oversight

Refugee Resettlement: Greater Consultation with Community Stakeholders Could Strengthen Program

Published by the Government Accountability Office on 2012-07-25.

Below is a raw (and likely hideous) rendition of the original report. (PDF)

             United States Government Accountability Office

GAO          Report to Congressional Requesters




July 2012
             REFUGEE
             RESETTLEMENT
             Greater Consultation
             with Community
             Stakeholders Could
             Strengthen Program




GAO-12-729
                                             July 2012

                                             REFUGEE RESETTLEMENT
                                             Greater Consultation with Community Stakeholders
                                             Could Strengthen Program
Highlights of GAO-12-729, a report to
congressional requesters




Why GAO Did This Study                       What GAO Found
In fiscal year 2011, the United States       Voluntary agencies consider various factors when determining where refugees
admitted more than 56,000 refugees           will be placed, but few agencies we visited consulted relevant local stakeholders,
under its refugee resettlement               which posed challenges for service providers. When deciding how many
program. Upon entry, a network of            refugees to place in each community, some voluntary agencies prioritize local
private, nonprofit voluntary agencies        agency capacity, such as staffing levels, while others emphasize community
(voluntary agencies) selects the             capacity, such as housing availability. Although the Immigration and Nationality
communities where refugees will live.        Act states that it is the intent of Congress for voluntary agencies to work closely
The Department of State’s PRM and            with state and local stakeholders when making these decisions, the Department
the Department of Health and Human           of State’s Bureau of Population, Refugees, and Migration (PRM) offers limited
Services’ ORR provide funding to help        guidance on how this should occur. Some communities GAO visited had
refugees settle in their communities         developed formal processes for obtaining stakeholder input after receiving an
and obtain employment and monitor            overwhelming number of refugees, but most had not, which made it difficult for
implementation of the program.               health care providers and school systems to prepare for and properly serve
Congress has begun to reexamine the
                                             refugees.
refugee resettlement program, and
GAO was asked to examine (1) the             State and local stakeholders reported that refugees bring cultural diversity and
factors resettlement agencies consider       stimulate economic development, but serving refugees can stretch local
when determining where refugees are          resources, including safety net services. In addition, refugee students can
initially placed; (2) the effects refugees   negatively affect performance outcomes for school districts because they often
have on their communities; (3) how           have limited English proficiency. Furthermore, some refugees choose to relocate
federal agencies ensure program              after their initial placement, and this secondary migration may stretch
effectiveness and integrity; and (4)         communities that do not have adequate resources to serve them. In fact,
what is known about the integration of       capacity challenges have led some communities to request restrictions or
refugees. GAO reviewed agency
                                             temporary moratoriums on resettlement.
guidance, monitoring protocols,
reports, and studies; conducted a            PRM and the Department of Health and Human Services’ Office of Refugee
literature review; reviewed and              Resettlement (ORR) monitor their refugee assistance programs, but weaknesses
analyzed relevant federal and state          in performance measurement may hinder effectiveness. Although refugees are
laws and regulations; and met with           eligible for ORR services for up to 5 years, the outcome data that ORR collects
federal and state officials, voluntary       focuses on shorter-term employment outcomes. ORR officials said that their
agency staff, and local stakeholders in      performance measurement reflects the goals outlined by the Immigration and
eight selected communities.                  Nationality Act—to help refugees achieve economic self-sufficiency as quickly as
What GAO Recommends                          possible. However, the focus on rapid employment makes it difficult to provide
                                             services that may increase refugees’ incomes, such as helping them obtain
GAO makes several recommendations            credentials to practice their professions in the United States.
to the Secretaries of State and Health
and Human Services to improve                Little is known about the extent of refugee integration into U.S. communities, but
refugee assistance programs in the           research offers a framework for measuring and facilitating integration. PRM and
United States. HHS and State                 ORR both promote refugee integration, but neither agency currently measures
generally concurred with the                 integration as a program outcome. While integration is part of ORR’s mission,
recommendations and each identified          ORR officials said one of the reasons they have not measured it is that there is
efforts they have under way or plan to       no clear definition of integration. In addition, research on refugee resettlement
undertake to address them.                   does not offer an overall assessment of how well refugees have integrated into
                                             the United States. Most of the 13 studies GAO reviewed were limited in scope
                                             and focused on particular refugee groups in specific geographic locations.
                                             However, these studies identified a variety of indicators that can be used to
View GAO-12-729. For more information,       assess integration as well as factors that can facilitate integration, such as
contact Kay Brown at (202) 512-7215 or       English language acquisition, employment, and social support from other
brownke@gao.gov.                             refugees. Despite limited national information, some U.S. communities have
                                             developed formal plans for refugee integration.
                                                                                     United States Government Accountability Office
Contents


Letter                                                                                   1
               Background                                                                3
               Voluntary Agencies Consider Various Factors in Placing Refugees,
                  but Few Consult with Local Service Providers                         11
               Refugees Bring Benefits to Communities but Can Pose Challenges
                  for Service Providers                                                17
               Agencies Monitor Resettlement and Measure Effectiveness, but
                  These Measures Have Weaknesses                                       25
               Little Is Known about the Extent of Refugee Integration, but
                  Studies Offer a Framework for Assessing Integration                  31
               Conclusions                                                             37
               Recommendations for Executive Action                                    38
               Agency Comments and Our Evaluation                                      39

Appendix I     Objectives, Scope, and Methodology                                      42



Appendix II    Studies Included in Literature Review                                   45



Appendix III   20 States with Largest Numbers of Refugees Arriving in FY 2011 and
               Refugees’ Countries of Origin                                           47



Appendix IV    Selected PRM and ORR Grant Programs                                     48



Appendix V     Status of Integration Working Group’s Recommendations to ORR            51



Appendix VI    Comments from the Department of Health and Human Services               52



Appendix VII   Comments from the Department of State                                   56




               Page i                                       GAO-12-729 Refugee Resettlement
Appendix VIII   GAO Contacts and Staff Acknowledgments                                                    58



Tables
                Table 1: Selected Refugee Assistance Programsa                                            9
                Table 2: Sample Factors That Voluntary Agencies Consider When
                         Assessing Community Capacity                                                     12
                Table 3: Benefits and Challenges of Refugee Resettlement
                         Identified in Site Visits                                                        20
                Table 4: Top 10 Recommendations for FY 2011 from PRM
                         Monitoring Visits                                                                26
                Table 5: Performance Outcome Measures for Major Refugee
                         Assistance Programs                                                              27
                Table 6: Selected Integration Indicators, Barriers, and Facilitators
                         Identified in Literature Review                                                  35


Figures
                Figure 1: Presidential Ceilings and Refugee Arrivals (FY 2001-2011)                        4
                Figure 2: Refugee Arrivals by State (FY 2011)                                              6
                Figure 3: Top 20 Countries of Origin for Refugees Arriving FY 2011                         7
                Figure 4: General Path of Refugee Resettlement in the United
                         States                                                                            8
                Figure 5: Flow of Funds from PRM and ORR to Service Providers                             10


                Abbreviations

                DHS               Department of Homeland Security
                HHS               Department of Health and Human Services
                ORR               Office of Refugee Resettlement
                PRM               Bureau of Population, Refugees, and Migration
                State             Department of State


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                Page ii                                                  GAO-12-729 Refugee Resettlement
United States Government Accountability Office
Washington, DC 20548




                                   July 25, 2012

                                   Congressional Requesters

                                   Millions of people worldwide have fled their countries because they have
                                   been persecuted—or fear being persecuted—on the basis of their race,
                                   religion, nationality, political opinions, or because they belong to a
                                   particular social group. The United States has traditionally provided
                                   refuge to such people, and continues to resettle at least half of all
                                   refugees referred for resettlement worldwide by the United Nations High
                                   Commissioner for Refugees each year. In fiscal year 2011, the United
                                   States resettled a little more than 56,000 refugees into communities
                                   throughout the country. 1

                                   Nine national voluntary agencies—the nongovernmental organizations
                                   that carry out much of the refugee resettlement process with funding from
                                   the Departments of State (State) and Health and Human Services
                                   (HHS)—take the lead in determining where refugees will initially be
                                   placed, with approval from State. The communities in which refugees are
                                   placed vary significantly in size, capacity, and experience in resettling
                                   refugees. Major gateway cities tend to have more experience
                                   incorporating large and steady streams of people from other countries,
                                   but can be very expensive places to live. Smaller cities and towns, on the
                                   other hand, can be more affordable and easier to navigate, but may not
                                   have sufficient resources to provide refugees adequate services,
                                   including education and health care. While some refugees stay in the
                                   community where they were initially resettled, others may decide to move
                                   to another community that may or may not have organizations and
                                   programs to help them become self-sufficient.

                                   The most recent economic downturn has made it increasingly difficult for
                                   refugees to become self-sufficient within months of arriving in the United
                                   States, raising questions about refugee placement and integration, as
                                   well as the oversight of refugee resettlement programs. In this context, we
                                   were asked to examine (1) the factors resettlement agencies consider
                                   when determining where refugees are initially placed; (2) the effects



                                   1
                                    According to data provided by the Department of State, 47 states and the District of
                                   Columbia resettled refugees in fiscal year 2011.




                                   Page 1                                                  GAO-12-729 Refugee Resettlement
refugees have on their communities; (3) how federal agencies ensure the
effectiveness and integrity of refugee resettlement programs; and (4)
what is known about refugees’ integration into the United States.

To address our research objectives, we reviewed relevant federal and
state laws, regulations, monitoring protocols, performance reports,
performance measures, and other relevant documents. We also
conducted a literature review of academic research on the integration of
refugees into the United States 2 and reviewed other pertinent reports. We
met with federal agency officials, national voluntary agency staff, and
experts on refugee programs. In addition, we conducted site visits to eight
communities, where we met with representatives from state and local
government entities, voluntary agency affiliates, community-based
organizations, local businesses, and other relevant individuals and
groups, including refugees. 3 For our site visits, we selected Boise, Idaho;
Chicago, Illinois; Detroit, Michigan; Fargo, North Dakota; Knoxville,
Tennessee; Lancaster, Pennsylvania; Owensboro, Kentucky; and Seattle,
Washington. 4 These eight communities represent a nongeneralizable
sample that was selected to include geographically distributed
communities with variations in their population sizes, levels of experience
resettling refugees, and racial and ethnic diversity. In addition to these
factors, several communities were selected because they are considered
examples of best practices in refugee resettlement by federal officials. For
additional information on our scope and methodology, see appendix I.

We conducted this performance audit from May 2011 through July 2012
in accordance with generally accepted government auditing standards.
Those standards require that we plan and perform the audit to obtain
sufficient, appropriate evidence to provide a reasonable basis for our
findings and conclusions based on our audit objectives. We believe that
the evidence obtained provides a reasonable basis for our findings and
conclusions based on our audit objectives.




2
    See appendix II for a list of the studies we included in our literature review.
3
    We did not meet with all of these groups in every community we visited.
4
  As part of our site visit to Chicago, we also met with city officials in Skokie, Illinois. Our
visit to the Detroit area focused on the cities of Dearborn and Sterling Heights, Michigan.
Our visit to Seattle included interviews with relevant groups in Kent, Washington.




Page 2                                                        GAO-12-729 Refugee Resettlement
                           A refugee is generally defined as a person who is outside his or her
Background                 country and who is unable or unwilling to return because of persecution or
                           a well-founded fear of persecution on account of race, religion, nationality,
                           membership in a particular social group, or political opinion. 5 The
                           Refugee Act of 1980, which amended the Immigration and Nationality
                           Act, provided a systematic and permanent procedure for admitting
                           refugees to the United States and maintains comprehensive and uniform
                           provisions to resettle refugees as quickly as possible and to encourage
                           them to become self-sufficient. 6 Several federal, state, and local
                           government agencies coordinate with private organizations to implement
                           the admission and resettlement process.


Refugee Placement in the   Each year the President, after appropriate consultation with the Congress
United States              and certain Cabinet members, determines the maximum number of
                           refugees the United States may admit for resettlement in a given year. 7
                           The number actually resettled is typically below this maximum number




                           5
                             8 U.S.C. § 1101(a)(42)(A). In special circumstances, a refugee also may be a person
                           who is within his or her country and who is persecuted or has a well-founded fear of
                           persecution on account of race, religion, nationality, membership in a particular social
                           group, or political opinion. Excluded from the definition of a refugee is any person who
                           participated in the persecution of another.
                           6
                             The Immigration and Nationality Act is Pub. L. No. 82-414, 66 Stat. 163 (1952) (codified
                           as amended at 8 U.S.C. § 1101 et seq.). The Refugee Act of 1980 is Pub. L. No. 96-212,
                           94 Stat. 102. While the Immigration and Nationality Act, as amended, states that
                           resettlement programs should help refugees achieve economic self-sufficiency as quickly
                           as possible, it does not define economic self-sufficiency. HHS’s Office of Refugee
                           Resettlement defines economic self-sufficiency in its regulations as earning a total family
                           income at a level that enables a family unit to support itself without receipt of a cash
                           assistance grant. 45 C.F.R. § 400.2. Refugees may still be found economically self-
                           sufficient if they receive other types of public noncash assistance, such as Supplemental
                           Nutrition Assistance Program benefits or Medicaid.
                           7
                             The Departments of State, Homeland Security, and Health and Human Services submit
                           a report on behalf of the President to the Congress with their recommendation on how
                           many refugees should be admitted, which according to Department of State officials, takes
                           into account federal agencies’ refugee processing capabilities.




