Refugee Resettlement: Greater Consultation with Community Stakeholders Could Strengthen Program
Published: 2012-07-25T00:00:00

Fast Facts:

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

section_title: Letter
paragraphs: Millions of people worldwide have fled their countries because they have  been persecuted—or fear being persecuted—on the basis of their race,  religion, nationality, political opinions, or because they belong to a  particular social group. The United States has traditionally provided  refuge to such people, and continues to resettle at least half of all  refugees referred for resettlement worldwide by the United Nations High  Commissioner for Refugees each year. In fiscal year 2011, the United  States resettled a little more than 56,000 refugees into communities  throughout the country.
Nine national voluntary agencies—the nongovernmental organizations  that carry out much of the refugee resettlement process with funding from  the Departments of State (State) and Health and Human Services  (HHS)—take the lead in determining where refugees will initially be  placed, with approval from State. The communities in which refugees are  placed vary significantly in size, capacity, and experience in resettling  refugees. Major gateway cities tend to have more experience  incorporating large and steady streams of people from other countries,  but can be very expensive places to live. Smaller cities and towns, on the  other hand, can be more affordable and easier to navigate, but may not  have sufficient resources to provide refugees adequate services,  including education and health care. While some refugees stay in the  community where they were initially resettled, others may decide to move  to another community that may or may not have organizations and  programs to help them become self-sufficient.
The most recent economic downturn has made it increasingly difficult for  refugees to become self-sufficient within months of arriving in the United  States, raising questions about refugee placement and integration, as  well as the oversight of refugee resettlement programs. In this context, we  were asked to examine (1) the factors resettlement agencies consider  when determining where refugees are initially placed; (2) the effects  refugees have on their communities; (3) how federal agencies ensure the  effectiveness and integrity of refugee resettlement programs; and (4)  what is known about refugees’ integration into the United States.
To address our research objectives, we reviewed relevant federal and  state laws, regulations, monitoring protocols, performance reports,  performance measures, and other relevant documents. We also  conducted a literature review of academic research on the integration of  refugees into the United States and reviewed other pertinent reports. We  met with federal agency officials, national voluntary agency staff, and  experts on refugee programs. In addition, we conducted site visits to eight  communities, where we met with representatives from state and local  government entities, voluntary agency affiliates, community-based  organizations, local businesses, and other relevant individuals and  groups, including refugees. For our site visits, we selected Boise, Idaho;  Chicago, Illinois; Detroit, Michigan; Fargo, North Dakota; Knoxville,  Tennessee; Lancaster, Pennsylvania; Owensboro, Kentucky; and Seattle,  Washington. These eight communities represent a nongeneralizable  sample that was selected to include geographically distributed  communities with variations in their population sizes, levels of experience  resettling refugees, and racial and ethnic diversity. In addition to these  factors, several communities were selected because they are considered  examples of best practices in refugee resettlement by federal officials. For  additional information on our scope and methodology, see appendix I.
We conducted this performance audit from May 2011 through July 2012  in accordance with generally accepted government auditing standards.  Those standards require that we plan and perform the audit to obtain  sufficient, appropriate evidence to provide a reasonable basis for our  findings and conclusions based on our audit objectives. We believe that  the evidence obtained provides a reasonable basis for our findings and  conclusions based on our audit objectives.
subsections: section_title: Background
paragraphs: A refugee is generally defined as a person who is outside his or her  country and who is unable or unwilling to return because of persecution or  a well-founded fear of persecution on account of race, religion, nationality,  membership in a particular social group, or political opinion. The  Refugee Act of 1980, which amended the Immigration and Nationality  Act, provided a systematic and permanent procedure for admitting  refugees to the United States and maintains comprehensive and uniform  provisions to resettle refugees as quickly as possible and to encourage  them to become self-sufficient. Several federal, state, and local  government agencies coordinate with private organizations to implement  the admission and resettlement process.
subsections: section_title: Refugee Placement in the United States
paragraphs: Each year the President, after appropriate consultation with the Congress  and certain Cabinet members, determines the maximum number of  refugees the United States may admit for resettlement in a given year.  The number actually resettled is typically below this maximum number  and has varied over time—sometimes due to security concerns (see fig.  1).
The federal government gives private, voluntary agencies responsibility to  determine where refugees will live in the United States, with approval  from the Department of State. Refugees are assigned first to a national  voluntary agency and then the voluntary agency decides where the  refugee will live. More specifically, the nine national voluntary agencies,  which maintain a network of about 350 affiliates in communities  throughout much of the United States, meet weekly to allocate individual  refugees based on an annual evaluation of the communities’ capacity to   See figure 2 for the number of refugees that arrived in  serve refugees.each state during fiscal year 2011. Appendix III provides additional detail  about the countries of origin for arrivals to the 20 states with the largest  refugee populations.
In the last 10 years, refugees have come to the United States from an  increasing number of countries, and the issues associated with these  diverse populations have become more complex. For example, many  refugees today arrive after having lived in refugee camps for years, and  may have little formal education or work experience, or untreated medical  or mental health conditions. In turn, receiving communities have needed  to adjust their language capabilities and services in order to respond to  the changing needs of these diverse refugee populations. Figure 3 shows  the top 20 countries of origin for refugees arriving in the United States in  fiscal year 2011.
Three federal agencies are involved in the refugee resettlement process.  The Department of Homeland Security (DHS) approves refugees for  admission to the United States. State’s Bureau of Population, Refugees,  and Migration (PRM) is responsible for processing refugees overseas.  Once refugees are processed and arrive in the United States, PRM  partially funds services to meet their immediate needs. PRM enters into  cooperative agreements with national voluntary agencies under its  Reception and Placement Program to provide funding that helps refugees  settle into their respective communities during their initial 30 to 90 days  and covers housing, food, clothing, and other necessities. Each local  affiliate receives $1,850 per refugee to provide these services. Figure 4  illustrates the general path of refugee resettlement in the United States.
Many refugees are then eligible to receive temporary resettlement  assistance from the Office of Refugee Resettlement (ORR), located within  HHS. In most states, ORR funds cash and medical assistance as well as  social services to help refugees become economically self-sufficient. ORR provides these funds through grants to state refugee coordinators,  who may be employed by a state agency or by a nonprofit organization  depending on how a state’s program is set up.grants provide funding for employment and other support services. States  also receive funding from ORR to award discretionary grants—including  school impact, services to older refugees, and targeted assistance  grants—to communities that are particularly affected by large numbers of  refugees or to serve specific refugee populations such as the elderly. See  table 1 for a list of selected refugee assistance programs.
section_title: Voluntary Agencies Consider Various Factors in Placing Refugees, but Few Consult with Local Service Providers
subsections: section_title: Voluntary Agencies Consider Various Factors When Making Refugee Placement Decisions
paragraphs: Voluntary agencies consider a variety of factors when they propose the  number of refugees to be resettled in each community (see table 2).  Before preparing their annual proposals for PRM’s Reception and  Placement Program for approval, national voluntary agencies ask local  voluntary agency affiliates to assess their own capacity and that of other  service providers in the wider community and propose the number of  refugees that they will be able to resettle that year. In making these  assessments, local voluntary agency affiliates typically consider both their  own internal capacity and the capacity of the community, with different   For example, when determining  levels of emphasis on one or the other.how many refugees their community can accommodate, local affiliates in  one community told us that they primarily consider their internal  capacity—such as staffing levels, staff skills, long-term funding needs, the  number of refugees they have served in the past, and success in meeting  refugee employment goals in the previous year. Local affiliates in another  community explained that they primarily consider community-based  factors, such as housing availability and employment opportunities. To  help make this process more consistent, Refugee Council USA, a  coalition of the nine national voluntary agencies, developed guidance and  a list of factors that local affiliates could use when evaluating community  capacity. However, national voluntary agencies do not require their local  affiliates to use the guidance. Moreover, national voluntary agencies may  adjust the numbers proposed by local affiliates.
