Citizenship and Immigration Canada Ontario Region Client...

Citizenship and Immigration CanadaOntario Region

Client Support Services for Government Assisted Refugees

Evaluation of Province –Wide Pilot Initiative

Final Report

Prepared by:Kappel Ramji Consulting Group

March 30, 2009

Kappel Ramji Consulting Group3 Ashgrove Place

Don Mills ON M3B 2Y9Tel: 416.445.4679

Email: [email protected]: Betsy Kappel & Zubeida Ramji

Kappel Ramji Consulting Group is a firm specializing in community basedprogram planning and development, evaluation, organizational reviews,strategic planning, training and anti-racist organizational change. Mostassignments are related to the development of strategies for organizationsto increase their responsiveness to their community’s needs, thereby improving access to services for vulnerable individuals and peopleexperiencing barriers.

Associates for this assignment: Karim Merali, Shazia Ramji, HusniaHakimy, Sakina Shahla, Samy Tawite, Anab Abdi, Hawa Dirie, Sunny Min,Linda Rochon, Ahid Zameel, Rimah Alramahi, Tha Dar Hsae, Mona Shiwa,Abeer Jaffer, Manzomah Musuni, Shaima Sakha, Hser Mu Lar, DelawarAzimy, Tha Gay.

Table of Contents

EXECUTIVE SUMMARY1.0 INTRODUCTION .............................................................................................. 12.0 BACKGROUND ................................................................................................. 2

2.1. CSS MODEL .............................................................................................. 22.1.1. Coordinated Approach........................................................................32.2.2. Case Management ..............................................................................32.2.3. Community Capacity Building ............................................................4

3.0 EVALUATION METHOD ................................................................................. 53.1. Phase II Process ...................................................................................... 5

3.1.1. Overview of Data Collection Strategies.............................................63.1.2 GAR Sample Selection & Profile........................................................73.1.3 Stakeholder Participation ...................................................................93.1.4 Limitations of the Method ................................................................10

4.0 EVALUATION FINDINGS ...............................................................................114.1. Effectiveness of Model for GAR Families with Complex/High Needs….11

4.1.1. Profile and Level of Need of Families in the Pilot ..........................124.1.2. Differential Interventions.................................................................134.1.3. Clarity of Roles of RAP/LSS/CSS/ISAP ...........................................154.1.4. One Year Timeframe for CSS ..........................................................174.1.5. Parameters of CSS ...........................................................................174.1.6. Satisfaction with CSS- GAR Families ..............................................184.1.7. Unmet Needs at End of CSS ............................................................194.1.8. Satisfaction with CSS- CSS Staff and Community Partners ...........20

4.2. Effectiveness of Community Capacity Building ..................................... 204.2.1. Community Readiness to Serve GAR Families ................................214.2.2. Case by Case Individual Advocacy ..................................................224.2.3. Joint Ventures...................................................................................224.2.4. Tensions within Communities ..........................................................23

4.3. Effectiveness of Province–wide Coordination ....................................... 234.3.1. Implementation of Specific Roles/Functions....................................244.3.2. Benefits of Centralised Coordination...............................................25

4.4. CSS Site Delivery –Effectiveness and Efficiency ................................. 254.4.1. Shared Values...................................................................................264.4.2. Different Program Delivery Structures............................................264.4.3. Group Based Interventions...............................................................284.4.4. Staff Workloads ................................................................................284.4.5. In-home visits ..................................................................................294.4.6. Frequency of Contact with GAR Families .......................................304.4.7. Language Interpretation ...................................................................324.4.8. Dependency Issues...........................................................................334.4.9. GAR Feedback on Staff Competency/Skills .....................................344.4.10. Vicarious Trauma .............................................................................354.4.11. Overall Cost Variation......................................................................36

4.5. Impact of CSS on the Lives of GAR Families......................................... 364.5.1. Retention of RAP Orientation & Life Skills Information..................364.5.2. Access to Health Care......................................................................384.5.3. Official Language Acquisition...........................................................404.5.4 Participation in Education/Training/Workplace ...............................414.5.5. Adaptation to Life in Canada .................................................................42

5.0. ANALYSIS AND RECOMMENDATIONS........................................................445.1. Conversion of CSS from Pilot to Program Status .................................. 455.2. Alignment of CSS within the new Terms and Conditions ...................... 455.3. Alignment of CSS with RAP SPOs .......................................................... 465.4. Retention of Coordination Role............................................................... 465.5. Establish Core Elements of CSS............................................................. 47

5.5.1 Case Management for GARs with Complex/High Needs .................475.5.2. Standard Priority Areas for Holistic Case Management .................485.5.3. Role of CSS in Emotional & Mental Health......................................485.5.4 Strategic Community Capacity Building ..........................................50

5.6. The CSS Model and Continuous Improvement....................................... 525.6.1 Benchmarking Across the Sites.......................................................525.6.2. Strengthening of Community Capacity Building Element of CSS....525.6.3. Tracking Acuity and Size of Case Loads.........................................535.6.4. Designating a Primary Case Coordinator.........................................545.6.5 Structured Assessment, Goal Setting, Follow-Up & Discharge.....555.6.6 Alignment with LSS ..........................................................................565.6.7 Vicarious Trauma .............................................................................565.6.8 In-Home Visiting ..............................................................................575.6.9 Privacy and Confidentiality ..............................................................585.6.10 Naming Case Management...............................................................58

5.7 Monitoring and Evaluation ..................................................................... 596.0 CONCLUSIONS................................................................................................61

AppendicesAppendix 1 CSS Evaluation Interim Report ..........................................................63Appendix 2: CSS Evaluation Framework.................................................................90Appendix 3: Data Gathering Tools...........................................................................95Appendix 4: Sampling Approach……………………………………………………… 121Appendix 5: Key Informants...................................................................................126Appendix 6: Consolidated Recommendations .......................................................131

Acronyms

CIC Citizenship and Immigration CanadaCSS Client Support ServicesESL English as a Second LanguageGARs Government Assisted RefugeesHOF Head of FamilyHOST Host Family ProgramIRPA Immigrant Refugee Protection ActISAP Immigrant Settlement and Adaptation ProgramKRCG Kappel Ramji Consulting GroupLCs Local Consultants (members of KRCG Team)LINC Language Instruction for Newcomers to CanadaLSS Life Skills SupportNAT Notice of ArrivalOW Ontario WorksPSR Privately Sponsored RefugeeRAP Resettlement Assistance ProgramSPOs Service Provider OrganisationsSWIS Settlement Workers in SchoolsYMCA Young Men’s Christian Association

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Final Evaluation Report: Executive Summary

Executive Summary

BackgroundClient Support Services (CSS) is an initiative piloted in the Ontario Regionof Citizenship and Immigration Canada, (CIC) from 2007-2009. It is partof ongoing attempts by CIC to improve the outcomes for GovernmentAssisted Refugees (GARs) resettling in the Province. With evidence ofcontinuing unmet needs of GARs, CIC funded the CSS pilot to achieve thefollowing goal:

To assist GARs with identifying their settlement needs, accessingcommunity resources and meeting settlement goals in the first year oftheir arrival by adopting and refining a coordinated and client centredapproach to service with an intensive support component for adults,children and families.

With input from over 240 individuals including 112 GAR families and 12GAR youth from five (5) of the six (6) pilot sites1, this evaluation answersthe following evaluative questions: How well is the CSS model working? How effective is the current approach to province-wide

coordination? Is CSS being delivered effectively and efficiently by the project

sites? What difference does CSS make to GARs’ resettlement in the first

year in Canada?

The CSS ModelCSS is a province wide initiative with programs in each of the six (6)Service Provider Organisations (SPOs) where the Resettlement AssistanceProgram (RAP) is being provided to GARs –Hamilton, Kitchener, London,Ottawa, Toronto and Windsor.

The CSS model has three (3) key aspects to it: Coordinated Approach: The YMCA Toronto coordinates CSS

province wide, providing database development and informationsharing, in-depth tracking and reporting, and support forinnovation, quality improvement and project evaluation.

Case Management Services: Case management in this context

1 As London just began to deliver services in Year II of the pilot, they did not fullyparticipate in the evaluation.

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means client centered assessment, planning and support to all GARfamily members in a desk-free mobile environment that assistsGAR family members to link to the supports and services theyneed in the community in the first year post arrival.

Community Capacity Building: Both within the CIC family ofsettlement services and the broader community, capacity buildingaims to strengthen the receiving community’s capacity to provide culturally and linguistically appropriate supports and services thatare responsive to newly arriving GAR families, especially thosewith complex/high needs.

Highlight of FindingsOverall the CSS pilot is being operated effectively and having manypositive impacts on the adaptation process of GAR families, especiallythose with complex/high needs. Findings suggest: A case management approach to working with GAR families with

complex/high needs is effective. GAR families are especially positiveand satisfied with the support that they have received. Communitypartners and other CIC funded programs also point to positiveimpacts that they have seen.

All CSS pilots are client centred with consistent assigned staff -either a single person or a designated team. All CSS teams take aholistic and coordinated approach to the central settlement needs ofGAR families. At the same time, there is evidence of differentialsupport being provided depending on the unique needs,circumstances and aspirations of GAR family members.

In addition to the CSS staff, families also have a team of communitybased supports and services that provide more specialised inputssuch as medical care or language instruction. These inputs areeffectively tracked and coordinated by CSS staff.

Specific outcomes that are reported by GAR families in the sample at12 –18 months post arrival include:

- Over 50% of GAR families feel that they are succeedingwell at managing their budgets, using public transit,shopping and being responsible tenants.

- 66% report that they have a regular doctor or health careprovider

- 75% feel that they can speak one of the official languages

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either quite well or not badly and 41% are comfortablespeaking English with their CSS worker on the phone.

- 85% of the children and youth are attending school and64% of parents report that they have attended theirchildren’s schools 2-3 times since arrival.

- 91% of adults are enrolled and attending LINC and 24% areemployed at least part time. GAR family members are alsoundertaking activities that will lead to employment such aslearning to drive, getting assistance with their resume,attending JSW workshops and /or volunteering.

- Finally, over 50% of the sample feel at home in Canada,are comfortable accessing services, have a positive familylife and feel safe and secure.

Those GAR families who are feeling less settled attribute this to griefand sadness over the loss of family members who could not join themand continued challenges with language acquisition which make themmore isolated.

Finally, CSS cannot meet all of the needs of GAR families withcomplex/high needs within the one year timeframe. The top six (6)unmet needs (each identified by over 20% GAR families in thesample) are: employment, poverty, language acquisition, housing,health and education/training.

The major issues with the CSS model include:- The one year time frame is not in keeping with typical case

management approaches serving clients who havecomplex/high needs. This means that some GAR familiesare being transitioned to other supports before they areready.

- Unresolved role of CSS within the area of emotional andmental health supports. Some CSS pilots are offeringspecific supports in this area, others are not. Some siteshave leveraged pro-bono community supports which arenot secure or sustainable. One site is fortunate to have anagency in the community dedicated to working with peoplewho have survived torture and trauma.

The community capacity building component of CSS has proven to bea critical aspect of the success of the pilots. Most sites have

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demonstrated skill at enhancing capacity through individual advocacyefforts as well as broader change initiatives. There is evidence insome communities of programs that have been started as a responseto GARs in partnership with CSS and then spun off. There are alsomany joint ventures.

However, there is also evidence that large systems like hospitals andthe mental health systems as well as LINC are not able to be asresponsive to GARs with complex/high needs as is desirable.

The central coordination role played by the YMCA Toronto has beenwell received. While local CSS staff have taken time to warm up tothe impressive data base, there is evidence that both individual sitesupports and group based meetings/ professional development areespecially valued.

There are some quality improvement issues that have been identifiedthat will warrant some attention as the pilot moves into ongoingprogram status. Highlights include:

- Not all CSS models have a primary designated casemanager for each GAR family.

- Staff workloads vary considerable between sites –from 60to 100 cases per worker as do the frequency of contactwith families and therefore the cost variation per GAR.

- Language interpretation is sometimes hard to locate andcan impact on the degree of involvement of CSS staff whospeak the same language as the GAR family in need.

- In some sites staff safety with respect to making homevisits, and privacy and confidentiality issues when using amobile service approach still need to be resolved.

- Dependency issues and vicarious trauma of CSS staff arecommon themes.

Analysis and RecommendationsOverall the CSS pilot is a welcome addition to the CIC funded spectrum ofsupports and services for GAR families with complex/high needs. Its needis clear, the case management approach is generally in keeping with suchmodels in other sectors where high need clients need intensive supportsand there does not appear to be duplication or overlap with other CICfunded initiatives. As well, there is ample evidence that a great deal ofeffort has gone into clarifying the roles of all of the supports and services

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that are mobilised to assist GAR families to settle in Canada.

Twenty-seven (27) recommendations are made which, if implemented,will strengthen the program and ensure its sustainability across theprovince.

Together they point to:√ Transitioning CSS from a pilot to a program in all six (6) sites under

the Terms and /Conditions for Settlement Services in Ontario andkeeping CSS aligned with RAP providing SPOs.

√ Retaining the full central coordination role of the YMCA Torontoand re-visit the financial element after the CSS has becomestabilised in 2 years.

√ Affirming that CSS is first and foremost for GAR families withcomplex/high needs and that the core elements will be standard inCSS in all six (6) sites.

√ Including in the CSS funding parameters a place for emotionalmental health supports provided in partnership with a communitybased agency that can provide supervision /support and eventuallyprovide the service itself.

√ Strengthening the community capacity building aspect of the modelthrough regular planning and professional development.

√ Undertaking steps to standardise some core aspects of CSSdelivery systems, striving to establish standard ranges orparameters for caseload levels, assessment and monitoring steps,cost per GAR family, safety and privacy/confidentiality policies.

√ Continuing to work towards common outcome measures that can betracked and used for quality improvement.

√ Spearheading an advocacy effort to create systemic change withinthe mental health sector so that GAR families have greater ease ofaccess to appropriate and responsive supports for trauma andPTSD.

√ Commissioning research that can answer the question of whetherthe assumption that is being made that CSS is indeed making theadjustment and integration of GAR families in Canada smoother,faster and easier is in fact correct.

ConclusionsThe CSS pilot has established the need and the model that can extend thenecessary support to GAR families, especially those with complex/highneeds that are arriving in Canada. It is being well received by GAR

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families and community partners alike. Continuing to strengthen andimprove the model will support GAR families to settle successfully in theirnew communities. It will also change communities so that they are morewelcoming and responsive to the unique circumstances and needs thatGAR families bring with them.

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Final Evaluation Report

1.0 INTRODUCTIONThe profile of refugees selected for Canada’s Resettlement Assistance Program (RAP) changed with the passage of the Immigrant RefugeeProtection Act (IRPA) in June, 2002. IRPA now places an emphasis onprotection for refugees as opposed to their ability to resettle in Canada asthe primary criteria for selection of potential government assisted refugees(GARs). The result has been GARs with far greater assistance needs than inthe past are making their new home in Canada.

The system of supports and services funded by Citizenship and ImmigrationCanada (CIC) to support GARs, particularly the RAP and Immigrant Settlementand Adaptation Program (ISAP) initiatives, have been challenged to meet thecomplex needs of resettling GARs. Nationally, RAP added a Life SkillsSupport (LSS) component to RAP to ensure that GARs have the basic skills tocope with daily living in western and urban environments. But gaps were stillevident in the ability of GARs families to effectively deal with all theirphysical and emotional health needs, gain necessary English/French languageskills, and navigate within the complex system of supports and services intheir new communities that cannot always understand nor respond to theirsituations appropriately. Many GAR families, following the intensive RAPsupport for the first two (2) months post arrival, were not adapting as well ashad been hoped. As well, most supports provided to GARs were targeted tothe adults in the family, primarily the head(s) of the family, not the childrenor extended family members.

Client Support Services (CSS), piloted in the Ontario Region of Citizenshipand Immigration Canada, (CIC) from 2007-2009, is a logical next step inongoing attempts by CIC to improve the outcomes for GARs resettling in theProvince. With the evidence of continuing unmet needs, CIC funded the CSSpilot to achieve the following goal:

To assist GARs with identifying their settlement needs, accessingcommunity resources and meeting settlement goals in the first year oftheir arrival by adopting and refining a coordinated and client centredapproach to service with an intensive support component for adults,children and families.

CIC contracted with Kappel Ramji Consulting Group (KRCG) to facilitate aqualitative evaluation of the CSS pilot with the following expected outcomes:

o Assess each service delivery model;o Identify the strengths, weaknesses of each;o Identify potential changes to each that could be made to increase



the efficiency and/or effectiveness of service delivery.o Address the question of whether the parameters of the service

delivery framework are correct and if there are other servicedelivery models that could be considered.

This is the Final Evaluation Report of the Client Support Services Pilot. Itbuilds on the Interim Report completed in January 2009 at the end of the firstphase of the evaluation (See Appendix 1).

2.0 BACKGROUNDThe CSS pilot grew out of a successful pilot project in 2005 undertaken by apartnership between COSTI and the YMCA of Toronto to test a casemanagement approach with ~ 70 GAR families with complex/high needs,focusing on the needs of the whole family. The goal of this pilot was todetermine what outcomes could be achieved for GAR families withcomplex/high needs if more intensive supports were provided for up to oneyear post arrival in a client centered approach. This pilot demonstrated somekey promising practices that CIC then built upon with the establishment of theCSS pilot.

For the CSS pilot, CIC Ontario Region funded all of the six (6) RAP ServiceProvider Organisations (SPOs) to develop and deliver a systematic,comprehensive and intensive range of support services to all GARs arrivingin Ontario.2 In recognition that many “mainstream” and other settlement services in the six (6) sites where GARs are settling are not able to provideresponsive, appropriate supports and services to GAR families, anotheremphasis of the pilot is to support key community services to enhance theirability to effectively serve GARs. Finally, funding was also allocated to theYMCA Toronto to coordinate the development and implementation of thesemodels province wide. The overall investment for this pilot phase was about$ 2.6 million per year in each of the two pilot (2) fiscal years.

2.1. CSS MODEL

The CSS model has three (3) key aspects to it: Coordinated Approach Case Management Services Community Capacity Building

2 The exception was in Toronto where all GARs could not be accepted into the pilot programdue to resource limitations.



2.1.1. Coordinated Approach

CSS is a province wide initiative with programs in each of the six (6) siteswhere RAP is being provided to GARs –Hamilton, Kitchener, London, Ottawa,Toronto and Windsor. The YMCA of Greater Toronto provides acoordinating function. While it has no legal authority to make any decisionsthat bind CIC, in its role as the CSS coordinator, the YMCA is responsible fornegotiating the contracts with each site and flowing the funds from CICthrough to the site for their monthly billing. As well, the YMCA has thefollowing additional responsibilities: Budget management –processing monthly billings and support SPOs to

fulfil their contractual agreements with CIC. Tracking and reporting –reviewing regular monthly reports submitted

by SPOs, and analysing them for common themes, challenges andhighlights and preparing consolidated reports for CIC.

Database development and information sharing - developing andimplementing a common data base capturing consistent informationfrom all sites so that the overall project can have access to up to datedata for decision making and policy change.

Relationship management –providing regular opportunities for jointlearning and training, researching information to support the work ofsites, troubleshooting around issues that emerge, regular site visits toensure in depth understanding of the various models being developed,their strengths and challenges, and advocating with broader groups(e.g. IFH) for changes that the data supports.

Project evaluation - developing a common evaluation protocol (this isjust beginning).

Support for innovation – collaborating with SPOs to understandpromising practices, support each to learn from their peers, andenhance programs as needed.

2.2.2. Case Management

While the pilot is named Client Support Services, there is at the heart of it,the notion of Case Management. The initial pilot between the YMCA andCOSTI had demonstrated what is widely acknowledged – that a casemanagement approach is effective for families with complex high needs.Case management was also appropriate because of the central philosophy ofthe service that, unlike RAP that is driven by common elements that areprovided to all GAR families, CSS was intended to be client centered/driven.That is, while certain interventions or activities might be offered to mostfamilies, the direction of the efforts was towards the individual family’s needs, goals and aspirations for the future. A case management approach



would also have the following key elements: A Plan developed with the client with both short and longer term goals

based on an in-depth, holistic assessment of the family’s needs, as wellas their capacities and aspirations.

Mobile/desk free service delivery that allows for accompanying clientsto appointments, monitoring and supporting difficult-to-serve clientswho might not be eager to see their worker, and in home/communitybased assessment of needs and accomplishments.

Individual supports in the community with such things as activities ofdaily living, setting and keeping appointments and mentoring.

Linkages to and coordination with other supports in the community –with extensive follow up to ensure that the services are meeting theneeds of the client.

Supportive counselling –but not clinical or therapeutic counselling. Ifthere is a need for in depth counselling, clients are referred for this.

Strong relationships that are respectful with a consistent worker thatfosters trust and is the basis on which clients are able to take risks andact on their goals.

Within CSS, the more common language for the individual/family level work is“case coordination”, “casework” or “mentoring” depending on the deliverysite.

2.2.3. Community Capacity Building

The other major focus of the CSS initiative is community capacity buildingand strengthening. This was a component of the pilot because of evidencethat the larger system of supports and services for immigrants to Canadacould not adequately also meet the unique and complex needs of GARfamilies. Within the CIC “family” of services, ISAP services were articulating that they were unable to adequately meet the needs of GAR families. HOSTwas having trouble finding matches for GAR families and LINC could notconsistently meet the needs of GARs who are illiterate in their first language.Furthermore, the broader community services in most sites where GARs aresettling are also not able to communicate with or support GARs attempting toaccess their services. This was especially evident within the health caresector.

The overall purpose of the capacity building element of CSS is to ensure thatGARs can access needed services from within the CIC family and elsewherethat are sensitive, accessible, appropriate and responsive overall. Thegeneral types of activities that are being undertaken include:



Educating various key stakeholder groups about GARs, their challengesand the supports that are being provided through SPOs.

Joining key community networking groups to bring the voices andissues of GARs to the policy and other decision making tables

Collaborating with community partners to enhance programs or developnew initiatives that will meet the unique needs of GARs as well asmodeling how to work effectively with GARs.

Divesting from those initiatives that can stand alone and continue to beavailable within the community for GARs and other target groups thatmight need them.

3.0 EVALUATION METHOD

The evaluation of the Client Services Support (CSS) Pilot was carried out intwo (2) phases. The first phase documented the models that were beingdeveloped and implemented in each of the six (6) sites, their similarities anddifferences, challenges of service delivery and identification of emergingpromising practices. This phase resulted in an Interim Report (see Appendix1).

Another important outcome of Phase I was the clarification of the keyevaluation questions, specific performance indicators and relevant data tocollect in the second phase. An Evaluation Framework was finalized to guidethe Phase II data collection process. (See Appendix 2)

3.1. Phase II Process

The goal of Phase II was to specifically evaluate five (5) out of the six (6)sites where the CSS pilot had been serving clients for at least one yearduration and had overcome the initial start-up problems. Since the Londonpilot site only started serving clients midway through 2008, it was notincluded in the second evaluative phase. Overall, the focus was to gatherinformation that provided answers to the key evaluative questions outlinedbelow and make recommendations for increased effectiveness and/orefficiency at the local and province wide levels: How well is the CSS model working?

