This article was downloaded by: [Oklahoma State University] On: 14 July 2010 Access details: Access Details:

[subscription number 784375628] Publisher Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 3741 Mortimer Street, London W1T 3JH, UK

Journal of Social Service Research

Publication details, including instructions for authors and subscription information: http://www.informaworld.com/smpp/title~content=t792306968

Case Management with Displaced Survivors of Hurricane Katrina

Holly Bella a the Center for Social Work Research, The University of Texas, Austin, USA

To cite this Article Bell, Holly(2008) 'Case Management with Displaced Survivors of Hurricane Katrina', Journal of Social

Service Research, 34: 3, 15 27 To link to this Article: DOI: 10.1080/01488370802085932 URL: http://dx.doi.org/10.1080/01488370802085932

PLEASE SCROLL DOWN FOR ARTICLE

Full terms and conditions of use: http://www.informaworld.com/terms-and-conditions-of-access.pdf This article may be used for research, teaching and private study purposes. Any substantial or systematic reproduction, re-distribution, re-selling, loan or sub-licensing, systematic supply or distribution in any form to anyone is expressly forbidden. The publisher does not give any warranty express or implied or make any representation that the contents will be complete or accurate or up to date. The accuracy of any instructions, formulae and drug doses should be independently verified with primary sources. The publisher shall not be liable for any loss, actions, claims, proceedings, demand or costs or damages whatsoever or howsoever caused arising directly or indirectly in connection with or arising out of the use of this material.

Case Management with Displaced Survivors of Hurricane Katrina: A Case Study of One Host Community
Holly Bell

Downloaded By: [Oklahoma State University] At: 02:57 14 July 2010

ABSTRACT. Case management is a staple of post-disaster recovery, but there is limited research on this topic. Utilizing in-depth interviews, observations, and document analysis, based on 78 interviews and attendance at approximately 50 public meetings, this longitudinal case study examined case management with displaced hurricane Katrina survivors in one host community between December 2005 and December 2006. Case managers identified, assessed, planned, linked, monitored, and advocated for survivors. They described engaging survivors and understanding their backgrounds and experiences as challenging. Lack of jobs, transportation, and affordable housing coupled with survivors trauma and preexisting needs presented barriers to long-term recovery. Despite these difficulties, case managers felt positively about their efforts and identified coordination as a critical element for successful human/social services responses to natural disasters. doi:10.1080/01488370802085932 [Article copies available for a fee from The Haworth
Document Delivery Service: 1-800-HAWORTH. E-mail address: <docdelivery@haworthpress.com> Website: <http://www.HaworthPress.com> 2008 by The Haworth Press. All rights reserved.]

KEYWORDS. Disaster, case management, qualitative methods, case study

Hurricane Katrina and the flooding that followed displaced many poor African-American residents of New Orleans and southern Mississippi. Many of those most affected by this disaster had lived in communities of concentrated and persistent poverty for generations. Host communities, the majority of them in neighboring southern states, were faced with helping to meet these families needs. They were particularly ill suited to this task. Southern states historically have had few state and federal safetynet services and relied more heavily on family,

church, and non-governmental organizations for these functions. Texas and Louisiana, for example, were among the 10 poorest states (Dalaker, 2001), and they had among the lowest welfare payments and use (U.S. Ways and Means Committee, 2000), highest rates of childhood poverty (U.S. Census Bureau, 2002), and lowest levels of health insurance (U.S. Census, 2002). The infrastructure of social service delivery within these communities greatly affected the communitys ability to care for its most vulnerable citizens.

Holly Bell, PhD, LCSW, is Research Associate at the Center for Social Work Research, The University of Texas at Austin. Address correspondence to her at: Center for Social Work Research, School of Social Work, the University of Texas at Austin, 1 University Station, D3510, Austin, TX 78712-0359 (E-mail: hbell@mail. utexas.edu). The author gratefully acknowledges Laura Lein, Ron Angel, and Julie Beausoleil for their assistance in the preparation of this manuscript. This research was funded by National Science Foundation grant number 0555113. Journal of Social Service Research, Vol. 34(3) 2008 Available online at http://jssr.haworthpress.com 2008 by The Haworth Press. All rights reserved. doi:10.1080/01488370802085932

15

16

JOURNAL OF SOCIAL SERVICE RESEARCH

This study focused on the functions and challenges of providing long-term disaster case management to hurricane survivors by examining the experience of one southern host city. Despite the coordinated efforts of local case managers in identifying, assessing, planning, linking, monitoring, and advocating for displaced hurricane survivors, the combined effects of their long-standing disadvantage, traumatic loss, and limited resources in the host community presented numerous barriers to survivors long-term recovery. CASE MANAGEMENT
Downloaded By: [Oklahoma State University] At: 02:57 14 July 2010

Case management is a staple of post-disaster recovery. Based on early models of social casework (Hall, Walsh, Huber, & Jampoler, 2002), social workers, other professionals, or paraprofessionals may provide these services (Rose & Moore, 1995). The goal of case management is the provision of high quality cost-effective services with the ultimate goal of improving the quality of clients lives (Hall et al., 2002). In their review of the history of case management, Hall et al. (2002) noted six generally accepted functions of case management. Identification or outreach to clients is the first step. Next, case managers conduct an assessment of clients needs. Case managers then engage in planning with the client about addressing his or her particular needs. An additional function of case management involves linking clients with needed services. Monitoring the outcomes of their interventions is important, to insure that clients actually receive the needed services. In cases where they do not, case managers engage in advocacy at both the mezzo and macro levels. While the focus of case management is assisting clients to deal with fragmented services, case managers often find themselves unable to help clients successfully navigate a broken system (Rose & Moore, 1995). There are a number of models of case management (Hall et al., 2002), making comparison and evaluation of case managementproblematic.Research on the effectiveness and cost-effectiveness of case management has been equivocal, although previous research has indicated that it improved client outcomes (e.g., Gorey, Leslie, Morris, Carruthers, John, & Chacko, 1998) but has not

