Evaluation of Government Assisted Refugees (GAR) and Resettlement Assistance Program (RAP)

4. Alternative delivery models

This section addresses possible changes/enhancements to the current design and delivery associated with the GAR and RAP programs. It should be emphasized that the information presented in this section is based on insights provided by key informants and, to a limited extent, a review of available documentation and literature.

Summary of Findings – Alternative Delivery Models (GAR)

  • UNHCR/IOM feel that Canada’s model of GAR processing represents a “best practice” that should be emulated by other settlement countries.
  • There are areas in which Canada could adopt some “best practices” from other jurisdictions including:
    • Linking UNHCR database (PROGRESS) to internal systems (USA);
    • Use of electronic medical records to transmit GAR medical information (Australia);
    • Provision of medical information to GARs upon departure (USA); and
    • Faster processing of GARs (Sweden).

Overall, based on interviews with UNHCR/IOM officials during the international case studies, it appears that Canada’s approach to selecting and processing GARs is seen to be a “best practice” among UNHCR/IOM officials. This is a particularly key finding given that UNHCR and IOM work with a number of resettlement countries and Canada is commonly cited by UNHCR/IOM staff as a model that other settlement countries should consider when establishing a similar resettlement program. It was noted during the key informant interviews that when Japan and New Zealand approached the UNHCR to establish a resettlement program, the UNHCR suggested that these countries examine Canada’s model for the processing of GARs.

It was felt that the Canadian practice of having dedicated refugee processing staff permanently located in CVOAs was an effective mechanism to support the resettlement of refugees. Having local CIC staff – Canadian Based Officers (CBOs) – to process refugees was deemed to have several advantages including:

  • Enhanced awareness of local/regional issues and the ability to be aware of changes in refugee flows/refugee issues;
  • Ability to rapidly respond to UNHCR requests for urgent protection cases (Canada noted that it could respond in 48 to 72 hours for an urgent protection case); and
  • Improved access to refugees (for example, US refugee staff were delayed in completing refugee processing in Syria due to the need to obtain visas).

Canada’s utilization of group processing was also seen as a best practice, as UNHCR officials felt that this model of refugee processing allowed settlement countries to quickly and efficiently process large numbers of refugees who shared the same ethnic background.

Notwithstanding the high level of support for Canada’s model of selecting and processing GARs, there are some “best practices” from other jurisdictions that Canada could adopt with respect to the GAR program. Among these include:

  • Enhanced technological supports. Other countries (i.e., US, Australia) have implemented systems to enhance the exchange of information between the UNHCR, IOM and the settlement country. The US was noted in developing systems that could directly communicate with the UNHCR database (PROGRESS) and Australia utilized a system of Electronic Medical Records (EMRs) to exchange medical information. Furthermore, on-the-ground observations of the research team noted that CAIPS appeared to be a cumbersome tool for information management and several CVOAs had developed in-house systems to better track progress/status of GAR cases.
  • Provision of medical information to GARs. IOM reported that US bound refugees were provided with extensive medical information (including X-rays) upon departure. Given the increased proportion of GARs arriving in Canada with high medical needs, it would be appropriate to increase the amount of medical information that the GAR would be able to provide to physicians upon arrival in Canada. Adopting the US approach could enhance the medical information available to physicians in Canada.
  • Faster processing of GARs. Although UNHCR officials preferred Canada’s approach of having “on the ground” CIC staff (CBOs) to process refugees, they did note that the Canadian GAR selection/approval process was a lengthy process. While it was not possible to study the Swedish model in detail, it was noted that after the initial interview, selected refugees were processed usually within six months. In contrast, as shown previously, Canadian refugee processing times were on average much longer than six months. UNHCR staff reported that Sweden’s processing times were also faster for selected cases because they accepted a file submission or dossier approach to approve refugees (no in-person interviews required) who had limited or no admissibility risks.

Summary of findings – Resettlement Assistance (RAP)

  • Canada’s RAP program was consistent with UNHCR guidelines as to supports that should be provided to resettled refugees.
  • Notwithstanding compliance with UNHCR guidelines, stakeholders noted opportunities for program enhancement, among these include:
    • More flexibility in terms of program delivery or program funding;
    • Recognition of complex medical conditions, including mental health and development of programs/services to address these specific health needs;
    • Enhancing the seamless provision of services to GARs;
    • Addressing housing needs; and
    • Examining income support levels

Overall, key informants interviewed as part of the evaluation were not in a position to identify “best practices”, but did offer suggestions for improvements and/or lessons learned. In general, stakeholders noted that RAP provides the urgent and necessary supports to refugees upon arrival in Canada. It should be noted that the UNHCR notes the importance of providing specific assistance to refugees upon arrival.