                           Page 3                                                   GAO-12-729 Refugee Resettlement
and has varied over time—sometimes due to security concerns (see fig.
1). 8

Figure 1: Presidential Ceilings and Refugee Arrivals (FY 2001-2011)




The federal government gives private, voluntary agencies responsibility to
determine where refugees will live in the United States, with approval


8
  The number of refugees entering the United States has increased in recent years
compared to the relatively low numbers entering after the terrorist attacks of September
11, 2001. In the aftermath of those attacks, a review of refugee-related security
procedures was undertaken, refugee admissions were briefly suspended, and enhanced
security measures were implemented. As a result of these and other factors, actual
refugee admissions declined from 68,393 in fiscal year 2001 to 26,383 in fiscal year 2002
and 28,348 in fiscal year 2003. Admissions gradually increased and peaked at 74,652 in
fiscal year 2009 and leveled off in 2010 with 73,311. Admissions decreased to a little over
56,000 in fiscal year 2011. According to the fiscal year 2012 refugee admissions proposal
submitted to Congress by the Departments of State, Homeland Security, and Health and
Human Services, this 2011 decrease was due largely to increased security clearance
procedures.




Page 4                                                   GAO-12-729 Refugee Resettlement
from the Department of State. Refugees are assigned first to a national
voluntary agency and then the voluntary agency decides where the
refugee will live. 9 More specifically, the nine national voluntary agencies,
which maintain a network of about 350 affiliates in communities
throughout much of the United States, meet weekly to allocate individual
refugees based on an annual evaluation of the communities’ capacity to
serve refugees. 10 See figure 2 for the number of refugees that arrived in
each state during fiscal year 2011. Appendix III provides additional detail
about the countries of origin for arrivals to the 20 states with the largest
refugee populations.




9
  According to the Department of State, during weekly allocation meetings, cases with a
tie in the United States are allocated to agencies with affiliates in communities where their
friends or relatives live. National voluntary agencies then choose cases based on their
total proposed capacity as well as local affiliates’ capacity and resources. After the
allocation meeting, the national voluntary agencies will assign individual cases to local
affiliates based on a variety of factors, including ethnicity, language, family size, family
composition, or medical conditions. For example, communities with an existing population
of a particular ethnicity may have existing infrastructure for serving refugees of a particular
ethnicity. Some communities are better able to accommodate larger families, while others
may be more hospitable to single households.
10
  According to voluntary agency staff, they identify new communities to receive refugees
based on requests from local stakeholders, recommendations by state officials, and the
need to expand services to secondary migrants, refugees who migrate from their initial
resettlement community to a community in another state.




Page 5                                                     GAO-12-729 Refugee Resettlement
Figure 2: Refugee Arrivals by State (FY 2011)




                                         In the last 10 years, refugees have come to the United States from an
                                         increasing number of countries, and the issues associated with these
                                         diverse populations have become more complex. For example, many
                                         refugees today arrive after having lived in refugee camps for years, and
                                         may have little formal education or work experience, or untreated medical
                                         or mental health conditions. In turn, receiving communities have needed
                                         to adjust their language capabilities and services in order to respond to
                                         the changing needs of these diverse refugee populations. Figure 3 shows
                                         the top 20 countries of origin for refugees arriving in the United States in
                                         fiscal year 2011.




                                         Page 6                                          GAO-12-729 Refugee Resettlement
Figure 3: Top 20 Countries of Origin for Refugees Arriving FY 2011




Federal Structure for                    Three federal agencies are involved in the refugee resettlement process.
Refugee Resettlement                     The Department of Homeland Security (DHS) approves refugees for
Programs                                 admission to the United States. State’s Bureau of Population, Refugees,
                                         and Migration (PRM) is responsible for processing refugees overseas.
                                         Once refugees are processed and arrive in the United States, PRM
                                         partially funds services to meet their immediate needs. PRM enters into
                                         cooperative agreements with national voluntary agencies under its
                                         Reception and Placement Program to provide funding that helps refugees
                                         settle into their respective communities during their initial 30 to 90 days
                                         and covers housing, food, clothing, and other necessities. Each local
                                         affiliate receives $1,850 per refugee to provide these services. 11 Figure 4
                                         illustrates the general path of refugee resettlement in the United States.



                                         11
                                           Participating organizations are expected to combine PRM’s financial assistance with
                                         existing and projected private resources for the provision of reception and placement
                                         services.




                                         Page 7                                                 GAO-12-729 Refugee Resettlement
Figure 4: General Path of Refugee Resettlement in the United States




                                         Many refugees are then eligible to receive temporary resettlement
                                         assistance from the Office of Refugee Resettlement (ORR), located within
                                         HHS. In most states, ORR funds cash and medical assistance as well as
                                         social services to help refugees become economically self-sufficient. 12
                                         ORR provides these funds through grants to state refugee coordinators,
                                         who may be employed by a state agency or by a nonprofit organization




                                         12
                                            Not all refugees receive cash and medical assistance through ORR-funded programs.
                                         Refugees who are eligible for or who are receiving cash assistance from programs outside
                                         of ORR, such as Temporary Assistance for Needy Families or Supplemental Security
                                         Income, are generally not eligible to receive cash assistance from ORR’s resettlement
                                         programs.




                                         Page 8                                                 GAO-12-729 Refugee Resettlement
depending on how a state’s program is set up. 13 ORR’s social services
grants provide funding for employment and other support services. States
also receive funding from ORR to award discretionary grants—including
school impact, services to older refugees, and targeted assistance
grants—to communities that are particularly affected by large numbers of
refugees or to serve specific refugee populations such as the elderly. See
table 1 for a list of selected refugee assistance programs.

                                                                            a
Table 1: Selected Refugee Assistance Programs

                                                                                                                      FY 2012
                                                                                                                       budget
                                                                                                                             a
                                                                                                                    authority
 Activities                 Purpose                                                                              (in millions)
 Reception and              Provides partial financial support to nongovernmental                                         $153.7
 placement                  organizations to provide services to refugees for 30
 grants                     to 90 days after arrival in the United States, including
                            basic needs, orientation, and case management
                            services
 Transitional and Provides cash and medical assistance to refugees,                                                        323.2
 medical services asylees, entrants, trafficking victims, and special
                  immigrant visa holders who participate in certain
                  ORR-funded programs.
 Social services            Supports employment and other services such as                                                 118.9
                            social adjustment, translation, child care, and
                            citizenship services as well as case management
 Targeted                   Primarily provides services designed to secure                                                   24.2
 assistance                 employment for refugees within 1 year or less in
                            counties that are impacted by high arrival numbers
                            and high concentrations of refugees
 Preventive                 Promotes refugee access to health screening,                                                       4.7
 health                     assessment, treatment, and follow-up services
Sources: PRM and HHS Administration for Children and Families Justification of Estimates for Appropriations Committees, fiscal year
2013.




13
   GAO, Refugee Assistance: Little is Known about Effectiveness of Different Approaches
for Improving Refugees’ Employment Outcomes, GAO-11-369 (Washington, D.C.: Mar.
31, 2011). ORR also partially funds a separate Matching Grant program, administered by
the national voluntary agencies. The Matching Grant program provides refugees with cash
and other assistance for 4 to 6 months with the goal of helping them become self-sufficient
without receiving cash benefits from a public assistance program. According to ORR,
refugees who receive assistance from the Matching Grant program may not receive
assistance or funding from any of ORR’s other three assistance programs at the same
time.




Page 9                                                                             GAO-12-729 Refugee Resettlement
                                       a
                                        ORR also funds targeted grants for unaccompanied alien children, victims of torture, and victims of
                                       trafficking. According to ORR, fiscal year 2012 funding levels reflect the reallocation of funding during
                                       FY 2012 to support the costs associated with the unprecedented level of Unaccompanied Alien
                                       Children referred to HHS/ORR by the Department of Homeland Security during FY 2012.


                                       In addition, communities may apply for grants from other nonrefugee
                                       programs to help provide services to refugees. Both PRM and ORR
                                       monitor the implementation of the refugee resettlement process, which
                                       involves overseeing and monitoring both government agencies and
                                       private organizations (see fig. 5).

Figure 5: Flow of Funds from PRM and ORR to Service Providers




                                       ORR and PRM officials coordinate with one another and with national and
                                       state stakeholders who specifically focus on serving refugees. Together
                                       with representatives from national resettlement agencies and state
                                       refugee coordinators, ORR and PRM also participate in a refugee
                                       resettlement working group convened by the White House National
                                       Security Staff, which supports both the Homeland Security Council and
                                       the National Security Council. The resettlement working group has
                                       worked on and been supportive of a variety of reforms that PRM and
                                       ORR have made to their processes. PRM and ORR also conduct joint
                                       quarterly consultation meetings with stakeholder groups, including
                                       voluntary agencies, state refugee coordinators, refugee health
                                       coordinators, ORR technical assistance providers, and ethnic community
                                       based organizations.



                                       Page 10                                                           GAO-12-729 Refugee Resettlement
Voluntary Agencies
Consider Various
Factors in Placing
Refugees, but Few
Consult with Local
Service Providers

Voluntary Agencies         Voluntary agencies consider a variety of factors when they propose the
Consider Various Factors   number of refugees to be resettled in each community (see table 2).
When Making Refugee        Before preparing their annual proposals for PRM’s Reception and
                           Placement Program for approval, national voluntary agencies ask local
Placement Decisions        voluntary agency affiliates to assess their own capacity and that of other
                           service providers in the wider community and propose the number of
                           refugees that they will be able to resettle that year. 14 In making these
                           assessments, local voluntary agency affiliates typically consider both their
                           own internal capacity and the capacity of the community, with different
                           levels of emphasis on one or the other. 15 For example, when determining
                           how many refugees their community can accommodate, local affiliates in
                           one community told us that they primarily consider their internal
                           capacity—such as staffing levels, staff skills, long-term funding needs, the
                           number of refugees they have served in the past, and success in meeting
                           refugee employment goals in the previous year. Local affiliates in another
                           community explained that they primarily consider community-based
                           factors, such as housing availability and employment opportunities. To
                           help make this process more consistent, Refugee Council USA, a
                           coalition of the nine national voluntary agencies, developed guidance and
                           a list of factors that local affiliates could use when evaluating community
                           capacity. However, national voluntary agencies do not require their local



                           14
                              The proposals typically include information on community capacity—such as
                           employment rates, available healthcare, and housing—as well as information on the
                           voluntary agency’s organizational management plans and policies. PRM reviews and
                           approves proposals from the national voluntary agencies.
                           15
                              While some local affiliates may gather information about community-based factors by
                           consulting with local stakeholders, others may choose to review publicly available
                           information, such as the unemployment rate and rental prices.




                           Page 11                                                GAO-12-729 Refugee Resettlement
                          affiliates to use the guidance. Moreover, national voluntary agencies may
                          adjust the numbers proposed by local affiliates.

                          Because refugees are generally placed in communities where national
                          voluntary agency affiliates have been successful in resettling refugees,
                          the same communities are often asked to absorb refugees year after
                          year. One state refugee coordinator noted that local affiliate funding is
                          based on the number of refugees they serve, so affiliates have an
                          incentive to maintain or increase the number of refugees they resettle
                          each year rather than allowing the number to decrease.

                          Table 2: Sample Factors That Voluntary Agencies Consider When Assessing
                          Community Capacity

                           Community factors                                             Internal factors
                           Employment opportunities                                      Language ability of staff
                           Availability of affordable housing                            Staff size (ratio of staff to refugees)
                           Existing ethnic and linguistic groups                         Number of Matching Grant program slots
                           Public transportation                                         Volunteer corps
                           Health care resources                                         Private revenue
                           State budget trends for public assistance                     Long-term financial needs of the organization
                           Number of available co-sponsors
                          Source: GAO analysis of PRM, Refugee Council USA guidance, and interviews with voluntary agency officials.