Because refugees are generally placed in communities where national  voluntary agency affiliates have been successful in resettling refugees,  the same communities are often asked to absorb refugees year after  year. One state refugee coordinator noted that local affiliate funding is  based on the number of refugees they serve, so affiliates have an  incentive to maintain or increase the number of refugees they resettle  each year rather than allowing the number to decrease.
Even though they are required to coordinate and consult with state and  local governments about their resettlement activities, voluntary agencies  have received only limited guidance from PRM on how to obtain input  from these and other community stakeholders when assessing  communities’ capacity. The Immigration and Nationality Act, as amended,  states that it is the intent of Congress that local voluntary agency activities  should be conducted in close cooperation and advance consultation with   and the cooperative agreements that the  state and local governments,Department of State enters into with national voluntary agencies require  the agencies to conduct their reception and placement activities in this  manner. Driven by concerns that voluntary agencies were not consulting  sufficiently with state and local stakeholders when developing their  proposals, PRM directed local voluntary agencies to do more to  document consultations with state and local stakeholders regarding the  communities’ capacity to serve refugees. However, PRM’s guidance on  consultation with state and local governments does not provide detailed  information regarding the agency’s expectations for the content of these  discussions. While the guidance provides some examples of state and  local stakeholders that the voluntary agencies could potentially consult, it  does not state which stakeholders must be consulted. PRM officials said  that they allow local voluntary agencies to decide whom to consult  because the voluntary agencies know their communities best and  because local circumstances vary.
Most local voluntary agencies we visited have not taken steps to ensure  that other relevant service providers are afforded the opportunity to  provide input on the number and types of refugees that can be served. As  a result, many local service providers experienced challenges in properly  serving refugees. Most of the local voluntary agencies told us they  generally consult with private stakeholders such as apartment landlords  or potential employers prior to resettling refugees in an area. They also  stated that they consult with some public entities, such as state refugee  coordinators; however, most public entities such as public schools and  health departments generally said that voluntary agencies notified them of  the number of refugees expected to arrive in the coming year, but did not  consult them regarding the number of refugees they could serve before  proposals were submitted to PRM. Moreover, service providers in one  community noted that because the local voluntary agencies did not  consult them on the numbers and ethnicities of refugees they were  planning to resettle, there were no interpreters or residents that spoke the  language of some of the refugees who were resettled there, even though  the providers could have served refugees that spoke other languages.
Voluntary agencies may not consult with relevant stakeholders if they  perceive them to be unaware of the resettlement process or if they  believe that refugees do not use certain services. For example, local  voluntary agency staff in one community said they did not consult with  certain stakeholders because they believed that they were not well  informed about the resettlement process and might unnecessarily object  to the proposed number of refugees to be resettled. In fact, one local,  elected official we spoke to was unaware that refugees were living in the  community. Other elected officials noted that it was difficult to tell if or  when refugees accessed services, even though school and health  department officials in those same communities had frequent interactions  with refugees and wanted opportunities to provide input.
Although they bear much of the responsibility for providing services to  refugees, some of the health care providers and schools that had not  been consulted on, or even notified of, the number of refugees that were  to be resettled sometimes felt unprepared to do so. For example, health  care providers in two communities told us that they were not notified in  advance that refugees would be arriving in their communities, and thus,  had no time to set up screening procedures. They were also unaware of  the specific needs and health challenges of the communities they were  serving.
In addition, in some instances when voluntary agencies were unable to  adequately prepare the community as a whole for the new arrivals and  provide refugees with the services they needed, some community  members expressed opposition toward the refugees. For example, in Fort  Wayne, Indiana, a few case studies show that the community, which had  been receiving fewer than 500 refugees per year prior to 2007,  experienced a rapid increase that more than tripled the number of  refugees resettled in the community. The community, in turn, was forced  on short notice to obtain new sources of funding and establish a new  infrastructure in order to serve their new arrivals. This unplanned increase  in refugees, combined with a growing unemployment rate, engendered  frustrations that resulted in backlash from the community. Moreover, a  number of other factors, including the high frequency of communicable  diseases among certain populations, unmet needs for mental health  services, overcrowding in homes, and cultural practices caused existing  residents to become concerned or even hostile. Similarly, officials in  Clarkston, Georgia, another community that was not initially consulted  regarding the resettlement of thousands of refugees beginning in 1996,  described the flight of long-time residents from the town in response to  refugee resettlement and the perceived deterioration of the quality of  schools.
In a few of the communities we visited, after reaching a crisis point due to  the influx of refugees, stakeholders took the initiative to develop formal  processes for providing input to the local voluntary agencies on the  number of refugees they could serve. For example, an influx of refugees in Fargo, North Dakota, in the 1990s overwhelmed local service  providers. In response, those service providers and the local voluntary  agency formed a Refugee Advisory Committee to provide a formal,  community-based structure for finding solutions to challenges in resettling  refugees. The committee includes representatives from the local  voluntary agency, state and county social services departments, various  city departments, school districts, as well as local health care providers,  nonprofit organizations, and the assistant state refugee coordinator. The  local voluntary agency solicits input from the committee annually on the  number of refugees the community has the capacity to serve in the  coming year and also meets quarterly to address other issues such as the  needs of service providers. Committee members told us that the number  of new refugees arriving in Fargo declined after the committee was  developed. Committee members and voluntary agency officials said that  their close communication allows them to better educate the community  and better serve the refugees, and both believe the number being  resettled is manageable.
Similarly, in Boise, Idaho, city officials formed a roundtable group to  develop a Refugee Resource Strategic Community Plan in 2009 to work  with the local voluntary agencies, the state refugee coordinator’s office,  and community organizations to identify strategies for successful  resettlement of Boise’s refugees, in light of the most recent economic  downturn. The group includes representatives from the state coordinator’s  office, local voluntary agencies, various city departments, school district  representatives, nonprofit organizations, as well as employers, health  care providers, and other community stakeholders. The group meets  quarterly to review progress on the objectives outlined in the strategic  plan. The local voluntary agencies obtain input from the group members  on the community’s capacity for serving refugees, but they do not discuss  the specific number of refugees that will be proposed to the national  voluntary agency and PRM for resettlement. Roundtable members told us  that the local voluntary agencies have worked with their national offices to  reduce the proposed number of refugees to resettle in Boise in 2011  based on community capacity.
