October 2020

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CENTRE FOR THE
STUDY OF LIVING
STANDARDS

Literature Review on Best Practices in
Government-Funded Services
Supporting the Resettlement andIntegration of Government-Assisted
Refugees

Ghada Abid
October 2020
CSLS Research Report 2020-09

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Literature Review on Best Practices in
Government-Funded Services Supporting theResettlement and Integration of GovernmentAssisted Refugees
Abstract
This literature review of government-funded refugee services identifies the issues
related to refugee resettlement programs; settlement location; housing; mental healthservices and employment services in different Canadian provinces and cities. It thensummarizes the best practices related to refugees’ integration in Canada or in otherrefugee resettlement countries. Wherever possible, the report mentions relevant policy
recommendations addressed to Immigration, Refugees and Citizenship Canada (IRCC) inthe different journal articles, papers or reports.

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Literature Review on Best Practices in
Government-Funded Services Supporting theResettlement and Integration of GovernmentAssisted Refugees
Table of Contents
Abstract .............................................................................................................................. 1
Executive Summary........................................................................................................... 4
I. Introduction ..................................................................................................................... 6
II. Refugee Resettlement Programs .................................................................................... 7
1. The insufficient duration and amount of RAP monthly support ................................. 8
2. The lack of information sharing .................................................................................. 8
3. The deficiency in the management and coordination of volunteers .......................... 10
4. The need to improve pre-arrival orientation.............................................................. 11
5. The importance of effective case management ......................................................... 12
III. Settlement Location .................................................................................................... 13
1. The limited resources in small communities: ............................................................ 13
2. The lack of co-ethnic communities in small cities .................................................... 14
3. Policies to encourage refugee settlement in smaller centres ..................................... 15
IV. Housing ....................................................................................................................... 16
1. The inadequacy of the shelter portion of the monthly income support GARs
receive to cover housing rents ....................................................................................... 16
2. The mismatch between the sizes of available housing for refugees and the actual
size of refugee families ................................................................................................. 17
3. The lack of information sharing between the federal government and RAP-SPOs
related to GARs’ housing needs .................................................................................... 18
4. The lack of refugees’ familiarization with the Canadian housing market ................ 18
5. The paucity of translation services when delivering housing services to GARs ...... 19
6. The suitability of the geographic location of housing within a community and how
it affects GARs’ access to services ............................................................................... 20
V. Mental Health Services ................................................................................................ 21
1. The prevalence of stigma surrounding the use of mental health services among
the refugee population and their lack of knowledge about mental health ..................... 21
2. The lack of medical staff knowledge about refugees’ cultural profiles .................... 23
3. Dealing with PTSD and trauma in the refugee community ...................................... 24
4. The limited use of internet when delivering mental health services to refugees ...... 25

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5. The insufficient use of multidisciplinary and holistic approaches to mental healthservices .......................................................................................................................... 26
VI. Employment Services ................................................................................................. 26
1. The referral process of SPOs that encourages GARs to finish their language
training before accessing employment services ............................................................ 26
2. The lack of foreign credentials recognition ............................................................... 28
3. GARs’ low level of social capital ............................................................................. 30
4. RAP income support’s high claw back rate .............................................................. 31
5. The Discrimination against GARs in the labour market ........................................... 31
VII. Conclusion ................................................................................................................. 33
References ......................................................................................................................... 34

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Literature Review on Best Practices in
Government-Funded Services Supporting theResettlement and Integration of GovernmentAssisted Refugees
Executive Summary
Under the Resettlement Program, Government Assisted Refugees (GARs) arereferred to Canada for resettlement overseas by the United Nations Refugee Agency(UNHCR) or another referral organization, and arrive in Canada as permanent residents.
Immigration, Refugees and Citizenship Canada (IRCC) provides them with a variety ofservices to support their settlement and integration into Canadian society.
In the case of government-assisted refugees resettling in Canada outside ofQuebec, resettlement supports and services are provided by the Government of Canada
through the Resettlement Assistance Program (RAP), IRCC funds 32 RAP SPOs todeliver RAP services in 34 communities across Canada outside of Quebec.
All resettled refugees, including GARs are also eligible to receive all Settlement
Program services that are available to all newcomers to Canada. These include language
training, needs and assets assessments and referrals (NAARS), information andorientation to various aspects of life in Canada, and employment services. The goal of
the settlement program is to encourage newcomers to be fully engaged in the economic,
social, political, and cultural life of Canada.
Under the auspices of the Government-Assisted Refugee Resettlement Assistance
Program Working Group (GAR-RAP WG), the Settlement and Integration Policy (SIP)
branch at IRCC is undertaking a review of services and how they are delivered to GARs
during their first year in Canada. The Review will be considered alongside a departmental
evaluation and will result in recommendations for program and policy improvement. A
synthesis of recent literature, the subject of this report, is one activity under the Review.
The objective of this report is to provide IRCC officials with a better
understanding of what the recent literature says about best and promising practices ingovernment-funded services designed to support resettled refugees to live independently
in their resettlement country. The report synthesizes the literature identified through the“knowledge scans” provided by IRCC and identifies key themes, insights and trends
found in the literature. It should, however, be noted that this report does not take into
account any efforts that may already be underway by IRCC to address some of the issues
identified.
The report consists of five main sections corresponding to the topics in theliterature scan, namely refugee resettlement programs, settlement location, housing,

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mental health services, and employment services. Within each section. key issues are
identified to frame the literature review.
In order to give the context for refugee (re) settlement in Canada, this document
includes a background appendix providing a portrait on refugees in Canada.
A key finding of the literature review is that a number of the issues are crosscutting and occur in more than one subject area. This suggests that these issues are ofparticular importance. These cross-cutting issues are highlighted below:•

the need for better information sharing between all actors and organizations
involved in the settlement process both within organizations and acrossorganizations domestically and internationally;•

the inadequacy of income support for GARs, with the impact more acute in
housing but also relevant in other areas such as transportation;•

the importance of pre-departure orientation services for refugees with information
on housing and other areas;•

the challenges of settlement for GARS in small cities where social isolation islinked to lack of co-ethnic communities can impede integration;•

The importance of effective case management systems to support the need ofrefugees to access and navigate existing services in all areas including housing,health and income assistance;•

the key role played by translation services for GARS in the early settlement
period to adapt to a new setting; and•the effectiveness of mixing work and language training so GARs can develop
language skills and vocabulary relevant to their job.

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Literature Review on Best Practices in
Government-Funded Services Supporting theResettlement and Integration of GovernmentAssisted Refugees1
I. Introduction
Background2
Under the Resettlement Program, Government Assisted Refugees (GARs) are referred to
Canada for resettlement overseas by the United Nations Refugee Agency (UNHCR) or anotherreferral organization, and arrive in Canada as permanent residents. Immigration, Refugees andCitizenship Canada (IRCC) provides them with a variety of services to support their settlement
and integration into Canadian society.
GARs are typically provided with one time start-up costs, monthly income support for up
to 12 months, and services to support their initial resettlement through the Resettlement
Assistance Program (RAP). RAP services include reception at the airport, RAP needs assessment
and referrals to Settlement and broader-based community services, immediate orientation(including financial), provision of temporary accommodation and help finding permanent
housing, and links to essential federal and provincial programs.
In the case of government-assisted refugees resettling in Canada outside of Quebec,
resettlement supports and services are provided by the Government of Canada through theResettlement Assistance Program (RAP), IRCC funds 32 RAP SPOs to deliver RAP services in
34 communities across Canada outside of Quebec.
All resettled refugees, including GARs are also eligible to receive Settlement Programservices that are available to all newcomers to Canada. These include language training, needs
and assets assessments and referrals (NAARS), information and orientation to various aspects oflife in Canada, and employment services.3 The goal of the settlement program is to encourage
newcomers to be fully engaged in the economic, social, political, and cultural life of Canada.