Given Limited Guidance,   Even though they are required to coordinate and consult with state and
Few Voluntary Agencies    local governments about their resettlement activities, voluntary agencies
We Visited Sought Input   have received only limited guidance from PRM on how to obtain input
                          from these and other community stakeholders when assessing
from Relevant Community   communities’ capacity. The Immigration and Nationality Act, as amended,
Stakeholders When         states that it is the intent of Congress that local voluntary agency activities
Placing Refugees          should be conducted in close cooperation and advance consultation with
                          state and local governments, 16 and the cooperative agreements that the
                          Department of State enters into with national voluntary agencies require
                          the agencies to conduct their reception and placement activities in this




                          16
                               8 U.S.C. § 1522(a)(1)(B)(iii).




                          Page 12                                                                          GAO-12-729 Refugee Resettlement
manner. 17 Driven by concerns that voluntary agencies were not consulting
sufficiently with state and local stakeholders when developing their
proposals, PRM directed local voluntary agencies to do more to
document consultations with state and local stakeholders regarding the
communities’ capacity to serve refugees. 18 However, PRM’s guidance on
consultation with state and local governments does not provide detailed
information regarding the agency’s expectations for the content of these
discussions. While the guidance provides some examples of state and
local stakeholders that the voluntary agencies could potentially consult, it
does not state which stakeholders must be consulted. PRM officials said
that they allow local voluntary agencies to decide whom to consult
because the voluntary agencies know their communities best and
because local circumstances vary.

Most local voluntary agencies we visited have not taken steps to ensure
that other relevant service providers are afforded the opportunity to
provide input on the number and types of refugees that can be served. As
a result, many local service providers experienced challenges in properly
serving refugees. Most of the local voluntary agencies told us they
generally consult with private stakeholders such as apartment landlords
or potential employers prior to resettling refugees in an area. They also
stated that they consult with some public entities, such as state refugee
coordinators; however, most public entities such as public schools and
health departments generally said that voluntary agencies notified them of
the number of refugees expected to arrive in the coming year, but did not
consult them regarding the number of refugees they could serve before
proposals were submitted to PRM. Moreover, service providers in one
community noted that because the local voluntary agencies did not


17
   The cooperative agreements provide the conditions that the recipient must meet in
exchange for receiving federal funding. The agreements signed by the national voluntary
agencies also require them to ensure that their local affiliates participate in meetings
called by state and local governments to coordinate plans for the placement of refugees.
Similarly, ORR’s regulations require states to provide an assurance in their state plan for
refugee resettlement funds that local voluntary agencies and other community service
agencies will meet with state and local governments at least quarterly to coordinate the
appropriate placement of refugees in advance of the refugees’ arrival. 45 C.F.R. §
400.5(h).
18
   For example, in fiscal year 2009, PRM required the voluntary agencies to provide the
date and content of discussions with state and local stakeholders. In fiscal year 2010,
PRM added a requirement for the voluntary agencies to include the results of those
discussions. In 2012, PRM required voluntary agencies to include any concerns raised
and compromises reached.




Page 13                                                   GAO-12-729 Refugee Resettlement
consult them on the numbers and ethnicities of refugees they were
planning to resettle, there were no interpreters or residents that spoke the
language of some of the refugees who were resettled there, even though
the providers could have served refugees that spoke other languages.

Voluntary agencies may not consult with relevant stakeholders if they
perceive them to be unaware of the resettlement process or if they
believe that refugees do not use certain services. For example, local
voluntary agency staff in one community said they did not consult with
certain stakeholders because they believed that they were not well
informed about the resettlement process and might unnecessarily object
to the proposed number of refugees to be resettled. In fact, one local,
elected official we spoke to was unaware that refugees were living in the
community. Other elected officials noted that it was difficult to tell if or
when refugees accessed services, even though school and health
department officials in those same communities had frequent interactions
with refugees and wanted opportunities to provide input.

Although they bear much of the responsibility for providing services to
refugees, some of the health care providers and schools that had not
been consulted on, or even notified of, the number of refugees that were
to be resettled sometimes felt unprepared to do so. For example, health
care providers in two communities told us that they were not notified in
advance that refugees would be arriving in their communities, and thus,
had no time to set up screening procedures. They were also unaware of
the specific needs and health challenges of the communities they were
serving.

In addition, in some instances when voluntary agencies were unable to
adequately prepare the community as a whole for the new arrivals and
provide refugees with the services they needed, some community
members expressed opposition toward the refugees. For example, in Fort
Wayne, Indiana, a few case studies show that the community, which had
been receiving fewer than 500 refugees per year prior to 2007,
experienced a rapid increase that more than tripled the number of




Page 14                                         GAO-12-729 Refugee Resettlement
refugees resettled in the community. 19 The community, in turn, was forced
on short notice to obtain new sources of funding and establish a new
infrastructure in order to serve their new arrivals. This unplanned increase
in refugees, combined with a growing unemployment rate, engendered
frustrations that resulted in backlash from the community. Moreover, a
number of other factors, including the high frequency of communicable
diseases among certain populations, unmet needs for mental health
services, overcrowding in homes, and cultural practices caused existing
residents to become concerned or even hostile. Similarly, officials in
Clarkston, Georgia, another community that was not initially consulted
regarding the resettlement of thousands of refugees beginning in 1996,
described the flight of long-time residents from the town in response to
refugee resettlement and the perceived deterioration of the quality of
schools. 20

In a few of the communities we visited, after reaching a crisis point due to
the influx of refugees, stakeholders took the initiative to develop formal
processes for providing input to the local voluntary agencies on the
number of refugees they could serve. 21 For example, an influx of refugees
in Fargo, North Dakota, in the 1990s overwhelmed local service
providers. In response, those service providers and the local voluntary
agency formed a Refugee Advisory Committee to provide a formal,
community-based structure for finding solutions to challenges in resettling
refugees. The committee includes representatives from the local
voluntary agency, state and county social services departments, various
city departments, school districts, as well as local health care providers,



19
  General Dynamics Information Technology, Inc., Building an Integrated Refugee
Program, a report prepared at the request of the Department of Health and Human
Services Office of Refugee Resettlement (ORR), November 2009. Staff of Senate
                                     th
Committee on Foreign Relations, 111 Cong., Abandoned Upon Arrival: Implications for
Refugees and Local Communities Burdened by a U.S. Resettlement System That is Not
Working (Comm. Print 2010).
20
   According to PRM, in the past five years, affiliate abstracts submitted in annual
proposals detail consultations and ongoing work with various state and local entities
concerning placement in Clarkston. These consultations include regular meetings of the
Georgia Coalition of Refugee Stakeholders, whose members include local elected
officials. They also note discussions regarding housing, health services, and public school
issues and consultations with the DeKalb county Board of Health/Refugee Clinic director
and the DeKalb County school system. By request of the State Refugee Coordinator, in
fiscal year 2011, refugee placements in Clarkston were reduced.
21
     These communities were recommended to us as examples of best practices.




Page 15                                                  GAO-12-729 Refugee Resettlement
nonprofit organizations, and the assistant state refugee coordinator. The
local voluntary agency solicits input from the committee annually on the
number of refugees the community has the capacity to serve in the
coming year and also meets quarterly to address other issues such as the
needs of service providers. Committee members told us that the number
of new refugees arriving in Fargo declined after the committee was
developed. 22 Committee members and voluntary agency officials said that
their close communication allows them to better educate the community
and better serve the refugees, and both believe the number being
resettled is manageable.

Similarly, in Boise, Idaho, city officials formed a roundtable group to
develop a Refugee Resource Strategic Community Plan in 2009 to work
with the local voluntary agencies, the state refugee coordinator’s office,
and community organizations to identify strategies for successful
resettlement of Boise’s refugees, in light of the most recent economic
downturn. The group includes representatives from the state coordinator’s
office, local voluntary agencies, various city departments, school district
representatives, nonprofit organizations, as well as employers, health
care providers, and other community stakeholders. The group meets
quarterly to review progress on the objectives outlined in the strategic
plan. The local voluntary agencies obtain input from the group members
on the community’s capacity for serving refugees, but they do not discuss
the specific number of refugees that will be proposed to the national
voluntary agency and PRM for resettlement. Roundtable members told us
that the local voluntary agencies have worked with their national offices to
reduce the proposed number of refugees to resettle in Boise in 2011
based on community capacity.

The state of Tennessee has passed legislation that creates formal
processes for communication between voluntary agencies and local
stakeholders. Specifically, the Refugee Absorptive Capacity Act, 23 which
was passed in 2011, requires the state refugee program office to enter
into a letter of agreement with each voluntary agency in the state. The


22
   Data from the voluntary agency show that the number of newly arriving refugees in
Fargo and West Fargo declined from 564 in fiscal year 2000 to 327 in fiscal year 2001 and
to 42 in fiscal year 2002. Over the next 8 years, the number of new arrivals increased, but
remained below the fiscal year 2000 level. In fiscal year 2010, there were 356 new
arrivals.
23
     Codified at Tenn. Code Ann. §§ 4-38-101 to 4-38-104.




Page 16                                                  GAO-12-729 Refugee Resettlement
                           letter of agreement must contain a requirement that local stakeholders
                           mutually consult and prepare a plan for the initial placement of refugees
                           in a community as well as a plan for ongoing consultation. In addition, the
                           state program office must ensure that local voluntary agencies consult
                           upon request with local governments regarding refugee placement in
                           advance of the refugees’ arrival. 24



Refugees Bring
Benefits to
Communities but Can
Pose Challenges for
Service Providers
Refugees Bring Diversity   Communities can benefit socially and economically from refugee
and Can Help Stimulate     resettlement. In all of the communities we visited, stakeholders said that
Development, but Can       refugees enriched their cultural diversity. For example, local service
                           providers in Fargo commented that refugees bring new perspectives and
Stretch Resources and      customs to a city with predominately Norwegian ancestry. Some city
Affect Program Outcomes    officials and business leaders we spoke with in several communities said
                           that refugees help stimulate economic development by filling critical labor
                           shortages as well as by starting small businesses and creating jobs. For
                           instance, new refugee-owned businesses revitalized a neighborhood in
                           Chicago after other businesses in the area closed. In addition, an official
                           in Washington State told us that diverse resettlement communities with
                           international populations attract investment from overseas businesses.
                           According to ORR officials, refugees also bring economic benefits to
                           communities by renting apartments, patronizing local businesses, and
                           paying taxes, and the presence of refugees may increase the amount of
                           federal funding that a community receives. 25 In Boise, officials


                           24
                              The law also requires the state program office to provide a written quarterly report to
                           local governments to plan and coordinate the placement of refugees, provide a quarterly
                           report to specified state legislative committees, and ensure that host community residents
                           and representatives of local governments are aware that they should notify the state
                           program office with any concerns about resettlement activities.
                           25
                              ORR officials noted, for example, that schools might receive additional federal funding if
                           the proportion of low-income students in a school increases.




                           Page 17                                                   GAO-12-729 Refugee Resettlement
commented that the refugee students helped stabilize the public school
population, which had been declining before the city established a
refugee resettlement program.

While refugees can benefit their communities, they can also stretch the
resources of local service providers, such as school districts and health
care systems. In several communities we visited, school district officials
said that it takes more resources to serve refugee students than
nonrefugee students, because they sometimes lack formal schooling or
have experienced trauma, which can require additional supports, such as
special training for school staff. In addition, newly arrived refugee
students often have limited English proficiency, and hiring interpreters can
be costly. 26 Similarly, some health care providers expressed concerns
about serving refugees, because they said that they are required to
provide interpreter services to patients with limited English proficiency. 27
One provider told us that their clinic spent more than $100,000 on
interpreter services in the previous year, costs that were not
reimbursed. 28 In addition, in some communities we visited, school district
officials and health care providers said that locating interpreters for
certain languages can be difficult. ORR and PRM officials noted that
these impacts are not unique to refugees and that serving immigrants
may pose similar challenges.

ORR offers discretionary grants to assist school districts that serve a
large number of refugees, but we learned that district officials may be


26
   According to ORR officials, the Department of Education provides supplemental funding
under Title III of the Elementary and Secondary Education Act, as amended, Language
Instruction for Limited English Proficient and Immigrant Students. However, school district
officials in one community we visited said that continuous cuts in Title III funding have had
significant impacts on schools that serve refugee students.
27
   ORR’s regulations require that in providing refugee medical assistance, states must
provide at least the same services in the same manner and to the same extent as under
the state’s Medicaid program. In addition, all recipients of federal funds are required to
comply with Title VI of the Civil Rights Act of 1964, which prohibits discrimination based on
race, color, or national origin under any program receiving federal financial assistance.
Several health care providers and voluntary agencies we spoke with viewed the hiring of
interpreters as a way to comply with this requirement. This report, however, does not
attempt to assess entities’ compliance with Title VI requirements.
28
   Under Medicaid, states may claim federal matching funds for interpreter costs;
however, in this case, the amount reimbursed by the state Medicaid program covered
approximately half of the cost of the interpreter services, which left the provider to cover
the remaining cost.




