Case Management With Displaced Survivors of Hurricane Katrina, A Case Study of One Host Community (Bell)

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Case Management with Displaced Survivors of Hurricane KatrinaHolly 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 SocialService Research, 34: 3, 15 — 27

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Case Managementwith Displaced Survivors of Hurricane Katrina:

A Case Study of One Host CommunityHolly Bell

ABSTRACT. Case management is a staple of post-disaster recovery, but there is limited re-search on this topic. Utilizing in-depth interviews, observations, and document analysis, basedon 78 interviews and attendance at approximately 50 public meetings, this longitudinal casestudy examined case management with displaced hurricane Katrina survivors in one host com-munity between December 2005 and December 2006. Case managers identified, assessed,planned, linked, monitored, and advocated for survivors.They described engaging survivors andunderstanding their backgrounds and experiences as challenging. Lack of jobs, transportation,

and affordable housing coupled with survivors’ trauma and preexisting needs presented barriersto long-term recovery. Despite thesedifficulties, case managers feltpositively about their effortsand identified coordination as a critical element for successful human/social services responsesto natural disasters. doi: [Article copies available for a fee from The Haworth

Document Delivery Service: 1-800-HAWORTH. E-mail address: <[email protected]>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 fol-lowed displacedmany poorAfrican-American

residents of New Orleans andsouthern Missis-sippi.Manyofthosemostaffectedbythisdisas-ter had lived in communities of concentratedand persistent poverty for generations. Hostcommunities, themajorityof theminneighbor-ing southern states, were faced with helping tomeet these families’ needs. They were particu-larly ill suited to this task. Southern states his-torically have had few state and federal safety-net services and relied more heavily on family,

church, and non-governmental organizationsfor these functions. Texas and Louisiana, for

example, were among the 10 poorest states(Dalaker,2001),andtheyhadamongthelowestwelfare payments and use (U.S. Ways andMeans 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 so-cial service delivery within these communitiesgreatlyaffectedthecommunity’sability tocarefor its most vulnerable citizens.

Holly Bell, PhD, LCSW, is Research Associateat the Center for SocialWork Research, The University of Texas

at Austin. Address correspondence to her at: Center for Social Work Research, School of Social Work, the Univer-sity of Texas at Austin, 1 University Station, D3510, Austin, TX 78712-0359 (E-mail: hbell@mail. utexas.edu).

Theauthor gratefully acknowledgesLaura Lein, Ron Angel, and Julie Beausoleil for their assistance in theprep-aration of this manuscript.

This research was funded by National Science Foundation grant number 0555113.

Journal of Social Service Research, Vol. 34(3) 2008Available online at http://jssr.haworthpress.com© 2008 by The Haworth Press. All rights reserved.

doi: 1510.1080/01488370802085932

10.1080/01488370802085932



Thisstudyfocusedonthefunctionsandchal-lenges of providing long-term disaster casemanagementtohurricanesurvivorsbyexamin-ing the experience of one southern host city.Despite the coordinated efforts of local casemanagers in identifying, assessing, planning,linking, monitoring, and advocating for dis-placed hurricane survivors, the combined ef-fects of their long-standingdisadvantage, trau-matic loss, and limited resources in the hostcommunitypresentednumerousbarrierstosur-vivors’ long-term recovery.

CASE MANAGEMENT

Case management isa stapleof post-disaster

recovery.Basedonearlymodelsof socialcase-work (Hall, Walsh, Huber, & Jampoler, 2002),social workers, other professionals, or para-professionalsmayprovidetheseservices(Rose& Moore, 1995). Thegoalof casemanagementis the provision of high quality cost-effectiveserviceswiththeultimategoalofimprovingthequality of clients’ lives (Hall et al., 2002). Intheir reviewof thehistory of case management,Hall et al. (2002) noted six generally acceptedfunctions of case management. Identificationoroutreach toclients is the first step. Next, casemanagers conduct an assessment of clients’

needs. Case managers then engage in planningwith the client about addressing his or her par-ticular needs. An additional function of casemanagement involves linking clients withneeded services. Monitoring the outcomes of their interventions is important, to insure thatclients actually receive the needed services. Incases where they do not, case managers engageinadvocacy atboththemezzoandmacrolevels.While the focus of case management is assist-ing clients to deal with fragmented services,case managers often find themselves unable tohelp clients successfullynavigatea brokensys-

tem (Rose& Moore, 1995). There are a numberof models of case management (Hall et al.,2002), making comparison and evaluation of casemanagementproblematic.Researchontheeffectiveness and cost-effectiveness of casemanagement hasbeen equivocal,althoughpre-vious research has indicated that it improvedclient 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 takesa slightly different form. Disasters destroy oralter normalsocialorganization,andneworgani-zational structures emerge in disaster responseand recovery (e.g., Dynes, 1970; Drabek &McEntire, 2003; Quarantelli, 2003; Scanlon,1999), requiringthat service providers respondflexibly to a changing service delivery system.Examples drawn from social service provisionafter the 1993 GreatFloodin Illinois (Poulin&Soliman, 1999), Hurricane Mitch in Honduras(Puig & Glynn, 2003), the September 21,1999earthquakeinTaiwan(Yueh-Ching,2003),ter-rorist attacks in Israel (Itzhaky & York, 2005),and the 1997 Red River of the North Flood

