Nationally, there is evidence that over time, refugees tend to become comparable to the United States-born population along a variety of indicators, including labor force participation and business ownership, but there is a variation on how well refugees do according to their demographic characteristics such as national origin and gender, as well as their place of resettlement.31 While there is much debate about the reasons behind the discrepancies, one conclusion is that there are ways to increase successful integration among groups of refugees across resettlement locations. This research starts to scratch the surface of what can be done to improve integration experiences by highlighting innovative programs from across the nation. As previously stated, the programs fall under four topics drawn out by common themes from the interviews: employment; education; social integration; and targeted services for children, refugees who need mental health services, and deaf refugees.
Employment and entrepreneurship programs
Refugees encounter multiple barriers that prevent them from getting jobs commensurate with their experience and qualifications. These barriers can stem from limited English language proficiency, difficulty getting foreign credentials recognized locally, lack of networks in their field, and pressure to take any type of job to quickly become economically self-sufficient. Refugees often face these barriers when they first arrive, preventing them from meeting their full potential and forcing them to take jobs that do not match their qualifications. The employment and entrepreneurship programs covered in this study primarily offer services such as job placement, counseling, skills training, and business development services, either as a suite of services or a stand-alone service. Each of these programs is geared toward meeting a combination of needs to ensure that their refugee clients can obtain better and sustainable jobs, most preferably in their field.
For those who want to start businesses, barriers such as a lack of assets, of credit history, and of understanding how to run a business in the United States prevent them from starting businesses. For example, a program coordinator from the International Institute of St. Louis working in the Economic Development Department expressed that “on average, the folks that we were looking at had to wait at least ten years before they could get a bank loan.” Yet, even with such barriers, research has found that refugees are entrepreneurial; for example, 31 out of 1,000 Bosnian refugees are business owners, which is comparable to the U.S.-born population.32 Helping refugees overcome these challenges would further unlock their entrepreneurial potential.
Ideas used to improve employment and entrepreneurship prospects for refugees
The innovative ideas that employment programs use to help refugees find jobs that better match their skill level, guide them through a career path, and help them start businesses—all of which place them on a path to achieve economic self-sufficiency.
Employment and entrepreneurship programs provide a suite of services
In programs that provided employment and entrepreneurship services, institutions offered their refugee clients a blend of services that assisted them in working toward their career goals. For instance, Global Talent Idaho (GTI), based in Boise, Idaho, caters to highly skilled refugees and focuses on helping them “reclaim their professional careers” and place them “on a pathway to get to where they were in their country,” according to its program administrator. GTI uses a variety of tactics to meet their goals. For example, with the widely used Upwardly Global33 model—which aims to further professional integration of skilled immigrants and refugees—GTI provides their refugee clients with core classes to prepare them for a career path in the United States, help them build their resume, and have their foreign credentials evaluated.34 One of the key features of GTI is that they offer paid internships in collaboration with local employers, which adds to refugees’ experience and builds professional networks. They also pay for short-term training classes, such as the Microsoft Excel class they provided for a client who only had experience working with an older version of the software.
For those refugees and immigrants who want to start businesses, the Economic Development Department at the International Institute of St. Louis offers its clients a combination of business products.35 They provide their clients with various business loans that start from as low as $500 to as high as $35,000; provide them with technical assistance to teach them the ins and outs of doing business in the United States; and develop their credit score, credit history, and a portfolio—or, in the program administrator’s words, “an identity that they can take to the bank for when they need a bank loan.”
Job placement programs maintain lasting relationships with local employers
Program coordinators of selected job placement programs frequently seek out new relationships with local employers and maintain older ties so that they are aware of the demands of the local job market and can match their clients accordingly. A strong relationship between organizations serving refugees and local employers is critical, since refugees themselves have limited or no networks in the United States—especially in the field in which they want to work. The lack of networks means a lack of information about the availability of jobs and the knowledge about required qualifications for those jobs. A career services program under New American Pathways, funded through the HHS’ Social Services Grant and TAG, in Atlanta, places its success in the strong relationships it has built with local employers. This program is open to any refugee that has been in the United States for five years or less. The program administrator stated that:
Employers understand the value of working with us, in working with refugee clients. A lot of times, employers will seek us out because they’re looking for new streams of getting employers there. They’re like, ‘I heard refugees are great. I heard they work hard, or they stay at the job, and they’re loyal to the company and that they can pass all the background checks that are here.’
Employment programs involve employers or individuals with industry experience
In addition to maintaining relationships with local employers, employment programs often also have employers or experienced individuals from relevant fields conduct trainings, give presentations, act as mentors, and develop curricula for classes. This type of hands-on involvement of professionals provides an even stronger connection for the refugees and helps them better understand industry culture and jargon. The Hospitality Careers Pathway in St. Paul, Minnesota, under the International Institute of Minnesota, is designed to train female refugees to work in the hospitality industry.36 They recently hired a hospitality instructor who is a former hotel executive housekeeper to prepare refugee women to work as hotel housekeepers. Besides teaching the women about safety policies at hotels and basic cleaning skills, the program also trains its clients to develop soft skills necessary to retain a job. It trains them to boost their communication skills, including how to talk to co-workers, help guests, and handle a complain. Furthermore, for women who want to advance in the hospitality field, they have a supervisor training program that focuses on building leadership and management skills.