Page 18                                                    GAO-12-729 Refugee Resettlement
unaware of these grants or may decide that the effort involved in applying
for them outweighs the potential benefits. For example, through its school
impact grant, ORR funds activities for refugee students such as English
as a Second Language instruction and after-school tutorials. However,
school district officials in one community that was new to the refugee
resettlement program said they had no information about where they
could find assistance in serving refugee students. In another community,
district officials were aware of the school impact grant, but said they did
not apply for it because they found the application process to be
burdensome and the funding level would have been insufficient to meet
their needs. 29

In addition to stretching school district resources, refugee students can
also negatively affect district performance outcomes. School district
performance is measured primarily by students’ test scores, including the
scores of refugee students. School district officials in several communities
said that even though refugee students often have limited English
proficiency, they are evaluated against the same metrics as their native
English-speaking peers, which can result in lower performance outcomes
for the district. In one community, officials told us that the district had not
demonstrated adequate yearly progress under the state standards in
recent years, and they attributed this in part to the test scores of refugee
students. 30

Furthermore, refugees who exhaust federal refugee assistance benefits
and are not self-sufficient can strain local safety nets. Refugees who are
no longer eligible to receive cash and medical assistance from ORR after
8 months but are unemployed—or are working in low-wage jobs that do
not provide sufficient income—may seek help from local service providers
such as food pantries, organizations providing housing assistance, and
even homeless shelters. If service providers are unprepared to serve
these refugees in addition to their other clients, it can stretch their



29
  For fiscal year 2012, the school impact grant program provided funding to states
ranging from $150,000 to $1 million, depending on the size of the school-age refugee
population and other eligible populations. States used these funds to award grants to state
departments of education, local school districts, or voluntary agencies.
30
   Under the Elementary and Secondary Education Act, as amended, all students are
expected to meet or exceed state standards in reading and in math by 2014. Each state
establishes its own definition of adequate yearly progress to determine school and school
district achievement toward this goal.




Page 19                                                  GAO-12-729 Refugee Resettlement
                           budgets and diminish the safety net resources available to others in the
                           community.

                           Table 3 lists the benefits and challenges of refugee resettlement identified
                           by stakeholders in the communities we visited.

                           Table 3: Benefits and Challenges of Refugee Resettlement Identified in Site Visits

                            Benefits                                                      Challenges
                            Refugees add diversity to their                               Communication can be difficult due to
                            communities                                                   language and cultural barriers
                            The presence of refugees in a community                       Mental health resources are limited for
                            teaches tolerance for others                                  refugees who have experienced trauma
                            Refugees take jobs that are difficult to fill                 The cost of interpreter services can strain
                            Refugees are reliable, dedicated                              service providers’ budgets, and some health
                            employees                                                     care providers have chosen to stop serving
                                                                                          refugees
                            Refugee-owned businesses create jobs
                                                                                          Refugee students with limited English
                            Public services developed to assist                           proficiency can affect school districts’
                            refugees, such as transit programs, also                      performance outcomes
                            benefit other vulnerable populations
                                                                                          Some refugees live in poverty due to
                                                                                          unemployment
                                                                                          Some refugees are unfamiliar with social
                                                                                          norms and laws in the United States
                           Source: GAO interviews with stakeholders in selected communities.



Some Refugees Relocate     Migration from one community to another after initial resettlement—
after Resettlement, and    referred to as secondary migration—can unexpectedly increase the
This Secondary Migration   refugee population in a community, and communities that attract large
                           numbers of secondary migrants may not have adequate, timely funding to
May Strain Communities     provide resettlement services to the migrants who need them. 31
That Lack Adequate         According to ORR, refugees relocate for a variety of reasons: better
Resources to Serve Them    employment opportunities, the pull of an established ethnic community,
                           more welfare benefits, better training opportunities, reunification with




                           31
                              According to PRM officials, refugees often migrate multiple times. Officials also noted
                           that some refugees who choose to migrate from their initial resettlement communities do
                           so within a few months of arrival, while others do so after a longer period of time.




                           Page 20                                                                     GAO-12-729 Refugee Resettlement
relatives, or a more congenial climate. 32 Not all refugees who migrate
choose to access resettlement services in their new communities,
according to PRM officials. However, for those migrants who need
resettlement services, federal funding does not necessarily follow them to
their new communities, even though refugees continue to be eligible for
some resettlement services for 5 years after arrival. According to ORR
officials, refugees who relocate while they are receiving cash assistance,
medical assistance, or refugee social services are eligible to continue
receiving those services in their new communities for a limited time. 33
However, ORR does not coordinate this continuation of service, and state
refugee coordinators must communicate with one another to determine
eligibility for each refugee who relocates.

In addition, ORR provides grants to communities and states affected by
secondary migration, but the annual cycle of these grants may not
provide ORR the flexibility to respond in a timely manner. ORR uses
secondary migration data submitted by states once a year, among other
data, to inform refugee social services funding allocations for future fiscal
years. 34 According to ORR officials, these formula grants are awarded
annually to states based on the number of refugee arrivals during the
previous 2 years. As a result, a year may pass before states experiencing



32
   According to PRM data for fiscal year 2011, 3,261 refugees, or 5.7 percent of refugees,
moved away from their initial resettlement community within the first 90 days of
resettlement. According to ORR data for fiscal year 2010, states reported that
approximately 11,143 refugees moved from their initial resettlement state. ORR collects
secondary migration data on refugees who have arrived within 36 months prior to the
beginning of the fiscal year. Fiscal year 2010 data showed that Texas and California had
large numbers of refugees moving both in and out. There was strong net migration into
Minnesota, Florida, Colorado, Ohio, and Kansas. There was strong net migration out of
Arizona, New York, New Jersey, Texas, and Georgia.
33
   Depending on the program in which they are enrolled, refugees are eligible to receive
ORR-funded cash assistance for 8 months if they are enrolled in a statewide program.
Refugees enrolled in a Matching Grant program are eligible to receive cash assistance for
4 to 6 months after arrival. Refugees are also eligible for ORR-funded medical assistance
for up to 8 months after arrival. Refugees are eligible to receive services through ORR’s
social services grant program for up to 5 years after arrival.
34
   Refugee social services programs provide employment and other services such as
social adjustment, translation, childcare, and citizenship services, as well as case
management. ORR allocates these funds to states based on estimates of arriving
refugees, as well as secondary migration data for the prior 2 years. These social services
funds do not increase within a given year if the number of refugees served is greater than
anticipated.




Page 21                                                  GAO-12-729 Refugee Resettlement
secondary migration receive increased funding. For example, Minnesota
reported to ORR that 1,999 refugees migrated into the state during fiscal
year 2010, but under ORR’s current formula funding process, the state
would not have received increased funding until fiscal year 2011. In
another example, social services funding did not keep pace with a large
number of arrivals of both newly resettled refugees and secondary
migrants in Detroit in fiscal year 2008. According to a report
commissioned by ORR, after this rapid influx of arrivals, caseloads rose
to 150 clients per caseworker in the employment and training program,
and caseworkers were forced to devote a majority of their time to
paperwork and case management, which limited their ability to provide
job development and training services. 35 Further, ORR will not adjust a
state’s level of social services funding to account for secondary migration
until it verifies that the refugees migrated to the state. According to one
state refugee coordinator, ORR rejects the data states submit if the
refugee’s information does not match the information in ORR’s database
or if two or more states claim to have served the same refugee. ORR
officials said that, while their process allows states to update missing data
and correct formatting errors, it does not allow states to resubmit data that
does not match the information in ORR’s database or that was submitted
by two or more states. 36

ORR offers supplemental, short-term funding to help communities
affected by secondary migration. For example, the Supplemental
Services for Recently Arrived Refugees grant is designed to help
communities provide services to secondary migrants or newly arriving
refugees when the communities are not sufficiently prepared in terms of
linguistic or culturally appropriate services or do not have sufficient
service capacity. However, this grant is only available to communities that
will serve a minimum of 100 refugees annually, and the funding is for a
fixed period of time. 37 Communities must apply and be approved for the


35
  General Dynamics Information Technology, Inc., Building an Integrated Refugee
Program.
36
  According to ORR officials, less than 10 percent of the data submitted on secondary
migrants are rejected.
37
   To be considered for the Supplemental Services for Recently Arrived Refugees grant,
communities must demonstrate situations such as (1) refugee services do not presently
exist or the service capacity is not sufficient to accommodate significant increases in
arrivals; and/or (2) the existing service system does not have culturally and linguistically
appropriate services. ORR provides grantees with funding for a grant project period of17
months.




Page 22                                                    GAO-12-729 Refugee Resettlement
grant, and funding may not arrive until many months after the influx
began. For example, in a draft report on secondary migration
commissioned by ORR, the Spring Institute for Intercultural Learning
found that one community did not receive supplemental funding until 14
months after secondary migrant refugees began arriving. 38

Without comprehensive secondary migration data, ORR cannot target
supplemental assistance to communities and refugees in a timely way.
Currently, the data that PRM and ORR collect on secondary migration are
limited and little is known about secondary migration patterns. PRM
collects data from local voluntary agencies regarding the number of
refugees who move away from a community within the first 90 days after
arrival, but does not collect data on the estimated number of refugees
who enter the community during the same time period. PRM officials said
that they use these out-migration data to assess the success of refugee
placement decisions. In contrast, ORR collects secondary migration data
annually from each state, but does not collect community-level data.
Specifically, ORR collects information on the number of refugees who
move into and out of each state every year. However, ORR officials
explained that they can only collect these data when secondary migrants
access services. As a result, refugees who move into or out of a state but
do not use refugee services in their new communities are not counted.
Even so, these refugees access other community services and their
communities may need additional assistance to meet their needs.

Secondary migration can strain local resources significantly. For example,
the draft report on secondary migration prepared for ORR by the Spring
Institute for Intercultural Learning found that refugees who migrate to new
communities can overwhelm local service providers, such as health
departments, that are unprepared to serve them. In addition, a report
prepared for ORR by General Dynamics Information Technology, Inc.
found that, in one community, the influx of a large number of secondary
migrants who lacked resources led to a homelessness crisis that stressed




38
  Spring Institute for Intercultural Learning. Rural Secondary Migration Pilot Project:
Impacts, Challenges, and Opportunities,, a report prepared at the request of the
Department of Health and Human Services Office of Refugee Resettlement (ORR),
October 2009.




Page 23                                                   GAO-12-729 Refugee Resettlement
                          the capacity of both the shelter system and the other agencies serving
                          refugees. 39


Capacity Challenges Can   Some communities that face challenges in serving additional refugees
Lead Communities to       have requested restrictions or even temporary moratoriums on refugee
Request Restrictions or   resettlement. According to PRM, the cities of Detroit and Fort Wayne,
                          Indiana, requested restrictions on refugee resettlement due to poor
Temporary Moratoriums     economic conditions. In response, PRM limited resettlement in Detroit
on Refugee Resettlement   and Fort Wayne to refugees who already have family there. 40 In addition,
                          the mayor of Manchester, New Hampshire, asked in 2011 that PRM
                          temporarily stop resettling refugees in the city because of a shortage of
                          jobs and sufficient affordable housing. While PRM did not grant the
                          requested moratorium, the agency reduced the number of refugees to be
                          resettled there in fiscal year 2011 from 300 to about 200. PRM officials
                          said that a moratorium on resettlement would not have made sense
                          because nearly all of the refugees slated to be resettled in Manchester
                          have family there and would likely relocate to Manchester eventually—
                          even if they were initially settled in another location.

                          Tennessee recently created a process by which communities could
                          request a temporary moratorium on refugee resettlement for capacity
                          reasons. The state’s Refugee Absorptive Capacity Act allows local
                          governments to submit a request to the state refugee office for a 1-year
                          moratorium on resettling additional refugees if they document that they
                          lack the capacity to do so and if further resettlement would have an
                          adverse impact on residents. The state refugee office may then forward
                          this request to PRM. 41 Passed in 2011, the law states that local
                          governments should consider certain capacity factors—the capacity of
                          service providers to meet existing needs of current residents, the


                          39
                            General Dynamics Information Technology, Inc., Building an Integrated Refugee
                          Program.
                          40
                             PRM initially limited resettlement in these cities to immediate family members of
                          refugees who were already living there. However, in response to requests from the local
                          voluntary agencies and a leveling in the flow of arrivals, the metro Detroit policy was
                          amended to allow placement of any refugees with ties to family or friends in the area.
                          According to voluntary agency officials, the policy was amended due to high levels of
                          secondary migration and the difficulty serving secondary migrants without funding.
                          41
                             PRM has discretion to approve or deny this request, as state law is not binding on the
                          federal government.




                          Page 24                                                  GAO-12-729 Refugee Resettlement
                          availability of affordable housing, the capacity of the school district to
                          meet the needs of refugee students, and the ability of the local economy
                          to absorb new workers—before making such a request. According to
                          PRM, to date, no community in Tennessee has submitted such a request.



