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S. Hrg. 111–543 

DISASTER CASE MANAGEMENT: DEVELOPING 

A COMPREHENSIVE NATIONAL PROGRAM 

FOCUSED ON OUTCOMES 

HEARING 

BEFORE THE

AD HOC SUBCOMMITTEE ON DISASTER RECOVERY 

OF THE

COMMITTEE ON 

HOMELAND SECURITY AND 

GOVERNMENTAL AFFAIRS 

UNITED STATES SENATE 

ONE HUNDRED ELEVENTH CONGRESS 

FIRST SESSION 

DECEMBER 2, 2009 

Available via http://www.gpoaccess.gov/congress/index.html 

Printed for the use of the Committee on Homeland Security 

and Governmental Affairs 

( 
(II) 

COMMITTEE ON HOMELAND SECURITY AND GOVERNMENTAL AFFAIRS 

JOSEPH I. LIEBERMAN, Connecticut, Chairman 

CARL LEVIN, Michigan 

DANIEL K. AKAKA, Hawaii 

THOMAS R. CARPER, Delaware 

MARK L. PRYOR, Arkansas 

MARY L. LANDRIEU, Louisiana 

CLAIRE MCCASKILL, Missouri 

JON TESTER, Montana 

ROLAND W. BURRIS, Illinois 

PAUL G. KIRK, JR., Massachusetts 

SUSAN M. COLLINS, Maine 

TOM COBURN, Oklahoma 

JOHN MCCAIN, Arizona 

GEORGE V. VOINOVICH, Ohio 

JOHN ENSIGN, Nevada 

LINDSEY GRAHAM, South Carolina 

ROBERT F. BENNETT, Utah 

MICHAEL L. ALEXANDER, Staff Director 

BRANDON L. MILHORN, Minority Staff Director and Chief Counsel 

TRINA DRIESSNACK TYRER, Chief Clerk 

AD HOC SUBCOMMITTEE ON DISASTER RECOVERY 

MARY L. LANDRIEU, Louisiana, Chairman 

CLAIRE MCCASKILL, Missouri 

ROLAND W. BURRIS, Illinois 

LINDSEY GRAHAM, South Carolina 

ROBERT F. BENNETT, Utah 

BEN BILLINGS, Staff Director 

ANDY OLSON, Minority Staff Director 

KELSEY STROUD, Chief Clerk 
(III) 

C O N T E N T S 

Opening statement: Page 

Senator Landrieu .............................................................................................. 1 

Prepared statement: 

Senator Landrieu .............................................................................................. 37 

WITNESSES 

WEDNESDAY, DECEMBER 2, 2009 

Elizabeth A. Zimmerman, Assistant Administrator, Disaster Assistance, Federal Emergency Management Agency, U.S. Department of Homeland Security ......................................................................................................................... 4

David Hansell, Principal Deputy Assistant Secretary, Administration for Children and Families, U.S. Department of Health and Human Services ............ 6 

Frederick Tombar, Senior Advisor, Office of the Secretary, U.S. Department 

of Housing and Urban Development .................................................................. 8 

Kay E. Brown, Director, Education, Workforce, and Income Security, U.S. 

Government Accountability Office ...................................................................... 10 

Amanda Guma, Human Services Policy Director, Louisiana Recovery Authority .......................................................................................................................... 11 

Rev. Larry Snyder, President and Chief Executive Officer, Catholic Charities 

USA ....................................................................................................................... 21 

Diana Rothe-Smith, Executive Director, National Voluntary Organizations 

Active in Disaster ................................................................................................. 22 

Irwin Redlener, M.D., Professor, Clinical Population and Family Health, Director, National Center for Disaster Preparedness, Columbia University 

Mailman School of Public Health, and President, Children’s Health Fund .... 24 

Stephen P. Carr, Program Director, Mississippi Case Management Consortium ....................................................................................................................... 27 

Monteic A. Sizer, Ph.D., President and Chief Executive Officer, Louisiana 

Family Recovery Corps ........................................................................................ 29 

ALPHABETICAL LIST OF WITNESSES

Brown, Kay E.: 

Testimony .......................................................................................................... 10 

Prepared statement .......................................................................................... 66 

Carr, Stephen P.: 

Testimony .......................................................................................................... 27 

Prepared statement with attachments ........................................................... 103 

Guma, Amanda: 

Testimony .......................................................................................................... 11 

Prepared statement .......................................................................................... 82 

Hansell, David: 

Testimony .......................................................................................................... 6 

Prepared statement .......................................................................................... 53 

Redlener, Irwin, M.D.: 

Testimony .......................................................................................................... 24 

Prepared statement .......................................................................................... 99 

Rothe-Smith, Diana: 

Testimony .......................................................................................................... 22 

Prepared statement .......................................................................................... 95 

Sizer, Monteic A., Ph.D.: 

Testimony .......................................................................................................... 29 

Prepared statement .......................................................................................... 161 
Page

IV 

Snyder, Rev. Larry: 

Testimony .......................................................................................................... 21 

Prepared statement .......................................................................................... 89 

Tombar, Frederick: 

Testimony .......................................................................................................... 8 

Prepared statement .......................................................................................... 63 

Zimmerman, Elizabeth A.: 

Testimony .......................................................................................................... 4 

Prepared statement .......................................................................................... 46 

APPENDIX 

Charts submitted for the Record by Senator Landrieu ........................................ 39 

Daniel Stoecker, Chief Operating Officer, BPSOS, prepared statement ............ 179 

John R. Vaughn, Chairperson, National Council on Disability (NCD), prepared statement ................................................................................................... 183 

Questions and responses submitted for the record from: 

Ms. Zimmerman ................................................................................................ 193 

Mr. Hansell ....................................................................................................... 195 

Mr. Tombar ....................................................................................................... 198 

Ms. Brown ......................................................................................................... 201 

Ms. Guma .......................................................................................................... 204 

Dr. Redlener ...................................................................................................... 206 

Mr. Carr ............................................................................................................ 210 

Dr. Sizer with an attachment .......................................................................... 214 
(1) 

DISASTER CASE MANAGEMENT: DEVELOPING 

A COMPREHENSIVE NATIONAL PROGRAM 

FOCUSED ON OUTCOMES 

WEDNESDAY, DECEMBER 2, 2009 

U.S. SENATE,

AD HOC SUBCOMMITTEE ON DISASTER RECOVERY,

OF THE COMMITTEE ON HOMELAND SECURITY

AND GOVERNMENTAL AFFAIRS, 

Washington, DC. 

The Subcommittee met, pursuant to notice, at 2:35 p.m., in room 

SD–342, Dirksen Senate Office Building, Hon. Mary L. Landrieu, 

Chairman of the Subcommittee, presiding. 

Present: Senator Landrieu. 

OPENING STATEMENT OF SENATOR LANDRIEU 

Senator LANDRIEU. Good afternoon, and I thank everyone for 

your attention. Welcome to our meeting of the Subcommittee on 

Disaster Recovery. My Ranking Member was planning to join us 

and was called away to the White House for an unexpected meeting, so Senator Graham will not be with us today, but his staff is 

here and other Members may come in. 

We have called this meeting today to discuss the ongoing efforts 

of the Federal Government to better coordinate the case management work associated with disasters, particularly catastrophic 

disasters, as was the case in the 2005 season with Hurricanes 

Katrina and Rita, and then followed on by Hurricanes Gustav and 

Ike in 2008, which really devastated the Gulf Coast. It is not the 

first time we have had a catastrophic natural disaster in the country, but it was one of the most significant and, of course, most recent. 

So let me first begin by welcoming our panel. I am going to give 

very brief opening remarks and then introduce our first panel. Before I do, there are a few announcements. 

I am pleased to have three Louisiana legislators with us, if you 

all would stand and let me recognize you all. We are always 

pleased to have legislators from any State, but particularly my 

State, so welcome. [Laughter.] 

And I understand it is Beth Zimmerman’s birthday today, so 

happy birthday, Beth. Working on her birthday. These FEMA people, they just keep working. So we appreciate you being here on 

your special day. 

