[Senate Hearing 111-543]
[From the U.S. Government Printing Office]
S. Hrg. 111-543
DISASTER CASE MANAGEMENT: DEVELOPING
A COMPREHENSIVE NATIONAL PROGRAM
FOCUSED ON OUTCOMES
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HEARING
before the
AD HOC SUBCOMMITTEE ON DISASTER RECOVERY
of the
COMMITTEE ON
HOMELAND SECURITY AND
GOVERNMENTAL AFFAIRS
UNITED STATES SENATE
ONE HUNDRED ELEVENTH CONGRESS
FIRST SESSION
__________
DECEMBER 2, 2009
__________
Available via http://www.gpoaccess.gov/congress/index.html
Printed for the use of the Committee on Homeland Security
and Governmental Affairs
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COMMITTEE ON HOMELAND SECURITY AND GOVERNMENTAL AFFAIRS
JOSEPH I. LIEBERMAN, Connecticut, Chairman
CARL LEVIN, Michigan SUSAN M. COLLINS, Maine
DANIEL K. AKAKA, Hawaii TOM COBURN, Oklahoma
THOMAS R. CARPER, Delaware JOHN McCAIN, Arizona
MARK L. PRYOR, Arkansas GEORGE V. VOINOVICH, Ohio
MARY L. LANDRIEU, Louisiana JOHN ENSIGN, Nevada
CLAIRE McCASKILL, Missouri LINDSEY GRAHAM, South Carolina
JON TESTER, Montana ROBERT F. BENNETT, Utah
ROLAND W. BURRIS, Illinois
PAUL G. KIRK, JR., Massachusetts
Michael L. Alexander, Staff Director
Brandon L. Milhorn, Minority Staff Director and Chief Counsel
Trina Driessnack Tyrer, Chief Clerk
AD HOC SUBCOMMITTEE ON DISASTER RECOVERY
MARY L. LANDRIEU, Louisiana, Chairman
CLAIRE McCASKILL, Missouri LINDSEY GRAHAM, South Carolina
ROLAND W. BURRIS, Illinois ROBERT F. BENNETT, Utah
Ben Billings, Staff Director
Andy Olson, Minority Staff Director
Kelsey Stroud, Chief Clerk
C O N T E N T S
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Opening statement:
Page
Senator Landrieu............................................. 1
Prepared statement:
Senator Landrieu............................................. 37
WITNESSES
Wednesday, December 2, 2009
Elizabeth A. Zimmerman, Assistant Administrator, Disaster
Assistance, Federal Emergency Management Agency, U.S.
Department of Homeland Security................................ 4
David Hansell, Principal Deputy Assistant Secretary,
Administration for Children and Families, U.S. Department of
Health and Human Services...................................... 6
Frederick Tombar, Senior Advisor, Office of the Secretary, U.S.
Department of Housing and Urban Development.................... 8
Kay E. Brown, Director, Education, Workforce, and Income
Security, U.S. Government Accountability Office................ 10
Amanda Guma, Human Services Policy Director, Louisiana Recovery
Authority...................................................... 11
Rev. Larry Snyder, President and Chief Executive Officer,
Catholic Charities USA......................................... 21
Diana Rothe-Smith, Executive Director, National Voluntary
Organizations Active in Disaster............................... 22
Irwin Redlener, M.D., Professor, Clinical Population and Family
Health, Director, National Center for Disaster Preparedness,
Columbia University Mailman School of Public Health, and
President, Children's Health Fund.............................. 24
Stephen P. Carr, Program Director, Mississippi Case Management
Consortium..................................................... 27
Monteic A. Sizer, Ph.D., President and Chief Executive Officer,
Louisiana Family Recovery Corps................................ 29
Alphabetical List of Witnesses
Brown, Kay E.:
Testimony.................................................... 10
Prepared statement........................................... 66
Carr, Stephen P.:
Testimony.................................................... 27
Prepared statement with attachments.......................... 103
Guma, Amanda:
Testimony.................................................... 11
Prepared statement........................................... 82
Hansell, David:
Testimony.................................................... 6
Prepared statement........................................... 53
Redlener, Irwin, M.D.:
Testimony.................................................... 24
Prepared statement........................................... 99
Rothe-Smith, Diana:
Testimony.................................................... 22
Prepared statement........................................... 95
Sizer, Monteic A., Ph.D.:
Testimony.................................................... 29
Prepared statement........................................... 161
Snyder, Rev. Larry:
Testimony.................................................... 21
Prepared statement........................................... 89
Tombar, Frederick:
Testimony.................................................... 8
Prepared statement........................................... 63
Zimmerman, Elizabeth A.:
Testimony.................................................... 4
Prepared statement........................................... 46
APPENDIX
Charts submitted for the Record by Senator Landrieu.............. 39
Daniel Stoecker, Chief Operating Officer, BPSOS, prepared
statement...................................................... 179
John R. Vaughn, Chairperson, National Council on Disability
(NCD), prepared statement...................................... 183
Questions and responses submitted for the record from:
Ms. Zimmerman................................................ 193
Mr. Hansell.................................................. 195
Mr. Tombar................................................... 198
Ms. Brown.................................................... 201
Ms. Guma..................................................... 204
Dr. Redlener................................................. 206
Mr. Carr..................................................... 210
Dr. Sizer with an attachment................................. 214
DISASTER CASE MANAGEMENT: DEVELOPING
A COMPREHENSIVE NATIONAL PROGRAM
FOCUSED ON OUTCOMES
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WEDNESDAY, DECEMBER 2, 2009
U.S. Senate,
Ad Hoc Subcommittee on Disaster Recovery,
of the Committee on Homeland Security
and Governmental Affairs,
Washington, DC.
The Subcommittee met, pursuant to notice, at 2:35 p.m., in
room SD-342, Dirksen Senate Office Building, Hon. Mary L.
Landrieu, Chairman of the Subcommittee, presiding.
Present: Senator Landrieu.
OPENING STATEMENT OF SENATOR LANDRIEU
Senator Landrieu. Good afternoon, and I thank everyone for
your attention. Welcome to our meeting of the Subcommittee on
Disaster Recovery. My Ranking Member was planning to join us
and was called away to the White House for an unexpected
meeting, so Senator Graham will not be with us today, but his
staff is here and other Members may come in.
We have called this meeting today to discuss the ongoing
efforts of the Federal Government to better coordinate the case
management work associated with disasters, particularly
catastrophic disasters, as was the case in the 2005 season with
Hurricanes Katrina and Rita, and then followed on by Hurricanes
Gustav and Ike in 2008, which really devastated the Gulf Coast.
It is not the first time we have had a catastrophic natural
disaster in the country, but it was one of the most significant
and, of course, most recent.
So let me first begin by welcoming our panel. I am going to
give very brief opening remarks and then introduce our first
panel. Before I do, there are a few announcements.
I am pleased to have three Louisiana legislators with us,
if you all would stand and let me recognize you all. We are
always pleased to have legislators from any State, but
particularly my State, so welcome. [Laughter.]
And I understand it is Beth Zimmerman's birthday today, so
happy birthday, Beth. Working on her birthday. These FEMA
people, they just keep working. So we appreciate you being here
on your special day.
Let me just begin by saying that in the aftermath of
Hurricanes Katrina and Rita, 250,000 families lost their homes.
So over a weekend, 240,000 people became unemployed. Schools,
hospitals, and transportation systems ceased to operate. So did
social support networks that we all count on when those things
happen. Churches, community centers, and nonprofits were unable
to reopen. All of this upheaval took a massive toll on the
physical, mental, emotional, and financial well-being of people
along the Gulf Coast.
In response to these complex and overwhelming needs,
disaster relief nonprofits and government agencies launched a
series of ad hoc case management programs to help families get
back on their feet, because, frankly, we didn't have anything
very well organized before this. The overarching objective of
case management, as we know, is to return households to a state
of normalcy and self-sufficiency as soon as possible. Case
managers are supposed to serve as a single point of contact to
help survivors access resources and services. Resources include
things, as we know, like furniture, cookware, clothing, or
housing, and services might be jobs, job placement, job
training, child care, mental health counseling, financial
counseling, or transportation to school and work, anything that
would help families who have been affected get back to normal.
FEMA, HUD, HHS, and the States of Louisiana and Mississippi
have all run case management programs since the 2005
hurricanes. The existence of so many programs in the same
region caused a great deal of confusion among service providers
and clients, but it also provided a diverse set of examples to
inform the development of better models for the future.
That is what this hearing is about today. The title of the
hearing refers to ``Developing a Comprehensive National Program
Focused on Outcomes.'' We are hoping that the information that
is given can provide a more comprehensive approach focused not
on process, but on outcomes, positive outcomes for these
families in the event that this happens again, and undoubtedly,
it will, someplace, somewhere in the United States, something
similar.
So several startling statistics I just want to raise as we
open this hearing. At one point, and I am not sure of the date
of this, but at one point sometime probably within a few months
of the storm, maybe within a year, a survey was taken and we
found that only one-third of school-aged children at a group
trailer site known as Renaissance Village in Baker, Louisiana,
of which many of us are very familiar with, were attending
school. That is not a good signal.
The homeless population of New Orleans, based on our
understanding, has doubled since these storms, although a
Herculean effort has been made, not only by our local groups
but also HUD, to try to find appropriate housing. There are
still thousands of people that we believe to be homeless, many
of whom are residing in abandoned or vacant buildings.
Case managers and their clients use separate programs with
different eligibility rules. We will learn more about that
today. As a result, clients went through intake multiple times.
Providers had to expend significant administrative resources. I
could go on and on.
Some of the previous pilot programs seemed to focus, as I
said, more on process than on outcomes. When they passed a
client on to someone else, the case was closed. That doesn't
necessarily mean the family was ultimately helped. It just
means the case was closed. We want to think about a system
where when cases are closed, that means the family is back in a
house, back in a job, the kids are back in school, and the
family has regained their livelihood and self-sufficiency.Some
of these families were on public assistance, but the majority
never were, but most certainly needed some government aid to
get back to normal after the hurricanes.
So we must continue to look at ways to improve, and that is
what this hearing is about. Case managers were required to meet
quotas for closing cases, which may have led to premature
closures, as I said, or just passing off families that were
difficult to serve.
Case management services are delivered under difficult
conditions that make communication, recordkeeping,
coordination, and efficiency tough. In areas like Southeast
Louisiana, where housing and mental health professionals had
all but disappeared, connecting people with the resources and
services they needed was sometimes an impossible task. But we
need to understand that this happens in a natural disaster.
What can we do to improve it?
There is always tension between consistency and
flexibility. We must standardize things like paper forms, data
entry, and funding. But we also need to give flexibility to
those trying to deliver these services in a difficult
situation.
Privacy Act regulations prohibit FEMA from sharing
registrants' information without written consent, so case
managers knock on trailer doors and relyed on word of mouth to
offer their services instead of having access to reliable data.
Maybe that is appropriate. Maybe it is not. We should review
that.
That is what I am hoping that we can get from some of our
panelists today, suggestions as to how we can improve the
situation.
Let me suggest, though, in closing, that we may not have to
look that far, and perhaps some of you have already looked at
the models that exist, that have existed for over 30 or 40
years, that serve to help foreign refugees resettle here in the
United States. In international circles, they are called
refugees. But in the context of our speaking, they share a lot
of similarities with people who are displaced inside of
America. American citizens are displaced temporarily from their
homes, and perhaps we can look at international models that are
successful and shape them and modify them so we can be more
helpful when thousands and thousands--tens of thousands--
hundreds of thousands of families are displaced, not for a day,
not for a weekend, not for a week, but for months, and some
displaced for years from their homes while the community is
trying to reestablish itself.