Agencies Monitor
Resettlement and
Measure
Effectiveness, but
These Measures Have
Weaknesses

PRM and ORR Take          PRM conducts regular on-site monitoring of national voluntary agencies
Different Approaches to   and about 350 local affiliates to ensure that the voluntary agencies deliver
Program Oversight         the services outlined in their cooperative agreements. Under the
                          cooperative agreements, local voluntary agencies must provide certain
                          services to refugees in the first 30 to 90 days after they arrive. PRM
                          monitors national voluntary agencies annually and local affiliates once
                          every 5 years, and requires national voluntary agencies to monitor their
                          affiliates at least once every 3 years. During its local affiliate monitoring
                          visits, PRM reviews case files and interviews staff. PRM officials also visit
                          a small sample of refugees in their homes to ensure that the refugees
                          received clean, safe housing and appropriate furniture. PRM also requires
                          voluntary agencies to report certain outcome measures for each refugee
                          they resettle.

                          In recent years, PRM found most local affiliates generally compliant, and
                          for those that were not, PRM made recommendations and required
                          immediate corrective action. For fiscal years 2009 through 2011,
                          according to PRM, it conducted 136 on-site monitoring visits. In over
                          three-quarters of those visits, PRM determined that the local affiliate was
                          compliant or mostly compliant. In about one-quarter of the cases,
                          however, PRM determined that they were partially or mostly noncompliant
                          (about 20 percent) or simply noncompliant (about 5 percent). PRM or
                          national resettlement agencies can make return, on-site monitoring trips
                          to assess the progress of affiliates when problems are identified.
                          Furthermore, if the problems persist, national voluntary agencies can
                          close an affiliate’s operation or PRM can decide not to allow placement of


                          Page 25                                         GAO-12-729 Refugee Resettlement
refugees at an affiliate. For fiscal year 2011, PRM determined that the
most common recommendation made to local affiliates was that the local
affiliate should document the reason core services could not be provided
in the required time frames. (See table 4 for the top 10 recommendations
made for fiscal year 2011.)

Table 4: Top 10 Recommendations for FY 2011 from PRM Monitoring Visits

 1.   Ensure that when core services cannot be completed within the time frames
      specified in the Cooperative Agreement, the case note logs specify the reason for
      the delay.
 2.   Ensure that services are provided with interpretation, as needed, that allows for
      communication with the refugee in his/her native language or in a common
      language in which the refugee is fluent, throughout the reception and placement
      period.
 3.   Take immediate steps to ensure that infestation noted in home visits is addressed.
 4.   Conduct at least two home visits for each case: the initial home visit within 24 hours,
      as well as an additional home visit within 30 days of arrival.
 5.   Ensure that refugees receive all essential furnishings upon arrival.
 6.   Ensure that a resettlement plan is developed for each refugee, including children,
      that indicates the initial assessment of employability for each employable refugee
      and includes a clear plan of action based on an assessment of the individual.
 7.   The headquarters should have in place a formal plan for training new headquarters
      staff and affiliate directors, and should ensure that each affiliate has a structured
      training plan for each of its new employees.
 8.   The affiliate should ensure that culturally appropriate, ready-to-eat food is available
      upon a refugee’s arrival, plus one day’s worth of additional food supplies. The
      affiliate should provide food or food allowance at least equivalent to the food stamp
      allocation continued food assistance until receipt of food stamps or until the
      individual or family is able to provide his or her own food.
 9.   Ensure minor suitability determinations are completed within 1 week of the minor’s
      arrival, and that minors’ files are segregated and can be readily identified.
 10. Ensure that every refugee has a health assessment within 30 days of arrival and
     that refugees with acute health care requirements receive appropriate and timely
     medical attention.
Source: PRM.



Whereas PRM’s oversight focuses on services provided, ORR’s oversight
focuses more on performance outcomes. In order to assess the
performance of its programs that provide cash, medical assistance, and
social services to refugees, ORR monitors employment outcomes and
cash assistance terminations (see table 5). It uses a similar set of
measures for its Matching Grant program.




Page 26                                                    GAO-12-729 Refugee Resettlement
Table 5: Performance Outcome Measures for Major Refugee Assistance Programs

                                a
     Statewide Measures                           Matching Grant program
     1. Entered Employment                        1. Entered Employment
     2. Average Wage at Employment                2. Average Wage at Employment
     3. Employment with Health Benefits           3. Employment with Health Benefits
     4. Job Retention for 90 days                 4. Self-Sufficient at 120th day
     5. Cash Assistance Reductions due to         5. Economic Self-Sufficiency Retention at the
     Earnings                                     180th day
     6. Cash Assistance Termination due to        6. Economic Self-Sufficiency Overall
     Earnings
Source: ORR program guidance.
a
 ORR prepares an Annual Performance Plan, which presents goals and progress toward six
measures of economic self-sufficiency. Each state negotiates with ORR to establish a target for each
measure, and states are encouraged to set or negotiate similar targets with programs within the state.
ORR uses these measures for all statewide programs—publicly administered, public private
partnerships, and Wilson-Fish programs, which are administered by a voluntary agency. For more
information on the statewide programs, see GAO-11-369.


According to ORR, its focus on employment outcomes as a measure of
effectiveness is based on the Immigration and Nationality Act, as
amended, which requires ORR to help refugees attain economic self-
sufficiency as soon as possible. 42 ORR considers refugees self-sufficient
if they earn enough income that enables the family to support itself
without cash assistance—even if they receive other types of noncash
public assistance, such as Supplemental Nutrition Assistance Program
benefits or Medicaid. 43

ORR conducts its on-site monitoring at the state level to ensure the
program is able to collect and report accurate data and to ensure that the
state is able to provide services to refugees. ORR’s on-site monitoring
identifies deficiencies as well as best practices. ORR generally monitors
state refugee coordinators onsite once every 3 years, as the state
coordinator is responsible for administering and overseeing ORR’s major
grants. During the on-site visit, ORR also monitors a sample of
subgrantees. In monitoring reports from its most recent on-site monitoring


42
  8 U.S.C. § 1522(a)(1)(A)(i). This law requires ORR to do so to the extent of available
appropriations.
43
  Cash assistance includes both refugee cash assistance and payments received under
the Temporary Assistance for Needy Families program.




Page 27                                                         GAO-12-729 Refugee Resettlement
in the states we visited, ORR identified a number of deficiencies
including:

•   failure to inform refugees that they were eligible for certain services
    for up to 5 years,
•   failure to ensure that medical assistance was terminated at the end of
    the 8-month eligibility period,
•   failure to ensure that translators were available when providing
    services to refugees, and
•   missing documentation in case files.
The monitoring reports contained ORR’s recommendations and noted
when corrective action was required. ORR’s monitoring reports also
identified program strengths and best practices that monitors observed
while on site. For example, one ORR monitoring report noted that having
a state refugee housing coordinator was a program strength, because this
coordinator can locate affordable housing and research funding sources,
which saves the caseworkers time and effort. In the same state, ORR
found that having an employment specialist at a voluntary agency who
can help refugees obtain job upgrades and pursue professional
certificates was also a program strength. According to ORR officials, they
supplement this on-site monitoring with desk monitoring, which may
include reviews of case files, or reviews of information provided in
periodic reports.

Neither ORR nor PRM has formal mechanisms for collecting and sharing
information gleaned during monitoring to improve services, such as
solutions to common problems or promising practices. ORR and PRM
officials identified some informal mechanisms for sharing such information
with service providers, but relied mostly on service providers to network
among themselves or share information during quarterly conference calls
and annual consultations. ORR also relies on external technical
assistance providers to disseminate best practices when training grantees
and expects state refugee coordinators to share findings of monitoring
reports with their local partners. However, monitoring reports are not
publicly available, and, unless the state coordinators share this
information, service providers may not be able to identify promising
practices, track monitoring results, identify trends, and address common
issues. As a result, service providers do not always get the information
they need to improve services, whether by preventing a problem or
implementing a best practice.




Page 28                                        GAO-12-729 Refugee Resettlement
ORR’s Performance            ORR’s performance measures focus on short-term outcomes, even
Measures Encourage           though refugees remain eligible for social services funded by ORR for up
Service Providers to Focus   to 5 years. 44 Because it is important for refugees to become employed
                             before their cash assistance runs out—8 months or less, depending on
on Short-Term Outcomes
                             the service delivery model—ORR’s performance measures provide
                             incentives for service providers to focus on helping refugees gain and
                             maintain employment quickly. Specifically, ORR requires grantees to
                             measure entered employment at 6 months for the Matching Grant
                             program or 8 months for statewide cash assistance programs. 45 In
                             addition, ORR requires grantees to measure job retention 90 days after
                             employment. This focus on short-term employment, however, can result
                             in a one-size-fits-all approach to employment services and may, in turn,
                             limit service providers’ flexibility to provide services that may benefit
                             refugees after the 6 to 8 month time frame. That is, with limited incentives
                             to focus on longer-term employment and wages, service providers may
                             not help refugees obtain longer-term services and training, such as on-
                             the-job or vocational training, which could significantly boost their income
                             or benefit the refugee in the long-term or after employment is measured. 46
                             For example, when assisting refugees who arrive with college degrees
                             and professional experience, service providers may not help them earn a
                             credential valid in the United States, because the providers’ effectiveness


                             44
                                Employment is measured for all cash assistance recipients, but after cash assistance
                             expires, employment is measured only for refugees who are enrolled in ORR-funded
                             employment assistance. The portion of the caseload that is receiving employment
                             services but not receiving cash assistance varies widely by state. For example, in 2010 in
                             California, 12 percent of the caseload was not receiving federal cash assistance, but in
                             Wisconsin, 66 percent of the caseload was receiving no federal cash assistance. ORR
                             requires service providers to give newly arrived refugees priority for services. Some
                             service providers have said that in order to ensure that new arrivals continued to receive
                             needed services, they provided employment services to refugees for only about 1 year
                             rather than the 5 years allowed.
                             45
                                Our 2011 report provides more information about the various ways states may opt to
                             deliver services. See GAO-11-369. All states, except Wyoming, administer an ORR-
                             funded assistance program that provides up to 8 months of cash and medical assistance,
                             as well as other social services. In addition, some refugees participate in the Matching
                             Grant program, which is only partially funded by ORR. According to ORR, a network of
                             national voluntary agencies administers this program. The Matching Grant program
                             provides refugees with cash and other assistance for 4 to 6 months with the goal of
                             helping them become self-sufficient without receiving cash benefits from a public
                             assistance program.
                             46
                               States do report to ORR the number of refugees they serve who have been in the
                             United States for more than 12 months. ORR officials noted that refugees may also
                             access mainstream employment services.




                             Page 29                                                  GAO-12-729 Refugee Resettlement
is measured by whether the refugee is employed. Additionally, ORR does
not allow skills certification training to exceed 1 year and requires the
refugees to be employed when receiving training and services. 47 Several
service providers mentioned this as a challenge for highly skilled Iraqi
refugees, in particular, some of whom include doctors and engineers. 48

In addition, voluntary agency officials noted that ORR’s employment
measures do not allow them to report on the longer-term or non-
employment-related outcomes of the other refugee resettlement services
they provide. As a result, services such as skills training, English
language training, or mental health services—which provide longer-term
benefits and benefits unrelated to employment—may not be emphasized.
According to some local voluntary agency officials we spoke to, given the
current performance measures, there is a disincentive to dedicate
necessary time and resources to the nonemployment activities that create
pathways to success for refugees. It may be particularly difficult to serve
those who do not arrive in the United States ready to work due to trauma,
illness, or lack of basic skills.

While much of ORR’s grant funding focuses on short-term employment,
ORR does have some discretionary grants that provide funding for
particular purposes that may include services that focus on longer-term
goals or more intensive case management. For example, the individual
development account program provides matching funds to help refugees
save money for the purchase of a vehicle or a home. 49 For these


47
   Obtaining credentials may require additional training, including English language
training, which may go beyond 6 or 8 months.
48
   A study commissioned by ORR on its social service and targeted assistance grant
highlighted a career-laddering program in Miami as a promising practice. The purpose of
the program is to help refugees who were professionals in their native countries but who
lack certification to do similar work in the United States. The program helps refugees with
obtaining credentials, training, and employment in a field that is consistent with their
career goals and similar to the work they did in their native countries. HHS, The
Evaluation of the Refugee Social Service (RSS) and Targeted Assistance Formula Grant
(TAG) Programs: Synthesis of Findings from Three Sites (Washington, D.C.: March 2008).
ORR also partially funds two other programs that promote professional recertification of
refugee physicians and other highly skilled professionals. One is located in Minnesota.
The other is located in San Diego, California.
49
  The individual development account program provides refugees with matched savings
accounts for the purchase of specific assets: a home, capital for a small business, post-
secondary education or training, and in some cases, the purchase of a car if needed to
maintain or upgrade employment.




