Gate City Health and Wellness

Document Sample
Gate City Health and Wellness Powered By Docstoc
					  Gate City Health & Wellness
Immigrant Integration Initiative
      Integration Plan
                                  Funding for
                       The Gate City Health and Wellness
                            Immigrant Integration
                             Initiative is Provided

                        This is a program of the City of Nashua
                  Division of Public Health and Community Services

September 2009                                                       1
Gate City Health & Wellness Immigrant Integration Initiative
                               Prepared by
                               Foqia Ijaz,
                          Program Coordinator
           Southern New Hampshire Area Health Education Center
                           Bobbie D. Bagley,
                        Chief Public Health Nurse
                  Community Health Department Manager
                             City of Nashua

September 2009                                                   2
Gate City Health & Wellness Immigrant Integration Initiative
Table of Contents

List of Stake Holders…………………………………………………...3

Executive Summary…………………………………………………….5

Key Components of the Integration Plan…………………………….…7

Schools and Family Outreach Pathway…………………………….…..7

Language Access Pathway……………………………………………..11

Employment and Economic Mobility Pathway………………………..14

Physical and Mental Health and Wellbeing Pathway………………….17

Definition of Immigrant Integration……………………………………21


Appendix: References Cited……………………………………………22

September 2009                                                 3
Gate City Health & Wellness Immigrant Integration Initiative

We would like to deeply thank all of our partners for their hard work, commitment, and
willingness to participate during the first phase of the Gate City Health and Wellness
Immigrant Integration Initiative. We were able to facilitate the engagement of
stakeholders to work together with immigrants and refugees to develop a coordinated
system for integration. We find ourselves fortunate that we were able to build
relationships that inform and strengthen national to local strategies and leverage
knowledge and resources. Following is the list of our stakeholders and partners:

Adult learning Center
American Red Cross – NH
ASPIR International
City of Nashua, Office of the Mayor
Community Council of Nashua
Cross Cultural Communication System
Dartmouth Hitchcock
Department of Health and Human Services
Division of Health and Community Services, Nashua
Endowment for Health
Grace Fellowship Church
Greater Nashua Community Prevention Coalition
NH Catholic Charities
International Institute of NH
Lutheran Social Services
Nashua School District
Nashua Area Health Center
Nashua Community College
Nashua Pastoral Care
Nashua Police Department
Nashua Telegraph
Nashua Transit Authority
Neighborhood Housing Services
NH Humanities Council
NH Minority Health Coalition
Office of Energy and Planning
Office of Minority Health, DHHS
Parent Information and Resource Center
Rivier College
St. Joseph Hospital
Southern NH AHEC
Southern NH Services
Southern NH Medical Center
Spring Institute Colorado
United Methodist Church
United Way

September 2009                                                                           4
Gate City Health & Wellness Immigrant Integration Initiative
                                  Executive Summary

Immigrants and Refugees in Nashua a Historical Perspective: The City of Nashua,
known as the Gate City, has a long history of immigrant resettlement that dates back to
World War II. The largest number of immigrants was from Canada. French Canadians
made up 45% of the population in 1945. By 1950, the Nashua population included
French, Irish, Polish, Jewish, Greek, Armenian, Romanian, Hungarian, Bulgarian,
Albanian and Russian heritage1. Today, the majority of the residents of the city are
predominately white of European or Canadian descent (89.25%)2. However, there are
more than 27 different nationalities and origins of ancestry represented within the City’s
87,000 residents. Approximately 10.75% of the city’s population represents those of
African, Asian, Native American, Pacific Islander, Mixed races and Latino/Hispanic
ethnicity3. The Nashua public schools taught 922 English Language Learners in grades 1-
12 representing 7.4% of the student population at the start of the current school year4.
There are 47 different languages, other than English and American Sign Language,
reported as spoken by the student population enrolled in the Nashua School District,
representing 39 different countries.5

In 2005, there were two refugees resettled in Nashua followed by five, in 20066. During
2007, there were 58 refugees resettled in Nashua, representing more than a ten-fold
increase in the number of refugees resettled. A total of 34 were African Burundi, 22 were
African Somali, and two were from Iraq. One month after their resettlement, Nashua
experienced an out-migration of all of the Somali families. The Iraqi family moved to
Manchester, leaving twelve Burundi families - a total of 40 individuals in Nashua.

The Process

In the fall of 2007, the scope and seriousness of the need for a systematic integration
process was identified during Nashua’s experience with refugee new arrivals from
Burundi and Somalia. There was no system in place to coordinate continued language
access services, provide linkages for new arrivals to resources in the community, or to
provide the community with information on cultural and language needs. City officials
soon realized Nashua was not prepared to deal with the challenges of integrating new
arrivals into the community.