1This report was written by Ghada Abid under the supervision of Dr. Andrew Sharpe. We would like to thankElizabeth Orton and Bonita Varga for valuable input in the preparation of this report.
2This section draws on the statement of work of the project.
3

Resettled refugees also receive coverage under the Interim Federal Health Program for certain pre-departure
medical services and for in-Canada basic services (e.g. hospital and physician care) until such time asprovincial/territorial health insurance takes effect, as well as supplemental services (e.g. urgent dental care, visioncare, counselling) and prescription drug coverage as long as the beneficiary receives income support from theResettlement Assistance Program (or its equivalent in Quebec) or is no longer under private sponsorship. Finally,
the Immigration Loans Program (ILP) provides GARs and other eligible immigrants, with access to funding thatwould otherwise not be available to them. Loans are used to cover a number of expenses, including travel to Canada

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Under the auspices of the Government-Assisted Refugee Resettlement Assistance Program
Working Group (GAR-RAP WG), the Settlement and Integration Policy (SIP) branch at IRCC isundertaking a review of services and how they are delivered to GARs during their first year in
Canada. The Review will be considered alongside a departmental evaluation and will result inrecommendations for program and policy improvement. A synthesis of recent literature, thesubject of this report, is one activity under the Review.
Objective and scope
The objective of this report is to provide IRCC officials with a better understanding ofwhat the recent literature says about best and promising practices in government-funded services
designed to support resettled refugees to live independently in their resettlement country. The
report synthesizes the literature identified through the “knowledge scans” provided by IRCC andidentifies key themes, insights and trends found in the literature.
The report consists of five main sections corresponding to the topics in the literature scan,
namely refugee resettlement programs, settlement location, housing, mental health services, andemployment services.4
Four IRCC documents provided useful background for this report: “Refugee
Resettlement Program Performance Information Profile (IRCC, 2017a), “Settlement Program
Performance Information Profile” (IRCC, 2017b), “Synthesis Report: Key Information
Interviews” (IRCC, 2020a), and the Powerpoint presentation “Review of Services and Service
Delivery for Government-Assisted Refugees” (Foran, 2020). The information in these
documents, particularly the third and fourth, is largely consistent with the findings of thisliterature review. But a comparison of these findings with those of this literature review isbeyond the terms of reference of the project.
In order to better understand the context for refugee (re) settlement in Canada, the Centre
for the Study of Living Standards prepared a background appendix on refugees in Canada. The
document discusses the definition of refugees, provides data on trends in refugees, broken downby the different types of refugees and country of origin. and examines the characteristics of
refuges, particularly GARs and briefly discusses refugee settlement programs. This document isincluded as a stand-alone appendix to this report.5

II. Refugee Resettlement Programs
Immigration, Refugees and Citizenship Canada (IRCC) provided the Centre for the Studyof Living Standards with 75 journal articles, papers or reports from different sources related toand other costs associated with resettlement, specifically to defray the cost of transportation to Canada(transportation loan) and/or to assist with establishment in Canada (assistance loan).
4

A sixth topic or section in the knowledge scan was financial support. The studies in this section were found not
relevant so the report includes no section on this. But the issue of financial support for refugees is very relevant andcovered under other sections.
5 The background appendix for this literature review can be found at http://www.csls.ca/reports/csls2020-09-appendix.pdf.

8refugee resettlement programs. Most of the publications were based on research outside of
Canada. After closely examining the reports and the studies, we were able to identify five issues:
the insufficient duration of RAP monthly support; the lack of information sharing; the deficiency
in the management and coordination of volunteers; the need to improve pre-arrival orientation;and the importance of effective case management.
1. The insufficient duration and amount of RAP monthly support
The RAP monthly support GARs receive during their first year in Canada is believed to
be inadequate with regard to its amount and its duration. Unlike PSRs, GARs are chosen basedon their vulnerability instead of their professional or linguistic skills (Agrawal & Zeitouny,2017). To better reflect GARs’ needs, as documented in several studies, IRCC might want toconsider making two simultaneous changes: adjusting the amount and extending the duration of
the monthly income support.
GARs in Lethbridge stated that the amount they received was inadequate as it “barely
covers their rent, insurance, bus passes, phone, and so forth” (Agrawal & Zeitouny, 2017:23).
The inadequacy of the RAP monthly allowance will be further discussed in the housing section.
According to an IRCC (2016c) evaluation of the Syrian refugee initiative, GARs’ income
support period needs to be extended beyond 12 months. GARs interviewed all agreed that thereceipt of income support for only 12 months was not enough for them to fully establish
themselves. They stated the need to overcome their language barriers and tackle their medical
issues before they access the labour market. GARs in Lethbridge conveyed their concerns about
the duration of the RAP income support fearing they “would not be able to learn English andthus would not be able to work full time to provide for their families”(Agrawal & Zeitouny,
2017:22).
Support for the case for an extension of income support for GARS is provided by theexperience of Syrian refugees to Canada, Syria represents of course the top country of origin for
GARs in Canada since 2015. The Syrian Outcomes Report by IRCC (2019:8) reports that only
43 per cent of adult Syrians found employment after 2 to 3 years in Canada. This was lower than
PSRs (60 per cent) and BVORs (55 per cent). GARs thus take longer to obtain employment
compared to refugees in other sponsorship streams. In order to give them more time to increase
their employability, GARs may need extended financial support beyond the one-year period.
2. The lack of information sharing
Improving information sharing within and between organizations involved in refugees’
resettlement both nationally and internationally was recognized as a problem in IRCC’s
evaluation (2016a). Information gaps can hinder IRCC staff, partners and stakeholders in their

9preparation for the arrival of refugees. Therefore, they need to be provided with accurate andcomplete refugee information to ensure GARs’ needs are effectively met. Examples of
information to be shared include refugees’ countries of origin and date and time of arrival in
Canada. According to IRCC (2016c:33), refugees’ “full socio-demographic and contact
information needs to be accurately captured for populations that arrive in Canada to allow for
effective ongoing monitoring and results reporting”. To better support refugees’ arrival andwelcoming, Quebec’s Ministry of Immigration, Diversity and Inclusion suggests thesystematization of rapid transmission of information related to refugees in conjunction withfederal authorities. Doing so would allow the actors involved in refugees’ (re)settlement tochannel resources and guarantee a better reception for refugees (Ministère de l’Immigration, dela Diversité et de l’Inclusion, 2017). In other words, information sharing in Canada represents anarea for improvement (Cronkrite et al., 2016).
Information sharing should not be limited to the period preceding refugees’ arrivals. It
should also be reinforced after refugees safely make it to Canada. If IRCC is not provided withaccurate information related to refugees’ (re)settlement challenges in a timely manner, this cannegatively impact the process of decision making. According to the Office of the Auditor
General of Canada (2017), the lack of information sharing concerning language training waitlists in Canadian provinces and cities prevented IRCC from properly addressing this issue. IRCC
“could not closely monitor where demand exceeded supply, and it was less able to make timely
decisions on where to spend money most effectively”.
In 2010, the Government of Canada along with the Province of Ontario funded a systemthat displays real-time information related to language classes’ provision to clients. Thereby,
IRCC, the provincial government and SPOs were able to see how many seats were available andwhich SPOs had waitlists. When Canada started welcoming resettled Syrian refugees in 2015,
IRCC used that system to allocate funds across Ontario. As pointed out by the Office of the
Auditor General of Canada (2017), that system only covered Ontario and was not implemented
in other provinces. Consequently, the federal government did not know how many refugees were
waiting to access language services nor did it have access to information related to waiting
periods in these provinces. Later on, IRCC started collecting waitlists information directly from
SPOs. It also made some changes to its Immigration Contribution Agreement Reporting
Environment (iCARE) system. As pointed out by the Office of the Auditor General of Canada(2017), the data shown were unreliable. Therefore, it was not possible to decide whether “theextra resources spent to expand language training services were used efficiently and gave Syrian
refugees quick access to language training”. This is an example of where better information
sharing is needed.

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The issue of information sharing is relevant in many areas. In the housing section, we
will highlight how the lack of information on the number of family members can negatively
impact GARs’ housing experience in Canada.
In the European Union, there is a myriad of good practices when it comes to improving
information sharing related to refugees either between Member States or on the national level.
For example, the SHARE Network was created in 2012 to connect different Member States’
local authorities as an attempt to foster peer learning about refugees’ resettlement. In Sweden, a
project called Strengthening the Reception of Resettled Refugees was set up to improve
communication between national and local actors involved in refugees’ resettlement. By
providing accurate information on refugees’ arrival dates, this programme “contributed toclarifying roles and responsibilities and fostered improved planning of resettlement procedures”(Stürner, 2019:10). Finland opts for an inclusive decision-making process. In fact, the Finnish
Immigration Office officials and Finnish integration experts from different municipalities jointly
conduct resettlement interviews. This approach enables better information sharing and therefore
facilitates decision-making related to refugees’ needs and challenges.
On the international level, the Organisation for Economic Co-operation and Development(OECD) recommends the implementation of information sharing mechanisms between
resettlement countries for refugees. Such mechanisms will allow them to share their bestpractices when it comes to resettling refugees. Canada, as a resettlement destination for refugees,
may want to consider “tak[ing] this international dimension into account in national contingency
planning and emergency response plans” (OECD, 2019:92). One such practice of international
information sharing is the Five Country Conference, or FCC, which is a forum of information
sharing and cooperation that facilitates biometric data on refugees between the immigration
agencies of Canada, Australia, New Zealand, the United Kingdom and the United States. The
purposes of this information sharing are “to assist in the effective administration andenforcement of the Participants’ citizenship and immigration laws; to facilitate the secure flow ofpeople to Canada or the United States through co-operative border management among theParticipants, [and]; to promote international justice and security by fostering respect for humanrights and by denying access to the United States and Canada to persons who are criminals or
security risks” (IRCC, 2003).

