R&P Cultural Orientation Model Assessment. Participant Name Case # Date CO Completed Date of Assessment. Additional Notes

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1 R&P Culural Orienaion Model Assessmen Paricipan Name Case # Assessor Name Dae CO Compleed Dae of Assessmen Addiional Noes Reminders for assessors: Locally- or culurally-relevan erms may be subsiued in English or in he language of he assessmen. Any erm used in English or oher languages may be defined or rephrased if he paricipan does no undersand he word. Parial credi should only be awarded where indicaed. Promp and boxes do no receive credi. The assessmen should be given o one paricipan a a ime. Do no indicae o he paricipan wheher responses are correc or incorrec during he adminisraion of he assessmen. You can say hank you or ok afer each response o indicae you are moving on o he nex quesion. You should provide reassurance or sop he assessmen if he paricipan becomes upse or frusraed. You should promp he paricipan for anoher answer or o be more specific if (1) he answer was almos correc bu oo vague, (2) he paricipan misundersood he quesion, or (3) he paricipan indicaes he quesion is no applicable o her or him. Before beginning he assessmen: Make a saemen such as he following: We are conducing his assessmen o find ou how much you know abou he U.S. afer aending culural orienaion. Your responses will no have any impac on he services provided o you and your name will no be used in any repors abou he resuls. Please le me know if you need o sop or ake a break. This saemen can be made in any language and using any wording ha feels comforable, as long as he following ideas are conveyed: o o Resuls will no affec services provided o individuals or case members. Daa will no be repored publically by name. R&P Culural Orienaion Model Assessmen Page 1

2 R&P Culural Orienaion Model Assessmen o Paricipans may sop or ake a break a any ime. R&P Culural Orienaion Model Assessmen Page 2

3 R&P Culural Orienaion Model Assessmen 1 Wha is one reason why i is imporan o learn English? Response: Give 1 poin for correc answer Reason should reflec survival or comfor in he U.S., e.g., employmen, acculuraion, alking o Americans, English is he language spoken here. A response like because he case worker said o should no be considered a correc answer. If he paricipan saes ha s/he already speaks English, promp Why is i imporan for anyone in he U.S. o learn English? 2 Wha is your address and phone number? Address (Mus include house #, sree name, ap # [if applicable], and ciy): Displayed or said correcly Give 0.5 poin for correc answer Phone number (Mus have area code if rouinely saed by locals): Displayed or said correcly Give 0.5 poin for correc answer EXEMPTION: Paricipan has no phone Informaion mus be said, wrien, or displayed in English. You may promp he paricipan if s/he does no menion a criical elemen (e.g., Wha is he ciy? ), and all criical elemens mus be saed accuraely for full credi. If a paricipan canno remember address and/or phone number or canno say i in English, promp Do you have i wrien down on somehing you carry wih you? Displaying address and phone number on somehing carried a all imes (including cell phone or pocke card) should be considered a correc answer. If paricipan does no have a personal phone number, you may mark Exemp. Exemp R&P Culural Orienaion Model Assessmen Page 3

4 R&P Culural Orienaion Model Assessmen 3 Can you ell me wo services provided by [name of agency] ha help refugees resele or adjus o life in he U.S.? Promp Response 2: Promp If needed, response 3: Give 0.5 poin for each correc answer (maximum 1 poin) If clien names somehing relaed o bu no he responsibiliy of he reselemen agency or does no specify how he service provided by anoher organizaion is conneced o he agency (e.g., says public assisance insead of signs me up for public assisance ), promp Can you hink of anyhing else? If an individual s responses are all oo general (e.g., hey will help me, healh ), you may promp Can you hink of specific hings hey can do o help you adjus o life in he U.S.? Local reselemen agencies should provide assessors wih a lis of correc responses (e.g., wha direc services and referrals are offered) and wha responses are close bu no direcly conneced or oo vague and hus suiable for promping. 4 For each healh concern ha I say, indicae wheher you should care for i yourself, make an appoinmen wih your docor s office, or go o a hospial emergency room. #1: Your ches or hear hurs (Answer: hospial) #2: You have a runny nose (Answer: yourself) #3: You have an earache for hree days (Answer: docor) #4: You have a small cu on your finger (Answer: yourself) #5: You hink you have broken your ankle (Answer: hospial) #6: You have a big rash on your back (Answer: docor) Give 1 poin for all 6 correc, 0.5 poin for 3-5 correc, and 0 poins for 0-2 correc R&P Culural Orienaion Model Assessmen Page 4