Similarly, the Manufacturing Employment Program—under the International Institute of Buffalo in New York—bases its curriculum in part on input from various manufacturing employers. The program coordinator discussed that involving employers has been an effective model:
What’s effective is that we’ve had the employers participate in the creation of the curriculum, so they really can’t say, ‘I don’t want to hire somebody.’ We asked them for their feedback when we created the class. We’ve used that model in the past, with other kinds of employers that we’ve worked with. We had a housekeeping program for years that we ran that was very successful, and that’s the model we used. We worked with a large employer in creating the curriculum.
In the same institute in Buffalo, another program called Healthcare Interpreter Training and Certification trains refugees to become certified medical interpreters. Geared toward bilingual refugees with at least a high school diploma or equivalent, this program uses a curriculum that meets national standards and calls on experts from the medical community, such as physician’s assistants, to discuss health conditions, treatments, procedures, tests, and other medical terms that students would need to know and understand while interpreting.
Similarly, a mentorship program known as Tatweer—which means “development” or “progress” in Arabic—under the Jewish Family Service of Seattle, uses professionals working in their fields as mentors to help refugees re-enter their fields and grow their networks.37 These mentors can provide refugees with valuable information about industry vocabulary; familiarize them with major and minor employers in that industry; validate their foreign training; and help them learn about their industry in the United States. For example, the program pair refugees who are civil engineers with civil engineers in the U.S. —or someone who works with civil engineers—to ensure that refugee professionals can get the most out of the program. Mentors also help with targeted job searches and are well-situated to connect their mentees to networks in the industry.
Counseling and mentorship programs utilize available community resources
Since counselors and mentors generally work one-on-one with refugees, they tailor their advice according to individual cases and often connect them to services available in the community. Programs increase their clients’ access to other service providers in the area when they pull from a larger pool of community resources. A vocational counseling program under New American Pathways focuses on helping refugees to “zero in on an achievable goal and reach that goal,” whether it is toward an educational path or a career path. They extensively pull from resources available in the community to provide refugees with the services that would benefit them. For example:
If it’s an IT [information technology] workshop, there are these different programs that are already set up that give IT workshops for free or low cost. … We’re connecting clients with that person, so that they can go that way. We’re not reinventing the wheel. We’re using the tools in the community to help clients out.
Similarly, Tatweer, the mentorship program, also collaborates with local community colleges to explore options for their clients—for instance, whether they would be better off taking a course that will help in their career goals or if there are other ways to help the client.
Entrepreneurship programs take advantage of online marketplaces to sell products made by refugees
One program selected for this research, in Clarkston, Georgia, is called Peace of Thread, which uses a sewing trainer from Iraq to train refugee women to sew bags and other items.38 At the end of their training, the refugees can take home the sewing machine they trained on and other sewing supplies, which gives them flexibility to work around their schedules, produce one-of-a-kind pieces, and earn an income. Finished pieces such as bags and purses are placed on Peace of Thread’s website to sell anywhere from $18 to more than $350. The women are paid $10 per hour for their labor and are taught to access their paychecks online. This program also has a branch in Memphis, Tennessee. While not included in this research study, versions of this model are used by other nonprofits such as SewREDI Buffalo in Buffalo, New York, and Re:new in Glen Ellyn, Illinois.39 These organizations are able to provide a range of services: Refugees learn a profitable skill; earn an income and become independent; learn how to manage their money and business; and get connected to other artisans in the community. They also provide the artisan refugees with a platform to sell their products—a service that would have been inaccessible for an individual without technical support and know-how.
Impact of employment and entrepreneurship programs on refugees
The employment programs had a variety of impacts on the lives of their refugee clients—beyond providing them with a way to earn income.
- For refugees trying to re-enter their professional fields, many of the participants obtained jobs in their fields. For example, Global Talent Idaho helped a refugee trained as a pharmacist find work as a pharmacy technician while studying to earn his pharmacy degree and helped an engineer find work in an engineering firm while working to get relicensed. The vocational counseling program in Atlanta successfully connected a doctor from the Middle East to a phlebotomy training program to become a phlebotomist while he was preparing for an exam to apply for a residency and practice medicine in the United States. Also, in their first year, Tatweer’s one-on-one mentorship program placed five of their 10 clients in jobs in their fields within six to nine months after they completed the program. They also have orientation classes that serve about 150 highly skilled individuals; these classes teach them about job markets and professional job searches.
- Working in professions that match their qualifications also provides refugees with dignity, hope, and a role model for their children. It is disheartening for a community to see a doctor or an engineer they know working as a taxi driver. The program coordinator for Global Talent Idaho recalled:
One of our doctors, when he first arrived, worked in a hot dog stand. It takes the dignity away from the entire community and the hope away from the children. I think when you start seeing teachers in the classrooms, which is happening through Global Talent Idaho … not only do the parents say, ‘OK, my kid can do it,’ or ‘I’m so glad the teacher—I know that teacher from the Congo.’ There’s just hope that others will rise above.