(Heitkamp, 1997) indicated the need for re-sponders tobe flexible,to activelyseek outsur-vivors,coordinateserviceswithmultipleagen-cies, work with limited information, andintervene at the micro, mezzo, and macro lev-els. Advocacy for survivors was an especiallyimportant part of disaster response. In cross-cultural situations, service providers needed tobe sensitive to the cultural, political, andsocioeconomic differences that inhibited rap-port building (Puig & Glynn, 2003). Collabo-rating with multiple agencies under stressmeant that service provision was hampered by

theuncertaintyandlackof integrationofpublicsystems andwaspronetoconflictsbetween cli-ent needs and government instructions, creat-ing conflicts for social workers (Yueh-Ching,2003).Culturaldifferences(such asvalues, jar-gon, and work styles) between the various pro-fessionals and between professionals and vol-unteerscausedfriction(Itzhaky& York, 2005).However, the required collaboration improvedboth agencies’ relationships with each otherand 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 andneeds(UMCOR,2001;NVOAD,2004).Inthisplan, the case manager and survivor identifiedthe survivors’ “unmet needs,” which must bedisaster-related, as opposed to pre-disasterconditions or ongoing social issues. BothNVOAD andUMCORstressedtheimportanceof survivor responsibility for their own recov-

16 JOURNAL OF SOCIAL SERVICE RESEARCH



eryandurgedcase managerstodiscourage sur-vivor dependence.The UMCOR trainingman-ual also instructed case managers aboutpotential cultural differences that may impacttheir relationship and sources of resistance toparticipation in the case management process(UMCOR, 2001).

Drawing on this background material, thepresent study focused on how case manage-ment was interpreted and implemented in re-sponse to theevacuation ofgulf coast residentsto Austin, Texas immediately after HurricaneKatrina.

EVACUATING KATRINA SURVIVORS

TO AUSTIN

After evacuation orders were issued in NewOrleansonAugust31,2005,approximately1.2million residents of the Gulf Coast evacuated.Texas received an estimated 250,000 evacuees(Nigg, Barnshaw,& Torres, 2006).TheCity of Austinbuilt andoperateda temporary, full-ser-vice shelter and from September 3 to Septem-ber23,2005housedover4,200survivors;Aus-tinbecamehome toanadditional8,000Katrinasurvivors (City of Austin, 2006).

Disasterssuch asKatrina have both revealedand created social inequalities (Fothergill &

Peek,2004; Kamel&Loukaitou-Sideris,2004).Persons living in poverty were more likely tosuffer disproportionate material, psychologi-cal, andphysical impacts, andfaced additionalbarriers duringresponse andrecovery (Fother-gill&Peek,2004;Zakour&Harrell,2003).Ka-trina evacuees were a case in point: 67% of theresidentsoffloodedNewOrleanswereAfricanAmerican; nearly30% lived below thepovertyline; 11.7% were over 65; only 74.7% werehighschoolgraduatesand27.3%ofhouseholdsdidnotowncars.Alargerthanaveragepercent-age had disabilities (Fussell, n.d.). In addition,

New Orleans ranked second among the na-tion’s 50 largest cities in which low-incomefamilies were concentrated in low-incomeneighborhoods(Berube&Katz,2005).Thisre-sulted in tight social networks of mutual sup-port, but isolated residents from supports out-side their impoverished community.

ThesurvivorswhoarrivedinAustin,mostof them from New Orleans, experienced a very

different city than the one they hadleft. Austinis the capital of Texas, with a total populationof over 650,000, of which only 9.8% are Afri-can American; 52.9% are European Ameri-can, and 30.6% are Hispanic. Home to one of the largest universities in the nation, Austin-ites were generally well-educated: 85.4% of residents had a high school degree or higher(v.84.2%nationwide), and44.1%had a bach-elor’s degreeor higher (v.27.2% nationwide).Due to itslargeHispanicpopulation,33.2% of the population spoke a language other thanEnglish at home (v. 19.4% nationwide). Ap-proximately 14% of families lived below thepoverty level (v. 10.2% nationwide) and18.1% of individuals lived below the povertylevel (v. 13.3% nationwide) (The demograph-

ics of Austin, Texas, n.d.; Fact sheet: AustinCity, Texas.2005). Affordable housing wasanacuteprobleminAustin.ComparedtotheHUD(U.S. Department of Housing and Urban De-velopment) fair market rent in New Orleans of $696/month (which required a full-time wageof$11.31/hourtoafford),thefairmarketrentinAustin was $804/month (which required afull-timewageof$15.46/hourtoafford)(TexasLow Income Housing Information Service,2005).Thehousingmarketwastight,withava-cancy rate of 9%. No new public housing unitshad been built since the early 1980s. As of De-

cember 2006, Austin had 1,928 units of publichousing, and a waiting list of over 3,300; therewere over 5,500 people on the waiting list forSection 8 (Housing Authority of the City of Austin, 2006).