So we are hoping to get some information at this hearing
about how to do that, and, of course, for the taxpayer picking
up the tab for all of this, it is important that we do it
efficiently and effectively so we are not wasting resources and
wasting funding, and that we do it, of course, with the
appropriate respect and deference to the families that we are
trying to serve and the communities that we are working within.
So with that, let me submit the rest of my statement for
the record and briefly introduce the first panel.\1\
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\1\ The prepared statement of Senator Landrieu appears in the
Appendix on page 37.
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We are very pleased that we had such a good response. Our
first witness today--I am going to introduce you all and then
we'll hear your testimony--again, Beth Zimmerman, our birthday
person, serves as Assistant Administrator for Disaster
Assistance at FEMA. She has had extensive State experience, has
acted as State Coordinating Officer for numerous federally-
declared disasters as well as scores of State-level disasters.
We are looking forward to your testimony on this issue of case
management.
David Hansell is the Principal Deputy Secretary for the
Administration for Children and Families with the Department of
Health and Human Services. Thank you for being here. We are
looking forward to hearing your views.
Fred Tombar is a Senior Advisor to Secretary Donovan. He
has probably been in New Orleans and other parts of Louisiana
as many times as I have in the last few months, and we
appreciate it. Being from the State of Louisiana, he is very
special to us, and we are looking forward to his testimony
today.
Kay Brown, our fourth witness, is Director of Education,
Workforce, and Income Security at the Government Accountability
Office (GAO). She will be here to discuss a report that GAO
released on disaster case management, which I co-requested with
Chairman Lieberman, and will shed some light on this challenge
before us.
And finally, Amanda Guma is Health and Human Services
Policy Director for our own Louisiana Recovery Authority, where
she is overseeing our case management programs in Louisiana,
and so she will be giving somewhat of the State perspective.
We have also invited our Mississippi folks to participate,
as well, and some of our international NGOs are here, which
won't be testifying, but that will provide input going forward.
So, Ms. Zimmerman, why don't we begin with you, and if you
could each limit your testimony to 5 minutes, we will then
begin the first round of questioning. Thank you.
TESTIMONY OF ELIZABETH A. ZIMMERMAN,\1\ ASSISTANT
ADMINISTRATOR, DISASTER ASSISTANCE, FEDERAL EMERGENCY
MANAGEMENT AGENCY, U.S. DEPARTMENT OF HOMELAND SECURITY
Ms. Zimmerman. Good afternoon, Chairman Landrieu. My name
is Beth Zimmerman and I am FEMA's Disaster Assistance Assistant
Administrator. It is a privilege to be here today on behalf of
the Department of Homeland Security and the Federal Emergency
Management Agency. As always, we appreciate your interest and
your continued support in emergency management and especially
in implementing the Disaster Case Management Program and
authorities.
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\1\ The prepared statement of Ms. Zimmerman appears in the Appendix
on page 46.
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FEMA's goal has always been to work with the communities
and assist them with their unmet disaster-related needs
following a disaster so they can move forward quickly on the
road to recovery, as one of these ways of achieving this goal
is to help survivors to understand and to navigate through the
wide array of services and programs that may be available to
them to return to self-sufficiency and sustainability. As the
coordinator of Federal disaster assistance, FEMA was charged
with securing the delivery of disaster case management
services. FEMA has been delivering disaster case management
services on a very limited basis since the beginning of the
Individual Assistance Recovery Programs in 1988.
Historically, these services have been very limited. They
provide referrals to Federal, State, and local assistance
programs, connecting the survivors to volunteer organizations
through long-term recovery committees. However, the widespread
devastation, as was noted, caused by Hurricanes Katrina and
Rita created new challenges for the delivery and coordination
of disaster recovery assistance at all levels of government.
In recognition of these challenges and the desire to
expedite the comprehensive disaster recovery, Congress provided
FEMA with the legal authority to implement a Disaster Case
Management Services Program under the Post-Katrina Emergency
Management Reform Act of 2006. Since that time, FEMA has been
working very closely with our Federal, State, and local
partners to pilot the delivery of several disaster case
management models.
Currently, FEMA is implementing a two-phase Disaster Case
Management Program model, and I am very pleased, in fact, today
to announce that just this morning, we signed an interagency
agreement between FEMA and the Administration for Children and
Families (ACF) so that we could finalize both agencies' role in
disaster case management. The agreement outlines the first
phase of disaster case management, where once a State requests
to have disaster case management, FEMA will notify ACF to
initiate their rapid deployment of disaster case management
assistance to the individuals and families in the affected
disaster area.
Phase two of the program consists of a transition to the
State-managed Disaster Case Management Program funded through a
direct grant from FEMA to the State, and this will ensure that
the State is an essential partner in the delivery of ongoing
disaster case management services and the use of local service
providers in the recovery of disaster survivors and the
surrounding communities will be maximized. It also allows for
States to build their capability and to care for their own
citizens.
The delivery of timely, appropriate disaster case
management services cannot be managed, as we know, at the
Federal level alone. In fact, the coordination is most
effective when it is on the ground, local, and close to the
people affected. Many communities have such systems for
coordination already in place through their established
relationships among Federal, State, and local partners, the
faith-based and the nonprofit organizations, the private
sector, and most importantly, the disaster survivors
themselves. Our goal is to build on the relationships to ensure
the survivors have a holistic approach to rebuilding their
lives in the wake of a disaster.
Because many of the disaster case management pilot programs
are still ongoing, FEMA will be incorporating the successes and
the challenges of the various models as well as the
recommendations from the July 2009 Government Accountability
Office report to develop the program guidance and regulations
for the future to be a permanent Disaster Case Management
Program.
FEMA is also committed to ensuring disaster survivors have
access to the resources and services they need to help them
rebuild and recover following a disaster.
But we can't do it alone. To be effective, our case
management efforts have to be coordinated with experts at the
Federal, State, and local levels of government and with faith-
based and nonprofit organizations. FEMA will continue to
fortify existing disaster case management partnerships and
encourage new collaboration to ensure the implementation of a
successful case management program, and I look forward to
answering any questions you may have.
Senator Landrieu. Thank you, and congratulations on coming
to that agreement. It has been something that I have asked for
for a long time now, and I am very pleased that you all have
taken this opportunity to make that announcement.
Mr. Hansell.
TESTIMONY OF DAVID HANSELL,\1\ PRINCIPAL DEPUTY ASSISTANT
SECRETARY, ADMINISTRATION FOR CHILDREN AND FAMILIES, U.S.
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Mr. Hansell. Thank you very much. Senator Landrieu, thank
you for the opportunity to testify on ACF's disaster case
management efforts. We share your commitment to improving the
well-being of disaster survivors and appreciate your support
for a well-coordinated, comprehensive disaster case management
strategy. My testimony today will focus on ACF's current
disaster case management efforts, the lessons we have learned,
and our plans to continue and strengthen this vital work.
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\1\ The prepared statement of Mr. Hansell appears in the Appendix
on page 53.
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After the Stafford Act was amended in 2006 to authorize the
President to provide funding for case management services to
survivors of major disasters, ACF worked closely with FEMA,
with Voluntary Organizations Active in Disaster, and States to
develop a holistic disaster case management model. Our approach
to disaster case management seeks to assist States in rapidly
connecting children, families, the elderly, and persons with
disabilities with critical services that can restore them, as
you indicated, to a pre-disaster level of self-sufficiency that
maintains their human dignity.
Our model is based on five principles: Self-determination,
self-sufficiency, federalism, flexibility and speed, and
support to States. Based on these principles, the pilot project
was designed to augment existing State and local capability to
provide disaster case management.
We first implemented a 2-week pilot project in September
2008 following Hurricane Gustav in Louisiana. FEMA then
requested that we continue our pilot throughout the recovery
process, which we have done with the support of the U.S. Public
Health Service and Catholic Charities USA. In addition, we
expanded the pilot to include survivors of Hurricane Ike to
allow enrollment of new clients for up to 6 months post-
disaster and to provide case management services for up to 12
months following enrollment. This expansion from Hurricane
Gustav to Hurricane Ike was seamless and resulted in no break
in services to disaster survivors.
The total program across all sites is designed to run for
18 months from implementation, and to date, we have provided
case management services to approximately 21,000 individuals,
far greater than the 12,000 that we expected to serve. The
majority of these clients had incomes below $15,000 a year, and
35 percent of the individuals that we served were children.
To improve the program, we have evaluated our disaster case
management efforts at multiple stages. We first conducted an
after-action report on the initial 2-week pilot following
Hurricane Gustav. This report identified strengths of the
program, including the ability to initiate services within 72
hours of activation; the use of volunteers as program support
and subject matter experts; the creation of effective links to
health care, human services, mental health, and disaster-
related resources; and the successful establishment of an
intake call center for clients seeking services.
The report also identified areas requiring improvement,
including the need to pre-identify case managers for
deployment; to determine the availability of full-time case
managers from voluntary organizations; and to establish clear
team member roles and responsibilities on initial deployment.
We subsequently awarded a contract to evaluate the
organizational structure and processes used for the pilot and
to identify any significant implementation barriers that
impacted clients' return to self-sufficiency or to access
needed services. After the pilot ends, we plan to conduct an
assessment of the impact and outcomes of case management
services on clients' abilities to return to self-sufficiency
and get back on their feet. Our focus on participant outcomes
responds to the concerns cited in the GAO report and, concerns
you expressed on the fact that Federal disaster case management
evaluations to date have addressed process and implementation
issues, but not outcome and impact issues, and we intend to do
that.
I am delighted to report, as Ms. Zimmerman already
indicated, that we have executed an interagency agreement with
FEMA to allow for implementation of our Disaster Case
Management Program after a future major disaster has been
declared by the President. The agreement states that in
coordination with FEMA and the States, ACF will initiate
disaster case management within 72 hours of notification and
for a duration of 30 to 180 days, depending on need.
At the end of the deployment period, we will transition
disaster case management to either existing State resources or
FEMA-funded State disaster case management programs. In
exceptional situations, FEMA may authorize ACF to continue
services until the State is able to assume disaster case
management, while meanwhile providing States technical
assistance, as needed.
Drawing on lessons learned from the pilot project and
existing human services and disaster management expertise, the
President's fiscal year 2010 budget request for ACF would fund
the contract with Catholic Charities USA to provide a Federal
disaster case management system. This contract will ensure that
trained personnel are credentialed and available when a serious
disaster strikes.
Before I conclude, I would like to share just two brief
stories that illustrate the significance of these efforts on
the lives of individuals. One case manager helped a 49-year-old
disabled man in Terrebonne Parish after his roof was damaged by
Hurricane Gustav. The case manager helped him apply for Food
Stamps, delivered the Food Stamp card to his home, and located
AmeriCorps volunteers to assist with roof repairs.
Our case management program also assisted a single mom with
five children in Saint Tammany Parish who could not evacuate
their mobile home prior to Hurricane Gustav. After meeting with
the case manager, this woman received immediate help with
housing services, Food Stamps, clothing, crisis counseling, and
disaster unemployment assistance.
These two are exemplary of thousands of other instances
where disaster case management has made a significant
difference in survivors' lives.
I truly appreciate the opportunity to appear before the
Subcommittee and look forward to working with you on this vital
effort. Thank you very much.
Senator Landrieu. Thank you, Mr. Hansell. Mr. Tombar.