Let me just begin by saying that in the aftermath of Hurricanes 

Katrina and Rita, 250,000 families lost their homes. So over a 
2 

weekend, 240,000 people became unemployed. Schools, hospitals, 

and transportation systems ceased to operate. So did social support 

networks that we all count on when those things happen. Churches, community centers, and nonprofits were unable to reopen. All 

of this upheaval took a massive toll on the physical, mental, emotional, and financial well-being of people along the Gulf Coast. 

In response to these complex and overwhelming needs, disaster 

relief nonprofits and government agencies launched a series of ad 

hoc case management programs to help families get back on their 

feet, because, frankly, we didn’t have anything very well organized 

before this. The overarching objective of case management, as we 

know, is to return households to a state of normalcy and self-sufficiency as soon as possible. Case managers are supposed to serve as 

a single point of contact to help survivors access resources and 

services. Resources include things, as we know, like furniture, 

cookware, clothing, or housing, and services might be jobs, job 

placement, job training, child care, mental health counseling, financial counseling, or transportation to school and work, anything that 

would help families who have been affected get back to normal. 

FEMA, HUD, HHS, and the States of Louisiana and Mississippi 

have all run case management programs since the 2005 hurricanes. 

The existence of so many programs in the same region caused a 

great deal of confusion among service providers and clients, but it 

also provided a diverse set of examples to inform the development 

of better models for the future. 

That is what this hearing is about today. The title of the hearing 

refers to ‘‘Developing a Comprehensive National Program Focused 

on Outcomes.’’ We are hoping that the information that is given 

can provide a more comprehensive approach focused not on process, 

but on outcomes, positive outcomes for these families in the event 

that this happens again, and undoubtedly, it will, someplace, somewhere in the United States, something similar. 

So several startling statistics I just want to raise as we open this 

hearing. At one point, and I am not sure of the date of this, but 

at one point sometime probably within a few months of the storm, 

maybe within a year, a survey was taken and we found that only 

one-third of school-aged children at a group trailer site known as 

Renaissance Village in Baker, Louisiana, of which many of us are 

very familiar with, were attending school. That is not a good signal. 

The homeless population of New Orleans, based on our understanding, has doubled since these storms, although a Herculean effort has been made, not only by our local groups but also HUD, to 

try to find appropriate housing. There are still thousands of people 

that we believe to be homeless, many of whom are residing in 

abandoned or vacant buildings. 

Case managers and their clients use separate programs with different eligibility rules. We will learn more about that today. As a 

result, clients went through intake multiple times. Providers had 

to expend significant administrative resources. I could go on and 

on. 

Some of the previous pilot programs seemed to focus, as I said, 

more on process than on outcomes. When they passed a client on 

to someone else, the case was closed. That doesn’t necessarily mean 

the family was ultimately helped. It just means the case was 
3 

1The prepared statement of Senator Landrieu appears in the Appendix on page 37. 

closed. We want to think about a system where when cases are 

closed, that means the family is back in a house, back in a job, the 

kids are back in school, and the family has regained their livelihood and self-sufficiency.Some of these families were on public assistance, but the majority never were, but most certainly needed 

some government aid to get back to normal after the hurricanes. 

So we must continue to look at ways to improve, and that is 

what this hearing is about. Case managers were required to meet 

quotas for closing cases, which may have led to premature closures, 

as I said, or just passing off families that were difficult to serve. 

Case management services are delivered under difficult conditions that make communication, recordkeeping, coordination, and 

efficiency tough. In areas like Southeast Louisiana, where housing 

and mental health professionals had all but disappeared, connecting people with the resources and services they needed was 

sometimes an impossible task. But we need to understand that this 

happens in a natural disaster. What can we do to improve it? 

There is always tension between consistency and flexibility. We 

must standardize things like paper forms, data entry, and funding. 

But we also need to give flexibility to those trying to deliver these 

services in a difficult situation. 

Privacy Act regulations prohibit FEMA from sharing registrants’ 

information without written consent, so case managers knock on 

trailer doors and relyed on word of mouth to offer their services instead of having access to reliable data. Maybe that is appropriate. 

Maybe it is not. We should review that. 

That is what I am hoping that we can get from some of our panelists today, suggestions as to how we can improve the situation. 

Let me suggest, though, in closing, that we may not have to look 

that far, and perhaps some of you have already looked at the models that exist, that have existed for over 30 or 40 years, that serve 

to help foreign refugees resettle here in the United States. In international circles, they are called refugees. But in the context of our 

speaking, they share a lot of similarities with people who are displaced inside of America. American citizens are displaced temporarily from their homes, and perhaps we can look at international 

models that are successful and shape them and modify them so we 

can be more helpful when thousands and thousands—tens of thousands—hundreds of thousands of families are displaced, not for a 

day, not for a weekend, not for a week, but for months, and some 

displaced for years from their homes while the community is trying 

to reestablish itself. 

So we are hoping to get some information at this hearing about 

how to do that, and, of course, for the taxpayer picking up the tab 

for all of this, it is important that we do it efficiently and effectively so we are not wasting resources and wasting funding, and 

that we do it, of course, with the appropriate respect and deference 

to the families that we are trying to serve and the communities 

that we are working within. 

So with that, let me submit the rest of my statement for the 

record and briefly introduce the first panel.1
4 

1The prepared statement of Ms. Zimmerman appears in the Appendix on page 46. 

We are very pleased that we had such a good response. Our first 

witness today—I am going to introduce you all and then we’ll hear 

your testimony—again, Beth Zimmerman, our birthday person, 

serves as Assistant Administrator for Disaster Assistance at 

FEMA. She has had extensive State experience, has acted as State 

Coordinating Officer for numerous federally-declared disasters as 

well as scores of State-level disasters. We are looking forward to 

your testimony on this issue of case management. 

David Hansell is the Principal Deputy Secretary for the Administration for Children and Families with the Department of Health 

and Human Services. Thank you for being here. We are looking forward to hearing your views. 

Fred Tombar is a Senior Advisor to Secretary Donovan. He has 

probably been in New Orleans and other parts of Louisiana as 

many times as I have in the last few months, and we appreciate 

it. Being from the State of Louisiana, he is very special to us, and 

we are looking forward to his testimony today. 

Kay Brown, our fourth witness, is Director of Education, Workforce, and Income Security at the Government Accountability Office 

(GAO). She will be here to discuss a report that GAO released on 

disaster case management, which I co-requested with Chairman 

Lieberman, and will shed some light on this challenge before us. 

And finally, Amanda Guma is Health and Human Services Policy 

Director for our own Louisiana Recovery Authority, where she is 

overseeing our case management programs in Louisiana, and so 

she will be giving somewhat of the State perspective. 

We have also invited our Mississippi folks to participate, as well, 

and some of our international NGOs are here, which won’t be testifying, but that will provide input going forward. 

So, Ms. Zimmerman, why don’t we begin with you, and if you 

could each limit your testimony to 5 minutes, we will then begin 

the first round of questioning. Thank you. 

TESTIMONY OF ELIZABETH A. ZIMMERMAN,1 ASSISTANT ADMINISTRATOR, DISASTER ASSISTANCE, FEDERAL EMERGENCY MANAGEMENT AGENCY, U.S. DEPARTMENT OF 

HOMELAND SECURITY 

Ms. ZIMMERMAN. Good afternoon, Chairman Landrieu. My name 

is Beth Zimmerman and I am FEMA’s Disaster Assistance Assistant Administrator. It is a privilege to be here today on behalf of 

the Department of Homeland Security and the Federal Emergency 

Management Agency. As always, we appreciate your interest and 

your continued support in emergency management and especially 

in implementing the Disaster Case Management Program and authorities. 

FEMA’s goal has always been to work with the communities and 

assist them with their unmet disaster-related needs following a disaster so they can move forward quickly on the road to recovery, as 

one of these ways of achieving this goal is to help survivors to understand and to navigate through the wide array of services and 

programs that may be available to them to return to self-sufficiency 

and sustainability. As the coordinator of Federal disaster assist-
5 

ance, FEMA was charged with securing the delivery of disaster 

case management services. FEMA has been delivering disaster case 

management services on a very limited basis since the beginning 

of the Individual Assistance Recovery Programs in 1988. 

