’s insurance plan, or ORR-funded medical coverage.
• Does not include medical or drug discount cards or plans.
23. Health insurance type: Medical
• Select “Yes” if the youth has health insurance coverage in the element described in 22 of this section,
which pays for all or part of the costs for medical care services.
24. Health insurance type: Mental health
• Select “Yes” if the youth has health insurance coverage as described in 22 of this section, which pays
for all or part of the costs for mental health services, such as counseling or therapy.
25. Health insurance type: Prescription drugs
• Select “Yes” if the youth has health insurance coverage as described in 22 of this section, which pays
for all or part of the costs of prescription drugs.
26. Health insurance type: Other
• Select “Yes” if the youth has health insurance coverage as described in 22 of this section that pays
for part of or all costs of other medical services, e.g., dental or vision. Enter the other type of
coverage in the blank provided.
SECTION VII: REPORT SUBMISSION AUTHORITY
Agency names will auto-populate from the first page of the report form.
1. Provider Agency
• Provide the name, title, phone number, and email address of the person preparing the report and the
date the report was prepared. Include a secondary contact at the provider agency.
• Do not backdate submission date.
2. State/URD Agency
• Provide the name, title, phone number, and email address of the state official submitting the report,
and the date the report was submitted to ORR.
• Do not backdate submission date.
• When returning reports for revisions, it is important to clearly identify the issue and explain corrective
measures.
3. ORR: Provide the name, title, and approval date. Enter any comments on the approval or denial of the
report.
ADDENDUM: Guidance for Caseworker/Provider Assessment of Youth Functioning for Section III.2.
Below are example criteria that can be used to help guide the ratings a caseworker selects. These are just
examples to help provide some consistency; the examples should not be used as explicit criteria where youth
must “check off” each element.
Poor
Below Average
Average
Above Average
Excellent
English
Language Skill
Client has no
English skills.
Client is not
enrolled in ESL
classes.
Client has limited
English
conversational,
reading and/or
writing skills.
Client speaks
conversational with
reading and writing
skills.
Client
communicates
effectively in English
through speaking,
reading, and writing.
Client is fully proficient
in English.
Client can read and
write in English.
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Poor
Below Average
Average
Above Average
Excellent
Client requires
interpretation.
Client is enrolled in
ESL classes or
other language
instruction.
Client requires
interpretation for
most interactions.
Client no longer
requires ESL
classes.
Client requires
interpretation for
specialized
services (e.g.
medical and legal).
Client requires
interpretation rarely,
utilizes interpreter or
technology
resources when the
need arises.
Client does not require
interpretation.
Education
(other than
English)
Client has no prior
educational
experiences or
has a gap of
several years in
education.
Client is not
enrolled in school
or refuses to
attend school.
Client has gaps in
prior educational
experiences.
Client unable to
complete age-
appropriate
coursework without
significant support.
Client enrolled in
school, has poor
attendance.
Client completes
age-appropriate
coursework,
receives age-
appropriate
supports such as
tutoring.
Client is enrolled
and consistently
attends school.
Client is passing
classes and
advancing in their
education.
Client completes
age-appropriate
coursework, with
minimal or no
educational
supports.
Client is enrolled
and has consistent
attendance at
school.
Client has passing
or good grades, has
a plan for future
education or career
goals.
Client excels in
classes with age-
appropriate peers.
Client does not require
educational supports,
such as tutoring.
Client receives good
to excellent grades.
Has completed, or is
on track to complete, a
high school education.
Has a plan for future
education or career
goals.
Health
Condition
Client has
untreated or
unaddressed
medical needs.
Client not
receiving needed
medical care for a
chronic
condition(s).
Client is
inconsistent in
managing health
needs.
Client has a
present illness or
physical health
concern that is not
stable.
Client has a
medical condition,
with proper
treatment received.
Client is stable in
managing chronic
health condition(s)
with support.
Client reports mostly
good health.
Client does not have
any new health
concerns.
Client is stable in
managing chronic
conditions with
minimal support.
Client has no medical
conditions and is in
good health.
Client has medical
conditions that are
well managed
independently.
Mental Health
Client has mental
health conditions
unaddressed or
untreated.
Client
demonstrates
patterns of
instability including
plans to harm self
or others.
Client has
identified mental
health concerns,
bouts of instability,
and/or refusing
treatment.
Client reports
some ideation of
harming self or
others, but denies
plan, intent, or
means.