How the city ofAustinwelcomed these newresidents and attempted to provide for theirneeds through the development of case man-agementserviceswas thefocusofthisstudy.Asthe largest relocation of American citizenssince the Dust Bowl migrations of the 1930s(Nigg, Barnshaw, & Torres, 2006), the reloca-tion of Katrina evacuees to Austin was a rare

opportunity to examine local responses to themass migration of a disadvantaged populationin the United States. Case managers fulfilledthe traditional functions of identifying survi-vors, assessingtheir needs,planningfor recov-ery, linking them with local services, monitor-ing the outcomes of their interventions andadvocating at both themezzo andmacro levelsfor services. Despite perceived cultural differ-

Holly Bell 17



ences that made connecting with survivors dif-ficult, case managers coordinated efforts toprovide efficient and effective services. How-ever, the long-standingdisadvantages of survi-vorscompoundingtheirdisaster-relatedlosses,strained the limited resources of the hostcommunity.

METHODS

The data that formed the basis of this articlewere collected by a team of researchers as partof a larger study that examined the ways inwhich governmental and non-governmentalagencies enhanced or impeded the recovery of disaster survivors. In this preliminary analysis

of the long-term recovery process, we exam-ined the structure of the formal community re-sponse to the influx of Katrina survivors. Thislongitudinal study used a single case study de-sign (Yin, 2003), an empirical inquiry examin-ingacurrentsituationincontext.Forthisstudy,the “case” was identified as the long-term re-covery process in Austin from the time survi-vors arrived in September 2005 through thepresent. As is common in case study research,we utilized multiple sources of data. Thestudyutilized purposive sampling of case managers,volunteers,supervisors,andmanagersfromap-proximately 50 agencies, including federal,state, non-profit, and faith-basedorganizationsthatfocusedwhollyorinpartonservicestosur-vivors that were represented at weekly casemanagement coordination meetings. Our ori-entation toward the research process is that of “transcendentalrealism”as describedby Milesand Huberman (1994): an understanding thatsocial phenomena exist not only in the subjec-tive reality of participants, but also in identifi-able patterns and relationships in the objectiveworld (p. 4). My own experience as a social

workerandcasemanager informedmyspecificresearch questions and my entrée into thisresearch site.

Interviews were digitally recorded and tran-scribed. Interview, observation, and archivaldata were consolidated into a database devel-oped for this purpose. Participants gave in-formed consent and were provided with pro-tections of confidentiality. This project was

approved by the IRB of the University ofTexasat Austin.

From December 2005 to December 2006,our team conducted approximately 78 inter-views and observed at over 50 public meetingsand Katrina-related events, including casemanagement coordination meetings, long-term recovery committee meetings, and Ka-trina memorial events. We collected relatednewspaper articles and agency reports, andmonitoredalistserve,whichwasaresourceforcoordinating long-term recovery efforts. Sincewe are studying the long-term recovery, datacollection is ongoing. For this analysis, we re-viewed field notes from interviews and obser-vations and selected transcriptions to look forexamples of the roles and experiences of case

managersovertime.Prolongedtimeinthefieldand triangulationof multiple data sources con-tributed to the rigor and trustworthiness of thisqualitativeanalysis(Padgett,1989).InNovem-ber 2006 we conducted a membercheck withaselectgroupof researchparticipantsandinMay2007 we conducted a second member check with the larger group of case managers. In gen-eral, participants endorsed the findings, addedand clarified some dates and specific policies.Their feedback wasincorporated into this anal-ysis, which focused on the functions of casemanagement in this particular situation.

FINDINGS

These preliminary findings focused on thecase management tasks performed with survi-vors and howthe process was organized.Over-all, case management in this situationexhibitedsome of the same functions described in priorresearch. In this particular environment, therewasanincreasedemphasisonadvocacyatboththemezzoandmacrolevels.Casemanagersde-velopeda well-coordinatedsystem to share in-

formation that streamlined efforts. Challengesin engaging survivors in case management andperceived cultural differences between casemanagers and survivors created some barriersto service. Despite efforts by the local commu-nity, survivors’ pre-disaster disadvantagesandthe trauma and displacement, coupled withyears of under-funding of safetynet services inTexas, created doubts about survivors’ ability




to become self-sufficient in their host commu-nity.