always been cost effective (e.g., Saleh, Vaughn, Levey, Fuortes, Uden-Holmen, & Hall, 2006). Case management in disaster recovery takes a slightly different form. Disasters destroy or alter normal social organization, and new organizational structures emerge in disaster response and recovery (e.g., Dynes, 1970; Drabek & McEntire, 2003; Quarantelli, 2003; Scanlon, 1999), requiring that service providers respond flexibly to a changing service delivery system. Examples drawn from social service provision after the 1993 Great Flood in Illinois (Poulin & Soliman, 1999), Hurricane Mitch in Honduras (Puig & Glynn, 2003), the September 21, 1999 earthquake in Taiwan (Yueh-Ching, 2003), terrorist attacks in Israel (Itzhaky & York, 2005), and the 1997 Red River of the North Flood (Heitkamp, 1997) indicated the need for responders to be flexible, to actively seek out survivors, coordinate services with multiple agencies, work with limited information, and intervene at the micro, mezzo, and macro levels. Advocacy for survivors was an especially important part of disaster response. In crosscultural situations, service providers needed to be sensitive to the cultural, political, and socioeconomic differences that inhibited rapport building (Puig & Glynn, 2003). Collaborating with multiple agencies under stress meant that service provision was hampered by the uncertainty and lack of integration of public systems and was prone to conflicts between client needs and government instructions, creating conflicts for social workers (Yueh-Ching, 2003). Cultural differences (such as values, jargon, and work styles) between the various professionals and between professionals and volunteers caused friction (Itzhaky & York, 2005). However, the required collaboration improved both agencies relationships with each other and services provided to clients after a disaster (Heitkamp, 1997). The focus of disaster case management has been the development of a Recovery Plan, which identified survivors resources and needs (UMCOR, 2001; NVOAD, 2004). In this plan, the case manager and survivor identified the survivors unmet needs, which must be disaster-related, as opposed to pre-disaster conditions or ongoing social issues. Both NVOAD and UMCOR stressed the importance of survivor responsibility for their own recov-

Holly Bell

17

ery and urged case managers to discourage survivor dependence. The UMCOR training manual also instructed case managers about potential cultural differences that may impact their relationship and sources of resistance to participation in the case management process (UMCOR, 2001). Drawing on this background material, the present study focused on how case management was interpreted and implemented in response to the evacuation of gulf coast residents to Austin, Texas immediately after Hurricane Katrina. EVACUATING KATRINA SURVIVORS TO AUSTIN After evacuation orders were issued in New Orleans on August 31, 2005, approximately 1.2 million residents of the Gulf Coast evacuated. Texas received an estimated 250,000 evacuees (Nigg, Barnshaw, & Torres, 2006). The City of Austin built and operated a temporary, full-service shelter and from September 3 to September 23, 2005 housed over 4,200 survivors; Austin became home to an additional 8,000 Katrina survivors (City of Austin, 2006). Disasters such as Katrina have both revealed and created social inequalities (Fothergill & Peek, 2004; Kamel & Loukaitou-Sideris, 2004). Persons living in poverty were more likely to suffer disproportionate material, psychological, and physical impacts, and faced additional barriers during response and recovery (Fothergill & Peek, 2004; Zakour & Harrell, 2003). Katrina evacuees were a case in point: 67% of the residents of flooded New Orleans were African American; nearly 30% lived below the poverty line; 11.7% were over 65; only 74.7% were high school graduates and 27.3% of households did not own cars. A larger than average percentage had disabilities (Fussell, n.d.). In addition, New Orleans ranked second among the nations 50 largest cities in which low-income families were concentrated in low-income neighborhoods (Berube & Katz, 2005). This resulted in tight social networks of mutual support, but isolated residents from supports outside their impoverished community. The survivors who arrived in Austin, most of them from New Orleans, experienced a very

different city than the one they had left. Austin is the capital of Texas, with a total population of over 650,000, of which only 9.8% are African American; 52.9% are European American, and 30.6% are Hispanic. Home to one of the largest universities in the nation, Austinites were generally well-educated: 85.4% of residents had a high school degree or higher (v. 84.2% nationwide), and 44.1% had a bachelors degree or higher (v. 27.2% nationwide). Due to its large Hispanic population, 33.2% of the population spoke a language other than English at home (v. 19.4% nationwide). Approximately 14% of families lived below the poverty level (v. 10.2% nationwide) and 18.1% of individuals lived below the poverty level (v. 13.3% nationwide) (The demographics of Austin, Texas, n.d.; Fact sheet: Austin City, Texas. 2005). Affordable housing was an acute problem in Austin. Compared to the HUD (U.S. Department of Housing and Urban Development) fair market rent in New Orleans of $696/month (which required a full-time wage of $11.31/hour to afford), the fair market rent in Austin was $804/month (which required a full-time wage of $15.46/hour to afford) (Texas Low Income Housing Information Service, 2005). The housing market was tight, with a vacancy rate of 9%. No new public housing units had been built since the early 1980s. As of December 2006, Austin had 1,928 units of public housing, and a waiting list of over 3,300; there were over 5,500 people on the waiting list for Section 8 (Housing Authority of the City of Austin, 2006). How the city of Austin welcomed these new residents and attempted to provide for their needs through the development of case management services was the focus of this study. As the largest relocation of American citizens since the Dust Bowl migrations of the 1930s (Nigg, Barnshaw, & Torres, 2006), the relocation of Katrina evacuees to Austin was a rare opportunity to examine local responses to the mass migration of a disadvantaged population in the United States. Case managers fulfilled the traditional functions of identifying survivors, assessing their needs, planning for recovery, linking them with local services, monitoring the outcomes of their interventions and advocating at both the mezzo and macro levels for services. Despite perceived cultural differ-