3. The deficiency in the management and coordination of volunteers
Integration is viewed as a two-way process between refugees and Canadian citizens(Parliament of Canada – House of Commons Canada, 2019). Therefore, community engagement
becomes an essential element to ensure refugees’ successful integration in their new country ofresidence. For this reason, the Government of Canada encouraged all Canadians to become
involved and play an active role in refugees’ (re)settlement by volunteering (Kenny & Mamuji,2019). Indeed, both RAP SPOs and Settlement SPOs stated that volunteers were extremely

11beneficial. However, if there are no formal community engagement programs, volunteer
coordination may become a challenge.
Kenny and Mamuji (2019:24) criticized the decreased funding for community
engagement programs. They mentioned that back in 1990, the Government of Canada
implemented the Host Program “designed to assist in resettlement and the development of social
networks by having volunteers familiar with Canadian ways help newcomers learn about
available services and how to use them, practice English and French, get contacts in their field ofwork and participate in the community”. But in 2008, IRCC amalgamated the Host Program andother settlement programs into one program. The authors point out that this action reflects
IRCC’s continuing efforts in reducing the costs of refugees’ (re)settlement in Canada. However,this modernization through amalgamation resulted in the absence of consistent volunteer
programs for RAP and Settlement SPOs on the national level. Consequently, this organizational
disconnect prevented volunteers from adequately supporting GARs (Kenny & Mamuji, 2019). In
fact, not all of them were aware of the scope of services made available to GARs. Some of them
do not even know all the community partners (IRCC, 2016c).
For this reason, IRCC is advised to implement formal mechanisms that manage
volunteers involved with refugees (IRCC, 2016c).
4. The need to improve pre-arrival orientation
Pre-arrival settlement services delivered to refugees before coming to Canada are asimportant as post-arrival services. In fact, pre-arrival orientation sessions play an important rolein the managing of refugees’ expectations. Therefore, this step should not be neglected or
dismissed as it provides refugees with basic information on their new country of residence.
According to Stürner (2019:10), the importance of pre-arrival orientation sessions’ provision liesin their role of “support[ing] refugees in taking proactive decisions and preparing for their future
integration”. However, IRCC’s Syrian Outcomes Report (2019) mentioned that the first Syrian
refugee cohort in Canada did not benefit from settlement services prior to their arrival to Canada
which may have made their integration process difficult compared to other refugee groups. For
this reason, Jenkins (2019:14) deems it “important to reinstate pre-arrival orientation” forrefugees.
Refugees resettled in an EU Member State usually have to participate in pre-arrival
orientation sessions lasting between two hours and one week. Stürner (2019:10) explains thatthese sessions need to be as transparent as possible and tailored to bridging refugees’ information
gaps on their new host country. In the Netherlands, former refugees offer their compatriots
cultural orientations through Skype calls to better prepare them for their arrival. In Sweden,

12municipal authorities are part of the pre-arrival cultural orientation sessions to ensure “predeparture cultural orientation [are] tailored to the receiving locality as much as possible”.
While it is common to have pre-departure orientation sessions for refugees, organizing
orientation sessions for the host community prior to refugees’ arrival is less common. One
example of the delivery of such sessions is found in Norway where the government provides
municipalities involved in refugee resettlement with information on refugees' cultural profiles
through the Norwegian Cultural Orientation Programme (NORCO). The Norwegian government
also holds seminars on refugees’ countries of origin (Stürner, 2019). Canada could follow the
Norwegian participatory strategy as a way of ensuring that its provinces and communities areprepared to welcome refugees and ready to support their integration process.
5. The importance of effective case management
The success of GARS resettlement is linked to an effective system of case managementby the agencies providing services to refugees. Shaw and Poulin (2015) have identified anumber of traits of effective case management, highlighted below.
•

A fixed limit on the duration of case management for a refugee may be optimal. It
has been found in the United States that six months of case management services
were insufficient for most refugees to acquire the necessary skills and knowledge
base to successfully transition to life.

•

Regular home visits (weekly through month 1, monthly through month 6, andquarterly through month 24), linguistically appropriate services, and weekly
individual and group supervision were found to be key components of an effective
case management program.

•

A 30 families caseload limit for managers makes for more effective casemanagement.

•

It is important to encourage self-sufficiency and positive adjustment by engaging
in dialogue with newcomers regarding how they are doing and how they can
become more independent. In this regard, the needs of individuals differ and aflexible extended case management system is desirable.

.

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III. Settlement Location
Immigration, Refugees and Citizenship Canada (IRCC) provided the Centre for the Study of
Living Standards with 18 journal articles, papers or reports from different sources related to
refugees’ settlement location. The research was mainly conducted outside of Canada. After
closely examining the total number of studies, we were able to identify three issues that arise
when refugees are assigned to reside in small Canadian cities: the limited resources in small
communities; the lack of co-ethnic communities in small cities, and policies to encourage
refugee settlement in smaller centres.
As part of its “regionalization” policy, the federal government assigns GARs to smaller
and medium-sized cities mainly because many of these cities face a declining population andalso to take the pressure off of Canada’s gateway cities such as Montreal, Toronto or Vancouverthat are experiencing a noticeable growth in their populations (Jenkins, 2019:4). Since refugees’
initial settlement destination is chosen by the Government of Canada, that they do not have any
agency in the decision-making process may not be the best from the point of view of theirintegration into Canadian society. One indicator of a poor initial settlement location is thepropensity of undertaking a second migration to a different city. We are especially interested in
refugees’ secondary migration from a small to a big city since “the size of an initial destinationcity matters when accounting for variations in immigrant retention rates by admission category”(Kaida et al., 2020:15). According to a study by Statistics Canada, GARs are more likely than
PSRs and economic migrants to leave their initial city of settlement during their first 10 years in
Canada. In addition, GARs’ likelihood of undertaking a secondary migration increases when thesize of their initial city of settlement decreases. In this section, we look at factors which may
contribute to GARs’ secondary migration when initially settled in small Canadian communities.
Addressing these factors may lead to a lower propensity for GARS to undertake secondary
migration within Canada.
1. The limited resources in small communities:
If refugees were free to choose where to initially settle upon their arrival, they would
probably “never set foot in small cities where they have no economic or social connections”(Kaida et al., 2020). The difficulty small communities have in retaining refugees may be
explained by their limited resources.
According to Cronkrite et al. (2016), the ability to meet the needs of refugees differ
depending on their settlement location. For example, refugees in small communities may
experience additional challenges compared to refugees that are settled in urban centres that tend
to have more resources available. When it comes to mental health services provision, rural
Manitoba communities still have a “limited experience with war-trauma [and] the refugee

14experience” (Cronkrite et al., 2016:1). For housing, smaller communities offer refugees anadvantage as the options tend to match refugee families’ sizes in an affordable way (Rose, 2019).
But as we will explain in the housing section, this may not represent a strong enough reason forrefugees to remain in these communities. Interpretation services are also not accessible torefugees as translators are often hard to find in small communities (Haugen, 2019:58). The
paucity of translation services, as we note in the fourth section of our literature review, may
impact refugees’ mental health and their settlement experience in general (Cronkrite et al., 2016).
In Australia, refugees’ initial destination is chosen by the Australian government
according to a number of factors that include “any existing links the refugees might have tofamily or friends, the location of others from the same background and the availability of support
services” (Piper, 2017:16).6 Piper (2017) explored possible ways to attract refugees to Australianregional centres. According to the author, a number of strategies are needed to ensure asustainable settlement. First, he mentions the importance of thinking about regional
communities’ capacities of supporting refugee families to make sure there are enough resources.
Resources required by regional communities for successful regional settlement are health care,education and training, settlement support and lifestyle resources. Health care resources consistof having major hospitals in proximity, local medical professionals with experience in aiding
refugees, the ability to use interpreters in health practice, nearby trauma outreach centres andgeneral practitioners who have space to treat the refugees. Education and training resources
would include ESL classes, support in schools for young individuals, education providers
familiar with people from culturally and linguistically diverse backgrounds and training
institutions with a variety of vocational courses. Settlement support resources comprise having
service providers with experience in working with refugees as well as having an understandingof refugee needs, regular contact between government and non-government providers and theability to user interpreters. Lifestyle resources include places of worship, venues for communal
and cultural activities, availability of culturally significant foods (e.g. halal), library resources inrefugees’ native languages, locally available and inclusive recreation and sports clubs and public
transport that is available on weekends and in evenings.Second, finding synergies or matches
between refugees’ skills and the regional area labour shortages should not be neglected. Third, hestates that ensuring support from refugee community leaders is essential given the important role
they play in convincing refugees of relocating to regional centres.
2. The lack of co-ethnic communities in small cities
The presence of co-ethnic communities is an important element that refugees consider
when deciding whether they will stay in their initial city of settlement or not. For example,

6

The Australian context is different from the Canadian one because refugees are initially placed in capital cities.
Both Canadian and Australian governments are exploring ways of retaining refugees in rural areas.