“…if resettled refugees are to have the best prospects for realizing their potential, most will require some support in the period immediately following their arrival. This is important both to redress the personal, social and economic disadvantage they have faced and to deal with the intensive demands of adjusting to a new society…” (UNHCR, 2002)

Analysis of Canada’s RAP program suggests that the RAP (and settlement) programs align well with the supports that the UNHCR feels are required to best support refugees, including immediate accommodation, orientation to systems and resources, assessment and early settlement support, income support, language assistance and targeted language instruction (UNHCR, 2002).

Notwithstanding that Canada’s RAP program addressed the core program elements as identified by the UNHCR as well as stakeholders interviewed as part of the evaluation, it was identified through the domestic case studies and information obtained through key informant interviews that the RAP program should consider alternative delivery options. These options/suggestions are detailed below:

  • Flexibility of program delivery. SPOs are under the impression that they are required to provide the same level of service to all refugees. During the course of the evaluation, however, SPOs noted that refugee needs/requirements differed on the basis of their personal situation. In this context, SPOs were advocating for a RAP funding model that would allow service providers to tailor the level of support to better reflect the needs of the individual refugee.
  • Recognition of the complex medical conditions of GARs, including mental health issues. Refugees arriving in Canada may have a range of medical conditions. Given that refugees have had typically only limited access to health services in the host country, the UNHCR notes that it is important to quickly connect refugees to a range of health services, and to enhance communication across health care providers to accelerate the “catch-up care” typically required by refugees. Stakeholders also noted that it would be important for GARs to arrive with additional medical information if possible. This would require that processes be established to support the transmission of medical information from the host country (where feasible) to attending physicians in Canada. Some SPOs felt that this would require CIC to establish a consent process to facilitate the release of such information. Alternatively, a process may be established that follows the US model whereby refugees are provided with medical information upon departure.

    It should also be noted that GARs have a much higher likelihood of being exposed to trauma and torture, and such exposure can have manifestations with respect to mental health issues. For example, the UNHCR notes that in clinical studies, among refugees exposed to torture or trauma that (UNHCR, 2002):
    • The rates of post traumatic stress disorder range between 39% to 100% (compared to 1% in the general population); and
    • The rates of depression range between 47% and 72%.

    Enhancing access to health services for refugees has also been identified in several Canadian studies (Pottie et al., 2010) (Kirmayer et al., 2010). These studies identify common health issues among refugees and note the need to develop “pro-active” approaches to provide health services to this population. In the context of RAP, this could include better training for SPOs to allow them to identify and be aware of mental health issues, and may also require that SPO’s strengthen linkages with mental health community organizations.
  • Enhancing the seamless provision of services for refugees. In recognition of the challenges faced by refugees in Canada, and noting that refugees develop close links with service providers, key informants felt that it would be important, where feasible, to establish a “one stop shop” for GARs whereby they could access a broad range of health, social and housing related services in one location. Consistent with this message was the concept of providing dedicated case management services for GARs. In a recent evaluation of a case management pilot project in Ontario, Client Support Services, it was recommended that case management services be made a permanent part of RAP (Kappel Ramji Consulting Group, 2009).
  • Adoption of group processing models as appropriate. SPOs interviewed as part of the evaluation who had experience with refugees arriving under a group designation felt that group processing offered several advantages from a resettlement perspective over single processing. These advantages included:
    • GARs arrived with more comprehensive information;
    • SPOs received a completed needs assessment of GARs;
    • GARs were able to support each other during the transition; and
    • SPOs had more information about the conditions that GARs were coming from.

    If group processing continued, it was noted during the key informant interviews that RAP could potentially be strengthened by directly addressing known concerns of certain refugee population in advance of arrival, e.g., medical conditions, including mental health.
  • Housing Needs. Housing needs of GARs was noted to be a major challenge, and that GARs seeking affordable housing were often forced to move to outlying regions that were not close to other social/economic services available in the community. Inadequate GAR housing was seen to be a major issue among service providers.
  • Income Support. CIC currently aligns the income support provided to GARs to be consistent with provincial social assistance rates. However, it was noted that unlike Income Assistance clients, GARs may have additional requirements that are not necessarily reflected in the income support. For example, most GARs arrive with no possessions, and have to incur considerable expenses to acquire basic necessities. Furthermore, GARs do not have the social and community supports that individuals already residing in Canada will have acquired. In addition, it has been noted in numerous studies that social assistance rates have failed to keep pace with inflation or even cost of living (as measured by Low Income Cut-Off Ratio – LICO or Market Basket Measure (MBM)).

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