- How effective is CSS for GARs with complex/high needs?- How is CSS distinct from RAP, Life Skills and ISAP?- What are the gaps in CSS?- How have community/partners changed to be more responsive as

a result of CSS interventions?



How effective is the current approach to province-wide coordination?- Are the core components of project coordination being managed

effectively & efficiently?- What are the benefits of a centralized approach to coordination

now and in the future?

Is CSS being delivered effectively and efficiently by the project sites?- Are the core elements of CSS being implemented effectively?- What are the consistencies between the SPOs?- How responsive are SPOs to GARs’ needs?

What difference does CSS make to GARs’ resettlement in the first year in Canada?

- How has CSS affected the retention of RAP Orientationinformation?

- Are appropriate supports provided in response to key needs?- Has GARs’ personal development/growth been effectively

promoted?

3.1.1. Overview of Data Collection Strategies

Qualitative information was collected from various stakeholder groups.Guided by specific data gathering tools, data was collected from each inspecific ways:

GAR families were interviewed individually in their homes bytrained interviewers who spoke the language of the family. Theinterviews occurred over a 3-4 week period in December 2008 –January 2009, at the convenience of the family.

GAR youth who were from families involved with CSS were invitedto participate in focus groups. The focus groups took place in two(2) sites (Toronto and Hamilton) where youth are a specificemphasis for the CSS pilot. The focus groups occurred over a 2week period during the December holiday period to make itconvenient for youth who are enrolled in school/college.

During a one day site visit by the Consultants, the following groups were alsoinvolved:

CSS Managers/Coordinators were interviewed individually or in asmall group format.

CSS staff team participated in a focus group. Secondary Informants from various CIC funded programs from

within and outside the SPO (e.g. Managers/Coordinators for ISAP,



SWIS, JSW, HOST, Youth Programs, Language Assessment, LINC,RAP, Life Skills etc) participated in a focus group.

Community Partners from various agencies where CSS has anactive relationship in terms of joint programming and/or whereGARs are referred (e.g. Community Health Centres, Police Service,CNIB, Clinical Psychologists, Canadian Red Cross, UniversityStudents’ Associations, Schools, Public Health, etc) alsoparticipated in a focus group.

Executive Directors and/or Senior Manager from the SPO wereinterviewed in person.

Local CIC Consultants were interviewed by telephone. In person meetingswere held with the staff team at YMCA Toronto to review their province widecoordination role for the context of CSS pilot.

The Evaluation Framework guided the line of inquiry for each of thestakeholder groups listed above. Data gathering tools were developed tofacilitate the interviews and the focus group discussions (see Appendix 3 fordata gathering tools). An important additional source of data was theprovince wide CSS Program Information System (database) which is managedcentrally by the YMCA Toronto. Requests for comparative aggregate datafor relevant indicators were made to the Database Manager at the YMCAToronto.

3.1.2 GAR Sample Selection & Profile

To hear directly from GAR families required several steps. First, a potential sample list of 604 families was generated through

the central database for all CSS clients who had been part of thepilot for a minimum of nine (9) months and up to a total of eighteen(18) months as of October, 2008. The rationale for specifying thistimeframe was to avoid interviewing families who were in an activephase of resettlement and receiving support through CSS. It wasimportant to ensure that sufficient time had passed for the GARs tohave experienced the supports received through CSS and tosafeguard against any perceived or actual conflict with their serviceproviders.

A total of 150 families were targeted for individual interviews andan overall sampling strategy (see Appendix 4) was developed. Asample from each city was selected proportionate to the totalnumber of GARs who are destined there each year. The sitespecific sample lists were also sorted for major languages spoken



by the head of the household and a decision was made to focus onthe top 3-4 language groups for each site.

A random selection of the families from each site’s list was carried out to arrive at that city’s allocated sample size. These lists were then sent to the CSS Coordinators/Managers to facilitate the“finding” of the families and to secure initial consent for participation. Instructions to the SPOs for obtaining of consent arealso included in Appendix 4.

Generally it was decided that, for each site, interviewers or LocalConsultants (LCs) would be recruited based on the predominant languagegroup(s) that were spoken by GARs served. Based on these decisions,interviewers or LCs were then recruited. While they needed to be from thevarious ethnocultural communities/language groups in the sample, theselected individuals also had to be screened to ensure they were not involvedwith the CSS program. Orientation and training was provided to the recruitedLCs before they were deployed to conduct interviews.

GAR families that consented and participated in the evaluation received a$75.00 honorarium for their time and input. The overall targeted sample sizewas 150 or 25% of the total 604 families who had been part of CSS PilotProject across the province for at least 9 to 18 months. Seventy-fivepercent (75%) of the target was achieved with the eventual number offamilies that were possible to interview being 112 or 18.5% of the totalpotential sample. Table 1 highlights the profile of the families in the sample.

The GAR youth sample involved in the focus groups was selected by the CSSteam with overall guidelines as follows: the youth had to be from familieswho were not part of the sample already, they were to be in the 16-25 yearage group, they had to have sufficient English to be able to participate in agroup discussion and multiple youth from the same family were to bediscouraged. Twelve (12) or 75% of the total of 16 invited youth actuallyparticipated. Each youth participant received a $25 Gift Card from Wal-Mart(as suggested by CSS teams).



Table 1: Profile of CSS GAR Evaluation Sample

PROFILE CATEGORYAverage(n=112) PROFILE CATEGORY

Average(n=112)

Family Structure Family SizeTwo Parents 44% Four - six 36%Single 32% Single 32%One Parent -Female 17% Two-three 20%Extended 4% Seven or more 12%Couple with No Children 2%One Parent -Male 2%

Age of Family MembersNumber of Months Since

Arrived0 - 5 years 14% 9–12 months 39%6–12 years 21% 13 - 16 months 49%13 - 16 years 11% 17 - 18 months 12%17 - 24 years 15%25 - 44 years 29%45 - 64 years 9%65+ 2%

Language (HOF's MotherTongue)

Country (HOF's Countryof birth)

Karen 27% Myanmar 38%Farsi-Persian 12% Afghanistan 12%Somali 11% Congo 11%Arabic 10% Somalia 11%Dari 9% Iran 10%Rohingya 9% Iraq 6%Swahili 8% Burundi 4%French 6% Sudan 3%Burmese 3% Thailand 3%Chin 2% Azerbaijan 1%African Lang. (Kinshasa) 1% Eritrea 1%Armenian 1%Tigrigna 1%

3.1.3 Stakeholder Participation

In all, including GAR families, at least 236 people gave input during Phase IIof the evaluation of the CSS initiative. Different secondary stakeholdergroups had more or less to contribute. Because of issue of confidentialityand privacy, the families that are receiving CSS were not identified directly inthe interviews with secondary informants. Thus, people were asked only toreflect on the impacts they noted based either on prior knowledge of who isreceiving the services or just in general. For some this proved more difficult



than others. Table 2 highlights the overall participation rates of the variousstakeholder groups.

Table 2: Stakeholder Participation –Phase II

YMCAToronto

Hamilton Kitchener Ottawa Toronto Windsor Total

GAR families* 16 23 28 26 19 112GAR youth/CSSclients

7 5 12

CSS Frontline &Management Staff

7 7 8 4 6 32

Other SecondaryInformants &CommunityPartners i.e. ISAP,LINC, SWIS,HOST, RAP, JSW,CHCs, etc

14 16 14 16 11 71

ProvincialCoordination 3 3CIC-OntarioRegional & LocalConsultants

1 1 1 3 5

Total 3 45 47 51 54 36 236*Family interviews were held with single individuals but also with multiple family members.For purposes of data entry, each family has been counted as one unit only.

Lists of all participants (except the GARs) according to stakeholder group andsite are contained in Appendix 5.

3.1.4 Limitations of the Method

The following are limitations to the method that warrant mentioning. The number of GARs who are in the eventual sample is lower than

originally planned. This is because it was difficult for the CSS teams totrack down families who had either changed addresses (and there wasno follow up contact details), moved away from the city or who did notwish to participate.

The final number of GAR youth who provided their input was also lowerthan planned. While the holiday period was expected to be moreconvenient for those in school/college, it was also a time when many ofthe youth were busy working at jobs. An additional constraint was thetransit strike in the City of Ottawa. The focus group planned for Ottawa



had to be cancelled as youth were living in different parts of the city andcould not access transportation to get to the venue.

While the overall sample is generally reflective of the total group ofGARs who have received CSS since the program’s inception, the original attempt to randomly select clients did not fully materialize. Given thenumbers who could not be reached, it was necessary then to selectanother round of families for the sample. In a few instances, in order tomeet the site and language specific targets, all of the families fromcertain backgrounds had to be included in the sample.

The Consultants made one day visits to each site to collect data from thestaff and secondary stakeholder groups. Despite gallant efforts on thepart of CSS Coordinators to round up all the necessary people formeetings on the specified day, this did not always work. There weresituations where dynamics between community organizations and theSPO would have also resulted in biased perspectives and a further strainon local relationships. In such instances, the net value of obtaininginformation from community partners was felt to be less than the risksassociated with the aftermath.

While these limitations exist, there is sufficient depth and breadth of dataavailable to give us confidence in our analysis of the findings.

4.0 EVALUATION FINDINGSThe Client Support Services evaluation process has generated much richdata, both quantitative and qualitative from five (5) of the six (6) pilot sites3.The data has been synthesized and analysed and is presented here accordingto the major evaluation questions that have guided the process.

4.1. Effectiveness of Model for GAR Families with Complex/High Needs

The concept of case management for families/clients with complex/highneeds is well accepted in social service and health care practice. In thissection we highlight the findings related to the utility of the CSS modelspecifically for GAR families with complex/high needs. Central to thisevaluation is the question: Is this the right model to be implementing for GARfamilies?

3 As London just began to deliver services in Year II of the pilot, they did not participate inthis phase of the evaluation.



4.1.1. Profile and Level of Need of Families in the Pilot

Since case management is an approach for families with complex /high needsit was important at the outset to try to define what constellation of needs thismight be for GAR families. Based on input from the participating SPOs aboutwhat profile characteristics or life experiences GAR families withcomplex/high needs typically have had, the following framework wasdeveloped to assist with identifying objectively which and how many GARfamilies might have high, moderate or low needs when they are assessed forCSS.

Table 3: Level of Need of GAR Families: Criteria and Ranking

Family Level of Need(at point of arrival/first assessment) Weighting

Fluency in English (family members > 16 yrs only) Minimum 1Moderate2

High 3

Fluency in French family members > 16 yrs only) Minimum 1Moderate2

High 3

Educational attainment (family members > 16 yrs only) None1Primary 2

Secondary3Post Secondary4

Relative/friend in Canada None 1Yes 2

Living conditions overseas Camp 1Rural 1

Urban 2

Health/disability concerns Minimum 3Moderate 2

High 1

Level of Need Total ScoreComplex/High need <9Moderate Need 9-13Low Need 14-17

The information used to assess the ranking was obtained from the initial needsassessment which has been captured in the YMCA data base where all GARfamilies are registered. The idea here was to assign a score to each family thatarrived within the time frame of the CSS initiative to determine the potentialratio of complex/high need to moderate/low need GAR families. Table 3 aboveis the scoring system developed.



Based on the scoring, Table 4 below highlights that about 64% or almosttwo-thirds of the GAR families served by CSS in fiscal year 2007/2008 wereconsidered to have complex/high needs.

Table 4 : Level of Need of GAR Families by SiteApril 2007 –March 2008 (N= 662)

GAR Families Hamilton Kitchener Ottawa Toronto Windsor Average

Complex/highneed Level

91% 63% 55% 55% 58% 64%

Moderate Level 8% 35% 38% 41% 36% 32%

Low Level 1% 3% 7% 3% 6% 4%

In comparison, during the LSS pilot (May 2005), only one-third of theGAR families were in high need for life skills support. It appears thatbeyond life skills support, the more encompassing focus of CSSwhich includes the introduction of health/mental health issues,accounts for the doubling of the target group for CSS.

Most agree that not every GAR family that participated in the CSSpilot really needed intensive coordinated supports. Assumingconsensus on the earlier criteria that define families with“complex/high needs”, then the information in Table 4 suggests thenumber who may have been successful at adapting to life in Canadausing the typical array of existing community services without CSSmight be about one-third of GAR families.

This information confirms objectively that the CSS model has beenutilised for families with complex/high needs. Overall, within fiscalyear 2007/2008, of the total of 1650 GARs who were served by CSS,1056 individuals or 201 families and 223 single GARs hadcomplex/high needs.

4.1.2. Differential Interventions

Once the score was assigned discreet data sets collected by the YMCAcould be reviewed against this measure to see if, for example, those with



the highest needs received the highest number of units of service, or themost out of office service.

CSS staff provide support services to GAR families in many different waysincluding face to face in the agency/office, in GAR families’ homes, in the community as they accompany them to health care and otherappointments, over the telephone, email and fax. When the level of needis factored in, specific data runs provided by the YMCA highlight thefollowing.

Graph 1: Mobile/Desk Free Service 2007/2008 by Level of Need

30%

27%

24%

10%8% 8%

0%

5%

10%

15%

20%

25%

30%

35%

0-3 months postarrival



Settlement Period

Per

centa

ge

ofF

ace

toFac

eSer

ivce

Outs

ide

oft

he

Offic

e

High NeedModerate Need

Graph 1 highlights that throughout the first 12 months ofresettlement, those GAR families with complex/high needsconsistently receive more services outside of the office ascompared to those with moderate/low needs. When the data isexamined to see what the main issue for complex/high needfamilies is at each stage in the 12 months post arrival, healthconcerns rank at the top. This validates why the interaction mightbe outside of the office and is an indication that services aredifferentially provided based on need.



Graph 2: Venue/Method of CSS Service Provision for Complex/HighNeed GARs in 2007/2008 by Settlement Period

24%

27%

30%

24%

19%

21%

30%

32%

23%

0% 5% 10% 15% 20% 25% 30% 35%


4-6 months post arrival

1-3 months post arrival

ElectronicallyIn officeOutside Office

Graph 2 highlights variation in the venue and /or type of servicedelivery methods for GAR families with complex/high needsaccording to their settlement period. There is a clear decline in outof office service delivery over time while the telephone/electronicmethods and in office methods fluctuate. One reason could be thatfamilies are becoming more familiar and comfortable in getting totheir health care appointments or that other supports have been putinto place to accompany them. Another reason might be that in thelast five (5) months of service there is a need to complete numerousforms such as applications for Ontario Works application for incomesubsidy once the RAP subsidy ends and subsidised housing. There isalso an exit interview which might happen in the office.

4.1.3. Clarity of Roles of RAP/LSS/CSS/ISAP

CSS is closely aligned with RAP, LSS and ISAP services. In fact CSS isdeliberately housed in those six (6) SPOs that welcome GAR families intoRAP. As part of RAP, LSS support is available for those GAR familiesdeemed to require it. In some cases SPOs with RAP also have CICcontracts to provide ISAP, HOST, LINC and/or JSW. Exploration about thedistinctness of the roles and responsibilities of each discreet servicehighlights the following: Each SPO providing CSS has worked diligently to define the respective

roles of RAP, LSS, CSS and ISAP/other CIC funded services so that the



staff and the GARs can be clear about “who does what”.

While this is especially the case in those SPOs that house all of theservices, it is also true for those SPOS that refer GARs for othersettlement services outside the agency.

There is ample evidence that there is synergy and effectivecommunication between the various CIC funded settlement servicesthat GAR families need as they settle in Canada. There are alsodeliberate efforts to sort out those relationships or communicationstrategies that may need adjustments to ensure a coordinated approachto service for the benefit of GAR families.

The main overlapping synergy that appears to exist is between LSSand CSS. This is natural as in some ways a case managementapproach is, in part, advanced life skills- helping families to organisethemselves to set and achieve goals. Some skills learned througheffective case management are practical, like how to make and keepappointments in the community while some are more complex such ashow to set goals and navigating complex governmental processes likeOW, subsidized housing, health care etc.

There are many instances where LSS staff are used as language aidesby CSS to accompany GAR families to community appointments wherethe teaching/relationship building role of the CSS staff is not required.Sometimes LSS staff are preferred to other language interpretersbecause they are part of the SPO, and they can bring back criticalinformation to the team about next steps/follow up needs that GARfamilies have which other interpreters might not see as within thescope of their role.

There are also instances when GAR families that have received therequisite number of LSS instructional hours face a crisis or need tolearn a new life skill. In these instances, LSS support might berequested by CSS to assist the family to deal with the issue –e.g.treating head lice.

When the LSS staff are utilised in either of these two roles, it is clearwhat the boundaries are for them. As well, since most LSS staff arepart time employees of the SPO, their hours are flexible and they canhandle working for two (2) different programs.



4.1.4. One Year Timeframe for CSS

Services for GARs have always been subject to time limits. The RAPintervention was only to be in the initial three (3) months post arrival andthen families were to be referred for longer term support from othersettlement services targeting immigrants such as ISAP, HOST, JSW etc. Inkeeping with this pattern, CSS was established with a one year time frame(except for Toronto which, in the pilot phase, had a two year time limit forservice.) This had some logic to it since the RAP stipend generally expiresafter one year. From a model point of view, a time limit on a case management

approach does not appear to be the norm. That is, most casemanagement models are more open ended in the timeline- consistentwith a client centered approach. That is, families are served until theyare able to become more independent in setting and accomplishingtheir goals on their own- whether this takes a short or longer time.

Most SPOs providing CSS as well as those in other settlement serviceareas have concerns that while many GAR families are able to organisetheir lives after the one year time frame, not all are. This is especiallytrue for the most complex/high need families with multiple healthissues, large family size and perhaps a single parent who is not able tolearn the language quickly due to illiteracy in his/her first language.

Ironically, when the RAP stipend expires, there are many GAR familieswho have to seek new housing as the rates for OW do not match theRAP stipend with its additional allowances. The relationships with OWare also not nearly as supportive and accommodating as they havebeen with the local CIC process. This means that many GAR familiesare facing uncharted territory precisely at the time when they are nolonger able to call on their CSS worker for support.

4.1.5. Parameters of CSS

While there is much synchronicity between the CSS programs in terms of thetypes of activities/services that are offered to GAR families, there isdivergence in the area of emotional/mental health. Three (3) of the CSS pilot initiatives offer support for emotional/

mental health issues that are paid for by the CSS program. The otherthree either leverage existing community agencies or pro-bonoservices for the GARs they are serving to support them in dealing withtrauma, Post Traumatic Stress Disorder (PTSD) and other emotionalissues.



While the emotional/mental health services being paid for through theCSS funding are not strictly speaking “clinical” services, they nevertheless do allow for GARs to explore their emotional well being,learn about signs and/or symptoms of emotional distress, PSTD and/ordepression and either participate in mutual support groups or workthrough their feelings in art related sessions.

To some extent, it also appears that all CSS staff, whether or not theirrole is designated to focus on emotional/mental health issues, confrontthese types of concerns when working with GAR families on a regularbasis.

4.1.6. Satisfaction with CSS- GAR Families

One gauge of whether a model is doing what it is intended to is thesatisfaction of the target group

Overall, when GARs in the sample were asked to “...rate the usefulnessof the work you/your family did with the CSS Worker?” 70% rated itvery useful and 30% somewhat useful.

It would be very hard if they did not help our family. We could not surviveand adjust life well if they did not help.

He has done everything to his abilities. That is why I can manage myself quitewell now. I would have had difficulties settling in Canada. I would have beenlost.

Would have had difficulty accessing many services, it would have been almostimpossible due to language barrier.

Other indications of GAR families’ level of satisfaction are gleaned from the question about what improvements could be made to CSS. 26% offamilies said that nothing needed to be done while 38% wanted more ofthe service- more time etc.

The program was wonderful and I met a lot people from …. that have helped me and my family a lot.

… [they] helped me to start my small business. I can weave so last summer…. helped me to get involve with the Sabawoon in the city. I sold my weaving stuffs and I got some money from that program. ….. did her best to help me.



The program is important for me in helping me to settle and adjust to this newenvironment. It is very useful.

It is perfect but we are hoping to make it for a longer time connection so forthe , after the one year, not to feel shy to ask for more help because if so weare still clients so we don’t feel shy when we go back

Through my experience with the program I would like to add something aboutthe program. I want the program to continue for a longer period to draw moresupport from the program.

We appreciate your help and we hope you will continue helping others aswell.

4.1.7. Unmet Needs at End of CSS

Another indication of the utility of an approach is the number and type ofunmet needs remaining at 12 months post arrival when the GARs are to bedischarged from CSS. Table 5 highlights the responses of GARs in the sample to questions

about unmet needs. The top six (6) unmet needs (each over 20%) are:employment, poverty, language acquisition, housing, health andeducation/training.

Table 5: Continuing Areas of Need Identified by GAR Families

Area of Need Response Frequency

Employment/ Volunteering 40%Income Assistance/financial issues 34%Language Issues 25%Housing 24%Education/Training –adults 24%Health / Disability / Access Health Care 21%School related issues –children 19%Immigration/Citizenship 11%Other family issues 10%Life Skills/ day to day help: shopping, using transit, banking 5%Parenting/Child behaviour management 3%Services in the community –recreation, sports 1%Other (please specify) 10%

These closely mirror the outstanding needs identified by CSS staff andcommunity partners. However, community partners also emphasisedsome additional areas including



- Trauma may not be evident or GARs may not be ready to dealwith trauma until after all the more instrumental needs are met-post year 1.

- Needs of young mothers when they give birth shortly afterarrival and so are unable to access most supports within the firstyear including any language supports.

- Inadequate time to assess learning and/or developmentaldisabilities

- Issues with being able to pay back transportation loan when GARfamilies move onto OW.

- Affordable and accessible child care for families in which theadults are all working

- Specialized supports for men to adjust to role reversals withspouse and children.

4.1.8. Satisfaction with CSS- CSS Staff and Community Partners

When CSS staff and the community were asked to reflect on their satisfactionwith CSS, it gets high grades. CSS staff feel that they are able to make a significant difference in the

lives of the GAR families with whom they work. This not only makesthem feel satisfied with the program but also with their jobs. Overallthere is a high level of job satisfaction and excitement among CSSstaff.

Generally stakeholders from outside CSS also express positivesatisfaction with CSS. Some areas worth noting include:

- RAP no longer gets numerous calls from GARs to assist withissues/crises after they have settled in their own homes.

- Other settlement services are able to do what they are skilled/equipped to do for GARs and not feel overwhelmed by all theother more complex needs that they bring.

- Services feel supported by CSS and part of a team working withGAR families, not trying to accomplish things alone.

4.2. Effectiveness of Community Capacity Building

Besides the direct work with GAR families, the CSS model has anothercentral component- work with the broader settlement, health, education, andsocial service community to support it to welcome GARs and provide themwith culturally and linguistically sensitive supports and services. Thiscomponent of CSS is critical for the success of the model as, without supportfrom these other community services; GARs cannot meet their complex



needs. Following are the findings about the effectiveness of the role thatSPOs are assuming to strengthen the community at large.

