Refugee Resettlement Agencies Research Articles

"Nobody does checkups back there": A qualitative study of refugees' healthcare needs in the United States from stakeholders' perspectives.

The number of refugees globally grew to 35.3 million in 2022, and many refugees are exposed to various health risks along their migration journey. As a result, they may arrive in host communities with numerous health issues, including communicable diseases and chronic and mental health conditions. Navigating the healthcare system in a host country proves to be a significant challenge for them, leading to delayed care. This qualitative study explored the convolute healthcare needs of refugees in the United States by soliciting insights from stakeholders involved in refugee resettlement and healthcare. In-depth interviews were conducted with fifteen stakeholders who work closely with refugees, including healthcare providers, cultural/clinical health navigators supporting refugees, staff from refugee resettlement agencies and governmental entities, and researchers studying refugee health. Following informed consent, interviews were audio-recorded, transcribed verbatim, and imported into MAXQDA 2022 (VERBI Software) for thematic analysis. The results revealed key themes, including the heterogeneity of refugee populations, limited awareness of preventive healthcare, high prevalence and suboptimal management of chronic conditions, complexity of the healthcare system, lack of follow-up, and language barriers. Further research is warranted concerning the long-term health of refugee populations in the United States. Additionally, more tailored programs involving peer educators are recommended to support refugee communities in navigating the complex healthcare system in the host country.

Dynamic Placement in Refugee Resettlement

Employment outcomes of resettled refugees depend strongly on where they are placed inside the host country. While the U.S. sets refugee capacities for communities on an annual basis, refugees arrive and must be placed over the course of the year. We introduce a dynamic allocation system based on potentials derived from dual prices of a linear programming (LP) relaxation to improve employment outcomes. Our algorithm achieves over 98% of the hindsight- optimal employment compared to under 90% of current greedy-like approaches. This dramatic improvement persists even when we incorporate a vast array of practical features of the refugee resettlement process including indivisible families, batching, and uncertainty with respect to the number of future arrivals. Our algorithm is now part of the Annie ™ Moore optimization software used by a leading American refugee resettlement agency.

SHOWING UP AND OPENING UP: CONDUCTING RESEARCH WITH AND ABOUT REFUGEE RESETTLEMENT ORGANIZATIONS

ABSTRACT This article uses research conducted with and about refugee resettlement agencies in traditional and nontraditional destinations to critically assess the opportunities and constraints that social scientists encounter when conducting research on refugee incorporation experiences. Drawing on ethnographic field notes and reflections from two qualitative research projects in the U.S. Northeast and Midwest examining refugee incorporation postresettlement, we analyze how the geographic and institutional contexts in the case studies impacted research outcomes and differences in refugee participants’ showing up and opening up during data collection. We describe how the priorities of refugee resettlement agencies, along with the social locations and positionality of researchers, shaped our relationships and negotiations with institutional gatekeepers, as well as how refugee participants responded to the research. We show how conducting community-based research can introduce overlapping and conflicting reciprocal moral obligations between researchers, refugee participants, and refugee-serving organizations that ultimately shape the research process, decisions, and outcomes.

Dynamic Placement in Refugee Resettlement

Boosting Employment of Resettled Refugees Whether a resettled refugee finds employment in the United States depends in no small part on which host community they are first welcomed to. Every week, resettlement agencies are assigned a group of refugees who they are required to place in communities around the country. In “Dynamic Placement in Refugee Resettlement,” Ahani, Gölz, Procaccia, Teytelboym, and Trapp develop an allocation system that recommends where to place an incoming refugee family with the aim of boosting the overall employment success. Should capacities in high-employment areas be used up as quickly as possible, or does it make sense to hold back for a perfect match? The simple algorithm, based on two-stage stochastic programming, achieves over 98% of the hindsight-optimal employment, compared with under 90% for the greedy-like approaches that were previously used in practice. Their algorithm is now part of the Annie™ MOORE optimization software used by a leading American refugee resettlement agency.

