Health-Responsive Integration Support for Refugees – Evaluation of the Triple A Pilot Project

The evaluation showed that the programme’s structures and processes are, in principle, well suited to achieving its objectives. Between January 2023 and July 2025, a total of 129 individuals were admitted to and supported within the programme. Thanks to rapid access to appropriate support measures, more intensive casework, and the development of newly tailored services, it was possible to achieve stabilisation and integration outcomes that had previously seemed unlikely, despite in some cases severe health-related burdens.

The programme also produced effects at a structural level: progress was made in inter-institutional collaboration, and new structures were created at the interface of health, integration support and social services – most notably the establishment of central health liaison or specialist units, as well as the further development of service provisions tailored to the specific needs of the target group. At the same time, the programme generated system-level relief by enabling earlier interventions and more coordinated case management, allowing individuals to be directed more quickly to appropriate treatment and thereby reducing both duplication of efforts and high follow-up costs associated with chronicisation.

The recommendations for further development and long-term implementation address the gaps, weaknesses and risks identified - each of which manifests differently across the three cantons - and focus on the following areas:

1. ensuring that early identification of individuals with health-related challenges is effectively implemented from the moment of cantonal assignment;
2. establishing continuous health-related case management with adequate resources and clearly defined responsibilities;
3. sensitively shaping the interface between health stabilisation and vocational integration;
4. closing specific service gaps affecting the target group;
5. consistently advancing the programme’s integration into regular structures across institutional and disciplinary boundaries;
6. strengthening knowledge generation and exchange to support the transfer of Triple A to additional contexts and its further development towards a comprehensive, health-responsive integration support model.

Background

In implementing the Swiss Integration Agenda (IAS), introduced in 2019, it became evident that a particular challenge concerns the adequate support of refugees who, for health-related reasons – whether somatic, psychological, or cognitive – are unable to keep pace with the standard processes of integration support. For these individuals, existing procedures and services often prove unsuitable.

At the same time, caseworkers frequently lack the resources, specific expertise, or appropriate services needed to recognise complex and sometimes hidden problems and to identify suitable steps and settings for or together with the affected persons. As a result, existing problems tend to become entrenched or worsen – an outcome that is unsatisfactory both from the perspective of providing dignified support to highly vulnerable individuals and from an economic standpoint. 

Against this backdrop, the cantons of Graubünden, Thurgau and Schaffhausen launched a joint pilot programme within the State Secretariat for Migration’s (SEM) initiative "Stabilising and Activating Resources of Persons with Special Needs". The programme, titled “Triple A”, aimed to prevent the chronicisation of such health-related challenges and to support stabilisation and vocational integration by enabling early identification, careful assessment and appropriate follow-up solutions.

The pilot programme was implemented as an inter-cantonal cooperation over three years, from January 2023 to December 2026, and was evaluated by ZHAW.

Aims, Questions and Methods

The evaluation aimed to systematically analyse the conceptual foundations and implementation of the pilot programme in the three participating cantons. The objective was to generate insights and evidence to inform further development and sustainable integration of the programme into cantonal integration support and, where feasible, into regular cantonal structures. Given the broader relevance of the topic, it was assumed that the findings would also be of interest beyond the participating cantons.

The evaluation focused on three core questions:

• To what extent were the programme’s objectives achieved – specifically, was chronicisation prevented, stabilisation achieved, and were opportunities for vocational integration improved?
• Which concepts, structures, processes and resources proved effective in achieving the programme’s aims?
• What are the key opportunities and risks associated with the programme?

To answer these questions, the evaluation included a review of all conceptual documents and the following empirical components: 55 interviews with professionals from the health sector, integration coaching/job coaching, social services, accommodation facilities and assessment or follow-up services; 25 interviews with programme participants, mostly conducted with interpreters, as well as structured observations within an assessment setting; Analysis of case file data for all individuals supported during the evaluation period (N = 129).

The specific design of the programme – implementing a single project concept across three distinct cantonal contexts – offered two advantages: it enabled a clear comparison of the strengths and weaknesses of the respective implementation models, and it allows the empirical findings to be meaningfully interpreted only when viewed in relation to each canton’s structural and procedural conditions within the asylum system.