TESTIMONY OF FREDERICK TOMBAR,\1\ SENIOR ADVISOR, OFFICE OF THE
SECRETARY, U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT
Mr. Tombar. Good afternoon, Chairman Landrieu, and thank
you for inviting me to testify here today.
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\1\ The prepared statement of Mr. Tombar appears in the Appendix on
page 63.
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As you noted, Madam Chairman, HUD has administered case
management services in the Gulf Coast for thousands of families
impacted by Hurricanes Katrina, Rita, Gustav, and Ike. Under
the largest of these programs, the Disaster Housing Assistance
Program (DHAP)-Katrina, HUD disbursed $63 million to public
housing agencies (PHAs), to provide case management services to
more than 36,000 families at a cost of $92 per month per
family. The purpose of the DHAP-Katrina case management was to
help families transition to permanent housing.
Using models like HUD's HOPE VI Program and FEMA's Katrina
Aid Today, a robust case management system was developed that
emphasized the case manager's service connector role.
Specifically, case managers completed needs assessments,
establishing Individual Development Plans (IDPs) that
identified the goals of each participant, primary of which was
finding permanent housing. To reach these goals, case managers
referred families to services that would assist in their
progress.
DHAP-Katrina case management was implemented for all active
DHAP-Katrina participants until February 28, 2009, the original
end date for DHAP-Katrina. Between September 2007 and February
2009, case managers completed over 37,000 risk assessments and
established over 34,000 IDPs. Nearly 97,000 referrals for
services were made. The average case manager-to-client ratio
was 1-to-28, and over 1,000 case managers were engaged in
service provision.
During the transitional close-out program for DHAP-Katrina,
from March 2009 to October, case management was provided in the
States of Tennessee and Louisiana, with 200 case managers
providing services to over 5,000 families.
While case management was being provided for DHAP-Katrina,
Hurricanes Gustav and Ike struck the Gulf Coast in September
2008. HUD again worked closely with FEMA to establish DHAP-Ike.
Case management services for DHAP-Ike participants began in
November 2008, and PHAs received a fee of $100 per month per
family to provide case management. DHAP-Ike is scheduled to end
in March 2010, and to date, $20 million has been disbursed to
PHAs to fund work of 400 case managers in providing services to
over 17,000 families.
Within HUD's Office of Community Planning and Development,
multiple programs provide case management and essential support
services. Both traditional and disaster-related Community
Development Block Grant (CDBG) program funds may be used for
public services in the areas of employment, job training, child
care, and other public services.
The State of Louisiana has obligated--the State of
Mississippi, I am sorry, has obligated more than $24.7 million
of its disaster CDBG funding toward case management for people
in its homeowners and small rental program. The State of
Louisiana has similarly embedded applicant-based case
management into its Housing Resource Assistance into its
homeowner and small rental programs. Neither the State of
Mississippi nor Louisiana has used disaster recovery CDBG money
to directly provide case management services outside of those
two programs.
Through the provision of DHAP case management, HUD has
learned several key lessons that would assist Federal policy
changes in the development of Disaster Case Management
Programs. Under DHAP, high-quality case management is often
provided when PHAs contract with local service providers rather
than providing the services in-house. As Ms. Zimmerman
testified to, local case management providers are already
positioned to provide assistance and have the expertise in case
management. Therefore, HUD recommends drawing on organizations
that have a history of providing case management to disaster-
impacted populations.
A second lesson learned is that even when utilizing local
case management organizations, they may be insufficient direct
post-disaster to fully serve these families. So beyond case
management provisions, disaster-impacted regions are in need of
increased resources for service providers.
A third lesson learned is the need to work more extensively
with other Federal or nonprofit partners to link vulnerable
populations to resources. For example, as DHAP-Katrina was
ending, concerns arose over whether the most vulnerable clients
had access to necessary resources. As a result, Housing Choice
Vouchers were prioritized for elderly and disabled
participants.
My final recommendation is that post-disaster case
management should formally include a housing self-sufficiency
function and that these services should be coordinated with HUD
and the PHAs for DHAP families. This will help clients to
navigate PHAs' policies, identify families eligible for HUD's
core programs, and focus clients on achieving housing self-
sufficiency.
Chairman Landrieu, thank you for having me here and I look
forward to your questions.
Senator Landrieu. Thank you very much.
Now that we have heard the agencies, FEMA, HHS, and HUD, we
will now hear from our Government Accountability Office for its
report on what they have done and how we can improve.
TESTIMONY OF KAY E. BROWN,\1\ DIRECTOR, EDUCATION, WORKFORCE,
AND INCOME SECURITY, U.S. GOVERNMENT ACCOUNTABILITY OFFICE
Ms. Brown. Madam Chairman, thank you for inviting me here
today to discuss our work on disaster case management following
Hurricanes Katrina and Rita. My remarks are based on the report
you referenced, which we issued in July of this year, along
with some updated information.
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\1\ The prepared statement of Ms. Brown appears in the Appendix on
page 66.
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This afternoon, I would like to focus on three issues.
First, the support Federal agencies provided for Disaster Case
Management Programs. Second, the challenges faced by the
agencies delivering the services. And third, the importance of
learning from these experiences to improve client outcomes
under the new program being developed.
First, regarding Federal agency support, as you have heard,
FEMA, HUD, and HHS provided more than $231 million to support
multiple Disaster Case Management Programs. These programs
provided services for as many as 116,000 families through
numerous social service and voluntary organizations. However,
as you can see in the graphic on my left, these programs
started and stopped at different times. Sometimes they
overlapped and sometimes there were breaks in funding and gaps
between the programs. These gaps led some service providers to
lay off workers or shut down services and may have allowed an
unknown number of people in need to simply fall through the
cracks.
Also, Federal agencies and case management providers had
difficulties sharing timely and accurate information on who was
getting or who needed services. In some cases, due to privacy
policies, FEMA was unable to provide needed client-level
information to service providers to help them assist those in
need.
Moreover, the service providers themselves use several
different and incompatible databases, making it difficult to
track clients across agencies. Again, this may have resulted in
some people not receiving needed services. It may also have
allowed others to receive services from multiple providers.
Second, turning to the challenges faced by the agencies
delivering disaster case management services, many agencies
faced high staff turnover and large caseloads. Some agencies'
caseloads ranged from 40 to as high as 300 cases per worker.
Also, clients frequently needed help finding housing,
employment, training, and other basic necessities, as you can
see from our graphic on the right. But these were in short
supply, and FEMA-funded service providers were not permitted to
provide direct financial assistance to their clients.
Unfortunately, many case management agencies conducted
little, if any, coordinated outreach. As a result, those most
in need may not have been offered or received services, such as
those in the group trailer sites. Further, Long-Term Recovery
Committees, which were intended to help marshal and direct
limited resources, did not always live up to their potential.
In some cases, they, too, were depleted of resources, and in
others, case managers viewed the process for obtaining
assistance as time consuming or confusing.
Third, regarding the importance of lessons learned to help
improve client outcomes under the new program. After 4 years
and more than $231 million, we still do not know enough about
whether these services actually helped storm victims. We need
to better understand how well the programs met their clients'
needs, and when they did, what specific factors contributed to
meeting those needs.
In our July report, we recommended that FEMA conduct an
outcome evaluation of the pilot programs. We understand that
FEMA currently plans to glean outcome information from
evaluations and use this information as it develops the model
for its new Federal Disaster Case Management Program. Learning
from these pilot programs is particularly important in light of
the coordination and other challenges service providers faced,
all of which could adversely affect client outcomes.
Given the uncertainty of when and how large the next
disaster will be, we also recommended that FEMA establish a
time line to hold itself accountable for progress in finalizing
its new program.
In conclusion, it will be crucial to incorporate lessons
learned over the past 5 years so that future disaster victims
have the best chance to get their lives back on track and so
government resources are put to the best use.
Madam Chairman, this concludes my prepared statement.
Senator Landrieu. Thank you, Ms. Brown. We really
appreciate the report that you all have done. It will be very
informative and already has been for us as we move forward to
try to improve.
Ms. Guma.
TESTIMONY OF AMANDA GUMA,\1\ HUMAN SERVICES POLICY DIRECTOR,
LOUISIANA RECOVERY AUTHORITY
Ms. Guma. Thank you, Senator Landrieu, for the invitation
to testify today, and thank you for your leadership in helping
to secure resources for disaster case management for the State
of Louisiana. We are also grateful to our Federal partners for
making such an important investment in this critical activity.
We appreciate the opportunity to reflect on our experiences and
to talk about the challenges and make recommendations for
future Disaster Case Management Programs.
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\1\ The prepared statement of Ms. Guma appears in the Appendix on
page 82.
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Since Hurricane Katrina, funding for Disaster Case
Management Pilot Programs has come down to Louisiana through
various channels, to nonprofit organizations, to local
entities, and to the State itself. Because most of those
programs have required reimbursement, local providers have
assumed significant financial burdens in launching them.
One of the primary reasons why our original partners in our
application for FEMA's Disaster Case Management Pilot Program
withdrew was because of the lack of up-front or advance costs
for the program. Having already experienced funding delays with
the reimbursement under Katrina Aid Today, those partners were
unwilling to take a similar risk again.
Another aspect of the Disaster Case Management Programs to
date that has presented a challenge for us in Louisiana is the
time lines. We remind the Subcommittee that virtually every
program created for human recovery has been extended beyond its
original time period. While we are grateful for the flexibility
that our Federal partners have shown in extending those
programs, we regret the negative impact of the changing time
lines on our residents.
Last-minute decisions from Washington have made it very
difficult for the State to protect its clients. We have seen
thousands of families leave trailers and rental units in
anticipation of upcoming deadlines, many of them turning to
unsafe alternatives. We know that some have returned to damaged
homes that are dangerously uninhabitable, while others are
renting apartments that do not meet quality standards.
Program periods are often determined at the beginning of
the recovery process and often in the absence of input from
local stakeholders. In every case to date, local leaders have
known that these program periods were too aggressive and not
reflective of the actual pace of recovery. The ultimate impact
of this has been felt most by the very people these programs
have been designed to serve.
The overarching challenge, however, that the State has
faced with Federal Disaster Case Management Programs is around
the need for greater coordination. Federal Disaster Case
Management Pilot Programs provide a critical tool to identify
needs and track recovery outcomes. As these programs move
forward, and certainly as they come to an end, the information
gathered must be made available to those State and local
government agencies that will be assuming responsibility for
the long-term recovery.
The case management process creates an invaluable
opportunity to translate the needs of residents into new or
expanded local assistance programs, but this can only be
achieved with proper coordination and information sharing.
The Louisiana Recovery authority (LRA) has spent countless
hours seeking information from Federal partners on program and
client status. Requests by the State for information should not
get stuck in agency headquarters where legal teams debate
privacy issues and the State's right to the data. Local
governments need access to this information to ensure their
ability to meet ongoing needs when Federal Disaster Assistance
Programs end.
We thank both HUD and FEMA for working with us towards
resolution on these issues, and we know that our progress has
already had a positive impact. We regret, however, that greater
change has not been made to date. In addition to data sharing,
the coordination that we are recommending is also in terms of
truly working together and collaborating on a local level. We
have made tremendous success locally, but we believe that
collaboration must be institutionalized within agencies and
within the program design to ensure process and success. There
are and there must be more effective ways for government
partners at all levels to share information and client data.