September 2009                                                                            5
Gate City Health & Wellness Immigrant Integration Initiative
The process of refugee integration begins with resettlement. The Refugee Act of 1980 has
a goal to “provide for the effective resettlement of refugees and to assist them to achieve
economic self-sufficiency as quickly as possible after arrival in the United States”.1 The
Act specifies that the Office of Refugee Resettlement within the US Department of
Health and Human Services would aim to accomplish this goal by providing funds for
training, establish partnerships with non-profit organizations and government at the state
and local levels, taking into account the availability of employment, affordable housing,
and public and private resources. Those would include educational, health care, and
mental health services in the area of placement. Agencies that serve to help refugees
when they first arrive in the country need to be prepared to help in the long-term
integration process. The integration process is a multi-dimensional, multi-generational
and multi-player process. Many stakeholders representing both public and private
institutions need to be involved.

The Gate City Health and Wellness Immigrant Integration Initiative (GCH&WII
Initiative) initiated a process to design an integration plan. The City of Nashua applied
for funding from the Endowment for Health to help coordinate efforts to reduce social
and cultural barriers to health, well-being and economic mobility of immigrants and
refugees. The City was awarded a two-year grant from the Endowment and sought
additional funding from the New Hampshire Charitable Foundation to support the


During phase I of this project, community members were mobilized at all levels to
participate in a fifteen-month planning effort to design an immigrant integration plan.
Stakeholders were identified from municipal, faith-based, social and health care agencies
and organizations, and within the immigrant and refugee populations living in Nashua
and other areas of NH. Immigrants and refugees from the community came to the table
with service providers to discuss language, culture and perceptions of immigration, needs
and expectations of a coordinated integration system.

Activities of the planning phase included attending monthly meetings, conducting
cultural competency trainings, piloting of a health orientation curriculum, hosting
community forums and informational education sessions and convening two Summits.

A consultant from the Spring Institute of Denver, CO facilitated the first Summit during
the fall of 2008. The purpose of the Summit was to lay a foundation for the development
of an integration plan using facilitated group discussions on primary target areas such as
health care access, education, housing, transportation, employment and linkages of
services. This Summit, attended by 51 participants who were service providers,
immigrants and refugees from New Hampshire, was a huge success. Outcomes from the
Summit included the identification and prioritization of fifteen key components to help
immigrants and the receiving community of Nashua achieve integration.

September 2009                                                                               6
Gate City Health & Wellness Immigrant Integration Initiative
To gather pertinent data from the immigrant and refugees who were not in attendance at
the Summit, four focus groups and a number of key informant interviews were held to
learn more about their expectations and experiences in their new communities. These
activities also allowed for the assessment of needs, identification of gaps and available
resources in the community. The participants were not only diverse in culture but also
across aspects of culture with respect to religion, education, length of time lived in New
Hampshire, employment and life experiences.

Workgroups were formulated to work on gathering specific information on the key
components identified as pathways to integration.

Key Components of the Integration Plan:

The key components identified as pathways during the Summit were:
    Schools/family outreach programs
    Language access and resources for interpretation/translation
    Communication between existing systems organizations working on and impacted
      by integration
    Mental and physical health and wellbeing/ Educating health care providers/other
      community groups
    English as a Second Language
    Housing
    Economic mobility/opportunity/job development/small business
    Inviting people in to design systems
    Employment, including cultural brokers
    Working through faith communities

After evaluating information received from the Summit findings, focus groups and key
informant interviews, these pathways were prioritized by the Planning Committee.
     Schools/Family Outreach Pathway
     Language Access Pathway
     Physical and Mental Health and Wellbeing Pathway
     Employment and Economic Mobility Pathway, and
     Faith Based Community Pathway

Schools/Family Outreach Pathway

Findings show many immigrants and refugee parents value education highly and believe
a good education is the key to success for their children. Parental involvement in schools
is an important aspect of education today, but many cultures see the teachers as an
authority figure and think that educating their child is the teacher’s responsibility. 7

Children, parents, as well as the teachers face a language barrier. It is tough for the
parents to get involved with schools or communicate their concerns to the teachers when
they don’t know the language. Teachers lack skills to assist refugee and immigrant
September 2009                                                                               7
Gate City Health & Wellness Immigrant Integration Initiative
populations and an understanding of what it means to be a refugee or an immigrant. This
makes it critical to recruit bilingual teachers and aids and provide ongoing teacher
education around cultural competency. Schools need to provide interpreters, especially at
parent teacher conferences, instead of asking a bilingual child to interpret. 7

Schools need to develop strategies on how to best help new families understand and feel
connected to the school. More established families can serve as cultural brokers in
schools for newer families to help them navigate the educational system and provide
emotional support. They also need to identify cultural community leaders and create
partnerships with them. 7

Information gathered from participants in attendance at the Nashua Summit held in the
fall of 2008 and from focus groups and key informant interviews conducted with
immigrants and new refugees in the community show similar findings. Based on this
information the Gate City Initiative identified challenges and opportunities to create goals
and activities to address the school and family outreach pathway.