The state of Tennessee has passed legislation that creates formal  processes for communication between voluntary agencies and local  stakeholders. Specifically, the Refugee Absorptive Capacity Act,was passed in 2011, requires the state refugee program office to enter  into a letter of agreement with each voluntary agency in the state. The   which  letter of agreement must contain a requirement that local stakeholders  mutually consult and prepare a plan for the initial placement of refugees  in a community as well as a plan for ongoing consultation. In addition, the  state program office must ensure that local voluntary agencies consult  upon request with local governments regarding refugee placement in  advance of the refugees’ arrival.
section_title: Refugees Bring Benefits to Communities but Can Pose Challenges for Service Providers
subsections: section_title: Refugees Bring Diversity and Can Help Stimulate Development, but Can Stretch Resources and Affect Program Outcomes
paragraphs: Communities can benefit socially and economically from refugee  resettlement. In all of the communities we visited, stakeholders said that  refugees enriched their cultural diversity. For example, local service  providers in Fargo commented that refugees bring new perspectives and  customs to a city with predominately Norwegian ancestry. Some city  officials and business leaders we spoke with in several communities said  that refugees help stimulate economic development by filling critical labor  shortages as well as by starting small businesses and creating jobs. For  instance, new refugee-owned businesses revitalized a neighborhood in  Chicago after other businesses in the area closed. In addition, an official  in Washington State told us that diverse resettlement communities with  international populations attract investment from overseas businesses.  According to ORR officials, refugees also bring economic benefits to  communities by renting apartments, patronizing local businesses, and  paying taxes, and the presence of refugees may increase the amount of  federal funding that a community receives. In Boise, officials  commented that the refugee students helped stabilize the public school  population, which had been declining before the city established a  refugee resettlement program.
While refugees can benefit their communities, they can also stretch the  resources of local service providers, such as school districts and health  care systems. In several communities we visited, school district officials  said that it takes more resources to serve refugee students than  nonrefugee students, because they sometimes lack formal schooling or  have experienced trauma, which can require additional supports, such as  special training for school staff. In addition, newly arrived refugee  students often have limited English proficiency, and hiring interpreters can  be costly. Similarly, some health care providers expressed concerns  about serving refugees, because they said that they are required to  provide interpreter services to patients with limited English proficiency.  One provider told us that their clinic spent more than $100,000 on  interpreter services in the previous year, costs that were not  reimbursed. In addition, in some communities we visited, school district  officials and health care providers said that locating interpreters for  certain languages can be difficult. ORR and PRM officials noted that  these impacts are not unique to refugees and that serving immigrants  may pose similar challenges.
ORR offers discretionary grants to assist school districts that serve a  large number of refugees, but we learned that district officials may be  unaware of these grants or may decide that the effort involved in applying  for them outweighs the potential benefits. For example, through its school  impact grant, ORR funds activities for refugee students such as English  as a Second Language instruction and after-school tutorials. However,  school district officials in one community that was new to the refugee  resettlement program said they had no information about where they  could find assistance in serving refugee students. In another community,  district officials were aware of the school impact grant, but said they did  not apply for it because they found the application process to be  burdensome and the funding level would have been insufficient to meet  their needs.
In addition to stretching school district resources, refugee students can  also negatively affect district performance outcomes. School district  performance is measured primarily by students’ test scores, including the  scores of refugee students. School district officials in several communities  said that even though refugee students often have limited English  proficiency, they are evaluated against the same metrics as their native  English-speaking peers, which can result in lower performance outcomes  for the district. In one community, officials told us that the district had not  demonstrated adequate yearly progress under the state standards in  recent years, and they attributed this in part to the test scores of refugee  students.
Furthermore, refugees who exhaust federal refugee assistance benefits  and are not self-sufficient can strain local safety nets. Refugees who are  no longer eligible to receive cash and medical assistance from ORR after  8 months but are unemployed—or are working in low-wage jobs that do  not provide sufficient income—may seek help from local service providers  such as food pantries, organizations providing housing assistance, and  even homeless shelters. If service providers are unprepared to serve  these refugees in addition to their other clients, it can stretch their  budgets and diminish the safety net resources available to others in the  community.
Table 3 lists the benefits and challenges of refugee resettlement identified  by stakeholders in the communities we visited.
Migration from one community to another after initial resettlement— referred to as secondary migration—can unexpectedly increase the  refugee population in a community, and communities that attract large  numbers of secondary migrants may not have adequate, timely funding to  provide resettlement services to the migrants who need them.  According to ORR, refugees relocate for a variety of reasons: better  employment opportunities, the pull of an established ethnic community,  more welfare benefits, better training opportunities, reunification with  relatives, or a more congenial climate. Not all refugees who migrate  choose to access resettlement services in their new communities,  according to PRM officials. However, for those migrants who need  resettlement services, federal funding does not necessarily follow them to  their new communities, even though refugees continue to be eligible for  some resettlement services for 5 years after arrival. According to ORR  officials, refugees who relocate while they are receiving cash assistance,  medical assistance, or refugee social services are eligible to continue receiving those services in their new communities for a limited time.However, ORR does not coordinate this continuation of service, and state  refugee coordinators must communicate with one another to determine  eligibility for each refugee who relocates.
In addition, ORR provides grants to communities and states affected by  secondary migration, but the annual cycle of these grants may not  provide ORR the flexibility to respond in a timely manner. ORR uses  secondary migration data submitted by states once a year, among other  data, to inform refugee social services funding allocations for future fiscal  years.  According to ORR officials, these formula grants are awarded annually to states based on the number of refugee arrivals during the  previous 2 years. As a result, a year may pass before states experiencing  secondary migration receive increased funding. For example, Minnesota  reported to ORR that 1,999 refugees migrated into the state during fiscal  year 2010, but under ORR’s current formula funding process, the state  would not have received increased funding until fiscal year 2011. In  another example, social services funding did not keep pace with a large  number of arrivals of both newly resettled refugees and secondary  migrants in Detroit in fiscal year 2008. According to a report  commissioned by ORR, after this rapid influx of arrivals, caseloads rose  to 150 clients per caseworker in the employment and training program,  and caseworkers were forced to devote a majority of their time to  paperwork and case management, which limited their ability to provide  job development and training services. Further, ORR will not adjust a  state’s level of social services funding to account for secondary migration  until it verifies that the refugees migrated to the state. According to one  state refugee coordinator, ORR rejects the data states submit if the  refugee’s information does not match the information in ORR’s database  or if two or more states claim to have served the same refugee. ORR  officials said that, while their process allows states to update missing data  and correct formatting errors, it does not allow states to resubmit data that  does not match the information in ORR’s database or that was submitted  by two or more states.
ORR offers supplemental, short-term funding to help communities  affected by secondary migration. For example, the Supplemental  Services for Recently Arrived Refugees grant is designed to help  communities provide services to secondary migrants or newly arriving  refugees when the communities are not sufficiently prepared in terms of  linguistic or culturally appropriate services or do not have sufficient  service capacity. However, this grant is only available to communities that  will serve a minimum of 100 refugees annually, and the funding is for a  fixed period of time. Communities must apply and be approved for the grant, and funding may not arrive until many months after the influx  began. For example, in a draft report on secondary migration  commissioned by ORR, the Spring Institute for Intercultural Learning  found that one community did not receive supplemental funding until 14  months after secondary migrant refugees began arriving.