Organizing the Response

Reports from the Gulf Coast indicated thatthemajority of survivors that arrived in Austinwouldnot be returninghome in theshort-term.Through Septemberof 2005, localagencies fo-cusedon transitioning survivorsoutof thecon-vention center and into more permanent hous-ing. The Red Cross paid for the first months’rent for a number of families and the city en-tered into a contract with the Federal Emer-gency Management Agency (FEMA) to pro-viderentalassistancedirectlytolocallandlordsfor approximately 1,800 survivor families un-

dersection403oftheStaffordAct.TheoriginalFEMAdeadlinefor terminating 403 assistancewas the end of February, but it was then ex-tended to March 31, then to May 31, then toJune30,thenJuly31.ItfinallyendedonAugust31, 2006.The ever-changingFEMA deadlinescreatedbothcomplacencyandadditionalstressfor survivors and service providers as they at-tempted tomakeplansforsurvivors’ futures. Inthe summer of 2006, some survivors weretransferred to FEMA 408 or individual assis-tance, where they were paid directly and were

responsible for their own rent and utilities;others lost assistance altogether.

The city’s relationship with FEMA formedthebackdrop against whichlocal services, par-ticularly case management, operated. Duringthe fall of2005, both survivors and local socialserviceagenciesreceivedashortpainfulcoursein FEMA, as they tried to respond to FEMApolicies and procedures. One typical responsewhen asked to comment on their interactionswith FEMA was:

Well, very, very frustrating. It’s just un-believable how you can have that manypeople working [at FEMA] and nobodyknows anything. . . . There’s no phonenumber that you can really call . . . youcan’t go to the FEMA headquarters . . .we just have to wait for a representativeto come around and let us know what’sgoing on.

InadditiontothefocusonFEMAassistance,service providers also addressed the variety of needs survivors presented as new Austin resi-dents: education,employment,healthcare,andtransportation.As survivors transitionedoutof hotels andtheconvention center into their ownapartments,localagenciesreceivedanddistrib-utedlargedonationsoffurnitureandhouseholditems. In December 2005, FEMA began to payfor furniture and the city took over the bulk of furnituredelivery.Manysurvivorswereplacedin apartments in outlying areas, away fromAustin’s limited bus routes, and transportationemerged as a major issue. In response, severalagencies housed case managers at some of these outlying apartment complexes.

New agencies developed directly in re-

sponse to survivor needs, and new collabora-tions developed between existing agencies. Inaddition, many established agencies began ex-panding their services to focus specifically onsurvivor issues. Additional funding allowedthem toaddnewservicestoaddress thevariousneeds of survivors. These included Adopt-A-Family programs at several non-profits. Foodpantries opened at apartment complexes withlarge concentrations of survivors. One agencyhad an available hotel and housed about 200survivor families. A faith-based organizationhoused an additional 50 families in churches.The Katrina Assistance Team (KAT), fundedby FEMA, provided emergency mental healthservices. Americorps volunteers provided ad-ditional hands at a number of agencies. Na-tionalEmergencyGrants (NEG) allowedagen-ciestohiresurvivorsinsomeofthesepositions.Agencies that had not previously collaboratedbefore, particularly disaster-focused organiza-tions likethe Red Cross and local VOAD(Vol-untary Organizations Active in Disaster), stateandcounty social services,private non-profits,and faith-based organizations, learned about

each otherandcoordinated their efforts. In No-vember 2005, UMCOR announced receipt of $66millionforcasemanagementservicesfromthe federal government and throughout early2006 Austin agencies begin to receive fundingfor case management from UMCOR as well asfrom private foundations and donors. Not allagencies provided case management: severalagencies provided funding and coordination

Holly Bell 19



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 inOctober and November 2005 to develop a sys-

temic approach. In mid-October, a listservewas organized for the purpose of information

sharing. In addition, case managers divided

their responsibilitiesby zipcodeto preventdu-plication of services. As the information about

various programs settled in, the focus of these

meetings shifted to assisting case managerswith individual cases andorganizingadvocacy

efforts.

Rationale for Case Management

Manyagencieswerefamiliarwithcaseman-

agement with their existing clients. As one cityemployeeexplained:“...casemanagerscanac-

tuallyguidepeople throughsystems, assess the

need and then get the information out that will

allow us to make a decision about more re-sources. . . .” A manager in a large non-profit

that was a key player in the recovery empha-

sized the assessment aspect of case manage-ment,“...we’vegottoengagetheclients...we

can’t identify the unmet needs if we’re not in-volvedwiththeclients.”Someofthecoordinat-ing agencies received funding from Katrina

Aid Today, a program of UMCOR, and explic-

itly used the UMCOR model. Other agencies

with different fundingdrew from other modelsof case management that they adapted to this

situation.Inatrainingfornewcasemanagersin

April 2006, an experienced case manager de-scribed the goal of case management as “hold-

ing the space” for clients so that they could de-

velop a trusting relationship, receive feedback about available resources to help them move

forward, and access needed services for long-

termstabilization.Asanothercasemanagerde-scribed it, case management focused on a triad

of needs, including income, housing, and

self-care. These expressed goals of case man-

agement drove the various activities that casemanagers engaged in with survivors.

Functions of Case Management

Case managers responding to displacedKa-trina survivors fulfilled functions described inprior literature on case management: identifi-cation,planning,assessment,linkage,monitor-ing,andadvocacy.Eachofthesefunctionstook on itsown uniqueaspectin this particular situa-tion, and will be described in turn.