Downloaded By: [Oklahoma State University] At: 02:57 14 July 2010

18

JOURNAL OF SOCIAL SERVICE RESEARCH

ences that made connecting with survivors difficult, case managers coordinated efforts to provide efficient and effective services. However, the long-standing disadvantages of survivors compounding their disaster-related losses, strained the limited resources of the host community. METHODS The data that formed the basis of this article were collected by a team of researchers as part of a larger study that examined the ways in which governmental and non-governmental agencies enhanced or impeded the recovery of disaster survivors. In this preliminary analysis of the long-term recovery process, we examined the structure of the formal community response to the influx of Katrina survivors. This longitudinal study used a single case study design (Yin, 2003), an empirical inquiry examining a current situation in context. For this study, the case was identified as the long-term recovery process in Austin from the time survivors arrived in September 2005 through the present. As is common in case study research, we utilized multiple sources of data. The study utilized purposive sampling of case managers, volunteers, supervisors, and managers from approximately 50 agencies, including federal, state, non-profit, and faith-based organizations that focused wholly or in part on services to survivors that were represented at weekly case management coordination meetings. Our orientation toward the research process is that of transcendental realism as described by Miles and Huberman (1994): an understanding that social phenomena exist not only in the subjective reality of participants, but also in identifiable patterns and relationships in the objective world (p. 4). My own experience as a social worker and case manager informed my specific research questions and my entre into this research site. Interviews were digitally recorded and transcribed. Interview, observation, and archival data were consolidated into a database developed for this purpose. Participants gave informed consent and were provided with protections of confidentiality. This project was

Downloaded By: [Oklahoma State University] At: 02:57 14 July 2010

approved by the IRB of the University of Texas at Austin. From December 2005 to December 2006, our team conducted approximately 78 interviews and observed at over 50 public meetings and Katrina-related events, including case management coordination meetings, longterm recovery committee meetings, and Katrina memorial events. We collected related newspaper articles and agency reports, and monitored a list serve, which was a resource for coordinating long-term recovery efforts. Since we are studying the long-term recovery, data collection is ongoing. For this analysis, we reviewed field notes from interviews and observations and selected transcriptions to look for examples of the roles and experiences of case managers over time. Prolonged time in the field and triangulation of multiple data sources contributed to the rigor and trustworthiness of this qualitativeanalysis (Padgett, 1989). In November 2006 we conducted a member check with a select group of research participants and in May 2007 we conducted a second member check with the larger group of case managers. In general, participants endorsed the findings, added and clarified some dates and specific policies. Their feedback was incorporated into this analysis, which focused on the functions of case management in this particular situation. FINDINGS These preliminary findings focused on the case management tasks performed with survivors and how the process was organized. Overall, case management in this situation exhibited some of the same functions described in prior research. In this particular environment, there was an increased emphasis on advocacy at both the mezzo and macro levels. Case managers developed a well-coordinated system to share information that streamlined efforts. Challenges in engaging survivors in case management and perceived cultural differences between case managers and survivors created some barriers to service. Despite efforts by the local community, survivors pre-disaster disadvantages and the trauma and displacement, coupled with years of under-funding of safety net services in Texas, created doubts about survivors ability

Holly Bell

19

to become self-sufficient in their host community. Organizing the Response Reports from the Gulf Coast indicated that the majority of survivors that arrived in Austin would not be returning home in the short-term. Through September of 2005, local agencies focused on transitioning survivors out of the convention center and into more permanent housing. The Red Cross paid for the first months rent for a number of families and the city entered into a contract with the Federal Emergency Management Agency (FEMA) to provide rental assistance directly to local landlords for approximately 1,800 survivor families under section 403 of the Stafford Act. The original FEMA deadline for terminating 403 assistance was the end of February, but it was then extended to March 31, then to May 31, then to June 30, then July 31. It finally ended on August 31, 2006. The ever-changing FEMA deadlines created both complacency and additional stress for survivors and service providers as they attempted to make plans for survivors futures. In the summer of 2006, some survivors were transferred to FEMA 408 or individual assistance, where they were paid directly and were responsible for their own rent and utilities; others lost assistance altogether. The citys relationship with FEMA formed the backdrop against which local services, particularly case management, operated. During the fall of 2005, both survivors and local social service agencies received a short painful course in FEMA, as they tried to respond to FEMA policies and procedures. One typical response when asked to comment on their interactions with FEMA was: Well, very, very frustrating. Its just unbelievable how you can have that many people working [at FEMA] and nobody knows anything. . . . Theres no phone number that you can really call . . . you cant go to the FEMA headquarters . . . we just have to wait for a representative to come around and let us know whats going on.

In addition to the focus on FEMA assistance, service providers also addressed the variety of needs survivors presented as new Austin residents: education, employment, health care, and transportation. As survivors transitioned out of hotels and the convention center into their own apartments, local agencies received and distributed large donations of furniture and household items. In December 2005, FEMA began to pay for furniture and the city took over the bulk of furniture delivery. Many survivors were placed in apartments in outlying areas, away from Austins limited bus routes, and transportation emerged as a major issue. In response, several agencies housed case managers at some of these outlying apartment complexes. New agencies developed directly in response to survivor needs, and new collaborations developed between existing agencies. In addition, many established agencies began expanding their services to focus specifically on survivor issues. Additional funding allowed them to add new services to address the various needs of survivors. These included Adopt-AFamily programs at several non-profits. Food pantries opened at apartment complexes with large concentrations of survivors. One agency had an available hotel and housed about 200 survivor families. A faith-based organization housed an additional 50 families in churches. The Katrina Assistance Team (KAT), funded by FEMA, provided emergency mental health services. Americorps volunteers provided additional hands at a number of agencies. National Emergency Grants (NEG) allowed agencies to hire survivors in some of these positions. Agencies that had not previously collaborated before, particularly disaster-focused organizations like the Red Cross and local VOAD (Voluntary Organizations Active in Disaster), state and county social services, private non-profits, and faith-based organizations, learned about each other and coordinated their efforts. In November 2005, UMCOR announced receipt of $66 million for case management services from the federal government and throughout early 2006 Austin agencies begin to receive funding for case management from UMCOR as well as from private foundations and donors. Not all agencies provided case management: several agencies provided funding and coordination

