Plenary _5 National Roll-Out of Life Skils Program

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					  RAP Conference Plenary #5: Group Processing and Client-Centered Approach
                          Friday, February 23, 2007

Panelists:     Heather McDonald – United Church of Canada
               Darcy Dietrich – Executive Director, Regina Open Door Society
               Joy Baldwin – Manager of Interim Federal Health Program, CIC NHQ
               Michael Casasola - UNHCR, Ottawa
               (Power Points available at

Micheal Casasola – UNHCR Ottawa
Role of UNHCR in Group Process
The presentation outlined the role of group processing and explained the process
undertaken to identify and refer groups for resettlement. The identification of potential
reception and integration challenges facing selected groups as well as future directions
for resettlement were also addressed.

 The number of refugees in the world has declined however people are remaining
   refugees much longer.
 Recognizing the increasing problem of protracted refugee situations, the Agenda for
   Protection (a set of goals set out by UNHCR and its international partners in
   response to current global refugee challenges) sets out as one of its goals
   redoubling the search for durable solution. To do this all durable solutions need to be
   strengthened. As for resettlement, the objectives are to diversify, increase the
   number of resettlement countries and try to use resettlement strategically so that
   more refugees can benefit from a durable solution.
 There are three durable solutions: voluntary repatriation, local integration and
   resettlement. Each year, resettlement amounts to a solution for less than 1% of the
   world’s refugees.
 The average of major refugee situations - protracted or not - has increased from nine
   years, in 1993 to 17 years at the end of 2003. The definition of a protracted refugee
   situation is – over 25,000 persons who have been displaced for over 5 years.
 In UNHCR’s 2007 Global Appeal, it notes it is reviewing 38 protracted situations
   worldwide. It is worth noting some of them such as the situation of Sudanese in
   Egypt, Afghans in Tajikistan, Bhutanese in Nepal, Myanmar refugees in Thailand,
   etc. are currently or will be populations from whom Canada selects refugees for
 The UNHCR has eight resettlement criteria. Seven of the criteria apply to refugees
   with acute protection problems or vulnerabilities. The most difficult to apply is the
   eighth criteria - refugees without local integration prospects because this applies to
   far more refugees than there are resettlement places.
 In addition, resettlement referral of individual cases is very resource intensive
   involving compiling information related to the refugee’s identity, family composition,
   reason(s) for flight and why no other solution is available.
 Group processing is a processing tool that provides a means to refer a group of
   refugees with a common protection and durable solution need at the same time.
 Group processing is a useful tool to address protracted refugee populations who
   have no other solution as it usually involves large numbers.

              National RAP Conference (Feb.19-23, 2007 – Vancouver B.C.)                    1
RAP Conference Plenary #5: Group Processing and Client-Centered Approach (cont’d)
                            Friday, February 23, 2007

 Settlement Issues
  Thus those resettled through group processing have been refugees for long periods
    of time. As a result, children may not know any other experience than life in a
    refugee camp. Some are from “closed camps”. Other consequences are nutritional
    and sanitations problems which can lead to health concerns.
  A resource is Chapter 1.3 of UNHCR’s Resettlement Reception and Integration
    Handbook, which provides a good general delineation of conditions for refugees in
    countries of origin and asylum and their possible emotional, personal and social
    consequences which may impact settlement. (Available at
  To make group processing effective the groups need to be large which may impact
    planning regarding destining.
  Groups often become “the face of resettlement” and receive extra public or media
    attention. This interest provides an opportunity for the public to understand not only
    why refugees need resettlement, but the needs of refugees overall.
  Observations from the field regarding protracted refugee populations and its impact:
            o Long-term factors weaken the ability of people to cope with emergencies.
            o They make people more susceptible to disasters and less able to cope
                with difficult situations.
            o To ensure that appropriate assistance and protection interventions are
                initiated, it is extremely important that special needs are identified early.