Identification. Identifying survivor clientsproved to be more challenging than expected.While some survivors were housed together inlarge apartment complexes, many seemed toget“lost.”Survivorsrarelyreachedouttoagen-cies. Oneprovider, whowasherselfa survivor,suggested that this was a “trust” issue betweenthe African American survivors from New Or-

leans and the mostly European American casemanagers. A local African American pastorsuggested that African American survivorswere unused to seeking assistance outside of their family, friends,andchurchcommunity. Inresponse, an African American faith-based or-ganization developed a program for survivoroutreach by other Katrina survivors.

Assessment . As they began to connect withsurvivors, case managers assessed survivors’needs and identified some of the challengesthey faced: disruption of their family and othersupportnetworks, employmentskills that were

mismatched with the Austin economy, lack of identification documents, limited transporta-tion, and trauma from the hurricane and after-math.DealingwithFEMAandmaintainingsta-ble housing were primary needs. Trying tounderstand the complex rules and regulationswasa time-consumingandfrustratingaspectof case managers’ jobs, as in the followingexample:

. . . one of the families that I’m workingwith, we have an issue of FEMA, wehave an issue of two household, you know,

a boyfriend and a girlfriend but separatehouseholds, and they came together soultimately we decided to consolidate un-der one FEMA case because they can’tboth get FEMA assistance in the samehousehold. Well, so I think FEMA took that as meaning that they were the samehousehold they were before [the hurri-cane] and they’re now telling her she




owes her two thousand dollars back, youknow, the emergency disbursement, inthirty days. . . . you’re sort of damned if you do, damned if you don’t. . . . Like,you’re supposed to give them all this in-formation . . . But then you give them toomuch information and then they make thewrong, you know, they make assump-tions and, and they’re so quick to yank your assistance but not very quick to ex-tend it if there’s been a mistake. . . .FEMA is its own monster.

In addition to struggleswith FEMA, obtain-ing identification documents (IDs) emerged inMarch 2006 as an additional barrier, as tempo-raryIDsissuedattheconventioncenterexpired

inJanuary2006and thechallengesofobtainingLouisiana Department of Public Safety ID orother primary forms of identification, such asbirth certificates, became apparent. Severalagenciesjoinedforces toaddress theidentifica-tion issue on a policy level,a “Catch-22” situa-tion between the Louisiana and Texas bureausof vital records:

. . . we found out that this really wasn’t astate issue. Because it is a state issueabout the IDs but that’s a set policy thatreallycan’t be changed. But the real issue

is the sharing of information betweenLouisiana and Texas, which is an inter-state issue, which means it’s a federal is-sue.

Lackofproperidentificationwasandcontinuesto be a major barrier for survivors to obtaintraining, jobs, leases, andservicessuchasFoodStampsandMedicaid. In addition to theidenti-fication issue, there were additional barriers toaccessing Food Stamps. The applications of about 6,000 central Texans requesting FoodStamps,MedicaidorTemporaryAssistancefor

Needy Families were stuck in a backlog, as thestate rolledouta newcall-in systemforTexansto apply for public assistance in January 2006(MacLaggan, 2006, March 6). As one agencysupervisor described it:

. . . itwas kindof the perfectstorm I think because that deadline [the end of Katrinaemergency Food Stamp eligibility] hit

right when the eligibility system was be-ing transitioned to this privatized modelof call centers . . . the private companythat was contracted to do the work, theyweren’t really doing it right. . . . Therewere lots and lots of problems with peo-ple calling in and things not being pro-cessed.

The challenge of changing rules for state pro-grams such as Food Stamps created additionalconfusion about available resources and re-sulted in numerous referrals to local foodbanks.

The size and geographical spread of Austinandlimitedpublictransportationbecameanad-ditional problem as many survivors were

placedinavailablehousing inoutlyingareas of the city. Survivors were unused to the city andto the longbus rides toget fromone locationtoanother. Elderly and disabled survivors foundthis particularly challenging.

Planning. As they assessed these variouscomplexandinterrelatedneeds, casemanagersworked with survivors to develop recoveryplans. While the overall focus of these planswas self-sufficiency, different agencies andfunding sources maintained somewhat differ-ent requirements for documentation of theplans.Onecasemanagerexplained thepurpose

of such a plan:

. . . just having a case management agree-ment with clients which says that youhave a responsibility, that I’m not justgoing to do everything for you, is some-thing. . . . it sets right off the boundariesthat say, you know, I’m here to help youbut you’re, you’re going to have to helpme too. And it’s a reciprocal relationship. . . I need to be able to help them but thenthey also need to be able to help them-selves.