Without comprehensive secondary migration data, ORR cannot target  supplemental assistance to communities and refugees in a timely way.  Currently, the data that PRM and ORR collect on secondary migration are  limited and little is known about secondary migration patterns. PRM  collects data from local voluntary agencies regarding the number of  refugees who move away from a community within the first 90 days after  arrival, but does not collect data on the estimated number of refugees  who enter the community during the same time period. PRM officials said  that they use these out-migration data to assess the success of refugee  placement decisions. In contrast, ORR collects secondary migration data  annually from each state, but does not collect community-level data.  Specifically, ORR collects information on the number of refugees who  move into and out of each state every year. However, ORR officials  explained that they can only collect these data when secondary migrants  access services. As a result, refugees who move into or out of a state but  do not use refugee services in their new communities are not counted.  Even so, these refugees access other community services and their  communities may need additional assistance to meet their needs.
Secondary migration can strain local resources significantly. For example,  the draft report on secondary migration prepared for ORR by the Spring  Institute for Intercultural Learning found that refugees who migrate to new  communities can overwhelm local service providers, such as health  departments, that are unprepared to serve them. In addition, a report  prepared for ORR by General Dynamics Information Technology, Inc.  found that, in one community, the influx of a large number of secondary  migrants who lacked resources led to a homelessness crisis that stressed  the capacity of both the shelter system and the other agencies serving  refugees.
section_title: Capacity Challenges Can Lead Communities to Request Restrictions or Temporary Moratoriums on Refugee Resettlement
paragraphs: Some communities that face challenges in serving additional refugees  have requested restrictions or even temporary moratoriums on refugee  resettlement. According to PRM, the cities of Detroit and Fort Wayne,  Indiana, requested restrictions on refugee resettlement due to poor  economic conditions. In response, PRM limited resettlement in Detroit  and Fort Wayne to refugees who already have family there.the mayor of Manchester, New Hampshire, asked in 2011 that PRM  temporarily stop resettling refugees in the city because of a shortage of  jobs and sufficient affordable housing. While PRM did not grant the  requested moratorium, the agency reduced the number of refugees to be  resettled there in fiscal year 2011 from 300 to about 200. PRM officials  said that a moratorium on resettlement would not have made sense  because nearly all of the refugees slated to be resettled in Manchester  have family there and would likely relocate to Manchester eventually— even if they were initially settled in another location.
Tennessee recently created a process by which communities could  request a temporary moratorium on refugee resettlement for capacity  reasons. The state’s Refugee Absorptive Capacity Act allows local  governments to submit a request to the state refugee office for a 1-year  moratorium on resettling additional refugees if they document that they  lack the capacity to do so and if further resettlement would have an  adverse impact on residents. The state refugee office may then forward  this request to PRM. Passed in 2011, the law states that local governments should consider certain capacity factors—the capacity of  service providers to meet existing needs of current residents, the  availability of affordable housing, the capacity of the school district to  meet the needs of refugee students, and the ability of the local economy  to absorb new workers—before making such a request. According to  PRM, to date, no community in Tennessee has submitted such a request.
section_title: Agencies Monitor Resettlement and Measure Effectiveness, but These Measures Have Weaknesses
subsections: section_title: PRM and ORR Take Different Approaches to Program Oversight
paragraphs: PRM conducts regular on-site monitoring of national voluntary agencies  and about 350 local affiliates to ensure that the voluntary agencies deliver  the services outlined in their cooperative agreements. Under the  cooperative agreements, local voluntary agencies must provide certain  services to refugees in the first 30 to 90 days after they arrive. PRM  monitors national voluntary agencies annually and local affiliates once  every 5 years, and requires national voluntary agencies to monitor their  affiliates at least once every 3 years. During its local affiliate monitoring  visits, PRM reviews case files and interviews staff. PRM officials also visit  a small sample of refugees in their homes to ensure that the refugees  received clean, safe housing and appropriate furniture. PRM also requires  voluntary agencies to report certain outcome measures for each refugee  they resettle.
In recent years, PRM found most local affiliates generally compliant, and  for those that were not, PRM made recommendations and required  immediate corrective action. For fiscal years 2009 through 2011,  according to PRM, it conducted 136 on-site monitoring visits. In over  three-quarters of those visits, PRM determined that the local affiliate was  compliant or mostly compliant. In about one-quarter of the cases,  however, PRM determined that they were partially or mostly noncompliant  (about 20 percent) or simply noncompliant (about 5 percent). PRM or  national resettlement agencies can make return, on-site monitoring trips  to assess the progress of affiliates when problems are identified.  Furthermore, if the problems persist, national voluntary agencies can  close an affiliate’s operation or PRM can decide not to allow placement of  refugees at an affiliate. For fiscal year 2011, PRM determined that the  most common recommendation made to local affiliates was that the local  affiliate should document the reason core services could not be provided  in the required time frames. (See table 4 for the top 10 recommendations  made for fiscal year 2011.)
Whereas PRM’s oversight focuses on services provided, ORR’s oversight  focuses more on performance outcomes. In order to assess the  performance of its programs that provide cash, medical assistance, and  social services to refugees, ORR monitors employment outcomes and  cash assistance terminations (see table 5). It uses a similar set of  measures for its Matching Grant program.
According to ORR, its focus on employment outcomes as a measure of  effectiveness is based on the Immigration and Nationality Act, as  amended, which requires ORR to help refugees attain economic self- sufficiency as soon as possible. ORR considers refugees self-sufficient  if they earn enough income that enables the family to support itself  without cash assistance—even if they receive other types of noncash  public assistance, such as Supplemental Nutrition Assistance Program  benefits or Medicaid.
ORR conducts its on-site monitoring at the state level to ensure the  program is able to collect and report accurate data and to ensure that the  state is able to provide services to refugees. ORR’s on-site monitoring  identifies deficiencies as well as best practices. ORR generally monitors  state refugee coordinators onsite once every 3 years, as the state  coordinator is responsible for administering and overseeing ORR’s major  grants. During the on-site visit, ORR also monitors a sample of  subgrantees. In monitoring reports from its most recent on-site monitoring  in the states we visited, ORR identified a number of deficiencies  including:  failure to inform refugees that they were eligible for certain services  for up to 5 years,  failure to ensure that medical assistance was terminated at the end of  the 8-month eligibility period,  failure to ensure that translators were available when providing  services to refugees, and missing documentation in case files.
The monitoring reports contained ORR’s recommendations and noted  when corrective action was required. ORR’s monitoring reports also  identified program strengths and best practices that monitors observed  while on site. For example, one ORR monitoring report noted that having  a state refugee housing coordinator was a program strength, because this  coordinator can locate affordable housing and research funding sources,  which saves the caseworkers time and effort. In the same state, ORR  found that having an employment specialist at a voluntary agency who  can help refugees obtain job upgrades and pursue professional  certificates was also a program strength. According to ORR officials, they  supplement this on-site monitoring with desk monitoring, which may  include reviews of case files, or reviews of information provided in  periodic reports.