That said, we would make a few recommendations moving
forward for Disaster Case Management Programs. We ask our
Federal partners to explore creative ways to release funding
more quickly for disaster case management, including up-front
advances and preapproved grant applications. We ask our Federal
partners to consult with local stakeholders when designing
programs and to establish a process for reviewing progress
halfway through the program period so that any extensions
required can be determined well in advance of the deadline.
We recommend that at the time of a disaster declaration,
the State or impacted locality be included as a partner in any
interagency agreement. And finally, we ask our Federal partners
to formalize a structure and process for working together with
local partners as part of all future program guidelines.
Thank you.
Senator Landrieu. Thank you very much, particularly for
those succinct and, I think, very excellent recommendations for
improvement.
Before I get into questions, you all have the charts, I
believe, on the table, and I would just like to refer you to
the time line first.\1\ Just to put this hearing in
perspective, while we are very encouraged by the agreement, Ms.
Zimmerman, between FEMA and the Department of Health and Human
Services, we want to recognize by this time line the fact that
actually before Hurricanes Katrina and Rita, there was
virtually no case management provision in the Federal law for
dealing with a disaster, as if it was not an essential
component of recovery, which it is.
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\1\ The charts referred to by Senator Landrieu appear in the
Appendix on page 39.
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When you see this time line on this chart, which is
represented up here, what strikes me as the hurricane hit in
2005 and the levees broke in August 2005, Mississippi didn't
have its own case management pilot program started until August
2008. You think about that. Three years later before the
program was even started? Well, it was phase two, I am sorry,
phase two in Mississippi.
Now, Louisiana Family Recovery Corps started in January
2006, which is much sooner, but still, think about families in
September and October and November and December, at some of the
most critical times in these families' lives and there wasn't
much to reach to. What was there was little, if anything, and
very fragmented. We don't want to see this happen again.
Another very interesting graph from this report which
struck me is not up on our chart, but you all at the table can
see it. It is a graph of how people found out about Katrina Aid
Today (KAT), which was the Federal program put together in, it
looks like here, sometime late in 2005. Eighty-five percent of
the clients, according to the GAO report, heard about it from
word of mouth. I mean, you would think in the midst of a major
disaster, people would be, of course, listening to the radio or
listening to public spots on the television. To think that
families had to hear about it from each other as sort of a
circle of survivors, like, what is working for you? Well, this
case manager helped me. Maybe she can help you. It threw me a
little bit. I don't know why we can't get free radio
advertisement for these services to all these families.
The other interesting chart, which is going to be part of
my questions, because I am going to ask you how we are going to
set up a system that actually can surge when necessary, is
demonstrated by this chart, which shows the number of clients
that were served. There were more clients served in Louisiana--
thank you for putting that up--30,000, than all the other
States combined. So Texas had 13,000 people, Mississippi had
9,000, Alabama, 2,500--I am just roughing these--Georgia,
2,500. So Louisiana had 30,000 clients that were served.
You could argue that three times as many people needed the
help as ever got it and just abandoned the effort altogether. I
don't know if we will ever know what those numbers were. But
even assuming that these were all the families that needed help
and we reached everyone, which is very wishful thinking, part
of what my questions are going to focus on today, is whether
the model that we are setting up can work well when only 2,000
families are looking for help? And what happens to the model
when 50,000 families need help? Is the model that we are
building going to be able to surge to the levels necessary to
do the job that is required?
Another thing that struck me came from the GAO report. It
said that the five most reported needs among the clients were
housing, furniture, health and well-being, utilities, and food.
I am very interested to see that jobs was not on here. I would
have thought, with 240,000 people out of work, that one of the
things that people might be scrambling the most for would be
employment. So I am interested to know from GAO why that didn't
come up more. Maybe it did in a different way. I mean,
obviously, housing should be first because that is what people
were scrambling the most for is shelter.
And so those are just some of the observations I wanted to
point out, and let me get to my questions and I will start with
those. Let us talk about, with the panelists, about the model
that you are developing. First of all, Ms. Zimmerman, do you
have any intention of asking HUD to be a party to this
agreement, or is this something that you all are doing just
with Health and Human Services? And if so, why, and if not, why
not?
Ms. Zimmerman. The current agreement is between us and
Health and Human Services. We recognize our partners with HUD
through the programs that we have used to date. One of the
initiatives that is going on right now is the Long-Term
Disaster Recovery Working Group that has been established
through the White House, which is in conjunction with the
Secretaries for HUD and the Secretary for Homeland Security. So
as we are moving forward with that, it is looking at disaster
recovery on the broader scale and the abilities that we have
today versus where we want to take disaster recovery in the
future.
So I believe one of the outcomes from that working group
and our recommendations and our reports will be to incorporate
all of the partners who have a piece of the case management and
what that program should look like going forward.
Senator Landrieu. And what is your view on that, Mr.
Tombar?
Mr. Tombar. I, too, reference the work that the two
agencies are heading in concert with, actually, all the
agencies across the Federal Government with the Long-Term
Disaster Recovery Working Group. I believe that out of that, we
will certainly see a recommendation to the President that, in
fact, there needs to be better coordination across the Federal
Government in a way that we provide services for recovery and
relief to families that are impacted by disasters.
Senator Landrieu. Right. And I think that all you really
need to make that point is this particular chart, if I can find
it, the one that says the thing that people needed most was
housing. When you are managing cases for families--I don't know
what I did with mine, but it is around here--they needed
housing, I think it was the number one on the chart, and then
furniture, health and well-being, utilities, and food. So we
should keep that in mind.
The other question that came to mind, just thinking about
regular work in regular times, how communities and how families
navigate among agencies to try to help them--without disasters
in mind, just normal days--they call a service 211, it is like
911, but there is a 211 service that we are trying to develop.
I have been helpful in trying to start that up and fund it in
many places around the country.
In addition, Public Health units sometimes do outreach in
urban areas. There would be Rural Extension Services in rural
areas. A lot of families will call up Rural Extension and say,
I need this help or I need that. They might call Public Health
offices. And they most certainly, at a volunteer level, non-
government, 211 is something that I think communities are
getting used to. How are we incorporating the bone structure
that is already there before we build? And are we building on
that? Are we paralleling some of their work? Are we using them
in some case management? Or is that just a reference? Is 211
just a referral service. It is not really case management, it
is referral. But could that be used in any way as we build this
system? Does anybody want to comment? Mr. Hansell.
Mr. Hansell. Yes, absolutely. One of the things that we
learned from the early part of our post-Gustav pilot was that
having a single toll-free call-in line for access to services
responded to the concern, Chairman Landrieu, that you mentioned
earlier of people not having a direct place to go to get access
to the services.
What we would intend to do in the future is, where
resources like 211 or other phone lines that exist, to build on
and collaborate with those rather than to create something new.
They don't exist in every State. They don't exist in every part
of the State. But we certainly would agree that where they do
exist, we would want to partner with them in building on an
existing capability.
Senator Landrieu. And I just think that would be a smart
approach, to survey what exists in the 50 States now and in the
counties, measuring that against the counties, or parishes in
our case, most at risk. You can just overlay that risk map
pretty easily over the assets, and when you are building a
national model, build it at least on some of the things that
are already there.
And let me correct myself, because I want to give credit
where credit is due. The bar graphs I mentioned earlier are
from the report on Katrina Aid Today by the national service
provider, which in this case was the United Methodist Committee
on Relief. So we thank them for this information. And then the
time line, of course, was presented by GAO.
Let me ask a couple of other questions of the panel. This
would be both for ACF and FEMA. Catholic Charities was awarded
a 5-year nationwide case management contract as part of the
task order which has not yet been funded. Catholic Charities is
required to pre-identify local regional volunteers and
subcontractors to be ready to deploy within 72 hours. Can you
elaborate on the Department's plan for funding this contract
and near-term tasks to develop a national team, and have you
all identified funds to implement this contract?
Mr. Hansell. Yes. That is our contract, so I will respond.
We are awaiting the approval of our fiscal year 2010 budget to
fund that contract. We are, like much of the government,
operating under a Continuing Resolution right now.
Senator Landrieu. And what is in the budget? I mean, what
is in the appropriations bill?
Mr. Hansell. The President requested $2 million, the bulk
of which would be used to fund the contract. We designed the
contract to respond to a number of the things that we learned
from our initial evaluation, as I mentioned, particularly the
difficulty in finding and recruiting enough qualified case
managers, especially in a quick response to a surge in need. So
the contract will fund Catholic Charities USA, both to be
prepared to provide disaster case management services in the
event of a future major disaster, but also to pre-identify and
pre-certify case managers so that they will be ready and
available when a disaster strikes.
Senator Landrieu. And I understand this was a competitive
bid. Can you talk about the other organizations that competed?
Catholic Charities was chosen, but are there others----
Mr. Hansell. There were several bidders. Catholic Charities
was chosen. We can provide you with a list of the bidders, if
you would like. We will be happy to do that.
INFORMATION PROVIDED FOR THE RECORD
The bidders that applied for this contract were Abt Associates,
Inc., Catholic Charities USA, and Louisiana Family Recovery Corps.
Mr. Hansell. But it was an open, competitive process, open
to any bidder that was interested.
Senator Landrieu. Does anybody else want to comment on
that?
Let us talk about the privacy issue for just a minute,
because this continues to come up in our review. Does anybody
want to comment about the current privacy issue and why it is
in place? Is it necessary? Are there modifications that we
could look to so that we can better serve the individuals that
we are trying to serve? And again, in disasters, these can be
very poor individuals who have been a part of some kind of
government help and assistance through either Medicaid,
housing, or job placement. It can be middle-class families who
have never been a part of any kind of government support system
and are unfamiliar with how to navigate.
So let us talk about the privacy issue. I don't know who
wants to start, Ms. Zimmerman, perhaps. And I would really like
to hear from you, Ms. Guma, on this.
Ms. Zimmerman. Sure. I would be happy to. First off, the
number one thing for FEMA is to protect the privacy rights of
the individuals, the disaster survivors. But through this
process, we know that we need to provide information to the
service providers for the disaster case management. So it is my
understanding we now have a better process in place so that
when an agency requests the information, we are able to
provide, working with the State and the local provider to get
that information that they need to be able to service the
applicants when they come in.
Senator Landrieu. Well, can you articulate for me the
reason that we would have to keep FEMA records private? Is it
that we are trying to protect them from what, from being
exploited by people trying to help them, or exploited by
unscrupulous salespeople, or what are we protecting them from?
Ms. Zimmerman. The latter of that. We gather a lot of
information when we are putting people into our database to
assist them through our programs of individual assistance--
Social Security numbers, a lot of personal information. Not all
of that information is needed when it goes forward to the other
providers for case management. So we are able to release that
other information, names, addresses, and phone numbers. So we
do have a process in place to do that.
Senator Landrieu. Yes.
Ms. Zimmerman. So I believe that has improved over time.
Senator Landrieu. Because I most certainly can understand
keeping Social Security numbers, banking information private,
but information about names, number of children in the
household, previous employment, if the father was a welder,
that might be helpful for the case manager to know because he
is looking for a job and what was his previous employment,
things that would be useful to help people.
Ms. Guma, do you want to comment about that?
Ms. Guma. Yes, I do. I want to first acknowledge that we
have made tremendous progress with both FEMA and HUD in this
regard. Having said that, we have gone down a very difficult
journey to share information, and when we started the process
of requesting information, both on households living in
trailers and households in the DHAP program, even the process
of getting aggregate data, which not even client level with any
identifying information, in the initial phases was a struggle.
We have, again, made leaps and bounds in information sharing
and it now flows much more easily.