Challenges related to the pathway include:
    Lack of financial resources
    Overpopulation of schools
    Schools spread thin with time and resources
    Shifting balance of power between parents and children
    Getting parents to come to school and seeing it as a resource
    Language barrier
    Schools don’t know who the cultural leaders are
    Scope of the teacher: focus is children, when need to teach children and families
    Do refugees qualify for Head Start?
    Parents not knowing what to do with school and where to put child in class/class
       placement issues
    Teachers lack skills to assist refugee population and an understanding of what it
       means to be a refugee

Opportunities identified were:
    Accessing Head Start and Visiting Nurses Association with parental resources
    Educating teachers about refugee students and what it means to be a refugee
    Connect to community resources
    Work with schools to connect with resources such as 211
    Adaptability of children
    Linkage to family
    Educate parents about school resources by members of their community
    Create partnerships with schools and cultural community leaders
    Resources like GED
    Educate teachers via school and teaching curriculum

Goals, activities and potential partners for the pathway:

September 2009                                                                            8
Gate City Health & Wellness Immigrant Integration Initiative
Goal                           Activity                        Potential partners
Vision of school as a base     Using school nurses,            School nurses, guidance
for resources                  teachers and guidance           counselors, Health
                               counselors to build trust and   department
                               partnerships to establish       Library, boy and girl scouts,
                               linkages to families            Visiting Nurses Association
Welcoming climate at           Educate school personnel        Trainers, cultural leaders,
school                         through mandatory               superintendent
                               professional development
                               on Cultural Competency
Grassroots community           School member goes to           Churches, community
communication                  church, community center        center
                               to disseminate information
                               about resources

The Schools/Family Outreach Sub-committee was formed to “examine interactions
between Nashua schools and immigrant and refugee families, and to work with families,
and School District personnel and staff to improve the welcoming climate in the schools
for all families regardless of background.”

    The climate at Nashua Schools sometimes feels unwelcoming for many parents
      including parents of refugee and immigrant backgrounds.
    New refugees and immigrants don’t have enough information on resources to
      explore how degrees can convert to credit toward a degree in the U.S.

Integration Activities for the Schools and Family Outreach Sub-committee

Activities agreed upon by the Schools and Family Outreach Sub-committee to deliver
over the course of the planning and implementation phases are:
  I. Gather and prepare a group of immigrant and refugee parents to speak to school
      officials and the Superintendent at the Follow the Child Committee.
             A group of 4-7 immigrants from diverse cultures and a local native of
                 Nashua will attend the meeting.
             The Director of the Nashua ESOL program will serve as the moderator to
                 help parent presenters expand on or reduce their comments.
                 a. The outcome of the activity will be to invite parents to the Follow the
                     Child Committee meetings regularly to hear about their issues and
                 b. Training and accountability for reception staff and teachers to make
                     parents feel welcome.
                 c. The anticipated output of the meeting is that the parents will feel that
                     their concerns are heard and understood, their confidence level will go
                     up and they will feel comfortable advocating for their child.

September 2009                                                                             9
Gate City Health & Wellness Immigrant Integration Initiative
The purpose of the parents meeting with the Follow the Child Committee is to have them
communicate their concerns and share their experiences (some have experienced a
welcoming environment and others have had an unwelcoming families experience).

  II. Follow up with Follow the Child Committee on what actions will be taken to
     address parents’ issues.
      The anticipated outcome will be that the Follow the Child Committee will
        recommend Cultural Competency trainings for the front office staff and teachers.
                a. Once the recommendation is made the project coordinator and a
                    representative from NH Minority Health coalition will design and
                    deliver two Cultural Competency trainings for the front staff and the
                b. The anticipated outcome of the trainings is that the front staff and
                    teachers will have skills to assist immigrant and refugee population
                    and will have a better understanding of what it means to be an
                    immigrant or a refugee.
III. Disseminate information among the immigrant and refugees communities that they
can have their degrees from foreign countries evaluated and converted into U.S.
equivalent through different private credentialing bureaus.
                a. The anticipated outcome would be increased awareness among the
                immigrants and refugees that services are available to convert foreign
                degrees into U.S. equivalent.
IV. Work collaboratively with International Institute and Lutheran Social Services.
                a. The anticipated outcome would be that when the new influx of
                refugees arrives they are welcomed and acquainted with the system right