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many SPOs assume that Syrian refugees prefer to live where they are more likely to find Arabicspeaking individuals and access ethnic services (Haugen, 2019). This is more likely found inlarger cities since they “offer a wider range of services and co-ethnic communities” compared tosmaller ones (Jenkins, 2019:20).
The lack of co-ethnic communities in small cities usually means that refugees may needto drive to the closest urban centre to obtain ethnic foods. In one community, local volunteers
decided to step in to help Syrian refugees by: driving them to the closest major city so they can
attend cultural events or access the mosque: connecting them to other Syrian or Arab refugees inneighbouring rural communities: ordering specific foods at local groceries; and finding
interpreters using their personal networks (Haugen, 2019).
Because of the lack of co-ethnic communities in rural areas, Canadians living there “maynot have had a lot of experience with other ethnicities or religions” (Haugen, 2019:57).
Consequently, refugees tend to assume that they would face intolerance and would not be
considered part of the new community. This fear of rejection can explain why refugees decide tomove from smaller cities to larger ones. Because big cities are often home to different culturaland ethnic groups, refugees think they would be easily accepted and that the likelihood of being
subject to negative comments would decrease.
In Australia, Piper (2017) states that if regional areas do not have communities that share
refugees’ cultural and ethnic backgrounds, the Australian government might want to assign three
to five families to reside in those areas as a start. By doing so, refugee families will not feel
isolated and will still be able to speak their language of origin and celebrate cultural and religious
events.
3. Policies to encourage refugee settlement in smaller centres
Despite the limited resources and lack of co-ethnic communities in smaller centre, it isdesirable that refugees settle throughout the country, not just in the large cities. Jenkins (2019)
has identified several best practices that may contribute to this objective.
Rather than sending refugees to these smaller cities from the outset, a voluntary incentive
approach might be more constructive. Provincial governments, in concert with interested
municipalities, could offer tax breaks and cash incentives to refugees and other immigrants who
were willing to locate in smaller centres.
Jenkins focuses on the key role that municipalities can play in making their community
attractive to refugees. For example, municipalities can coordinate offers of volunteer assistance,

16
and establish and fund permanent procedures and protocols for this, in consultation withsettlement sector organizations and existing volunteer networks.
Municipal governments in smaller centres can attempt to create a reputation or brand as
welcoming communities for refugees by supporting the development of effective multi-sector
newcomer support networks. These networks can play a key role in facilitating refugee
integration.

IV. Housing
Immigration, Refugees and Citizenship Canada (IRCC) provided the Centre for the Studyof Living Standards with 18 journal articles, papers or reports from different sources related toGovernment-Assisted Refugees’ (GARs) housing issues. They were evenly divided between
research conducted in Canada and research on the international level. After closely examining
them, we were able to identify six issues: the inadequacy of the shelter portion of the monthly
income support GARs receive with the housing rents; the mismatch between the sizes ofavailable housing for refugees and the actual size of refugee families; the lack of information
sharing between the federal government and RAP-SPOs related to GARs’ housing needs; thelack of refugees’ familiarization with the Canadian housing market; the paucity of translation
services when delivering housing services to GARs; and the suitability of the geographic
location of housing within a community for GARs and how it affects their access to services.
1. The inadequacy of the shelter portion of the monthly income support GARs receive tocover housing rents
As part of the Resettlement Assistance Program (RAP), GARs receive a monthly income
support (based on provincial social assistance rates) intended to help them cover the expenses of
housing and other basic needs for up to one year or until they become self-sufficient, whichevercomes first (IRCC, 2016). The monthly income support that GARs receive is often not sufficient
to cover their housing costs which often exceeds 30 percent of their available income. Affordable
housing for refugees is defined as housing that costs less than 30 percent of before-tax householdincome, according to the housing standards set by Canada Mortgage and Housing Corporation(CMHC) (Brown & Armenakyan, 2020). For this reason, most of the studies on housing in theknowledge scan provided by IRCC call for more affordable housing for GARs. The importanceof housing affordability is highlighted by Coley et al. (2019) who found that having access toadequate housing is positively correlated with well-being.
When it comes to housing affordability, Rose and Charette (2017) identified theincompatibility between the allowance GARs receive for housing and the actual housing rents.
They compared RAP allowances and Canada Child Benefit (CCB) rates with CMHC’s Rental

17Market Survey data for average rents in the lowest quartile of the housing market that is the mostbasic housing units that are found in cheaper neighbourhoods. The authors found that refugee
families would be spending more than 30 per cent of their income on rent alone. The amount a
couple with two children receives for housing through the RAP allowance in Ontario is $795 but
the rent for a 3-bedroom apartment (if the two children were of different sexes and age ranges) in
Toronto is $1,300. In this case, even with their Child Benefit, the family would spend 49 per centof their modest income on rent. Consequently, GARs often resort to using their CCB or otherforms of income to cover their other basic needs7.
The situation is worse for small families, families with no children or single people.
Refugees with no children are not eligible for CCB (Canada Revenue Agency, n.d.) and only relyon the income provided by RAP. For example, a basic studio apartment in Calgary would use up
to 83 per cent of the RAP income of a single person (Rose & Charette, 2017:18). The fact that
GARs need to repay their transportation loans to the Government of Canada worsens theirfinancial situation and makes their housing budget even tighter. For this reason, Rose andCharette (2017) recommend that IRCC revisit the income support given to GARs in a way that
better reflects the provincial and local housing markets’ prices and reduces if not eliminates theexisting gaps between housing needs and the monthly income support for housing.
2. The mismatch between the sizes of available housing for refugees and the actual size of
refugee families
Another particularly poignant issue identified by Rose and Charette (2017:17) was thedearth of housing units that correspond to the needs of large and multi-generational refugee
families. For large refugee families, “finding suitable housing units while respecting occupancy
codes'' becomes quite a challenge. The average size of Syrian families is well above that of
Canadian families. For example, between November 2015 and July 2016, the governmentassisted Syrian refugee families with 5 and 7 members accounted for almost 50 per cent of
Syrian families resettled to Canada (Open Government, 2016.-c). By comparison, householdswith five or more persons make up approximately 8.4% of all Canadian households (Statistics
Canada, 2017). This means that the RAP Service Provider Organization (SPO) would often haveto convince landlords to adjust their housing arrangements. For example, they were able topersuade landlords to make changes to connect two apartments in Halifax and merge some sideby-side duplexes in Windsor. According to Silvius et al. (2019) and Rose and Charette (2017), a
greater number of affordable larger units for large refugee families is needed because size
requirements and affordability constraints limit the range of options RAP-SPOs currently offer to
7 RAP Income Support rates for housing are aligned with provincial social assistance rates. In 2017, IRCC introduced a national

RAP housing supplement for clients who require financial assistance with their rental and utility costs over and above theapplicable RAP rate. The RAP housing supplement serves as a substitute for the more comprehensive rental supplement andsubsidized housing programs offered by provincial and municipal social assistance programs. However, the housing supplement
amount is not typically enough to raise household income to a level such that housing costs do not exceed 30 of their income.

18
GARs. Addressing the federal and provincial housing policy decision makers and stakeholders,
Rose and Charette (2017:31) call for a diversification of available housing options to meet
refugees’ housing needs.
3. The lack of information sharing between the federal government and RAP-SPOs related
to GARs’ housing needs
The lack of information transmission between the federal government and RAP-SPOs in
relation to GARs’ housing needs was recognized as an issue in Rose and Charette (2017). In thecase of Syrian refugees, the lack of information concerning refugees’ profiles increased thesettlement challenges (Rose, 2019:23). Being aware of the family structure and composition of
refugees and their health conditions is crucial to ensuring the success of housing strategies for
GARs. This can involve other community partners, not just the RAP SPOs. For example, anumber of cities, municipalities and non-profit organizations wanted to take part in Syrian
refugee resettlement efforts. They set up online housing portals to assist refugees with theirhousing search. Many of the housing offers on these platforms were inconsistent with refugees’
housing needs because the “general public had limited information about refugee profiles andneeds” (Rose, 2019:18). Rose (2019) calls for improving the information transmission between
overseas processing offices, the Operations Branch of IRCC in Ottawa and RAP providers in
different cities as this would facilitate advance planning for housing. Refugees can then be more
effectively matched to suitable housing. Rose (2019) also believes that this would reduce therefugees’ stay in temporary housing or hotels. Therefore, IRCC officials are advised to provide
accurate advance notification of the profile of GARs where it would ideally specify their family
sizes and their estimated arrival dates.
4. The lack of refugees’ familiarization with the Canadian housing market
Services offered to GARs by settlement agencies include a variety of workshops andcourses. However, these workshops tend to provide little information on housing, resulting in
refugees lacking familiarization with the Canadian housing market (Brown and Armenakyan,2020). Each country has its own housing culture and laws so it goes without saying that refugees
coming to Canada cannot be fully aware of all these differences. Rose (2019:23) stresses theimportance of providing refugees with clear and accurate basic information about theresettlement country’s housing system as this would help them develop “realistic expectations
about their future housing (that it will be basic) and aspirations (that is normal and very possible
to move to better housing later on in the settlement process)”. A RAP SPO interviewee in Rose
and Charette (2017:16) suggested that a number of Syrian refugees have difficulties accepting
their initial housing option as they were not aware that, unlike in Syria, it is completely normal in
Canada to upgrade to a better dwelling once their financial situation improves.