Page 30                                                  GAO-12-729 Refugee Resettlement
                           relatively small competitively awarded discretionary grant programs, ORR
                           gathers data on how much money was saved and what assets were
                           purchased, but does not gather data on how these asset purchases
                           affected earnings or self-sufficiency. Descriptions of discretionary grants
                           that can be used to fund services beyond the initial resettlement period,
                           as well as other selected ORR and PRM grant programs, can be found in
                           appendix IV.

                           In addition to the employment measures’ focus on short term outcomes,
                           one state coordinator also noted that these employment measures leave
                           room for interpretation. Specifically, some voluntary agencies may have a
                           narrow definition of employment services while others may have a
                           broader definition. In turn, the percentage of refugees who become
                           employed after receiving employment services could vary based on what
                           types of services are considered employment services. As a result,
                           according to a state coordinator, measures may not provide consistent
                           information about how well a program is performing in different
                           communities.



Little Is Known about
the Extent of Refugee
Integration, but
Studies Offer a
Framework for
Assessing Integration

Federal Agencies Promote   While federal refugee resettlement programs generally provide only short-
but Do Not Currently       term assistance, PRM and ORR both aim to prepare refugees for long-
Measure Refugee            term integration into their communities. Although there is no single,
                           generally accepted definition of integration in the literature, integration
Integration                can be defined as a dynamic, multidirectional process in which
                           newcomers and the receiving communities intentionally work together,
                           based on a shared commitment to acceptance and justice, to create a




                           Page 31                                        GAO-12-729 Refugee Resettlement
secure, welcoming, vibrant, and cohesive society. 50 The federal
government’s efforts to facilitate integration begin before refugees even
enter the United States, as PRM offers cultural orientation for all refugees
and recently piloted English language training for refugees in certain
overseas locations. 51 According to PRM, this cultural orientation and
language training is intended to lay the groundwork for refugees’ long-
term integration into the United States. Integration is also a part of ORR’s
mission and overall goal, 52 and officials told us that they consider
integration to be a central aspect of refugee resettlement. Although ORR
only provides refugees with cash and medical assistance for a maximum
of 8 months, officials noted that this initial assistance helps set the
foundation for long-term integration. Other ORR programs provide longer-
term services that are intended to further facilitate integration, but these
services may not be as widely available as cash and medical assistance.
For example, ORR’s social services grant program funds employment
services and other support services to refugees for up to 5 years after
arrival, but communities may choose to provide these services for a
shorter period of time due to local resource constraints. ORR’s
discretionary grants for micro-enterprise assistance and individual
development accounts are also designed to facilitate integration by
helping refugees start businesses in the communities where they live,
among other goals. 53 However, these discretionary grants are
competitively awarded and are thus not available to all communities.



50
   This definition is the working definition adopted by ORR’s integration working group,
and is not an official definition adopted by ORR. ORR created an integration working
group in 2006 to review and analyze the integration process for refugees in communities
throughout the United States.
51
   PRM offers cultural orientation in both overseas locations and the resettlement location
in the United States, and recently piloted English language training programs in Kenya,
Thailand, and Nepal.
52
   ORR’s mission statement is: “Founded on the belief that newly arriving populations
have inherent capabilities when given opportunities, the Office of Refugee Resettlement
(ORR) provides people in need with critical resources to assist them in becoming
integrated members of American society.” ORR’s major goal is to “provide assistance to
refugees and other eligible persons through its various programs and grants, so that they
can achieve self-sufficiency and integration within the shortest time period after arriving in
the United States.”
53
   The micro-enterprise assistance program provides refugees with loans and training to
start, expand, or strengthen their own businesses. As noted above, the individual
development account program provides refugees with matched savings accounts for the
purchase of specific assets, including capital for a small business.




Page 32                                                    GAO-12-729 Refugee Resettlement
ORR has studied approaches that facilitate refugee integration. In 2006,
ORR created an integration working group to identify indicators of refugee
integration and ways in which ORR could more fully support the
integration process. In a 2007 interim report, the working group made
both short-term and long-term recommendations to ORR, including that it
(1) consider expanding ORR’s discretionary grant programs; (2) focus on
integration in the areas of employment, English language acquisition,
health, housing, and civic engagement; and (3) identify lessons learned
from communities where refugee integration appears to be taking place.
ORR officials told us that they have implemented many, but not all, of the
working group’s recommendations due to funding constraints. 54 For
example, ORR commissioned a study to identify promising practices that
appear to facilitate integration in four U.S. cities. 55

Neither PRM nor ORR currently measure refugee integration as a
program outcome. According to PRM, it does not measure refugee
integration due to the short-term nature of the Reception and Placement
Program. While refugee integration is part of ORR’s mission and overall
goal, ORR officials said they have not measured it because there is no
clear definition of integration, because it is unclear when integration
should be measured, and because the Refugee Act focuses on self-
sufficiency outcomes related to employment. Even so, ORR officials told
us that they collect some data related to refugee integration. Specifically,
as part of its annual report to Congress, ORR conducts a survey to gauge
refugees’ economic self-sufficiency that includes integration-related
measures such as employment, English language proficiency,
participation in job training, attendance in a high school or university
degree or certificate program, and home ownership. 56 However, ORR
officials noted that the survey is not designed to measure integration and
should not be used for this purpose, especially since there is no clear




54
  See appendix V for a complete list of the working group’s recommendations to ORR
and their implementation status.
55
    ISED Solutions, Exploring Refugee Integration: Experiences in Four American
Communities, a report prepared at the request of the Department of Health and Human
Services Office of Refugee Resettlement (ORR), June 2010. We included this study in our
literature review.
56
  Each year, an ORR contractor surveys a random sample of refugees selected from the
population of all refugees who arrived in the U.S. in the last 5 years.




Page 33                                               GAO-12-729 Refugee Resettlement
                            definition of integration. In addition, the survey has had a low response
                            rate, which may affect the quality of the data. 57


Studies Offer a Framework   Studies on refugee resettlement do not offer a broad assessment of how
for Measuring and           well refugees have integrated into the United States. Of the 13 studies we
Facilitating Integration    identified that addressed refugee integration, almost all were limited in
                            scope in that they focused on particular refugee groups in specific
                            geographic locations. 58 The studies describe the integration experiences
                            of specific refugee groups, including factors that help refugees
                            successfully integrate into their communities. However, because of the
                            studies’ limited scope and differences in their methodologies, they provide
                            limited insight into how refugees overall have integrated in the United
                            States or how the experiences of different groups compare to one
                            another.

                            Although the studies we reviewed were not directly comparable, together
                            they identified a variety of indicators that can be used to assess progress
                            toward integration for both individuals and communities, as well as
                            common facilitators of integration. Indicators of integration include
                            employment, English language acquisition, housing, physical and mental
                            health, and social connections, as well as political involvement,
                            citizenship status, and participation in community organizations. One
                            study noted that when assessing integration, it is important to ask
                            refugees whether they consider themselves to be integrated.

                            The studies we reviewed also identified a range of barriers to integration.
                            Some frequently cited barriers were a lack of formal education, illiteracy
                            or limited English proficiency, and insufficient income from low-paying
                            jobs. For example, refugees who are illiterate or have limited English
                            proficiency may be limited to low-paying jobs such as hotel housekeepers
                            and may not earn sufficient income to meet their needs. Furthermore, one
                            study found that the timing of employment can be a barrier to integration.
                            Specifically, the study found that taking a job soon after arrival can slow
                            down the acquisition of English language skills because refugees may
                            have less available time to attend language classes.


                            57
                              For example, the survey response rate was 50.3 percent in 2008 and 36.6 percent in
                            2007.
                            58
                                 See appendix II for a list of the studies we included in our literature review.




                            Page 34                                                       GAO-12-729 Refugee Resettlement
In addition, the studies we reviewed identified facilitators of integration—
circumstances and strategies that can help refugees integrate
successfully into their communities. English language acquisition is an
important facilitator of integration. For example, one study found that
refugees who are proficient in English are better able to connect with
nonrefugees in their communities, expanding their social connections and
sources of support. Other facilitators of integration included employment,
social support from other refugees, and affiliation with or sponsorship by a
religious congregation. For example, religious congregations may provide
refugees with language classes, social activities, emotional and financial
support, and linkages with employment and educational opportunities,
medical care, and transportation. See table 6 for additional examples of
indicators of integration, barriers to integration, and facilitators of
integration.

Table 6: Selected Integration Indicators, Barriers, and Facilitators Identified in
Literature Review

Indicators of
integration           Barriers to integration             Facilitators of integration
Civic participation   None identified                     •    Political involvement
                                                          •    Community organizing of
                                                               refugee groups
Culture               •   Unfamiliarity with “Western”    •    Availability of public service
                          culture                              providers to educate
                      •   Intolerance for non-English          community about refugees’
                          speakers                             cultures (and vice versa)
                      •   Intolerance for cultural or
                          religious differences
Education or          •   Lack of or little formal        •    Adult education
training                  education prior to arrival in        opportunities
                          the U.S.
                      •   Lack of options for re-
                          credentialing for skilled
                          workers or professionals
Employment            •   Insufficient income from low-   •    English proficiency, which
                          paying jobs                          may help refugees obtain
                      •   Workplace environments with          work that generates
                          no opportunity to speak              sufficient income
                          English                         •    Networks and support
                                                               groups that help refugees
                                                               find employment
                                                          •    Ethnic small businesses




Page 35                                                   GAO-12-729 Refugee Resettlement
                           Indicators of
                           integration                     Barriers to integration                Facilitators of integration
                           English language                •   Illiteracy or limited English      •    Opportunities to learn and
                           acquisition                         proficiency                             practice speaking English
                                                           •   “Work first” emphasis, which       •    Participation in English
                                                               may slow language                       classes for an extended
                                                               acquisition if it limits time to        period of time
                                                               attend English classes
                           Host community                  •   Harassment and                     •    Preparation of the
                                                               discrimination                          community to receive
                                                           •   Negative interactions with              newcomers
                                                               government entities, creating      •    Bilingual and culturally
                                                               mistrust                                competent staff at
                                                           •   Limited resources of                    agencies serving refugees
                                                               agencies serving refugees          •    Community events to
                                                                                                       celebrate refugees’
                                                                                                       cultures
                           Housing                         •   Inadequate housing                 •    Moving out of low-income
                                                           •   Low-income, high-crime                  neighborhoods
                                                               neighborhoods
                                                           •   Housing settings with no
                                                               opportunity to speak English
                           Social connections              •   Social isolation                   •    Social support from other
                                                                                                       refugees
                                                                                                  •    Friendship or mentoring
                                                                                                       programs
                                                                                                  •    Community dinners and
                                                                                                       gardens
                                                                                                  •    Affiliation with or
                                                                                                       sponsorship by a religious
                                                                                                       congregation
                          Source: GAO literature review.



Some Communities Have     While most of the communities we visited had not established formal
Developed Formal Plans    goals or strategies to facilitate refugee integration, two of the eight
for Refugee Integration   communities had developed formal plans to promote integration. The City
                          of Boise, for example, developed a plan to facilitate the successful
                          resettlement of refugees that includes goals related to integration.
                          Specifically, the plan aims to facilitate integration by (1) establishing
                          refugee community centers, (2) using a media campaign to increase
                          community awareness and support of refugees, and (3) creating a
                          mentoring program for refugee youth, among other things. Similarly, the
                          Village of Skokie, Illinois, a suburb of Chicago, created a strategic plan to
                          help facilitate the integration of immigrants, including refugees, by (1)
                          establishing a coordinating council of key service providers, (2)
                          developing a system to improve providers’ access to interpreters, and (3)



                          Page 36                                                                 GAO-12-729 Refugee Resettlement
              recruiting and training immigrant and refugee community leaders for
              government commissions and school boards, among other strategies.

              Additionally, in Lancaster, Pennsylvania, Franklin & Marshall College had
              taken a variety of steps to help facilitate the integration of refugees,
              including using student volunteers to teach refugees English, tutor
              refugee students, and help refugee families enroll their children in school
              and access public health services. In addition, at the time of our visit, the
              college was partnering with a local voluntary agency affiliate to plan a
              community conference on refugee integration with the goals of (1) better
              understanding and addressing the needs of refugees, (2) identifying
              strategies for fostering rapid integration, and (3) developing a broad
              coalition of organizations serving refugees that could continue to work
              together on these issues in the future.