      NH Minority Health Coalition design and deliver two Cultural Competency
       trainings in collaboration with Gate City Health and Wellness Immigrant
       Integration Initiative for the school district staff. The trainings cannot be made
       obligatory for the staff whose participation is needed the most i.e. the security,
       receptionists, academy secretaries, guidance secretaries. The sub-committee
       suggests that if the recommendation for attending the trainings comes from a
       higher rank e.g. the superintendent, the outcome would be better in terms of front
       staff attendance.
      Future endeavors of the school district, in which parents are invited, be introduced
       differently i.e. Meet n’ Greet has a different connotation attached to it than a
       Registration Night, etc.


      Gaining consensus to change the system, this can be achieved by the decision
       makers’ increased awareness of the issues. They need to be informed to take
       action so staff may be obliged to change behavior and be held accountable.

September 2009                                                                          10
Gate City Health & Wellness Immigrant Integration Initiative
      The resettlement agencies have confidentiality laws they must follow that at times
       only allow for assistance to refugees through and with their assistance. This adds
       another step to helping this population.

September 2009                                                                        11
Gate City Health & Wellness Immigrant Integration Initiative

      The sub-committee has a set plan of action with the Follow the Child committee
       to bring about much needed change that we are hopeful about.
      Overall Work Plan in place to guide the sub-committee to work with immigrant
       and refugee community as well as to bring about the needed change in the
      People are consistently coming together on the sub-committee to address issues
       Nashua’s immigrants and refugees are experiencing related to education.
      Some immigrants and refugees have been empowered previously in getting their
       academic credits transferred to the U.S. With our plan to share this information,
       more will have economic mobility and access to a better quality of life.

Tools and resources needed:

      Memorandum of Agreement in place with the NHMHC to provide cultural
       competency trainings at the School
      offer continuing education credits for staff
      The school district seeks for additional funding from other sources for continued
       cultural competency trainings.

The School/Family Outreach Sub-committee includes members from Adult Learning
Center, Nashua School District English S Other Languages Program (ESOL), Program
Coordinator of the GCH&WII Initiative, NH Minority Health Coalition, Southern NH
Services Head Start, Parent Information Center, and Nashua Health Department.

Language Access Pathway: Many immigrants and refugees know that learning English
is a key component of immigrant integration. They understand that in order to fully
access community services and fully participate in community life in United States they
have to learn English, but this process can be quite difficult. Most children learn English
quickly in schools and gain language skills faster than their parents. Adults have a more
difficult time learning English. One main reason is that they are often working long hours
which leave little energy and time to learn a language. 7

Immigrants and refugees faced language barriers when they go to public library, saw a
doctor, at their child’s school, and when lost and seeking help. 8 Language barriers stop
immigrants and refugees from making vital connections in the community. They believe
that they cannot get better jobs until they learn the language.

English for Speakers of Other Languages (ESOL) classes’ maybe the most valuable
service to the immigrant and refugee community, 7 Accessing ESOL programs can be
difficult, however. Only a few places offer English classes and mostly they are not
compatible. Lack of funding is another obstacle. There is a need to encourage business
community and employers to support language development and provide incentives such
as earning and practicing English at certain times during work.

September 2009                                                                          12
Gate City Health & Wellness Immigrant Integration Initiative
Information gathered from participants in attendance at the Nashua Summit held in the
fall of 2008 and from focus groups and key informant interviews conducted with
immigrants and new refugees in the community show similar findings. Based on this
information the Gate City Initiative identified challenges and opportunities to create goals
and activities to address the Language Access pathway.

Challenges related to this pathway include:
    In classrooms, teachers are reluctant to have ESL students – disruptive and affect
       test scores
    Immigrants who come from an oral culture are illiterate
    Police responding to emergency calls, like domestic violence, frequently use
       children to interpret
    Gateways??? – need for translated documents
    City Hall – not every department has interpreters

Opportunities identified were:
    ALC Classes with childcare in the evening
    ESL classes for elders who are intimidated by young learners
    Domestic violence outreach through churches
    Community police
    Youth stories/mentoring

Important goals, activities and potential partners for this pathway
Goal                            Activity                        Potential partners
Mentoring for youth             Program to match new            Youth council, Boys and
                                immigrant children with         Girls Club
                                experienced children/young
Interpretation for police       Access to language line and Existing interpreter services
interventions, eg., domestic interpreter services
ESL classes for elders          Neighborhood/home classes ALC
                                And Elder-only classes
Community Watch program Recruit bilingual residents             ALC, churches
– incorporate bilingual
residents/community police

The Language Access Sub-committee was formed with the goal to “work with
community agencies, organizations, and businesses to assure that their services are
accessible to all residents regardless of what language they speak.”