Historically, these services have been very limited. They provide 

referrals to Federal, State, and local assistance programs, connecting the survivors to volunteer organizations through long-term 

recovery committees. However, the widespread devastation, as was 

noted, caused by Hurricanes Katrina and Rita created new challenges for the delivery and coordination of disaster recovery assistance at all levels of government. 

In recognition of these challenges and the desire to expedite the 

comprehensive disaster recovery, Congress provided FEMA with 

the legal authority to implement a Disaster Case Management 

Services Program under the Post-Katrina Emergency Management 

Reform Act of 2006. Since that time, FEMA has been working very 

closely with our Federal, State, and local partners to pilot the delivery of several disaster case management models. 

Currently, FEMA is implementing a two-phase Disaster Case 

Management Program model, and I am very pleased, in fact, today 

to announce that just this morning, we signed an interagency 

agreement between FEMA and the Administration for Children 

and Families (ACF) so that we could finalize both agencies’ role in 

disaster case management. The agreement outlines the first phase 

of disaster case management, where once a State requests to have 

disaster case management, FEMA will notify ACF to initiate their 

rapid deployment of disaster case management assistance to the individuals and families in the affected disaster area. 

Phase two of the program consists of a transition to the Statemanaged Disaster Case Management Program funded through a 

direct grant from FEMA to the State, and this will ensure that the 

State is an essential partner in the delivery of ongoing disaster 

case management services and the use of local service providers in 

the recovery of disaster survivors and the surrounding communities 

will be maximized. It also allows for States to build their capability 

and to care for their own citizens. 

The delivery of timely, appropriate disaster case management 

services cannot be managed, as we know, at the Federal level 

alone. In fact, the coordination is most effective when it is on the 

ground, local, and close to the people affected. Many communities 

have such systems for coordination already in place through their 

established relationships among Federal, State, and local partners, 

the faith-based and the nonprofit organizations, the private sector, 

and most importantly, the disaster survivors themselves. Our goal 

is to build on the relationships to ensure the survivors have a holistic approach to rebuilding their lives in the wake of a disaster. 

Because many of the disaster case management pilot programs 

are still ongoing, FEMA will be incorporating the successes and the 

challenges of the various models as well as the recommendations 

from the July 2009 Government Accountability Office report to develop the program guidance and regulations for the future to be a 

permanent Disaster Case Management Program. 
6 

1The prepared statement of Mr. Hansell appears in the Appendix on page 53. 

FEMA is also committed to ensuring disaster survivors have access to the resources and services they need to help them rebuild 

and recover following a disaster. 

But we can’t do it alone. To be effective, our case management 

efforts have to be coordinated with experts at the Federal, State, 

and local levels of government and with faith-based and nonprofit 

organizations. FEMA will continue to fortify existing disaster case 

management partnerships and encourage new collaboration to ensure the implementation of a successful case management program, 

and I look forward to answering any questions you may have. 

Senator LANDRIEU. Thank you, and congratulations on coming to 

that agreement. It has been something that I have asked for for a 

long time now, and I am very pleased that you all have taken this 

opportunity to make that announcement. 

Mr. Hansell. 

TESTIMONY OF DAVID HANSELL,1 PRINCIPAL DEPUTY ASSISTANT SECRETARY, ADMINISTRATION FOR CHILDREN AND 

FAMILIES, U.S. DEPARTMENT OF HEALTH AND HUMAN 

SERVICES 

Mr. HANSELL. Thank you very much. Senator Landrieu, thank 

you for the opportunity to testify on ACF’s disaster case management efforts. We share your commitment to improving the wellbeing of disaster survivors and appreciate your support for a wellcoordinated, comprehensive disaster case management strategy. 

My testimony today will focus on ACF’s current disaster case management efforts, the lessons we have learned, and our plans to continue and strengthen this vital work. 

After the Stafford Act was amended in 2006 to authorize the 

President to provide funding for case management services to survivors of major disasters, ACF worked closely with FEMA, with 

Voluntary Organizations Active in Disaster, and States to develop 

a holistic disaster case management model. Our approach to disaster case management seeks to assist States in rapidly connecting 

children, families, the elderly, and persons with disabilities with 

critical services that can restore them, as you indicated, to a predisaster level of self-sufficiency that maintains their human dignity. 

Our model is based on five principles: Self-determination, selfsufficiency, federalism, flexibility and speed, and support to States. 

Based on these principles, the pilot project was designed to augment existing State and local capability to provide disaster case 

management. 

We first implemented a 2-week pilot project in September 2008 

following Hurricane Gustav in Louisiana. FEMA then requested 

that we continue our pilot throughout the recovery process, which 

we have done with the support of the U.S. Public Health Service 

and Catholic Charities USA. In addition, we expanded the pilot to 

include survivors of Hurricane Ike to allow enrollment of new clients for up to 6 months post-disaster and to provide case management services for up to 12 months following enrollment. This ex-
7 

pansion from Hurricane Gustav to Hurricane Ike was seamless and 

resulted in no break in services to disaster survivors. 

The total program across all sites is designed to run for 18 

months from implementation, and to date, we have provided case 

management services to approximately 21,000 individuals, far 

greater than the 12,000 that we expected to serve. The majority of 

these clients had incomes below $15,000 a year, and 35 percent of 

the individuals that we served were children. 

To improve the program, we have evaluated our disaster case 

management efforts at multiple stages. We first conducted an afteraction report on the initial 2-week pilot following Hurricane Gustav. This report identified strengths of the program, including the 

ability to initiate services within 72 hours of activation; the use of 

volunteers as program support and subject matter experts; the creation of effective links to health care, human services, mental 

health, and disaster-related resources; and the successful establishment of an intake call center for clients seeking services. 

The report also identified areas requiring improvement, including the need to pre-identify case managers for deployment; to determine the availability of full-time case managers from voluntary 

organizations; and to establish clear team member roles and responsibilities on initial deployment. 

We subsequently awarded a contract to evaluate the organizational structure and processes used for the pilot and to identify any 

significant implementation barriers that impacted clients’ return to 

self-sufficiency or to access needed services. After the pilot ends, we 

plan to conduct an assessment of the impact and outcomes of case 

management services on clients’ abilities to return to self-sufficiency and get back on their feet. Our focus on participant outcomes responds to the concerns cited in the GAO report and, concerns you expressed on the fact that Federal disaster case management evaluations to date have addressed process and implementation issues, but not outcome and impact issues, and we intend to 

do that. 

I am delighted to report, as Ms. Zimmerman already indicated, 

that we have executed an interagency agreement with FEMA to 

allow for implementation of our Disaster Case Management Program after a future major disaster has been declared by the President. The agreement states that in coordination with FEMA and 

the States, ACF will initiate disaster case management within 72 

hours of notification and for a duration of 30 to 180 days, depending on need. 

At the end of the deployment period, we will transition disaster 

case management to either existing State resources or FEMA-funded State disaster case management programs. In exceptional situations, FEMA may authorize ACF to continue services until the 

State is able to assume disaster case management, while meanwhile providing States technical assistance, as needed. 

Drawing on lessons learned from the pilot project and existing 

human services and disaster management expertise, the President’s fiscal year 2010 budget request for ACF would fund the contract with Catholic Charities USA to provide a Federal disaster 

case management system. This contract will ensure that trained 
8 

1The prepared statement of Mr. Tombar appears in the Appendix on page 63. 

personnel are credentialed and available when a serious disaster 

strikes. 

Before I conclude, I would like to share just two brief stories that 

illustrate the significance of these efforts on the lives of individuals. One case manager helped a 49-year-old disabled man in 

Terrebonne Parish after his roof was damaged by Hurricane Gustav. The case manager helped him apply for Food Stamps, delivered the Food Stamp card to his home, and located AmeriCorps volunteers to assist with roof repairs. 

Our case management program also assisted a single mom with 

five children in Saint Tammany Parish who could not evacuate 

their mobile home prior to Hurricane Gustav. After meeting with 

the case manager, this woman received immediate help with housing services, Food Stamps, clothing, crisis counseling, and disaster 

unemployment assistance. 

These two are exemplary of thousands of other instances where 

disaster case management has made a significant difference in survivors’ lives. 