Neither ORR nor PRM has formal mechanisms for collecting and sharing  information gleaned during monitoring to improve services, such as  solutions to common problems or promising practices. ORR and PRM  officials identified some informal mechanisms for sharing such information  with service providers, but relied mostly on service providers to network  among themselves or share information during quarterly conference calls  and annual consultations. ORR also relies on external technical  assistance providers to disseminate best practices when training grantees  and expects state refugee coordinators to share findings of monitoring  reports with their local partners. However, monitoring reports are not  publicly available, and, unless the state coordinators share this  information, service providers may not be able to identify promising  practices, track monitoring results, identify trends, and address common  issues. As a result, service providers do not always get the information  they need to improve services, whether by preventing a problem or  implementing a best practice.
section_title: ORR’s Performance Measures Encourage Service Providers to Focus on Short-Term Outcomes
paragraphs: ORR’s performance measures focus on short-term outcomes, even  though refugees remain eligible for social services funded by ORR for up  to 5 years. Because it is important for refugees to become employed  before their cash assistance runs out—8 months or less, depending on  the service delivery model—ORR’s performance measures provide  incentives for service providers to focus on helping refugees gain and  maintain employment quickly. Specifically, ORR requires grantees to  measure entered employment at 6 months for the Matching Grant  program or 8 months for statewide cash assistance programs. In  addition, ORR requires grantees to measure job retention 90 days after  employment. This focus on short-term employment, however, can result  in a one-size-fits-all approach to employment services and may, in turn,  limit service providers’ flexibility to provide services that may benefit  refugees after the 6 to 8 month time frame. That is, with limited incentives  to focus on longer-term employment and wages, service providers may  not help refugees obtain longer-term services and training, such as on- the-job or vocational training, which could significantly boost their income  or benefit the refugee in the long-term or after employment is measured.For example, when assisting refugees who arrive with college degrees  and professional experience, service providers may not help them earn a  credential valid in the United States, because the providers’ effectiveness  is measured by whether the refugee is employed. Additionally, ORR does  not allow skills certification training to exceed 1 year and requires the  refugees to be employed when receiving training and services. Several  service providers mentioned this as a challenge for highly skilled Iraqi  refugees, in particular, some of whom include doctors and engineers.
In addition, voluntary agency officials noted that ORR’s employment  measures do not allow them to report on the longer-term or non- employment-related outcomes of the other refugee resettlement services  they provide. As a result, services such as skills training, English  language training, or mental health services—which provide longer-term  benefits and benefits unrelated to employment—may not be emphasized.  According to some local voluntary agency officials we spoke to, given the  current performance measures, there is a disincentive to dedicate  necessary time and resources to the nonemployment activities that create  pathways to success for refugees. It may be particularly difficult to serve  those who do not arrive in the United States ready to work due to trauma,  illness, or lack of basic skills.
While much of ORR’s grant funding focuses on short-term employment,  ORR does have some discretionary grants that provide funding for  particular purposes that may include services that focus on longer-term  goals or more intensive case management. For example, the individual  development account program provides matching funds to help refugees  save money for the purchase of a vehicle or a home. For these  relatively small competitively awarded discretionary grant programs, ORR  gathers data on how much money was saved and what assets were  purchased, but does not gather data on how these asset purchases  affected earnings or self-sufficiency. Descriptions of discretionary grants  that can be used to fund services beyond the initial resettlement period,  as well as other selected ORR and PRM grant programs, can be found in  appendix IV.
In addition to the employment measures’ focus on short term outcomes,  one state coordinator also noted that these employment measures leave  room for interpretation. Specifically, some voluntary agencies may have a  narrow definition of employment services while others may have a  broader definition. In turn, the percentage of refugees who become  employed after receiving employment services could vary based on what  types of services are considered employment services. As a result,  according to a state coordinator, measures may not provide consistent  information about how well a program is performing in different  communities.
section_title: Little Is Known about the Extent of Refugee Integration, but Studies Offer a Framework for Assessing Integration
subsections: section_title: Federal Agencies Promote but Do Not Currently Measure Refugee Integration
paragraphs: While federal refugee resettlement programs generally provide only short- term assistance, PRM and ORR both aim to prepare refugees for long- term integration into their communities. Although there is no single,  generally accepted definition of integration in the literature, integration  can be defined as a dynamic, multidirectional process in which  newcomers and the receiving communities intentionally work together,  based on a shared commitment to acceptance and justice, to create a  secure, welcoming, vibrant, and cohesive society. The federal  government’s efforts to facilitate integration begin before refugees even  enter the United States, as PRM offers cultural orientation for all refugees  and recently piloted English language training for refugees in certain  overseas locations. According to PRM, this cultural orientation and  language training is intended to lay the groundwork for refugees’ long- term integration into the United States. Integration is also a part of ORR’s  mission and overall goal, and officials told us that they consider  integration to be a central aspect of refugee resettlement. Although ORR  only provides refugees with cash and medical assistance for a maximum  of 8 months, officials noted that this initial assistance helps set the  foundation for long-term integration. Other ORR programs provide longer- term services that are intended to further facilitate integration, but these  services may not be as widely available as cash and medical assistance.  For example, ORR’s social services grant program funds employment  services and other support services to refugees for up to 5 years after  arrival, but communities may choose to provide these services for a  shorter period of time due to local resource constraints. ORR’s  discretionary grants for micro-enterprise assistance and individual  development accounts are also designed to facilitate integration by  helping refugees start businesses in the communities where they live,  among other goals. However, these discretionary grants are  competitively awarded and are thus not available to all communities.
ORR has studied approaches that facilitate refugee integration. In 2006,  ORR created an integration working group to identify indicators of refugee  integration and ways in which ORR could more fully support the  integration process. In a 2007 interim report, the working group made  both short-term and long-term recommendations to ORR, including that it  (1) consider expanding ORR’s discretionary grant programs; (2) focus on  integration in the areas of employment, English language acquisition,  health, housing, and civic engagement; and (3) identify lessons learned  from communities where refugee integration appears to be taking place.  ORR officials told us that they have implemented many, but not all, of the  working group’s recommendations due to funding constraints. For  example, ORR commissioned a study to identify promising practices that  appear to facilitate integration in four U.S. cities.
Neither PRM nor ORR currently measure refugee integration as a  program outcome. According to PRM, it does not measure refugee  integration due to the short-term nature of the Reception and Placement  Program. While refugee integration is part of ORR’s mission and overall  goal, ORR officials said they have not measured it because there is no  clear definition of integration, because it is unclear when integration  should be measured, and because the Refugee Act focuses on self- sufficiency outcomes related to employment. Even so, ORR officials told  us that they collect some data related to refugee integration. Specifically,  as part of its annual report to Congress, ORR conducts a survey to gauge  refugees’ economic self-sufficiency that includes integration-related  measures such as employment, English language proficiency,  participation in job training, attendance in a high school or university  degree or certificate program, and home ownership. However, ORR officials noted that the survey is not designed to measure integration and  should not be used for this purpose, especially since there is no clear  definition of integration. In addition, the survey has had a low response  rate, which may affect the quality of the data.
section_title: Studies Offer a Framework for Measuring and Facilitating Integration
paragraphs: Studies on refugee resettlement do not offer a broad assessment of how  well refugees have integrated into the United States. Of the 13 studies we  identified that addressed refugee integration, almost all were limited in  scope in that they focused on particular refugee groups in specific  geographic locations.of specific refugee groups, including factors that help refugees  successfully integrate into their communities. However, because of the  studies’ limited scope and differences in their methodologies, they provide  limited insight into how refugees overall have integrated in the United  States or how the experiences of different groups compare to one  another.
The studies describe the integration experiences  Although the studies we reviewed were not directly comparable, together  they identified a variety of indicators that can be used to assess progress  toward integration for both individuals and communities, as well as  common facilitators of integration. Indicators of integration include  employment, English language acquisition, housing, physical and mental  health, and social connections, as well as political involvement,  citizenship status, and participation in community organizations. One  study noted that when assessing integration, it is important to ask  refugees whether they consider themselves to be integrated.