Cultivating Integration via Placemaking: an ArcGIS StoryMap and Inventory of Refugee-Centered Farming Organizations in the USA.

This paper inventories the number, type, location, and characteristics of refugee resettlement agencies and refugee third sector organizations (RTSOs) in creating opportunities for placemaking and longer-term integration via refugee-centered farming programs in the USA. Using an ArcGIS StoryMap and accompanying database, we map how resettlement organizations engage in farming programs and provide insight into the various actors implementing refugee resettlement and integration policy in the USA, while also highlighting the role of place and placemaking in that process. Findings indicate that there are 40 total organizations involved in 30 states, with 100 farm sites scattered across 48 cities, primarily found in nontraditional sites of resettlement. Using Ager and Strang's (Journal of Refugee Studies, 21(2):166-191, 2008) integration model as a theoretical starting point, we use a two-cycle content analysis to illustrate that organizations have diverse goals focusing on employment, social connections, health, safety and security, and placemaking. Sponsored activities and community projects concentrate on workforce training and community-supported agriculture. This interactive visualization and analysis of existing programs nationwide allow the organizations involved, policymakers, scholars, and members of the public to explore the locations of programs with pertinent information about each organization. The research also illustrates that refugee-centered farming organizations should continue to emphasize their efforts on placemaking as a beneficial strategy for the longer-term integration of resettled refugees. Additionally, this research contributes to larger debates and theoretical understandings of longer-term integration by extending Ager and Strang's (Journal of Refugee Studies, 21(2):166-191, 2008) integration model and embedding place and placemaking as underpinning elements in the process.

The impact of COVID-19 on service delivery systems: evidence from a survey of United States refugee resettlement agencies

BackgroundKey to the US refugee resettlement effort is the role of non-governmental organizations (NGOs) who receive, place, and provide transitional programs and referrals to new and recently resettled refugees. Yet only one rapid assessment study thus far examined the impact of COVID-19 on service delivery systems of US refugee resettlement agencies. This exploratory study describes the capability and preparedness of US refugee resettlement agencies to provide services and care to clients during the COVID-19 pandemic.MethodsUsing both telephone interviews and an internet survey, we assessed the impact of COVID-19 on service delivery, agency capacity, and preparedness of 101 US refugee resettlement agencies. Descriptive statistics were used to describe the dataset, while chi-square (χ2) tests were used to examine relationships by resettlement agency size (number of employees in each agency).ResultsDespite a temporary pause on refugee admissions, restrictive stay-at-home orders, and refugee travel restrictions, the majority of responding US refugee resettlement agencies continued to provide specialized services and care to resettled refugees and other immigrants. Among the more important findings was that agencies that continued to provide refugee services and care onsite in their existing facilities or office rather than moving such services offsite differed by agency size [χ2 (9.494, n = 101), p < 0.05]. Almost all agencies (93.1%) strongly agreed or agreed that staff have timely access to COVID-19 information. Most of the refugee services were provided offsite (n = 72 agencies, some with multiple offices across the US).ConclusionsUS refugee resettlement agencies continued to perform admirably despite a lack of funding. Future research is underway to obtain a more balanced understanding of the impact of COVID-19 on practice or operations.

Problem-based service-learning project in an intercultural communication course: Collaboration with a nonprofit refugee resettlement agency

A service-learning (SL) version of the Intercultural Communication course was designed in collaboration with a nonprofit refugee resettlement agency. Through the collaborative discussions prior to the start of the semester, the instructor and community partner identified the needs and possible ideas for problem-based SL projects. In the SL course, students were asked to create and improve cultural orientation materials and to review and improve sections of the agency’s website. The students working in groups reviewed the options, took the initiative to explore specific issues, and applied their knowledge to the projects. At the end of the semester, students presented their cultural orientation materials and proposals for new content for specific sections of the agency’s website to the members of the agency and refugees. By completing this semester-long course in the SL Intercultural Communication course, students were given opportunities to review American culture in comparison to other cultures, learn about the world refugee crisis, refugee resettlement, and cultural integration processes, and apply course concepts to their SL project assignments. The benefits of problem-based SL assignments and insights from collaborating with a community partner are discussed. Courses Intercultural Communication

Qualitative research on maternal care access among Arabic-speaking refugee women in the USA: study protocol

BackgroundRefugees tend to have greater health needs and pre-existing medical conditions due to poor living conditions, lack of health services, exposure to a variety of risk factors, and a high...