I truly appreciate the opportunity to appear before the Subcommittee and look forward to working with you on this vital effort. Thank you very much. 

Senator LANDRIEU. Thank you, Mr. Hansell. Mr. Tombar. 

TESTIMONY OF FREDERICK TOMBAR,1 SENIOR ADVISOR, OFFICE OF THE SECRETARY, U.S. DEPARTMENT OF HOUSING 

AND URBAN DEVELOPMENT 

Mr. TOMBAR. Good afternoon, Chairman Landrieu, and thank 

you for inviting me to testify here today. 

As you noted, Madam Chairman, HUD has administered case 

management services in the Gulf Coast for thousands of families 

impacted by Hurricanes Katrina, Rita, Gustav, and Ike. Under the 

largest of these programs, the Disaster Housing Assistance Program (DHAP)-Katrina, HUD disbursed $63 million to public housing agencies (PHAs), to provide case management services to more 

than 36,000 families at a cost of $92 per month per family. The 

purpose of the DHAP-Katrina case management was to help families transition to permanent housing. 

Using models like HUD’s HOPE VI Program and FEMA’s 

Katrina Aid Today, a robust case management system was developed that emphasized the case manager’s service connector role. 

Specifically, case managers completed needs assessments, establishing Individual Development Plans (IDPs) that identified the 

goals of each participant, primary of which was finding permanent 

housing. To reach these goals, case managers referred families to 

services that would assist in their progress. 

DHAP-Katrina case management was implemented for all active 

DHAP-Katrina participants until February 28, 2009, the original 

end date for DHAP-Katrina. Between September 2007 and February 2009, case managers completed over 37,000 risk assessments 

and established over 34,000 IDPs. Nearly 97,000 referrals for services were made. The average case manager-to-client ratio was 1-to- 
9 

28, and over 1,000 case managers were engaged in service provision. 

During the transitional close-out program for DHAP-Katrina, 

from March 2009 to October, case management was provided in the 

States of Tennessee and Louisiana, with 200 case managers providing services to over 5,000 families. 

While case management was being provided for DHAP-Katrina, 

Hurricanes Gustav and Ike struck the Gulf Coast in September 

2008. HUD again worked closely with FEMA to establish DHAPIke. Case management services for DHAP-Ike participants began in 

November 2008, and PHAs received a fee of $100 per month per 

family to provide case management. DHAP-Ike is scheduled to end 

in March 2010, and to date, $20 million has been disbursed to 

PHAs to fund work of 400 case managers in providing services to 

over 17,000 families. 

Within HUD’s Office of Community Planning and Development, 

multiple programs provide case management and essential support 

services. Both traditional and disaster-related Community Development Block Grant (CDBG) program funds may be used for public 

services in the areas of employment, job training, child care, and 

other public services. 

The State of Louisiana has obligated—the State of Mississippi, I 

am sorry, has obligated more than $24.7 million of its disaster 

CDBG funding toward case management for people in its homeowners and small rental program. The State of Louisiana has similarly embedded applicant-based case management into its Housing 

Resource Assistance into its homeowner and small rental programs. Neither the State of Mississippi nor Louisiana has used disaster recovery CDBG money to directly provide case management 

services outside of those two programs. 

Through the provision of DHAP case management, HUD has 

learned several key lessons that would assist Federal policy 

changes in the development of Disaster Case Management Programs. Under DHAP, high-quality case management is often provided when PHAs contract with local service providers rather than 

providing the services in-house. As Ms. Zimmerman testified to, 

local case management providers are already positioned to provide 

assistance and have the expertise in case management. Therefore, 

HUD recommends drawing on organizations that have a history of 

providing case management to disaster-impacted populations. 

A second lesson learned is that even when utilizing local case 

management organizations, they may be insufficient direct postdisaster to fully serve these families. So beyond case management 

provisions, disaster-impacted regions are in need of increased resources for service providers. 

A third lesson learned is the need to work more extensively with 

other Federal or nonprofit partners to link vulnerable populations 

to resources. For example, as DHAP-Katrina was ending, concerns 

arose over whether the most vulnerable clients had access to necessary resources. As a result, Housing Choice Vouchers were 

prioritized for elderly and disabled participants. 

My final recommendation is that post-disaster case management 

should formally include a housing self-sufficiency function and that 

these services should be coordinated with HUD and the PHAs for 
10 

1The prepared statement of Ms. Brown appears in the Appendix on page 66. 

DHAP families. This will help clients to navigate PHAs’ policies, 

identify families eligible for HUD’s core programs, and focus clients 

on achieving housing self-sufficiency. 

Chairman Landrieu, thank you for having me here and I look 

forward to your questions. 

Senator LANDRIEU. Thank you very much. 

Now that we have heard the agencies, FEMA, HHS, and HUD, 

we will now hear from our Government Accountability Office for its 

report on what they have done and how we can improve. 

TESTIMONY OF KAY E. BROWN,1 DIRECTOR, EDUCATION, 

WORKFORCE, AND INCOME SECURITY, U.S. GOVERNMENT 

ACCOUNTABILITY OFFICE 

Ms. BROWN. Madam Chairman, thank you for inviting me here 

today to discuss our work on disaster case management following 

Hurricanes Katrina and Rita. My remarks are based on the report 

you referenced, which we issued in July of this year, along with 

some updated information. 

This afternoon, I would like to focus on three issues. First, the 

support Federal agencies provided for Disaster Case Management 

Programs. Second, the challenges faced by the agencies delivering 

the services. And third, the importance of learning from these experiences to improve client outcomes under the new program being 

developed. 

First, regarding Federal agency support, as you have heard, 

FEMA, HUD, and HHS provided more than $231 million to support multiple Disaster Case Management Programs. These programs provided services for as many as 116,000 families through 

numerous social service and voluntary organizations. However, as 

you can see in the graphic on my left, these programs started and 

stopped at different times. Sometimes they overlapped and sometimes there were breaks in funding and gaps between the programs. These gaps led some service providers to lay off workers or 

shut down services and may have allowed an unknown number of 

people in need to simply fall through the cracks. 

Also, Federal agencies and case management providers had difficulties sharing timely and accurate information on who was getting or who needed services. In some cases, due to privacy policies, 

FEMA was unable to provide needed client-level information to 

service providers to help them assist those in need. 

Moreover, the service providers themselves use several different 

and incompatible databases, making it difficult to track clients 

across agencies. Again, this may have resulted in some people not 

receiving needed services. It may also have allowed others to receive services from multiple providers. 

Second, turning to the challenges faced by the agencies delivering disaster case management services, many agencies faced high 

staff turnover and large caseloads. Some agencies’ caseloads ranged 

from 40 to as high as 300 cases per worker. Also, clients frequently 

needed help finding housing, employment, training, and other basic 

necessities, as you can see from our graphic on the right. But these 
11 

1The prepared statement of Ms. Guma appears in the Appendix on page 82. 

were in short supply, and FEMA-funded service providers were not 

permitted to provide direct financial assistance to their clients. 

Unfortunately, many case management agencies conducted little, 

if any, coordinated outreach. As a result, those most in need may 

not have been offered or received services, such as those in the 

group trailer sites. Further, Long-Term Recovery Committees, 

which were intended to help marshal and direct limited resources, 

did not always live up to their potential. In some cases, they, too, 

were depleted of resources, and in others, case managers viewed 

the process for obtaining assistance as time consuming or confusing. 

Third, regarding the importance of lessons learned to help improve client outcomes under the new program. After 4 years and 

more than $231 million, we still do not know enough about whether these services actually helped storm victims. We need to better 

understand how well the programs met their clients’ needs, and 

when they did, what specific factors contributed to meeting those 

needs. 

In our July report, we recommended that FEMA conduct an outcome evaluation of the pilot programs. We understand that FEMA 

currently plans to glean outcome information from evaluations and 

use this information as it develops the model for its new Federal 

Disaster Case Management Program. Learning from these pilot 

programs is particularly important in light of the coordination and 

other challenges service providers faced, all of which could adversely affect client outcomes. 