The studies we reviewed also identified a range of barriers to integration.  Some frequently cited barriers were a lack of formal education, illiteracy  or limited English proficiency, and insufficient income from low-paying  jobs. For example, refugees who are illiterate or have limited English  proficiency may be limited to low-paying jobs such as hotel housekeepers  and may not earn sufficient income to meet their needs. Furthermore, one  study found that the timing of employment can be a barrier to integration.  Specifically, the study found that taking a job soon after arrival can slow  down the acquisition of English language skills because refugees may  have less available time to attend language classes.
In addition, the studies we reviewed identified facilitators of integration— circumstances and strategies that can help refugees integrate  successfully into their communities. English language acquisition is an  important facilitator of integration. For example, one study found that  refugees who are proficient in English are better able to connect with  nonrefugees in their communities, expanding their social connections and  sources of support. Other facilitators of integration included employment,  social support from other refugees, and affiliation with or sponsorship by a  religious congregation. For example, religious congregations may provide  refugees with language classes, social activities, emotional and financial  support, and linkages with employment and educational opportunities,  medical care, and transportation. See table 6 for additional examples of  indicators of integration, barriers to integration, and facilitators of  integration.
While most of the communities we visited had not established formal  goals or strategies to facilitate refugee integration, two of the eight  communities had developed formal plans to promote integration. The City  of Boise, for example, developed a plan to facilitate the successful  resettlement of refugees that includes goals related to integration.  Specifically, the plan aims to facilitate integration by (1) establishing  refugee community centers, (2) using a media campaign to increase  community awareness and support of refugees, and (3) creating a  mentoring program for refugee youth, among other things. Similarly, the  Village of Skokie, Illinois, a suburb of Chicago, created a strategic plan to  help facilitate the integration of immigrants, including refugees, by (1)  establishing a coordinating council of key service providers, (2)  developing a system to improve providers’ access to interpreters, and (3)  recruiting and training immigrant and refugee community leaders for  government commissions and school boards, among other strategies.
Additionally, in Lancaster, Pennsylvania, Franklin & Marshall College had  taken a variety of steps to help facilitate the integration of refugees,  including using student volunteers to teach refugees English, tutor  refugee students, and help refugee families enroll their children in school  and access public health services. In addition, at the time of our visit, the  college was partnering with a local voluntary agency affiliate to plan a  community conference on refugee integration with the goals of (1) better  understanding and addressing the needs of refugees, (2) identifying  strategies for fostering rapid integration, and (3) developing a broad  coalition of organizations serving refugees that could continue to work  together on these issues in the future.
section_title: Conclusions
paragraphs: Each year, as part of its humanitarian role in the international community,  the United States admits tens of thousands of refugees who add richness  and diversity to our society but can also have a significant impact on the  communities in which they live, particularly in cases where relevant state  and local stakeholders are not consulted before refugees are resettled.  Advance consultation is important because stakeholders need time to  plan so that they can properly serve refugees when they arrive, and  because their input on the number of refugees to be resettled can help  communities avoid reaching a crisis point. Information about communities  that have developed effective strategies for consultation would likely  benefit other communities facing similar obstacles. Without more specific  guidance and information on effective strategies for consultation,  communities may continue to struggle to meet refugees’ needs, which  may negatively affect both refugees and their communities and would  likely deter integration. Similarly, while ORR has recognized that some  service providers have particularly effective strategies for resettlement,  neither ORR nor PRM disseminate this information to other service  providers. As a result, not all communities are aware of ways they can do  their work more effectively.
Furthermore, while refugees can receive resettlement services for up to 5  years, some find it difficult to access those services when they relocate to  another community. In addition, states do not receive increased funding  for serving secondary migrants until the year after refugees relocate. As a  result, in communities that experience high levels of secondary migration,  voluntary agencies and service providers may not have the resources to  provide services to the migrants who need them. Without a funding  process that would respond more quickly to localities experiencing high  rates of secondary migration, voluntary agencies may have to prioritize  serving recently arrived refugees and communities may find their  resources for refugees stretched too thin.
As required by the Immigration and Nationality Act, as amended, ORR’s  programs are designed to help refugees become employed as quickly as  possible. ORR’s measures of effectiveness, which focus on whether  refugees gain employment in the short term, in turn, influence the types of  services that refugees receive. Specifically, service providers may choose  to provide services that encourage short-term independence from cash  assistance, but might not help refugees achieve long-term self- sufficiency. However, refugees may face unique challenges such as a  lack of formal education or work experience, language barriers, and  physical and mental health conditions that can make the transition to the  United States difficult. Without some incentives to focus on long-term self- sufficiency in addition to short-term independence from cash assistance,  refugees may be more likely to need government assistance again in the  future, and it may take longer for both refugees and their communities to  experience the benefits of integration.
section_title: Recommendations for Executive Action
paragraphs: We are making the following four recommendations based on our review:  To help ensure that state and local stakeholders have the opportunity to  provide input on the number of refugees resettled in their communities,  we recommend that  the Secretary of State provide additional guidance to resettlement  agencies and state coordinators on how to consult with local  stakeholders prior to making placement decisions, including with  whom to consult and what should be discussed during the  consultations; and  the Secretaries of State and of Health and Human Services collect  and disseminate best practices related to refugee placement  decisions, specifically on working with community stakeholders, as  well as other promising practices from communities.
To assist communities in providing services to secondary migrants, we  recommend that the Secretary of Health and Human Services consider  additional ways to increase the responsiveness of the grants designed for  this purpose. This could include asking states to report secondary  migration data more often than once a year, allowing resubmission of  secondary migration data from states that was rejected because it did not  match ORR’s database, creating a process for counting migrants who  received services in more than one state, and establishing an emergency  grant that could be used to more quickly identify and assist communities  that are struggling to serve high levels of secondary migrants.
To give service providers more flexibility to serve refugees with different  needs and to create incentives to focus on longer term goals, including  integration, independence from any government services, and career  advancement, we recommend that the Secretary of Health and Human  Services examine ORR’s performance measures in light of its goals and  determine whether changes are needed.
section_title: Agency Comments and Our Evaluation
paragraphs: We shared a draft of this report with HHS and State for review and  comment. In its written comments, reproduced in appendix VI, HHS  generally concurred with our recommendations. Specifically, HHS stated  that it supports our recommendation to disseminate best practices,  including promising practices from communities, while noting that State  and nonprofit community-based and faith-based organizations have  traditionally taken the lead on resettling refugees. HHS highlighted the  efforts it has made in conducting quarterly placement meetings, which  include resettlement agencies and refugee coordinators. While these  meetings may be helpful, we believe that HHS can also implement this  recommendation by disseminating best practices and program strengths  that it documents through its monitoring of states and service providers.
In addition, HHS concurred with our recommendation that it consider  additional ways to increase the responsiveness of grants that help  communities provide services to secondary migrants, but noted that it  already provides Supplemental Services grants, which provide short-term  assistance to areas that are impacted by increased numbers of new  arrivals or secondary migrants. In addition, it raised concerns that an  increase in the frequency of data collection would significantly increase  the reporting burden without a mandatory need for the data. HHS also  stated that it has a process in place for notifying states of technical  problems with population data submitted and allowing them to make  corrections. While we recognize that HHS has strategies in place to serve  secondary migrants, we continue to believe that (1) the Supplemental  Services grants can be improved to be more responsive; (2) more up-to- date population data can help HHS respond more quickly to communities  experiencing high levels of secondary migration; and (3) improvements  can be made to the process for correcting population data.