  Future Trends
  Resettlement will continue to be diverse.
  There will be increased resettlement from Asia. This will likely include continued large
    numbers of Myanmar refugees and possibly Bhutanese from Nepal.
  Given improvements in Afghanistan, Southern Sudan and West Africa will mean
    fewer refugees from these locations.
  Iraqi refugees will be a large movement for UNHCR as it plans to refer 20,000 Iraqis
    in the region to resettlement countries this year.
  UNHCR is working to improve global predictability and consistency in resettlement
  UNHCR will continue efforts to try to promote resettlement fraud awareness.

               National RAP Conference (Feb.19-23, 2007 – Vancouver B.C.)                   2
RAP Conference Plenary #5: Group Processing and Client-Centered Approach (cont’d)
                            Friday, February 23, 2007

 Darcy Dietrich – Executive Director, Regina Open Door Society
 A Collaborative Approach to Group Processing in Regina, Saskatchewan
 The presentation focused on Regina Open Door Society’s involvement and experiences
 as a Service Providing Organization-(SPO) in the group processing of the Karen refugee
 group while the organization itself was in a state of significant change. It illustrates a
 community response in successful group resettlement in the face of extreme challenges.
  For the past four years cooperative efforts of the Regina and Area Refugee Support
    Group, Regina CIC and the Regina Open Door Society to promote the plight and the
    contribution of refugees to our community has resulted in annual World Refugee Day
    celebrations, the release of a 2007 public education calendar “Dispelling the Myths”
    and increased numbers of Joint Assisted Sponsorships and volunteer participation.
    The community resettled 220 GARS, 30 over the target of 190. 133 were Karen
    refugees, 93 of whom were sponsored by 17 JAS groups.
  In 2006, Regina truly committed itself to sponsoring by welcoming the Karen
    refugees to our community. 96 of 133 individuals were sponsored by 17 JAS groups
  April 2006 – The number of GARs to Regina was reduced from 196 to 190, asked to
    wind down LINC Child minding and transportation services and a successful life skills
    pilot could not be continued past March 31, due to lack of funds
  To cope with the reductions and improve service delivery, RODS restructured its
    human resources in June of 2006. The Settlement and Integration Manager and RAP
    Coordinator positions were eliminated and the Manager of Family Services assumed
    responsibility for those areas.
  In the presence of these changes we were notified to prepare to resettle a large
    group of Karen refugee.
  Regina CIC, RARSG and RODS began preparing to resettle a large group of Karen refugees
  Our most experienced settlement workers were assigned to work with the Karens.

 Prior to Arrival
 • Locating and securing temporary and permanent accommodations
 • Locating supplier for household furnishing and other items
 • Getting orientation materials/packages translated into Karen languages and
    locating/hiring Karen interpreters.

 The resettlement of the Karens was and could not be done in isolation, but required
 collaboration between RODS S&F staff, Community Services staff, CIC, RARSG, JAS
 sponsors and community volunteers/agencies/employers, etc.

 Some of the Challenges
 • Affordable, appropriate housing for large families (need to be close to others, gender
   issues) and for those with medical and/or accessibility needs. Presently
   accommodation in the area is already stressed.
 • Additional funds were provided & staff were being interviewed, hired and trained
   during and following the Karen group arriving and as services were being delivered
 • Delay in travel for various medical and other reasons resulted in the majority of
   Karens arriving in November during Regina’s one week annual international Agribition
   Show affecting reservations and length of stay in temporary accommodations

               National RAP Conference (Feb.19-23, 2007 – Vancouver B.C.)                 3
RAP Conference Plenary #5: Group Processing and Client-Centered Approach (cont’d)
                            Friday, February 23, 2007

 • Within one month we saw growth within the Settlement programs from 3.5 FTEs (front
   time equivalents) to 8 including interpreter/support caseworkers, life skills trainers and
   admin support.
 • Continued to receive and settle non Karen arrivals with special needs at the same
   time. Most experienced caseworkers (3) were assigned to Karens while others were
   trained to meet the needs of current caseloads.
 • Protocols for after hours arrivals, emergency healthcare, lines of communication were

