Findings From An Extended Case Management U.S. Refugee Resettlement Program
Methods: Every three months in the process of service delivery, caseworkers conducted a language specific assessment with at least one adult member of the household. To measure wellbeing, caseworkers asked clients to choose a number to describe how well they felt their household was doing in each area (overall adjustment, health, employment, finances, education and language, housing, and family/community). As an indicator of integration, caseworkers also asked clients whether or not they needed assistance with a variety of services in 6 specific categories. Households were also asked to evaluate agency services. Additionally, employment outcomes were tracked over time. To consider possible factors associated with wellbeing, integration, employment, and perspectives on agency services over repeated assessments, generalized estimating equations (GEE) were used. Multivariate models included the following covariates: employment status, country of origin, household type, English ability, literacy, education, employment history, whether or not the family had a caseworker from the same country of origin, and time in transit (number of years between leaving the country of origin and resettlement to a third country).
Results: Substantial improvements in wellbeing and reductions in needs in relation to health, employment, finances, housing, education, and family/community circumstances were observed over the course of two years. Variations in wellbeing and integration over time were related primarily to English ability at arrival, household type, country of origin, and employment status. Education, employment experience prior to arrival, and literacy were also associated with some outcomes. Employment increased dramatically over time, with at least one person employed in over 75% of households that had reached 24 months of extended case management support.
Implications: Rapid and substantial improvements were observed over the two-year period among refugee groups with diverse backgrounds who participated in this extended case management program. As families and individuals adjusted to life in the U.S. and found jobs, they reported that their wellbeing improved while their needs for outside assistance decreased dramatically. Despite the challenges inherent to standardizing programs for such diverse clientele as resettled refugees and despite the difficulties of outcome measurement, this report shares a practical model of service provision that is focused on the foundational resettlement goal of employment, while incorporating supportive services to enhance wellbeing and integration experiences. Intensive and extended case management services are necessary to assure that newly arrived refugees gain sufficient access to health care, mental health care, affordable housing, English language training, child care, transportation, and other fundamental services.