Case managers continually encouraged survi-vors to take responsibility for their own recov-erywhile providingneededsupport.Caseman-agers expressed frustration at the slow pace of survivors’ progress, all the while acknowledg-ing the numerous barriers survivors exper-ienced to resettling in Austin including theirloss of important social networks, the mis-

Holly Bell 21



matchbetween their skillsandexperiencesandthe requirements of the Austin economy, trau-matic stress, and their longing to return home.As one case manager expressed it, “I feel likeI’mwalkingthelinebetweenhelpingandenab-ling.”

Linkage and Monitoring. One of the mostimportant, and time consuming, tasks of thecasemanagerswaslocatingresourcesforsurvi-vors’ varying needs, linking them to resources,andmonitoring theoutcomeof referrals.Giventhechanging landscapeof thesocial service de-livery system as a result of Katrina-relatedfunding and program changes, accessing ap-propriate information about services was es-sential. Weekly case management meetingswere critical to this process. They were consis-

tently attended by an average of about 30 ser-vice providers each week. One case managerdescribed the weekly meetings as:

Fantastic. It has been the best one. Just toknow, first of all, that you’re not in thisboat alone. And that there are other orga-nizations out there that can help or mightknow a different phone number or some-body else. Yeah, it’s been great.

In thesemeetings,case managersdealtwith theinterlocking problems of transportation, em-

ployment, identification, housing, and FEMA.They identified emerging needs and brain-stormedwaystoadvocatefor survivors.Repre-sentatives of agencies providing direct ser-vices, such as employment and job training,providedupdatesontheirservices.FEMAVol-untary Agency Liaisons (VALs) also attendedand assisted in clarifying FEMA rules.

Advocacy. Advocacy at both the mezzo andmacro levels became a large part of case man-agers’ functions. Backed by two Austin legalservice groups, case managers advocated forclients with FEMA and landlords. One case

manager described her intervention in aneviction 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 moneywhile FEMAwas paying themmoney. . . .legal aid was working with us, too, and at

the last minute, legal aid told us that theycouldn’t help him with the eviction, butthey would try to help him with themoney. So, I had to be his lawyer. Oh, Ifind myself in all kinds of job duties, so Ihad to be the lawyer in court, and I actu-ally won. They didn’t put an eviction onhis record, and the judge made him[apartment manager] give him [survivor]his money that same day.

Case managers were creative and proactivein identifying and creating resources for survi-vors. The local long-term recovery agencyhosted a forum in May 2006 to assess localhousing resources and options for survivorswho lost FEMA assistance andcouldno longer

affordtheirhousing. That same month, thecasemanagement agencies arranged for utility de-posit waivers for families transitioning fromFEMA public assistance to individual assis-tance and would then be responsible for theirown utilities. To address the issue of survivoridentificationdocuments,manycasemanagersbecame voter registrars and registered survi-vors to vote in Texas since voter registrationcould be used as one form of identification.When the Section 8 waiting list opened in July2006, case managers actively recruited survi-vorstoapply,andsetuptablesattheeventtoen-

gage survivors who were not yet in case man-agement. In the summer of 2006, serviceproviders hosted “clinics” in apartment com-plexes, where survivors could work with casemanagers and FEMA representatives, to ex-plain FEMA requirements and iron out dif-ficulties. WhenFEMAstreamlined the recerti-ficationprocessinOctober2006for continuing408 assistance, local agencies sponsored arecertification clinic. Case management agen-cies were on hand to assist survivors withrecertification and again reached out to thosewhowerenotyetreceivingcasemanagement.

Service providers also advocated for survi-vors on the macro level. In June of 2006, afaith-based group held a community forum toremind community and faith-based organiza-tions of the ongoing needs of survivors. Orga-nizers asked attendees to write letters to Texasand Louisiana representatives about survivorissues,particularlyregardingidentificationandhousing issues. In August 2006, a housing ad-




vocacy group sponsored another statewidemeeting inHouston topush the federal govern-ment for additional housing assistance inTexas. Several Austin agencies co-sponsoredthe event and a number of Austin serviceproviders attended.

In summary, case management provided es-sential links between survivors and local ser-vices. Casemanagersengagedsurvivors, iden-tified unmet needs, and consolidated andcoordinatedresources.Theycreatedadditionalservices and streamlined access for others.Case managers assisted survivors in negotiat-ing FEMA requirements and advocated forchanges in federal policy regarding identifica-tion and affordable housing.

Case managers were able to report somesuccesses as in the following story: OK,there’s a mother, with two kids and afiancée, and when she first moved here itwas just her and her fiancée and neitherone was working. And they had, they gottheir FEMA money and spent it–and herkids were living back with her parents.They were trying to go to school. Andshe’s been like, she’s been self-motivated,and she came in here, built up a resumé,worked with her fiancée finding employ-ment and she got employed–encouraged

other people in this complex to find that,that employer was hiring. And her twokids are living with her now, and she hasa wedding date for two weeks from now.. . . [she just found out she’s been ac-cepted on the Fannie Mae home owner-ship program] and she’s excited aboutthat. You know, she wants to do that,[she has] never has owned a house, butyou know, it’s looking to take advantageof being able to save money and beingable to have an affordable house.