Given the uncertainty of when and how large the next disaster 

will be, we also recommended that FEMA establish a time line to 

hold itself accountable for progress in finalizing its new program. 

In conclusion, it will be crucial to incorporate lessons learned 

over the past 5 years so that future disaster victims have the best 

chance to get their lives back on track and so government resources 

are put to the best use. 

Madam Chairman, this concludes my prepared statement. 

Senator LANDRIEU. Thank you, Ms. Brown. We really appreciate 

the report that you all have done. It will be very informative and 

already has been for us as we move forward to try to improve. 

Ms. Guma. 

TESTIMONY OF AMANDA GUMA,1 HUMAN SERVICES POLICY 

DIRECTOR, LOUISIANA RECOVERY AUTHORITY 

Ms. GUMA. Thank you, Senator Landrieu, for the invitation to 

testify today, and thank you for your leadership in helping to secure resources for disaster case management for the State of Louisiana. We are also grateful to our Federal partners for making 

such an important investment in this critical activity. We appreciate the opportunity to reflect on our experiences and to talk about 

the challenges and make recommendations for future Disaster Case 

Management Programs. 

Since Hurricane Katrina, funding for Disaster Case Management 

Pilot Programs has come down to Louisiana through various channels, to nonprofit organizations, to local entities, and to the State 
12 

itself. Because most of those programs have required reimbursement, local providers have assumed significant financial burdens in 

launching them. 

One of the primary reasons why our original partners in our application for FEMA’s Disaster Case Management Pilot Program 

withdrew was because of the lack of up-front or advance costs for 

the program. Having already experienced funding delays with the 

reimbursement under Katrina Aid Today, those partners were unwilling to take a similar risk again. 

Another aspect of the Disaster Case Management Programs to 

date that has presented a challenge for us in Louisiana is the time 

lines. We remind the Subcommittee that virtually every program 

created for human recovery has been extended beyond its original 

time period. While we are grateful for the flexibility that our Federal partners have shown in extending those programs, we regret 

the negative impact of the changing time lines on our residents. 

Last-minute decisions from Washington have made it very difficult for the State to protect its clients. We have seen thousands 

of families leave trailers and rental units in anticipation of upcoming deadlines, many of them turning to unsafe alternatives. We 

know that some have returned to damaged homes that are dangerously uninhabitable, while others are renting apartments that 

do not meet quality standards. 

Program periods are often determined at the beginning of the recovery process and often in the absence of input from local stakeholders. In every case to date, local leaders have known that these 

program periods were too aggressive and not reflective of the actual 

pace of recovery. The ultimate impact of this has been felt most by 

the very people these programs have been designed to serve. 

The overarching challenge, however, that the State has faced 

with Federal Disaster Case Management Programs is around the 

need for greater coordination. Federal Disaster Case Management 

Pilot Programs provide a critical tool to identify needs and track 

recovery outcomes. As these programs move forward, and certainly 

as they come to an end, the information gathered must be made 

available to those State and local government agencies that will be 

assuming responsibility for the long-term recovery. 

The case management process creates an invaluable opportunity 

to translate the needs of residents into new or expanded local assistance programs, but this can only be achieved with proper coordination and information sharing. 

The Louisiana Recovery authority (LRA) has spent countless 

hours seeking information from Federal partners on program and 

client status. Requests by the State for information should not get 

stuck in agency headquarters where legal teams debate privacy 

issues and the State’s right to the data. Local governments need 

access to this information to ensure their ability to meet ongoing 

needs when Federal Disaster Assistance Programs end. 

We thank both HUD and FEMA for working with us towards 

resolution on these issues, and we know that our progress has already had a positive impact. We regret, however, that greater 

change has not been made to date. In addition to data sharing, the 

coordination that we are recommending is also in terms of truly 

working together and collaborating on a local level. We have made 
13 

1The charts referred to by Senator Landrieu appear in the Appendix on page 39. 

tremendous success locally, but we believe that collaboration must 

be institutionalized within agencies and within the program design 

to ensure process and success. There are and there must be more 

effective ways for government partners at all levels to share information and client data. 

That said, we would make a few recommendations moving forward for Disaster Case Management Programs. We ask our Federal partners to explore creative ways to release funding more 

quickly for disaster case management, including up-front advances 

and preapproved grant applications. We ask our Federal partners 

to consult with local stakeholders when designing programs and to 

establish a process for reviewing progress halfway through the program period so that any extensions required can be determined 

well in advance of the deadline. 

We recommend that at the time of a disaster declaration, the 

State or impacted locality be included as a partner in any interagency agreement. And finally, we ask our Federal partners to formalize a structure and process for working together with local partners as part of all future program guidelines. 

Thank you. 

Senator LANDRIEU. Thank you very much, particularly for those 

succinct and, I think, very excellent recommendations for improvement. 

Before I get into questions, you all have the charts, I believe, on 

the table, and I would just like to refer you to the time line first.1

Just to put this hearing in perspective, while we are very encouraged by the agreement, Ms. Zimmerman, between FEMA and the 

Department of Health and Human Services, we want to recognize 

by this time line the fact that actually before Hurricanes Katrina 

and Rita, there was virtually no case management provision in the 

Federal law for dealing with a disaster, as if it was not an essential 

component of recovery, which it is. 

When you see this time line on this chart, which is represented 

up here, what strikes me as the hurricane hit in 2005 and the levees broke in August 2005, Mississippi didn’t have its own case 

management pilot program started until August 2008. You think 

about that. Three years later before the program was even started? 

Well, it was phase two, I am sorry, phase two in Mississippi. 

Now, Louisiana Family Recovery Corps started in January 2006, 

which is much sooner, but still, think about families in September 

and October and November and December, at some of the most 

critical times in these families’ lives and there wasn’t much to 

reach to. What was there was little, if anything, and very fragmented. We don’t want to see this happen again. 

Another very interesting graph from this report which struck me 

is not up on our chart, but you all at the table can see it. It is a 

graph of how people found out about Katrina Aid Today (KAT), 

which was the Federal program put together in, it looks like here, 

sometime late in 2005. Eighty-five percent of the clients, according 

to the GAO report, heard about it from word of mouth. I mean, you 

would think in the midst of a major disaster, people would be, of 

course, listening to the radio or listening to public spots on the tele-
14 

vision. To think that families had to hear about it from each other 

as sort of a circle of survivors, like, what is working for you? Well, 

this case manager helped me. Maybe she can help you. It threw me 

a little bit. I don’t know why we can’t get free radio advertisement 

for these services to all these families. 

The other interesting chart, which is going to be part of my questions, because I am going to ask you how we are going to set up 

a system that actually can surge when necessary, is demonstrated 

by this chart, which shows the number of clients that were served. 

There were more clients served in Louisiana—thank you for putting that up—30,000, than all the other States combined. So Texas 

had 13,000 people, Mississippi had 9,000, Alabama, 2,500—I am 

just roughing these—Georgia, 2,500. So Louisiana had 30,000 clients that were served. 

You could argue that three times as many people needed the 

help as ever got it and just abandoned the effort altogether. I don’t 

know if we will ever know what those numbers were. But even assuming that these were all the families that needed help and we 

reached everyone, which is very wishful thinking, part of what my 

questions are going to focus on today, is whether the model that 

we are setting up can work well when only 2,000 families are looking for help? And what happens to the model when 50,000 families 

need help? Is the model that we are building going to be able to 

surge to the levels necessary to do the job that is required? 

Another thing that struck me came from the GAO report. It said 

that the five most reported needs among the clients were housing, 

furniture, health and well-being, utilities, and food. I am very interested to see that jobs was not on here. I would have thought, 

with 240,000 people out of work, that one of the things that people 

might be scrambling the most for would be employment. So I am 

interested to know from GAO why that didn’t come up more. 

Maybe it did in a different way. I mean, obviously, housing should 

be first because that is what people were scrambling the most for 

is shelter. 

And so those are just some of the observations I wanted to point 

out, and let me get to my questions and I will start with those. Let 

us talk about, with the panelists, about the model that you are developing. First of all, Ms. Zimmerman, do you have any intention 

of asking HUD to be a party to this agreement, or is this something that you all are doing just with Health and Human Services? 