4.2.1. Community Readiness to Serve GAR Families

When Canada made a commitment with IRPA to support the re-settlement ofGARs most in need, it was committing whole communities to engage withthese families. However, most communities are not aware of thegovernment’s priority nor do they know much about GARs, their needs, the situations they have escaped, or their hopes and aspirations. Thus thecapacity building aspect of CSS was included in the model. Following arehighlights about the effectiveness of SPOs in preparing their communities toreceive and serve GAR families. Because many supports and services in most communities are not

familiar with GARs, SPOs have undertaken broad community educationefforts with multiple stakeholder groups to raise their awareness.These efforts have been undertaken with CIC funded settlementservices such as ISAP and HOST, police, health care providers,Children’s Aid Societies, public health providers, recreation and othersocial service providers.

There is evidence that a broad educational approach has beenpositively received by many stakeholder groups who are eager tosupport GAR initiatives once they know about the need.

There are several examples where, once a community realised thatthere was need, specific services were offered to GARs. Examplesinclude:

- Pro bono Trauma counselling offered to GARs by a FamilyService Association

- A refugee Health Clinic established to screen all newly arrivingGAR families in a timely fashion

- Pro-bono psychological counselling provided by PhD candidatesfrom a local university

- Pro-bono counselling provided by local psychologists- Art and play program offered to GAR youngsters and their

parents

One SPO providing CSS has a Multicultural Health Worker whose job isto work with local health care institutions specifically on broadsystemic change. This role seems to have helped broaden theperspective of the local institutions and pushed them to begin to take



stock of what they need to do to better serve not just GAR families butalso newly arriving immigrants in their community.

Not all stakeholders are so receptive, however. In some cases CSSstaff talk about having to be extra firm with community groups to stepup and fulfil their mandate with GARs.

4.2.2. Case by Case Individual Advocacy

Advocacy with community based services on a case by case basis forindividual GARs is the norm in all CSS programs. In this type ofinteraction, the needs of a GAR family are introduced as is the purposeof the CSS program overall along with some education about the needsof GARs in general. This is one effective way of laying the groundwork for similar and perhaps smoother individual responses to GARs inthe future.

There is also evidence that broad teams are built around individualGAR families to meet their complex needs. These teams are made upof CSS staff as well as other key players in the community. Theirsuccess depends on the CSS staff consistently getting feedback infollow up phone calls about what is happening with the family andcoordinating next steps that might be indicated.

In some cases there are actual “case conferences” with the whole “team” when a GAR family is facing a crisis.

It appears that much of the success of the capacity building efforts forindividual GAR families rests on the provision of interpretationsupports for them when they attend community appointments. That is,most community health and social services are not yet equipped toprovide/access interpretation supports to make their services moreaccessible.

4.2.3. Joint Ventures

Broad education and change brought about through experience with individualGAR families are important ways to prepare communities to better serve GARfamilies. Another way is to establish joint ventures that can concretely showthe way to customise or adapt programs to better suit GARs. There is evidence in most sites of initiatives that have been developed

by CSS staff in partnership with a distinct community group tospecifically meet the needs of GAR families. Some examples include:



- A GRD program for French speaking adults- A leadership program customised for Karen and other GAR youth- Safety program for youth customised for GAR children and adults- Sexuality workshops for GAR Youth- Onsite health clinics to improve access to primary care upon

arrival- Community gardening project for GAR seniors and other adults- Youth mentoring with a focus on career exploration and

guidance.

Many joint ventures have been spun off so that the CSS staff no longerneed to stay involved. Others still are offered to GAR families in apartnership model.

All of these ventures extend the reach and depth of the CSS servicemodel while at the same time leveraging community talent, expertiseand support for families. Joint ventures also increase the knowledgeand commitment community stakeholder have to GARs and theirsettlement process.

4.2.4. Tensions within Communities

The community capacity building aspect of CSS is not without its tensions.Several were identified. In some communities there are many new settlement services vying for

the same clients. While CSS does not provide services based onnumbers or expected units of service, others do. This reality can setup a competitive dynamic within a community that can work to thedisadvantage of GAR families. This can mean that some GARs arereferred to in-house settlement services rather than those moregeographically proximate.

Some services, both settlement and others, can become defensiveabout their lack of responsiveness to GARs’ needs, creating difficult relationships with CSS SPOs. These difficulties can result in CSShaving to take on more traditional settlement functions in order forGAR families to receive service in a timely fashion. This is more likelyto happen in those communities without a range of choice of settlementservices.

4.3. Effectiveness of Province–wide Coordination

A major feature of CSS is the province wide coordination of the initiative



contracted to the YMCA of Toronto. This is not a new concept for CIC.There are province wide coordinators for the SWIS and HOST programs,though their roles are more limited. The coordination function for thisinitiative is broader and more encompassing, though it carries with it noadditional authority. Final responsibility for decision making resides with thefunder, CIC.

4.3.1. Implementation of Specific Roles/Functions

Through collaboration and strong relationships with the CSS staff, the YMCAfulfills the following functions/roles:

Budget management Tracking and reporting Database development and information sharing Relationship management Project evaluation Support for innovation

The YMCA gets high marks from the SPOs providing CSS for its roleas the Project Coordinator. All SPOs speak positively about theYMCA’s sensitivity to their work, support for mutual learning and sharing across the sites and through conferences and regularmeetings. Even those CSS site coordinators who admit to initialscepticism about the role are strongly in favour of it now.

No site mentioned any significant issues with the YMCA’s role vis a vis contracting/budget development, relationship management or supportfor innovation.

The major focus of most sites in terms of the coordination function isthe data base - its development, utility and on-going timerequirements. The data base has been developed collaboratively andthe CSS teams’ concerns with each edition have been heard andresponded to. The on site training for each release of the data basehas been appreciated. The three major issues with the data base are:

- The time it takes staff monthly to complete the necessarydocumentation in the data base - ~ 1.5 days per staff person

- The inability coordinators have to generate uniquereports/information for monitoring or evaluation purposes.

- In at least one site the central database for CSS is not linked tothe SPO’s organization-wide system thereby necessitating dataentry in multiple places.



Most sites acknowledge the value of the information. They note thatIFH improvements have come about because of the collection andanalysis of case specific incidents related to the fund. They also notethat they know more about the results of their efforts because of theinformation that is produced.

However, there is a lingering question for some about what the database really needs to accomplish as the CSS initiative moves forward.They are not convinced that the time investment to complete the database will be warranted going forward.

The other activity that is not yet complete is the evaluation element ofthe YMCA role. Having said this, work is underway to begin to identifycommon outcomes that all six (6) sites can potentially measure in thefuture to demonstrate the impact of CSS.

4.3.2. Benefits of Centralised Coordination

With its numerous roles, there are clear benefits from this centralisedfunction for the CSS initiative. There is evidence that sharing about what each site is doing has

prompted sites to develop initiatives that they might not otherwisehave conceived of.

The six (6) sites work well together, sharing openly and honestly injoint sessions in such ways that their learning and analysis isdeepened.

It appears that the six (6) coordinators are mutually supportive of oneanother’s successes and challenges.

The joint training initiatives offered once or twice a year by the YMCAhave been well received by CSS staff.

4.4. CSS Site Delivery –Effectiveness and Efficiency

Each CSS site is working towards similar goals but has a unique approach toservice delivery. Each site has unique names for its CSS program, and oftenlabels the staff roles differently. This is due to the unique community andagency contexts within which the CSS initiative is located. There are alsosome key philosophical or value based elements which, while delivereddifferently, are shared.



4.4.1. Shared Values

Each CSS approach has, at the heart, a case management function with three(3) key shared values:

√ Client-Centered Approach√ Coordination√ Consistency

Central to case management is the notion of a client centeredapproach. Each site initiates this approach with an in depth needsassessment of each family member along with short and longer termgoal setting.

The needs of each family member are then addressed. In some sites,to expedite this, there are specific workers assigned to support youthwith the identification and achievement of their goals. As goals aremet, new ones are added.

Another key shared value in the case management work iscoordination. This refers to the lead that the CSS staff take inensuring that all the inputs or stakeholders that GAR families areinvolved with are working together synergistically for the bestinterests of the family. While the GAR family is working with CSS, itappears that this coordination function is always carried by the CSSstaff member assigned to the family as opposed to any other teammember.

While the specific steps of assessment, goal setting and follow up areinherent in this approach, each of the sites has formalized theseprocesses to different degrees. At least one site has an built-inexpectation that each case will be reviewed at the 4 and 8 month markin the process, at which point a decision would be made about whetherthe family is likely to ready for discharge from CSS by 12 months, inwhich case there are active steps taken to transition over to ISAP orother appropriate service provider(s). This type of structuredapproach with specific “check points” is not standard across the sites.

4.4.2. Different Program Delivery Structures

While the six (6) program models of CSS share similar values, there are twodistinct models in place for the delivery of case management.



Traditional Single Case Manager The most common model is one in which a single staff person is thedesignated “case manager” for the family or youth they are assigned to work with. In these instances the assigned person is responsible forthe assessment process of the family unit as well as coordinating theinterventions that will assist families to meet their short and longerterm gaols. This is also the staff person most likely to accompanyfamilies on their initial appointments with community health, settlementand/or other social services. This is the staff person who enters allthe data about the family into the data base.

In those sites where there is a single “case manager” for a family or youth, the team is still quite active in supporting one another,troubleshooting around issues, sharing particular expertise/knowledgeto sort out issues etc. In at least one site, there is a drop-in approachencouraged with GAR families and if the designated “case manager” is not available to assist a drop-in, another team member will instead.

Team Case Management The second model is a team approach in which each staff member has

certain skills or emphases and no one individual is assignedresponsibility for ensuring that the assessment and activities areaccomplished. Rather the whole team carries this responsibility. Whenthe team is comprised of staff with different areas of focus e.g. health,emotional health, education/employment etc, the family will haveseveral assessments of specific areas of their lives and work with thespecialist to accomplish specific goals in that area.

In a team model, the person who has the most contact with the familiesseems to be the one who gets all the calls if a crisis occurs e.g. awater-main break, even if that is not his/her area of responsibility. Itis then his/her job to refer the family to someone who can help withthe particular issue.

If the team approach is one in which one staff member works withadults and another with youth, needs assessments are often donejointly and then specific activities are carried out based on the personbeing supported.

In the team approach to case management, many different staff enterinformation into a family’s files in the data base system. All decisions



about approaches to the work with the family are made by the wholeteam.

It does not appear that the number or length of team meeting times isinfluenced by the model. That is, those sites with a team approach donot spend more time in team meetings than those with individual casemanagers.

4.4.3. Group Based Interventions

While the hallmark of CSS is client centred unique interventions with eachfamily based on their needs and aspirations, there is evidence that in all sitesthere are group based interventions being organised to meet those needs thatsub-target groups of GARs may have share. Some group based interventions are offered by the CSS staff

themselves and others are developed in partnership with communitypartners who have a skill or expertise that can benefit a sub targetgroup of GARs.

The CSS role in joint initiatives varies from assisting the communitypartner to adjust the materials based on the needs of GAR families,arranging for the venue, invitations etc. for the event, providinginterpretation for those GARs who do not speak English, and/orassisting in the actual delivery.

Examples of group based interventions include:- A support group for women from one ethnocultural group

experiencing depression and isolation- Sexuality workshops for GAR youth- A facilitated community meeting with several factions from

within one community that needed to get along better- A youth leadership initiative for youth- Art sessions with families- An art/play session for children while their parents attended

separate sessions on parenting/ for support.

4.4.4. Staff Workloads

The overall workload is an issue raised by CSS staff themselves as well asby community partners and GAR families. CSS staff each carry between 60-100 cases at any one time. The

exception is in the team models where a staff person would carry thewhole caseload - ~300-400 at any one time –albeit with respect to a



specific issue only. CSS staff acknowledge that not every GAR familyrequires the same intensity of support. It is also the case that with theperiodic admission of GARs into RAP, and the tendency for largenumbers of GAR families to arrive at one time, the intensity of workfor a case manager can fluctuate dramatically.

However, concerns were raised that these caseload levels are high andsometimes it is hard for staff to be as responsive as they would like tobe to individual family issues/concerns. There have also been issueswith staff overtime in several of the sites as teams struggle to meetthe needs of their clients.

Community partners seemed to be aware of the caseloads that CSSstaff carries as they also commented on the high numbers of familiesthat they were working with at one time. One community partner wentfurther, observing that the number of cases being carried by CSS teammade her think that this was not a case management model since intypical situations involving complex/high need clients staff carry fewercases so they are able to provide intensive, flexible support.

The number of cases that CSS staff carry also was observed by someGAR families. It came up as they reflected on the fact that staffaccompanying them to appointments in the community were often onthe phone with other families while they were waiting. In some cases,GAR families also reported that they felt that they were not asimportant as other families were because staff might tell that thereason they could not do some sort of activity with them was due tothe needs of other families.

One site is further challenged to manage caseloads by the hugegeographic area that it serves combined with the fact that staff do notdrive so have to take public transit wherever they go. In this site, staffoften are obliged to make phone calls to families and/or communitypartners while on the public transit system, raising potential issues ofprivacy and confidentiality.

4.4.5. In-home visits

It is clear that there are different policies in the six (6) CSS Pilot sites aboutvisits to GARs in their homes.



In some CSS pilot sites, home visits are common. However, in othersthere are policies that require two (2) staff to visit to ensure the safetyof the staff.

Still other sites are working on policies related to in home visits andwhile they are in transition, carry out more of their work either in thecommunity or at the agency. While it seems that it is not as much ofan issue with LSS staff- who cannot do their teaching job unless theyare in the home –it is an issue with CSS staff.

What is clear is that in spite of these issues, efforts are made toaccommodate the needs of GAR families while at the same timeenhance their ability to manage the interface with the community ontheir own. This provides the rationale for expecting the families totravel to the agency for appointments from time to time.

4.4.6. Frequency of Contact with GAR Families

There is some variation between the pilot sites in the numbers of contactsGAR families have with CSS staff, based on data from the YMCA compiled onthose families who had been part of the pilot for 9 to 18 months at the time ofevaluation. Table 6 highlights the overall variation in the average number of

contacts per complex/high need family that the CSS team has at 3different stages within the first 12 months of resettlement. Overall,there is an average of 12 contacts for a complex/high need familyduring the first 3 months of CSS. However, the variation between thesites during this period ranges from an average of 3 to 23 contacts perfamily.

Table 6: According to Site, Average Number of Contacts per GAR Familywith Complex/High Needs

Pilot Site 0-3 monthspost arrival

4-6 monthspost arrival

7-12 monthspost arrival

Toronto 3 3 3Hamilton 10 2 2Kitchener 13 7 12Ottawa 13 9 8Windsor 23 18 20Overall Average4 12 8 9

4 The average is derived by counting all of the entries (each representing a single contact)during the defined timeframe and then dividing the total by the number of complex/high needclients for the designated period.



It is not clear what accounts for the wide variation. It could be thatthere is inconsistent data entry among sites such that not all contactsare recorded. It must also be remembered that a contact is just that.There is no allocation of time associated with the contact, making itimpossible to actually understand if the contact was 2 minutes to makean appointment or 5 hours in an emergency room waiting fortreatment.

Graph 3: Frequency of Contact with GAR Families with Complex/HighNeeds by Settlement Period

0

5

10

15

20

25

0-3 mothspos t arrival

4-6 mothspos t arrival

7-12 monthspos t arrival

Ave

rage

Num

berof

Con

tact

s

Toronto

Hamilton

Kitchener

Ottawa

Windsor

Graph 3 shows that, except for one site which appears to remainsteady, the middle 4-6 months generally sees a drop in contacts fromthe first three (3) with increased contact towards the end of therelationship. As has been noted before, this could be due to the needlater in the first year to complete some paper work related to OW,housing applications etc for many families.

Finally, Table 7 shows that, at 3 out of the 5 sites, GARs withmoderate needs in the sample received more contacts from CSS staffthan GAR families with complex/high needs in the first 3 months of theprogram. This might reflect the consistent set of activities with allGARs (e.g. family needs assessment, reinforcing orientation, advancedlife skills support, etc) regardless of level of need within the first three



(3) months of involvement. However beyond the initial period, contactwith the moderate need families subsides while contact with the higherneed families is sustained.

Table 7: Average # of Contacts per Family According to Level of Need

Hamilton Kitchener Ottawa Toronto Windsor

Period High Mod High Mod High Mod Low High Mod High Mod

0-3 Months 10 16 13 14 13 9 3 3 4 23 94-6 Months 2 1 7 6 9 4 0 3 2 18 67-12 Months 2 0 12 7 8 4 1 3 3 20 6

Some GAR families in the sample noted that they could benefit frommore case worker input than they receive but are too shy to call themand make their needs known.

CSS worker needs to call us to know our situation. Newcomers are shy anddoesn’t have the courage to call and ask for help or explain.

4.4.7. Language Interpretation

Language acquisition is a key goal for almost all GAR families arriving inCanada except for those coming from French speaking countries. A centralrole that CSS ends up playing is facilitating interpretation for communityservice providers in the health and social services. CSS staff are hired for their skills/competencies in casework and

support as well as their language skills. In some cases there is amatch between the language of the CSS worker and the GAR familys/he is working with, in many cases there is not. When there is not alanguage match, CSS has funds to hire interpreters and, as has beennoted, one pool of interpreters is often the LSS staff.

The CSS data shows that two (2) of the five (5) sites have submittedno data showing significant need for interpretation supports. Thismight be because they are utilising internal supports for which thereare no extra costs. In the three (3) sites that do report the need forinterpreters health needs are one of the main areas where support isrequired. One site has a significant need for interpreters for purposesof the Information Sessions delivered.



At the outset of an involvement with a family, it is not uncommon for aCSS worker to accompany a family to important communityappointments in order to build trust in the relationship with the familybut also start the advanced teaching agenda about how systems in theWest work. Finally the accompaniment role is also important when theorganisation being visited may still require some education about theCSS initiative in general and GARs in particular. If the CSS workeralso speaks the same language as the family, they will also fill theinterpreter role.

As time passes and the role of the CSS worker is beginning to changeas the family is able to do more on its own, it is sometimes hard forthose CSS workers who speak the same language as the family todisengage from the specific role of interpreter. That is, those CSSworkers may continue to fill the interpreter role past the time that theyshould be pulling back.

4.4.8. Dependency Issues

There is a heightened awareness among CSS staff and community partnersabout the potential for and actual dependency developed by GARs in anintensive case management approach.

For some there are concerns that the CSS model might somehowmake GAR families too “dependent” on CSS in that many sites acknowledge that given their holistic approach, they tend to addressmany diverse needs that GAR families have.

Most sites acknowledge that whereas RAP used to receive manyfollow up crisis and other calls from GARs after they were“discharged”, this has now abated. At the same time, CSS workers indicate that they get the calls which they perceive to be part oftheir role for the time they are involved,

Some CSS staff acknowledge that at the transition time of one yearit sometimes hard to successfully move the family on to the newsupports that are available to them. This is related in part to thefact that community agencies are still not fully equipped to supportthe needs of GARs even with the capacity building strategy that is inplace.

From the community angle, there are some who say that theapproach of CSS which is to meet needs in a timely fashion may



teach GARs unreasonable expectations of services. That is, GARsseem to expect them also to answer their phones in person, seethem when they drop-in etc. They sometimes label this type ofissue as a form of “dependency.”

4.4.9. GAR Feedback on Staff Competency/Skills

One indicator of program effectiveness is the degree to which the targetgroup - in this case GAR families –feel supported, respected, valued andpositively assisted etc by the staff they work with. As Table 8 below indicates, there is a high degree of positive feedback

from the sample of GAR families about their experience with the CSSstaff. About 96% of the families had positive feedback and the top six(6) positive elements noted (by over 50% of the respondents) wererespect, knowledge (i.e. ability to answer questions), patience,understanding, language match and consistency.

Table 8: Elements of the CSS Staff Role that have been Most Helpful to GARFamilies (N=108)

Answer Options Response FrequencyRespect 81%Able to answer questions 62%Patience 61%Understanding re their situation 58%Spoke the language 58%Consistency –always ready to help 57%Able to advocate on their behalf 47%Accompaniment to appointments 44%Easily reached by phone 44%Availability of other team members as back-up 29%Culturally competent 29%Gender sensitivity 13%Other (please specify) 7%

Table 9 highlights the aspects of the CSS staff role that GAR familiesdid not fully appreciate or find helpful. It is important to note herethat only 58% of the GAR families chose to make comments in thissection which is considerably lower than those who provided positivefeedback as per the preceding table.



Table 9: Elements of CSS Staff Role that were not Helpful to GAR Families(N=65)

Answer Options Response FrequencyNot gender sensitivity 29%Did not speak the language 26%Not culturally competent 20%Could not easily reach by phone 20%No availability of other team members as back-up 20%Need more time/help/longer program/they were too busy 15%Inconsistency –not always ready to help 12%Did not accompany us to appointments when we thought s/he should 9%Unable to answer questions 9%Impatient 5%Little understanding re their situation 3%Unable to advocate on their behalf 3%Disrespectful 2%Other (please specify) 11%

4.4.10. Vicarious Trauma

Both CSS staff and community partners raised issues related to the potentialfor vicarious trauma as the team works so intensely with GAR families.

Everyone agrees that the situations that many GAR families haveleft behind in their country of asylum but also in their country oforigin are traumatic and horrific. Direct exposure to the horrors ofwar and gruesome violent death of family members are notuncommon realities for GAR adults and children.

CSS staff work intensively with families and begin to observe anddiscuss some of the behaviours or adjustment issues that they arerunning into that could be signs of PTSD. CSS or LSS staff who alsofill interpreter roles are also exposed to GAR family stories whenthey are present in sessions with trauma counsellors/ mental healthworkers.

Concern has been raised that, given the workloads CSS stafftypically carry and the stories they are consistently exposed to,there is not enough attention being paid to self care with respect tovicarious trauma. Self care has been the topic of a centrallyorganized CSS staff training event recently. One site has alsoleveraged support from a community based trauma counsellor to



meet with staff. However, this is not universal across all CSSprograms.

4.4.11. Overall Cost Variation

There is considerable overall variation in the cost and FTE per GAR amongthe six (6) CSS pilot sites. The average cost per GAR ranges from $686 to $2571. Taking into

account full time equivalent (FTE) staff that provide direct serviceonly, the range of the average number of GARs per FTE is from 50 –123 with the average at 82.

Each SPO providing CSS negotiates its contract based on its actualneeds. However, given that the types of services that are beingprovided are comparable even if delivered in different ways, it is notclear what accounts for these variations especially when the differencein level of need is not that great between sites. Some possibleexplanations may have to do with the size and infrastructure of theSPO, and the degree to which a new initiative such as CSS can beabsorbed. For example two (2) sites do not have full time dedicatedprogram coordinators for the CSS pilot and at least one of these alsohas no administrative support staff, driving the overall budget for thepilot down.

4.5. Impact of CSS on the Lives of GAR Families

In this final section we turn to the question: What overall difference did CSSmake in the lives of GAR families? To answer this question we return to theinformation gathered directly from GAR families as part of this evaluation.We also highlight the views of those working with the families –both CSSstaff and community partners.

4.5.1. Retention of RAP Orientation & Life Skills Information

Part of RAP is the LSS component –preparing GAR families to successfullymaster some key tasks of daily living. As part of the interview process withfamilies, questions were asked to ascertain their sense of accomplishments infour (4) key areas –tenancy, budgeting, transit use and shopping once thefamilies had been in Canada nine (9) to eighteen (18) months. Graph 4highlights the findings.