- Besides helping them learn basic entrepreneurship skills and open businesses, the economic development programs also help refugees become financially literate. They teach refugees the importance of saving, building credit, and utilizing mainstream banking. For instance, Peace of Thread teaches women to open an account and access their paychecks online. Credit building is so important that the Economic Development Department in Atlanta recently launched a credit-builder loan product focused exclusively on building credit history for their refugee and immigrant clients.40
- Also, since many of these services—especially skills trainings—are delivered in a group setting, refugees build relationships with other refugees from diverse backgrounds because many face similar issues. For example, the participants in the Hospitality Careers Pathway develop deep friendships and relationships that outlast the program.
Educational opportunities for refugees and their families
The programs identified in this set provide a range of educational services to children, youth, and adults to overcome different types of barriers. Many organizations provide English language classes, but the two English language programs selected for this report were designed to reach populations among the refugees who are homebound—mothers who must stay home with young children.41 This isolation essentially cuts women off from interacting with others and from improving their language skills. It also prevents children under the age of 5 from getting necessary experience to help them prepare for school. Furthermore, many parents of refugee children—young or school-age—are unaware of the benefits of early childhood education and are unfamiliar with the school systems.
Additionally, school-age children in refugee families face major hurdles in performing well at schools. For example, according to a program administrator at Bright Futures’ after-school program, many refugee children are placed in grades beyond their reading level. The after-school programs attempt to bridge the gap as much as possible so that the children can do well in school. And as such, this collection of programs is critical to refugee integration because they make vital language services accessible to many homebound refugees and their children; raise awareness among refugee parents; and help refugee students flourish in school—all of this will help in other aspects of their lives.
Selected innovative ideas in delivering educational services
Some programs use techniques to devise solutions for issues that make it difficult for refugees to access essential educational services. Others are able to broaden refugees’ social networks to enhance their knowledge about cultures, norms, and systems.
Educational programs utilize home-based classes for hard-to-reach refugee women and families with young children
Many refugee women with small children may not be able to leave their homes and access mainstream English language classes for reasons such as child care. The HELLO Program, under the International Institute of Buffalo in New York, is modeled to deliver English language classes to such women at home. A trained volunteer goes to his or her client’s home for two hours per week for eight weeks and follow a curriculum to teach them English—some end up also teaching their clients about practical matters such as money and shopping in grocery stores. The program usually matches clients and volunteers by gender because many female refugees prefer female volunteers. The home-based nature of the classes can sometimes benefit the whole family. The coordinator of this program recalled an example of a volunteer:
He went there with the assignment of working with the mom, and all the sudden, the grandparents were participating. He wound up teaching the whole family.
This model has been so successful that they are looking toward expanding this program to refugees in the workforce—those who may be too tired to go to English classes after work.
Another program uses the same model to reach refugees, although to meet a different goal. New American Pathways has two programs for parents: one called Parents as Teachers (PAT), for those with young children under the age of 5, and another called School Liaison Services, for those with school-age children. While each program has a distinct goal, both involve regular home visits. The PAT program is designed for parents of young children to ensure school readiness and prevent child abuse. The program coordinator relayed that the main activities during these visits are:
Helping parents do skill building—activities with the children that are developmentally appropriate. Also, talk about expectations that the parents may have from their children. Talk about developmental milestones. Talk about appearance. Talk about different topics that are important: nutrition, safety, sleep, discipline, attachment. Also, do different screening from the children—developmental screening, health screening.
Through home visits, the School Liaison Services tracks how the child fares in the home environment and if there is anything that needs improvement. This program is primarily designed to form a bridge between parents, schools, and children.
Many educational programs have staff and volunteers who are U.S.-born or former refugees, increasing refugees’ networks
Although not by design, many volunteers in the HELLO Program are U.S.-born or former refugees. This increases the interaction of refugees with people outside the resettlement agencies and helps them develop different relationships. These interactions introduce them to American culture and a different way of life. Another program in Clarkston, Georgia, called the Refugee Family Literacy Program, offers English classes designed for mothers and their small children of age 5 and under. While mothers are attending the English classes, their young children go through an early childhood development program.42 The program also has a component that brings mothers and children together for activities and another component that teaches mothers life skills. The Refugee Family Literacy Program uses volunteers from the refugee community as teacher’s assistants for young children, helping them to maintain a connection with their first language while learning English.
The staff in the PAT program and School Liaison Services are also former refugees who understand the challenges that refugee parents face; can clearly communicate the responsibility of parents who have students enrolled in American schools; and can guide them as they navigate the school system. As the program coordinator of the Refugee Family Literacy Program stated:
The staff are former refugees themselves. The parents who know very well what it is to try to register your kid to school. Who know very well what it is to try to talk to the teacher who doesn’t speak your language, to try to even read that progress report that has all this weird symbols and numbers. You have no idea what it says. They are the pioneers. They came here maybe eight years ago trying to navigate the system. Now they’re the experts. They share the knowledge. They have relationships with schools established already. They literally guide the families and newly arrived families with the process.