Social Connections and Community Engagement Trends Among Unaccompanied Refugee Minors Exiting Foster Care

The United States has more immigrants than any other country in the world. The Unaccompanied refugee minor program has been serving thousands of youth annually since the 1970s and yet there is still a dearth of research and some apprehension of how to assist these vulnerable children in making friends and supportive relationships in the US. Social ties, social support networks, and engagement in the local/ immigrant community have all been shown to help ease the transition to the United States and improve mental health well being for immigrants. A national refugee resettlement agency sent surveys to all the Unaccompanied Refugee Minors who had existed foster care program three to 15 months prior to assess their social connections and community engagement after the program ended. Thirty youth replied and results show that living arrangements varied among participants, social engagement in the community was present for most of the young adults, relationships were an aspect of social support, and reliance on public benefits was relatively low among respondents. There are implications for caseworkers in terms of case planning to help ensure youth are connected before they leave the program, and future recommendations for more in-depth research are included.

Overview of challenges faced by refugees following resettlement in Houston, Texas: a qualitative study at five refugee resettlement agencies

PurposeThis paper aims to conduct a qualitative needs assessment to explore the effectiveness of Houston’s refugee resettlement efforts in the areas of employment, health care and education.Design/methodology/approachUsing referral sampling, the authors identified refugee community leaders and staff members at the five refugee resettlement agencies in Houston. The authors conducted 29 qualitative interviews with these contacts from February–August 2017.FindingsRecently resettled refugees may struggle to find and maintain employment in Houston due to difficulty accessing public transportation. Refugees seeking medical care in Houston often have difficulty navigating the complexities of the health-care system and communicating with their physicians due to language barriers. Finally, refugee children may have trouble adapting to Houston public schools, sometimes because they have limited experience with formal education. This study provided insights into the challenges Houston refugees face during resettlement and these barriers can be mitigated with policies designed specifically to address them.Practical implicationsThe authors recommend decreasing public transportation fees for refugees, supporting programs that donate used vehicles to refugees, expanding access to English as a Second Language classes for refugee children and adults and giving refugees designated time to learn English upon arrival.Originality/valueHouston welcomes more resettled refugees than any other American city. However, few studies have explored the barriers refugees face during the resettlement process.

Resettlement Education Case Managers’ Roles Supporting Refugee Families With Children With Disabilities

Refugees have been resettling in the United States for decades, but there has been little attention in the special education literature to this population. The existing literature notes numerous systemic barriers refugee families and professionals who work with them encounter but has not investigated the roles of professionals in refugee resettlement agencies in supporting families who have children with disabilities. In this study, we used semi-structured interviews to explore in resettlement education case managers (ECMs) the roles and experiences of assisting refugee families to access special education. Our findings revealed that ECMs provided intensive support to newly resettled families by educating them on the special education process, connecting them with supports, and sharing information about disability characteristics. Implications for research and practice are also provided.

Sexual and reproductive health information and referrals for resettled refugee women: A survey of resettlement agencies in the United States.