19
Municipalities, local immigration partnerships and other newcomer support networks areencouraged to establish permanent local housing tables and task forces involving the “full rangeof local housing providers, including private developers and landlords as well as the public andnon-profit sectors” to ensure their active participation in securing suitable and affordable housing
for GARs (Rose & Charette,2017:.29). Doing so would provide a space to discuss predictableand unpredictable needs related to housing that can arise with refugees’ arrivals to Canada.
More effective information sessions by RAP providers that pinpoint both tenants andlandlords’ rights and responsibilities in the Canadian housing market are needed for GARs. To
do this, housing policy staff are advised to make better use of multimedia resources provided by
Canada Mortgage and Housing Corporation (CMHC)’s Newcomer Housing Information team
(Rose & Charette, 2017). These resources are available in eight languages (including English andFrench). Expanding settlement workshops beyond language classes to cover additional topics
that directly target housing-related issues in a Canadian context can be beneficial for refugees(Brown & Armenakyan, 2020).
Informing newcomers of discriminatory behaviour they may face during their housing
search or housing-related scams they may fall for will definitely help avoid deception. Ideally,
information and orientation sessions provided to refugees prior to their arrival to Canada, during
their first weeks of resettlement and also in the following months to ensure a successful
settlement process need to have a strong housing component (Rose & Charette, 2017). .

5. The paucity of translation services when delivering housing services to GARs
The lack of translation services can make communication between landlords and refugeetenants difficult. English or French is generally not one of refugees’ spoken languages. In fact,
almost 80 per cent of GARs resettled in Canada between January 2015 and May 2020 speakneither English nor French (Open Government, 2016.-a). For this reason, Silvius et al. (2019)
deem it important to address the shortage of translation services. They explain that by doing so,
refugee tenants’ access to social housing would be facilitated. Refugee tenants who do not speak
English or French (depending if the province is francophone or anglophone) are unable to fill out
the required housing-related documents alone or fully comprehend the information given to themduring housing-related workshops. Refugees mainly depend on service providers to translate
documents or make calls for them but this takes up an important amount of service providers’time.
Language barriers prevent refugees from directly communicating with housing providers.
In some cases, when refugees do not understand the content of a phone call/text, a letter or anemail, it can result in missed opportunities or even losing their social housing tenancy (Silvius et20al., 2019). A recommendation to IRCC would then be to increase the collaboration with“provinces, territories, municipalities and other stakeholders to better coordinate the availabilityof interpretation so that newcomers have meaningful access to provincially and municipally
delivered social services” (Parliament of Canada – House of Commons Canada, 2019). The
shortage of translation services applies beyond housing as we will discuss it in future sections.
6. The suitability of the geographic location of housing within a community and how it
affects GARs’ access to services
Rose (2019) addressed the issue of the existing mismatch within a community between
refugees’ housing and the location of services designed to support GARs’ resettlement andsettlement. RAP housing-search workers that help GARs find their future home must satisfy two
criteria at the same time: housing affordability and housing suitability. According to Rose(2019:15), a house is suitable if it is accessible to settlement services, health care and everyday
services by public transportation.
Small cities and towns in Canada often have an adequate supply of affordable housing
options that match refugee families’ sizes (Rose, 2019). But public transportation is usually very
limited (Rose, 2016) so the transportation barriers to accessing services need to be addressed.
Whenever public transportation is not available, GARs’ access to resources and services can beseriously hindered since GARs generally cannot afford to own a car. According to Cronkrite etal. (2016), the absence of public transportation in rural communities in Canada results in
refugees’ dependence on volunteers for their transportation. If the family size is large, then asingle refugee family might need the help of multiple volunteers to drive them or even rent a bus
for them (Haugen, 2019). For this reason, Texeira and Drolet (2016) recommend reducing thetransportation barriers by expanding bus routes and making bus services more frequent in thecase of car-oriented cities. It may be unrealistic to do just for refugees.
Wilkinson and Garcea (2017:21) adopted another approach. They advise policy makers in
Canada to provide settlement agencies with funding to help refugees cover their transportation
costs particularly in rural areas. By doing so, they believe it would improve the effectiveness of
settlement services delivered to GARs. Rose (2016) suggests shifting the attention to otherprograms that can be easier to implement such as “ride-sharing, taxi-buses, non-profit selfservice bicycle and car rentals, and coaching for driver education especially for women”. For
example, newcomers in Winnipeg are able to receive assistance to obtain\ their driver’s licencethrough a program offered by Manitoba Public Insurance (Cronkrite et al.,2016).

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V. Mental Health Services
For this section of the literature review, Immigration, Refugees and Citizenship Canada(IRCC) provided the Centre for the Study of Living Standards with 39 journal articles, papers orreports from different sources related to mental health services for refugees. Out of the total
number of studies provided, 70 per cent were conducted in countries other than Canada such as
the United States, Australia, and Denmark. After closely examining them, we were able toidentify five issues: the prevalence of stigma surrounding the use of mental health services
among the refugee population and their lack of knowledge about mental health; the lack of
medical staff knowledge about refugees’ cultural profiles; dealing with PTSD and trauma in the
refugee community; the limited use of internet when providing mental health services; and theinsufficient use of multidisciplinary and holistic approaches to mental health services forrefugees.
1. The prevalence of stigma surrounding the use of mental health services among the
refugee population and their lack of knowledge about mental health
According to Agic et al. (2016), successful interventions for delivering mental healthservices to refugees are the ones that are linguistically appropriate and culturally sensitive. In
other words, successful interventions understand and overcome refugees’ cultural barriers in thedelivery of mental health services. Cultural barriers are linked, among other things, to refugees’
omnipresent stigma surrounding mental illness that consequently prevents them from seeking
mental health assistance and their belief in traditional alternative practices (Thomson et al.,2015:1897).
A report by British Columbia’s Ministry of Mental Health and Addiction (2018:7) statedthat the terms or language used during consultations with refugees is very important whenaddressing stigma. For example, the use of the words “anxiety”, “depression” or any other term
related to mental health during the diagnosis or during the mental health promotion makes it
difficult for refugees to acknowledge they may suffer from it as they believe these are Westerndiseases. Being diagnosed with a mental health illness can also mean being labeled “crazy”(Kaplan et al., 2016) and can eventually lead to the loss of social status, social exclusion, anddiscrimination (Salami et al., 2019). A refugee family will not simply accept that their child has
Attention Deficit Hyperactivity Disorder (ADHD). Instead, they prefer to think that their child isactive and that nothing is wrong with him or her (British Columbia, 2018). Another example ofthe stigma related to mental health disorders among refugees would be believing their problems
are a consequence of their sins or bad karma rather than admitting they might have a mental
health condition (Kaplan et al., 2016).

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Some refugees also fear for their legal status in Canada if they were to access mental
health services. They believe that if they admit they are mentally-ill, there is a chance they would
lose custody of their children or risk being deported to their country of origin (Salami et al.,2019). Whenever refugees access mental health services, they are asked to provide theirpermanent residence (PR) number. That leads some to think that the government has access totheir medical file and that their mental health condition is a barrier to becoming Canadiancitizens in the future (British Columbia, 2018:9).
Due to their aversion to Western treatment approaches and their fear of stigma, refugees
usually resort to alternative therapies and stress management techniques. They believe that“being strong” or “staying busy” can help them overcome depression. The most common
treatment models are prayer, music and family support. Refugees believe in the curative powerof cultural prescriptions which may explain their reluctance to use mental health services(Thomson et al., 2015).
In order to offer mental health services that are adapted for specific refugee groups, thepresence of a cultural broker becomes a necessity. As discussed in Brar-Josan and Yohani(2019:513), a cultural broker is “an individual who takes on the role of bridging individuals orgroups of differing cultures for the purpose of improving communication and reducing conflict”.
Examples of cultural brokers that assist mental health practitioners include, but are not limited to,paraprofessionals, settlement workers and bi-cultural members (Brar-Josan & Yohani,
2019:513).
Cultural brokers help overcome cultural barriers to accessing mental health services by“facilitating cultural integration and sense of belonging, bridging to settlement services,supportive counselling, facilitating referrals to mental health practitioners, educating about
mental health, providing contextual information and cultural interpretation” (Brar-Josan &Yohani, 2019:512). For Bhayana and Bhayana (2018), the presence of a cultural broker when
delivering mental health services can ensure that the communication between the mental healthprofessional and refugee patients is valid.
Thomson et al. (2015) recommend that media campaigns related to mental healthpromotion use imagery and messages that are designed in a culturally-sensitive manner whentargeting specific refugee groups. Since Salami et al. (2019) advocate for the use of a prevention
approach rather than a crisis management one when it comes to refugees’ mental health, these
media campaigns will essentially “clarify the role of mental health services to those unfamiliar
with such services” (Thomson et al., 2015:1900). Examples of messages that target refugees’
poor self-recognition of mental health disorders are “if you’re feeling sadness or crying
frequently call this” (Forrest-Bank et al., 2019:680).