I guess one of our concerns, just speaking back to one of
our recommendations, is that the process really does need to be
institutionalized. It is wonderful that we have great partners
now at the table with us who work really well. We can make
requests and get the information so quickly and we tremendously
appreciate that. But our concern is that in a new place, on a
new day, at a new time, it would perhaps be a different
scenario for that government body seeking that information. So
we do think it is important.
We also encountered a challenge with FEMA and HUD where
there was not clarity about who was allowed to give us data,
and I think that has been something that has been worked out.
But when we have sought data in the past from HUD, there has
been some confusion about who had the authority to release it,
and I do think we have made progress on that front. But it was
a big challenge for us for a very long time.
Mr. Tombar. If I may, Ms. Guma is right. There was a
challenge with providing the data, and the data that the State
was requesting was full access to all data that we had because
they wanted to know as much as they possibly could about the
families, and it made sense to be able to provide the
comprehensive type of case management that you reference.
What we learned was that the Privacy Act prohibited HUD
from being able to provide that data because we did not have
the type of arrangements and agreements and approvals through
the systems of record for those data to be able to provide that
to the State. But in a conversation with Ms. Zimmerman and
others over at DHS, we found that FEMA did, in fact, have
ongoing agreements with the State and therefore was able to
simply, by not making the request for the same data to HUD, but
simply to FEMA, that FEMA could provide the data.
And, in fact, I am pleased to announce that for DHAP-Ike,
where the State of Louisiana has made a request for data that
was provided to them on behalf of families in DHAP-Katrina,
just today on a conference call jointly with HUD, FEMA, and the
State of Louisiana, we think that we have been able to resolve
that issue so that those data will be able to flow forward to
the State at sometime soon.
Senator Landrieu. Well, I just urge you all to stay focused
on finding the right solution to this issue so that we are
treating people as quickly as we can, helping them with
dignity. People want help. They don't want to fill out multiple
forms giving their name, their Social Security information
multiple times to different agencies because the law doesn't
allow the agencies to talk with each other.
Now, there is a reason why some personal data should be
protected, but when you are trying to help, it is imperative
that local officials and local entities, the nonprofits, the
State, the parishes, particularly because those locals are in
some way held accountable for the outcomes, so that the Federal
Government looks down on the City of New Orleans and would say,
why do you have 10,000 homeless people still? That is a good
question to the city. Well, if the city says, we don't even
have information about these people because we can't get it
other than a door-to-door daily survey, then that is a real
issue. And I am sure that is true across other places in the
Gulf Coast.
Let me do one or two more questions and then we are going
to move to the second panel. This duplication of benefits
issue, it is my understanding that Public Housing Authorities
at State and local levels considered themselves to be
caseworkers, which required the Mississippi Case Management
Consortium to close cases with other voluntary agencies to
avoid duplication of benefits. Could you comment about this? I
guess it is Fred Tombar with HUD. What are the Public Housing
Agencies--will they continue to provide case management? Will
this continue to be judged as a duplication of services, which
is against the law? Is that the situation? Does anybody want to
comment or know anything about that? Did GAO look into that at
all?
Ms. Brown. We went only as far as looking at the fact that
there were stops and starts and multiple service providers at
the same time. We didn't look to see whether there should be--
--
Senator Landrieu. You weren't looking for the content for
the services provided, or the quality of the services provided?
Ms. Brown. We would have liked to have looked at the
quality of the services provided, but I think the information
just wasn't there for us to make a judgment on that.
Mr. Tombar. The duplication of benefits is sort of a term
of art that has multiple meanings, and you know about it well
in the context of the Road Home Program and our Community
Development Block Grant Program and how----
Senator Landrieu. Small Business Loan Program----
Mr. Tombar [continuing]. It is a little bit confused with
it being used in this context. But my understanding is that
what is at issue here is that there were agreements with one of
the groups that you have testifying on your next panel,
Mississippi Case Management Consortium (MCMC), to provide
services on behalf of some 400 families initially. Those were
families who subsequently became a part of the DHAP Program and
were services by Public Housing Authorities (PHAs) in terms of
the payments that were being made on their behalf.
And so what we didn't want was precisely the thing that you
are critical of here, was that we had multiple service
providers providing the same services on behalf of families. So
that was the issue, was to not have the Public Housing Agencies
duplicate services that were already being provided by an
already contracted service provider.
Senator Landrieu. Well, I will ask the Mississippi folks to
clarify that, but let me ask this final question, because I
really want to get this clear with you all because it is
important, I think, for those trying to create a better system.
The National Disaster Housing Strategy calls for HUD to
continue providing case management services. But if FEMA and
HHS have an agreement, there still is confusion among the at-
large community about which agency is in charge, and so can you
comment about who is the lead here on case management? Who
should people be talking to? Is it FEMA? Is it Health and Human
Services? Or is it HUD?
Ms. Zimmerman. As of right now, FEMA has the authority in
the laws to do disaster case management. With our agreement
that we have right now with ACF, we have that ability to get
them on the road within 72 hours to do disaster case
management. And as we are moving forward to put together the
permanent program--this is our interim program--then we will
take that and take the lessons that we have learned and put
together the program so it is comprehensive and it covers all
aspects of it. So right now, a State, if they get declared for
a disaster and need disaster case management assistance, they
would apply to FEMA for assistance and we would institute the
program as it is today.
Senator Landrieu. OK. Well, I, for one, would urge you to
work as quickly as you can to reach out to HUD, which is an
obvious agency that needs to be included. And if you think
about particular populations, the Justice Department may be
another one in terms of case management. When you think about
families and the status of family members, whether they were in
prison when this happened, if they are on probation when this
happens, for either juvenile cases or adult cases, in some of
these communities and States it is thousands and thousands of
people that may be affected. We haven't even looked at the
coordination that is required with the Department of Justice.
But definitely with HUD, given that in case management, we
are learning that what most families needed was permanent
housing so that they could sort of reestablish themselves, get
into a church or a synagogue, get into a school, get into a job
and stabilize themselves until they could figure out when they
could get back into their original community.
All right. Thank you all very much. I am going to have to
move to the next panel.
As the next panel is coming up, just to save time, I am
going to go ahead and do brief introductions, and again, thank
you all very much.
We have, first, Rev. Larry Snyder, our first witness, who
oversees Catholic Charities USA's work to reduce poverty in
America. Rev. Snyder will discuss Catholic Charities'
experiences under Katrina Aid Today and their work on the ACF
model for disaster case management that was utilized after
Hurricanes Gustav and Ike.
Next, we have Diana Rothe-Smith, who is Executive Director
of the National Voluntary Organizations Active in Disaster.
NVOAD is the forum through which nonprofit relief organizations
share knowledge and resources. She will discuss their proposal
to improve case management guidelines and programs.
Dr. Irwin Redlener is President and Co-Founder of the
Children's Health Fund. Dr. Redlener has testified before this
Subcommittee many times. We are happy to see him again and hear
his views on case management.
Stephen Carr is a Program Director for the Mississippi Case
Management Consortium. He is also a consultant to ABT
Associates, through which he contributed extensively to the
design and writing of the ACF-HHS model that we have just
talked about.
And finally, Dr. Monteic Sizer is President and Chief
Executive Officer of Louisiana Family Recovery Corps. He will
discuss the Louisiana Family Recovery Corps' disaster case
management work after Hurricanes Katrina and Rita and the need
to develop long-term human recovery plans at the Federal level.
I look forward to all of your testimony, and thank you.
Rev. Snyder, we will begin with you.
TESTIMONY OF REV. LARRY SNYDER,\1\ PRESIDENT AND CHIEF
EXECUTIVE OFFICER, CATHOLIC CHARITIES USA
Rev. Snyder. Thank you. Good afternoon, Chairman Landrieu.
I want to thank you for the opportunity to appear before you to
discuss the partnership between the Federal Government and
Catholic Charities USA to provide disaster case management.
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\1\ The prepared statement of Rev. Snyder appears in the Appendix
on page 89.
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Catholic Charities agencies have a long history of serving
those most in need at critical and vulnerable times. The
services we provide are grounded in the fundamentals of social
work practice and are delivered in accordance with sound ethics
and our faith tradition. Case management is a critical
component of the services provided in local Catholic Charities
agencies.
In the interest of time, I would refer you to my written
testimony, which details the efforts of Catholic Charities in
the area of disaster response for over 40 years.
Recently, Catholic Charities USA responded to the
government's competitive solicitation for a contract to provide
a Federal Disaster Case Management Program and has been awarded
a 5-year indefinite duration, indefinite quantity contract for
these services. And while the overall agreement is for 5 years,
we have only been authorized and funded to continue disaster
case management services through March 31, 2010 to the victims
of Hurricanes Gustav and Ike. Further funding for the
implementation of the Federal Disaster Case Management Program
has not been authorized.
I want to take this opportunity, though, to acknowledge the
partnership Catholic Charities USA has with the Administration
for Children and Families of the Department of Health and Human
Services and the confidence that has been placed in our
organization with the awarding of this Federal contract.
At the same time, we have faced a number of challenges
throughout the process of providing these services, beginning
with Hurricane Katrina until today. Each time, we have provided
case management services during a disaster, the players have
been different, the funding streams changed, the policies and
procedures have been different, and the forms and requirements
inconsistent and sometimes conflicting between and among both
Federal and non-Federal partners.
Victims of disasters deserve and should receive services
quickly and through a well-developed system at the national and
regional levels. This can only be achieved if the resources are
made available to do this work prior to a crisis.
When it became apparent that funds were not available to
implement the Federal Disaster Case Management Program under
the new contract, our contracting officer notified us that we
would not be required to respond with a national and regional
team within 72 hours should these services be authorized. My
remarks, of course, were prepared before the announcement of
the IAA ???? between FEMA and ACF, which is, in fact, talking
about that funding, so we welcome that news today, as well.
We firmly believe that if we are to avoid the travesty of
Hurricanes Katrina and Rita, where we saw thousands of people,
especially those living in poverty and already marginalized,
left behind, we must invest in a system that responds early
with a network that can deliver the diversified services
necessary to meet the needs of those affected.
Let me tell you a story about one client. James is a
disabled client in Louisiana whose house was damaged by
Hurricane Gustav. For an extended period of time, James did not
receive his disability benefits because the support structure
was not in place. Through the assistance of a case manager,
James was able to obtain the documentation to apply for and
receive his disability benefits. With the back payment he
received, James is going to replace his roof and move back into
his own home. While we were able to assist James, the process
was significantly delayed.
With the infrastructure of a National Disaster Case
Management Program in place, the response to James could have
been far more timely. The investment to do this is small and
the number of staff required to create and maintain such a
structure is minimal. In fact, we estimate the total annual
cost of operating this program to be a little over $2 million.
The Federal Government historically has provided funding
for the immediate needs of food and shelter following a
disaster. But just as critical in the early stages of a
disaster is the need for case management services. Based on the
collective experience of our Catholic Charities agencies, I
offer the following five recommendations to the Subcommittee.
First of all, fund a single national Disaster Case
Management Program as part of disaster preparedness, including
infrastructure and readiness for rapid response.
Two, establish a lead Federal agency that will have
oversight and accountability for ensuring that agreed-upon
outcomes are established and met.
Three, establish a consistent definition of disaster case
management and policies and procedures to be adopted by both
Federal and non-Federal organization.
Four, identify and implement one database for the
collection of information that meets the needs of both Federal
and non-Federal partners with consistency in meeting privacy
requirements.
And finally, involve key stakeholders in all aspects of the
National Disaster Case Management Program.
I thank you for the opportunity to testify about this
important work and to make these recommendations based on our
experience.