Downloaded By: [Oklahoma State University] At: 02:57 14 July 2010

20

JOURNAL OF SOCIAL SERVICE RESEARCH

Downloaded By: [Oklahoma State University] At: 02:57 14 July 2010

while other agencies provided only direct services. With so many agencies focusing on this problem, coordination between them became an issue and numerous meetings were held in October and November 2005 to develop a systemic approach. In mid-October, a listserve was organized for the purpose of information sharing. In addition, case managers divided their responsibilities by zip code to prevent duplication of services. As the information about various programs settled in, the focus of these meetings shifted to assisting case managers with individual cases and organizing advocacy efforts. Rationale for Case Management Many agencies were familiar with case management with their existing clients. As one city employee explained:. . . case managers can actually guide people through systems, assess the need and then get the information out that will allow us to make a decision about more resources. . . . A manager in a large non-profit that was a key player in the recovery emphasized the assessment aspect of case management, . . . weve got to engage the clients . . . we cant identify the unmet needs if were not involved with the clients. Some of the coordinating agencies received funding from Katrina Aid Today, a program of UMCOR, and explicitly used the UMCOR model. Other agencies with different funding drew from other models of case management that they adapted to this situation. In a training for new case managers in April 2006, an experienced case manager described the goal of case management as holding the space for clients so that they could develop a trusting relationship, receive feedback about available resources to help them move forward, and access needed services for longterm stabilization. As another case manager described it, case management focused on a triad of needs, including income, housing, and self-care. These expressed goals of case management drove the various activities that case managers engaged in with survivors.

Functions of Case Management Case managers responding to displaced Katrina survivors fulfilled functions described in prior literature on case management: identification, planning, assessment, linkage, monitoring, and advocacy. Each of these functions took on its own unique aspect in this particular situation, and will be described in turn. Identification. Identifying survivor clients proved to be more challenging than expected. While some survivors were housed together in large apartment complexes, many seemed to get lost. Survivors rarely reached out to agencies. One provider, who was herself a survivor, suggested that this was a trust issue between the African American survivors from New Orleans and the mostly European American case managers. A local African American pastor suggested that African American survivors were unused to seeking assistance outside of their family, friends, and church community. In response, an African American faith-based organization developed a program for survivor outreach by other Katrina survivors. Assessment. As they began to connect with survivors, case managers assessed survivors needs and identified some of the challenges they faced: disruption of their family and other support networks, employment skills that were mismatched with the Austin economy, lack of identification documents, limited transportation, and trauma from the hurricane and aftermath. Dealing with FEMA and maintainingstable housing were primary needs. Trying to understand the complex rules and regulations was a time-consuming and frustrating aspect of case managers jobs, as in the following example: . . . one of the families that Im working with, we have an issue of FEMA, we have an issue of two household, you know, a boyfriend and a girlfriend but separate households, and they came together so ultimately we decided to consolidate under one FEMA case because they cant both get FEMA assistance in the same household. Well, so I think FEMA took that as meaning that they were the same household they were before [the hurricane] and theyre now telling her she

Holly Bell

21

owes her two thousand dollars back, you know, the emergency disbursement, in thirty days. . . . youre sort of damned if you do, damned if you dont. . . . Like, youre supposed to give them all this information . . . But then you give them too much information and then they make the wrong, you know, they make assumptions and, and theyre so quick to yank your assistance but not very quick to extend it if theres been a mistake. . . . FEMA is its own monster. In addition to struggles with FEMA, obtaining identification documents (IDs) emerged in March 2006 as an additional barrier, as temporary IDs issued at the convention center expired in January 2006 and the challenges of obtaining Louisiana Department of Public Safety ID or other primary forms of identification, such as birth certificates, became apparent. Several agencies joined forces to address the identification issue on a policy level, a Catch-22 situation between the Louisiana and Texas bureaus of vital records: . . . we found out that this really wasnt a state issue. Because it is a state issue about the IDs but thats a set policy that really cant be changed. But the real issue is the sharing of information between Louisiana and Texas, which is an interstate issue, which means its a federal issue. Lack of proper identificationwas and continues to be a major barrier for survivors to obtain training, jobs, leases, and services such as Food Stamps and Medicaid. In addition to the identification issue, there were additional barriers to accessing Food Stamps. The applications of about 6,000 central Texans requesting Food Stamps, Medicaid or Temporary Assistance for Needy Families were stuck in a backlog, as the state rolled out a new call-in system for Texans to apply for public assistance in January 2006 (MacLaggan, 2006, March 6). As one agency supervisor described it: . . . it was kind of the perfect storm I think because that deadline [the end of Katrina emergency Food Stamp eligibility] hit