Current Status

As of October 2006, local service providersestimated thattherewereapproximately3,500-4,000 survivor households living in Austin.Due to the mobility of this population, therewerenoexactcountsofthenumberofsurvivorscurrently in thearea. As Austinservice provid-ers and survivors faced the one-year anniver-

sary of the storm and evacuation, case manag-ers tried to make sense of why after nearly ayear, many survivors were not self-sufficient.

The Texas Health and Human ServicesCommission (2006) released the results of astatewide survey of survivors in Texas in Au-gust 2006. The survey of 6,415 of the approxi-mately 251,000 survivors in Texas indicatedthat 40% believed they would still be in Texasin two years. Survivors were struggling finan-cially: 59% were unemployed and 41% re-portedahouseholdincomeoflessthan$500permonth. More than half remained dependent onhousing subsidies. Survivors had extensivehealthandmentalhealthneeds:37%describedtheir current physicalhealthas poor or fair; and40% described their current mental health aspoor or fair. Only 33% of households were re-ceiving Medicaid. Despite these challenges,survivors rated Texas’ response as excellentorvery good.Theexperience of case managers inAustin mirrored these statistics.

While there was no upsurge in documentedhomelessness, as a result of dwindling FEMAassistance as many had predicted, there waswhat one agency director described as a “slowleak” of survivor families being evicted, be-cominghomeless,returningtoNewOrleans,or“doubling up” with family or friends in Austinor other host cities. This case manager, whenasked what might happen to survivors whenFEMA assistance ended, expressed a concerncommon to case managers: “Major homeless-ness. Like as if Austin doesn’t have it bad al-ready. Because there’s not even anything forthemtogobacktoinLouisianayet.Nothing.”

Despite these limitations, the vast majorityofprovidersinterviewedforthisstudyfeltgoodabouttheircollectiveresponsetothisdisaster:

It’s amazing that we’re the poorest group

of people [non-profits], but we pull to-gether like nobody’s business, and wefind the resources, you know. We don’thave the money, we don’t have the dol-lars sitting around that these federal agen-cies have or these state agencies, we justdon’t have that type of funding, but it’samazing how much we can get done,without all that funding. It justhappens . . .

Holly Bell 23



Many participants talked about the increasedcollaboration that had developed as a result of theevacuationofKatrinasurvivorstoAustinasa positive benefit to the community.

Summary

Despite the efforts of case managers, survi-vors continued to struggle toward self-suffi-ciency. Many survivors didn’t seem to under-stand, trust, or engage with service providers.Case managers were challenged to understandthe backgrounds and experiences of gulf coastresidents. Lack of jobs, transportation, and af-fordable housing coupled with survivors’traumaandpre-existingneeds created newdif-ficulties for bothsurvivors and case managers.

Despite these challenges, the majority of casemanagers interviewed felt positively abouttheirefforts toassisthurricanesurvivors.Coor-dination of their efforts was repeatedly namedas critical to success.

DISCUSSION

As a result of recent catastrophes such as9/11 andHurricanesKatrina andRita, therehasbeen increased interest by social workers indi-sasters. Twospecial issuesof socialwork jour-

nals have focused on disasters (NASW, n.d.)and another is forthcoming. NASW has a pol-icystatementregardingsocialwork’s responseto disasters (NASW, n.d. 2) that focuses on thebroad range of contributions that social work-ers can make in disaster prevention, prepara-tion, mitigation and long-term recovery. In re-sponse, schools of social work around thecountryaredevelopingadditionaldisaster-spe-cific programs and courses and the Council onSocialWork Education(CSWE)isdisseminat-ing curriculum resources (CSWE, n.d.). A re-centinternationalseminarondisasterplanning,

management,andreliefbroughtsocialworkre-searchers and educators together to address awide range of topics from disaster theory andsocial vulnerability to infusion of disaster-re-lated material into the social work curriculum(CSWE, 2007). Despite this interest, however,there is limited social work research on disas-ters, particularly long-term recovery (NASW,n.d.). Hurricane Katrina, with itslarge ongoing

displacement of disaster survivors, is a specialcase worth consideration by social workers.

Thepresent study contributes to the body of socialworkknowledge of disastersby describ-ingtheexperiencesof case managers ina disas-terandextracting lessons learned. It representsa preliminary analysis of a small group of ser-vice providers from one mid-sized host city. Itmay notreflect the experienceof other host cit-ies,norisitbasedonarandomsampleofserviceproviders. Further, it reflects the initial stagesof an ongoing recovery process. However, itdoes begin to address questions about the im-pact of displacement on both hurricane survi-vors and their host communities that haveimplications for social work education andpractice.