              Each year, as part of its humanitarian role in the international community,
Conclusions   the United States admits tens of thousands of refugees who add richness
              and diversity to our society but can also have a significant impact on the
              communities in which they live, particularly in cases where relevant state
              and local stakeholders are not consulted before refugees are resettled.
              Advance consultation is important because stakeholders need time to
              plan so that they can properly serve refugees when they arrive, and
              because their input on the number of refugees to be resettled can help
              communities avoid reaching a crisis point. Information about communities
              that have developed effective strategies for consultation would likely
              benefit other communities facing similar obstacles. Without more specific
              guidance and information on effective strategies for consultation,
              communities may continue to struggle to meet refugees’ needs, which
              may negatively affect both refugees and their communities and would
              likely deter integration. Similarly, while ORR has recognized that some
              service providers have particularly effective strategies for resettlement,
              neither ORR nor PRM disseminate this information to other service
              providers. As a result, not all communities are aware of ways they can do
              their work more effectively.

              Furthermore, while refugees can receive resettlement services for up to 5
              years, some find it difficult to access those services when they relocate to
              another community. In addition, states do not receive increased funding
              for serving secondary migrants until the year after refugees relocate. As a
              result, in communities that experience high levels of secondary migration,
              voluntary agencies and service providers may not have the resources to
              provide services to the migrants who need them. Without a funding


              Page 37                                         GAO-12-729 Refugee Resettlement
                      process that would respond more quickly to localities experiencing high
                      rates of secondary migration, voluntary agencies may have to prioritize
                      serving recently arrived refugees and communities may find their
                      resources for refugees stretched too thin.

                      As required by the Immigration and Nationality Act, as amended, ORR’s
                      programs are designed to help refugees become employed as quickly as
                      possible. ORR’s measures of effectiveness, which focus on whether
                      refugees gain employment in the short term, in turn, influence the types of
                      services that refugees receive. Specifically, service providers may choose
                      to provide services that encourage short-term independence from cash
                      assistance, but might not help refugees achieve long-term self-
                      sufficiency. However, refugees may face unique challenges such as a
                      lack of formal education or work experience, language barriers, and
                      physical and mental health conditions that can make the transition to the
                      United States difficult. Without some incentives to focus on long-term self-
                      sufficiency in addition to short-term independence from cash assistance,
                      refugees may be more likely to need government assistance again in the
                      future, and it may take longer for both refugees and their communities to
                      experience the benefits of integration.


                      We are making the following four recommendations based on our review:
Recommendations for
Executive Action      To help ensure that state and local stakeholders have the opportunity to
                      provide input on the number of refugees resettled in their communities,
                      we recommend that

                      •   the Secretary of State provide additional guidance to resettlement
                          agencies and state coordinators on how to consult with local
                          stakeholders prior to making placement decisions, including with
                          whom to consult and what should be discussed during the
                          consultations; and
                      •   the Secretaries of State and of Health and Human Services collect
                          and disseminate best practices related to refugee placement
                          decisions, specifically on working with community stakeholders, as
                          well as other promising practices from communities.
                      To assist communities in providing services to secondary migrants, we
                      recommend that the Secretary of Health and Human Services consider
                      additional ways to increase the responsiveness of the grants designed for
                      this purpose. This could include asking states to report secondary
                      migration data more often than once a year, allowing resubmission of



                      Page 38                                        GAO-12-729 Refugee Resettlement
                     secondary migration data from states that was rejected because it did not
                     match ORR’s database, creating a process for counting migrants who
                     received services in more than one state, and establishing an emergency
                     grant that could be used to more quickly identify and assist communities
                     that are struggling to serve high levels of secondary migrants.

                     To give service providers more flexibility to serve refugees with different
                     needs and to create incentives to focus on longer term goals, including
                     integration, independence from any government services, and career
                     advancement, we recommend that the Secretary of Health and Human
                     Services examine ORR’s performance measures in light of its goals and
                     determine whether changes are needed.


                     We shared a draft of this report with HHS and State for review and
Agency Comments      comment. In its written comments, reproduced in appendix VI, HHS
and Our Evaluation   generally concurred with our recommendations. Specifically, HHS stated
                     that it supports our recommendation to disseminate best practices,
                     including promising practices from communities, while noting that State
                     and nonprofit community-based and faith-based organizations have
                     traditionally taken the lead on resettling refugees. HHS highlighted the
                     efforts it has made in conducting quarterly placement meetings, which
                     include resettlement agencies and refugee coordinators. While these
                     meetings may be helpful, we believe that HHS can also implement this
                     recommendation by disseminating best practices and program strengths
                     that it documents through its monitoring of states and service providers.

                     In addition, HHS concurred with our recommendation that it consider
                     additional ways to increase the responsiveness of grants that help
                     communities provide services to secondary migrants, but noted that it
                     already provides Supplemental Services grants, which provide short-term
                     assistance to areas that are impacted by increased numbers of new
                     arrivals or secondary migrants. In addition, it raised concerns that an
                     increase in the frequency of data collection would significantly increase
                     the reporting burden without a mandatory need for the data. HHS also
                     stated that it has a process in place for notifying states of technical
                     problems with population data submitted and allowing them to make
                     corrections. While we recognize that HHS has strategies in place to serve
                     secondary migrants, we continue to believe that (1) the Supplemental
                     Services grants can be improved to be more responsive; (2) more up-to-
                     date population data can help HHS respond more quickly to communities
                     experiencing high levels of secondary migration; and (3) improvements
                     can be made to the process for correcting population data.


                     Page 39                                         GAO-12-729 Refugee Resettlement
HHS also stated that it will consider modifying its performance measures
and will also continue to assess the usefulness of data elements collected
through required reporting to ensure that the program addresses both
self-sufficiency and integration. HHS noted, for example, that it has
already begun collecting more information about health through its annual
survey of refugees and expanded the number of reporting elements
pertaining to health in its program performance reporting form. In addition,
it is developing approaches to increase the overall participation rates in its
annual survey.

In its written comments, reproduced in appendix VII, State generally
concurred with our recommendations and outlined steps it will take to
address them. HHS and State also provided technical comments that
were incorporated, as appropriate.


As agreed with your offices, unless you publicly announce the contents of
this report earlier, we plan no further distribution until 30 days from the
report date. At that time, we will send copies to relevant congressional
committees, the Secretary of Health and Human Services, the Secretary
of State, and other interested parties. In addition, the report will be
available at no charge on the GAO Web site at http://www.gao.gov.

If you or your staff have any questions about this report, please contact
me at (202) 512-7215 or brownke@gao.gov. Contact points for our
Offices of Congressional Relations and Public Affairs may be found on
the last page of this report. Key contributors to this report are listed in
appendix VIII.




Kay E. Brown
Director, Education, Workforce, and Income Security Issues




Page 40                                         GAO-12-729 Refugee Resettlement
List of Requesters

The Honorable Richard G. Lugar
Ranking Member
Committee on Foreign Relations
United States Senate

The Honorable Patrick Leahy
Chairman
Committee on the Judiciary
United States Senate

The Honorable Bob Corker
United States Senate

The Honorable Duncan Hunter
House of Representatives

The Honorable Gary C. Peters
House of Representatives




Page 41                          GAO-12-729 Refugee Resettlement
Appendix I: Objectives, Scope, and
              Appendix I: Objectives, Scope, and
              Methodology



Methodology

              To identify the factors resettlement agencies consider when deciding
              where refugees are initially placed, we reviewed relevant federal and
              state laws and regulations and other relevant documents, and conducted
              interviews with federal agency officials and national voluntary agency
              staff. We interviewed officials from the U.S. Department of State’s Bureau
              of Population, Refugees, and Migration (PRM) and the Department of
              Health and Human Services’ Office of Refugee Resettlement (ORR), as
              well as representatives from several national voluntary resettlement
              agencies. We also reviewed documents related to the refugee placement
              process, such as relevant federal and state laws and regulations,
              guidance for determining community capacity to resettle refugees, the
              terms of the cooperative agreements between PRM and national
              voluntary agencies, and funding opportunity announcements for PRM’s
              Reception and Placement Program.

              To understand the effects refugees have on their communities, we met
              with experts on refugee programs and conducted site visits to eight
              communities across the United States where we met with representatives
              from state and local government entities, voluntary agency affiliates,
              community-based organizations, local businesses, and other relevant
              individuals and groups, including refugees, professors from local
              universities, and a local church that provided assistance to refugees. 1 For
              our site visits, we selected Boise, Idaho; Chicago, Illinois; Detroit,
              Michigan; Fargo, North Dakota; Knoxville, Tennessee; Lancaster,
              Pennsylvania; Owensboro, Kentucky; and Seattle, Washington. 2 These
              eight communities represent a nongeneralizable sample that was
              selected to include geographically distributed communities with variations
              in their population sizes, levels of experience resettling refugees, and
              racial and ethnic diversity. In addition to these factors, several
              communities were selected because they are considered examples of
              best practices in refugee resettlement by federal officials. All of the
              selected communities were receiving refugees at the time we visited. We
              developed site selection criteria based on available literature that
              discussed factors that influence the impact of refugees on their respective
              communities and factors that either facilitate or hinder refugee integration.



              1
                  We did not meet with all of these groups in every community we visited.
              2
                As part of our site visit to Chicago, we also met with city officials in Skokie, Illinois. Our
              visit to the Detroit area focused on the cities of Dearborn and Sterling Heights, Michigan.
              Our visit to Seattle included interviews with relevant groups in Kent, Washington.




              Page 42                                                      GAO-12-729 Refugee Resettlement
Appendix I: Objectives, Scope, and
Methodology




We used these criteria in combination with one another to arrive at a
diverse set of communities with varying characteristics.

To assess the effectiveness and integrity of refugee resettlement
programs, we interviewed federal agency officials, state coordinators, and
local voluntary agencies. We also reviewed federal agencies’ monitoring
plans, protocols and selected monitoring reports for the communities we
visited. We reviewed the terms of the cooperative agreements between
PRM and national voluntary agencies, as well as reporting guidance,
sample performance reports, and performance measures federal
agencies use to monitor their programs.

To determine what is known about refugees’ integration into the United
States, we conducted a literature review of academic research on this
topic. To identify relevant studies, we conducted searches of various
databases including Academic OneFile, EconLit, Education Resources
Information Center, National Technical Information Service, PAIS
International, PASCAL, ProQuest, PsycINFO, Social Sciences Abstracts,
Social Services Abstracts, Social SciSearch, Sociological Abstracts, and
WorldCat. We conducted a search using the following criteria, which
yielded 18 studies:

•   Studies must address the integration of refugees into U.S.
    communities; 3
•   Studies must have been published from 1995 to the present;
•   Studies must be in English; and
•   Studies must be scholarly, such as peer-reviewed journal articles.
We performed these searches and identified studies between August
2011 and October 2011.

In addition, ORR officials provided us with an ORR-commissioned study
of promising practices that appear to facilitate refugee integration, and
this study met our selection criteria.

To assess the methodological quality of the 18 studies that met our
selection criteria, we evaluated each study’s research methodology,
including whether the study was original research, the reliability of the


3
 We excluded studies addressing refugees’ integration into the countries where they first
sought asylum.




Page 43                                                 GAO-12-729 Refugee Resettlement
Appendix I: Objectives, Scope, and
Methodology




data set, if applicable, and the study’s findings, assumptions, and
limitations. We determined that 13 of the 18 studies were sufficiently
reliable for our purposes. We then analyzed the findings of these 13
studies. 4

In addition to conducting a literature review, we met with officials from
ORR and PRM to determine what, if any, efforts the federal government
has to define, measure, or facilitate refugees’ integration into the United
States. We discussed refugee integration in our interviews with state and
local entities during our site visits. We also reviewed the ORR integration
working group’s 2007 interim report and ORR’s annual reports to
Congress.

We also obtained secondary migration data from ORR’s annual report.
We assessed the reliability of this data by interviewing ORR officials
knowledgeable about the data. We determined that the data were
sufficiently reliable for the purpose of background in this report.

We conducted this performance audit from May 2011 through July 2012
in accordance with generally accepted government auditing standards.
Those standards require that we plan and perform the audit to obtain
sufficient, appropriate evidence to provide a reasonable basis for our
findings and conclusions based on our audit objectives. We believe that
the evidence obtained provides a reasonable basis for our findings and
conclusions based on our audit objectives.




4
    See appendix II for a list of the studies we included in our literature review.




Page 44                                                       GAO-12-729 Refugee Resettlement
Appendix II: Studies Included in Literature
               Appendix II: Studies Included in Literature
               Review



Review

               Abu-Ghazaleh, F. “Immigrant Integration in Rural Communities: The Case
               of Morgan County.” National Civic Review, vol. 98, no. 1 (2009).

               Birman, D., and N. Tran. “Psychological Distress and Adjustment of
               Vietnamese Refugees in the United States: Association with Pre- and
               Postmigration Factors.” American Journal of Orthopsychiatry, vol. 78, no.
               1 (2008).

               Duchon, D. A. “Home Is Where You Make It: Hmong Refugees in
               Georgia.” Urban Anthropology, vol. 26, no. 1 (1997).