Graph 4: Percentage of GAR Families Rating High Success at Tasks of DailyLiving

85%

83%

68%

53%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

Tenancy Responsibilites

Shopping

Use of Public Transit

Managing Budget

Tas

ksC

ove

red

inL

SS

Percentage Retaining Skills

Over 50% of GAR families in the sample feel that they are doing well inthese four areas of life skills. It is notable that many CSS staff talkabout assisting with some of the reinforcement of these life skills asthey work with families. That is, the input from LSS alone does notnecessarily suffice especially when language remains an issue.

Further light is shed on these accomplishments by the words of GARfamilies:

At the orientation, it was explained that this country is much different fromour country. Here, rent must be paid on time.

We get the money on time so it's our responsibility to pay the rent also ontime.

They taught us how to write cheque, when and how to pay rent. So there isno problem now

Can find native foods, no problem shopping, found less expensive places, i.e.Dollarstore. Malls are for window-shopping ONLY!

A life skill trainer showed me where to shop for groceries and the differenttypes of food. They showed me where I can get what I need.



Sometimes, I need help from other, but sometimes I can manage it (transit) onmy own. If I know appointment location well I have no problem with it.

CSS worker assisted client and her family to get familiar with the TTCsystem. Subway is far from their house.

I know how to manage our expenses.

I'm trying day by day by improving the current situation and managing theexpenses by experience.

I have to be organized since I am engaged I have to send some money for myfiancée. I don’t have to go to many places that my friends are going to spendmoney.

However, language remains a crucial issue for many GARs, especiallywhen they are talking about tasks of daily living. In their words:

Re shopping:Still have difficulties because we have problems communicating inEnglish

Re transit:... we cannot speak English and we don't know how to get to differentplaces.

Due to language barrier, we still need help to get the directions.

4.5.2. Access to Health Care

A key emphasis of the CSS initiative has been increasing access for GARS tohealth care. GAR families were asked about their experience with the health care

system. One area of inquiry had to do with whether or not familieshave a regular doctor or health care provider. A Total of 66%reported positively as seen in Graph 5.



Graph 5: Percentage of GAR Families with Consistent Medical Care

66%

34%

25%

75%71%

29%

68%

32%

77%

23%

79%

21%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Yes (N=73) No (N=37)

Total

Hamilton

Kitchener

Ottawa

Toronto

Windsor

Families were also asked about their ability to manage their medicalneeds on their own. Graph 6 shows that 68% report that they haveconfidence in their ability to do this task.



Graph 6: Percentage of GAR Families Managing Medical Issues on their Own

68%

11%

21%

69%

0%

31%

59%

18%

23%

71%

11%

18%

62%

8%

31%

84%

16%

0%0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Very Comfortable (N=76) Ok/Sometimes Confused (N=12) Need Help (N=23)

Total

Hamilton

Kitchener

Ottawa

Toronto

Windsor

However, as with the tasks of daily living, fluency in the Englishlanguage remains a barrier for about 32% with respect to takingownership of their health care needs.

4.5.3. Official Language Acquisition

Language acquisition is a key factor for successful settlement and adaptationin Canada. GAR families are feeling fairly successful when it comes to fluency in

English or French as seen in Graph 7. 75% of the sample either feelsthey can speak quite well or not badly.

The one caution here is that those speaking French, who have settledmainly in Ottawa, while they can speak French with their RAP and CSSworkers, are not able to get other supports in the community inFrench. Therefore they have to attend English LINC classes in order



to be able to access services. The French language school system isthe one exception.

Graph 7: Ability to Communicate in English/French

25%

50%

26%

6%

56%

38%

14%

45%

41%

32%

46%

21%

31%

54%

15%

35%

47%

18%

0%

10%

20%

30%

40%

50%

60%

Quite Well (N=27) Ok/Not Bad (N=54) Not at all/need interpretation (N=28)

Total

Hamilton

Kitchener

Ottawa

Toronto

Windsor

As well. 41% GARs report being more comfortable speaking Englishwith their CSS workers over the telephone.

However, as has been noted, some GAR families in the sampleattribute poor language acquisition at the end of 9 –18 months inCanada with remaining difficulties with some of the tasks of dailyliving.

4.5.4 Participation in Education/Training/Workplace

A major area of involvement for GAR families in their first 12 –18 months inCanada related to education for children and youth, attendance at LINCclasses for adults and for some, pursuing employment/higher education.



85% of families report that their children and youth are comfortablyattending school. 64% also report that they have attended theirchildren’s schools 2-3 times since arrival.

91% of adults in the sample report that they are attending LINCclasses and 24% that they are employed. Of those that are employed,10% are employed full time.

Employment is a strong aspiration for most GAR adults. Table 11shows that other types of activities GARs in the sample areundertaking to prepare for participation in the marketplace.

Table 11: Preparation for Engaging in the Workplace

Type of Activity Percentage of SampleLearning to Drive 25%Getting help with Résumé 25%Attending JSW Workshop 21%Volunteering 13%

4.5.5. Adaptation to Life in Canada

A key factor in settlement and adaptation to life in a new country is thedegree to which people feel they belong. GARs in the sample were asked a series of questions about their

comfort in Canada. Graph 8 shows that over 50% feel at home, safeand secure, have a positive family life and are comfortable accessingservices.



Graph 8: Settlement and Adaptation Accomplishments for GAR families inCanada 9-18 months

92%

76%

61%

57%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Feel Safe and Secure

Positive Family Life

Comfort Accessingservices

Feel at home in Canada

When they elaborate on these scores GARS say:

Re positive family life :Because our children are young and we can discipline them. My wifeand I we understand each other and my children are well behaved

…being away from home, we have to get along with each other and that iswhat we are doing right now, and celebrating festivities whenever we can.

Religious faith helps the family to be hopeful and trust each other. Believe intheir future and be satisfied.

..because my children respect me and they are very polite.

Re Comfort accessing servicesI know that they will help me with whatever I need and I feel comfortablecoming to them. They are like my family now and anytime I need help I go tothem.

People in Canada are very friendly and helpful.

We call them when we need them and tell them honestly. We speak in mymother tongue



Now I understand English so I am able to access available resources in thecommunity.

Re Feeling at Home in CanadaMy family has access to healthcare, and education, and there is no war.

Because we have freedom and a good health care system.

Because the Canadian people are very friendly. Canadian culture is also aculture of acceptance and tolerance.

I Did not feel alienated in Canada and I don’t want to return back to my country because my children and I found comfort and safety. The kind ofassistance from CSS did not fail me in anyway.

Less nervous, no fear of starvation, peace.

Re Feeling Safe and SecureHere there is no discrimination and no fighting. On top of that people are veryhelpfulIf you do not commit illegal activities or crimes there is nothing to worryabout my safety here.

The troubles that I left home are not here. No war here. Canada is safe.

We have friends to depend on. If we do not commit crime, we are safe. Wecan work, travel, freely.

Not everyone is feeling as settled, however. Most common issues arethe grief and sadness of the loss of family members who were not ableto come with them to Canada and language issues which make it hardfor some to navigate day to day life in Canada. Lack of income is alsonoted as a limiting issue for GAR Families.

5.0. ANALYSIS AND RECOMMENDATIONS

This section of the report synthesises the findings and presentsrecommendations for consideration. The recommendations are made in thespirit of “consideration” because this is a complex initiative with multiple strategies and goals that together create the overall impact for GAR families.This initiative which, at its heart, has a case management concept, is alsonew to the resettlement sector and therefore still evolving. It will continue tochange as more families are served and more is learned about how best tomeet complex needs in the time available. The recommendations need to be



considered carefully by CIC and the CSS program staff together to ensurethat their implementation in whole or in part would be feasible andsustainable.

5.1. Conversion of CSS from Pilot to Program Status

There is little doubt of the value of CSS for GAR families. All the dataindicates that the support families receive assists them to consolidate the lifeskills they have acquired to cope in their new environment, as well as gainconfidence with more advanced skills such as how to navigate the health caresystem and generally organise their lives. Families report that they indeedfeel safe and secure in Canada and supported by the CSS program.

The CSS pilots have worked hard to define program boundaries with staffroles that are distinct from those of other settlement and communitysupports. There are high levels of satisfaction from GAR families with theprogram but also from community partners.

Recommendation #1: Continue funding CSS, converting it from pilot toprogram status.

5.2. Alignment of CSS within the new Terms and Conditions

CSS is currently a program for GARs funded under ISAP. There are severalkey benefits pointing to the fact that it should remain outside of the RAPfunding stream: The ISAP funding stream has more funding than RAP. RAP has had

very little infusion of new funds over recent years in spite of theincreasing needs GAR families arrive with.

The new Terms and Conditions for settlement programs in Ontario(T&Cs) allow for a longer period of service and do not have anarbitrary time limit ending at one year. Removing the 1 year time limitthat is attached to most of the CSS pilots would allow those GARfamilies that need intensive support for longer to receive it.

Down the road, an intensive case management support might well beneeded by families who are not GARs such as privately sponsoredfamilies or some families that are re-unified. By situating CSS withinthe T&Cs, it could, at a later date, be opened up to other immigrantand refugee families with complex high needs.

Recommendation #2: Retain the CSS program within the Terms andConditions for Settlement Services in Ontario.



5.3. Alignment of CSS with RAP SPOs

Currently all of the CSS contracts have been given to SPOs that provide RAPservices to GAR families province wide. This is logical and necessary.These are the agencies that are most in tune with the fluctuating needs ofnewly arriving GAR families and how best to serve them. Staff working inthe same agency can more readily work out the transfer of responsibilities,scheduling, and solving complex, unexpected issues that might emerge in thecourse of working with families e.g. child welfare situations, hospitalisationsof single parents etc. In fact, one of the reasons for establishing CSS hasbeen that other settlement agencies have not been able to adequatelyaccommodate or meet the needs of GARs. It is important to keep CSS closelyaligned with RAP SPOs .

Recommendation #3: Award CSS contracts to those SPOs that provide theRAP services in Ontario to ensure continuity and quality of service.

5.4. Retention of Coordination Role

The coordination role played by the YMCA has been a key factor in thesuccess of the CSS pilot. The role is implemented with sensitivity and care,making the SPOs feels included, valued and heard. While there have beenvirtually no criticisms of this approach to coordination, the findings of thisevaluation suggest that as CSS moves from a pilot to a program there maybe a need for greater attention to matters related to monitoring quality andefficiency of CSS delivered out of the six (6) sites. This might mean that amore slightly directive role has to be negotiated between CIC and the CentralCoordinator.

All of the roles that the coordination function currently has appear to bereasonable. The only anomaly is the central role that is played with respectto budgeting and monthly billings. Most other coordinating roles for CICinitiatives do not encompass this function. However, this is a complexinitiative with a unique high need target group. As a result of this evaluation,more changes may be made to the model. The model will also still evolveover the next couple of years based on continued learning with new groupsof GAR families. All of these factors will make the budgeting and funding ofCSS more complex. Thus it can be argued that keeping the financial functionas part of the role makes sense. To divest this program to local CIC fundersat this point in time could dilute the core need to keep this initiativestandardised as it continues to evolve over time. However, as there willcome a time when divestment of the budgeting and funding function may be



indicated, the central coordination role should be re-evaluated in two (2)years.

Recommendation #4: Retain the central coordination role with the existingfunctions.

Recommendation #5: Re-evaluate the central coordination role and local CICcapacity in two (2) years to determine if transferring the financial and/orprogram management function to the local CIC is warranted.

5.5. Establish Core Elements of CSS

A central question for this evaluation has been: What ought the parameters ofthe CIC funding for CSS be? During the pilot phase it has become clear thatthere is potential for the scope of CSS to grow quite broadly and become “all things to all GARs”. There is a critical need to balance what is expected as a“standard basket of services” with allowing flexibility for the SPOs to mount projects/initiatives within the CSS framework that are responsive to thechanging needs of the GARs and the local community capacity.

There are several elements of the CSS model discussed below that arecentral to its overall effectiveness. It is important that as CSS is rolled outfrom a pilot to a program, there is a process to reaffirm what the essentialsof CSS ought to be based on the findings of this evaluation.

Recommendation #6: Affirm the core elements of CSS that would be standardin all sites.

5.5.1 Case Management for GARs with Complex/High Needs

In all sites except one, all GAR families have been given access to CSSsupports. However, evidence suggests that this general intensive supportmodel is most required by GARs with complex/high needs. Those GARs withmore moderate needs are assisted, but it is not certain that all those withmoderate to low needs really require the intensity of support that the CSSmodel is geared for. Thus, while not recommending exclusion of moderate tolow need GAR families from CSS, it is recommended that priority be given tothose with the most complex high needs first.

Recommendation #7: Establish GAR families with complex/high needs asthe primary target group for CSS.



5.5.2. Standard Priority Areas for Holistic Case Management

There is variation across the sites with respect to the degree to which CSStakes a holistic approach to working with families versus a more narrowfocus. For example, one site only focuses on health and mental health issues.Because CSS has as its goal enhancing the overall settlement and adaptationof GAR families with complex/high needs, a more narrow focus may beproblematic. To ensure that GAR family needs are being systematically,consistently and comprehensively addressed, there are at least 4- 5 areasthat should be part of CSS. These are health, mental health,education/training for children and adults including language training andilliteracy remediation, and advanced life skills to navigate through the systemof supports and services that are required. Other important areas that needto be considered are disability issues and the needs of sub target groups suchas youth, seniors etc.

If a CSS site wishes to narrow its focus, it should be required to demonstratehow all the other major needs that GAR families typically have will beaddressed systematically, consistently and comprehensively by partnerprograms that are closely coordinated or linked into the specialised CSS.Otherwise it is anticipated that a more holistic approach to case managementwould be the norm in CSS funded programs.

Recommendation #8: Continue to fund those CSS programs that candemonstrate how the major resettlement needs of GAR families will beaddressed in a coordinated, systematic, comprehensive and consistentmanner –in the areas of health, mental health, education/training for childrenand adults including language training and illiteracy remediation, andadvanced life skills to be able to navigate the system of supports andservices.

5.5.3. Role of CSS in Emotional & Mental Health

The question of CSS parameters has also been prompted by the fact thatsome sites use CSS funding to directly fund staff who provide emotionalthough not clinical support to GAR family members who are struggling withPTSD, depression and/or trauma.

The findings from this process suggest that for now, using the CSS funds forsuch staff might be required. When we consider the field of mental health,there is little optimism that any time soon it will become accessible,affordable and responsive to the unique needs of GAR families. This is asystem that has not demonstrated much support even for the need for



interpretation in most instances. It is also heavily dependent on individualpractitioners and is a much more costly service as it is often not covered bymost insurance plans. While it is commendable that several sites haveleveraged pro-bono psychological/counselling supports for GARs, thesecannot be counted on over the long term as a sustainable solution.

At the same time it is well established that the trauma that GAR families haveexperienced prior to re-settling in Canada is real, profound and potentiallydebilitating. Currently, only in Toronto is there a non-profit that is wellestablished which can support GAR individuals needing emotional/mentalhealth supports for trauma. Unless this agency were to have satellite officesin all sites welcoming GARs, there is not a ready solution to the gaps inculturally and linguistically sensitive mental health services in the remainingsites.

The pilot has given an opportunity for sites to try out various roles. Basedon their experiences, there does not appear to be one model of emotionalsupport that is preferred over any other. Art/play/ expressive mediums,emotional support in groups and trained social workers with expertise intrauma all seem to have been effective in supporting target GARs.

Recommendation #9: In the funding parameters for CSS allow for staff whoserole is to provide emotional/mental health support to GAR families. This canbe done in groups, art/play formats. However such work should be done inpartnership with a community mental health organization that could provideclinical supervision/support and eventually provide the service itself.

A recommendation that CIC should consider funding support for theemotional/mental health needs of GARs is in no way intended to take awayfrom the reality that community mental health services need to be pushed andprodded into providing support for this important target group. Clearexpectations should continue to exist that SPOs lobby for such support in thecommunity in sustainable ways, perhaps as one part of any emotional supportworker’s role. As well, funding for this type of dedicated position should be reviewed province wide periodically to prevent a situation where CSS takesmainstream mental health providers off the hook.

Recommendation #10: In two (2) years, evaluate the role of CSS in the areaof emotional/mental health support to discern the degree to which the local



community mental health system is changing to assume more of theresponsibility.

SPOs and their local communities will be able to make significant in-roads intheir local mental health sector’s capacity to serve GARs. However, alone, the six (6) communities cannot really impact the broad systemic issues thatprevent people such as GARs experiencing severe trauma and PSTD fromreceiving timely, affordable and culturally and linguistically appropriatesupports and services. CIC Regions and National Headquarters need to takeresponsibility for tackling this issue more broadly. The precedent set by thepartnership between CIC and the Canadian Public Health sector to containand protect GARs and the public from infectious diseases that GARs mighthave when they land in Canada shows that a broad health issue related toGARs can be addressed. A similar partnerships approach needs to be takenwith the issue of trauma and PTSD. Supporting local communities with abroader change effort will maximize the desired impact.

Recommendation #11: At the regional and national level, CIC needs to planand implement a partnership strategy to address the pressing mental healthneeds including trauma and PTSD that GAR families are arriving with.

5.5.4 Strategic Community Capacity Building

A central and impressive aspect of CSS is the capacity building element ofthe model. While some accomplishments have meant more accessibleindividual service for GAR families, there is evidence of broader changebeing accomplished within important systems in the community as well aswithin the Settlement Sector itself. These systems being impacted are theones that GAR families need immediate access to during the first year ofresettlement –and thus the need for this to continue to be an emphasis ofCSS as it moves forward is paramount. As one site has pointed out, the wholenetwork of community health, education and social services are settlementagencies /supports for GARs. As such they all need to be able to serve GARfamilies in culturally and linguistically appropriate and sensitive ways. At thesame time, GAR families need strong advocates. They are a small grouprelative to other newly arriving families and given their unique situations, canbe marginalised even within the settlement sector. Therefore this aspect ofCSS is essential to their ultimate success in adapting to Canadian life.

There are two major areas that community capacity building needs to focuson - one is strengthening community capacity in the areas that are beingemphasised in case management - health, mental health, education/training



for children and adults including language training and illiteracy remediation,and advanced life skills to be able to navigate the system of supports andservices. The second is to place emphasis on the areas of unmet needs thatwere identified by GARs, including employment and housing.

Recommendation #12: Strengthen the community capacity building element ofCSS and strategically align the areas of concentration with those beingfocused on in case management and the key unmet needs that GARs haveidentified.

The capacity building aspect of CSS has been well instituted and is creatingboth individual and more systemic results for the benefit of GARs. However,change is slow and there are numerous potential targets for change- bothinternal to CIC and in the broader community. Within CIC there is still a needfor JSW, HOST, ISAP and LINC to become more responsive to GARs. In thelarger community there are still huge gaps in knowledge about Canada’s commitment to GAR families and what their needs are.

It is also not clear that SPOs have systematic annual plans for their targetsfor change. Rather, many have been effectively opportunistic based onspecific situations that they have been faced with. As CSS rolls out, thecapacity building aspect of CSS will need to be better planned and linked tothe major areas of intervention that the CSS program is working on- e.g.health, mental health, education, language etc. As part of the planning,thought will have to be given to issues of sustainability or an exit strategyespecially if the SPO is putting resources into a support/service temporarily.

Finally there is evidence of competition in some communities for clientswithin the CIC family of services. This competitive spirit is not necessarilypositive for GARs who can both get caught in the middle or run from serviceto service asking for the same thing.

Recommendation #13: Ensure that community capacity building funds arelinked to an annual plan that highlights priority targets for change both withinCIC and in the broader community along with sustainability/exit strategiesand ways to reduce the impact of negative competition between CIC fundedservices.



5.6. The CSS Model and Continuous Improvement

While it has been established that the CSS model is effective in supportingGAR families with complex/high needs, there are several ways that the modelcan be strengthened.

Overall, the models used to deliver CSS vary considerably between sites. Onthe face of it, this is not an issue and in fact can be considered a strength ofCSS. However, there is a need to standardise some aspects of the service toensure that overall quality is maintained regardless of the service deliverymechanisms across the province.

5.6.1 Benchmarking Across the Sites

The data shows variation among the sites with respect to the number ofclients per FTE and cost per GAR client. It is not clear what accounts forthis variation especially since workloads are heavier in places where CSS isleast expensive and the profile of the GARs is not significantly different fromsite to site. One possibility is that those sites with no dedicated programcoordinator and/or administrative staff are able to offer service for a lowercost

However, when the programs are looked at this way, it highlights thepossibility that there may be some unintended inequities in the staffing and/orfunding process. It is logical that funding for CSS should be moving towardsallocations based on the “acuity” of the needs of GAR families destined to the site. That is, the more complex/high need the client base, the greater theresources might need to be. Over time this could be figured out based ondata that is emerging about what the cost is for low need clients vs. moderatevs. clients with complex/high needs. Funding would also have to be alignedwith the agreed upon the core elements /services that the CSS initiativeoffers. Finally, as the formal CSS program starts, dedicated coordinator andadministrative staff should become the norm so that caseworkers are alsodedicated to their roles.

Recommendation #14: Re-align CSS budgets after consensus is establishedregarding the core elements of CSS as well as further assessment of therationale for the apparent variations in current funding allocations.

5.6.2. Strengthening of Community Capacity Building Element of CSS

Currently the community capacity building function appears to be integratedinto the case management role with support from CSS coordinators. This isappropriate and effective especially as a central aspect of the function



evolves from advocacy about individual GAR situations. However, with thehigh caseloads that case managers typically have, this function can getsidelined or receive less attention as priority is given to the families.

A secondary issue is that in those sites that do not have a SWIS program,CSS staff can become quite involved in the school systems supportingchildren and teachers with settlement/adaptation issues. This means thatlittle time is left for the same staff to work within other systems to effectchange.

Finally, systemic change is a specific body of knowledge and expertise thatnot all case managers will be equipped with. Indeed, this type ofknowledge/expertise is often a gap in many large, mainstream organisationsas it gets to the core issues of access and equity - and why certain groupsmay be marginalised or denied access. All of this points to dedicated timeand specialized resources for capacity building within CSS program budgetsso that this critical element of the model can get the attention that is requiredif GARs are to be fully integrated into Canadian society. It also points to aneed to enhance the central professional development agenda so that CSSteams can become more skilled and knowledgeable about how systemicchange works and the role that they can play.

Recommendation #15: Require CSS programs to identify where the skills andexpertise to implement the annual Capacity Building plans are located on theteam and support this aspect of the CSS model with professional developmentfocussed on systemic change.

5.6.3. Tracking Acuity and Size of Case Loads

For purposes of this evaluation a set of criteria with weightings were used toidentify those GAR families that have complex/high needs as compared tothose with more moderate/low needs. While the criteria need to be adjustedfurther (e.g. family size was overlooked as another important factor toconsider) the overall concept of using such a weighting system as anadditional assessment tool deserves consideration. A more objective guide,when added to the qualitative, in-depth needs assessment process eachfamily undergoes, can assist in ensuring that those families withcomplex/high needs are indeed getting the most service. It also allows for alook at what the moderate to low need families might be receiving and whatrationale there might be for them to be on the CSS caseloads. Finally, theweighting allows for refined data analysis comparisons within and acrosssites for enhanced learning and quality improvement.