Findings of the Language Access Sub-committee demonstrate the following:
    Access to language interpretation services is missing or limited at local agencies
       and businesses that provide essential services

September 2009                                                                           13
Gate City Health & Wellness Immigrant Integration Initiative
         Low English proficiency speakers do not attempt to access and utilize services
          based on the unavailability of interpreters. Most will try to find someone who
          speaks English in order to access and utilize the services.

 Integration Activities of the Language Access Sub-committee

I. Developed a protocol with the Nashua Police Department to have access to language
    interpretation for non English speakers.
              a. Explored options to have a phone with speaker options. The target date for
                  the enactment of the protocol was 9/1/09
              b. Create access to “I Speak” cards with them.
  The sub-committee also explored what other Police Departments were doing for language
  interpretation. They found out that Manchester Police Department uses the Language line
  for interpretation if they need to communicate with non - English speakers.
   Information gathered from focus groups and key informant interviews revealed some
  immigrants are afraid of police in general because of their experiences in their home

  II. Assist the Police Department in developing relationships with immigrant and
      refugee community members to increase awareness of the NPD role of safety and
      protection to community members working through agencies that provide services
      to the population such as the Nashua Soup Kitchen and the Adult Learning Center.

  III. Exploration of difficulties in learning the English language as expressed by students
       in ESOL classes at Adult Learning Center. With a focus on clarify what the issues
       are and how to address them. An ESOL classroom is similar to the immersion
       method that one experiences when they live in another country, rather than a typical
       language class that an English-speaking person would take in this country. There
       are many languages represented in each classroom; the teacher does not need to
       speak each language.

 IV. Make available to the community a list of volunteers that are available to assist non-
     English speakers:

              a. Compile the list to distribute. That list will be distributed only when the
                 volunteers give written permission to distribute it.

  V.      Improve access to language interpretation at Nashua City Hall and other
         community services:
                  Assess current language availability
                  Identify areas of possible improvement
                  Initiate improvements with agencies

     Contracting with a telephonic interpretation service
     Distributing "I Speak" cards to reception/front office staff

 September 2009                                                                                14
 Gate City Health & Wellness Immigrant Integration Initiative
       Posting accessibility notices of language interpretation services around the
        reception areas at City Hall and other social service agencies.
The Language Access Committee decided to add as a goal, to look into funding sources
for the volunteers in the community to have Medical Interpretation trainings to support
fee for interpretation services.

   Raising community awareness about the need for language access
   Working with agencies to develop systems that provide language access
   Cost of interpreter services, both telephonic and in-person
   Locating and recruiting volunteer interpreters and securing funding resources for
      volunteers to become trained interpreters.

    Telephonic language access for Nashua Police Dept patrol officers on all shifts
    Compilation of a list of current volunteer interpreters
    Clarification of what the Adult Learning Center is able to provide for ESOL

The Language Access Sub-committee includes members from Greater Nashua Healthy
Communities Collaborative, Nashua Police Department, Cross-Cultural Communication
System, Gate City Health and Wellness Immigrant Integration Initiative, Nashua Area
Health Center, Greater Nashua Community Prevention Coalition, a citizen from minority
community, and Nashua Soup Kitchen.

Employment and Economic Mobility Pathway:
While newcomers genuinely appreciate the employment opportunities available to them
in the United States, some feel that they often have to work harder than other Americans
to be treated equally, or to be recognized for their skills and knowledge. Many
immigrants with trainings in specific fields are unable to use these skills after coming
here because credentialing requirements are quite different. Many also want to gain
Knowledge needed to start their own businesses. Assistance in thee areas is perceived as
an important part of integration into the financial reality of life in the United States. 7

Information gathered from focus groups and key informant interviews conducted with
immigrants and new refugees in the community show similar findings. Based on this
information the Gate City Initiative identified challenges and opportunities to create goals
and activities to address the Employment and Economic Mobility pathway.