right when the eligibility system was being transitioned to this privatized model of call centers . . . the private company that was contracted to do the work, they werent really doing it right. . . . There were lots and lots of problems with people calling in and things not being processed. The challenge of changing rules for state programs such as Food Stamps created additional confusion about available resources and resulted in numerous referrals to local food banks. The size and geographical spread of Austin and limited public transportation became an additional problem as many survivors were placed in available housing in outlying areas of the city. Survivors were unused to the city and to the long bus rides to get from one location to another. Elderly and disabled survivors found this particularly challenging. Planning. As they assessed these various complex and interrelated needs, case managers worked with survivors to develop recovery plans. While the overall focus of these plans was self-sufficiency, different agencies and funding sources maintained somewhat different requirements for documentation of the plans. One case manager explained the purpose of such a plan: . . . just having a case management agreement with clients which says that you have a responsibility, that Im not just going to do everything for you, is something. . . . it sets right off the boundaries that say, you know, Im here to help you but youre, youre going to have to help me too. And its a reciprocal relationship . . . I need to be able to help them but then they also need to be able to help themselves. Case managers continually encouraged survivors to take responsibility for their own recovery while providing needed support. Case managers expressed frustration at the slow pace of survivors progress, all the while acknowledging the numerous barriers survivors experienced to resettling in Austin including their loss of important social networks, the mis-

Downloaded By: [Oklahoma State University] At: 02:57 14 July 2010

22

JOURNAL OF SOCIAL SERVICE RESEARCH

Downloaded By: [Oklahoma State University] At: 02:57 14 July 2010

match between their skills and experiences and the requirements of the Austin economy, traumatic stress, and their longing to return home. As one case manager expressed it, I feel like Im walking the line between helping and enabling. Linkage and Monitoring. One of the most important, and time consuming, tasks of the case managers was locating resources for survivors varying needs, linking them to resources, and monitoring the outcome of referrals. Given the changing landscape of the social service delivery system as a result of Katrina-related funding and program changes, accessing appropriate information about services was essential. Weekly case management meetings were critical to this process. They were consistently attended by an average of about 30 service providers each week. One case manager described the weekly meetings as: Fantastic. It has been the best one. Just to know, first of all, that youre not in this boat alone. And that there are other organizations out there that can help or might know a different phone number or somebody else. Yeah, its been great. In these meetings, case managers dealt with the interlocking problems of transportation, employment, identification, housing, and FEMA. They identified emerging needs and brainstormed ways to advocate for survivors. Representatives of agencies providing direct services, such as employment and job training, provided updates on their services. FEMA Voluntary Agency Liaisons (VALs) also attended and assisted in clarifying FEMA rules. Advocacy. Advocacy at both the mezzo and macro levels became a large part of case managers functions. Backed by two Austin legal service groups, case managers advocated for clients with FEMA and landlords. One case manager described her intervention in an eviction case: I had to go to court with one of them [survivors] because [apartment manager] wanted to evict him. Took his money, [the apartment manager] took his money while FEMA was paying them money. . . . legal aid was working with us, too, and at

the last minute, legal aid told us that they couldnt help him with the eviction, but they would try to help him with the money. So, I had to be his lawyer. Oh, I find myself in all kinds of job duties, so I had to be the lawyer in court, and I actually won. They didnt put an eviction on his record, and the judge made him [apartment manager] give him [survivor] his money that same day. Case managers were creative and proactive in identifying and creating resources for survivors. The local long-term recovery agency hosted a forum in May 2006 to assess local housing resources and options for survivors who lost FEMA assistance and could no longer afford their housing. That same month, the case management agencies arranged for utility deposit waivers for families transitioning from FEMA public assistance to individual assistance and would then be responsible for their own utilities. To address the issue of survivor identification documents, many case managers became voter registrars and registered survivors to vote in Texas since voter registration could be used as one form of identification. When the Section 8 waiting list opened in July 2006, case managers actively recruited survivors to apply, and set up tables at the event to engage survivors who were not yet in case management. In the summer of 2006, service providers hosted clinics in apartment complexes, where survivors could work with case managers and FEMA representatives, to explain FEMA requirements and iron out difficulties. When FEMA streamlined the recertification process in October 2006 for continuing 408 assistance, local agencies sponsored a recertification clinic. Case management agencies were on hand to assist survivors with recertification and again reached out to those who were not yet receivingcase management. Service providers also advocated for survivors on the macro level. In June of 2006, a faith-based group held a community forum to remind community and faith-based organizations of the ongoing needs of survivors. Organizers asked attendees to write letters to Texas and Louisiana representatives about survivor issues, particularlyregarding identificationand housing issues. In August 2006, a housing ad-

Holly Bell

23

Downloaded By: [Oklahoma State University] At: 02:57 14 July 2010

vocacy group sponsored another statewide meeting in Houston to push the federal government for additional housing assistance in Texas. Several Austin agencies co-sponsored the event and a number of Austin service providers attended. In summary, case management provided essential links between survivors and local services. Case managers engaged survivors, identified unmet needs, and consolidated and coordinated resources. They created additional services and streamlined access for others. Case managers assisted survivors in negotiating FEMA requirements and advocated for changes in federal policy regarding identification and affordable housing. Case managers were able to report some successes as in the following story: OK, theres a mother, with two kids and a fiance, and when she first moved here it was just her and her fiance and neither one was working. And they had, they got their FEMA money and spent itand her kids were living back with her parents. They were trying to go to school. And shes been like, shes been self-motivated, and she came in here, built up a resum, worked with her fiance finding employment and she got employedencouraged other people in this complex to find that, that employer was hiring. And her two kids are living with her now, and she has a wedding date for two weeks from now. . . . [she just found out shes been accepted on the Fannie Mae home ownership program] and shes excited about that. You know, she wants to do that, [she has] never has owned a house, but you know, its looking to take advantage of being able to save money and being able to have an affordable house. Current Status As of October 2006, local service providers estimated that there were approximately 3,5004,000 survivor households living in Austin. Due to the mobility of this population, there were no exact counts of the number of survivors currently in the area. As Austin service providers and survivors faced the one-year anniver-