Recommendation #16: As part of the initial needs assessment process,institute a weighting system that flags the level of need of all GAR familiesin the data base as complex/high, moderate or low. Use this weighting forsite specific as well as province wide data analysis and comparisonpurposes.

In typical case management approaches, case loads are not as high as theyare in this program. CSS staff have indicated that there have been/are someovertime issues in some sites. Having said this, this case managementapproach is unique, working with highly resilient families that are adjusting tomany new things at once and will have various ways that they will want toaccess support. It is not possible to set a case load limit at this point, but itwould be useful for the six (6) Coordinators to work through a process torecommend caseload parameters based on the experience to date with GARfamilies with complex/high needs as well as GAR families with moremoderate needs so that appropriate levels can be established.

The second issue that needs to be addressed around caseloads is the notablevariation in the number of contacts per GAR that the data is showing. As partof the review of caseloads, this variation needs to be explored in more depth,to uncover what accounts for it. This might lead to new documentationexpectations or to further delineation of the general case management roleand service parameters.

Recommendation #17: Task the Provincial Coordinator with establishing andworking through a process with the CSS site coordinators that createsparameters for target caseload levels of GAR families with complex/highneeds and those with moderate needs.

5.6.4. Designating a Primary Case Coordinator

As was noted, there are two (2) pilot sites that have no designated casecoordinator for GAR families accessing CSS. Rather the whole team carriesthe responsibility for assessing, coordination, data entry etc. This approachto case management has some strengths. It exposes families to severaldifferent workers with various skills/expertise, helps them to learn to adaptto different approaches and can prevent staff burn out. However, it alsorelies heavily on trust in one’s team members that each person will do what needs to be done in a timely, responsible fashion. It also assumes thatbetween all the individuals on the team, no need will go unmet becausesomeone will remember it.



In order to ensure that no GAR family falls through the cracks, there is aneed for each family to have a designated primary case coordinator-someone who is the lead in ensuring that all the right interventions oractivities have been facilitated for the GAR family and that the right data hasbeen entered into the data base at the right time. Assigning such a person toeach family is not intended to undermine the excellent team work that seemsto exist on those teams that “team coordinate” but it will provide a safety net and a “go-to” person for each family.

Recommendation #18: Set a standard that all families served in CSS will havean assigned primary case coordinator but leave it to teams to define thespecific tasks that this lead will assume based on a set of common roles.

5.6.5 Structured Assessment, Goal Setting, Follow-Up & Discharge

All CSS programs conduct in-depth needs assessments with each familymember and set short and long term goals with them. Here is where theconsistency seems to end. At least one program has a regular check in withall families to review their status and determine what accomplishments havebeen made. Some discharge families when they are ready, others keep allcases open until the one (1) year mark and then close the file- in case thefamily needs them. Some sites conduct exit interviews, others, until recently,did not. The rationale for these various practices is the client focus - workis done with each family based on their unique needs and circumstances,reviews done when indicated and at the pace of each family.

The client focus of CSS, as a case management program, is important andshould not be changed. However, within a true client focussed casemanagement model there is room for standardisation- or regular consistentcheck points where everyone can step back and look at the accomplishmentsto date. The value of standardisation includes: Turning anecdotal information into more usable data; Ensuring that those clients who may be too shy to call for support are

not being inadvertently overlooked or under-served. Contributing to consistent tracking, monitoring and evaluation of

program outcomes and client impacts; Surfacing any quality issues related to individual case manager

caseloads; Creating an environment where continuous quality improvement based

on concrete data can become a regular team consideration.



Recommendation #19: Task the Provincial Coordinator to work with CSSCoordinators to develop and implement standard initial needs assessmentprotocols, regular check in and exit interview practices/protocols and linkthis data into regular reporting schedules

5.6.6 Alignment with LSS

As has been described there is a natural link between the staff in RAP whoprovide LSS to GAR families and the CSS initiative. First, as LSS is intendedfor the GAR families with the highest need, most who receive LSS wouldautomatically be referred for CSS –this is how it works in the one site thatdoes not automatically serve all GAR families. Second, LSS is a service thatis provided in the language of the family. Frequently LSS staff are used bythe CSS program to accompany clients out into the community to act aslanguage aides and/or make sure the GAR family arrives at the right locationat the right time. This is because they are either better suited to the task asthey will go the extra mile and bring back important information to the casecoordinator and/or because community based interpreters are too costlyand/or not available. Finally, one of the goals of CSS can be thought of asadvanced life skills –how to interface with institutions such as health care –how to get to appointments on time, how to organise your life etc. This isone of the emphases of the case coordinator’s role.

It is critical that this relationship between CSS and LSS be maintained andleveraged for the benefit of GAR families.

Recommendation #20: Ensure that CSS continues to enjoy a close alignmentwith the RAP LSS program in order to streamline support, leverage existingLSS staff relationships with GAR families and provide reliable effectiveresources for accompaniment and language interpretation.

5.6.7 Vicarious Trauma

The work that case coordinators do in CSS, while highly satisfying, can alsobe highly stressful. They often hear the traumatic stories that GAR familiestell about their lives in war torn countries, and living conditions that do notpromote health and well being. They witness GAR families’ grief and loss of loved ones who have been killed/died or have been left behind. They hearabout torture and people doing horrible things to stay safe or alive. All ofthis can take its toll on the staff.

It is important that the reality of the intensive work and longer termrelationship with GAR families be acknowledged and that CSS staff be



actively supported to work through the “vicarious” trauma that the work cancreate. This can be done individually through the individual SPO EmployeeAssistance Programs (EAPs) or as a team with outside expertise. Currentlyat least one site is getting pro-bono support for the time being, but, as withsuch support for GARs, this can be withdrawn whenever the agency changesit priorities.

Recommendation #21: Include funding for professional support for staff todeal with the vicarious trauma they experience as part of the daily work withGAR families in CSS budgets.

5.6.8 In-Home Visiting

Staff safety concerns have prompted some SPOs delivering CSS to createpolicies that either require two people to visit GAR families in their home orthat no home visiting will happen. Other SPOs have no such policies as yet.Staff safety is a real and important issue that must be balanced with the CSSprogram goals and service values/principles.

As CSS is intended to be a responsive service that supports GAR families inmany ways including going to their homes, it is important that this flexibilitynot be lost. In home visiting is the hallmark of many community basedprograms such as nursing home care, Children’s Aid, mother and child programs, and community mental health ACT teams, public health visitorsetc. Indeed, LSS coaches still go into homes alone in many cases. In thisinstance it is not clear why CSS staff might be at more risk than these otherprofessional groups going into homes.

As well, it is expensive for GAR families to travel in the community, so whileit might be argued that asking families to come to the office helps them gainconfidence and practice navigating the community, once they are no longerreceiving the RAP stipend, most families will not be able to afford this.There are also some GAR family members for whom travel is not possible,especially older family members. Currently they might keep a child out ofschool to assist them to get to appointments and it is not in CSS’ interests to appear to support such practices. So if families are asked to come to theoffice, minimally they need to be reimbursed for transit costs if they do notalready have transit passes.

There might be a role that the central coordinator can play in assisting theSPOs to scan policies and practices of other in-home visiting programs to



ascertain the range of practice and inform that policies that individual SPOsmight like to put in place for the safety of their clients and staff.

Recommendation #22: Task the Provincial Coordinator to work with CSSCoordinators in an exercise that scans the staff/client safety policies of otherhome visiting programs and ensures that each SPO has a policy in placerelated to staff safety that also addresses the impact this will have on clientgroups such as GARs accessing CSS and how the impact will be mitigated.

5.6.9 Privacy and Confidentiality

This evaluation has been reassuring in terms of the steps SPOs take toprotect the privacy and confidentiality of GAR families. There is one area ofconcern however. Many case managers do their work in the community andoften take phone calls while on public transit or possibly while sitting inwaiting rooms with families for many hours. It is not clear that SPOs haveclear policies about how work can be conducted in public in ways that protectclient privacy and confidentiality.

Recommendation #23: Require SPOs to review their current privacy andconfidentiality policies to ensure that they cover contingencies related toworking in the public arena- on public transit, in waiting rooms etc.

5.6.10 Naming Case Management

There has been some hesitation to name the individual casework of CSS as aCase Management approach to providing service to GAR families - in spite ofthe fact that it bears many of the hallmarks of just such an approach. Thereare advantages to formally identifying CSS as a case management modelincluding: Professional development opportunities sponsored by case

management professional bodies; Learning from the literature/experience of other case management

programs; Creating clearer pathways of support with other case management

programs for special needs e.g. Canadian Mental Health Associationuses a case management model- could they be accessed for some ofthe GAR individuals with mental health issues?

Recommendation #24: Embrace case management as a way to describe thecasework with GARs within CSS and align with other case managementmodels and professionals as a way to further legitimise this function and to



also grow and learn from others outside the narrow confines of thesettlement sector.

5.7 Monitoring and Evaluation

The program management information system for CSS casually known as the“data base” that the YMCA has built to track CSS program information is impressive. The reports that are prepared for the funder have meaningfuldetails. While the funder appears to find the information useful, it is still tooearly to know if the SPOs are really utilizing their site specific information forprogram management.

The YMCA has worked long and hard to create a data base that meets theneeds of the CSS sites as well as the funder. It has plans, once the programis rolled out as permanent, to work with each site to reduce the currentoverlap that exists with other data bases within agencies. It is beginning tooutline some common outcome measures or accomplishments that might betracked by all sites consistently.

When the data base was used as part of this evaluation process, several keythings were learned. In spite of efforts to have consistent utility of the database, there still appear to be variations in how the sites enter data due todifferent interpretations of definitions/categories. There is tracking ofactivities but no units of time associated with the activity so that eachintervention/activity is given equal weight. And while there may be ways ofdetermining which activities are direct face-to-face activities with familiesas opposed to indirect contacts such as setting up an appointment with adoctor’s office on behalf of the GAR, the information is not easily retrieved.

For this evaluation, outcome indicators were introduced so that the impact ofthe CSS pilot on the lives of GARs could begin to be measured. Theindicators closely align with those that are under development in CSS andinclude accomplishments in such areas as: Ability to access services Attendance at LINC/ESL Children/youth school attendance Parental involvement in children’s school Participation in training and/or volunteering activities Retention of LSS skills – tenancy responsibilities, use of transit,

budgeting, grocery shopping English/French proficiency Employment –part or full time



Feeling of safety/security Feeling of belonging Family relationships Access to consistent health care Client satisfaction with CSS worker

At the productivity level the following were identified Cost of CSS per client Right GARs getting the right amount of service Location of service- mobile/desk free

While measures of the outcomes of the capacity building work were notspecifically identified, three (3) warrant consideration from a tracking pointof view: # of calls initiated by community groups that request the expert input

from CSS team about an issue/situation/joint initiative related to accessand equity for GARs in their service (not including languageinterpretation!)

Availability within mainstream organisations of interpretation such thatCSS is not relied on to provide it

Access to priority wait lists, block appointments set aside for GARsetc.

Agreeing on the outcomes that each site will track consistently and enter intoa common data base is a key next step in the development that is underway.Once these outcomes are finalised it is crucial that they become a central andhigh priority feature of the data base. It is time for the data base to movefrom descriptive data to an outcome focus. It is also important that thenumber of outcome indicators is kept manageable and contained to those thatare the most relevant. It is also wise to have a mixture of indicators that areobjective and subjective or based on client self reports to not loose the voiceof the GAR families in the on-going evaluation and monitoring processes.

With the addition of outcome measure tracking to the data base, it will beimportant to review the types of information that are being collected toensure that the data base remains streamlined and useful on a day-to-daybasis to the sites for program monitoring and quality improvement.

Recommendation #25: Have the Provincial Coordinator continue to workdiligently to complete the identification of the central outcome measures for



both case management and community capacity building that will be regularlytracked by all CSS sites in a consistent manner.

Recommendation #26: Report on these measures at least quarterly both inaggregate form as well as by each site so SPOs can note theiraccomplishments and make adjustment where needed.

Finally, this evaluation could not answer any questions related to whether ornot the CSS initiative creates a better, smoother and/or quicker integrationprocess for GAR families with high needs. This is because the evaluationprocess did not include a control group for comparison. As the CSS programstabilises, this broader evaluative or research question is worth answering.It would entail finding a comparator group either from within RAP (i.e. GARssettling in other regions across Canada where there is not a casemanagement model) or from within the PSR stream of refugee re-settlement.CIC Region and /or national office need to consider how such a researchinitiative could enhance the overall settlement process for all GAR familieswith high needs arriving in Canada.

Recommendation #27: Fund an evaluative research initiative that comparesthe settlement achievements of GAR families with high needs with CSSsupports with a sample of refugee families that did not have this opportunity.

6.0 CONCLUSIONSThere is consensus that the CSS program is an important support for GARfamilies and a welcome addition to the continuum of settlement andadaptation services that currently exists. It is rated highly by GAR familiesthemselves as well CSS staff and their community partners. Its justificationfor GAR families with complex high needs is especially clear and the essenceof what CSS offers does not appear to duplicate existing supports andservices. The central coordination provided by the YMCA is highly valued byprogram sites and appears to play an important role in continuousimprovement of the initiative overall. The community capacity buildingelement of CSS is central to its success.

Twenty-seven (27) recommendations are made which, if implemented, couldstrengthen the program overall at the individual sites. Each site has alsoreceived specific recommendations to improve their local operations andincrease their impact. Once the report is tabled, each site will also need to



review the common recommendations and determine what they need to do toimplement them to the fullest. The recommendations also highlight some keyroles that the central coordinator can play in continuing to standardise andstrengthen the model province wide.

This is a new and complex program that is still evolving. As such there is aneed to continually analyse the program, improving it as new learnings occur.The program management information system or the data base can be usedto assist with this as it moves into the next phase which will produce moreevaluative outcome information. However, CSS will need to guard againstbecoming the “answer” for GARs. That is, as helpful and supportive as this program is, whole communities are part of the settlement continuum thatGARs need to access and they need to step up and embrace their roles fully.Only then will GARs have what they need to fully adapt and integrate intoCanadian life. CSS has the necessary components to support this to happen,but it cannot do it all.



Appendix 1



CITIZENSHIP AND IMMIGRATION CANADASETTLEMENT AND INTERGOVERNMENTAL AFFAIRS DIRECTORATE ONTARIO

REGION

CLIENT SUPPORT SERVICES FOR GOVERNMENT ASSISTED REFUGEES

EVALUATION OF THE PILOT PROJECT

INTERIM REPORT

Prepared by:Kappel Ramji Consulting Group

December 15, 2009



Table of Contents1.0 Introduction .................................................................................... ...................... 702.0 Evaluation Process…………………………………………………………………....... 713.0 Need for CSS……………………………………………………………………………. 664.0 CSS Concept……………………………………………………………………........... 67

4.1. Case Management for High Needs Clients……………………………………….... 734.2. Community Capacity Building..............................................................................74

5.0 CSS Implementation………………………………………………………………………755.1. Approach to Province-wide Coordination ..........................................................755.2. Client/Family Based Models ............................................................. ................. 76

5.2.1. Approaches to Service Delivery……………………………………………..775.2.2. Assignment of Staff to Work with Families…………………………………775.2.3. Organisation to Meet Physical & Mental Health Needs…………………..785.2.4. Structure to CSS Initiatives…………………………………………………..79

5.3. Community Capacity Building Strategies …………………………………………796.0 Challenges with Implementation………………………………………………………….807.0 Conclusions…………………………………………………………………………………76

AppendicesAppendix 1: Site Visit Template ...................................................................................82Appendix 2: Site Visit Participants................................................................................85Appendix 3: References and Key Informants ..............................................................88

_______________________________________________________________________________________Kappel Ramji Consulting Group CIC GARs Client Support Services Pilot

70 Final Evaluation Report

1.0 IntroductionThe profile of refugees selected for Canada’s Refugee Assistance Program (RAP) changed with the passage of the Immigrant Refugee Protection Act (IRPA)in June, 2002. IRPA now places an emphasis on protection for refugees asopposed to their ability to resettle in Canada as the primary criteria for selectionof potential government assisted refugees (GARs). The result has been GARswith far greater assistance needs than in the past are making their new home inCanada.

The system of supports and services funded by Citizenship and ImmigrationCanada (CIC) to support GARs, particularly the RAP and Immigrant Settlementand Adaptation Program (ISAP) initiatives, have been challenged to meet thecomplex needs of resettling GARs. Nationally, RAP added a Life Skills Support(LSS) component to RAP to ensure that GARs have the basic skills to cope withdaily living in western and urban environments. But gaps are still evident in theability of GARs families to effectively deal with all their physical and emotionalhealth needs, gain necessary English/French language skills, and navigatewithin the complex system of supports and services in their new communitiesthat cannot always understand nor respond to their situations appropriately.Many GARs families, following the intensive RAP support for the first 2 monthspost arrival, were not adapting as well as had been hoped. As well, mostsupports provided to GARs are targeted to the adults in the family, primarily thehead(s) of the family, not the children or extended family members.

Following a successful pilot project in 2005 undertaken by a partnership betweenCOSTI and the YMCA of Toronto to test a case management approach with ~ 70high needs GAR families–the whole family, CIC Ontario Region funded all of thesix (6) RAP Service Provider Organisations (SPOs) to develop and deliver asystematic, comprehensive and intensive range of support services to all GARsarriving in Ontario.5 In recognition that many “mainstream” and other settlement services in the six (6) sites where GARs are settling are not able to provideresponsive, appropriate supports and services to GAR families, anotheremphasis of the pilot is to support key community services to enhance theirability to effectively serve GARs. Finally, funding was also allocated to the YMCAToronto to coordinate provincially, the development and implementation of thesemodels.

Referred to generically as Client Support Services (CSS), the pilot has beenunderway now for 1.5 years.6 At this juncture, CIC has contracted Kappel RamjiConsulting Group to facilitate an independent qualitative evaluation of the pilotincluding the coordination function to:

o Assess each service delivery model;

5 The exception was in Toronto where not all GARs could access the new program due toresource limitations.6 The London SPO just began to provide direct services to GARs in Fall 2008.



o Identify the strengths, weaknesses of each; ando Identify potential changes to each that could be made to increase

the efficiency and/or effectiveness of service delivery.o Address the question of whether the parameters of the service

delivery framework are the correct parameters and if there areother service delivery models that could be considered.

This is the report of the first phase of the evaluation process. The aim of thisinterim report is not to be analytical, but to describe how CSS is unfoldingincluding the various ways that each SPO has conceived and implemented theirunique model.

2.0 Evaluation ProcessThe overall evaluation of the CSS pilot is being carried out in two (2) distinctstages.

Phase I: Document the six (6) models that are being implemented, theirsimilarities and differences, challenges and emerging PromisingPractices. Also document the coordination role/model. At the end ofthis phase a comprehensive evaluation framework will be finalised toguide Phase II.

Phase II: Evaluate five (5) of the pilots7 including interviews with ~ 150 GARyouth and families and make recommendations for increasedeffectiveness and/or efficiency to the model overall and/or on a site bysite basis. At this time the coordination model will also be evaluated.Information gathered will be used to recommend those practices whichappear to have the greatest success in meeting GARs’ overall re-settlement and adaptation needs.

Phase I ProcessIn Fall, 2008, site visits were made to each of the six (6) SPOs providing CSSprograms and with the YMCA Toronto. Guided by a common Site Visit Template(see Appendix 1), information was gathered about how each SPO isconceptualising their model of CSS and the ways that they are implementing theprogram and services. The primary sources of information in each site were theCSS staff as well as RAP staff. Appendix 2 has a list of key informants who wereconsulted from each site during this phase. Copies of materials such as jobdescriptions, needs assessment tools, periodic re-assessment and exit interviewforms etc. were also collected.

Following the site visit, the consultants summarised the information in a sitespecific template and further validated it with each of the respective CSS

7 Because the London site has just begun its program delivery, enough time has not passed toactually evaluate its results. Therefore it will only be involved in the first phase of the evaluationprocess.



coordinators. Because the coordination role of the YMCA Toronto is morestraightforward and well documented, similar steps were not taken with theinformation collected from them at this stage.

This interim report draws on information collected during the site visits. Theobjective is to describe the models that have been developed and to highlightvariations between the six (6) sites as well as the challenges that are beingencountered. This report specifically refrains from specific analysis –this will bedone at the end of the next phase.

3.0 Need for CSSThe need for an intensive, longer term supportive intervention for GARs familieshas been known for some time. RAP services have always been intensive frontend interventions that support families, mostly the adults, to get established in ahome and connected to on-going settlement services such as HOST, ISAP, LINCetc. The introduction of Life Skills Supports within the RAP continuum ofservices enhanced those skills that families required to be safe in their home andcommunity and be better able to attend to tasks of daily living.

However, it was clear that GAR families were still struggling to attend LINCclasses, make and keep appointments to attend to their myriad of physical andmental health needs, understand how to budget month to month and pay bills,and deal with all of the emotional/adjustment issues related to settling in a newcountry. These issues were being manifested in family disruption, depression,increased marginalisation and social isolation instead of integration. Within theCIC “family” of services, ISAP services were articulating that they were unable toadequately meet the needs of GAR families. HOST was having trouble findingmatches for GAR families and LINC could not meet the needs of illiterate GARswho required English skills. Furthermore, the broader community services inmost sites where GARs are settling are also not able to communicate with orsupport GARs attempting to access their services. This was especially evidentwithin the health care sector.

The YMCA Toronto, in 2004, responded to a call from CIC Ontario Region for acase management pilot project to determine what outcomes could be achievedfor high needs GAR families if more intensive supports were provided for up toone year post arrival in a client centered approach. This pilot demonstratedsome key promising practices that CIC then built on with the establishment of theCSS pilot.

The broad goals for the CSS pilot are to: Create a client support program that will enhance RAP and

facilitate better transition to settlement and community services forGARs;

Achieve a better settlement experience for GARs with more positiveoutcomes;



Follow-up with RAP clients and track their progress by assessingneeds on an on-going basis;

Test local models tailored to each community’s needs; Identify core program components and document good practices.

4.0 CSS ConceptClient Support Services is two pronged – first is the longer term casemanagement or individual, client centered support for GAR families. Thesecond core element of CSS is a range of initiatives that build communitycapacity through systemic advocacy and change both within the CIC “family” of services as well as in the broader systems of support in the community so thatGARs can use the existing set of services in the community.

4.1. Case Management for High Needs ClientsWhile the pilot is named Client Support Services, there is at the heart of it anotion of Case Management. This is due to the central philosophy of the servicethat, unlike RAP that is driven by common elements that are provided to all GARfamilies, CSS was intended to be client centered/driven. That is, while certaininterventions or activities might be offered to most families, the direction of theefforts was towards the individual family’s needs, goals and aspirations for the future.

Case Management is used in many settings for many client groups, those withcomplex needs and those with more moderate needs. The following definitionbegins to highlight the common elements of most case management initiatives,regardless of the target group.

Definition of Case Management

Case Management is a client-centred strategy for the provision of quality health andsocial services. Case Management is used to manage the provision and coordinationof care across the continuum and to balance potential client outcomes with effectiveuse of available resources.