 • Continuous communication with CIC, JAS, community and volunteers regarding the
   needs of arrivals and excellent support from community, funders and volunteers
 • “Settling in Saskatoon” translated and provided in orientation packages
 • Bringing JAS groups (CR5s) first and then CR1s. Allowed staff to focus on CR1s
   while collaborating with JAS to ensure the needs of JAS and VORs were met
 • Thanks to the IOM - Needs assessment questionnaires offered guidance, understanding
   and appreciation for the Karen families by staff. Staff made adjustments to better meet
   the needs and prepare a more culturally welcoming experience.
 • Local businesses responding to our increased needs for furniture and supplies.
 • Regional authorities and services such as police, housing, disability organizations,
   and local charities became involved in assisting to provide for immediate needs from
   accommodations, wheel chairs, clothing and household items.
 • The Royal Bank assigned additional staff members to assist with cashing start up
   cheques and opening accounts
 • The most vulnerable families received additional support from KidsFirst home visits to
   over additional support not provided in the settlement program.

 The Past 8 Months at RODS
 • Increased from 35 to 51 staff members with support from CIC and the Provincial
   Immigration Branch
 • Opened, renovated and moved into a 3 location to accommodate growth.
   Board/Staff Facilities Committee continues to develop plans for facility enhancement.
 • Approved by province to open new licensed Child Care Centre. Recently completed
   major renovations.
 • In cooperation with CIC, expanded from 6 to 11 LINC classes to accommodate over
   150 learners.
 • Additional teaching staff, disabilities specialist, admin support…..
 • Newly funded Enhanced Host and Volunteer Training project and Health Services
 • Planning for commencement of new provincially funded programs and services as
   Saskatchewan expands nominee program. Working to attract & retain up to 5000
   immigrants annually by 2008.

               National RAP Conference (Feb.19-23, 2007 – Vancouver B.C.)                  4
RAP Conference Plenary #5: Group Processing and Client-Centered Approach (cont’d)
                            Friday, February 23, 2007

 Heather Macdonald – United Church of Canada (see speaking notes –

 Joy Baldwin – Manager of Interim Federal Health Program, CIC NHQ
               (see PowerPoint at
 Enhanced medical assessment approach to group processing for protracted
 groups of refugees coming from high risk environments

  Rationale for an enhanced immigration health management
  International trend: - Other major immigration receiving countries such as U.S. and
    Australia are enhancing their immigration medical screening for high-risk populations.
  Epidemiological evidence - Certain populations are at higher risk of developing
    conditions of public health concern such as is the case with large movements of
    people from high health risk environments entering Canada over a short period of
    time .Significant number of individuals to resettle in limited number of cities
  Expected Outcomes
  Better integration of high risk populations for mutual benefits of Canadians and immigrants
  To ensure optimal immigration medical screening of high risk populations
  For the protection of public health of Canadians
  For the benefits of individuals at high risk
  Interventions to happen
  Pre-departure
  Post-arrival
 Limitations and challenges
  Demographic constraints
  Time constraints
  Technical constraints
  Communication challenges.
 Medical processing of a high risk population: the Karen Refugees
 Pre-departure and post-arrival initiatives
  Enhanced TB management:
  Shorter validity date of the immigration medical examination (IME)
  All children ≤ 10 years referred to Public Health (PH) authority
  All cases of Pulmonary TB-inactive (PTI) referred to PH authority for an urgent
  Fitness to fly assessment within 72 hours pre-departure
  Strengthened communication with provincial health authorities and timely sharing of information
  Enhanced coordinator role for CIC
  Comprehensive medical examination covered by the Interim Federal Health (IFH) program

               National RAP Conference (Feb.19-23, 2007 – Vancouver B.C.)                5
 RAP Conference Plenary #5: Group Processing and Client-Centered Approach (cont’d)
                          Friday, February 23, 2007