23
2. The lack of medical staff knowledge about refugees’ cultural profiles
Almost all refugees that resettle in Canada come from non-western countries andcultures. The lack of medical staff’s knowledge about refugees’ backgrounds can represent
additional barriers to the provision of mental health services as this can impact “effective
diagnosis and treatment, due to different culturally based perceptions of the nature of the mental
health problems and different expectations about the role of health services in responding tothem” (Kaplan et al., 2016:1161). Thomson et al. (2015) affirm the need for linguistically andculturally sensitive service that includes an awareness of how culture impacts health andtreatment.
To improve mental health practitioners’ cultural awareness and sensitivity, Thomson etal. (2015:1899) suggest “strengthen[ing] the cultural diversity component of the medical training
programs and sensitivity of health care providers” to refugees’ specific mental health needs. If
general practitioners or mental health professionals' awareness of refugees’ cultural backgrounds
increases, it will be easier for them to detect and manage unusual representations of mental
disorders. The World Health Organization (WHO) also recommends ensuring that the mental
health workforce understands refugees’ different family and social structures (WHO, 2018).
Hebebrand et al. (2016:5) recommend that general practitioners and mental healthprofessionals consult refugee-specific websites such as the Cultural Orientation Resource Centerto gain better understanding of the refugee patients they serve. Through a compilation of
refugees’ culture profiles, this website “provide[s] a basic introduction to the social structure,
language, geography, and history of various cultural groups”.
Another best practice is the use of cultural brokers as a means of addressing the lack of
medical staff knowledge (Brar-Josan and Yohani, 2019). These brokers facilitate cultural
understanding to help mental health practitioners overcome cross-cultural differences that
account for some of the barriers in providing services to refugee and immigrant populations.
Cultural brokers can play three roles to facilitate refugee youth’s access to formal
psychological support:•

Facilitating referrals: (1) identifying mental health issues, (2) consultation with youth andfamily, (3) determining which professional to refer to, and (4) introducing youth to theprofessional;•

Educating: brokers can help refugee youth and their parents learn about the benefits ofseeking mental health services. They can explain the process in a manner that the family
could understand and relate to; and24•

Providing contextual information: brokers can obtain pertinent background information
relating to clients and transferring that information to the mental health practitioners.

3. Dealing with PTSD and trauma in the refugee community
As noted by Agic et al. (2016), the incidence of refugees coming to Canada with PTSD isincreasing. PTSD and trauma, along with depression and anxiety are the main mental healthissues facing refugees.
For an effective planning of refugee youth mental health services, Hebebrand et al.
(2016:2) highlight the importance of understanding refugees’ flight experiences, not just thetrauma they have gone through in their countries of origin. The authors assert that the “flight initself can be traumatic or compound trauma via, for instance, separation experiences, sexual
abuse, and trafficking including forced labor and sexual exploitation”.
According to Forrest-Bank et al. (2019), Sijbrandij et al. (2017) and Agic et al. (2016),
the mental health practices with the most promising outcomes when dealing with traumatizedrefugees and refugees with PTSD were the NET (Narrative Exposure Therapy) and CBT(Cognitive Behavioral Therapy).
NET allows refugee patients to “develop a chronological narrative of their life story witha focus on the traumatic experiences in order to transform fragmented reports of the traumatic
experiences into a coherent narrative” (WHO, 2018:21). During this intervention, the therapist
usually resorts to the “employment of empathic understanding, active listening, congruence andunconditional positive regard” (Mitschke et al., 2017:3).
Using behavioural and cognitive techniques (e.g. exercises to reduce avoidance andhyperarousal), CBT “aims to reduce distress related to traumatic memories and their impact on
the current life of the patient” (WHO, 2018:21).
Mind Spring (MS) is a community group intervention and promising practice that has
been developed in Denmark to address PTSD and trauma in refugees (Husby et al., 2020). MS
functions as an early group intervention for newly arrived refugees. The purpose of MS is to givethe participants new knowledge and awareness about their own psychosocial reactions to war,flight, and exile‐life as well as the importance of social networks. Groups are undertaken in thenative language of the participants and led by an MS trainer with a refugee background incollaboration with a co-trainer (usually a social worker) from the municipality where the group isheld. The co-trainer is assisted by an interpreter during the sessions. The MS intervention isorganized into groups for parents, youth and children. Each group includes 8‒10 participants

25
attending nine sessions of 2 hr each. The sessions cover psychoeducation and psychosocial
themes such as identity, culture, stress, trauma, and parenting. The acceptability and outcome of
MS have not yet been systematically investigated.
4. Limited online delivery of mental health services to refugees
As already noted, there are many barriers to the delivery of services to refugees including
mental health services. These barriers include language and transportation. For example, “notbeing fluent in English and/or French can pose challenges to gaining access to mental healthservices” (Thomson et al., 2015:1898). Most of the studies in the knowledge scan confirm that
language barriers between health care providers and refugees led to the underuse of mental
health services. Another barrier that can explain refugees’ reluctance to using mental healthservices is transportation. Kaplan et al. (2016) suggest that arranging refugees’ transport andsending them reminders of their mental health appointments can be used to encourage them to go
see a mental health professional.
An innovative solution to all these barriers would be to rely on online mental healthservices. E-mental health is defined as “the use of the internet and other electronic
communication technologies to deliver mental health information and care” (Mental HealthCommission of Canada [MHCC], 2018:3). Techniques used to deliver e-mental healthinterventions include, but are not limited to, instant messaging and video-based counselling
services (also referred to as telehealth or telepsychiatry), online support groups, mobile phone
applications, online assessment or diagnostic tools, blogs and podcasts and therapeutic gaming
programs. To support refugees’ use of e-mental health services, the Mental Health Commissionof Canada prepared an implementation toolkit intended for community health workers,
counsellors/psychotherapists, psychologists (including general, clinical, health, counselling),
mental health nurses, social workers, occupational therapists, peer support workers and otherallied health workers (MHCC, 2018). The type of technologies that would be used for refugees’
mental health services include artificial intelligence that can overcome language barriers byoffering translation services.8
The World Health Organization states that “computer technologies and tele-psychiatry
can be explored as an alternative to face-to-face interpretation and may become more important
over time, given their potential for cost reduction and easy access” given that interpreters,
cultural mediators and the mental health workforce are well-equipped and well-trained to usethem (WHO, 2018:23). According to Sijbrandij et al. (2017), e-mental health interventions canpotentially reduce refugees’ fear of stigmatization with no transportation costs. The authors
mentioned that additional advantages of the online delivery of mental health services are “the8Artificial intelligence is defined as “computer systems that apply algorithms and machine learning techniques [to]perform tasks that normally require human intelligence” (MHCC, 2018:11).

26
relative brevity of e-mental health interventions and the possibility to automatize parts of thetreatment” (Sijbrandij et al., 2017:5).
An example of transcultural tele-psychiatry is the Little Prince Psychiatric Centre in
Copenhagen, Denmark which matches refugees to culturally competent mental healthprofessionals. Refugees said that they preferred these online consultations compared to theinterpreter-assisted ones because tele-psychiatry reduces their concerns when it comes toinformation confidentiality (WHO, 2018). Salami et al. (2019) draw attention to the close knit
nature of refugees’ communities. For this reason, using cultural brokers or translators from thesame ethnic group is not the best option in the delivery of mental health services.
5. The insufficient use of multidisciplinary and holistic approaches to mental healthservices
A multidisciplinary approach in mental health services is one that seeks to expand thescope of actors involved in delivering mental health services to refugees to include interpreters,social workers, and community members alongside general practitioners and mental healthprofessionals (Kostiuk, 2019). As stated in Agic et al. (2016:10), “what is needed is the politicaland institutional strategy for developing a system that will link and support clinicians, nurses,
and social workers who offer treatment, as well as the settlement workers and communities whowill provide the social support and sense of belonging to incoming refugees”.
Multidisciplinary approaches may be particularly relevant in dealing with PTSD andtrauma in the refugee community. These approaches can be evidence-based and can draw upon
the best practices from different disciplines to tailor the most effective mental healthinterventions based on the needs of the refugee.