After-school programs offer well-rounded services to bridge the educational gap facing refugee children
Refugee children often need an extra push to bring them up to speed with other children in their age group; they may have suffered from trauma, had limited access to education, and have parents who are themselves learning English.43 A program coordinator at Bright Futures’ after-school program in Atlanta pointed out that many refugee children are behind their grade level because they are often placed in classes above their reading level. The result of this mismatch is that the children struggle to do the work assigned to them. These after-school programs for elementary and middle school students follow a curriculum that matches the children’s reading level and provide students with homework assistance when parents cannot help because they may lack sufficient education or English language proficiency. They conduct a literacy assessment in the beginning and middle of the year to identify and track the reading levels of children. Then, the students are divided into small reading groups, which meet at least once a week, according to their reading level. They also provide students with a safe space to stay after school because their parents may work double shifts.
Impact of education programs on refugee families, children, and youth
- Providing opportunities to learn English is one of the main impacts of programs focused on language, especially for refugees who may not have easy access to these programs. For example, the HELLO Program increases access to English language services by teaching refugees English at home, and the Refugee Family Literacy Program provides parallel classes for mothers and their small children.
- Given that young children in some of these programs, such as the Refugee Family Literacy Program and PAT program, take development assessments and are under educators’ constant supervision, there are more opportunities to diagnose developmental challenges at an early age.
- After-school programs have observed increases in refugee children’s literacy levels and positive changes in their behavior at school. For example, according to the program coordinator, the program in Atlanta saw an average of around five levels of advancement, which is “more than a grade level in a year of after school.”
- The PAT program coordinator stated that, in 2017, the program registered more than 100 refugee children in pre-K, which it sees as a direct result of educators working with refugee parents. The coordinator stated that the PAT educators working with the refugee parents explain:
To them, the value of early learning, sharing the research, shifting stereotypes—from ‘my child is too young to learn’ to the point where the parents understand that ‘no, actually this extra year will prepare them better for school.’ It will set them up for success. They will learn valuable skills, particularly because parents have limited ability to help them once they enter school system.
- In programs that encourage group activities, such as in the Refugee Family Literacy Program, refugee women develop a sense of community, build a support system, and camaraderie. For example, the program coordinator recalled:
Another huge effect which maybe is the most important thing we’re doing, is development of community and the mothers at our school. They’re always on duty with their children, and this is their only uninterrupted adult time that they have ever. They really, really cherish that and are able to form friendships with other students in their classes and with teachers.
- Another program, called the Colorful Growers program under Project Focus on Integrating Newcomers through Education (FINE) in Winona, Minnesota, aims to educate refugee and immigrant youth about agriculture—teaching them how to grow vegetables, as well as how to sell them in the market, where they also learn about entrepreneurship, teamwork, and communication.44 While the young people learn leadership and responsibility, the larger community gets an opportunity to interact with people from diverse backgrounds selling fresh produce in the local market.
Boosting social integration of refugees
Social integration programs chosen for this research are unique and have different goals, but they all have an impact on furthering social integration of refugees. While there are many definitions of social integration, it generally occurs when newcomers and the larger society adapt to one another while maintaining their own cultural integrity.45 Interaction among groups is one of the main ways through which social integration occurs. Highlighted here are initiatives started by police departments to serve their respective refugee communities better; a refugee settlement model in Connecticut that involves volunteers as co-sponsors; and an honors class taught in Jacksonville, Florida, that involves college students with the refugee community. These programs are diverse in their goals and methods but offer opportunities for refugees to interact and build trust with other community members. In doing so, they illustrate a range of practical ideas.
Initiatives focus on interaction and education between refugees and community members
Programs that have a focus on bringing community members together help build trust and relationships among participants. The Boise Police Department in Idaho has a full-time refugee liaison officer who stated that he works “closely with the community and the stakeholders that affect refugee and former refugees’ lives.”46 The officer added that while working toward building trust, his job is to educate refugees about how to become integrated and good community members. But the burden is not just on the refugees; the program involves police officers from different departments, such as property crime detectives, school resource officers, patrol officers, and canine officers, to meet with refugees to explore issues together during a 10-week program. The liaison officer recalled:
They got the chance to really share some stories, share background information, discuss lifestyles growing up. How is growing up in Boise different than growing up in Baghdad? How was traveling throughout the United States as a young kid different than traveling throughout the region of Congo, the Democratic Republic of [Congo]? They had a chance to really discuss what it was like to be human in different parts of the world.
Another initiative at Hicks Honors College (HHC) at the University of North Florida (UNF) in Jacksonville combines elements of education and interaction in college coursework. HHC has a class for their first-year honors students where they are paired up with refugee families to provide some basic assistance, such as mentoring their young children, providing homework assistance, practicing the English language, playing games, and helping parents with simple chores. The class is mutually beneficial for the college students and refugee families. It provides students who may have had very little interaction with refugees with a chance to see how they live and how hard they work and to learn about their lives; it allows refugee families to form a connection with college students who are typically from outside their networks.
Another program in Winona, the diversity training program under Project FINE, uses education to bridge the gap between refugees and the community by providing opportunities for local businesses to learn about refugees and build cultural competency. Project FINE’s staff go out in the community and conduct diversity trainings for businesses, government, and educational institutions. These are paid services, and the presenters tailor the trainings according to the needs of the client. Most of the staff who conduct presentations are themselves refugees or immigrants.