Services target a specific population: Case Management can be of particular benefitto clients and their families when the following exists:

- Complex physical needs

- Complex mental health needs

- Complex psychosocial needs

- Potential or actual high care cost

And, who also need assistance in using the service delivery system effectivelybecause of:



- Inability to access and coordinate services on their own behalf

- Compromised or reduced access to informal support systems

Alberta Health services Chinook Health http://www.chr.ab.ca/bins/index.asp

Key Informants (KI) from the Settlement, Community Mental Health and ViolenceAgainst Women sectors (see Appendix 3 for list of KIs) confirmed that thisdefinition is common. They also concurred that the following characteristics aretypical of case management models for high need clients:

A Plan developed with the client with goals both short and longer term- based on an in-depth, holistic assessment of needs, as well ascapacities and aspirations

Mobile/desk free service delivery –This allows for accompanyingclients to appointments , monitoring and supporting difficult to serveclients who might not be eager to see their worker , and inhome/community based assessment of needs and accomplishments

Individual supports in the community –with such things as activities ofdaily living, setting and keeping appointments and mentoring

Linkages to and coordination with other supports in the community –with extensive follow up to ensure that the services are meeting theneeds of the client

Supportive counseling –but not clinical or therapeutic counseling. Ifthere is a need for in depth counseling, clients are referred for this.

Heavily relationship based- that is, a respectful relationship with aconsistent worker fosters trust and is the basis on which clients areable to take risks and act on their goals.

Other observations about the efficacy of a case management model for highneed GARs include:

When privately sponsored refugees (PSRs) are reunited with families,even if their needs are high, families will often play an important role intheir settlement and integration process, perhaps lessening the needfor as many other supports.

The RAP process provides insufficient time for a formal, in depthassessment of needs for the whole family and so short or long termplanning with follow-up is not possible.

Given their pre-arrival experiences, many high needs refugees arefearful of governments and their services - so extra supports alongwith continued orientation is needed to be able to follow through withreferrals

Case management allows for attention to be paid equally to assets andcapacities as well as needs. (VAW)

4.2. Community Capacity BuildingThe other major focus of the CSS initiative is community capacity building and



strengthening. As has been noted, the overall purpose here is to ensure thatGARs can access needed services from within the CIC family and elsewhere thatare sensitive, accessible, appropriate and responsive overall. The general typesof activities that are being undertaken include:

Education of various key stakeholder groups that do not know aboutGARs, their challenges nor the supports that are being provided throughSPOs.

Joining key community networking groups to bring the voices and issuesof GARs to the policy and other decision making tables

Collaborating with community partners to enhance programs or developnew initiatives that will meet the unique needs of GARs as well asmodeling how to work effectively with GARs.

Divesting from those initiatives that can stand alone and continue to beavailable within the community for GARs and other target groups thatmight need them.

5.0 CSS ImplementationThe overall approach for this pilot is to fund local SPOs in the six (6) communitieswelcoming GARs to develop unique client support models that share somecommon features or approaches and are working towards the same overallgoals. As well, there is a central coordination function provided by the YMCAToronto. Site visits carried out in Fall 2008 provided insight into the models thatare currently in place. We will start with a description of the coordinationfunction.

5.1. Approach to Province-wide CoordinationThe YMCA Toronto (YMCA) coordinates the CSS pilot across the province.While it has no legal authority to make any decisions that bind CIC, in its role asthe CSS coordinator, the YMCA is responsible for negotiating the contracts witheach site and flowing the funds from CIC through to the site for their monthlybilling. As well, the YMCA has the following additional responsibilities:

Budget management – processing monthly billings and supportSPOs to fulfil their contractual agreements with CIC.

Tracking and reporting–reviewing regular monthly reports submittedby SPOs, and analysing them for common themes, challenges andhighlights and preparing consolidated reports for CIC.

Database development and information sharing- developing andimplementing a common data base capturing consistent informationfrom all sites so that the overall project can have access to up todate data for decision making and policy change

Relationship management –providing regular opportunities for jointlearning and training, researching information to support the work ofsites, troubleshooting around issues that emerge, regular site visits



to ensure in depth understanding of the various models beingdeveloped, their strengths and challenges, advocating with broadergroups (e.g. IFH) for changes that the data supports.

Project evaluation - developing a common evaluation protocol forongoing monitoring of quality of services and measurement ofoutcomes. This area of work is just beginning to unfold.

Support for innovation – collaborate with SPOs to understandpromising practices, support each to learn from their peers, andenhance programs as needed.

The overall approach to coordination then that the YMCA uses is collaborativeand supportive. It fulfills its functions not through wielding authority but throughbuilding strong, mutually beneficial relationships with SPOs and especiallycoordinators of local CSS projects.

Perhaps this is best typified when looking at how the database has beendeveloped. A central element of the CSS project is the detailed andsophisticated database that has been customised to collect and analyseinformation about the GAR families being served by the pilot but also to track theinterventions with families as well as the short and long term plans that are beingworked on and outcomes being achieved. This Fall, the 4th “edition” of the database was launched. Each edition has been developed through in depthdiscussions with each project about what is working and not working in theprevious edition. Each question or concern that is raised is responded tospecifically and if the desired change is not made an explanation is given as tothe rationale. This attention to detail as well as the respect and mutuality of therelationships is at the heart of the CSS coordination model.

5.2. Client/Family Based ModelsThe six (6) pilot sites have much in common in terms of the general thrust ofeach of the CSS models. Following are the common elements that are evident:

A client centred approach, building on the uniqueness of each family’s needs as well as capacities and fosters a strong respectful and trustingrelationship between the worker and family

An assessment process and goal oriented plan that encompasses theneeds of each family member

Consistent staff working with families Services that are provided both in the community as well as in house Service coordination that results from referrals to needed supports for

GARs Accompaniment of GARs to appointments in the community Initial intensity soon after arrival with much tapering off after GARs are

able to handle more on their own Specialised programming for sub target groups e.g. Children, youth,



women, elders, etc.

When this list of features is compared to the information about case managementfor high needs groups, it is clear that this aspect of CSS is well aligned within acase management approach.

However, while the overall case management philosophy seems to be common,there is a good deal of variation in the ways that the services are delivered.

5.2.1. Approaches to Service DeliveryThere are two main approaches to the delivery of services to GAR families.

Many are delivered one-to-one. That is a worker works directly with afamily or distinct family member, supporting them to achieve family orindividual goals. The worker generally starts by getting to know the family,its needs and capacities, and then develops some goals with them. Thenthe worker goes into the home or meets the family in the community at anappointment and works on issues unique to the person/family.

However, most sites have also piloted initiatives that are group based e.g.a support group for a specific group of women who are experiencingdepression so they can learn about mental health issues. Other one-offgroup events have also been held such as a workshop on sexual healthfor young people. These group based events are predicated on an indepth understanding of the needs of the target group and efforts toencourage mutual support and learning as well as reach more peopleeffectively and efficiently.

5.2.2. Assignment of Staff to Work with FamiliesIn all sites frontline CSS staff are specifically designated to work in the program-that is they do not have dual responsibilities as well in other programs e.g. LSSor RAP. This keeps the lines of responsibility quite clearly delineated andreduces confusion and overlap of job responsibilities. Most sites report a gooddeal of time has been spent on ensuring that roles are clear when working withGAR families, particularly those sites that have in-house RAP, ISAP, HOST andLINC.

Most sites assign a specific worker to each family to work holistically - i.e.assess and address all the needs of the family members. Two variationsto this approach are being piloted. In two sites, youth (generally from 16-24 years of age) have workers who are uniquely working with those in thisage group. While they coordinate their work with what is happening withthe rest of the family, they are also working on independent goals with theyouth.

Another variation is that one site has staff who manage need areas, notfamilies. The need areas are health, mental health, education/employment



and child safety. In fact, there is no one person who manages the case inthis site since all the staff can work with the family. Families who haveneeds in all four (4) areas will get to know all four (4) staff, while thosewho do not will only work with the necessary ones.

The staff hired to work in the CSS programs are selected for two differentreasons. Some are hired with a primary emphasis on specializedoccupation-specific skills which might be technical and/or clinical in nature(e.g. Trauma counselling, Art therapy, etc). Others have been chosen fortheir skills in general case management as well as their fluency inlanguage(s) that match the client group. Those staff whose languagedoes not match those of the GAR families work with interpreters. Thosewhose language skills match the clients’ are able toconnect with theclients directly until the GAR profile changes and then they too useinterpreters for their work.

5.2.3. Organisation to Meet Physical & Mental Health NeedsIt is also worth noting that, in many sites, at least at the outset, there are somecommon content or need areas that are emphasised. At the top of the list are thecomplex medical and mental health issues that many GAR families arrive with.To meet these needs, sites have organised differently.

While CSS generally begins to work with families as RAP and LSS arewinding down their involvement, when it comes to complex health careissues, CSS can get involved as soon as is required. Several of the CSSsites had one staff person on the team who has as all or part of his/her jobthe responsibility for linkages with health care. This has taken severaldifferent forms:

- Arranging for in-house clinics with Public Health and/orphysicians;

- Connecting with key health care provider organisations in thecommunity to negotiate speedy assessment and treatment forGARs

- Working with community partners to establish a clinic that isclose to or onsite at the Reception Centre that can attend toGARs’ health care needs as soon as they have arrived.

- Monitoring all GAR families’ health care needs, facilitatinglinkages to specific health care providers, ensuring interpretersare available to accompany families to appointments andfollowing up after appointments to ensure that individuals takethe next steps that have been recommended.

Most staff, in the initial assessment phase, will aim to understand howeach family member is coping with the unique circumstances that theyhave experienced. To address the complex mental health issues thatmany GARs have, there are also several different approaches

- An assigned worker who talks with families in an educational



way about stress, the relationship between mental and physicalailments and when families are ready refers them to a roster ofmental health professionals to assist the individual. In one site,a Trauma Counsellor has been hired on the CSS team.

- Case workers, as they get to know the family, begin tounderstand some of the mental health challenges and referindividuals to community supports.

- Art sessions where GARs can engage in various artisticexpression is also another intervention being used in one site, toaid with the identification of individuals who may benefit from areferral to a mental health professional for extra support.

- Educational groups where individuals with similar experiences,ethnocultural; and/or linguistic background might come togetherto learn about how to manage stress and through the process,begin to explore their issues in a safe and supportiveenvironment.

- Some sites have arranged of mental health workers orcounsellors to be on site at regular times so that GAR individualcan explore these sorts of issues in a familiar and safe setting.

5.2.4. Structure to CSS InitiativesWhile most CSS initiatives have a clearly delineated structure and process, thereare some variations.

It appears that all sites have a formal needs assessment and goal settingprocess in place with families.

However, not all have formal, periodic times when plans and goals are re-evaluated and adjusted based on the accomplishments to date. As well,some programs have formal exit interviews, while others do not.

There are various ways of thinking about “discharge” from CSS. At some sites GARs families exit the program when there is mutual agreement thatthey have achieved their goals and no longer need on-going support. Inthese cases, if the discharge happens before the first year is up, familiesknow that they can still be back in touch with the program if somethingchanges.

Other sites do not discharge anyone until the year is up. This is to avoidhaving to re-open the case should needs re-emerge.

One site is working on a 2 year model- that is, their cases can stay openfor that length of time even if there is not much contact with the family.

5.3. Community Capacity Building StrategiesThe Capacity Building component of CSS is clearly a part of each site model.There is evidence of:



New programs for GARs that have been developed with communitypartners to be delivered in a partnership modality with the SPO.

New programs for GARs that have been developed in a collaborative waywith SPO involvement and then spun off to be the permanentresponsibility of the community organisations.

Educational seminars, meetings, lunch and learns to inform keycommunity stakeholder groups about GARs, their needs, their capacitiesand the ways the contributions that they can make to enhancing their livesand well being.

Individual meetings with ISAP and other key settlement agencies inneighbourhoods where GARs are settling to ensure that they can acceptand respond to referrals of GARS appropriately.

Conference presentations where large numbers of settlement workersand/or other key stakeholder groups can be reached with the messagesabout the needs of GARs for unique services.

While all of the sites have a deliberate focus on capacity building within thehealth sector, other targets for change included CIC funded programs as welle.g. Language Assessment Centres and LINC Classes, Job Search Workshopsand ISAP. Additional sectors where capacity building efforts are underwayinclude examples like food security, justice system, school system, postsecondary education and training, employment, parks and recreation, etc.

6.0 Challenges with ImplementationDuring the Site Visits, informants were asked to identify some of the keychallenges that they are facing as they implement the pilots. Following are theissues they have been identified so far.

Community capacity building is frustrating since rewards or outcomes arefrequently very modest and slow to realize. While this is typical ofprocesses that require participatory approaches with a set of multiple anddiverse stakeholder groups, sustaining interest and momentum requiresan exceptionally passionate group of staff as well as strategic, thoughtfuland nurturing leadership at the management level.

Communities still do not have the range of LINC programs that GARsseem to need or require. For example, there is little tolerance for GARswho are not in regular attendance at LINC classes or who are missingsignificant portions of class time. As well, for those GARs who areilliterate in their mother tongue, LINC is not able to always provide therequired level of language training. Finally, in some sites there are issueswith the type of child day care spaces that may or may not be available forGARs who need to attend LINC.

In some communities there has been a growth in settlement servicesrecently due to the infusion of COIA funds. While in many instances thisadditional capacity was well overdue, there is a lack of clarity and



overlapping mandates in the community. This has resulted in competitionbetween agencies and the extent to which continuity of services for GARsmay be getting compromised.

Some sites are questioning the need for a longer CSS program for a subtarget group of GARs who, within the first year, have still not been able tomeet some of the basic milestones that others have in terms ofindependence, problem solving, financial security etc. They arewondering whether for this sub-target group a two (2) year program isrequired.

Interpretation budgets are not always adequate to purchase the type ofinterpretation that is required for medical and legal appointments. Theconcern is that “lay” interpreters may not be appropriate to interpret formedical and legal appointments. While they are secure in the concepts ofconfidentiality, they are not always able to adequate understand thecontext and content to successfully interpret for families. The CSS budgetline in some sites does not allow for the extent of medical interpretationthat is required

The budgets also do not have enough funds for transportation costs inlarge cities where getting around on public transit to necessaryappointments can severely limit a family’s ability to take care of basicneeds such as food. One site has the funds for 15 transit passes that ituses for various families in financial distress in turn, but it does hamper afamily’s abilities to attend appointments.

For several SPOs, there are significant space issues that the introductionof CSS has highlighted. While CSS is a community based “desk-free” program, all staff still need a base at the agency. Space requirementshave grown as a result of CSS due to need for staff team meetings,private space to meet with those clients are who are able or prefer tocome to the agency for supports, administrative functions like data entry,spaces for group meetings/workshops etc. Several of the programs arelooking for other space solutions already,

7.0 ConclusionsThe CSS pilot programs are well underway. There appears to be a common setof principles or values that both position the direct services aspect of CSSsquarely within a case management framework. As well, each one is wellthought through and there are clear rationales for the ways that they haveestablished their delivery processes. The community capacity building aspect iswell entrenched in each model and there is discernable activity with keystakeholders. In addition the supportive coordination model and the detailedsophisticated data base that has been developed all nicely set the stage for thenext stage of evaluation.



Appendix 1: Site Visit Template



Client Support Services EvaluationWorksheet - Site Visits Fall 2008

1. Agency Name: _________________ 2. Contact Person(s) Telephone :

3. Program Details:

Goals/Objectives of CSS (per CA)Changes to objectives since inception of program

Target GroupHow families/clients selected for CSSHow would you describe the target group for CSS? Any sub-groupings that have emerged formally or informally?

Referral/linking processWhen in RAP process is family linked to CSS worker

Program Delivery model- What are the specific components- How is the overall “case” coordinated? Probes re consistent

staff/ ensuring↓ duplication - How frequent are interactions?- How/where do interactions occur?- How are individual family members needs distinguished ?- How are other components of RAP distinguished from CSS

(esp. LSS) & coordinated with RAP?- How service is made accessible (language capacity of workers)- -notion of “systematic” –how are they systematic ?>- How does your model empower GARS /promote self

management

Duration{extent to which there are phases–intensive, moderate, light?)“Intensive” notion- how does this apply?“differential” services based on needs ?

Where clients Referred for on-going settlement support

Outcome Measures–how do they track success?- Adaptation & adjustment to community faster & more smoothly- Ability to deal with life challenges- Personal development & growth- Established social support networks- Knowledge & ability to access & use local services- Specific access to emotional & mental health support- Progress towards self sufficiently–sense of direction/ownership

.



of future plan- Physically, mentally & socially balanced & adjusted (from Y

Proposal & Y CA )

Evaluation/Results–how do they know they are successful?

Community Links - what are there activities to strengthen thebroader community? Who does them?Results –how do they know they are successful in strengtheningthe community?

- Awareness of refugee issues & needs by broader based services- Knowledge & ability to access & use local services- Specific access to emotional & mental health support (From Y

Proposal & Y CA)

Best Practices/ Key Features

Major Challenges/Gaps

# FTEs- pay scale/ recruitment strategies/ challenges facing the

staff/volunteersRole overlap issues with other RAP workers?

Other info.



Appendix 2: Site Visit Participants



YMCA Toronto

Katarina Canic Project Manager

Ali Manesh Data Integrity Specialist

Hamilton SISO

Marufa Shinwari Project Lead/Coordinator

Pradeep Navaratna Life Coach and Personal Mentor

Teresa Simms-Obidi Life Coach and Personal Mentor

Janette Godwin Life Coach Outreach Counsellor

Hana Pinthus "Healing and Counselling Through Art"Counsellor

Andrew Ostapeanko Assistant Counsellor

Kitchener Waterloo Reception House

Mira Malidzanovic Program Director, Reception Centre

Lynne Griffiths-Fulton

Project Lead/Coordinator

Hadembes Yebetit Case Worker

Wilma Laku Case Worker

Bashir Shahbaz Case Worker

Rojas-Perez Pamela Case Worker

COSTI

Yasmine Dossal Director - Interim Project Lead

Elisa Oncel Youth Support Worker

Brigita Katona Support Worker

Fatemeh Veisi Support Worker

Myriam Garcia Youth Support Worker



MCC Windsor

Nermin Basic Project Lead/Coordinator

Ana Milojevic Support Worker (Employment-PT)

Patricia Carter Support Worker (Health)

Radenko Curguz Life Skill Enhancement Case Worker (PT)

Catholic Immigration Centre, Ottawa

Chamroeun Lay Manager, Reception House

Lucila Cabrera Project Lead/Coordinator

Livingstone Saw Community Integration Worker - English

Jose Mukesa Community Integration Worker - counselling;african

Breanne England CIS Counselor -youth

Radia Fadel CIS-Health Worker

LCLLC, London

Sherin Hussein Settlement Health Worker

Jan Jasnos Project Coordinator

Jennifer Outreach/ Education Worker



Appendix 3: References and Key Informants



Key Informants

CIC National Headquarters Ian McGrath, Strategic Policy AdvisorCIC Toronto Grace Hsu HolmesCIC Prairies Joan PullenCanadian Mental Health Association Kathy Chau, Manager of Court Support

and Diversion ServicesImmigrant Support Services Vancouver Gulalai HabibInterim Place Women’s Shelter Priyanka Seth, Program Manager, Malton

Site

References

Alberta Health Services Chinook Health; What is Case Managementhttp://www.chr.ab.ca/bins/index.asp

Alberta Alcohol and Drug abuse Commission ; Making the Link : Case Managementand Concurrent Disordershttp://www.aadac.com/documents/making_the_link_case_managment_and_concurrent_disorders.pdf



Appendix 2: CSS Evaluation Framework



Client Support Services’ Evaluation Framework Key Questions (DRAFT, Oct 30, 2008)

Key Question Indicators Data Source“How well is the CSS modelworking?”

1. How effective is CSS for GARswith high needs?

Criteria/guidelines for differentiating GARs’ level of needs are implemented

GARs receiving CSS are high need per profileinfo

Differential level of intervention based on needsof GARs–ie. Right service for the rightclient/need by the right service provider

Promising practices evident

Needs addressed/ Goals set/ Progress beingmade

GARs’ satisfaction

Staff/peer service provider satisfaction

CSS components are all within CIC mandate

SV #1: CSS team

Y; SV #2: CSS team;GARs Int

SV #2:CSS team,Partners; GARs Int

Y; SV#2:CSS team

Y; SV#2: File RevGARs Int

SV#2: CSS team;Partners

SV #2: CSS Coord;SPO ED; CIC

2. How is CSS distinct from RAP,Life Skills and ISAP?

Distinct criteria for admission

Clear/distinct criteria for discharge/referral toISAP/other programs

Unique staff roles/responsibilities

Team work/collaboration with other peerprograms

Working in partnership with other CIC fundedprograms

Management/team clarity about distinctness,synergies and potential overlap/conflict

Management/team efforts/recommendations foraddressing effective transitions within servicespectrum

SV#1: CSS Team

SV#2: ISAP/otherpartners

SV#1: CSS Team

SV#2: ISAP/otherpartners; GARs

SV#2: ISAP/otherpartners

SV#2: CSS team

SV#2 CSS Coord;RAP Mgr

3. What are gaps in CSS? Unmet needs of GARs–ongoing/ unresolvedissues beyond 12 months; issues related toaccess to culturally and linguistically appropriateservices (including Francophone support)

SV#2: CSS team;Partners, ISAP/ otherCIC colleagues; SPOED; GARs



Key Question Indicators Data Source

4. How have communitypartners/services changed to bemore responsive as a result of CSSinterventions?

↓ Wait times/ ↑ priority access for GARs Integrated systems–intake/assessment/ referral Evidence of↑ Cultural competence Reduced attitudinal barriers Appropriate accommodations being made

Joint ventures–RAP / community

SV#2 CSS team;Partners; ISAP/ othercolleagues; SPO ED““

SV#2 CSS Coord;Doc Rev

“How effective is the current approach to province-wide coordination??5. Are the core components ofproject coordination being managedeffectively & efficiently?

Effectiveness of:- Project Delivery & Support for Innovation- Budget mgt- Tracking & Reporting- Db development/maintenance- Communication/ info sharing/relationship

management- Eval Framework Dev

SPOs’ and funders’ level of satisfaction

Coordinator’s insights re. limitations Recommendations for improvement Unmet needs for SPOs

SV#2 CSS Coord &team; Y team/ Coord;Doc Rev

SPO ED; CIC

Y; CSS Coord““

6. What are the benefits of acentralized approach tocoordination now and in the future?

Responsiveness/timeliness of inputs

Evidence of growth of “Community of Practice”

Cost of centralized vs. decentralizedcoordination/support

Knowledgeable, resourceful, effective outreachskills = Capacity

Value added Anticipated role in the future

SV#2 CSS Coord &team; Y team/ Coord;

SV#2 CSS Coord& team; Y Coord;CICCIC

CIC; Y; SPO ED“

“

“Is CSS being delivered effectively and efficiently by Project Sites?”7. Are the core elements of CSSbeing implemented effectively?