sary of the storm and evacuation, case managers tried to make sense of why after nearly a year, many survivors were not self-sufficient. The Texas Health and Human Services Commission (2006) released the results of a statewide survey of survivors in Texas in August 2006. The survey of 6,415 of the approximately 251,000 survivors in Texas indicated that 40% believed they would still be in Texas in two years. Survivors were struggling financially: 59% were unemployed and 41% reported a household income of less than $500 per month. More than half remained dependent on housing subsidies. Survivors had extensive health and mental health needs: 37% described their current physical health as poor or fair; and 40% described their current mental health as poor or fair. Only 33% of households were receiving Medicaid. Despite these challenges, survivors rated Texas response as excellent or very good. The experience of case managers in Austin mirrored these statistics. While there was no upsurge in documented homelessness, as a result of dwindling FEMA assistance as many had predicted, there was what one agency director described as a slow leak of survivor families being evicted, becoming homeless, returning to New Orleans, or doubling up with family or friends in Austin or other host cities. This case manager, when asked what might happen to survivors when FEMA assistance ended, expressed a concern common to case managers: Major homelessness. Like as if Austin doesnt have it bad already. Because theres not even anything for them to go back to in Louisiana yet. Nothing. Despite these limitations, the vast majority of providers interviewed for this study felt good about their collectiveresponse to this disaster: Its amazing that were the poorest group of people [non-profits], but we pull together like nobodys business, and we find the resources, you know. We dont have the money, we dont have the dollars sitting around that these federal agencies have or these state agencies, we just dont have that type of funding, but its amazing how much we can get done, without all that funding. It just happens . . .

24

JOURNAL OF SOCIAL SERVICE RESEARCH

Many participants talked about the increased collaboration that had developed as a result of the evacuation of Katrina survivors to Austin as a positive benefit to the community. Summary Despite the efforts of case managers, survivors continued to struggle toward self-sufficiency. Many survivors didnt seem to understand, trust, or engage with service providers. Case managers were challenged to understand the backgrounds and experiences of gulf coast residents. Lack of jobs, transportation, and affordable housing coupled with survivors trauma and pre-existing needs created new difficulties for both survivors and case managers. Despite these challenges, the majority of case managers interviewed felt positively about their efforts to assist hurricane survivors. Coordination of their efforts was repeatedly named as critical to success. DISCUSSION As a result of recent catastrophes such as 9/11 and Hurricanes Katrina and Rita, there has been increased interest by social workers in disasters. Two special issues of social work journals have focused on disasters (NASW, n.d.) and another is forthcoming. NASW has a policy statement regarding social works response to disasters (NASW, n.d. 2) that focuses on the broad range of contributions that social workers can make in disaster prevention, preparation, mitigation and long-term recovery. In response, schools of social work around the country are developing additional disaster-specific programs and courses and the Council on Social Work Education (CSWE) is disseminating curriculum resources (CSWE, n.d.). A recent international seminar on disaster planning, management, and relief brought social work researchers and educators together to address a wide range of topics from disaster theory and social vulnerability to infusion of disaster-related material into the social work curriculum (CSWE, 2007). Despite this interest, however, there is limited social work research on disasters, particularly long-term recovery (NASW, n.d.). Hurricane Katrina, with its large ongoing

displacement of disaster survivors, is a special case worth consideration by social workers. The present study contributes to the body of social work knowledge of disasters by describing the experiences of case managers in a disaster and extracting lessons learned. It represents a preliminary analysis of a small group of service providers from one mid-sized host city. It may not reflect the experience of other host cities, nor is it based on a random sample of service providers. Further, it reflects the initial stages of an ongoing recovery process. However, it does begin to address questions about the impact of displacement on both hurricane survivors and their host communities that have implications for social work education and practice. Consistent with the literature on case management, Austin case managers and the agencies that supported them have worked for nearly two years to identify survivors, assess their needs, establish recovery plans, link them with available resources, monitor their progress, and advocate for them at the mezzo and macro levels (Hall et al., 2002; Rose & Moore, 1995). Similar to other descriptions of service provision after disasters (Heitkamp, 1997; Itzhaky & York, 2005; Poulin & Soliman, 1999; Yueh-Ching, 2003), they have also worked flexibly in a changing service delivery environment to coordinate their response. As the experience of the 1997 Red River of the North Flood (Heitkamp, 1997) suggested, service providers felt that the increased collaboration required by this event was a silver lining. The importance of collaboration and the skills needed to accomplish it under stress are important lessons for social workers interested in disaster work. Many Katrina survivors suffered not only disaster-related loss, but were also the victims of pre-existing inequities that made them more vulnerable to disaster and less likely to receive disaster assistance (Fothergill & Peek, 2004; Zakour & Harrell, 2003). It was not possible to focus solely on their disaster-related unmet needs as suggested by disaster case management models (UMCOR, 2001; NVOAD, 2004). The extended displacement of thousands of survivors from their homes and natural social supports was a unique feature of this ca-