5 R&P Culural Orienaion Model Assessmen 5 If you were a he hospial and needed an inerpreer, wha would you say in English or do o ask for one? If needed, response 2: Fully correc bu requires promp Give 1 poin for fully correc iniial response, or give 0.5 poin for each correc answer (maximum 1 poin) A fully correc iniial response would include a quesion or a saemen in English signifying he need for an inerpreer and an indicaion of which language is needed (1 poin). If he paricipan does no say he name of her or his language, promp How would you ell hem wha language you speak? (response mus be in English). English responses need no be grammaically correc bu mus be comprehensible. Demonsraing he use of a language reques card or saing ha he paricipan would call someone hey know who speaks English should be awarded full credi (1 poin). If he paricipan saes ha s/he already speaks English, promp Wha if you needed o ask for an inerpreer for anoher person? 6 When your [name of iniial assisance program] ends, how will you/your family ge money? Promp If needed, response 2 Give 1 poin for correc iniial response or response o promp (maximum 1 poin) If he paricipan says somehing vague like he governmen or he communiy, promp Can you be more specific? (he paricipan mus hen name or describe a governmen/communiy program or office). If he paricipan saes ha anoher family member will suppor her or him, promp How will s/he ge money o suppor he family? Depending on he paricipan s siuaion, correc responses may include employmen of self or oher household members as well as federal or sae income suppors. R&P Culural Orienaion Model Assessmen Page 5

6 R&P Culural Orienaion Model Assessmen 7 Wha are wo hings a refugee can do o become employed? Response 2: Promp Promp If needed, response 3: Give 0.5 poin for each correc answer (maximum 1 poin) Response should reflec angible seps oward employmen, including seps on a job search or applicaion, learning English, job raining, or geing necessary documenaion. If refugee s response is oo general (e.g., go o he agency ) or relaed o aribues ha make one employable (e.g., be hardworking and hones ), promp Can you hink of anyhing else? If he refugee indicaes hey canno work due o age or disabiliy or if hey are already employed, promp Wha can any refugee do o become employed? 8 Imagine I am a friend who is saying wih you a your home. Tell me how o ge from your home o he neares grocery sore. Be sure o give me specific insrucions so ha I can ge here by myself. Response: Promp If needed, response 2: Give 1 poin for correc iniial response or response o promp (maximum 1 poin) Assessor may subsiue anoher criical service such as drug sore, food panry, or laundroma (if no in paricipan s own aparmen complex). answers may be a descripion of driving or walking direcions or saing which bus/rain o ake and where o ge off. The paricipan need no name specific srees bu should provide some descripion of which direcion and how far o go (if walking or driving) or how far o go on public ransporaion. The answer should provide sufficien evidence ha he paricipan knows where he grocery sore or oher criical service is; he quesion is no esing he paricipan s abiliy o provide direcions. R&P Culural Orienaion Model Assessmen Page 6

7 R&P Culural Orienaion Model Assessmen 9 Wha migh happen if you do no pay your ren? Promp If needed, response 2 Give 1 poin for correc iniial response or response o promp (maximum 1 poin) If paricipan saes ha anoher family member pays he ren, promp Wha migh happen o your family if [name of family member] does no pay he ren? answers include become eviced/have o leave he home, bad credi repor, ge sued by landlord, oher legal consequences depending on he localiy. 10 Wha are hree hings you should do o be safe in your home? Response 2: Response 3: Give 1 poin for all 3 correc, 0.5 poin for 1-2 correc, and 0 poins for 0 correc Answers may be saed as hings o do or o have (e.g., supervise children in he bahub, keep a fire exinguisher in he aparmen) or hings o avoid (e.g., don smoke in bed). R&P Culural Orienaion Model Assessmen Page 7

8 R&P Culural Orienaion Model Assessmen 11 Imagine you are helping a newly-arrived refugee learn o use he local ransporaion sysem (buses or subway). Wha are wo specific hings you would ell or show him or her in order o ake he bus or subway? Deail 1: Deail 2: Give 0.5 poin for each correc answer (maximum 1 poin) Exemp EXEMPTION: There is no public ransporaion Relevan deails migh include: buy a icke, use a icke, use coins o pay, read a map, board he rain/bus, exi he rain/bus, where o ge on, where o ge off (each of hose couns as one deail). If paricipan is likely o need specialized ransporaion for he disabled, ask abou his sysem. For specialized ransporaion, one deail such as whom o call may suffice, depending on he level of independence required o access/use service. TOTAL SCORE: ou of Toal poins awarded # quesions aemped (9.5, 10, or 11) R&P Culural Orienaion Model Assessmen Page 8