BackgroundRefugee resettlement offices are the first point of contact for newly arrived refugees and play a significant role in helping refugees acclimate and settle into life in the United States. Available literature suggests that refugee women are vulnerable to poor sexual and reproductive health (SRH) outcomes, including sexually transmitted infections and HIV infections as well as adverse pregnancy outcomes, but little is known about the role that refugee resettlement offices play in supporting refugee women’s SRH. This study examines the capacity and interest of resettlement offices in providing SRH information and referrals to newly arrived refugees.Methods and findingsThe research team conducted an online survey of staff members at refugee resettlement offices throughout the US in 2018 to determine (1) available SRH resources and workshops; (2) referrals to and assistance with making appointments for SRH and primary care appointments; (3) barriers to addressing SRH needs of clients; and (4) interest in building the capacity of office staff to address SRH issues. The survey was created for this study and had not been previously used or validated. Survey data underwent descriptive analysis. A total of 236 resettlement offices were contacted, with responses from 100 offices, for a total response rate of 42%. Fifteen percent (N = 15) of refugee resettlement agencies (RRAs) who responded to the survey provide materials about SRH to clients, and 49% (N = 49) incorporate sexual health into the classes they provide to newly arrived refugee clients. Moreover, 12% (N = 12) of responding RRAs screen clients for pregnancy intention, and 20% (N = 20) directly refer to contraceptive care and services. This study is limited by the response rate of the survey; no conclusions can be drawn about those offices that did not respond. In addition, the survey instrument was not validated against any other sources of information about the practices of refugee resettlement offices.ConclusionsIn this study, we observed that many resettlement offices do not routinely provide information or referrals for SRH needs. Responding offices cite lack of time and competing priorities as major barriers to providing SRH education and referrals to clients.

Enhanced Transitions of Care for Medically Complex Refugees.

Between 2015 and 2019, 261,091 refugees were resettled through the U.S. Refugee Admissions Program. Few are chronically ill, but previously these went to emergency rooms upon arrival. We designed a pilot program to anticipate, assess, and safely assume care of chronic health needs and stabilize sick and medically complex refugees upon arrival. Academic internal medicine and pediatrics clinics are linked to the Washington State Refugee Health Program and Refugee Resettlement Agencies. Arriving refugees deemed medically complex through overseas medical evaluation or post-arrival were selected for the program. We reviewed biodata of 2,947 refugees deemed medically complex. We referred five hundred and sixty one (19%) of these for evaluation, and 257 (46%) of referrals received care. Safe transitions of care are standard practice in medical systems. This innovation in Seattle is one example of a system for the safe and cost-effective relocation of refugees with complex illnesses.

Refugee healthcare perceptions in regional northern Australia: transition through engagement, access, trust, privacy, the old, and the new.

Current Australian Government policy aims to resettle refugees in regional Australia, but little is known about their primary and hospital healthcare experiences in these settings. By taking an interpretive approach to a narrative inquiry methodology, a qualitative study was performed to examine refugee perceptions of health care in a regional centre of northern Queensland, Australia. Purposive sampling and an interview guide were developed in partnership with the local refugee resettlement agency. Semi-structured interviews were performed with 14 refugees and involved interpreters. Transcripts were thematically organised into a story, validated by participants. Using QSR NVivo 12, all researchers analysed the transcripts. Themes were validated at a community event. Six themes were described: service issues, self-advocacy, knowledge and understanding that changes with time, interpreter issues, regional-metropolitan differentials, and the influence of the past on present behaviour. A conceptual framework involving engagement, access, trust and privacy, and the old versus the new, can be used to describe refugees' experiences. Discrimination, transport, and reliance on family and peers may be experiences that are more prominent in regional Australia. Refugees require high-quality information-sharing practices, formal support systems, and better models of service delivery for interpreting support. Clinicians need to be culturally respectful with their interactions.

Anticipating the Side Effects: A Review of a Refugee English Placement Test In the U.S.