HHS also stated that it will consider modifying its performance measures  and will also continue to assess the usefulness of data elements collected  through required reporting to ensure that the program addresses both  self-sufficiency and integration. HHS noted, for example, that it has  already begun collecting more information about health through its annual  survey of refugees and expanded the number of reporting elements  pertaining to health in its program performance reporting form. In addition,  it is developing approaches to increase the overall participation rates in its  annual survey.
In its written comments, reproduced in appendix VII, State generally  concurred with our recommendations and outlined steps it will take to  address them. HHS and State also provided technical comments that  were incorporated, as appropriate.
As agreed with your offices, unless you publicly announce the contents of  this report earlier, we plan no further distribution until 30 days from the  report date. At that time, we will send copies to relevant congressional  committees, the Secretary of Health and Human Services, the Secretary  of State, and other interested parties. In addition, the report will be  available at no charge on the GAO Web site at http://www.gao.gov.
If you or your staff have any questions about this report, please contact  me at (202) 512-7215 or brownke@gao.gov. Contact points for our  Offices of Congressional Relations and Public Affairs may be found on  the last page of this report. Key contributors to this report are listed in  appendix VIII.
section_title: Appendix I: Objectives, Scope, and Methodology
paragraphs: To identify the factors resettlement agencies consider when deciding  where refugees are initially placed, we reviewed relevant federal and  state laws and regulations and other relevant documents, and conducted  interviews with federal agency officials and national voluntary agency  staff. We interviewed officials from the U.S. Department of State’s Bureau  of Population, Refugees, and Migration (PRM) and the Department of  Health and Human Services’ Office of Refugee Resettlement (ORR), as  well as representatives from several national voluntary resettlement  agencies. We also reviewed documents related to the refugee placement  process, such as relevant federal and state laws and regulations,  guidance for determining community capacity to resettle refugees, the  terms of the cooperative agreements between PRM and national  voluntary agencies, and funding opportunity announcements for PRM’s  Reception and Placement Program.
To understand the effects refugees have on their communities, we met  with experts on refugee programs and conducted site visits to eight  communities across the United States where we met with representatives  from state and local government entities, voluntary agency affiliates,  community-based organizations, local businesses, and other relevant  individuals and groups, including refugees, professors from local  universities, and a local church that provided assistance to refugees. For  our site visits, we selected Boise, Idaho; Chicago, Illinois; Detroit,  Michigan; Fargo, North Dakota; Knoxville, Tennessee; Lancaster,  Pennsylvania; Owensboro, Kentucky; and Seattle, Washington. These  eight communities represent a nongeneralizable sample that was  selected to include geographically distributed communities with variations  in their population sizes, levels of experience resettling refugees, and  racial and ethnic diversity. In addition to these factors, several  communities were selected because they are considered examples of  best practices in refugee resettlement by federal officials. All of the  selected communities were receiving refugees at the time we visited. We  developed site selection criteria based on available literature that  discussed factors that influence the impact of refugees on their respective  communities and factors that either facilitate or hinder refugee integration.
We used these criteria in combination with one another to arrive at a  diverse set of communities with varying characteristics.
To assess the effectiveness and integrity of refugee resettlement  programs, we interviewed federal agency officials, state coordinators, and  local voluntary agencies. We also reviewed federal agencies’ monitoring  plans, protocols and selected monitoring reports for the communities we  visited. We reviewed the terms of the cooperative agreements between  PRM and national voluntary agencies, as well as reporting guidance,  sample performance reports, and performance measures federal  agencies use to monitor their programs.
To determine what is known about refugees’ integration into the United  States, we conducted a literature review of academic research on this  topic. To identify relevant studies, we conducted searches of various  databases including Academic OneFile, EconLit, Education Resources  Information Center, National Technical Information Service, PAIS  International, PASCAL, ProQuest, PsycINFO, Social Sciences Abstracts,  Social Services Abstracts, Social SciSearch, Sociological Abstracts, and  WorldCat. We conducted a search using the following criteria, which  yielded 18 studies:
Studies must address the integration of refugees into U.S.
Studies must have been published from 1995 to the present;
Studies must be in English; and
Studies must be scholarly, such as peer-reviewed journal articles.
We performed these searches and identified studies between August  2011 and October 2011.
In addition, ORR officials provided us with an ORR-commissioned study  of promising practices that appear to facilitate refugee integration, and  this study met our selection criteria.
To assess the methodological quality of the 18 studies that met our  selection criteria, we evaluated each study’s research methodology,  including whether the study was original research, the reliability of the  data set, if applicable, and the study’s findings, assumptions, and  limitations. We determined that 13 of the 18 studies were sufficiently  reliable for our purposes. We then analyzed the findings of these 13  studies.
In addition to conducting a literature review, we met with officials from  ORR and PRM to determine what, if any, efforts the federal government  has to define, measure, or facilitate refugees’ integration into the United  States. We discussed refugee integration in our interviews with state and  local entities during our site visits. We also reviewed the ORR integration  working group’s 2007 interim report and ORR’s annual reports to  Congress.
We also obtained secondary migration data from ORR’s annual report.  We assessed the reliability of this data by interviewing ORR officials  knowledgeable about the data. We determined that the data were  sufficiently reliable for the purpose of background in this report.
We conducted this performance audit from May 2011 through July 2012  in accordance with generally accepted government auditing standards.  Those standards require that we plan and perform the audit to obtain  sufficient, appropriate evidence to provide a reasonable basis for our  findings and conclusions based on our audit objectives. We believe that  the evidence obtained provides a reasonable basis for our findings and  conclusions based on our audit objectives.
section_title: Appendix II: Studies Included in Literature Review
paragraphs: Abu-Ghazaleh, F. “Immigrant Integration in Rural Communities: The Case  of Morgan County.” National Civic Review, vol. 98, no. 1 (2009).
Birman, D., and N. Tran. “Psychological Distress and Adjustment of  Vietnamese Refugees in the United States: Association with Pre- and  Postmigration Factors.” American Journal of Orthopsychiatry, vol. 78, no.  1 (2008).
Duchon, D. A. “Home Is Where You Make It: Hmong Refugees in  Georgia.” Urban Anthropology, vol. 26, no. 1 (1997).
Franz, B. “Transplanted or Uprooted? Integration Efforts of Bosnian  Refugees Based Upon Gender, Class and Ethnic Differences in New  York City and Vienna.” The European Journal of Women’s Studies, vol.  10, no. 2 (2003).
Grigoleit, G. “Coming Home? The Integration of Hmong Refugees from  Wat Tham Krabok, Thailand, into American Society.” Hmong Studies  Journal, vol. 7 (2006).
Hume, S.E., and S.W. Hardwick. “African, Russian, and Ukrainian  Refugee Resettlement in Portland, Oregon.” The Geographical Review,  vol. 95, no. 2 (2005).
ISED Solutions. Exploring Refugee Integration: Experiences in Four  American Communities. A report prepared at the request of the  Department of Health and Human Services Office of Refugee  Resettlement. June 2010.