And if so, why, and if not, why not? 

Ms. ZIMMERMAN. The current agreement is between us and 

Health and Human Services. We recognize our partners with HUD 

through the programs that we have used to date. One of the initiatives that is going on right now is the Long-Term Disaster Recovery Working Group that has been established through the White 

House, which is in conjunction with the Secretaries for HUD and 

the Secretary for Homeland Security. So as we are moving forward 

with that, it is looking at disaster recovery on the broader scale 

and the abilities that we have today versus where we want to take 

disaster recovery in the future. 

So I believe one of the outcomes from that working group and 

our recommendations and our reports will be to incorporate all of 
15 

the partners who have a piece of the case management and what 

that program should look like going forward. 

Senator LANDRIEU. And what is your view on that, Mr. Tombar? 

Mr. TOMBAR. I, too, reference the work that the two agencies are 

heading in concert with, actually, all the agencies across the Federal Government with the Long-Term Disaster Recovery Working 

Group. I believe that out of that, we will certainly see a recommendation to the President that, in fact, there needs to be better 

coordination across the Federal Government in a way that we provide services for recovery and relief to families that are impacted 

by disasters. 

Senator LANDRIEU. Right. And I think that all you really need 

to make that point is this particular chart, if I can find it, the one 

that says the thing that people needed most was housing. When 

you are managing cases for families—I don’t know what I did with 

mine, but it is around here—they needed housing, I think it was 

the number one on the chart, and then furniture, health and wellbeing, utilities, and food. So we should keep that in mind. 

The other question that came to mind, just thinking about regular work in regular times, how communities and how families 

navigate among agencies to try to help them—without disasters in 

mind, just normal days—they call a service 211, it is like 911, but 

there is a 211 service that we are trying to develop. I have been 

helpful in trying to start that up and fund it in many places around 

the country. 

In addition, Public Health units sometimes do outreach in urban 

areas. There would be Rural Extension Services in rural areas. A 

lot of families will call up Rural Extension and say, I need this help 

or I need that. They might call Public Health offices. And they 

most certainly, at a volunteer level, non-government, 211 is something that I think communities are getting used to. How are we incorporating the bone structure that is already there before we 

build? And are we building on that? Are we paralleling some of 

their work? Are we using them in some case management? Or is 

that just a reference? Is 211 just a referral service. It is not really 

case management, it is referral. But could that be used in any way 

as we build this system? Does anybody want to comment? Mr. Hansell. 

Mr. HANSELL. Yes, absolutely. One of the things that we learned 

from the early part of our post-Gustav pilot was that having a single toll-free call-in line for access to services responded to the concern, Chairman Landrieu, that you mentioned earlier of people not 

having a direct place to go to get access to the services. 

What we would intend to do in the future is, where resources 

like 211 or other phone lines that exist, to build on and collaborate 

with those rather than to create something new. They don’t exist 

in every State. They don’t exist in every part of the State. But we 

certainly would agree that where they do exist, we would want to 

partner with them in building on an existing capability. 

Senator LANDRIEU. And I just think that would be a smart approach, to survey what exists in the 50 States now and in the counties, measuring that against the counties, or parishes in our case, 

most at risk. You can just overlay that risk map pretty easily over 
16 

the assets, and when you are building a national model, build it 

at least on some of the things that are already there. 

And let me correct myself, because I want to give credit where 

credit is due. The bar graphs I mentioned earlier are from the report on Katrina Aid Today by the national service provider, which 

in this case was the United Methodist Committee on Relief. So we 

thank them for this information. And then the time line, of course, 

was presented by GAO. 

Let me ask a couple of other questions of the panel. This would 

be both for ACF and FEMA. Catholic Charities was awarded a 5- 

year nationwide case management contract as part of the task 

order which has not yet been funded. Catholic Charities is required 

to pre-identify local regional volunteers and subcontractors to be 

ready to deploy within 72 hours. Can you elaborate on the Department’s plan for funding this contract and near-term tasks to develop a national team, and have you all identified funds to implement this contract? 

Mr. HANSELL. Yes. That is our contract, so I will respond. We are 

awaiting the approval of our fiscal year 2010 budget to fund that 

contract. We are, like much of the government, operating under a 

Continuing Resolution right now. 

Senator LANDRIEU. And what is in the budget? I mean, what is 

in the appropriations bill? 

Mr. HANSELL. The President requested $2 million, the bulk of 

which would be used to fund the contract. We designed the contract 

to respond to a number of the things that we learned from our initial evaluation, as I mentioned, particularly the difficulty in finding 

and recruiting enough qualified case managers, especially in a 

quick response to a surge in need. So the contract will fund Catholic Charities USA, both to be prepared to provide disaster case 

management services in the event of a future major disaster, but 

also to pre-identify and pre-certify case managers so that they will 

be ready and available when a disaster strikes. 

Senator LANDRIEU. And I understand this was a competitive bid. 

Can you talk about the other organizations that competed? Catholic Charities was chosen, but are there others—— 

Mr. HANSELL. There were several bidders. Catholic Charities was 

chosen. We can provide you with a list of the bidders, if you would 

like. We will be happy to do that. 

INFORMATION PROVIDED FOR THE RECORD 

The bidders that applied for this contract were Abt Associates, Inc., Catholic 

Charities USA, and Louisiana Family Recovery Corps. 

Mr. HANSELL. But it was an open, competitive process, open to 

any bidder that was interested. 

Senator LANDRIEU. Does anybody else want to comment on that? 

Let us talk about the privacy issue for just a minute, because 

this continues to come up in our review. Does anybody want to 

comment about the current privacy issue and why it is in place? 

Is it necessary? Are there modifications that we could look to so 

that we can better serve the individuals that we are trying to 

serve? And again, in disasters, these can be very poor individuals 

who have been a part of some kind of government help and assistance through either Medicaid, housing, or job placement. It can be 
17 

middle-class families who have never been a part of any kind of 

government support system and are unfamiliar with how to navigate. 

So let us talk about the privacy issue. I don’t know who wants 

to start, Ms. Zimmerman, perhaps. And I would really like to hear 

from you, Ms. Guma, on this. 

Ms. ZIMMERMAN. Sure. I would be happy to. First off, the number 

one thing for FEMA is to protect the privacy rights of the individuals, the disaster survivors. But through this process, we know 

that we need to provide information to the service providers for the 

disaster case management. So it is my understanding we now have 

a better process in place so that when an agency requests the information, we are able to provide, working with the State and the 

local provider to get that information that they need to be able to 

service the applicants when they come in. 

Senator LANDRIEU. Well, can you articulate for me the reason 

that we would have to keep FEMA records private? Is it that we 

are trying to protect them from what, from being exploited by people trying to help them, or exploited by unscrupulous salespeople, 

or what are we protecting them from? 

Ms. ZIMMERMAN. The latter of that. We gather a lot of information when we are putting people into our database to assist them 

through our programs of individual assistance—Social Security 

numbers, a lot of personal information. Not all of that information 

is needed when it goes forward to the other providers for case management. So we are able to release that other information, names, 

addresses, and phone numbers. So we do have a process in place 

to do that. 

Senator LANDRIEU. Yes. 

Ms. ZIMMERMAN. So I believe that has improved over time. 

Senator LANDRIEU. Because I most certainly can understand 

keeping Social Security numbers, banking information private, but 

information about names, number of children in the household, 

previous employment, if the father was a welder, that might be 

helpful for the case manager to know because he is looking for a 

job and what was his previous employment, things that would be 

useful to help people. 

Ms. Guma, do you want to comment about that? 

Ms. GUMA. Yes, I do. I want to first acknowledge that we have 

made tremendous progress with both FEMA and HUD in this regard. Having said that, we have gone down a very difficult journey 

to share information, and when we started the process of requesting information, both on households living in trailers and households in the DHAP program, even the process of getting aggregate 

data, which not even client level with any identifying information, 

in the initial phases was a struggle. We have, again, made leaps 

and bounds in information sharing and it now flows much more 

easily. 

I guess one of our concerns, just speaking back to one of our recommendations, is that the process really does need to be institutionalized. It is wonderful that we have great partners now at the 

table with us who work really well. We can make requests and get 

the information so quickly and we tremendously appreciate that. 