While social integration is not the goal of the Community Co-Sponsorship Program in New Haven, Connecticut, its unique model uses community groups across the state to resettle refugees, encouraging interaction between volunteers and refugees. By design, it has an impact on the social integration of refugees, because the community groups conduct all aspects of resettlement and personally make sure that refugees learn to navigate the community. The community group comprises individuals, mostly women, who are educators, social workers, retired professionals, medical professionals, and retired doctors. The program coordinator said:
There’s no better way for people, U.S. citizens, to meet and learn about and understand refugees. It can build long-term, sustained political support for refugee resettlement, in addition to being, really, the best way for a refugee family to get off to a good start.
Impact of these programs on the social integration of refugees
- The Refugee Liaison Program is effective in connecting refugees with the police department at a personal level and building trust through education and interaction. For example, refugees often reach out to the refugee liaison officer to ask him questions such as:
‘How is the best way to go about getting permits if we want to do a human rights march?’ ‘We want to bring our culture and our festivals to the city of Boise. How do we go about doing that?’ Having someone within city government that they can trust and know on a first name basis—they know my cell phone number. The refugee community knows how to get ahold of me. They can ask those questions and get an honest, timely answer.
- Through the community co-sponsorship model, refugees are in constant communication with volunteers and have opportunities to learn English and understand American and local culture. Even when refugees are resettled in places without a large refugee population, they are not as isolated; volunteers visit them and take care of them, making up for the lack of a community in their area.
- The activities in the first-year honors class at HHC in Jacksonville help encourage social integration for both college students and the refugees they serve. For example, an HHC program coordinator states:
The students are introducing them to American board games. They’re going out and playing soccer with them. They are talking to them about social media. They’re showing them movies. I think they get a guided, a curated version of American culture, which might make it a little easier for them, probably a safe place to ask a question of this older person—like, ‘What is this Facebook thing my parents won’t let me have?’
For the college students, they see the refugees from a different perspective and have a better understanding of their circumstances.
- In 2016, more than 700 individuals received diversity training in Winona through Project FINE, and organizations in Winona and the larger region often reach out to them to run more trainings. The program coordinator shared:
People want so much from us. We share the story of us. We share our story of who we are, why we are here, who are those refugee immigrants. Of course, the power of story is really so evident everywhere you go, because when trying to talk about Hmong people and share our personal experience, that’s a powerful thing, and people really feel that and want to learn more.
Targeted services for refugees with specific needs
The U.S. refugee resettlement program prioritizes vulnerable individuals, such as victims of torture; people with physical or mental disabilities; and women and children at risk.47 The prioritization of these groups also indicates the need for services tailored to unique barriers they may face. Initiatives discussed here use a variety of techniques to serve discrete groups of people. For example, there is a program for deaf refugees in Buffalo, New York; programs for those who need mental health care; and health care services for refugee children. While the programs are not directly comparable, there are some commonalities in their goals and in how services are delivered.
Programs aim to identify needs of refugees at arrival and connect them to service providers
Specialized programs aim to provide proper care for refugees with special needs quickly so that their integration process is smoother. In Buffalo, New York, the Deaf Access Services works with the Jewish Family Service of Buffalo and Erie County to quickly route deaf refugees to the program that provides a wraparound service especially tailored for them.48 Many times, newly arrived deaf refugees waste months going through programs that are not best suited to their needs or easily accessible. The Deaf Refugee Program focuses on providing cultural orientation, American Sign Language (ASL) classes, and a connection to other necessary services. One of the main problems for refugees who are deaf is the diversity in sign language they know or inadequate knowledge of any sign language. For example:
The common denominator … is that none of them knew American Sign Language. They all are coming with different sign languages. Many of them have inadequate language skills of any kind, because they didn’t have access to education, nor had they ever had exposure to other deaf people. We’re really starting at a very elementary level with a lot of these adults.
Similarly, some programs also focus on screening refugees for mental health issues so that they can be directed to services tailored for them. Many refugees are likely to have mental health barriers that they need to overcome to better settle in their community. They leave their home countries under traumatic circumstances; may have experienced or witnessed violence or torture; or lost a loved one. Such factors could place them under high psychological and emotional stress that requires proper mental health care. Additionally, their experiences in refugee camps, which often extend to years, is likely to negatively affect their mental health.49 Post-traumatic stress disorder (PTSD) and depression are some of the most common mental health issues among refugees.50 While general health screenings are required by the ORR, it is unclear how often refugees are screened for their mental health.51 In cases where they are screened, organizations use various types of screening tools, such as the Vietnamese Depression Scale, the PTSD Symptom Scale—Self-Report Version, and Refugee Health Screener-15 (RHS-15). When refugees first arrive in St. Louis through the International Institute of St. Louis, they are screened for mental health using the RHS-15.52 This tool has 14 questions and a distress thermometer used to screen refugees for symptoms of distress such as anxiety, PTSD, and depression.53 The results from this test are used to identify any mental health needs and to refer individuals to appropriate care. That care may be in the form of group counseling or long-term counseling.