Critical language testing considers the cultural, social, and political context of tests (Kramsch, 1993; Pennycook, 1994; Shohamy 1998). Existing research examines the role of testing at the national (or international) level in immigration, citizenship, and asylum (e.g., Kunnan, 2009; Saville, 2009; Shohamy &amp; Kanza, 2009). However, as Bachman (2005) criticizes, critical language testing research insufficiently acknowledges the link between consequences and the validity of inferences made from tests. This paper reviews an English placement test used at the local level in the United States by a refugee resettlement agency where test takers are from low literacy and low education backgrounds. Methods include observations, interviews, and collection of testing materials (i.e., test scores and placement decisions). Validity is analyzed through the theories of Messick (1989) and Bachman and Palmer (2010) to explore the discrepancy between functionality and lurking potential washback. Monitoring washback is important because tests can become de facto policies which shape programs (King &amp; Bigelow, 2016; Shohamy 2014). Findings indicate that validity of the literacy and oral proficiency constructs must be improved to mitigate possible negative consequences, which stem from defining self-sufficiency and the prerequisite language proficiency for it (Shohamy 2013).

Abstract PO-043: Understanding the perception of health and cancer in the Rohingya community

Abstract Refugees in the United States, specifically the Rohingya, have emigrated from areas with large health disparities. Because of the government-authorized ethnic cleansing, the Rohingya have been fleeing to nearby countries for safety and survival. In the last 4 years, over 1,000 Rohingya families have resettled to Milwaukee, Wisconsin. Considering the impact of the trauma and disparities experienced by the Rohingya, we sought to identify the health needs and perceptions of the Rohingya community in Milwaukee. This project consisted of 10 in-depth key informant interviews with community health workers and stakeholders from voluntary refugee resettlement agencies, healthcare clinics, and community-based organizations that serve the Rohingya community. The interviews included questions related to the definition and understanding of health, challenges in achieving a healthy community, perception of healthcare institutions, available health resources, and knowledge about cancer. All interviews were transcribed, coded, and analyzed to identify themes. The following themes were identified: 1) health is defined as being able to meet basic needs (i.e., financial stability, housing, safety, well-being) of the family/community and is prioritized over individual concerns; 2) prior and existing mistrust for healthcare institutions and fear of systems of authority (i.e., workplace, government) impact healthcare-seeking behavior; 3) past trauma is common and negatively impacts physical and mental health; 4) religion and spirituality influence beliefs about illness, recovery and wellbeing; 5) linguistic, cultural, and educational barriers impact healthcare access and quality, as well as an understanding of disease leading to fatalistic attitudes. These findings provide insight into the assets and barriers associated with the health needs and beliefs of the Rohingya community in Milwaukee. Barriers including historical trauma leading to mistrust, limited knowledge and understanding of prevention and early detection of cancer and other diseases, and low access to linguistically and culturally tailored health resources must be addressed. Additionally, collectivism, religious devotion, and spirituality should be acknowledged as important sources of support and connection. These can potentially be leveraged to promote health and self-care. While the voices of stakeholders are valuable, understanding more about the beliefs and experiences of community members themselves is critical. These findings will inform our next steps, which include focus groups and interviews with Rohingya members to gain their perspectives. We will then partner with stakeholders and community members to co-design and evaluate a health promotion intervention tailored to the needs of the community. These efforts will be grounded in a model that leverages community strengths to implement sustainable interventions that can build trust, improve health outcomes, and support the efforts of our Rohingya neighbors. Citation Format: Shabi Haider, Aniya Maheen, Moiz Ansari, Kathleen Jensik, Melinda Stolley. Understanding the perception of health and cancer in the Rohingya community [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-043.

"Where Is the Women's Center Here?": The Role of Information in Refugee Women's Help Seeking for Intimate Partner Violence in a Resettlement Context.

A qualitative study examined factors that hinder help seeking for intimate partner violence among women who resettled to the United States as refugees. A refugee resettlement agency recruited female clients (n = 35) and service providers and stakeholders (n = 53) in the metropolitan area. The study employed individual interviews and focus group discussions to collect data. An inductive and interpretive thematic approach guided the analytical process. The analysis revealed challenges related to information gaps and communication struggles complicating help-seeking processes. The findings point to the importance of bolstering information sharing within and across informal and formal networks to help women navigate support and services in resettlement.