Implementation and coordination
 Establish contact with high level Public Health officials in each province, with network
   of local CIC, Public Health and SPO reception centre personnel and maintain contact
   with IOM personnel conducting Fit to Fly assessments
 Prepare/distribute
 PHAC recommendations to public health and primary care physicians
 Interim Federal Health billing instructions
 Letters to clients
 Prepare sealed medical files on each client and with instructions to primary care
   physicians to be sent to local CIC offices and distributed to each client prior to their
   comprehensive medical examination
 Provide local Public Health with lists of children prior to their arrival
 Copy and send files and films on all PTI cases to local Public Health as soon as
   destination is confirmed
 Ensure post evaluation information is collected from local CIC, Public Health and
   primary care practitioners where possible
Enhanced immigration health management: success
 Timely support and advice by stakeholders (such as the Public Health Agency of
   Canada (PHAC) and the Canadian Tuberculosis Committee (CTC)
 Great opportunity to strengthen our network internally and with at all levels of
   government, and local NGO.
 Close collaboration amongst CIC Branches involved in the Karen refugee
   resettlement process
 Timely sharing of information, facilitating the health assessment by PH authorities
 More efficient interface with primary care for high risk population
Enhanced immigration health management of Karen Refugees: challenges
 The need to refine criteria defining non fitness to fly
 Process challenged by a recent outbreak of acute hemorrhagic conjunctivitis
 Operational challenges due to the fitness to fly assessment location
 Facilitation of the process if done within the refugee camp
 Late involvement/awareness of Medical Services Branch, CIC in the Karen Refugee
   resettlement process
 MSB to work in early and close collaboration with other CIC Branches for future
   refugee group processing

 RAP Conference Plenary #5: Group Processing and Client-Centered Approach (cont’d)
                          Friday, February 23, 2007

Communication challenges
 Wide audience: international, national, provincial, municipal and non-governmental
 Need to develop network of contacts at multiple levels
 Timely communications with all stakeholders

               National RAP Conference (Feb.19-23, 2007 – Vancouver B.C.)                 6
 RAP Conference Plenary #5: Group Processing and Client-Centered Approach (cont’d)
                          Friday, February 23, 2007

Key elements of success:
 Participation of provincial/municipal public health authorities
 Participation of involved health care providers
 Successful integration into the Canadian health care system and optimal health
   outcomes for clients

Next steps
 Analyse the impact/benefits of the enhanced immigration health management of high
   risk populations
 Review and refine the medical content of the protocol
 Pre-departure initiatives
 Post-arrival initiatives
 Develop criteria defining high risk populations
 Not limited to refugees

Questions (Q) Responses (R) & Comments (C)
Q. Regarding group processing – does UNHCR have a plan to move the camp in Thailand?

R. Can’t say because information is classified until an announcement. Discussion is still active.

Q. What role is played by UNHCR in repatriation? We see lots of progress but still a few
things happening – things which are difficult from refugees to correct once they are here
i.e. spelling of names and meaning of names. Its important that in each group one
person is be able to speak English but it’s a brain drain from the camps and have left
camps where there are no or little English resources.
Q. Can we treat active TB in the camps prior to departure – because it results in anti-
immigrant sentiment?

R. Usually do try to identify and treat TB prior to departure but there are always times when
cases come through – most people are not communicable. I understand the stigma attached
to refugees bringing in diseases that may affect the Canadian population.

R. We focus on voluntarily repatriation however our ability to do that is affected by
funding – for example southern Sudan – not nearly enough funding to make it possible
and meaningful – certainly that is our reason d’etre. With respect to the Karens,
voluntary repatriation is not a possibility in the near future.

R. Mistakes – What is documented at registration follows you through – unfortunately if
its wrong the first time then it continues to be wrong.

R. We realize resettlement draws on best and brightest – we have used an entirely
different process –and let people come forward who wanted to be resettled – this is a
challenge for resettlement overall there is a lot of discussion back and forth. In the end
people decide what is best for their families.

              National RAP Conference (Feb.19-23, 2007 – Vancouver B.C.)                     7
RAP Conference Plenary #5: Group Processing and Client-Centered Approach (cont’d)
                            Friday, February 23, 2007

  Ron Parent - Manager, Refugees Program Delivery; CIC NHQ
  Concluding Statements
  Thank you to panelists and special invited guests –
  Steering Committee and to staff at NHQ
  Organization has been great from Mark and his team.
  All of participants – degree of interest and participation.
  Our commitment is to have a conference once every 2 years not every 8 years.

              National RAP Conference (Feb.19-23, 2007 – Vancouver B.C.)          8