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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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). 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. 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. 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. 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.

Summary: 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. 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. 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.