Desk free/mobile service

Needs Assessed Access to community resources facilitated Settlement goals (short & long-term) set and met Coordinated interventions - who/how Client-centred approach–what/how; issues of

cultural & language sensitivity Intensive support–freq/type Continuity of staff working with family

SV #1: CSS team

SV#2: File Rev; Y;GARs; Partners“”””

””



Key Question Indicators Data Source Follow up–when/how Focus on adults, children, youth and families i.e.

whole family and individual needs within family

””

8. What are the consistenciesbetween SPOs?

Same level of service for similar level of need % admissions % discharged at 12 months % carried over into Yr 2 # clients/FTE Frequency of contact ie. # contacts/client % who achieve standards for needs

assessments, short-term goal setting, long termgoal setting

% in-home/onsite/telephone support

Y; Doc Rev“”““’’’”‘“

9. How responsive are SPOs toGARs needs?

Evidence of- Innovative initiatives–based on

analysis of aggregate needs- Group based activities

Community partnerships that facilitate speedyreferrals/enrolments in needed programs

Systemic change efforts–focus onHealth/Mental Health, Education, Employment,LINC

SV #1: CSS Team

GARs Int; SV#2: CSSCoord; ISAP/otherpartners; SPO ED“

“What difference does CSS make to GARs’ resettlement in first year in Canada?”10. How has CSS affected theretention of RAP Orientationinformation?

Evidence of appropriate/enhanced- Life skills–personal space/ in-home,

building, neighborhood- Time management- Money management- Parenting skills

Staff/peer service provider satisfaction

GARs Int; SV#2: CSSCoord/team;ISAP/other partners;

SV#2: CSSCoord/team;ISAP/other partners;

11 Are appropriate supportsprovided in response to key needs?

% GARs have primary health care practitioners % GARs visit/follow through with primary care

practitioners appropriately and in timely manner % Culturally appropriate mental health support is

in place for GARs who need % GAR Children/youth have been enrolled in

appropriate class/academic placement % GAR Children/youth are attending school

regularly Advocacy/support re. education related issues

for children % GAR adults with language/literacy needs are

attending LINC/literacy classes

Y; CSS team; GARs;

“

“

“

“

“



Key Question Indicators Data Source GAR adults have been assessed for skills/talents

and supported for skills training, job search,volunteer placement or economic development

% GARs who are in skills training, volunteerroles, employment or business

GARs’ satisfaction Staff/peer service provider satisfaction

“

“

“GARs IntSV#2: CSS team;ISAP/other partners

12. Has GARs’ personal development/growth been effectivelypromoted?

GARs are- Independently accessing services–self

reliance- Exhibiting Self confidence- Problem solving independently- Showing familiarity with community

resources/ knowing where to go for help- Participating in community activities–

school/neighborhood/ faith/ cultural Evidence of support network/peers/friends GARs report↓/little isolation/frustration GARs report sense of community/belonging GARs report feeling safe and protected

GARs Ints; SV #2:CSS Team;ISAP/other partners

““““



Appendix 3: Data Gathering Tools



Evaluation of CIC’s Pilot Project –Client Support Services to Government-Assisted Refugees inOntario

Interview Guide–GARS from the Client Services Support Project

1.0 INTRODUCTION[Interviewers: The following introduction has been developed for you to use as a guide. You may need toadjust the wording depending on the family and context - especially if you are translating into anotherlanguage. However, key/minimum points to cover are:

o Involvement in the interview is voluntaryo There are no right or wrong answers –we want to understand how they think about or view the

experience of receiving from this program to re-settle and adapt to Canadian lifeo There will be no breach of confidentiality]

You will need to go over key points from this information on the phone when you set up the appointment,and then review in more detail at the beginning of the interview.“ Hello,We are talking to some refugee families who have arrived in Canada over the last 1–1.5 years and havebeen receiving support from ________________ [use agency name and/or name of worker(s) ]who hasbeen helping you resettle here in ____________ (name of city). We are talking to these families to try tounderstand what it’s been like so far to live in and get used to being in their new country, the types of problems they might have, where and how they get the help or support they need and the role that theagency and its workers (use name of agency and worker again ________) has been playing. Byunderstanding these issues better, it is the aim of the agency (use agency name ______________) tofind better ways of supporting families to cope with adjusting to these new conditions - of living in awestern city like this one.

We will need to meet for approximately one hour to talk about this. It is preferred if we meet in yourhome and I hope some of the other members of your family/household can join us. We can decide on atime that is convenient to youand when I’m available.

You may decide what you want to share. There are no right or wrong answers to what we’ll be discussing. Also, you do not have to comment on any issues/topics that you are not comfortablewith. You are free to withdraw at any time during this process …and you do not have to worry that it’s going to affect you negatively in any way…if you are receiving services/support from the agency, you can be assured that will continue as usual.

While we’re talking, I will be writing down notes so that I can remember what you have said but I wantto assure you that what you share with me about your experience in receiving support from (use workerand agency names ________) will be kept confidential. I will not be writing your name down onthese papers and when your experiences are included in the report, you will not be identified ashaving said certain things. I will sign a promise of confidentiality and give you a copy.

I’m happy to answer any questions you have before we begin. Are you comfortable with proceeding? “-----------------------------------------------------------------------------------------------------------------------------------------------[At this point, you can provide the family/interviewee with a signed copy of the statement of confidentiality.You, as the interviewer, also need to check that all of the key areas above have been covered off and signbelow]

1.1 Date: ___________________1.2 Signature (Interviewer/Local Consultant):_______________________



1.3 Primary Contact/Head of Household Present: __________________[initials only] 1.4 CaseNo.________

1.5 City:____________________1.6 No. of additional family members present : ________________

1.7 Language of Interview:In Mother tongue of client (specify: __________) not in mother tongue of client(specify:______________)

2.0 BACKGROUND/PROFILE DATA

Arrival in Canada

2.1 How long have you been in Canada now?

2.2 Where are you originally from?[[Note Try and obtain a brief overview of “their story” of where they lived, for how long, their living conditions and reasons for fleeing home country- this is an important “warm up” question which sets the stage and rapport with the family]

Demography of the family

2.3 I want to understandyour family’s background a bit more … Who are the members of your family?

Name(initials)

Sex/AgeRole

Major activity/involvement of each member at present: Attending School? Grade? Attending LINC/ESL? Employed?–Where? Part or full time? Training Program? Where? Part or Full time? Volunteering? Where? Part or Full time?



3.0 WORKING WITH CLIENT SUPPORT SERVICE (CSS)Getting Connected[Note: the answers given are not to be read to people. Rather, write down their responses and then lateryou can go back and code their answers by ticking the appropriate box].

3.1. When did you first meet (name of CSS worker(s): ___________________)?□ While in hotel□ While in reception centre□ When in own home □ Other ____________

3.2 What was your understanding about her/his/their role? How were they going to helpyou?

3.3 How long did you think s/he/they would be supporting your family?□ <3 months□ 4-9 months□ 9- 12 months□ over 1 year □ as long as I needed□ didn’t say□ Don’t’ remember

3.4 Are you still working with (name of CSS worker(s): ___________________? □ Yes □no

3.5. How did/do you contact him/her/them when you had a concern or needed their help?□ went in person to agency office□Telephoned; □ email□ did not have to call –they came themselves to check in□ Other _________________

3.6. Where would /does he/she/they usually meet you?□ Home□ agency office□ coffee shop or another community location□ other ________________

3.7. How often are you in contact with the CSS staff?□ every couple of months□ every couple of weeks□ once a week□ few times a week□ daily□ other ___________________



4.0 NEEDS ASSESSMENT/ GOAL SETTING

Focal Areas Covered

4.1. When the CSS Worker (use name_________) has come over to work with you/your family, what hasbeen the focus of attention? What are the goals / areas of concern that you have been spending timeon the most?[Note: Ask this question first to the head(s) of household and also to others present]

4.2. What are the goals/areas of concern affecting the children or other members of the family that theworker has also been helping with?

4. 3 When people first move to the west from other parts of the world and have to get used to living in aCanadian city like this one, there are many new skills that they find they have to learn about, new thingsthey have adjust to and accomplishments theyhope to achieve. I’m interested in knowing what you think are some of your main achievements in adjusting to life in Canada–in other words, what are thethings that you have been able to adjust to quite well or skills you have learned? ”

4. 4 Now I’dlike to ask you about how you and your family are adjusting in some specific areas of your dailylife

[VERY IMPORTANT Go through each section in the tables below The categories are for codingpurposes - or possibly to use as probes if they do not understand the question- but we are interested intheir spontaneous answers most of all]

Also- whenever you ask someone “Why do you say that? You can also ask them to give an example or tell a story about something the might have happened that causes them to answer the way they did.]



4.4.1 Housing - First about where you are living–how is this arrangement working out for you/your family?[The categories are for coding purposes - or possibly to use as probes if they do not understand thequestion- but we are interested in their spontaneous answers most of all]

Very comfortable Ok/ Not bad Uncomfortable/ Need to move

Why do you say this?[Whenever you ask someone “Why do you say that? You can also ask them to give an example or tell astory about something the might have happened that causes them to answer the way they did.]

4.4.1.1 For many families one of the things that is hard to understand and remember is when the rent hasto be paid, how much it is each time, who to pay it to and where, etc….how has it been for you to manage your responsibility as a tenant?

Very regular/on time Ok/ Sometimes confused Unable to handle/ Need help

Why do you say this?

4.4.1.2 What supports do you still need with housing?

4.4.1.3 Who helps you with housing now?□ n/a

CSS workers/team Someone else from RAP/agency Another worker Family/friends Other/neighbor/landlord or superintendent No one



4.4.2 Life Skills - On a day to day basis getting groceries and adjusting to types offoods, all the choices/varieties and the experience of going to the supermarket isa big area of learning for most newcomers to Canada. How comfortable are youwith shopping on your own?

Very comfortable on my own Ok/ Sometimes confused Need help


4.4.2.1 What supports do you still need with going shopping for groceries?

4.4.2.2 Who helps you with this now?

CSS workers/team Someone else from RAP/agency Another Other worker Family/friends Other/neighbor/landlord or superintendent No one

4.4.2.3 What about expectations related to getting to different places for appointments using the publictransportation–how well can you manage that now?



4.4.2.4 What supports do you still need with getting to places using the transit system?

4.4.2.5 Who helps you with using the transit now?




4.4.3 Official Language Acquisition (ie. English or French Skills) –Taking the time inthe early months of being in Canada to learn how to speak English or French/oneof the official languages, is an important investment to make as a newcomer. Howwell would you say you are able to communicate now in English/French? [Ask thisof head of household/primary contact]

Quite well Ok/ Not bad Not at all/ Needinterpretation always


4.4.3.1 When you have a problem you need help with from your CSS worker–are you comfortablespeaking in English/French with her/him on the telephone?

Very comfortable Ok/ Not bad Not at all/ Need interpretation always


4.4.3.2 Are you attending any English/French instruction classes at present?[Ask about the adults .i.e. 18 years + in the family]

1. Yes No2. Yes No3. Yes No4. Yes No5. Yes No6. Yes No7. Yes No



4.4.4 Health/ Accessing Health Care– In Canada, everyone can access the healthcare system for free regardless of their status. How often have you been to adoctor or a clinic since you’vein Canada?More than 10 times 2-3 times Not been at all


4.4.4.1 Do you visit the same doctor or clinic each time you need help?Yes No


4.4.4.2 There are expectations related to getting to different places for medical appointments andmanaging to get there on time to see the doctor–how well can you manage that now?

Very comfortable on my own Ok / Sometimes confused Need help

4.4.4.3. What supports do you still need with going to the doctor/clinic?4.4.4.4. Who helps you with this now?

CSS workers/team Someone else from RAP/agency Another worker Family/friends Other/neighbour/landlord or superintendent No one



4.4.5 Academic /Educational Milestones/ Training-[Ask if there are children/youth attending school]

Again, In Canada, we are fortunate that all children between 6 and 16 years can attend / in factHAVE to attend school. Children from many newcomer families find it hard to get into a routine to goto school–what has it been like for your children?

Very comfortable /attends regularly Ok/ Misses occasionally Very difficult/ Need helpWhy do you say this?

4.4.5.1 How often have you visited your child(ren)’s school?

More than 10 times 2-3 times Not been at all

4.4.5.2 What supports do you still need with problems related to the children’seducation?

4.4.5.3 Who helps you with this now? CSS workers/team Someone else from RAP/agency Another worker Family/friends Other/neighbor/landlord or superintendent No one



4.4.6 Employment- For most newcomers to Canada, one of their first priorities is to be able to get a jobas soon as possible. Are you working anywhere?

[Ask adults i.e. 18 years + only]1. Yes P/T or F/T No2. Yes P/T or F/T No3. Yes P/T or F/T No4. Yes P/T or F/T No5. Yes P/T or F/T No6. Yes P/T or F/T No7. Yes P/T or F/T No

4.4.6.1. Many have to take specifics steps leading up to paid employment. What are the steps you havetaken (are taking) to help with this?

Learning English/FrenchVolunteeringAttending school/training programGetting help with resumeAttended Job Search WorkshopLearning to DriveExploring a business idea/developing business planOther _____________________________________________________

4.4.6.2. What supports do you still need with employment?

4.4.6.3. Who helps you with employment issues now? CSS workers/team Someone else from RAP/agency Another worker Family/friends Other/neighbor/landlord or superintendent No one



4.4.7 Economic Self-sufficiency- There are many things that impact on how much moneywe are left with at the end of the month and how we make ends meet. How wellwould you say you are able to manage your own budget?

Quite well Ok/ Not bad Not well/ Need help


4.4.7.1 What supports do you still need with sorting out money issues?

4.4.7.2 Who helps you with sorting out money issues now?


4.4.8 Parenting Skills/ Family Life-Now that you’re living in Canada, how would you describe your family life and relationships between family members?

Perfect Quite Well/ Ok Not too well/ There are many misunderstandings/ conflicts


[Ask if there are children under 12 years]4.4.8.1 When you have to go out to class/work/appointments or the stores, who looks after your children?

Friends Neighbours Family member (adult) Childcare/ Drop In Other ______________



4.4.9 Participation in the Community/Neighbourhood- What are the different places inyour neighbourhood or community that you frequently go to or spend time ?

School Library Stores/Malls Community/Recreation/Sports Centre Park Friends’/Family/Neighbours’ home Cultural centre/place of worship Other___________________

4.4.9.1 How comfortable do you feel going to agencies/places in the community to get specific types ofhelp or services?



4.4.9.2 To what degree do you feel you are “at home” here in Canada or like you “belong”?

Very much at ease/ relaxed Ok/ Miss home a lotNot at all/would leave if I had a choice


4.4.9.3 What about your sense of feeling safe and secure–living here in Canada?

Feel very safe Somewhat safe Quite fearful/unsafe feeling


4.5 What are some of the other areas of your /your family’s life that you need help with or that you’re worried about?”

5.0 WORKER STYLE/COMPETENCE

5.1 What is it about _____________ (name of CSS Worker)’s approach or the way /he has helped you/your family adapt/adjust to life in Canada that you have found to be the most effective?

. [Note: The categories are for coding purposes - or possibly to use as probes if they do not understand thequestion- but we are interested in their spontaneous answers most of all]



Coding Accompaniment to appointments Respectful Patience Consistency–always ready to help Easily reached by phone Availability of other team members as back-up Understanding re their situation Able to answer questions Able to advocate on their behalf Spoke the language Gender sensitivity Culturally competent Other __________________________

5.2 What is it about _____________ (name of CSS Worker)’s approach or the way in which s/he has helped your family adapt/adjust to life in Canada that you/your family have found to NOT be aseffective or helpful?

Coding

Did not accompany us to appointments when we thought s/he should Disrespectful Impatient In consistency–not always ready to help Could not easily reach by phone No availability of other team members as back-up Little understanding re their situation Unable to answer questions Unable to advocate on their behalf Did not speak the language Not gender sensitivity Not culturally competent Other __________________________

5.3 Overall how helpful was the work you/your family did with ______________(name CSS Worker).

Very useful Sort of useful/OK not veryhelpful

5.3.1. If _________(name of CSS worker) had not been there to help you, what would have happened?




6.0 COMMUNITY/SERVICE CONNECTIONSI am now going to ask you about the other supports.\/services that you area accessing and what they helpyou with.

Are you/your family connected with or get help from:Support/Worker What does each help them with?

ISAP worker? (Name: )SWIS worker? (Name: )HOST? (Name: )Own faith or culturally-based supports?Family Doctor?Friends/Neighbors?

LINC?Health Clinic?Support groups?Other workers e.g. welfare, housing

7.0 SUGGESTION FOR IMPROVEMENTS

7.1. What improvements can you suggest to the program that _______________ (name of CSSWorker) is part of?

7.2. Is there anything else that you would like to say about the program or your experience with it?

Thank the family and provide the honorarium–obtain receipt

8.0 REFLECTIONS/OBSERVATIONS OF LOCAL CONSULTANT

Make notes about things that interviewee said or did that made you are important to consider when this datais analyzed or interpreted. You may also make notes on

- conditions of the living situation/environment that might suggest whether or not theinterviewees have acquired certain skills eg. Apartment cleanliness, personal hygiene,family’s resourcefulness, abiltity to get to places on their own etc.

- how they seem- get along as a family/household, support one another, seem isolated orconnected, burden on the kids to do for the parents etc



Evaluation of CIC’s Pilot Project –Client Support Services to Government-Assisted Refugees inOntario

Focus Group Guide–GAR Youth from the Client Services Support Project

PreambleOver the last 1 to 2 years, this agency (name: __________) has put into place specialsupport/services to assist newcomer youth and their families who have to Canada toresettle as government assisted refugees. We have been asked to evaluate this extrasupport/service and to find out how youth are adjusting to life in Canada and what theyhave found specifically helpful, what are some of the needs that are still a concern or arecoming in the way of getting more settled in their new life/new country.

We have some key questions to guide our discussion. You do not have to worry aboutbeing critical/negative…yourcritical input will not be a reflection of you in any way andwe will keep this information confidential. In other words, the staff here at _______willnot find out what you said. Your observations/experiences/ideas will help improve theprogram in the future. At this point, we will not be debating any of these nor trying to getto any consensus on decisions. Everyone’s ideas are welcomed and there is no right or wrong answer. Are there any questions before we begin?

1. To begin with, we would like to first find out a little bit about each of you–so can you please tell usyour name, your age, how long have you been in Canada, what is your country of origin?

[Keep track of total numbers from various countries and who has been here < 9 mths; 9- 12 mths,13-18 mths, >18 mths and age groups: <16 yrs, 16-18 yrs, >18 yrs]

2. Overall, how would you describe your experience of resettling in Canada so far?

Probes: What has been the most amazing?What has been the most difficult?What have you been really surprised or shocked by?

3. Can you tell us what you’re currently doing with your life….what is occupying you the most?

[Keep track of total numbers in ESL, LINC, regular school, working, training program, nothing/athome, etc]

4. Since you’ve been here, what has worked out really well for you?

Probes: Living/home arrangements?Adjusting to culture/how youth in Canada behave?...dress?...socialize?Enrolling in language classes?Registering and attending school/training programs?Figuring out future opportunities in terms of career/occupations?Finding employment?

5. What/Who has been most helpful for you so far in terms of these areas of resettling/adjusting to lifein Canada?

Probes: Why?



6. How has __________(name of agency/Youth Worker) been supporting you or what have theybeen doing with you/for you?

7. What has ___________(name of agency/Youth Worker) being doing for you that has worked wellfor you?

8. How could ______________(name of agency/Youth Worker) have done things differently to bemore helpful or relevant to what you were experiencing or needing?

9. What are some of the areas of concern/needs that you have today that you need help with?

Probes: Who/where will you go for help with these?

10. If ______________(name of agency/youth worker) had not been available to support you, whatwould have been different for you today?

11. What are ideas/suggestions/advice you have for the agency (________________) in terms oftypes of help to be providing refugee youth in first 12 months of being/arriving in Canada?

12. Other Comments?

Thank participants.

Provide their honorarium– explain that it’s a Gift Certificate (how it is used)

Have each participant sign chit for the honorarium



Evaluation of CIC’s Pilot Project - Client Support Services for Government-Assisted Refugees inOntario

Interview Guide–Local CIC Staff

Preamble: During this second phase of the Evaluation we are gathering information from variousstakeholders, including CSS project staff and management, GARS themselves, as well as other relatedprogram staff and secondary informants. The overall questions that we are trying to answer are:

o What difference is the CSS Project making in supporting the adaptation process of governmentassisted refugees (GARS) to be able to live in an urban setting independently?

o Are the CSS operations effective and efficient?

Overall Assessment1. Based on your understanding, what is CSS (or use local name)? What is its main purpose?

What are the core elements of CSS?

2. Overall what changes would you say that the CSS has made in the adaptation process ofGARS? Can you describe situations/examples that highlight your point of view? What aresome of the specific skills accomplishments that you have heard that GARs are achievingbecause of CSS?

Case Management

3. One of the core elements of CSS is case management. To what extent do you feel that it isdelivering a CM model? What seems to you to be out of sync with CM?

4. Target Group: From your vantage point, which GARs should be provided case managementsupport? Why do you say that? If CSS could not target all GARs, what is your idea about theappropriate target group?

5. Interfaces with Other Supports: What are your concerns, if any about duplication of effortsbetween RAP, LSS, CSS and ISAP- how can these be mitigated?

6. How well do you think the referral process to ISAP and other supports are working for GARsinvolved with CSS? How do you find out about this?

7. How can the “seamlessness” of these linkages be further enhanced?

Community Strengthening/Capacity Building

8. The second core element of CSS is capacity building within the broader community so thatprograms/services in the various systems (Education, Health, Social Services, etc) can bemore appropriate and responsive. What are some of the accomplishments that the SPO hasmade in this area? Can you provide some specific examples of what’s been changed or customized for GAR?

9. CSS places a heavy emphasis on physical and emotional/mental health issues. Whatparameters do you think this implies- i.e. what should CIC fund and what types of activities doyou think it should not fund? Why do you say this?



10. Aside from health sector, what are the other systems where priority should be placed for thecapacity building efforts of CSS?

Unmet Needs11. What are some of the unmet needs that GARs are demonstrating in their adaptation? How

should be getting addressed? Is there a role that a CSS initiative could play?

Summary

12. With respect to the specific sites you’re monitoring, what are some of the questions that youhave about ways in which CSS is being delivered and its effectiveness?

13. What encounters have you had with the YMCA Toronto - in their role as provincial coordinatorfor CSS?

14. What type of centralized supports do you think the CSS teams need or could benefit from?

Any other input you would like to give?




Interview Guide –Senior Manager/ED of SPO




Original Proposal vs. Reality of Implementation1. CSS was designed to provide more intense support for an extended period (12 months) to

GARs. It was also expected that it would provide relief to the RAP and ISAP programs. Towhat degree do you think this has been achieved? Why do you say that?

2. Organizationally, CSS has been more closely aligned with RAP than ISAP it seems –wouldyou agree? Was this your intention from the beginning? What are the benefits of this? Whatare the challenges?

3. Now that you’ve had experience with CSS for almost 2 years, what are some of the changesyou’re thinking of in terms of how it is positioned within your organization? Are there changes that will result in greater efficiencies and more of a seamless/integrated approach to servingGARs for their ongoing settlement needs?

Case Management4. One of the core elements of CSS is case management. To what extent do you feel that it is

delivering a CM model? What seems to you to be out of sync with CM?

Community Strengthening/Capacity Building5. The second core element of CSS is capacity building within the broader community so that

programs/services in the various systems (Education, Health, Social Services, etc) can bemore appropriate and responsive. What have been your biggest successes? What havethese taught you about the best use of your capacity building resources?

6. CSS places a heavy emphasis on physical and emotional/mental health issues. Whatparameters do you think this implies- i.e. what should CIC fund and what types of activities doyou think it should not fund? Why do you say this?