               Franz, B. “Transplanted or Uprooted? Integration Efforts of Bosnian
               Refugees Based Upon Gender, Class and Ethnic Differences in New
               York City and Vienna.” The European Journal of Women’s Studies, vol.
               10, no. 2 (2003).

               Grigoleit, G. “Coming Home? The Integration of Hmong Refugees from
               Wat Tham Krabok, Thailand, into American Society.” Hmong Studies
               Journal, vol. 7 (2006).

               Hume, S.E., and S.W. Hardwick. “African, Russian, and Ukrainian
               Refugee Resettlement in Portland, Oregon.” The Geographical Review,
               vol. 95, no. 2 (2005).

               ISED Solutions. Exploring Refugee Integration: Experiences in Four
               American Communities. A report prepared at the request of the
               Department of Health and Human Services Office of Refugee
               Resettlement. June 2010.

               Ives, N. “More than a ‘Good Back’: Looking for Integration in Refugee
               Resettlement.” Refuge, vol. 24, no. 2 (2007).

               Kenny, P., and K. Lockwood-Kenny. “A Mixed Blessing: Karen
               Resettlement to the United States.” Journal of Refugee Studies, vol. 24,
               no. 2 (2011).

               Patil, C.L., M. McGown, P.D. Nahayo, and C. Hadley. “Forced Migration:
               Complexities in Food and Health for Refugees Resettled in the United
               States.” NAPA Bulletin, vol. 34, issue 1 (2010).




               Page 45                                       GAO-12-729 Refugee Resettlement
Appendix II: Studies Included in Literature
Review




Shandy, D., and K. Fennelly. “A Comparison of the Integration
Experiences of Two African Immigrant Populations in a Rural
Community.” Journal of Religion & Spirituality in Social Work, vol. 25, no.
1 (2006).

Smith, R.S. “The Case of a City Where 1 in 6 Residents is a Refugee:
Ecological Factors and Host Community Adaptation in Successful
Resettlement.” American Journal of Community Psychology, vol. 42, no.
3-4 (2008).

Westermeyer, J.J. “Refugee Resettlement to the United States:
Recommendations for a New Approach.” The Journal of Nervous and
Mental Disease, vol. 199, no. 8 (2011).




Page 46                                        GAO-12-729 Refugee Resettlement
Appendix III: 20 States with Largest Numbers
              Appendix III: 20 States with Largest Numbers
              of Refugees Arriving in FY 2011 and Refugees’
              Countries of Origin


of Refugees Arriving in FY 2011 and
Refugees’ Countries of Origin




              Page 47                                         GAO-12-729 Refugee Resettlement
Appendix IV: Selected PRM and ORR Grant
                                       Appendix IV: Selected PRM and ORR Grant
                                       Programs



Programs


Agency Grant                 Type                Recipient            Description
PRM    Reception and         Cooperative         National Voluntary   Provides financial support to partially cover resettlement
       Placement             agreement           Agencies             services based on a fixed per capita sum per refugee
                                                                      resettled in the United States. Services include arranging
                                                                      for refugees’ placement and providing refugees with
                                                                      basic necessities and core services during their initial
                                                                      resettlement period.
                                                       a
ORR    Refugee Cash and      Formula             States               Reimburses states and alternative refugee assistance
       Medical Assistance                                             programs for the cost of cash and medical assistance
                                                                                             b
                                                                      provided to refugees during the first 8 months after their
                                                                      arrival in this country or grant of asylum. It does not
                                                                      provide reimbursement for refugees deemed eligible for
                                                                      Temporary Assistance for Needy Families, Supplemental
                                                                      Security Insurance, and Medicaid.
       Voluntary Agency      Cooperative         National Voluntary   Funds are provided on a matching basis to provide
       Matching Grant        agreement           Agencies             private, nonprofit organizations to fund an alternative to
                                                                      public cash assistance and to support case
                                                                      management, employment services, maintenance
                                                                      assistance, cash allowance, and social services for new
                                                                      arrivals for 4 to 6 months.
       Refugee Social        Formula             States               Provides funding for employment and other social
       Services                                                       services to refugees for 5 years after their data of arrival
                                                                      or grant of asylum.
       Targeted Assistance   Formula             States               Provides funding for employment-related and other
       Grant                                                          social services for refugees in counties with large
                                                                      refugee populations and high refugee concentrations.
       Preventative Health   Discretionary       States and           Provides funds to provide medical screenings to newly
                                                 designated health    arriving refugees, interpreter services, information and
                                                 agencies             referral, and health education.
       Targeted Assistance   Discretionary       States               Funds to states to implement special employment
       Discretionary                                                  services not implemented with formula social services
                                                                      grants. Provides funding for employment-related and
                                                                      other social services for refugees in counties with large
                                                                      refugee populations and high refugee concentrations.
       School Impact         Discretionary       States               Provides funds to subcontract with local school systems
                                                                      and nonprofits to support local school systems that are
                                                                      impacted by significant numbers of newly arrived refugee
                                                                      children.
       Services to Older     Discretionary       States               Provide funds to ensure that older refugees will be linked
       Refugees                                                       to mainstream aging services in their communities or to
                                                                      provide services directly to older refugees if they are not
                                                                      currently being provided for in the community.




                                       Page 48                                                  GAO-12-729 Refugee Resettlement
                                         Appendix IV: Selected PRM and ORR Grant
                                         Programs




Agency Grant                   Type                   Recipient                       Description
       Preferred               Discretionary          National voluntary              The Preferred Communities Program supports the
       Communities                                    agencies                        resettlement of newly arriving refugees with the best
       Program                                                                        opportunities for their self-sufficiency and integration into
                                                                                      new communities, and supports refugees with special
                                                                                      needs that require more intensive case management,
                                                                                      culturally and linguistically appropriate linkages and
                                                                                      coordination with other service providers to improve their
                                                                                      access to services.
       Services for Survivors Discretionary           Nonprofit                       Provides funding for a comprehensive program of
       of Torture                                     organizations,                  support for survivors of torture, including rehabilitation,
                                                      voluntary agencies,             social and legal services, and training for providers.
                                                      local governments
       Individual          Discretionary              Nonprofit                       Funds projects to establish and manage Individual
       Development Account                            organizations,                  Development Accounts, which are matched savings
                                                      voluntary agencies,             accounts available for the purchase of specific assets.
                                                      state and local                 Matching funds, together with the refugee’s own savings,
                                                      governments                     are available for purchasing one (or more) of four
                                                                                      savings goals: home purchase; microenterprise
                                                                                      capitalization; postsecondary education or training; and
                                                                                      purchase of an automobile if necessary for employment
                                                                                      or educational purposes.
       Technical Assistance    Discretionary—         Nonprofit                       Grants to enable organizations with expertise in a
                               Cooperative            organizations,                  particular area to provide assistance to ORR-funded
                               agreement              voluntary agencies              agencies.
       Microenterprise         Discretionary          Nonprofit                       Provides funding to assist refugees to become financially
       Development                                    organizations,                  independent by helping them develop capital resources
                                                      voluntary agencies,             and business expertise to start, expand, or strengthen
                                                      state and local                 their own businesses. Microenterprise projects typically
                                                      governments                     include components of training and technical assistance
                                                                                      in business skills and business management, credit
                                                                                      assistance, and credit in the form of micro loans.
       Refugee Agricultural    Discretionary          Nonprofit                       Provides agricultural and food related resources and
       Partnership                                    organizations,                  technical information to refugee families that are
                                                      voluntary agencies,             consistent with their agrarian backgrounds, and results in
                                                      state and local                 rural and urban farming projects that supports increased
                                                      governments                     incomes, access to quality and familiar foods, better
                                                                                      physical and mental health, and integration into this
                                                                                      society.
       Supplemental            Discretionary          Nonprofit                       Provides funds to provide services to newly arriving
       Services for Recently                          organizations,                  refugees or sudden and unexpected large secondary
       Arrived Refugees                               voluntary agencies,             migration of refugees where communities are not
                                                      state and local                 sufficiently prepared in terms of linguistic or culturally
                                                      governments                     appropriate services and/or do not have sufficient
                                                                                      service capacity.
       Ethnic Community        Discretionary          Nonprofit                       Provides funds to support ethnic community based
       Self-Help                                      organizations                   organizations in providing refugee populations with
                                                                                      critical services to assist them in becoming integrated
                                                                                      members of American society.
                                         Sources: ORR annual report, ORR grant announcements, ORR program descriptions, the Catalog of Federal Domestic Assistance, and
                                         PRM grant announcements. ORR also funds additional programs for certain populations, including the Cuban Haitian Program, Anti-
                                         Trafficking in Persons Program, and an Unaccompanied Alien Children Program.




                                         Page 49                                                                        GAO-12-729 Refugee Resettlement
Appendix IV: Selected PRM and ORR Grant
Programs




a
 For the purposes of this table, states refers to state agencies, state alternative programs, and state
replacement designees. State alternative programs include (1) the Wilson/Fish program, which gives
states flexibility in how they provide assistance to refugees, including whether to administer
assistance primarily through local voluntary agencies, and (2) the Public Private Partnership program,
which allows states to partner with local voluntary agencies to provide assistance. State replacement
designees are authorized by ORR to administer assistance to refugees when a state withdraws from
all or part of the refugee program.
b
 For the purposes of this table, refugees refers to refugees, certain Amerasians from Viet Nam,
Cuban and Haitian entrants, asylees, victims of a severe form of trafficking, and Iraqi and Afghan
Special Immigrants.




Page 50                                                         GAO-12-729 Refugee Resettlement
Appendix V: Status of Integration Working
                                              Appendix V: Status of Integration Working
                                              Group’s Recommendations to ORR



Group’s Recommendations to ORR

                                              In January 2007, ORR’s Integration Working Group made short-term and
                                              long-term recommendations regarding ways in which ORR could more
                                              fully support the integration process for refugees.



                                                                                                                                                     Not
                                                                                                     Implemented                   In process    implemented
Short-term recommendations
Include integration language in all grant announcements.                                                      X
Review discretionary grant programs offered in the standing announcement,                                     X
ensuring that they promote integration.
Establish the Department of Health and Human Services as the lead federal                                                                            X
agency for integration.
Consider expanding ORR’s discretionary programs.                                                                                                     X
Focus on integration in the areas of employment, English language                                             X
acquisition, health, housing, and civic engagement.
Focus technical assistance providers to support integration as an intentional                                 X
process leading to civic engagement and citizenship.
Seek and fund pilot programs such as the Building the New American                                                                                   X
Community project.
Develop an initiative to support professional recertification and credentialing                                                           X
for qualified individuals.
Long-term recommendations
Identify and share best practices through a survey of states, mutual aid                                      X
associations, and voluntary agencies.
Identify lessons learned, including case studies, from communities in which                                   X
integration appears to be working well and where there are challenges.
Study the effect of ORR policy and funding initiatives to promote integration                                                                        X
over a three to five year period.
Refine/develop/disseminate an action model to be used for other immigrants                                                                           X
and marginalized populations.
Seek broader collaboration with nonfederal entities such as private                                           X
foundations, businesses, financial institutions, and the United Way.
                                              Sources: Report of the Integration Working Group, January 2007, and information provided by ORR.




                                              Page 51                                                                          GAO-12-729 Refugee Resettlement
Appendix VI: Comments from the
             Appendix VI: Comments from the Department
             of Health and Human Services



Department of Health and Human Services




             Page 52                                     GAO-12-729 Refugee Resettlement
Appendix VI: Comments from the Department
of Health and Human Services




Page 53                                     GAO-12-729 Refugee Resettlement
Appendix VI: Comments from the Department
of Health and Human Services




Page 54                                     GAO-12-729 Refugee Resettlement
Appendix VI: Comments from the Department
of Health and Human Services




Page 55                                     GAO-12-729 Refugee Resettlement
Appendix VII: Comments from the
             Appendix VII: Comments from the Department
             of State



Department of State




             Page 56                                      GAO-12-729 Refugee Resettlement
Appendix VII: Comments from the Department
of State




Page 57                                      GAO-12-729 Refugee Resettlement
Appendix VIII: GAO Contacts and Staff
                  Appendix VIII: GAO Contacts and Staff
                  Acknowledgments



Acknowledgments

                  Kay E. Brown (202) 512-7215 or brownke@gao.gov
GAO Contact
                  In addition to the contact named above, Kathryn Larin, Assistant Director;
Staff             Cheri Harrington and Lara Laufer, Analysts-in-Charge; James Bennett;
Acknowledgments   David Chrisinger; Caitlin Croake; Bonnie Doty; Ashley McCall; Jean
                  McSween; James Rebbe; and Carla Rojas made key contributions to this
                  report. Sharon Hermes, Margaret Weber, and Amber Yancey Carroll
                  verified our findings.




(131095)
                  Page 58                                       GAO-12-729 Refugee Resettlement
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