Downloaded By: [Oklahoma State University] At: 02:57 14 July 2010

Holly Bell

25

tastrophe. In part because of survivors pre-existing disadvantages, as well as the limited resources in Texas, survivors are making slow progress toward self-sufficiency. This situation points to the ongoing need for social work research and advocacy on behalf of groups particularly vulnerable to disaster and displacement. As in other disasters (UMCOR, 2001; Puig & Glynn, 2003), Austin service providers struggled with what they perceived to be cultural differences between themselves and survivors, as they weighed survivors efforts against the substantial barriers they faced. These findings illustrate the ongoing importance of cultural competence in social work education and practice and push our current understanding of culture beyond race, ethnicity, and religion, to an understanding of place. The city of New Orleans had its own irreplaceable culture and understanding survivors loss of their connection to that culture has been an important part of case managers education about their new clients. Case managers struggled, sometimes unsuccessfully, to help clients navigate fragmented and confusing state and federal programs such as FEMA and Food Stamps (Rose & Moore, 1995) encountering conflicts between client needs and government policy (Yueh-Ching, 2003). As the basis for all disaster assistance in this country, a basic understanding of FEMA and the Stafford Act that authorizes it needs to be a part of any social work course or training about disaster. Local case managers worked within the context of decreasing federal involvement in safety net functions. Over the past three decades the U.S. has chosen the path of limiting the federal role in the delivery of basic services. This has been more particularly apparent in the south, which has historically spent less for social programs than other parts of the country. Similarly, the role of FEMA has been reduced to a back up for local response (e.g., Schneider, 2005). The impact of limited federal involvement in the immediate aftermath of Hurricane Katrina has been widely examined (e.g., Bier, 2006; Schneider, 2006; White House, 2006), but its impact on host communities who may become responsible for thousands of low-income survi-

vors over the long term deserves further exploration. Case management with limited local resources (most notably affordable housing) may not sustain displaced survivors over the long haul. After the Northridge earthquake, Congress instructed the Department of Housing and Urban Development (HUD) to administer emergency housing vouchers to many of the displaced low-income households, which werelatermadepermanent(Kamel&LoukaitouSideris, 2004; Winston et al., 2006). At the time of this writing, the federal government is considering transitioning survivors currently receiving rental assistance to HUD after the August 2007 FEMA assistance deadline (FEMA, 2007). Social workers need to continue to advocate for resources for survivors from both governmental and non-governmental sources. Our research team will continue to track the process of long-term recovery in Austin. In addition to our research with service providers, we are also conducting a parallel wave of interviews with Katrina survivors about their needs and their perceptions of services that will allow for additional insight and triangulation with service provider data. We plan to compare the Austin experience with research emerging from other host communities. Future analysis of this material will focus on the specific function of local efforts and advocacy and their impact on federal policy. In addition, we will further examine the partnership between governmental and non-governmental organizations in order to illustrate which services can be most effectively provided by each. A particular focus on displacement as an additional barrier to disaster survivors recovery will be an important aspect of future analysis as well as understanding the particular vulnerabilities of specific cultural groups. The response of the Austin community to displaced survivors from Hurricane Katrina represents a critical case study of a local response to a national disaster. At this stage it appears that local resources and case management, no matter how skillfully executed and coordinated, cannot replace the substantial federal commitment needed to rebuild the gulf coast and support its displaced residents.

Downloaded By: [Oklahoma State University] At: 02:57 14 July 2010

26

JOURNAL OF SOCIAL SERVICE RESEARCH

REFERENCES
Ball, A. (2006, July 16). A visible housing crunch. The Austin American-Statesman, p. A01. Berube, A. & Katz, B. (2005). Katrinas window: Confronting concentrated poverty across America. Retrieved December 7, 2006 from the Brookings Institution website: www.brookings.edu/metro/pubs/20051012_ Concentratedpoverty.pdf Bier, V. (2006). Hurricane Katrina as a bureaucratic nightmare. In R. J. Daniels, D. F. Kettl, & H. Kunreuther (Eds.), On risk and disaster: Lessons from Hurricane Katrina (pp. 243-254). Philadelphia: University of Pennsylvania Press. City of Austin (2006). A city within a city: A model for the nation. City of Austin Hurricane Katrina shelter operations after action report. Council on Social Work Education (2007). Proceedings of the international seminar on disaster planning, management, and relief: New responsibilities for social work education. St. Michael, Barbados. Retrieved May 13, 2007 from http://www.cswe.org/NR/rdonlyres/ A587858F-A61A-4F71-88FF-BFC4003BE1A3/0/ SeminarProceedings.pdf. Council on Social Work Education (n.d.). Curriculum resources: Disaster management and social work. Retrieved May 13, 2007 from http://www.cswe. org/CSWE/centers/kendall/Resources.htm. Dalaker, J. (2001). Poverty in the United States: 2000. Current population reports. U. S. Census Bureau, Washington, DC The demographics of Austin, Texas. Retrieved December 5, 2006 from City of Austin website: http://www. ci.austin.tx.us/census/faqs.htm Drabek, T. E. & McEntire, D.A. (2003), Emergent phenomena and the sociology of disaster: Lessons, trends and opportunities from the research literature. Disaster Prevention and Management, 12, 2, 97112. Dynes, R. (1970). Organized behavior in disaster. Lexington: Heath Lexington Books. Fact sheet: Austin city, Texas. 2005 American community survey data profile highlights. Retrieved December 6, 2006 from http://factfinder.census.gov/ servlet/ACSSAFFFacts?_ FEMA (2007, April 26). Housing assistance extended for gulf coast hurricane victims for another 18 months. Retrieved June 1, 2007 from http://www.fema.gov/news/ newsrelease.fema?id=35729 Fothergill, A. & Peek, L.A. (2004). Poverty and disasters in the United States: A review of recent sociological findings. Natural Hazards, 32, 89-110. Fussell, E. (n.d.). Leaving New Orleans: Social stratification, networks, and hurricane evacuation. Retrieved December 4, 2006 from the Understanding Katrina website: http://understandingkatrina.ssrc.org/ Fussell/ Gorey, K.M, Leslie, D.R., Morris, T., Carruthers, W.V., John, L., & Chacko, J. (1998). Effectiveness of case