Senator Landrieu. Thank you very much, Rev. Snyder. Ms.
Rothe-Smith.
TESTIMONY OF DIANA ROTHE-SMITH,\1\ EXECUTIVE DIRECTOR, NATIONAL
VOLUNTARY ORGANIZATIONS ACTIVE IN DISASTER
Ms. Rothe-Smith. Thank you, Madam Chairman. Thank you for
the opportunity to speak with you today about disaster case
management and the role of voluntary agencies.
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\1\ The prepared statement of Ms. Rothe-Smith appears in the
Appendix on page 95.
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My name is Diana Rothe-Smith and I am the Executive
Director with National Voluntary Organizations Active in
Disaster. National VOAD, as we are more commonly known, is made
up of the 49 largest disaster-focused nonprofit organizations
in the country. From the American Red Cross to Catholic
Charities and the United Jewish Communities, from the Salvation
Army to Feeding America and Habitat for Humanity, our member
organizations are the driving force behind disaster response,
relief, and recovery in this country.
Historically, voluntary agencies have partnered with
survivors through the recovery and have done so successfully
without standardization. In recent years, however, catastrophic
disasters, funding for case management, and emerging
organizations providing long-term recovery services have
necessitated us to look anew at how we define and implement
disaster case management.
Recognizing that disaster case management is most effective
when implemented by local partners as part of a coordinated
effort for community recovery, the National VOAD Disaster Case
Management Committee offers these standards as guidance to
support disaster case management delivery systems locally.
These draft standards, as they are submitted into the record,
are not intended to replace organizational policies, but may be
useful in policy development.
I want to tell you today about disaster case managers.
Disaster case managers are the reason why recovery happens in
this country. If my family and I have been through a natural
disaster, I sit down with a case manager and she becomes my
companion on the road to recovery. You see, before we even
meet, my case manager spends her time learning the ins and outs
of every resource available to people in my area. And because
they are normally hired from within the community itself,
disaster case managers can do so by drawing on their own
existing networks and contacts.
The case manager can link me with community services and
volunteer labor and can help me navigate through the maze of
governmental programs. Even in the midst of my confusion and
hardship, trying to put my life back together, my case manager
is my resource maven, helping me plan for filling in the
missing pieces of my recovery. The disaster case manager is the
most important resource for many survivors.
When Hurricanes Katrina and Rita hit, several members of
National VOAD participated in a first-of-its-kind case
management program. By December 2005, Katrina Aid Today put
case managers in jobs not only along the Gulf Coast, but around
the country, in all the places where evacuees had been
resettled. This program was initially funded by international
donations through FEMA, which were then matched with additional
nonprofit contributions. Katrina Aid Today was the most
comprehensive collaborative National Disaster Case Management
Program in the history of the United States. Because of its
long history providing disaster case management, the United
Methodist Committee on Relief was chosen as a lead agency for
nine partnering faith-based and voluntary organizations.
Let me tell you about one partner in particular. Lutheran
Disaster Response was given $7 million as one of the consortium
members, and per the various agreements, it matched that with
$7 million of their own donor contributions. Then the case
manager hired with those dollars found over $29 million worth
of resources for their clients. That is what I call a return on
investment.
As part of this testimony, I submit the Katrina Aid Today
final report.
Unfortunately, in the time since Hurricane Katrina, our
country has entered into a new reality. Nonprofit groups are
hurting as a down economy means a dip in contributions. An
increase in recent disasters also means fewer resources to go
around. Two-thousand-and-eight was one of the most active
disaster years on record. This means that the resources that
were once available for clients have decreased or even dried up
altogether. And because we know that disasters
disproportionately impact communities that were already
hurting, we are working in communities that were not well
resourced to begin with.
For this reason, survivors of Hurricane Ike or the vast
flooding in the Midwest this past year did not see the type of
return on investment that was seen from Katrina Aid Today.
These communities and the nonprofit partners that comprise the
local long-term recovery groups are making incredible strides
to meet the needs of the clients, despite these increasing
hurdles. However, many of them lack the public-private
partnership that made Katrina Aid Today such an overwhelming
success.
And this is part of the issue. While case managers are the
backbone of recovery, case management only works if there are
supplies and resources to fulfill the needs of the clients, and
there is only so much government systems can do to fill these
resources. Much of the work is filled by the voluntary agencies
and the volunteer labor and donated dollars they bring with
them.
My point is this. The instinct to create further levels of
bureaucracy is rarely appropriate given the power of voluntary
agencies to complete the work faster, cheaper, and with a
keener sense of the community's underlying needs. The more
resources that find their ways to these organizations and
without having to pass several layers of red tape, the more
real work that can happen for the people who need it.
Thank you. This concludes my testimony, if there aren't any
questions.
Senator Landrieu. Thank you very much. Dr. Redlener.
TESTIMONY OF IRWIN REDLENER, M.D.,\1\ PROFESSOR, CLINICAL
POPULATION AND FAMILY HEALTH, DIRECTOR, NATIONAL CENTER FOR
DISASTER PREPAREDNESS, COLUMBIA UNIVERSITY MAILMAN SCHOOL OF
PUBLIC HEALTH, AND PRESIDENT, CHILDREN'S HEALTH FUND
Dr. Redlener. Thanks, Chairman Landrieu. I am very happy to
be here. I am actually wearing three hats. I am President of
the Children's Health Fund and I direct the National Center for
Disaster Preparedness at Columbia University, and to avoid any
unpleasant feedback from Chairman Mark Shriver, I am also a
happy, active member of the National Commission on Children and
Disasters.
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\1\ The prepared statement of Dr. Redlener appears in the Appendix
on page 99.
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So in the years since Hurricanes Katrina and Rita
devastated the Gulf Coastal region, we learned and are still
learning that many already at-risk children, perhaps 20,000 or
more, may have survived the initial trauma of a major disaster
only to find themselves 4 years hence still living with
extraordinary uncertainty, chaos, and isolation from essential
services. At the least, and as has been stated by others here,
we need to learn from this unfortunate situation and make sure
that future recovery efforts are not plagued, as Hurricane
Katrina recovery has been, by similar levels of bureaucratic
confusion and turf battles further complicated by a persistent
inability to share critical information among relevant
agencies, and I know you explored this in the last panel. But I
would say that I would characterize this lack of sharing of
information as really devastating to the needs of families and
children, and we are still paying a heavy price for that.
It is also important to appreciate the fact that the
additional trauma related not to the storms and flooding, but
to this mismanaged and dysfunctional recovery, will have
significant and long-lasting consequences for thousands of
highly-vulnerable children.
So what happened? Well, in the first phase of this botched
recovery, thousands of families needed help that never came.
They needed obvious sustaining services that fall under the
general rubric of what we have been referring to as disaster
case management, and that was then. But now we are in a new
phase of recovery where much more than access to basic services
is needed because now we face far more difficult and, sad to
say, entirely predictable challenges of restoring stability and
structure and providing emotional and academic remediation when
much of the damage has already been done.
As you are aware, Senator, on October 7 of this year,
Children's Health Fund hosted a roundtable at LSU that involved
participants from key Federal, State, and local agencies as
well as many NGOs and local provider organizations. The focus
of the day-long discussions was single-minded: How can we make
sure that in future large-scale disasters we can do more to
protect and stabilize families while they wait for
renormalization of their lives and communities? And we all
recognize that one of the key strategies to achieving this goal
is to make sure that services and stability are provided by a
cohesive and effective system of case management.
Although the Post-Katrina Emergency Management Reform Act
from 2006 established a Federal responsibility for disaster
case management, it has become abundantly clear that much
remains to be done to strengthen the Federal disaster case
management structure and functionality. To that end, we are
very happy to learn that just this morning, the interagency
agreement was signed between FEMA and HHS, although I did
actually think it was going to be HUD on board, as well, but
apparently I heard that it was FEMA and HHS, and that is a
great first step.
But of greater significance is the fact that the National
Recovery Framework and Stafford Act reform are now on the
immediate horizon, and the goal of both of these efforts is
straightforward. Let us use the experiences of the last 4 years
to be certain that proposed legislative modifications and the
new operational guidelines provide assurances that recovery
from future disasters is much more effective and responsive to
the critical needs of all survivors.
I also believe that, although local flexibility in
implementing programs is clearly important, and it is, there
must be overarching federally-designated case management
principles which apply to all federally-funded programs. These
programs need to be accountable and monitored with clear
outcomes.
I just want to conclude with the recommendations that came
out of our roundtable, which really coalesced around three
primary recommendations for the Subcommittee's consideration in
drafting any new legislation. I am going to add a fourth from
my own work and experiences in the Gulf, which actually started
just a few days after Hurricane Katrina. And some of these were
already mentioned by Rev. Snyder.
But I think it is important that--and maybe most
important--a single lead Federal agency with experience and
expertise in complex case management should be designated to
coordinate and direct implementation of all Disaster Case
Management Programs. I still actually am not clear why this has
ever been FEMA's responsibility, since it is not an area of
expertise or experience that they have and we have other
Federal agencies that could easily fit this into their ongoing
agenda, so let us say AFC, for instance, at HHS--ACF, rather.
And I know this is something that may or may not be taken up in
the legislation on the table, but I think we should at least
think about why FEMA in this. FEMA is a spectacularly good and
capable organization, but is this a square peg in a round hole
as far as case management is concerned?
Second, a single Federal model, what I refer to as
overarching principles, for case management should be
established that is clearly defined, comprehensive, responsive
to local conditions, accountable, and, of course, fully and
appropriately funded.
Third is we must have mechanisms, as you pressed hard on in
the earlier panel, to ensure rapid, sufficient, and efficient
sharing of client information among relevant agencies and
provider organizations.
So let me just say in bringing this to a close that while
this next recommendation is not part of the formal roundtable
consensus, it is based on what we actually know about disaster
vulnerability, population resiliency, and the challenges
associated with recovery. The fact is that populations with
significant pre-disaster adversity, including poverty and
chronic inadequacies in health care and education, consistently
and predictably fare the worst in all phases of disasters as
compared to less-disadvantaged populations. So I think it is,
therefore, important that a clear commitment to alleviating
social and economic disparities be a central mission of long-
term disaster mitigation and recovery planning.
Finally, there is much unfinished business with respect to
the children of Hurricane Katrina. For example, what about
those kids that were exposed to formaldehyde in the trailers?
What are we doing for them? What is happening? And as we
deliberate on strategies to improve recovery effectiveness in
the aftermath of future disasters, that we not forget the
ongoing, overwhelming challenges being faced by the children
and families affected by the storms of 2005. They are still
waiting.
Senator Landrieu. Thank you very much.
And I noticed some people are pulling their shawls a little
tighter. I have noticed the room is cool. I have tried to get
it warmed up. We will see if that happens.
Mr. Carr.
TESTIMONY OF STEPHEN P. CARR,\1\ PROGRAM DIRECTOR, MISSISSIPPI
CASE MANAGEMENT CONSORTIUM
Mr. Carr. Good afternoon, Senator Landrieu. My name is
Stephen Carr. I am the Program Director for the Mississippi
Case Management Consortium. On behalf of the leadership and
field management teams of MCMC, I thank you for the opportunity
to speak with you today about the topic of disaster case
management.
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\1\ The prepared statement of Mr. Carr appears in the Appendix on
page 103.
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We are certainly proud of the accomplishments we have
achieved to date and look forward to continuing our work with
those individuals and families who continue to struggle toward
recovery over 4 years after the impact of Hurricanes Katrina
and Rita. I am prepared and welcome the opportunity to answer
any questions you might have with regard to MCMC and to discuss
any information that was provided to you in my written
testimony.