Consistent with the literature on case man-agement, Austin case managers and the agen-cies that supported them have worked fornearly two years to identify survivors, assesstheir needs,establishrecovery plans, link themwith available resources, monitor their prog-ress, and advocate for them at the mezzo andmacro levels (Hall et al., 2002; Rose & Moore,1995). Similar to other descriptions of serviceprovision after disasters (Heitkamp, 1997;Itzhaky & York, 2005; Poulin & Soliman,1999; Yueh-Ching, 2003), they have alsoworked flexibly in a changing service delivery

environment to coordinate their response. Asthe experience of the 1997 Red River of theNorth Flood (Heitkamp, 1997) suggested, ser-vice providers felt that the increasedcollabora-tion requiredbythis eventwasa “silver lining.”The importance of collaboration and the skillsneeded to accomplish it under stress areimportant lessons for socialworkers interestedin disaster work.

ManyKatrinasurvivorssufferednotonlydi-saster-related loss, butwere also the victims of pre-existing inequities that made them more

vulnerable to disaster and less likely to receivedisaster assistance (Fothergill & Peek, 2004;Zakour & Harrell, 2003). It was not possible tofocus solely on their disaster-related unmetneeds as suggested by disaster case man-agement models (UMCOR, 2001; NVOAD,2004). The extended displacement of thou-sandsofsurvivorsfromtheirhomesandnaturalsocial supports was a unique feature of this ca-




tastrophe. In part because of survivors’ pre-ex-isting disadvantages, as well as the limited re-sources in Texas, survivors are making slowprogress toward self-sufficiency. This situa-tion points to the ongoing need for social work researchandadvocacyonbehalf of groups par-ticularly vulnerable to disaster and displace-ment.

As in other disasters (UMCOR, 2001; Puig& Glynn, 2003), Austin service providersstruggled with what they perceived to be cul-tural differences between themselves and sur-vivors, as they weighed survivors’ effortsagainst the substantial barriers they faced.These findings illustrate the ongoing impor-tanceof cultural competence insocialwork ed-ucation and practice and push our current un-

derstanding of culture beyond race, ethnicity,and religion, to an understanding of place. Thecity of New Orleans had its own irreplaceableculture and understanding survivors’ loss of their connection to that culturehas been an im-portantpartof case managers’ education abouttheir new clients.

Casemanagers struggled, sometimesunsuc-cessfully, to help clients navigate fragmentedand confusing state and federal programs suchas FEMA and Food Stamps (Rose & Moore,1995) encountering conflicts between clientneeds and government policy (Yueh-Ching,2003). As the basis forall disaster assistance inthis country, a basic understanding of FEMAand the Stafford Act that authorizes it needs tobe a part of any social work course or trainingabout disaster.

Localcase managersworkedwithinthecon-textofdecreasingfederalinvolvementinsafetynet functions. Over the past three decades theU.S. has chosen the path of limiting the federalrole in the delivery of basic services. This hasbeen more particularly apparent in the south,which hashistoricallyspent less for socialpro-

gramsthanotherpartsof thecountry.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 inthe immediate aftermath of Hurricane Katrinahas been widely examined (e.g., Bier, 2006;Schneider, 2006; White House, 2006), but itsimpact on host communities who may becomeresponsibleforthousandsoflow-incomesurvi-

vors over the long term deserves furtherexploration.Case managementwithlimitedlo-cal resources (most notably affordable hous-ing) may not sustain displaced survivors over

thelonghaul. After theNorthridgeearthquake,Congress instructed the Department of Hous-ing and Urban Development (HUD) to ad-minister emergency housing vouchers to manyof the displaced low-income households, whichwerelatermadepermanent(Kamel&Loukaitou-Sideris,2004;Winstonetal.,2006).Atthetimeof this writing, the federal government is con-sidering transitioning survivors currently re-ceiving rental assistance to HUD after the Au-gust 2007 FEMA assistance deadline (FEMA,2007).Socialworkersneedtocontinuetoadvo-

cate for resources for survivors from both gov-ernmental and non-governmental sources.Our research team will continue to track the

process of long-term recovery inAustin. In ad-dition to our research with service providers,weare alsoconducting a parallelwaveof inter-views with Katrina survivors about their needsandtheir perceptions of services that will allowfor additional insight and triangulation withservice provider data. We plan to compare theAustin experience with research emergingfrom other host communities. Future analysis

of this material will focus on the specific func-tion of local efforts and advocacy and their im-pact on federal policy. In addition, we willfurther examine the partnership between gov-ernmental and non-governmental organiza-tions inorder to illustrate whichservicescanbemost effectivelyprovided byeach.A particularfocus on displacement as an additional barrierto disaster survivors’ recovery will be an im-portant aspect of future analysis as well as un-derstanding the particular vulnerabilities of specific cultural groups.

The response of the Austin community todisplaced survivors from Hurricane Katrinarepresents a critical case study of a local re-sponse toa nationaldisaster. At this stage it ap-pears that local resources and case manage-ment, no matter how skillfully executed andcoordinated,cannot replace thesubstantialfed-eral commitment needed to rebuild the gulf coast and support its displaced residents.

Holly Bell 25



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

ACCEPTED: 07/30/07

Holly Bell 27

Documents

Case Management With Displaced Survivors of Hurricane Katrina, A Case Study of One Host Community (Bell)