management with severely and persistently mentally ill people. Community Mental Health Journal, 34(3), 241-250. Hall, J. A., Carswell, C., Walsh, E., Huber, D. L., & Jampoler, J. S. (2002). Iowa Case Management: Innovative social casework. Social Work, 47(2), 132141. Heitkamp, T. (1997). Human service providers perceptions of system response to the 1997 Red River of the North flood. Applied Behavior Science Review, 7(2), 189-198. Housing Authority of the City of Austin (2006). Retrieved December 28, 2006 from: http://www. hacanet.org/ Itzhaky, H. & York, A.S. (2005). The role of the social worker in the face of terrorism: Israeli communitybased experience. Social Work, 50(2), 141-149. Kamel, N. M. O & Loukaito-Sideris, A. (2004). Residential assistance and recovery following the Northridge earthquake. Urban Studies, 41(3), 533-562. MacLaggan, C. (2006, March 6). Food stamp backlog affects 6,000 central Texans: Applications for food stamps sharply decline in Travis County. Austin American-Statesman. Retrieved March 25, 2006 from http://www.statesman.com/news/content/news/ stories/local/03/6callcenters.html Miles, M. B., & Huberman, M. A. (1994). Qualitative data analysis: An expanded sourcebook. Thousand Oaks, CA: Sage Publications, Inc. National Association of Social Workers (NASW) (n.d.). Disasters. Retrieved December 30, 2006 from: http://www.socialworkers.org/research/naswResearch/ 0205Disasters/default.asp?print NationalAassociation of Social Workers (NASW) (n.d.2) Disasters. Retrieved December 30, 2006 from: http://www.socialworkers.org/pressroom/events/ 911/disasters.asp National Voluntary Organizations Active in Disaster (2004). Long-term recovery manual. Retrieved December 5, 2006 from the NVOAD website: http://www.nvoad.org/articles/LTRManualFinalApr 232004a.pdf Nigg, J. M., Barnshaw, J., & Torres, M. R. (2006). Hurricane Katrina and the flooding of New Orleans: Emergent issues in sheltering and temporary housing. Annals, The American Academy of Political and Social Science, 604 (March), 113-128. Padgett, D. K. (1998). Qualitative methods in social work research: Challenges and rewards. Thousand Oaks, CA: Sage. Poulin, J. & Soliman, H. H. (1999). Disaster outreach provision: The development of an index. Journal of Social Service Research, 25(4), 77-92. Puig, M. E. & Glynn, J. B. (2003). Disaster responders: A cross-cultural approach to recovery and relief work. Journal of Social Service Research, 30(2), 55-66.

Downloaded By: [Oklahoma State University] At: 02:57 14 July 2010

Holly Bell

27

Downloaded By: [Oklahoma State University] At: 02:57 14 July 2010

Quarantelli, E. L. (2003). A half century of social science disaster research: Selected major findings and their applicability. Preliminary Paper #336. Retrieved 10/18/06 from the University of Delaware Disaster Research Center website: http://www.udel.edu/ DRC/ Preliminary_Papers/PP336%20HALF%20CENTURY %20.pd Rose, S. M. & Moore, V. L. (1995). Case management. In R. L. Edwards & J. G. Hopps (Eds.), Encyclopedia of Social Work, 19th Edition (pp. 335-340). Washington, DC: NASW Press. Saleh, S. S., Vaughn, T., Levey, S., Fuortes, L., Uden-Holmen, T., & Hall, J. A. (2006). Cost-effectiveness of case management in substance abuse treatment. Research on Social Work Practice, 16(1), 38-47. Scanlon, J. (1999). Emergent groups in established frameworks: Ottawa Carletons response to the 1998 ice storm. Journal of Contingencies and Crisis Management, 7(1), 30-37. Schneider, S. K. (2006). Special report: Administrative breakdowns in the governmental response to Hurricane Katrina. Public Administration Review, 65(5), 515-516. Texas Health and Human Services Commission (2006, August). Hurricane Katrina evacuees in Texas. Retrieved December 29, 2006 from http://www.hhsc. state.tx.us/survey/KATRINA_0806_FinalReport.PDF Texas Low Income Housing Information Service (2005). A low-income hurricane evacuee in Texas . . . We just dont want to be here and then after everything is all over, they cut everything off, push us to the side like we are trash and be forgotten about. Housing Matters. Retrieved December 16, 2006 from http://www.texashousing.org/webnews/issues/ news015.pdf. United Methodist Committee on Relief (2001). Casework in disaster response and recovery. General

Board of Global Ministries, The United Methodist Church. U.S. Bureau of the Census, Table HI-4. Health insurance coverage status and type of coverage by state all people: 1987 to 2000. www.census.gov/hhes/hlthins/ historic/hihistt4.html, accessed July 29, 2002). U.S. Census Bureau, State and County Quick Facts. Available online at: http://quickfacts.census.gov/qfd/ states/00000.html. Last accessed on August 6, 2002. White House (2006). The federal response to Hurricane Katrina: Lessons learned. Retrieved December 3, 2006 from http://www.whitehouse.gov/reports/katrinalessons-learned.pdf Winston, P., Golden, O., Finegold, K., Rueben, K., Turner, M. A., & Zuckerman, S. (2006). After Katrina: Federalism after Hurricane Katrina: How can social programs respond to a major disaster? Retrieved December 5, 2006 from http://www.urban. org/UploadedPDF/311344_after_katrina.pdf Yueh-Ching, C. (2003). Social workers involvement in Taiwans 1999 earthquake disaster aid: Implications for social work education. Social Work and Society 1(1). Retrieved December 29, 2006 from http://www.socwork.net/2003/1/articles/395/SWearthquaketaiwan_ Chou2003_.pdf Yin, R. K. (2003). Case study research: Design and methods, 3rd Edition. Thousand Oaks, CA: Sage Publications. Zakour, M. J. & Harrell, E. B. (2003). Access to disaster services: Social work interventions for vulnerable populations. Journal of Social Service Research, 30(2), 27-54.

RECEIVED: 01/03/07 REVISED: 06/01/07 ACCEPTED: 07/30/07