But our concern is that in a new place, on a new day, at a new 
18 

time, it would perhaps be a different scenario for that government 

body seeking that information. So we do think it is important. 

We also encountered a challenge with FEMA and HUD where 

there was not clarity about who was allowed to give us data, and 

I think that has been something that has been worked out. But 

when we have sought data in the past from HUD, there has been 

some confusion about who had the authority to release it, and I do 

think we have made progress on that front. But it was a big challenge for us for a very long time. 

Mr. TOMBAR. If I may, Ms. Guma is right. There was a challenge 

with providing the data, and the data that the State was requesting was full access to all data that we had because they wanted 

to know as much as they possibly could about the families, and it 

made sense to be able to provide the comprehensive type of case 

management that you reference. 

What we learned was that the Privacy Act prohibited HUD from 

being able to provide that data because we did not have the type 

of arrangements and agreements and approvals through the systems of record for those data to be able to provide that to the State. 

But in a conversation with Ms. Zimmerman and others over at 

DHS, we found that FEMA did, in fact, have ongoing agreements 

with the State and therefore was able to simply, by not making the 

request for the same data to HUD, but simply to FEMA, that 

FEMA could provide the data. 

And, in fact, I am pleased to announce that for DHAP-Ike, where 

the State of Louisiana has made a request for data that was provided to them on behalf of families in DHAP-Katrina, just today on 

a conference call jointly with HUD, FEMA, and the State of Louisiana, we think that we have been able to resolve that issue so 

that those data will be able to flow forward to the State at sometime soon. 

Senator LANDRIEU. Well, I just urge you all to stay focused on 

finding the right solution to this issue so that we are treating people as quickly as we can, helping them with dignity. People want 

help. They don’t want to fill out multiple forms giving their name, 

their Social Security information multiple times to different agencies because the law doesn’t allow the agencies to talk with each 

other. 

Now, there is a reason why some personal data should be protected, but when you are trying to help, it is imperative that local 

officials and local entities, the nonprofits, the State, the parishes, 

particularly because those locals are in some way held accountable 

for the outcomes, so that the Federal Government looks down on 

the City of New Orleans and would say, why do you have 10,000 

homeless people still? That is a good question to the city. Well, if 

the city says, we don’t even have information about these people 

because we can’t get it other than a door-to-door daily survey, then 

that is a real issue. And I am sure that is true across other places 

in the Gulf Coast. 

Let me do one or two more questions and then we are going to 

move to the second panel. This duplication of benefits issue, it is 

my understanding that Public Housing Authorities at State and 

local levels considered themselves to be caseworkers, which required the Mississippi Case Management Consortium to close cases 
19 

with other voluntary agencies to avoid duplication of benefits. 

Could you comment about this? I guess it is Fred Tombar with 

HUD. What are the Public Housing Agencies—will they continue 

to provide case management? Will this continue to be judged as a 

duplication of services, which is against the law? Is that the situation? Does anybody want to comment or know anything about that? 

Did GAO look into that at all? 

Ms. BROWN. We went only as far as looking at the fact that there 

were stops and starts and multiple service providers at the same 

time. We didn’t look to see whether there should be—— 

Senator LANDRIEU. You weren’t looking for the content for the 

services provided, or the quality of the services provided? 

Ms. BROWN. We would have liked to have looked at the quality 

of the services provided, but I think the information just wasn’t 

there for us to make a judgment on that. 

Mr. TOMBAR. The duplication of benefits is sort of a term of art 

that has multiple meanings, and you know about it well in the context of the Road Home Program and our Community Development 

Block Grant Program and how—— 

Senator LANDRIEU. Small Business Loan Program—— 

Mr. TOMBAR [continuing]. It is a little bit confused with it being 

used in this context. But my understanding is that what is at issue 

here is that there were agreements with one of the groups that you 

have testifying on your next panel, Mississippi Case Management 

Consortium (MCMC), to provide services on behalf of some 400 

families initially. Those were families who subsequently became a 

part of the DHAP Program and were services by Public Housing 

Authorities (PHAs) in terms of the payments that were being made 

on their behalf. 

And so what we didn’t want was precisely the thing that you are 

critical of here, was that we had multiple service providers providing the same services on behalf of families. So that was the 

issue, was to not have the Public Housing Agencies duplicate services that were already being provided by an already contracted 

service provider. 

Senator LANDRIEU. Well, I will ask the Mississippi folks to clarify 

that, but let me ask this final question, because I really want to 

get this clear with you all because it is important, I think, for those 

trying to create a better system. 

The National Disaster Housing Strategy calls for HUD to continue providing case management services. But if FEMA and HHS 

have an agreement, there still is confusion among the at-large community about which agency is in charge, and so can you comment 

about who is the lead here on case management? Who should people be talking to? Is it FEMA? Is it Health and Human Services? 

Or is it HUD? 

Ms. ZIMMERMAN. As of right now, FEMA has the authority in the 

laws to do disaster case management. With our agreement that we 

have right now with ACF, we have that ability to get them on the 

road within 72 hours to do disaster case management. And as we 

are moving forward to put together the permanent program—this 

is our interim program—then we will take that and take the lessons that we have learned and put together the program so it is 

comprehensive and it covers all aspects of it. So right now, a State, 
20 

if they get declared for a disaster and need disaster case management assistance, they would apply to FEMA for assistance and we 

would institute the program as it is today. 

Senator LANDRIEU. OK. Well, I, for one, would urge you to work 

as quickly as you can to reach out to HUD, which is an obvious 

agency that needs to be included. And if you think about particular 

populations, the Justice Department may be another one in terms 

of case management. When you think about families and the status 

of family members, whether they were in prison when this happened, if they are on probation when this happens, for either juvenile cases or adult cases, in some of these communities and States 

it is thousands and thousands of people that may be affected. We 

haven’t even looked at the coordination that is required with the 

Department of Justice. 

But definitely with HUD, given that in case management, we are 

learning that what most families needed was permanent housing 

so that they could sort of reestablish themselves, get into a church 

or a synagogue, get into a school, get into a job and stabilize themselves until they could figure out when they could get back into 

their original community. 

All right. Thank you all very much. I am going to have to move 

to the next panel. 

As the next panel is coming up, just to save time, I am going to 

go ahead and do brief introductions, and again, thank you all very 

much. 

We have, first, Rev. Larry Snyder, our first witness, who oversees Catholic Charities USA’s work to reduce poverty in America. 

Rev. Snyder will discuss Catholic Charities’ experiences under 

Katrina Aid Today and their work on the ACF model for disaster 

case management that was utilized after Hurricanes Gustav and 

Ike. 

Next, we have Diana Rothe-Smith, who is Executive Director of 

the National Voluntary Organizations Active in Disaster. NVOAD 

is the forum through which nonprofit relief organizations share 

knowledge and resources. She will discuss their proposal to improve case management guidelines and programs. 

Dr. Irwin Redlener is President and Co-Founder of the Children’s 

Health Fund. Dr. Redlener has testified before this Subcommittee 

many times. We are happy to see him again and hear his views on 

case management. 

Stephen Carr is a Program Director for the Mississippi Case 

Management Consortium. He is also a consultant to ABT Associates, through which he contributed extensively to the design and 

writing of the ACF-HHS model that we have just talked about. 

And finally, Dr. Monteic Sizer is President and Chief Executive 

Officer of Louisiana Family Recovery Corps. He will discuss the 

Louisiana Family Recovery Corps’ disaster case management work 

after Hurricanes Katrina and Rita and the need to develop longterm human recovery plans at the Federal level. 

I look forward to all of your testimony, and thank you. Rev. Snyder, we will begin with you. 
21 

1The prepared statement of Rev. Snyder appears in the Appendix on page 89. 

TESTIMONY OF REV. LARRY SNYDER,1 PRESIDENT AND CHIEF 

EXECUTIVE OFFICER, CATHOLIC CHARITIES USA 

Rev. SNYDER. Thank you. Good afternoon, Chairman Landrieu. I 

want to thank you for the opportunity to appear before you to discuss the partnership between the Federal Government and Catholic Charities USA to provide disaster case management. 