The Relationship Between Refugee Health Status and Language, Literacy, and Time Spent in the United States.

Background:There are 3 million refugees living in the United States today whose health and wellbeing may be diminished by not being able to understand and use health information. Little is known about these barriers to health in multiethnic refugee communities.Objective:This present study examined (1) the relationship between English proficiency, health literacy, length of time in the US, and health status; and (2) differences in poor health status caused by limited English proficiency and low health literacy individually and in combination to better understand which barriers might be addressed by improving refugee health.Methods:Refugees (N = 136) age 18 to 65 years were recruited using health clinics and refugee resettlement agencies. Survey questions included demographics, health status, health literacy, English language proficiency, social determinants of health, and barriers to getting health care. Interpreters were used as necessary. We used a cross-sectional study with purposeful sampling.Key Results:There is a high correlation (Pearson's r = 0.77) between health literacy and English proficiency; they were moderately correlated with health status (r = 0.40 and 0.37, respectively). Length of time in the US only modestly correlated with health status (r = 0.16). Health literacy and English proficiency taken individually were strong predictors of health status (health literacy odds ratio [OR] = 4.0; 95% confidence interval [1.6–9.9], English proficiency OR = 3.6, confidence interval [1.5–9.0]) but not significant. Their interaction, however, was significant and accounted for most of the effect (log odds for interaction = 1.67, OR = 5.1, p < .05).Conclusions:English proficiency and health literacy individually and in combination facilitate poor health and present health-related barriers for refugees. Length of time in the US for refugees may not correlate with health status despite studies that suggest a change in health over time for the larger immigrant population. [HLRP: Health Literacy Research and Practice. 2020;4(4):e230–e236.]Plain Language Summary:The combined effects of limited English proficiency and low health literacy can create significant barriers to good health outcomes in refugee populations. Length of time in the US for refugees may not correlate with health status despite studies that suggest a change in health over time for the larger immigrant population.

The Neurological Implications of Forced Migration

The high prevalence of PTSD and depression among refugees represents a significant public health concern for a growing portion of the population of developed countries. These neurological implications vary in severity and are often caused by a multitude of factors before, during, and after migration that compound upon one another to cause mental health issues that may prevent a refugee from successfully integrating into their new host country. The prevalence of PTSD and depression varies among groups of refugees, and these kinds of mental health issues generally occur more often among women and children. Post-migrational trauma and challenges upon arrival in a new country can contribute to the severity of these neurological implications of migration, but they can be mitigated by various types of social support provided to them by the government, the immigrant community, medical and mental health resources, and refugee resettlement agencies.

Pushing the Boundaries: Education Leaders, Mentors, and Refugee Students

Purpose: In this study, we trace the work of refugee student–family mentors (mentors) in an Arizona school district who work across school–family boundaries. Utilizing boundary spanning theory, we examine how education leaders—teachers, school principals, assistant principals, and district administrators—work with the mentors. We document the interactions between the school leaders and the mentors and compare them with the interactions between the refugee families and the mentors. Research Methods/Approach: We draw on data collected in a 3-year ethnography of refugee networks and on a related set of extended interviews with refugee parents. Data includes interviews with refugee mentors, school leaders, and refugee parents, as well as interviews with staff members of refugee support organizations, resettlement agencies, and state programs. Observational fieldnotes and documents were also collected. Data analysis included emergent coding and theme comparison across all data. Conclusions: We demonstrate that the refugee parents respect and depend on the mentors, while school leaders often treat them as “helpers.” We analyze how the mentors are delegitimized by the actions of education leaders in schools, and also by their marginalization in the school district. We recommend additional research be conducted on how school districts interact with refugee students and families. We suggest that education leaders better support the work of staff who work with refugees and other culturally and linguistically diverse students by taking a resource inventory, clarifying staff roles, including parents in decision making, and making a commitment to build inclusive school communities.