Challenges related to this pathway include:
    Immigrants and refugees lack sufficient language skills and American education.
    Not enough time to attend ESL classes after one or two jobs.
    Employers lack cultural sensitivity and don’t understand the worth of diverse
    Lack of guidance for immigrants and refugees who want to start their own small

September 2009                                                                            15
Gate City Health & Wellness Immigrant Integration Initiative
Opportunities identified were:
     Collect data on the employers of refugees and immigrants in Nashua area and find
       out who are the biggest employers of refugees and immigrants.
     Reach out to the business community to seek representation from them by
       contacting the Rotary and the Chamber of Commerce.
     Committee members attend job fairs and try to do outreach to both the employers
       and the immigrant and refugee community.
     Help the immigrants and refugees with:
            readiness for interviews
            resume preparation
            talk to employment security
            micro business opportunities like home based child care
            language barriers and not knowing how to navigate the system
     Employment security can be contacted to find out how they can help with the
     There is an Organization called SCORE-Service Core of Retired Executives that
       help people who want to open small businesses.
Important goals, activities and potential partners for this pathway are:
Goal                            Activity                        Potential partners
Understanding of economic Focus groups pertaining to            Adult Learning Center,
and employment issues           economic and employment Area Health Center
faced by immigrant and          needs.
refugee community.              Adult Learning Center
Understanding of overall        student demographic
Nashua population data          information.
Understanding economic          Identify top Nashua area         Nashua Chamber of
and labor market                employers hiring from            Commerce
information for Nashua.         refugee and immigrant            Rotary Club of Nashua
                                labor pool.                      Nashua Employment
Provide technical support        Workshop for refugees and City home based child care
and “tools” for running          immigrants by city child        licensing coordinator.
home day care centers for        care licensing coordinator
Low English Proficiency
individuals (LEP).

The Employment and Economic Mobility Sub-committee was formed the with goal, “ To
help inform community businesses, service agencies, and area industries about language
and cultural strengths as well as the barriers to employment opportunities for Nashua
area immigrant and refugee populations so these businesses, agencies, and individuals
may better reach out to Nashua’s immigrant and refugee populations for jobs and

September 2009                                                                      16
Gate City Health & Wellness Immigrant Integration Initiative
    Many refugees and immigrants experience difficulties finding jobs related to their
      fields and up to their level.
    Lack of affordable and LEP friendly day care centers prevent women from
    Lack of ESL classes that are after hours and are on job-sites.

Integration Activities of the Employment and Economic Mobility Sub-committee:

         I. Study the information obtained from focus groups and key informant
            interviews pertaining to economic and employment needs of immigrants and
            refugees. This would give a better understanding of economic and
            employment issues faced by immigrant and refugee community and the sub-
            committee will be able to assess possible solutions for assistance.
        II. Collect demographic data on economic and labor market information for
            Nashua. Data collected from the Adult Learning Center on who are the
            student populations enrolled and Area Health Center on who are the biggest
            employers in Nashua area.
       III. Create an employer presentation aimed at:
            Raising awareness around barriers to employment and
            Showcasing value-added skills and language capacity pertaining to
              immigrant and refugees in the workforce.
            The sub-committee can make a presentation by using the content of the focus
            groups and then present it to Nashua Rotary Club, Chamber of Commerce,
            the office of Employment Security, and big employers like BAE.

       IV. Gather job growth projections information for Nashua. Need is seen to
           compile information about what agencies are working to build skills, what
           jobs are needed, and how to get this information to immigrant and refugee
        V. Compile a list or database of refugees and immigrants so that information
           can be disseminated in a timely manner. E.g. information on a job fair. At
           the same time confidentiality also has to be kept in mind.
       VI. In-home child care/ small business development awareness opportunities for
           immigrant and refugee population. Arrange a workshop for refugees and
           immigrants who are interested in opening up home-based day care centers.
           Sub-committee will work in collaboration with the Child Care licensing
           coordinator at the city to give information and guidelines on home-based
           child care centers at the workshop.
      VII. Research job growth areas.

    Employers need to invest in job-site ESL classes to improve access for LEP
    Early intervention with immigrant and refugee youth focused on career planning

September 2009                                                                       17
Gate City Health & Wellness Immigrant Integration Initiative
     Create an assessment and resource matrix to identify major skills of immigrants
      and refugees and how to direct them to career pathways
    Help build stronger relationships between employers and immigrant and refugees
    Create a brochure for employers giving information about the resettlement path of
      a refugee.
    Getting input and representation from Nashua Employment Security due to their
      increased workload because of the economic downturn and job losses.
    Reaching out to the business community to let them know about the barriers that
      immigrants and refugees face in finding employment and also the strengths and
      skills they bring with them.
    Choosing a lead person from the sub-committee who is based in Nashua.
    Researched current and identified potential employment sources.
    Identified top Nashua area employers hiring from refugee and immigrant labor pool.

The Employment and Economic Mobility Sub-committee includes members from
GCH&WII Initiative, NH Minority Health Coalition, ASPIR, Office of Minority Health,
Department of Health and Human Services, and American Red Cross.