Identifying health issues quickly is especially important when dealing with refugee children. The local resettlement agency in St. Louis sets up new refugee children with appointments in the Foreign Adoption Clinic and Educational Services (FACES) International Adoption and Refugee Clinic at the Cardinal Glennon Children’s Hospital. There, the children go through initial evaluation so that any health or behavioral issues of the children can get diagnosed and addressed sooner.54 According to the program coordinator, one of the main problems in providing health care to refugee children is that many do not attend follow-up appointments because they lack transportation or often do not actively monitor health statuses. The clinic has hired a nurse to manage these children’s cases to make sure that they do not fall through the cracks.
Initiatives provide specific services for vulnerable populations to better tackle their unique barriers
Along with offering ASL classes, the Deaf Refugee Program has innovative ways to support its clients’ everyday needs. For example, because many deaf refugees do not understand ASL, it is often not enough to have an ASL interpreter accompany them to medical appointments. This program has a two-step interpreting service involving both an ASL interpreter and a deaf interpreter that is better-suited for deaf refugee patients. The program staff recalled:
The doctor would be speaking English. The ASL interpreter would hear the English and turn it into American Sign Language, and a deaf interpreter … will take the ASL and turn it into something which is really a gesturing language.
Likewise, in Jacksonville, Florida, a mental health service called Project for Healing offers a barrier reduction service to their patients to help them overcome barriers in their day-to-day lives, such as transportation and communication.55 For example, volunteers in this program ride a bus with their patients to their psychiatrist until they learn to do it themselves; teach them how to manage their medications; and walk them through how to obtain those medications from the pharmacy. The program coordinators pointed out that the hands-on nature of their service has been instrumental in helping refugee clients with mental health needs and easing their integration into the larger community.
The pediatrician and nurses from the children’s clinic in St. Louis focused their efforts on increasing access to their health care services to encourage follow-up appointments. To resolve the transportation problem, the pediatrician emphasized that home visits were increasingly becoming a preferred service delivery method because it allows clinic staff to consistently deliver health care services to these children. The pediatrician recalled a story of a Somali family:
A Somali family … has difficulty following up on appointments—they have eight kids. One of their kids is [in a] wheelchair. … She is now 4; she’s bigger than an infant. They have eight concrete steps that the mother has to get the wheelchair down and out, plus the child is now getting bigger. She’s a small lady herself. Then she’s got two younger infants. I mean how many of us could get to many appointments if we had that kind of barrier just to get in and out of the house, and then to get on a bus?
The programs highlighted here provide only a glimpse of how targeted services can be effective in delivering to certain groups of refugees who are hard to reach and what such programs can do for them. For these individuals, these services become instrumental to boost their integration since mainstream services are harder to access and often unsuitable for them.
Impact of specialized services on the targeted refugee population
- One of the direct impacts of the Deaf Refugee Program is increased access to the services that are specifically designed for them—for instance, teaching them how to communicate in the United States using ASL. Once they learn how to communicate, they are able to take other steps toward integration. The program coordinator of the Deaf Refugee Program recalled that “people are starting to have the capacity to communicate about social issues, so we’re starting to touch on issues like parenting and domestic violence. The group itself is starting to form a peer support.”Furthermore, they are also connecting refugees with the deaf community in the area and aiding in wider social integration.
- The children’s clinic in St. Louis was able to increase access of their services by offering case management and flexible home visits. Through consistent medical care, they were able to identify many nutritional deficiencies, such as iron and vitamin deficiencies. They were also able to get these children to dentists and eye doctors.Their impact can be measured through the increase in demand of their services. The first year they were in operation they had 77 new children. The second year, the clinic exceeded its goal of reaching 120 and ended up serving 148 new children. This year—their third year—they are confident that they will serve more than their goal of 120 children again, as they are servicing 12 to 18 children per month.
- Both mental health programs specified that meeting the mental health care needs of their clients encourages them to be well-adjusted and healthy. It helps them be self-sufficient, as well as to avoid homelessness and unnecessary emergency room visits.
Collaboration is one of the key ways for programs to meet the needs of their clients
Each of the organizations in this report built relationships with resettlement agencies; employers; other organizations; medical and health institutions; and local governments, to be more effective in serving their clients and to have a more significant impact.
Employment programs thrive when they maintain mutually beneficial relationships with local employers and other organizations, namely government entities and nonprofits. Global Talent Idaho, for example, values these relationships. The program coordinator stated:
We spend a lot of time outreaching to employers and educating them. … I think making sure we’re pretty tied into the community, from the resettlement agencies to other nonprofit organizations, the ethnic community groups—I think that’s really important, that you have good partners—to the city of Boise. Really, one thing I have to say is our relationship with [Department of] Labor is really important. It’s taken us a while to cultivate that.
Programs targeted at refugee parents and students collaborate with schools and other related institutions. The coordinator of the PAT program stated:
Parents as Teachers obviously—we have well-established partnerships. … We collaborate with local pre-Ks. We collaborate with the local library branch, with Atlanta Board of Health, with other providers who deliver home visits. We have good relationships with Early Head Start, Head Start in the area.