Ives, N. “More than a ‘Good Back’: Looking for Integration in Refugee  Resettlement.” Refuge, vol. 24, no. 2 (2007).
Kenny, P., and K. Lockwood-Kenny. “A Mixed Blessing: Karen  Resettlement to the United States.” Journal of Refugee Studies, vol. 24,  no. 2 (2011).
Patil, C.L., M. McGown, P.D. Nahayo, and C. Hadley. “Forced Migration:  Complexities in Food and Health for Refugees Resettled in the United  States.” NAPA Bulletin, vol. 34, issue 1 (2010).
Shandy, D., and K. Fennelly. “A Comparison of the Integration  Experiences of Two African Immigrant Populations in a Rural  Community.” Journal of Religion & Spirituality in Social Work, vol. 25, no.  1 (2006).
Smith, R.S. “The Case of a City Where 1 in 6 Residents is a Refugee:  Ecological Factors and Host Community Adaptation in Successful  Resettlement.” American Journal of Community Psychology, vol. 42, no.  3-4 (2008).
Westermeyer, J.J. “Refugee Resettlement to the United States:  Recommendations for a New Approach.” The Journal of Nervous and  Mental Disease, vol. 199, no. 8 (2011).
section_title: Appendix III: 20 States with Largest Numbers of Refugees Arriving in FY 2011 and Refugees’ Countries of Origin
section_title: Appendix IV: Selected PRM and ORR Grant Programs
subsections: section_title: Agency Grant PRM
paragraphs: Description  Provides financial support to partially cover resettlement  services based on a fixed per capita sum per refugee  resettled in the United States. Services include arranging  for refugees’ placement and providing refugees with  basic necessities and core services during their initial  resettlement period.
Reimburses states and alternative refugee assistance  programs for the cost of cash and medical assistance  provided to refugees during the first 8 months after their arrival in this country or grant of asylum. It does not  provide reimbursement for refugees deemed eligible for  Temporary Assistance for Needy Families, Supplemental  Security Insurance, and Medicaid.
Funds are provided on a matching basis to provide  private, nonprofit organizations to fund an alternative to  public cash assistance and to support case  management, employment services, maintenance  assistance, cash allowance, and social services for new  arrivals for 4 to 6 months.
Provides funding for employment and other social  services to refugees for 5 years after their data of arrival  or grant of asylum.
Provides funding for employment-related and other  social services for refugees in counties with large  refugee populations and high refugee concentrations.
Provides funds to provide medical screenings to newly  arriving refugees, interpreter services, information and  referral, and health education.
Funds to states to implement special employment  services not implemented with formula social services  grants.  Provides funding for employment-related and  other social services for refugees in counties with large  refugee populations and high refugee concentrations.
Provides funds to subcontract with local school systems  and nonprofits to support local school systems that are  impacted by significant numbers of newly arrived refugee  children.
Provide funds to ensure that older refugees will be linked  to mainstream aging services in their communities or to  provide services directly to older refugees if they are not  currently being provided for in the community.
section_title: Agency Grant
paragraphs: Description  The Preferred Communities Program supports the  resettlement of newly arriving refugees with the best  opportunities for their self-sufficiency and integration into  new communities, and supports refugees with special  needs that require more intensive case management,  culturally and linguistically appropriate linkages and  coordination with other service providers to improve their  access to services.
Provides funding for a comprehensive program of  support for survivors of torture, including rehabilitation,  social and legal services, and training for providers.
Funds projects to establish and manage Individual  Development Accounts, which are matched savings  accounts available for the purchase of specific assets.  Matching funds, together with the refugee’s own savings,  are available for purchasing one (or more) of four  savings goals: home purchase; microenterprise  capitalization; postsecondary education or training; and  purchase of an automobile if necessary for employment  or educational purposes.
Grants to enable organizations with expertise in a  particular area to provide assistance to ORR-funded  agencies.
Provides funding to assist refugees to become financially  independent by helping them develop capital resources  and business expertise to start, expand, or strengthen  their own businesses. Microenterprise projects typically  include components of training and technical assistance  in business skills and business management, credit  assistance, and credit in the form of micro loans.
Provides agricultural and food related resources and  technical information to refugee families that are  consistent with their agrarian backgrounds, and results in  rural and urban farming projects that supports increased  incomes, access to quality and familiar foods, better  physical and mental health, and integration into this  society.
Provides funds to provide services to newly arriving  refugees or sudden and unexpected large secondary  migration of refugees where communities are not  sufficiently prepared in terms of linguistic or culturally  appropriate services and/or do not have sufficient  service capacity.
Provides funds to support ethnic community based  organizations in providing refugee populations with  critical services to assist them in becoming integrated  members of American society.
For the purposes of this table, states refers to state agencies, state alternative programs, and state  replacement designees. State alternative programs include (1) the Wilson/Fish program, which gives  states flexibility in how they provide assistance to refugees, including whether to administer  assistance primarily through local voluntary agencies, and (2) the Public Private Partnership program,  which allows states to partner with local voluntary agencies to provide assistance. State replacement  designees are authorized by ORR to administer assistance to refugees when a state withdraws from  all or part of the refugee program.
For the purposes of this table, refugees refers to refugees, certain Amerasians from Viet Nam,  Cuban and Haitian entrants, asylees, victims of a severe form of trafficking, and Iraqi and Afghan  Special Immigrants.
section_title: Appendix V: Status of Integration Working Group’s Recommendations to ORR
paragraphs: In January 2007, ORR’s Integration Working Group made short-term and  long-term recommendations regarding ways in which ORR could more  fully support the integration process for refugees.
Include integration language in all grant announcements.
Review discretionary grant programs offered in the standing announcement,  ensuring that they promote integration.
Establish the Department of Health and Human Services as the lead federal  agency for integration.
Consider expanding ORR’s discretionary programs.
Focus on integration in the areas of employment, English language  acquisition, health, housing, and civic engagement.
Focus technical assistance providers to support integration as an intentional  process leading to civic engagement and citizenship.
Seek and fund pilot programs such as the Building the New American  Community project.
Develop an initiative to support professional recertification and credentialing  for qualified individuals.
Identify and share best practices through a survey of states, mutual aid  associations, and voluntary agencies.
Identify lessons learned, including case studies, from communities in which  integration appears to be working well and where there are challenges.
Study the effect of ORR policy and funding initiatives to promote integration  over a three to five year period.
Refine/develop/disseminate an action model to be used for other immigrants  and marginalized populations.
Seek broader collaboration with nonfederal entities such as private  foundations, businesses, financial institutions, and the United Way.
section_title: Appendix VI: Comments from the Department of Health and Human Services
section_title: Appendix VII: Comments from the Department of State
section_title: Appendix VIII: GAO Contacts and Staff Acknowledgments
subsections: section_title: GAO Contact
section_title: Staff Acknowledgments
paragraphs: In addition to the contact named above, Kathryn Larin, Assistant Director;  Cheri Harrington and Lara Laufer, Analysts-in-Charge; James Bennett;  David Chrisinger; Caitlin Croake; Bonnie Doty; Ashley McCall; Jean  McSween; James Rebbe; and Carla Rojas made key contributions to this  report. Sharon Hermes, Margaret Weber, and Amber Yancey Carroll  verified our findings.