Physical and Mental Health and Wellbeing Pathway: Immigrants and refugees often
come across many hurdles in trying to obtain health care that is both complicated and
expensive. When the refugees arrive they get Medicaid for eight months. At that time
they have case management too, but it dissipates after some time. It is at this time that
they stop seeking medical help. Many immigrants lack health insurance and do not get
preventative care.

Many work for employers who do not offer health insurance, or cannot afford it even if
the employer offers it. Also preventative care is an unfamiliar concept for most
immigrants and refugees. They go to the emergency room instead if they get sick.
Language barrier is another major problem when they do seek medical help and it also
prevents them from learning about available health programs in their communities.
Experiences with discrimination also affect the willingness of immigrants and refugees to
see providers. 7

Other barriers-such as transportation problems, stigma around discussing certain things
like birth control, understanding medical instructions, including medications and refills
and, resistance to taking medicine. Many prefer traditional remedies from their own
culture rather than go to the doctor. 7

At the same time, health care institutions are struggling with the issues of language
interpretation, translation of materials, and culturally competent care. Language
interpretation is at times provided haphazardly. Sometimes janitorial staff is called upon
or a child of a patient to provide this critical service. Language lines are often used, but
are often less affective and very expensive. 7

September 2009                                                                              18
Gate City Health & Wellness Immigrant Integration Initiative
Challenges related to this pathway include:
    Getting patients to their appointments – transportation
    Case management that gradually dissipates
    Cultural differences regarding access to health care – especially for women (birth
       control, taboo to touch or talk to a man)
    Cost of translations and interpreters to make follow up calls
    Communication at health center
    Medicaid ends after eight months
    Hidden mental health issues and cultural stigma (trauma, alcohol abuse, etc)
    Understanding medical instructions, including medications and refills and
       resistance to taking medicine. Preferring traditional remedies from own culture
    Paperwork and $15 co-pays are a barrier
    Lack of interpreters at mental health center

Opportunities identified were:
    Faith-based group meetings
    Publishing and printing transportation schedules and translating them in other
    Multi-lingual volunteers are an untapped potential of skills and experience
    Capitalizing on immigrants real skills to enhance job possibilities, i.e., foreign-
      trained health workers
    Cultural competence training for health care workers
    Cultural assessment tools

Important goals, activities and potential partners for health and mental health were
brainstormed to be:
Goal                            Activity                        Potential partners
Improve ability and             Educate regarding               Faith-based organizations,
knowledge of public             transportation availability;    volunteers, Gate City
transportation and              Translate bus schedule;         Initiative project
coordinate volunteer            Signs on busses;                coordinator
resources for transportation Volunteer drivers
to medical appointments
Overcoming cultural             Interpreters serve as cultural Cultural broker
barriers and misconceptions interpreters, not just
                                Coffee house with health        Churches, parish nurse
                                information and to connect      program
                                with people who have been
                                here longer;
                                Systematic assessment of
                                Nashua health care provider
                                cultural effectiveness using

September 2009                                                                             19
Gate City Health & Wellness Immigrant Integration Initiative
Address stigma and hidden                                         Cultural broker, parish
mental health issues                                              nurses, primary care
                                                                  providers, schools

The Physical and Mental Health and Wellbeing Sub-committee was formed the with
goal,“ Help families develop an effective support network, increase their sense of competence,
acquire new skills for managing their health needs, and have access to the supportive resources
they need.”

Integration Activities of the Physical and Mental Health and Wellbeing
      I. Identify representatives from different key health organizations to be the
         members of round table committee.
     II. Reach out to health professionals from a wide variety of fields to become Ad
         hoc members of the sub-committee and attend the wraparound meetings on as
         needed basis.
    III. Find grants for professionals and community leaders to come to the table and be
         paid small stipends.
    IV. Create a more seamless system of care with a perspective of client centered
         services that provides individualized, comprehensive, community-based
         services and supports to immigrant and refugee families.

       Lack of funding
       Getting professionals to take time out of their busy schedules and attend
          wraparound meetings
       Don’t have all the players at the table
       Professionals and community members don’t realize the value of case
       Sign releases to share information with different agencies at the table.
       Why do this for immigrants and refugees when the mainstream population
          doesn’t even have enough?

Strengths of a Case Management Model:
        Better communication
        Professionals share better networking
        Use of less resources
        Patient and community centered
        More focused on the goal to deliver services that are needed
        Already have a pool of professionals in case management with experience and
        Already have a system of care with a perspective of client centered services.