And even if not physically housed within the hospital, programs in health services need strong relationships with the medical community to operate smoothly. For example, the program coordinator of the Healthcare Interpreter Training and Certification service in Buffalo emphasized that they need people who work in the medical field as partners so that they can have effective trainings for the interpreters. Additionally, she mentioned:
You need buy-in from the medical community. That’s the main thing. … We’re so lucky because we have people that were just thrilled that this is happening. They do see non-English speakers, limited-English speakers in the hospitals every day. The people working in the field know that language is a huge barrier and culture is a huge barrier. Those who have worked with our interpreters, or with any interpreter, really appreciate the value that they’re bringing into a medical encounter. You can’t overstate it.
The Refugee Liaison Program with the Boise Police Department relies on community partners from government agencies and leaders of the refugee community to build trust with the refugee community and establish a line of communication. The officer stated that his work would not have been “possible without support from the mayor’s office, city council, other divisions.” He added:
It’s partnering with the stakeholders that work with refugees on a daily basis. Then it is partnering with the informal and formal leaders within the refugee or former refugee community. Simply going out as a Boise police officer, I could not do this job as effectively as I can when I go alongside someone from the International Rescue Committee or the Agency for New Americans or the English Language Center. When I need to go out and meet with someone from the Congolese community, I can call up my friend … who’s been here for years and is very well-respected, educated. We can work off of one another to provide our community members with the correct resources that they need.
The program coordinators of the Colorful Growers program stressed that their program worked because of the partnership they had built within the community. They stated:
If we didn’t have the collaboration and partnership that we have, we wouldn’t be here. First of all, the county wouldn’t allow us to have the plot, and that would be a big challenge.
Many organizations use their relationship with the refugee resettlement organizations to get connected to refugees. For example, children’s health services, various deaf access services, and the honors class at HHC rely on their relationship with the resettlement agencies.
While many organizations rely on relationships they developed with other service providers in the area, one initiative in Boise, Idaho, plays a central role in building critical relationships among local agencies—both governmental and nongovernmental. Neighbors United, a refugee collaborative, is an example of a formal partnership between the Boise mayor’s office and the Idaho Office for Refugees with an aim to bring different institutions together to advance refugee integration in Idaho.56
This group collaborates with representatives from hospitals, educational institutions, and law enforcement to formulate and implement a plan to create opportunities to better integrate refugees into their communities. They have a steering committee that comprises major decision-makers, as well as an implementation team with seven committees that is responsible for achieving various objectives, mainly pertaining to education, employment, health care, housing, transportation, and social integration. They have a paid local consulting agency that works with the planning team consisting of staff from the Idaho Office for Refugees and a representative from the mayor’s office to coordinate and organize meetings among stakeholders in different committees. Having a platform for different institutions—from education to health—to regularly discuss the refugee community and collectively come up with a structured plan that better serves the entire community’s needs and helps ensure that the city uses a multipronged plan in its approach as well.
Programs hosted within large organizations benefit from their structure
Many programs and initiatives are housed within larger organizations and they frequently benefit from the existing infrastructure, services offered in that institution, and relationships within the community. The clients of the Economic Development Department under the International Institute of St. Louis can take advantage of the myriad services offered at the institute, if needed. A program coordinator recalled a story of a client who was missing loan payments because she was going through a trauma-related issue. As soon as the staff found out, they were able to connect her to appropriate services in their in-house trauma center, after which she did much better.
Having a larger institutional support can also provide some programs with the infrastructure needed to operate. For example, the children’s clinic that caters to refugee children in St. Louis is housed within the larger children’s hospital and benefits from its support. A fourth-year medical student in the hospital, which is also an academic institution, has been working with the children’s clinic to provide home visits for the refugee children. In this way, the program not only increases access, but it also trains future physicians to serve sensitive populations such as refugee children.
Another program that would not have been possible without the support of a larger institution is the first-year seminar at UNF’s HHC, which connects students with refugee families. UNF already had connections with Lutheran Social Services, which resettles refugees.
Smaller programs that are not under a larger organization can still make a significant impact through connections elsewhere in the community. These programs rely on resources available in the larger community to provide services that the clients need but are not available in-house. Project for Healing in Jacksonville explicitly runs their program on what the program administrator calls “the center without walls perspective,” meaning that “the focus is the community and being able to use the people in your community to connect your refugees with in order to help them.” Even though this program is small with few full-time staff, they depend on programs available elsewhere in their community to help integrate their clients better and avoid being constrained by their size.
Overall, the programs presented in this report face several common challenges ranging from funding constraints to staffing issues. They reported using creative solutions to resolve some of these issues—solutions that can provide guidance for other organizations with similar concerns.
Lack of funds constrain programs’ potential
One of the biggest challenges facing most programs is lack of funding. Insufficient funding limits service providers from better serving their refugee clients. They are unable to expand their reach or offer more services even when the demand is high; they are unable to hire as many full-time staff as necessary and must rely on part-time staff and volunteers; and many programs are funded by nonrenewable grants. These programs rely on a variety of funding sources—not solely on federal and state funds. They apply for grants from nonprofits such as United Way and private foundations, as well as seek individual donations to meet their needs. For example, Global Talent Idaho started with a federal grant from the Idaho Department of Labor; however, since that funding has expired, they rely mostly on individual donors. Some programs, such as the ones offered by the Economic Development Department in St. Louis, are largely funded by the ORR, but they also receive some funds from the Community Development Block Grant program and some contributions from local banks. Project for Healing in Jacksonville uses different funding streams to pay their expenses. Their staff member pointed out:
Florida Department of Health pays for our therapists and our rent, and then we have a grant through our hospital that pays for our case manager, and then … our regular case manager is free, because she’s an intern at the university. Then have another intern that’s a clinical intern and she is also free, because she comes through the university, I believe. Then we also have what we call community collaborators and they are our volunteers.