In addition to that written record, I am thankful for the
opportunity to present this opening statement to you, as well.
We, the leadership team of MCMC, are often asked the question,
why is it taking you so long to complete your work? This
question is understandable when asked by someone who has never
experienced a disaster of any form in his or her own life, and
yet we know that that would be a very small group of people
walking this earth. What is not understandable is when this
question is asked by members of the disaster recovery community
itself or even those inside Federal and State agencies whose
job it is to support the efforts of projects like MCMC.
I offer in response to that particular question a very
straightforward answer. The job of recovery is simply not
complete.
The cases that we are currently working include the most
vulnerable populations among us who have the most severe
barriers to recovery to overcome. The work that we do as
disaster case managers is what I refer to as messy casework.
This work requires us to get our hands dirty, so to speak, and
it is not work that is done by the faint of heart. The barriers
that could be overcome easily have been cleared. What are left
are the barriers that take the most time and coordinated effort
to navigate. Easy solutions, if there ever were any, are a
thing of the past, and disaster case managers are working
harder now at this point in time to find creative solutions to
a complex mix of problems facing disaster victims.
There were many critics of the leadership team of MCMC as
we began to set up the infrastructure that would be necessary
to implement the program according to the FEMA program
guidance. The main source of that criticism was that the
program guidance included no funding for direct services that
would be used to assist case managers in meeting clients'
recovery needs. And yet, as I have witnessed time and again
over the last couple of years, the most successful case
management is done often in the absence of easily obtained
resources.
Creativity, determination, and a true belief that every
problem presents an opportunity for excellence to emerge are
the hallmarks of high-quality disaster case managers, and those
are the traits that are representative of the men and women who
make up the ranks of MCMC case mangers. We have shown that in
spite of the many obstacles that are the legacy of Hurricane
Katrina, progress can be made and recovery can be achieved,
even without the presence of direct service dollars for case
managers.
The leadership team of MCMC believes that striving toward
perfection is a much better approach than waiting on perfection
to manifest itself before acting. Had we waited for the perfect
program or the perfect program guidance, we would not have been
able to facilitate the recovery of so many individuals and
families and we would have been standing on the sidelines
watching. This was simply not an acceptable alternative.
MCMC continues to look forward and hopes to leave the State
and the affiliates a platform to continue their work with
clients once our period of service come to an end. To that end,
we recently launched the Adopt a Family Program in order to
continue to raise awareness and needed resources for the
clients we all serve. More information about this program can
be found on the MCMC website, www.mc-mc.org.
In closing, I want to share this story. One affiliate
supervisor recently told me that she had never been a part of
such an exciting and professional program in her entire 27-year
career as a social worker in the public sector. She challenged
me to think of ways that this model could be duplicated within
the larger social service sector in order to address many of
the social problems facing our country today. Indeed, a
collaborative and coordinated program like the one that MCMC
has been able to establish presents the possibility for States
and communities all around the country to address issues like
school drop-out rates, the rising number of homeless veterans,
and the challenges presented as a result of illiteracy.
While that work may loom on the horizon, our immediate
concern continues to be on disaster recovery. The leadership
and field management teams, our affiliate organizations, and
all of our case managers will not rest until we have done all
that we can not only to overcome the barriers to recovery that
we experience, but also to shape future programs so that when
disaster strikes again, we will be ready to respond in a
systematic, organized, and professional fashion that is worthy
of this great nation.
Senator Landrieu, thank you once again for your time and
attention to this important aspect of disaster recovery.
Senator Landrieu. Well, thank you, Mr. Carr, for that very
passionate and inspirational testimony. We appreciate it.
Mr. Sizer.
TESTIMONY OF MONTEIC A. SIZER, PH.D.,\1\ PRESIDENT AND CHIEF
EXECUTIVE OFFICER, LOUISIANA FAMILY RECOVERY CORPS
Mr. Sizer. Thank you, Chairman Landrieu, for the
opportunity to speak with you today about the challenges faced
by Louisiana survivors, specifically those families impacted by
Hurricanes Katrina, Rita, Gustav, and Ike.
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\1\ The prepared statement of Mr. Sizer appears in the Appendix on
page 161.
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I would also like to publicly thank you, Chairman Landrieu,
for the remarkable support you have shown to the Louisiana
Family Recovery Corps, as well as to so many disaster recovery-
related organizations and nonprofits across the State of
Louisiana. You have certainly been a friend to those
Louisianans impacted by the various hurricanes.
Again, my name is Monteic Sizer. I am the President and CEO
of the Louisiana Family Recovery Corps. The Recovery Corps was
founded after Hurricane Katrina by the State of Louisiana in
2005. Since 2005, we have served more than 30,000 households,
and that equates to approximately 100,000 individuals across
the State of Louisiana. We have been a part of every case
management program in the State of Louisiana since 2005, that
the Federal Government has launched.
The Recovery Corps is on record for its advocacy on behalf
of Louisiana citizens, especially the most vulnerable
populations, which are comprised of children, the elderly,
persons with disabilities, people with mental illness, etc. I
have submitted for the record, Madam Chairman, extensive detail
regarding both problems, as well as the solutions associated
with what we need to do in order to help so many people who are
still struggling to recover.
So for the brief time I have remaining, Madam Chairman, I
would like to focus on a few things, and I would also like to
talk about a few common challenges that ran across the three
Federal case management programs.
Namely, there was always--and I think this has been
mentioned before--late and inconsistent program guidance that
came down from the Federal Government. I think it was mentioned
that there is a need for an organized, systematic, outcome-
based IT platform that is uniform. There are certainly
challenges all of us faced, such as: Data sharing challenges,
late payment for services rendered on behalf of Louisiana
citizens, and cost reimbursement challenges.
Considering the fact that everything we received from the
Federal Government came in late, and the fact that we were
given an unreasonable timeline with stringent time frame to
operate. The situation was very uncomfortable and we were not
able to help people who had significant needs and multiple
challenges. I would also say there was limited oversight
provided, and the abrupt ending of programs essentially left
Louisiana citizens in limbo. Many of them came to rely on the
case managers they had, but the Federal programs had a tight
time frame by which they were to end. Consequently, the case
managers had ethical dilemmas; namely they had families under
their care, and yet the programs were ending, so they had to
let these individuals go. We continue to hear over and over
again the challenges that were posed to many case management
providers, as well as licensed social workers, psychologists,
and others who rendered services on behalf of these wonderful
Louisiana citizens.
It was mentioned that success was not clearly defined as to
what it is the Federal Government wanted to achieve by way of
helping Louisiana, Mississippi, and Texas citizens. Many
clients certainly fell through the cracks. I think you
identified the time frame here. Certainly, we are one of the
few organizations that provided case management, and while that
money came from the Department of Social Services, we were also
later involved in some of the Federal projects. We closed out
Katrina Aid Today on behalf of the Federal Government. We were
going to be part of D.C.M.P. phase two, but it never got off
the ground.
We were one of the few organizations that actually received
client data from FEMA. We had all the individuals in each
trailer park disaggregated by the name, disability, age, race,
you name it. We developed a rapid deployment model, with which
we were ready to move froward, but the money never came.
Therefore, we could not provide the services in which we were
dubbed by the State of Louisiana to provide. With no money, we
couldn't provide the service. We had information, we knew where
people were, and we had relationships with nonprofits
throughout the State due to our earlier involvement with money
from the Department of Social Services.
So now that I have discussed some of the common
programmatic challenges, I would like to talk about some of the
structural recommendations. I guess the bottom line is, you can
have wonderful things on paper, but if you don't have the
proper systems and structures in place, then you are likely to
receive the same results as the ones we had with the previous
three case management models.
Senator Landrieu. You have got an additional 30 seconds to
a minute, but go ahead.
Mr. Sizer. Thank you, ma'am. I will be quick. There needs
to be a lead coordinating case management entity with human
services experience. There needs to be a standard definition of
case management. Certainly, there needs to be an identified,
selected IT platform, and a modification of the Stafford Act to
support case management services.
There needs to be identification and a blending of human
services dollars in order to be able to assist with case
management provision. Again, we need to work through the data
sharing agreements between Federal agencies and State agencies.
There certainly needs to be money advanced quickly to the
State to begin services after a declared disaster. Furthermore,
we need to prepare and have these things in place prior to
disasters, especially in disaster-prone areas.
I would also say that at the State level, we have to have
integrated agency functions that work across human services
entities, and have those plans tied to the Governor's Office of
Homeland Security's plans. We need this because the bottom line
is, these programs end. If there is nothing in place to be able
to receive these individuals post-closing of programs, our
citizens are likely to be in limbo. I also believe that it is
part of the State's responsibility, due to receiving taxpayers'
money, to provide efficient and effective programs and services
to the citizens they serve.
With that, Madam Chairman, I will be respectful of the time
and conclude my remarks and welcome any questions that you may
have.
Senator Landrieu. I have several questions, and
unfortunately, we are only going to have another 10 or 15
minutes, and I am going to have to close the hearing slightly
early.
But let me begin with you, Doctor, and also with you, Ms.
Rothe-Smith. I tell my staff I love charts, because when you
put them out in the right way, it is so clear and you just
can't fudge it. And when you look at this chart,\1\ there were
two entities in the entire country that stood up to help people
as the Federal Government just didn't have any case management
systems in place, and that was, according to this, Katrina Aid
Today, which stood up in December 2005, and you all did that by
marshaling the resources of the 30 or so largest nonprofits in
the country and put your good resources together and built a
model where there was none.
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\1\ The chart referred to by Senator Landrieu appears in the
Appendix on page 43.
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And then under--because I remember when this was done under
the extraordinary work of Governor Blanco in the face of having
nothing offered in this particular area--the Louisiana Family
Recovery Corps, which was stood up primarily with State
funding, as I recall.
Mr. Sizer. Yes.
Senator Landrieu. Do you remember how much initial funding
the State put up? Do you know how much it was?
Mr. Sizer. Through the Department of Social Services, it
was about $22 or $26 million.
Senator Landrieu. Twenty-six-million dollars toward this
effort. So I am going to rely on your two efforts, to really
give some good information about the early days because you all
were there, what people really needed in the very early days.
I am extremely impressed with what Mississippi has done, as
well. Your work, from what I can tell, and from your passionate
testimony, has really added a tremendous amount to this debate
as we shape this program that is going to have to work much
better, much more quickly, much more comprehensively.
So let me ask you, Ms. Rothe-Smith, how should we define
when a case should be closed, or maybe I should say, how do we
define success when we are dealing with families? Or how did
you all define success so that you could report to your own
donors a proper evaluation of the work that you did? How would
you explain this definition and these conclusions to your
donors or contributors?
Ms. Rothe-Smith. Our definition of success or what we
define as recovered is completely determined based upon the
local community and the needs of the individual client and
family. So the term ``recovered'' is determined between the
client, his or her family, and the case manager that is working
with them.
Senator Landrieu. And what they asked for----
Ms. Rothe-Smith. Yes.
Senator Landrieu [continuing]. If they walked in and said,
we need a refrigerator, you got them one, that was success?
Ms. Rothe-Smith. Yes.
Senator Landrieu. OK. If they walked in and said, we need
an apartment, you got it for them, that was success?
Ms. Rothe-Smith. Yes. A recovery plan is developed right in
the beginning between the client and the case manager, and then
the process by which it is achieved is what determines success.