Client presents as
mostly stable and
mostly uses age-
appropriate
emotional
regulation skills.
Client is aware of
mental health
needs and is
receiving regular
treatment or
support.
Client does not
report, or does not
demonstrate,
behaviors indicating
mental health
concerns.
Client is receiving
treatment and
effectively managing
mental health needs
with support.
Client does not report,
or does not
demonstrate,
behaviors indicating
mental health
concerns.
Client has mental
health conditions that
are well managed
independently.
Social
Adjustment
Client
demonstrates
major challenges
adjusting to life in
the U.S., including
adjusting to a
different value
Client is
inconsistent in
adjusting to life in
the U.S. and
engaging with their
community.
Client regularly
demonstrates that
they are adjusting
to the U.S. and
engaging in their
community.
Client frequently
demonstrates that
they are adjusting to
the U.S. and
engaging in their
community.
Client has fully
adjusted to life in the
U.S. and is an active
member of the
community.
12 of 13
Poor
Below Average
Average
Above Average
Excellent
system, and
engaging with
their community.
Client
demonstrates no
knowledge of
coping skills.
Client has no
social connections
including with
peers, caregivers,
or other trusted
adults.
Client has
knowledge of
coping skills but
does not apply
them.
Client has limited
social connections
with peers,
caregivers, or other
trusted adults.
Client
demonstrates
knowledge of
coping skills and
applies them with
age-appropriate
consistency.
Client has regular
social connects
with peers,
caregivers, or other
trusted adults.
Client has coping
skills that they
consistently apply.
Client has close
connections to
peers, caregivers, or
other trusted adults.
Client has many
coping skills that they
consistently use
independently.
Client has strong,
long-term connections
to peers, caregivers,
or other trusted adults.
Preservation of
Ethnic and
Religious
Heritage
Client is not
connected to their
ethnic or religious
community.
Client does not
participate in
ethnic or religious
community
activities to retain
a connection to
their heritage.
Client has no
social connections
to others from a
similar
background in the
community.
Client is minimally
connected to their
ethnic or religious
community.
Client does not
regularly
participate in
ethnic, or religious
community
activities to
preserve a
connection to their
heritage.
Client has limited
social connections
to others from a
similar background
in the community.
Client is connected
to their ethnic or
religious
community.
Client regularly
participates in
ethnic or religious
community
activities to
preserve a
connection to their
heritage.
Client has regular
social connections
to others from a
similar background
in the community.
Client has strong
connections to their
ethnic or religious
community.
Client frequently
participates in ethnic
or religious
community activities
to preserve a
connection to their
heritage.
Client has close
peer, mentor, or
social connections
to others from a
similar background
in the community.
Client has strong
connections to their
ethnic or religious
community and
demonstrates a
healthy sense of pride
in their heritage.
Client frequently
participates in ethnic
or religious community
activities and
encourages peers and
others in the
community to remain
connected to their
heritage.
Client has strong,
long-term peer,
mentor, or social
connections to others
from a similar
background in the
community.
Readiness to
Live
Independently
Client is far less
prepared to live
independently
than their peers
(of similar age) in
the community.
Client lacks
necessary
understanding of
basic U.S. laws
and customs.
Client is unable to
complete age-
appropriate daily
Client has fewer
independent living
skills that their
peers (of similar
age) in the
community.
Client has a basic
understanding of
U.S. laws and
customs.
Client is able to
care for most of
their own age-
appropriate daily
living tasks with
Client
demonstrates a
level of readiness
to live
independently after
age 18, that is at a
similar level as their
peers (of similar
age) in the
community.
Client is familiar
with U.S. laws and
customs.
Client is able to
care for their own
Client demonstrates
readiness to live
independently after
age 18, that is at a
more advanced
level than their
peers (of similar
age) in the
community.
Client utilizes their
understanding of
U.S. laws and
customs to navigate
the community.
Client lives
independently in the
community or
demonstrates
readiness to live
independently.
Client successfully
navigates U.S.
systems on their own.
Client cares for all
their own age-
appropriate daily living
tasks independently.
13 of 13
Poor
Below Average
Average
Above Average
Excellent
living tasks without
support
appropriate
support though
may need
significant support
with more
advanced skills
age-appropriate
daily living tasks.
Based on age,
some support may
be needed with
advanced skills.
Client cares for their
own age-
appropriate daily
living tasks with
minimal support.