It is common for program coordinators to find creative ways when obtaining funding to pay their staff. The position of volunteer coordinator for the HELLO Program is fully funded through AmeriCorps. The volunteer coordinator took on the project and was able to create the beginnings of the program. Similarly, the after-school program in Atlanta also uses AmeriCorps service members to partly staff the program.
Staffing and volunteer issues pose a challenge
A closely related issue to funding is having staff who are part-time or volunteers. A program administrator at the same after-school program in Atlanta found that:
One of the biggest impacts we’ve seen is when staff stay on. Currently, all of our after-school programming has part-time staff. There’s a lot of turnover. But when we have staff who stay on for another year, and those relationships build more deeply, you see a bigger impact, I think, on the kids that are attending because they’ve built trust. They can open up more. That’s also how we end up finding out a lot about issues going on in the home because a child trusts the teacher, knows him or her quite well. I would say that that’s a very important component when we’re able to have staff stay.
Furthermore, since the after-school program in Atlanta sometimes has children that have gone through trauma, staff and volunteers must quickly respond even when they are not trained social workers. The program coordinator from the Refugee Family Literacy Program also relayed similar challenges of teaching children below age 5 who speak multiple languages and have experienced trauma.
Programs that rely on volunteers illustrate the challenges in recruiting and training them. The program coordinator of the HELLO Program in Buffalo, which provides at-home English literacy classes, relayed that finding volunteers who are consistent with their work can sometimes be challenging because volunteers are busy with their own work.
Barriers stem from rigidity and time constraints in the refugee resettlement requirements
Often, the standard nature of the refugee resettlement process does not match up with the diversity of refugees and their needs. For example, according to the Deaf Refugee Program, the refugees who are deaf and hard of hearing may not be identified as requiring specialized support at the outset. Their coordinator states:
It’s extremely scripted. This is what you have to do before they arrive, when they arrive. Here’s a checklist. There’s nothing in that process that has been developed to assess a person’s hearing or instruct the resettlement worker on how to provide services to a deaf individual. We see folks coming to us several months after arrival, and the resettlement agency just can’t understand why they didn’t understand. ‘We used an interpreter.’ ‘We used a sign language interpreter.’ They don’t understand about the DI, the deaf interpreter, thing. By the time they refer, all the sorts of important topics have been presented to them already. It’s sort of missed opportunities.
Additionally, limited funding from the federal government for basic support such as housing puts a strain on resettling refugees in areas that have a high cost of living. In such cases, the community groups in New Haven, Connecticut, who are in charge of resettlement successfully raise private funding to fill those gaps.
To ensure that people don’t fall through the cracks, programs get creative to support refugees beyond the 90-day basic support provided by the federal government. The HELLO Program in Buffalo links their clients with at-home English classes later so that there is some overlap between when the case closes at the 90th day and when the classes begin. The timing of classes allows for a safety net for those refugees beyond the cutoff date.
Some challenges are unique to serving the refugee population
Program coordinators state that attrition is one of the problems they face while serving refugees, especially when they need to come for training classes, English language classes, and go for regular doctor visits in addition to taking care of children or working full time. Many times, people drop out of programs because they must stay at home and take care of their children since there is no affordable child care, or they must take survival jobs. The U.S. refugee program’s primary goal is to make people quickly self-sufficient, which sometimes leads to taking jobs even though they do not fit their qualifications. Programs have tried to decrease barriers: For example, the Tatweer program in Seattle covers the living expenses of the refugees enrolled in that program to ensure that they are able to attend classes and take advantage of their mentorship program—ultimately leading to a job that better matches their qualification. Other programs have tried to increase access by delivering services at home, such as English language services, children’s health services, and mentorship for parents of young children.
Transportation is also a huge barrier for refugees especially in places without a good public transportation system. It limits access to training classes, hospitals, schools, and other program sites. Many programs taught their clients to ride buses, sometimes provided bus passes, and helped them become independent. They also found alternatives to public transits where public transits were not available—for example, they arranged carpool drivers.
Finally, while English language fluency is a barrier for many refugees when they first enter, they are able to improve their language skills with time and the right resources. Most of these programs had a component that made an effort to improve refugees’ communication skills either directly through English language classes or indirectly through interaction with others. The skills-training programs pointed out that there were many issues because the training materials were in English and the trainers had to be creative in teaching some of those materials. In programs that tried to increase social integration, service providers sometimes used interpreters to bridge the language gap and increase interaction. For instance, the refugee liaison officer in Idaho explained:
One of the challenges also leads itself right back into one of our biggest partnerships—language access and interpretation. As law enforcement officers, we’re honored to get to work with all members of our community. Just because someone doesn’t speak English doesn’t mean that they shouldn’t get served with the same level of respect, trust, and dedication that a naturally born American or a proficient English speaker receives. We contract with a large group of community members that are skilled interpreters and translators.