7. Aside from health sector, what are the other systems where priority should beplaced for the capacity building efforts of CSS?

Coordination8. The provincial coordination of CSS by the YMCA Toronto entails providing support to all of the

sites, facilitating networking/sharing between sites, education/training, resource developmentand information management (data base). From your vantage point, how effective has theYMCA Toronto been in this central role? Where have they been helpful to you? Where havethey not been as helpful?



9. What additional or different types of centralized supports do you think the CSS teams need orcould benefit from?

10. Any other input?




Interview Guide –Coordinator/Manager(s) of the CSS Project




Original Proposal vs. Reality of Implementation1. When you reflect on your original project proposal to CIC …. In what ways has the project been

implemented differently? Rationale for changes?

Case Management

2. One of the core elements of CSS is case management. To what extent do you feel that it isdelivering a CM model? What seems to you to be out of sync with CM?

3. [Review aggregate data] What are your observations? Trends? Any surprises/no surprises?

4. Target Group: From your vantage point, which GARs should be provided case managementsupport to CSS? Why do you say that? If CSS could not target all GARs, what is your idea aboutthe appropriate target group?

5. Interfaces with other supports: What are your concerns, if any about duplication of effortsbetween RAP, CSS and ISAP- how can these be further mitigated?

6. How well do you think the referral process to ISAP and other supports are working for GARSinvolved with CSS? How do you find out about this?

7. How can the “seamlessness” of these linkages be further enhanced?

8. Discharge from CM: What is your discharge process? How could it be improved?


9. The second core element of CSS is capacity building within the broader community so thatprograms/services in the various systems (Education, Health, Social Services, etc) can be moreappropriate and responsive. What have been the biggest challenges in preparing your communityto receive and serve GARs appropriately?

10. What have been your biggest successes? What have these taught you about the best use of yourcapacity building resources?

11. CSS places a heavy emphasis on physical and emotional/mental health issues. What parametersdo you think this implies- i.e. what should CIC fund and what types of activities do you think itshould not fund? Why do you say this?



12. Aside from health sector, what are the other systems where priority should be placed for thecapacity building efforts of CSS?

Staff Competencies13. What would you say are the key attributes and competencies required to be effective in delivering

case management support to GARs? To what degree would you say these are reflected in yourstaff team?

14. What are the biggest challenges or gaps in terms of staff skills in working with GARs in thisintensive manner?

15. With respect to effectiveness in the area of community strengthening/capacity building, what wouldyou say are the key attributes and competencies required on the team? To what degree would yousay these are reflected on your team?

Coordination16. What are the challenges of coordination that you have faced? [Go through recruitment, retention,

training, deployment (matching) of staff, supervision etc.]

17. What are the efficiencies/program improvements that you are working on with the team?

18. What are key challenges that remain in terms of the program design and delivery? Ideas foraddressing these?

19. The provincial coordination of CSS by the YMCA Toronto entails providing support to all of thesites, facilitating networking/sharing between sites, education/training, resource development andinformation management (data base). From your vantage point, how effective has the YMCAToronto been in this central role? Where have they been helpful to you? Where have they notbeen as helpful?

20. What additional or different types of centralized supports do you think the CSS teams need orcould benefit from?

Overall Assessment21. Overall what impact has CSS had on the adaptation process of GARs in your community?

22. What are some of the things you would like to change/improve on how the CSS project is deliveredhere?

23. Any other input?



Evaluation of CIC’s Pilot Project –Client Support Services (CSS) for Government-AssistedRefugees in Ontario

Focus Group Guide–Staff/Workers of the CSS Project

PreambleDuring this second phase of the Evaluation we are gathering information from various stakeholders,including CSS project staff and management, GARS themselves, as well as other related program staff andsecondary informants. The overall questions that we are trying to answer are:

o What difference is the CSS Program making in facilitating the adaptation process of governmentassisted refugees (GARS) to be able to live in an urban setting independently?

o Are the CSS operations effective and efficient?[Go over format/rules of Focus Group]

Case Management1. A core element of CSS is case management -[Review their Case Management operating

principles]- Who“manages” the case, philosophy re being proactive vs reactive –i.e. calling clientsvs responding to call for assistance; regularity of check ins with people for re-assessment; whendischarge happens and why;

To what extent do you feel that you are delivering case management? What seems to you to beout of sync with case management?

2. Target group: right now all GARs are part of the case management component of CSS. What areyour thoughts re the appropriateness of this? Should admission to case management be restrictedto certain GARs i.e. should the resources be intensified even further to fewer families? Whoshould it target? Why do you say this?

3. What are the most effective ways you have found to engage with families in a respectful/dignifiedway… so that they do not feel ignorant or helpless?

4. What are the most challenging issues that GARs need support with? Why are they so challenging?What are the ways you have found to make these situations less challenging?

5. Some families need more intensive supports than others. How do you think about the level of needof families? How would you describe a low, medium and high need family- e.g. what are the levelsof need you observe?


6. Another core element of CSS is the community strengthening/capacity building within the broadercommunity so that programs/services in the various systems (Education, Health, Social Services,etc) can be more appropriate and responsive. What have been the biggest challenges inpreparing your community to receive and serve GARs appropriately?

7. What have been your biggest successes? What are the key lessons you have learned?

Program Impact8. What is your overall assessment of the impact of CSS? Why do you say that?



9. What have people / other workers told you about the difference it makes when GARs haveaccomplished these things? [ask about the people/secondary informants who might have said this]

10. What are the outcomes that you can observe within the community organizations or systems thatyou’ve been trying to work with or change? How have they changed specifically to be more responsive?

Unmet Needs & Ongoing Connections

11. What are some of the remaining unmet needs of GARS? What are the concerns/worries you havethe most about GARS’ ability to cope/adjust to living in their new conditions?

12. What happens when GARS are discharged from CSS? How many of the clients are wellconnected with ISAP and other support services? How do you know this?

13. How would you describe the experience of linking/liaising with the community agency staff abouttheir work with GARs? What sorts of gaps in knowledge/expertise do they seem to have? What doyou do about that?

Overall Satisfaction/Recommendations

14. For you at the individual staff level, what has been the most satisfying part of being part of thisproject team?

15. What are some of the things you would like to change/improve on how the CSS project is deliveredhere?

Other comments/input?



Evaluation of CIC’s Pilot Project - Client Support Services (CSS) to Government-Assisted Refugeesin Ontario

Focus Group / Interview Guide–Secondary Informants (ISAP, ESL/LINC, SWIS, JSW, HOST , CHCs,Community Partners etc)

PreambleDuring this second phase of the Evaluation we are gathering information from various stakeholders,including CSS project staff and management, GARS themselves, as well as other related program staff andsecondary informants. The overall questions that we are trying to answer are:

o What difference is the CSS program making in facilitating a smooth adaptation to life in Canada?o Are the CSS Project’s operations effective and efficient?

[Go over rules/format of focus groups]

Overall Assessment1. Based on your understanding, what is CSS (or use local name)? What is its main purpose? What

are the core elements of CSS?

2. Overall what changes would you say that the CSS has made in the adaptation process of GARS?Can you describe situations/examples that highlight your point of view? What are some of thespecific skills/ accomplishments that you have heard that GARs are achieving because of CSS?

Case ManagementOne of the core elements of CSS is case management.

3. Target Group: From your vantage point, are the right people being given case managementsupport? Why do you say that?

4. Interfaces with Other Supports: When are referrals of GARS receiving case managementsupport being made to you for follow up services/supports? Is this the right time in the settlementprocess? What changes could be made?

5. How would you describe the experience of linking/liaising with the CSS Coordinator and staff aboutthe various roles you and they will play in assisting GARS to settle? How do you think of thedistinctions between the different roles?

[For RAP, LSS, ISAP partners: What are your concerns, if any about duplication of effortsbetween RAP, LSS, CSS and ISAP- how can these be further mitigated?]

Unmet Needs6. What are some of the areas of adaptation to life in Canada that GARs have not made as much

progress despite being given this extra case management support?

Community Strengthening/Capacity Building7. As part of CSS, funds have been allocated to the SPO to help you become better able to support

GARs should you need this support. What type of support have you received?

8. How helpful has this type of support been? How available are the staff from CSS to answerquestions, help you solve problems that might arise and generally support you in your efforts toserve GARs better?

9. Other advice/comments?



Appendix 4: Sampling Approach



CIC - CSS Evaluation - Proposed Sampling Approach

9 - 18 months in CSS Toronto Kitchener Windsor Ottawa Hamilton LondonSingles 70 53 64 103 27Families 57 62 52 70 46Cases 127 115 116 173 73 604Individuals 287 338 274 375 255

% of Total 9-18mth 21 19 19 29 12Proportion of Total Sample(150) 26 24 24 36 15 125

Top 5 LangDari 46 16 14 8Farsi 30 15Karen 23 18 24 38 29Arabic 8 10 11 9Burmese 6Rohinga 16Chin 11Somali 5 14 12French 12Swahili 46Tigrina 4Spanish 5

Summary - Proposed # Interviews: Farsi - 10 Rohinga-10 Dari - 4 Dari - 6 Karen-10Karen - 10 chin - 10 Somali 10 Farsi - 6 Somali-10Arabic 6 Arabic 4 French 10 Karen - 6 Dari - 5

Swahili-10

Summary - Proposed Lang of Int (total):Farsi - 16 Rohinga 10 Swahili 10Karen - 26 Chin 10 Somali 20Arabic 10 Dari - 11 French - 10



Completing the Sample for the CSS EvaluationInterviews with GAR Families

Instructions1. So far for each site you have confirmed whether the families we have randomly selected to

participate in the interview aspect of the evaluation are available to participate–e.g. are still intown, can be reached to set up a time etc. Now it is time to get consent from families, since youcannot give us any information about the families until they agree to participate.

2. Using the sample list we provide that includes the name of the interviewer, call the head of thefamily for each case number noted and obtain verbal consent that they would be willing to beinterviewed by the Evaluation Team’s Local Consultant. Use the overview below as a sample script for gaining consent so that the GAR understands the basic elements of what they areagreeing to. Be assured that the Evaluation Team’s Local Consultant will review this information again upon contact with the GAR and in a sense will be re-confirming consent to proceed.

Sample Script–Gaining Verbal Consent from GAR/Family Head Involved with CSSProject

“Citizenship and Immigration Canada is interested in knowing if the government-assisted refugees who arereceiving extra help/support from the special project that ______________(use name of CSS Worker(s) ) isa part of, are getting the right type of help and having their needs met. A Local Consultant _____________(use name of LC when it’s available) who has been hired by a private consulting firm would like to meetyou/your family to talk about the experience you have had so far. The interview will take 1 hour of yourtime and it will be carried out in ___________(specify preferred language).

Your participation is fully voluntary and it will not affect the service/support our agency is providingyou. You can choose what you want to share or not. Everything you say will be held in confidence bythe Local Consultant and evaluation team.The information will be used to have a better understanding of how refugee individuals / families cope withchallenges of adapting and re-settling in Ontario, and if the Client Support Project is a meaningful way ofhelping with this adjustment.

To show appreciation for your participation, you/your family will be provided with a token of $75.00 cash. Isit alright with you if I go ahead and submit your name to the Evaluation Team to be in touch with you?”

3. Prepare a list for us according to the template provided. This will be used by the Local Consultantto contact the family and set up a time and place to meet. If you think there are any specialconsiderations we should know about the do not breach the family’s confidentiality please let us know e.g. the family prefers to meet somewhere other than their home; not all family members canattend; it would be best for a single woman interviewer to meet this person in a public place etc

4. If the family head agrees, let him/her know that the Local Consultant will be in touch within the next2 weeks. Fill in their contact information in the attached form for the Evaluation Team/ LocalConsultant to use.

5. It is possible that the family head is unsure about participating but is willing to give you consent tosubmit their name for the interviews. In this case, when the Local Consultant contacts them, thedetails of the process will be reviewed once again and the family head can ask more/otherquestions before agreeing to go ahead with the interview.



6. In order for us to complete the data collection in a timely manner, we need this list from you byDecember 15, 2008.

Thanks very much for your assistance with this!If you questions/concerns, contact Zubeida (416-497-9582) or Betsy (416-445-4679)



Appendix 5: Key Informants



List of Key Informants

CIC –Ontario RegionDarlyn Mentor, Director of Settlement Programs, Ontario RegionFiona Corbin, Regional Program Advisor

CIC –Local OfficesJackie Cameron, KitchenerAnn Kotanko, HamiltonDavid Parkinson, OttawaJulie Ruffolo, TorontoRosemarie Conte. Toronto

Central Coordination –YMCA TorontoKatarina Canic, Project ManagerAli Manesh, Data Integrity SpecialistDonna Morrison, Acting Project Manager

CSS - KitchenerMira Malidzanovic, Program Director, KW Reception CentreJoseph Oywak, RAP CoordinatorIbtihag Sidahmed, LSW CoordinatorZakim Takay Housing CoordinatorGada Faez, RAP Settlement CounsellorLynne Griffiths-Fulton NIP CoordinatorHadembas Yebetit, NIP Case WorkerBashir Shabaz, NIP Case WorkerWilma Laku, NIP Case WorkerPamela Rojas, NIP Case WorkerAgnes Kiciak, NIP Administrative AssistantGillian Wells, Catholic Family CounsellingWende Bedirian RN. Refugee Health ClinicAnne Arjas, Public HealthSara Cassleman, Sexual Assault Support CentreTracey Rayner, Language Assessment YMCAJalil Zalmey, SEPWR, YMCAChristina Koenig, HOST, YMCAHeidi Ingold, HOST, YMCAColleen Boehmer, LINC St Louis Adult Education CentreKumrije Ashimi, ISAP, YMCASunanda Sachdev, ISAP, YMCABlanka Djeric, SEPWR, YMCA

CSS - TorontoYasmine Dossal, Director, Interim Project Lead for CSS, COSTI



Fatemah Veisi, Support Worker, COSTIBrigita Katona, Support Worker, COSTIMyriam Garcia, Youth Support Worker, COSTIColin Mackay, RAP General ManagerMary Garwhal, RAP Program LiaisonSevgul Topkara-Sasu, Woodgreen Immigrant ServicesNagla Masood , Dixie Bloor Neighbourhood CentreRanee Ferguson, Access Alliance Multicultural CHCFouzia Rane, Access Alliance Multicultural CHCMeb Rashid, Access Alliance Multicultural CHCSara Vasquez, COSTI North YorkMary Ibrahimi, COSTI North YorkIris Iskander, SWIS- Centre for Information and Community ServicesTamam McCallum, Turtle House Art/Play CentreNirupa Rasiah, Catholic Crosscultural Services BramptonAislinn Clancy, Canadian Centre for Victims of TortureEzat Mossallanejac, Canadian Centre for Victims of TortureGulnaar Dharamshi, United Muslim Women FoodbankElesa Martinez, The Learning Enrichment Foundation

CSS - WindsorKathleen Thomas, Executive Director, Multicultural Council of Windsor & Essex

CountyNermin Basic, BASIC Program ManagerPatricia Carter, Health Support WorkerAna Milojevic, Education/Employment Support WorkerLaw Eh Has, Client Outreach WorkerJoyce Abbonwaneten, Emotional Support WorkerRosemary Messecar,HOST Manager Multicultural Council of Windsor & Essex

CountySherry Kwan-Hopper,WRAP Multicultural Council of Windsor & Essex CountyHeather McNAmara, LINC Multicultural Council of Windsor & Essex CountyShannon Ciampi, JSW Multicultural Council of Windsor & Essex CountyMarcela Diaz, ISAP Multicultural Council of Windsor & Essex CountyColleen Mitchell, Multicultural Health Coordinator Multicultural Council of

Windsor & Essex CountyBen Kuo, Associate Professor University of WindsorFrederic Riviere,Directeur Education Permanente /Ecoles SecuritairesLaura Liebrock, City Centre Health CareLeda Jaggs-Conlon, Challenges for Success ROPES CourseIrene Gorelicj, J.L. Forster Secondary School ESL Department Head

CSS - HamiltonMarufa Shinwari, Manager RAP/LCPM, SISO



Pradeep Navaratna, LCPM, SISOTeresa Simms-Obidi, LCPM, SISOJanette Godwin, Life Coach Outreach Counsellor, SISOHana Pinthus, Healing & Counselling Through Art Counsellor, SISOAndrew Ostapeanko, Assistant Counsellor, SISOJenny Hayward, Life Skills Support Coordinator, SISOGordon Ajak, Housing Worker, SISOAhmed Mohammed, RAP Counsellor, SISOliban Abdi, ISAP Manager, SISOSouhaila Dihani, SWISH Manager, SISOCharmaine Routery, LINC Manager, SISOArsim Aliu, HOST Manager, SISOAurelia Tokaci, Employment Manager, SISODeborah Schwienken, HR Manager, SISONabil Rashidi, Youth Program Manager, SISOBelkis Ozery, Interpretation Services Manager, SISOMorteza Jafarpour, Executive Director, SISOSandra Wilson, Community Relations Coordinator, Hamilton Police ServiceSandi Mugford, Disability Information Service Helpline, Hamilton Public LibraryHila Taraky, McMaster Students’ UnionMaaz Mahmood, McMaster Students’ Union

OttawaLucila Cabrera, CSS Coordinator, Catholic Immigration CentreSaw Livingstone, Case Worker, CSSJose Mukesa, Case Worker, CSSBreanne England, Case Worker, CSSRadia Fadel, Case Worker, CSSNele Vejnovic, Admin/data entry Support worker, CSSChamroeun Lay, Reception House Manager, Catholic Immigration CentreHeng Chau, Housing Coordinator, Catholic Immigration CentreVesna Markovic, RAP Coordinator, Catholic Immigration CentreMirjana Djuric, Life Skills Coordinator, Catholic Immigration CentreRobyne Warren, Coordinator (K-12), Family Reception CenterCameron Ketchum, Coordinator International/Youth Program, Canadian Red CrossHelena Plamondon, Case Manager, Canadian National Institute for the BlindJessica White, Intervener, Canadian National Institute for the BlindsAbdul Yussuf, Manager Settlement Services - Somali CentreLaura Kollenberg, Nurse Practitioner, Champlain Immigrant Health NetworkJennifer Adams, CHIN-Reception House ClinicBarbara Fulford, PsychologistMary Malek, LINC –Language AssessorLucila Spigelblatt, Deputy of the Executive Director, Catholic Immigration

CentreDalmar Mohamed, Manager Settlement Services, Catholic Immigration Centre



Melanie Witty, Host Worker, Catholic Immigration CentreNicola Hodson, Youth Program Coordinator, Catholic Immigration Centre



Appendix 6: Consolidated Recommendations



Consolidated Recommendations

Recommendation #1: Continue funding CSS, converting it from pilot toprogram status.

Recommendation #2: Retain the CSS program within the Terms andConditions for Settlement Services in Ontario.

Recommendation #3: Award CSS contracts to those SPOs that provide theRAP services in Ontario to ensure continuity and quality of service.

Recommendation #4: Retain the central coordination role with the existingfunctions.

Recommendation #5: Re-evaluate the central coordination role and localCIC capacity in two (2) years to determine if transferring the financialand/or program management function to the local CIC is warranted.

Recommendation #6: Affirm the core elements of CSS that would bestandard in all sites.

Recommendation #7: Establish GAR families with complex/high needsas the primary target group for CSS.

Recommendation #8: Continue to fund those CSS programs that candemonstrate how the major resettlement needs of GAR families will beaddressed in a coordinated, systematic, comprehensive and consistentmanner – in the areas of health, mental health, education/training forchildren and adults including language training and illiteracy remediation,and advanced life skills to be able to navigate the system of supports andservices.

Recommendation #9: In the funding parameters for CSS allow for staffwhose role is to provide emotional/mental health support to GAR families.This can be done in groups, art/play formats. However, whereverpossible such work should be done in conjunction with a communitypartner that could eventually provide the service itself.

Recommendation #10: As sites gain more experience with their role inemotional/mental health support, consider evaluating this component ofCSS to discern the impact it is having and the degree to which the



community mental health system is changing to assume more of theresponsibility.

Recommendation #11: At the regional and national level, CIC needs toplan and implement a national strategy to address the pressing mentalhealth needs including trauma and PTSD that GAR families are arrivingwith.

Recommendation #12: Strengthen the community capacity buildingelement of CSS and strategically align the areas of concentration withthose being focused on in case management and the key unmet needs thatGARs have identified.

Recommendation #13: Ensure that community capacity building funds arelinked to an annual plan that highlights priority targets for change bothwithin CIC and in the broader community along with sustainability/exitstrategies and ways to reduce the impact of negative competition betweenCIC funded services.

Recommendation #14: Re-align CSS budgets after consensus isestablished regarding the core elements of CSS as well as furtherassessment of the rationale for the apparent variations in current fundingallocations.

Recommendation #15: Require CSS programs to identify where the skillsand expertise to implement the annual Capacity Building plans are locatedon the team and support this aspect of the CSS model with professionaldevelopment sessions focussed on systemic change.

Recommendation #16: As part of the initial needs assessment process,institute a weighting system that flags the level of need of all GAR familiesin the data base as complex/high, moderate or low. Use this weightingfor site specific as well as province wide data analysis and comparisonpurposes.

Recommendation #17: Task the Provincial Coordinator with establishingand working through a process with the CSS site coordinators that createsparameters for target caseload levels of GAR families with complex/highneeds and those with moderate needs.



Recommendation #18: Set a standard that all families served in CSS willhave an assigned primary case coordinator but leave it to teams to definethe specific tasks that this lead will assume based on a set of commonroles.

Recommendation #19: Task the Provincial Coordinator to work with CSSCoordinators to develop and implement standard initial needs assessmentprotocols, regular check in and exit interview practices/protocols and linkthis data into regular reporting schedules

Recommendation #20: Ensure that CSS continues to enjoy a closealignment with the RAP LSS program in order to streamline support,leverage existing LSS staff relationships with GAR families and providereliable effective resources for accompaniment and languageinterpretation.Recommendation #21: Include funding for professional support for staff todeal with the vicarious trauma they experience as part of the daily workwith GAR families in CSS budgets.

Recommendation #22: Task the Provincial Coordinator to work with CSSCoordinators in an exercise that scans the staff/client safety policies ofother home visiting programs and ensures that each SPO has a policy inplace related to staff safety that also addresses the impact this will haveon client groups such as GARs accessing CSS and how the impact will bemitigated.

Recommendation #23: Require SPOs to review their current privacy andconfidentiality policies to ensure that they cover contingencies related toworking in the public arena- on public transit, in waiting rooms etc.

Recommendation #24: Embrace case management as a way to describethe casework with GARs within CSS and align with other casemanagement models and professionals as a way to further legitimise thisfunction and to also grow and learn from others outside the narrowconfines of the settlement sector.

Recommendation #25: Have the Provincial Coordinator continue to workdiligently to complete the identification of the central outcomes measuresfor both case management and community capacity building that will beregularly tracked by all CSS sites in a consistent manner.



Recommendation #26: Report on these measures at least quarterly both inaggregate form as well as by each site so SPOs can note theiraccomplishments and make adjustment where needed.

Recommendation #27: Fund a research initiative that compares thesettlement achievements of GAR families with high needs with CSSsupports with a sample of refugee families that did not have thisopportunity.

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