Senator Landrieu. And how about you, Mr. Sizer? How did you
all frame your success or your goals when you started the
program?
Mr. Sizer. Yes, ma'am. We determine it in three ways.
Namely, clients come in and identify what it is they believe,
based on an assessment, their needs are.
Second to that, we place accountabilities on agencies we
work with to ensure they help the clients meet their need
objectives.
And third, we determine success by what clients actually
contributed towards their own success because oftentimes, it
takes some creative initiative on behalf of people who have
been impacted to also do things in accordance with their
desired recovery goals. So it is what individual families bring
to the table. It is what the case provider does on behalf of
the clients, and also what those entities do in conjunction
towards the success of an identified plan. That is done between
an impacted family and a case manager.
Senator Landrieu. Mr. Carr, let me ask you. How did you
all, when you started your program, or how do you currently
define success?
Mr. Carr. Sure. I want to clarify one thing, and that is
that the Katrina Aid Today model had a presence in Mississippi
throughout its tenure.
Senator Landrieu. And they had a presence in all the
States, I think.
Mr. Carr. Correct. We had five affiliate agencies in
Mississippi throughout the length of its operation. I began as
Program Director for MCMC during phase one and then continues
on to phase two. So there has not been a break in case
management activity in Mississippi. What I will say is that as
time goes on, the case management has gotten better. We have
done a better job because we are able to focus locally. At the
height of Katrina Aid Today, we had somewhere around 50 case
managers in Mississippi. At the beginning of phase one for the
MCMC, we had almost 300 because the need was there and we were
able to document the need and be able to procure funds.
We define success based on the recovery plan. We use a
holistic model. For me and what we teach in our training is
that when a client is self-determined, that is a good
indication of recovery. When that client is able to access
resources and services on his or her own, that is a point at
which case managers should consider that case for closure, when
they don't need us to take them or advocate for them to HUD or
for a voucher or for a refrigerator or for an apartment. When
they show signs that they are able to function in that arena on
their own, that is what we call self-determination, and that is
when we look at case closure. We leave the client with a
recovery plan that they use as a road map well beyond our
involvement with that case.
Senator Landrieu. OK. We covered this in the first panel,
but I would like your individual impressions on this privacy
issue and just some brief--each a brief suggestion as to how we
might approach it, I don't know, maybe starting, Rev. Snyder,
if you have something you want to add on this privacy issue,
but anyone that wants to speak to it, because we have got to
solve this as we move forward. Does anybody have a suggestion
about how it could be done or something we should look to? Ms.
Smith, would you like to comment, or Rev. Snyder?
Rev. Snyder. I do not have a suggestion to show how we
could actually solve that other than to say that, in fact, I
mean, it is something that is very critical and that we do need
to find a way to be more effective with how we do that. But I
do not personally have a suggestion.
Ms. Rothe-Smith. I don't have a suggestion for the Federal
family, but the way it is resolved through the voluntary
agencies is usually through a technology solution called the
Coordinated Assistance Network, and it is a way that the
voluntary agencies provide information to one another about a
client in the family through shared mechanism so that the
duplication is diminished, but also the need for the client to
share that information again and again, as well.
Mr. Carr. Senator Landrieu, if I could add, the sharing of
a FEMA number is critical for de-duplicating effort. In the
State of Mississippi, when we were asked to set up phase one,
we requested data from FEMA. We got names, addresses, telephone
numbers. We didn't get FEMA numbers. Identifying information
such as that is critical for us. We requested information from
our affiliates. We got 17,000 names. We compared that to the
information that we got from FEMA, 5,000 names. Do you know how
many John Smiths there are in the State of Mississippi? And a
lot of them we got that didn't have phone numbers or addresses.
A key identifier, a FEMA number, is critical for especially
contractors.
So for me, a suggestion is that once FEMA or HHS or HUD
enters into a contractual agreement with a service provider,
that they give that information to that contractor, and then it
is our responsibility to hold that information confidential,
not sell FEMA numbers, etc. But when we are not given the trust
to handle information in a way that helps us serve clients more
efficiently, quite frankly, it is irresponsible.
Senator Landrieu. Let me ask, Rev. Snyder, if I could,
because you all have the contract for responding now, Catholic
Charities does, and if this issue of privacy is not worked out,
I am not sure how effective that next response will be. But
also, or a different subject, how do you protect against
secondhand trauma to case managers, because in some instances
when the situations are very difficult, we found that some of
the people that needed the most help after the first couple of
weeks or months were the first responders themselves, the
nurses who just collapsed, or the case workers that just
couldn't take it anymore. So are we thinking about how to deal
with that in this whole response, psychological support and
case management for the case managers?
Rev. Snyder. I think that is an excellent point, and I
guess I would go back to what our experience was after
Hurricanes Katrina and Rita in that, fortunately, we did have a
large network of case managers to draw upon and many of them
came from throughout the country to Baton Rouge or to New
Orleans, to Biloxi. An agency would send--Albany, New York, for
example, sent four or five people on a rotating basis for 6
months to Baton Rouge, which allowed the local folks, who were
dealing with their own trauma, to have that time, that space.
I look at the days just beyond Hurricane Katrina at how the
folks who themselves were affected also could not help
themselves from working and reaching out. Until they knew there
was someone else who was qualified to come in and take their
place and give them the space, they wouldn't rest. So I think
that is something that we have to make sure is there.
We also had some mental health services that we brought in
for whole agencies that would deal with case managers. There
was take a day, just 1 day a month, to try to address that. So
I agree with you that is a critical piece to help prevent that
burnout.
Senator Landrieu. And, Dr. Redlener, do you want to comment
about that at all? I know your focus has been children, but it
has also been mental health.
Dr. Redlener. Yes. And actually, I would like to comment
about the previous question, if I might, also, Senator.
Senator Landrieu. Go ahead.
Dr. Redlener. OK. So this issue about the privacy is
extraordinarily important. We face this all the time in medical
practice, as well, obviously. And I think the key--there are
three steps, really, that I would suggest. One is that we
really have to have the concept ingrained of a one-stop shop
for Federal services. That means that you enter the system and
you enter then the service purview of any major agency of the
Federal Government that you might need.
And second, along with that would go this standardized
database, so there is one time where people fill out the data
forms and that is it, and that form is shared among people.
But the third and critical step, I think, is to simply at
intake ask parents for permission to share data. That is the
end of the privacy problem. All you have to do is you have to
sign, obviously, an appropriate form that is readable that is
explained to families that says, in order to help you, we would
like to be able to share your information with relevant
agencies. These are the safeguards. Ninety-nine-point-nine
percent of families will sign it, and to me, that is a very
simple solution to what otherwise is a very complex problem
that would require law changes and regulations and all sorts of
things that might be very long in coming. So I would just
recommend that.
Senator Landrieu. OK. I have got to, unfortunately, end,
but I am going to give each of you 30 seconds. If there is
something I didn't cover, something you want to mention, this
would be the time to do it. We will start with you, Dr. Sizer.
Mr. Sizer. Again, thanks, Chairman Landrieu, for the
opportunity. I will just mention the issue of reintegration.
Many of our citizens were deported to other parts of the
country and have yet to return. I think trying to find a way in
which to identify those individuals and bring them back home
and help them get reestablished will be critically important.
The second issue I will raise is the issue of cultural
competency. I certainly welcome the national model to descend
on the State, especially when there is a catastrophic event.
However, I will also mention that understanding the local
players, what transpires and what takes place, is critically
important because you could have well-meaning efforts and
unintended negative consequences.
So those are the other two points I would like to raise.
Senator Landrieu. Thank you. Mr. Carr.
Mr. Carr. Senator Landrieu, I wanted to circle back to the
question that was raised with HUD about duplication of
benefits. I use the term duplication of effort because that is
what we are trying to prevent. And the issue that you raised
was, I believe, in my written testimony where I talked about
silos. Whatever we can do to prevent silo behavior, either
within an agency or within Federal programs altogether, the
better off we are.
The issue of one case manager per program is an example of
HUD having DHAP case managers, FEMA having MCMC case managers,
and others trying to serve the same client.
Senator Landrieu. We need one case manager per family.
Mr. Carr. Per family, that has access----
Senator Landrieu. One case manager per family.
Mr. Carr [continuing]. To all resources. Correct. So that
was the issue that--whatever we can do to prevent silos.
Families benefit. We have a consistent, systematic structure.
And that is what is needed most in order to be cost effective
and most impactful on the families that we are serving. Thank
you.
Senator Landrieu. Thank you. Dr. Redlener.
Dr. Redlener. A cautionary note about defining when a case
is closed because it is a very dynamic situation and I wouldn't
necessarily depend on a decision made between a family and a
case manager at point X that at X-plus-6 months, the situation
will be the same. And what we are learning from this prolonged
dislocation and recovery is that the definition is clear. You
need a stable, safe home. You need access to essential
services, schools and health care. And you need some way of
getting into a livelihood, returning to a livelihood.
Those should be the criteria. Those are objective criteria
that could be combined with a family's understanding of what
they think they need. But if they don't have stability and
structure, even if today they say, things are fine, we don't
need you, we have already got the refrigerator, 6 months from
now, you could have a family struggling with horrible problems
of poor access to health care, academic failure, and a lot of
other stress and mental and emotional health issues that will
need to be taken care of down the road. So I think we should be
very clear about what we mean by a reestablished, renormalized
situation for families.
Senator Landrieu. Thank you. Ms. Rothe-Smith.
Ms. Rothe-Smith. I want to highlight a comment that Rev.
Snyder illustrated earlier, and that is that while Katrina Aid
Today started in December 2005, the organizations that were
part of that used a model that had been in existence for quite
a long time, and the organizations like Catholic Charities USA,
UMCOR, Lutheran Disaster Response, and the American Red Cross
and others have been providing disaster case management for
decades. So I would strongly encourage to really look and to
continue to look to them as the experts that have been doing
this work and will continue to do this work regardless of the
models that come out.
Senator Landrieu. Thank you very much. Rev. Snyder.
Rev. Snyder. Thank you. I have already talked about my
concern for the funding of a national infrastructure, so I
guess I would like to end with saying that let us not lose
sight of the need for flexibility, that even though we are
saying 18 months of case management should be enough, in some
cases, it is not. I know our local providers right now who are
working on Hurricanes Gustav and Ike have written a letter and,
I think, made a good case on the fact that because case
management did start a little late or whatever, that it still
might need a little more time. So just, again, the need for
flexibility in whatever services we are trying to provide.
Senator Landrieu. OK. I really want to thank our FEMA
Director for staying, the HUD Director for staying and
listening to the testimony. We really appreciate the way these
agencies are really leaning forward to work better and faster,
with all the other pressures that the Administration and
Congress has before it. But this Subcommittee is focused on
staying on the job until the job is done, to get better laws in
place, better procedures in place, better overall response and
recovery.
And in that, I will announce I will be sending several
staffers to the international conference on disaster response
and recovery. I, myself, can't attend, but we will be sending
several staffers and we will ask the Administration to send
people to Kobe, Japan, which will be hosting an international
conference on this and other subjects related to recoveries
from disasters. That city will be celebrating its 15th year of
recovery from a great earthquake. So there will be high-level
individuals, elected officials, community leaders, I am
assuming from all over the world.
So what we are doing here is going to help frame what we do
in the United States, but we are hoping to share that
information, of course, internationally to help victims of
major disasters everywhere. So we thank you for your testimony
and we will put it to good use.
The hearing is adjourned.
[Whereupon, at 4:29 p.m., the Subcommittee was adjourned.]
A P P E N D I X
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