VI. Employment Services
Immigration, Refugees and Citizenship Canada (IRCC) provided 27 journal articles,
papers or reports related to employment services for refugees. Among the studies, 12 wereconducted in Canada. After closely examining them, we were able to identify six issues: thereferral process of SPOs that encourages GARs to finish their language training before accessing
employment services; the focus on language acquisition through formal language classes rather
than combining it with employment-related services; the lack of foreign credentials recognition;
GARs’ low social capital; RAP income support’s high claw back rate; and discrimination against
GARs in the labour market.
1. The referral process of SPOs that encourages GARs to finish their language training
before accessing employment services

27

In theory, GARs can be simultaneously referred to language training and employmentrelated services by SPOs. However, in practice, SPOs usually encourage them to focus on theirlanguage learning while they are receiving RAP income support (IRCC, 2016a). The logic
behind this is the fact that acquisition of one of Canada’s official languages facilitates refugees’
entry into the labour market and longer-term integration into Canadian society. For this reason,
GARs tend to enroll in language classes within their first year in Canada before accessing
employment-related services and starting the job hunt (Neufeld, 2018). On the other hand, PSRs
who also need language training are usually encouraged to enter the labour market soon after
arriving in Canada. Neufeld (2018:17) ties this different approach to private sponsors’“understanding of the connection between employment, settlement, and language acquisition”.
Due to this approach, GARs report that they are not connected to employment-related
services nor are they matched to employment opportunities until later in their integration process(IRCC, 2016c). While GARs fundamentally know that non-existent or poor language skills
impede their ability to find a job (Neufeld, 2018), almost 85 per cent of them stated that language
classes actually prevented them from looking for a job (Public Policy Forum, 2020). This
challenge may be magnified by the inaccessibility of language classes due to various reasons. In
that case, GARs find themselves unproductively unoccupied as neither language classes nor
employment services are available to them. In addition to that, acquiring job-related vocabulary
is not guaranteed through the language classes given to GARs.
As part of the evaluation of the settlement program, IRCC (2016b) found that
employment-related services had a greater impact on the use and the improvement of GARs’
language skills than formal language classes.9 The evaluation also mentions that combining
language training and employment-related services had even greater positive outcomes on GARs
than language training alone. Programs that offer language in a work environment are believed tohave “better outcomes than general language courses in terms of participation and labor market
integration trajectories” (Vincenza Desiderio, 2016:26). Cronkrite et al. (2016:3) agree thatmaking language skills’ acquisition a prerequisite to securing employment is not the only option.
The authors mention that it is possible for “workplace language learning and language supports[to] [occur] at the worksite, using the worksite to promote active learning”.
An occupation-specific vocabulary is crucial when looking for a job in a particular field.
To ensure refugees gain this vocabulary during language classes, Rietig (2016) recommends
tailoring a part of language classes to a specific jargon. An example of this approach is theIntegration through Education and Work project by the Bavarian Labour Ministry in Germany. It
provides a space for asylum-seekers that already have university degrees or technical education
9 Employment-related services are part of the Settlement Program and include work placements; networking; employment-

specific language training; mentoring; employment counselling; and resume matching (IRCC, 2017).

28
certificates “to attend language courses linked to practical experience and focus on specialized
vocabulary” (Rietig, 2016:15). Ghadi et al. (2019) extol language classes that are embedded in
the workplace thus providing refugees with the necessary occupational-specific language skills.
Vincenza Desiderio (2016) cites the Swedish experience as an example for vocation-specificlanguage classes. Through the Swedish for Professionals program, refugees have access tolanguage classes tailored to specific professions ranging from highly-skilled occupations(economists, teachers and engineers) to skilled trades.
A recommendation made to the Government of Canada is to “support the development ofcollaborative options in which GARs can access programs to simultaneously improve theirlanguage skills while acquiring Canadian work experience and earning wages” (Public Policy
Forum, 2020:17). The Public Policy Forum offers multiple suggestions on how the government
can support this type of approach. First, it could collaborate with The Future Skills Centre to
implement programs that combine language learning and employment tailored to refugees’
needs. Second, the federal government could consider granting a tax credit similar to theApprenticeship Job Creation Tax Credit to the employers who offer GARs a flexible work
schedule that makes it possible for them to work and attend language classes at the same time.
This will ease GARs’ dual burden of developing language skills and becoming economicallyindependent. Third, the Government of Canada could expand the Federal Internship for
Newcomers Program. Currently, the program requires a post-secondary degree (someadministrative positions can be an exception) and is just open to refugees living in the following
areas and their surroundings (up to 100 kilometers): Ottawa/Gatineau, Fredericton, Halifax, St.
John’s, Toronto and Victoria (Wilkinson & Garcea, 2017). Through the expanded version of the
program, GARs, regardless of their province or city of residence, would be able to apply forentry-level positions that do not require a post-secondary education.

2. The lack of foreign credentials recognition
As shown in the Appendix to this report, a much smaller proportion of GARs have postsecondary qualifications in comparison to other refugees (PSRs and BVORs) and economic
immigrants. Nonetheless, the problem of GARs’ foreign credentials recognition still needs to beaddressed. As previously noted in the housing section, most refugees resettled in Canada comefrom non-Western countries. Therefore, the education they have received may be perceived as
not necessarily matching Western standards. Therefore, it risks not being formally recognized in
the Canadian context. Even though Canada has made important investments in foreign
credentials recognition through for example the Foreign Credential Recognition Program, morework needs to be done to make the process more accessible and affordable to refugees(Wilkinson & Garcea, 2017).

29
As noted in Neufeld (2018), refugees have the lowest levels of foreign credentials
recognition among all Canadian immigrants. A report by Statistics Canada sheds the light on theexisting disparities between refugees’ levels of credentials and work experience recognition
compared to those of other immigrant groups in Canada. In fact, after four years, “only 11% ofrefugees receive credential recognition and 14% receive work experience recognition, compared
to 38% and 51% for skilled workers, and 19% and 31% for family class migrants” (Neufeld,
2018:18). This low recognition rate of refugees’ foreign credentials and work experience may berelated to two factors. First, it may just reflect the much lower proportion of refugees that havecredentials and work experience compared to other immigrants. Second, it may arise from thelack of knowledge of the foreign credential and experience recognition process on the part ofrefugees.
To address this problem, Neupane (2012) states that the three levels of the Canadiangovernment, services providers and employers need to come together to deal with foreign
credentials recognition for GARs. In other words, the credential equivalency process requires
collaboration between all parties that are involved in refugees’ employment. Wilkinson andGarcea (2017) recommend the creation of a database that allows refugees to register theirdegrees, certificates and/or diplomas. Ideally, it would be accessible to settlement agencies andemployers to check refugee applicants’ educational records. Enhancing employers’ awarenessabout refugees’ experiences and skills gained overseas should accompany the foreign credential
recognition process (Correa‐Velez et al., 2015). Employers will recognize that refugees’ previous
work experience and education credentials obtained in their countries of origin can be as
valuable as their Canadian counterparts.
Neupane (2012) also draws attention to the high cost of assessment fees associated withforeign credentials recognition. Rietig (2016:20) affirms that “cost may be a barrier for lowincome applicants who do not depend on government transfers”. Wilkinson and Garcea (2017)
reported that would-be refugee nurses found the credentials recognition process long andexpensive which can cause frustration. For this reason, Neupane (2012) encourages theelimination of assessment fees wherever it is possible to do so.
Hooper et al. (2017:10) provided examples of how cities can work hand in hand withlocal educational institutions or employer associations to assess refugees’ qualifications. In
Finland, a collaboration between the city of Helsinki, Helsinki Metropolia University and Luona
Oy (which is the organization responsible for Finland’s reception centres) led to theimplementation of a programme that “recognises the credentials of asylum seekers andimmigrants in the field of technology, engineering and business”. To evaluate their skills, thisprogramme relies on case studies from the Helsinki Metropolia University’s courses and carries
out tests in Arabic, English and Finnish.