The Physical and Mental Health and Wellbeing Sub-committee include members from
Nashua Area Health Center, Dartmouth Hitchcock Medical Center, Cross Cultural
Communication Systems Inc., Bridges, and Nashua Health Department.

September 2009                                                                                   20
Gate City Health & Wellness Immigrant Integration Initiative
Interagency Communication:
Although the resettling agency provides interpretation services through case managers
during visits to the health department, community health center and schools, there is no
system in place to coordinate continued language access services, provide linkages for
new arrivals to resources in the community, or to provide the community with
information on cultural and language needs. Given the large number of resources,
newcomers are challenged to understand which agency is doing what? Paper work to
apply for different services is lengthy and complicated. It is very expensive for providers
to translate materials in different languages. There is a need for a system in place that
would help new arrivals learn about their resources in the community and one that would
better help the service provider identify needs

Housing: Finding appropriate housing can be very challenging. Cost is the biggest
barrier, since immigrant and refugee families say they usually obtain only low-paying
jobs in the beginning. Public housing assistance is available but many families do not
qualify for public housing assistance, with incomes limits slightly higher than the income
limits because both parents work at least one job. 8 If they do qualify, they are put on
waiting lists up to one year long.

There is need to educate immigrant and refugee families about being a first-time renter in
the United States and about available housing services. It is also important to educate
landlords about incoming immigrants and their different ways of life.

Inviting People to Design the System: Emphasis needs to be placed on building
partnerships and relationships between different service providers and immigrant and
refugee community. Service providers are responsible for meeting the needs of
immigrants and refugees so that equal access and opportunities are available. However,
they need help with outreach and cultural competency as they increase their efforts to
work with the immigrant population. 7 Facilitated discussions or forums can help identify
issues and solutions in a supportive manner that brings people together. 7 There is also a
need to develop interagency communication.

Reaching Out to Cultural Brokers:
It is important to identify potential leadership in the immigrant communities, as well as to
mobilize them to influence policy making and help bring about movements. Immigrant or
refugee families who are settled here can serve as cultural brokers and play a significant
role in educating newer immigrants about their responsibilities, customs, values and laws
in their new community. 7 There is very little representation by immigrants and refugees
at meetings and on committees within organizations. If cultural brokers are encouraged to
participate in provider meetings they can help understand cultural issues and help them
build trust in the immigrant community. On the other hand, they can also help understand
the challenges immigrants are facing in reaching those services.

September 2009                                                                           21
Gate City Health & Wellness Immigrant Integration Initiative
Definition of Immigrant Integration by Gate City Health & Wellness Immigrant
Integration Initiative:

After numerous discussions and the information obtained from the summit, the focus
groups, and key informant interviews the Planning Committee created the following
definition of Integration:

“Integration is a phenomenon in which all groups and individuals within a society
participate fully in all aspects of social, cultural and community life. Not necessarily a
complete assimilation to one particular culture, but the valuing of one’s own cultural
identity and beliefs, based on a shared commitment of appreciation of one another to
build a stronger and healthier community.”


As the immigrant and refugee population continues to grow, we face the challenge of
how to best ensure that these newcomers integrate into our community. The Gate City
Initiative engaged a collaborative process to develop an integration plan for new refugees
and immigrants and existing community members.

Recommendations for community groups, service providers, municipality, and
community-based organizations:

      Build partnerships between Mayor, municipality, funders, community members,
       immigrant community, and community organizations.
      Increase community awareness and education opportunities for the staff.
      Use of community meetings to gain input on the integration process through
       assessing immigrant and refugee needs as well as service provider needs and gaps
       in services.
      Host events in collaboration with churches and other service providers to
       welcome new refugees, gather funds from the community, and to disseminate
       general information on community norms, rules and citizenship process.
      Form subcommittees to work on the key components of the integration process.
       Subcommittees should meet on an ongoing basis so that they can identify and
       prioritize the needs of immigrant and refugee community.

September 2009                                                                               22
Gate City Health & Wellness Immigrant Integration Initiative
References Cited:

 The History of Nashua, NH USA 1900-1950. Source:
  Nashua, NH Population Estimates. Source:
  Nashua, NH. Source:,_New_Hampshire
  Nashua School District Annual Report to the Community. Source:
  2007-2008 Nashua School District English Language Learner Program Data. Nashua
School District.
  Year to Date, Resettlement by Towns. Source: NH Office of Refugee Resettlement
  The Colorado Trust. A Grantmaking Foundation, “Immigrant Integration in Colorado.”
  Living In America: Challenges Facing New Immigrants and Refugees

September 2009                                                                     23
Gate City Health & Wellness Immigrant Integration Initiative