30
In Germany, undocumented refugees or refugees who do not have written proof of theireducational level can still be certified as fully qualified in certain professions. Thanks to theGerman Federal Institute for Vocational and Professional Education (BIBB) partnership with six
chambers of trade, industry and skilled crafts, refugees can be subjected to an innovative
qualification analysis. Refugees will be granted the opportunity to showcase their skills to apanel composed of experts from the chambers. Those experts will “evaluate the refugees’ skills(through interviews, work samples, or presentations) and decide whether to issue them anequivalency certificate” (Hooper et al., 2017:10). If refugees receive the certificate, that means
their skills are “comparable to those expected from a member of the [corresponding] chamber”(Rietig, 2016:19). In Germany, this process is only valid for non-regulated professions. For
refugees given a partial credentials’ recognition, the Integration through Qualification (IQ)
Network directs them towards adequate bridge courses and intensive programs to fill their skills
and experiences’ gaps (Rietig, 2016).
In Sweden, fast-track programs were designed for refugees to help them overcome theirknowledge gaps. Foreign-trained chefs, health-care professionals (nurses, pharmacists, dentists,
doctors, etc) and teachers were eligible to receive tailored bridging training (Vincenza Desiderio,2016).
3. GARs’ low level of social capital
Having a high level of social capital, defined as well-developed personal and professional
networks, is considered a driver of employment opportunities (Neufeld, 2018). According to the
Public Policy Forum (2020:18), “85 percent of jobs are filled through social networking” inNorth America, that is to say, employers tend to hire people they have already shared aconversation with or who were introduced to them through mutual connections. Unlike
Privately-Sponsored Refugees (PSRs) and Blended Visa Office-Referred (BVOR) refugees,
GARs have lower levels of social capital (Neufeld, 2018) and they even “may not know a single
person upon arrival” (Public Policy Forum, 2020:18). Some Syrian GARs in Lethbridge statedthat even after a number of years of residency, they still have limited connections with the local
community (Agrawal & Zeitouny, 2017). GARs’ lack of social networks in Canada may prevent
them from accessing jobs that are not advertised online.
For this reason, the Government of Canada is advised to prioritize building andenhancing GARs’ social capital as part of its settlement strategy (Public Policy Forum, 2020).
The emphasis needs to be put on developing bridging social capital, as opposed to bonding social
capital10 Drolet and Moorthi (2018) argued that bridging social capital, that is connections and
10

Social bridging happens when refugees make connections with individuals that are from different ethnicities andcultures whereas social bonding is when refugees that share the country of origin, the language and the religion stick
together (Public Policy Forum, 2020).

31
networks between refugees and others outside the refugee community, is a key factor forrefugees’ successful integration. Senthanar et al. (2020) call for more specialized employmentrelated services for GARs in lieu of the homogenized ones currently offered to refugees andimmigrants alike. The authors state that the services available do not take into account GARs’lack of social ties. Therefore, they might be inadequate and not respond to GARs’ employment
needs. The Public Policy Forum (2020) suggests strengthening partnerships between SPOs andlocal volunteer communities to provide initial social connections for GARs. The authors of thereport exhort the federal government to further support local and national organizations that help
refugees make meaningful connections in Canadian society. For instance, Tides Canada, throughits initiative Together Project, helps connect refugees and Canadians “to build social support
systems that result in stronger, more integrated communities” (Public Policy Forum, 2020:20).
4. RAP income support’s high claw back rate
Under the RAP, GARs can “earn up to 50% of their total monthly RAP income support
payment before any deduction is made to the monthly income support entitlement” (IRCC, n.d.).
Once their earnings exceed 50 per cent of the monthly RAP allowance, “all RAP funds over thatthreshold are reduced on a dollar-for-dollar basis for each dollar earned over the incentive
allowance amount” (IRCC, n.d.). In other words, as soon as GARs go beyond the set threshold,their additional earnings will be clawed back by 100 per cent. Exceptions can be made forchildcare or education expenses. This high claw back rate represents a disincentive to findemployment (Neufel, 2018). Employed GARs that still receive RAP income support findthemselves discouraged from seeking and accepting job positions that are better paid or require
more working hours. Some GARs believe their best option is to reduce their working hours(Public Policy Forum, 2020) or volunteer to gain some Canadian experience (Agrawal and
Zeitouny, 2017).
The Public Policy Forum (2020) report deems it important to reexamine the 100 per centclaw-back rate for GARs’ additional income above the 50 per cent of their RAP monthly income
support. They suggest a reduction from a 100 per cent claw-back rate to a 50 per cent one whensurpassing the 50 per cent threshold. If GARs’ additional income equals the total RAP income,that is 100 per cent, or goes beyond it, then the claw back rate can reach 75 per cent.
5. Discrimination against GARs in the labour market
Barriers to GARs’ employment that were previously listed can be amplified bydiscrimination they may face in the labour market because of their ethnicity, race, religion,
gender, disability and/or mental illness. By exploring the relationship between demographic
factors and refugees’ employment status, Khawaja et al. (2018) found that the more refugees are32“visibly” different than locals, the more difficult for them to be employed. Anti-refugee
sentiment is noticeably increasing worldwide and Canada is no exception.
According to the United Nations High Commissioner for Refugees (2018), 64 per cent ofresettled refugees in Canada in 2017 were from the Middle East. Since the majority of refugees
from that region are Muslims, Islamophobia may be a key form of discrimination. In fact, a 2018
survey found that slightly more than 80 per cent of Canadian citizens believe Islamophobia exists
in Canada. In addition to that, hate crimes against Muslims witnessed a 253 per cent increase
between 2014 and 2017 (Public Policy Forum, 2020). Nationals from Somalia and Eritrea, that is
the third and fourth most common countries of origin for GARs resettled in Canada (Open
Government, -c), may face anti-black racism during job interviews or at their workplace. This
also applies to any black refugee in Canada. Black women are less likely to be employedcompared to white women even when they are more educated and better qualified (Ontario AntiRacism Directorate). According to the report by the Public Policy Forum (2020:12), “employers
discriminate against equivalently educated and experienced job applicants who have names thatsound African, Asian or Muslim”. Additionally, Wilkinson and Garcea (2017) highlight that
employers tend to favour Canadian education or work experience over non-Canadian credentials.
To enhance GARs’ employability, the Government of Canada must effectively address
the issues of Islamophobia and anti-black racism. It needs to implement a national antidiscrimination strategy in the workplace. The Public Policy Forum’s (2020:28) argues that “antiIslamophobia and anti-black racism policy needs to be a key component of Canada’s 2019–2022
Anti-Racism Strategy to combat racism [and] discrimination”. The anti-racism strategy needs tobuild upon existing initiatives and events in Canada such as “World Refugee Day, the National
Day of Remembrance and Action on Islamophobia, Islamic History Month, and Black History
Month” (Public Policy Forum, 2020:28). Government of Canada’s funding for settlement
agencies’ programs for workplace sponsorship should require an anti-racism component and an
unconscious bias training to raise awareness aiming at improving GARs’ social and economic
integration.
Cronkrite et al. (2016:3) pointed out the need of an educational campaign to debunk the
belief that refugees represent a financial burden for the Canadian government. The authors statethis can be achieved by “countering messages shared through international media which canaffect the mindset of Canadians”. They also called upon the actors involved in refugees’(re)settlement to make Canadians understand that “refugees, in the long term, are low cost and infact a negative cost: refugees will pay more in taxes than they take out of services and will help
to build our economy”.
A report by the OECD (2019:92) advocates for the strengthening of economic acceptancetowards refugees. To do so, equal working conditions between national and refugee populations
need to be guaranteed by promoting fair recruitment practices that would protect refugees from33
discrimination and exploitation. Refugees may not be well-informed about their rights as
employees. Therefore, local authorities in collaboration with settlement agencies and employers’
associations are encouraged to “use websites, social media and other means of communication to
inform refugees and other vulnerable migrants about opportunities, rights and obligations related
to social and labour”.

VII. Conclusion
This report has surveyed a vast literature related to best and promising practices ingovernment-funded services supporting the resettlement and integration of government-assisted
refugees based on a knowledge scan provided by IRCC. The scan divided the literature into fivemain areas, namely refugee resettlement programs, settlement location, housing, mental healthservices, and employment services. The report has followed this structure in its synthesis of theliterature. The report identified key themes, insights, and trends under the general heading ofissues. A total of 24 specific issues have been identified in the five areas.
A key finding is that a number of the issues are cross-cutting and occur in more than one
subject area. These cross-cutting issues consequently are of high priority and merit attention.
Examples of cross-cutting issues are highlighted below:•

the need for better information sharing between all actors and organizations involved in
the settlement process both within organizations and across organizations domesticallyand internationally;•

the inadequacy of income support for GARs, with the impact more acute in housing but
also relevant in other areas such as transportation;•

the importance of pre-departure orientation services for refugees with information on
housing and other areas;•

the challenges of settlement for GARS in small cities where social isolation linked to lackof co-ethnic communities can impede integration;•

The importance of effective case management systems to support the need of refugees toaccess and navigate existing services in all areas including housing, health and income
assistance;•

the key role played by translation services for GARS in the early settlement period toadapt to a new setting; and•the effectiveness of mixing work and language training so GARS can develop language
skills and vocabulary relevant to their job.

34
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