Catholic Charities agencies have a long history of serving those 

most in need at critical and vulnerable times. The services we provide are grounded in the fundamentals of social work practice and 

are delivered in accordance with sound ethics and our faith tradition. Case management is a critical component of the services provided in local Catholic Charities agencies. 

In the interest of time, I would refer you to my written testimony, which details the efforts of Catholic Charities in the area of 

disaster response for over 40 years. 

Recently, Catholic Charities USA responded to the government’s 

competitive solicitation for a contract to provide a Federal Disaster 

Case Management Program and has been awarded a 5-year indefinite duration, indefinite quantity contract for these services. And 

while the overall agreement is for 5 years, we have only been authorized and funded to continue disaster case management services 

through March 31, 2010 to the victims of Hurricanes Gustav and 

Ike. Further funding for the implementation of the Federal Disaster Case Management Program has not been authorized. 

I want to take this opportunity, though, to acknowledge the partnership Catholic Charities USA has with the Administration for 

Children and Families of the Department of Health and Human 

Services and the confidence that has been placed in our organization with the awarding of this Federal contract. 

At the same time, we have faced a number of challenges throughout the process of providing these services, beginning with Hurricane Katrina until today. Each time, we have provided case management services during a disaster, the players have been different, 

the funding streams changed, the policies and procedures have 

been different, and the forms and requirements inconsistent and 

sometimes conflicting between and among both Federal and nonFederal partners. 

Victims of disasters deserve and should receive services quickly 

and through a well-developed system at the national and regional 

levels. This can only be achieved if the resources are made available to do this work prior to a crisis. 

When it became apparent that funds were not available to implement the Federal Disaster Case Management Program under the 

new contract, our contracting officer notified us that we would not 

be required to respond with a national and regional team within 

72 hours should these services be authorized. My remarks, of 

course, were prepared before the announcement of the IAA ???? between FEMA and ACF, which is, in fact, talking about that funding, so we welcome that news today, as well. 

We firmly believe that if we are to avoid the travesty of Hurricanes Katrina and Rita, where we saw thousands of people, especially those living in poverty and already marginalized, left behind, 
22 

1The prepared statement of Ms. Rothe-Smith appears in the Appendix on page 95. 

we must invest in a system that responds early with a network 

that can deliver the diversified services necessary to meet the 

needs of those affected. 

Let me tell you a story about one client. James is a disabled client in Louisiana whose house was damaged by Hurricane Gustav. 

For an extended period of time, James did not receive his disability 

benefits because the support structure was not in place. Through 

the assistance of a case manager, James was able to obtain the documentation to apply for and receive his disability benefits. With 

the back payment he received, James is going to replace his roof 

and move back into his own home. While we were able to assist 

James, the process was significantly delayed. 

With the infrastructure of a National Disaster Case Management 

Program in place, the response to James could have been far more 

timely. The investment to do this is small and the number of staff 

required to create and maintain such a structure is minimal. In 

fact, we estimate the total annual cost of operating this program 

to be a little over $2 million. 

The Federal Government historically has provided funding for 

the immediate needs of food and shelter following a disaster. But 

just as critical in the early stages of a disaster is the need for case 

management services. Based on the collective experience of our 

Catholic Charities agencies, I offer the following five recommendations to the Subcommittee. 

First of all, fund a single national Disaster Case Management 

Program as part of disaster preparedness, including infrastructure 

and readiness for rapid response. 

Two, establish a lead Federal agency that will have oversight 

and accountability for ensuring that agreed-upon outcomes are established and met. 

Three, establish a consistent definition of disaster case management and policies and procedures to be adopted by both Federal 

and non-Federal organization. 

Four, identify and implement one database for the collection of 

information that meets the needs of both Federal and non-Federal 

partners with consistency in meeting privacy requirements. 

And finally, involve key stakeholders in all aspects of the National Disaster Case Management Program. 

I thank you for the opportunity to testify about this important 

work and to make these recommendations based on our experience. 

Senator LANDRIEU. Thank you very much, Rev. Snyder. Ms. 

Rothe-Smith. 

TESTIMONY OF DIANA ROTHE-SMITH,1 EXECUTIVE DIRECTOR, 

NATIONAL VOLUNTARY ORGANIZATIONS ACTIVE IN DISASTER 

Ms. ROTHE-SMITH. Thank you, Madam Chairman. Thank you for 

the opportunity to speak with you today about disaster case management and the role of voluntary agencies. 

My name is Diana Rothe-Smith and I am the Executive Director 

with National Voluntary Organizations Active in Disaster. National 

VOAD, as we are more commonly known, is made up of the 49 

largest disaster-focused nonprofit organizations in the country. 
23 

From the American Red Cross to Catholic Charities and the United 

Jewish Communities, from the Salvation Army to Feeding America 

and Habitat for Humanity, our member organizations are the driving force behind disaster response, relief, and recovery in this country. 

Historically, voluntary agencies have partnered with survivors 

through the recovery and have done so successfully without standardization. In recent years, however, catastrophic disasters, funding for case management, and emerging organizations providing 

long-term recovery services have necessitated us to look anew at 

how we define and implement disaster case management. 

Recognizing that disaster case management is most effective 

when implemented by local partners as part of a coordinated effort 

for community recovery, the National VOAD Disaster Case Management Committee offers these standards as guidance to support 

disaster case management delivery systems locally. These draft 

standards, as they are submitted into the record, are not intended 

to replace organizational policies, but may be useful in policy development. 

I want to tell you today about disaster case managers. Disaster 

case managers are the reason why recovery happens in this country. If my family and I have been through a natural disaster, I sit 

down with a case manager and she becomes my companion on the 

road to recovery. You see, before we even meet, my case manager 

spends her time learning the ins and outs of every resource available to people in my area. And because they are normally hired 

from within the community itself, disaster case managers can do 

so by drawing on their own existing networks and contacts. 

The case manager can link me with community services and volunteer labor and can help me navigate through the maze of governmental programs. Even in the midst of my confusion and hardship, 

trying to put my life back together, my case manager is my resource maven, helping me plan for filling in the missing pieces of 

my recovery. The disaster case manager is the most important resource for many survivors. 

When Hurricanes Katrina and Rita hit, several members of National VOAD participated in a first-of-its-kind case management 

program. By December 2005, Katrina Aid Today put case managers 

in jobs not only along the Gulf Coast, but around the country, in 

all the places where evacuees had been resettled. This program 

was initially funded by international donations through FEMA, 

which were then matched with additional nonprofit contributions. 

Katrina Aid Today was the most comprehensive collaborative National Disaster Case Management Program in the history of the 

United States. Because of its long history providing disaster case 

management, the United Methodist Committee on Relief was chosen as a lead agency for nine partnering faith-based and voluntary 

organizations. 

Let me tell you about one partner in particular. Lutheran Disaster Response was given $7 million as one of the consortium members, and per the various agreements, it matched that with $7 million of their own donor contributions. Then the case manager hired 

with those dollars found over $29 million worth of resources for 

their clients. That is what I call a return on investment. 
24 

1The prepared statement of Dr. Redlener appears in the Appendix on page 99. 

As part of this testimony, I submit the Katrina Aid Today final 

report. 

Unfortunately, in the time since Hurricane Katrina, our country 

has entered into a new reality. Nonprofit groups are hurting as a 

down economy means a dip in contributions. An increase in recent 

disasters also means fewer resources to go around. Two-thousandand-eight was one of the most active disaster years on record. This 

means that the resources that were once available for clients have 

decreased or even dried up altogether. And because we know that 

disasters disproportionately impact communities that were already 

hurting, we are working in communities that were not well 

resourced to begin with. 

For this reason, survivors of Hurricane Ike or the vast flooding 

in the Midwest this past year did not see the type of return on investment that was seen from Katrina Aid Today. These communities and the nonprofit partners that comprise the local long-term 

recovery groups are making incredible strides to meet the needs of 

the clients, despite these increasing hurdles. However, many of 

them lack the public-private partnership that made Katrina Aid 

Today such an overwhelming success. 

And this is part of the issue. While case managers are the backbone of recovery, case management only works if there are supplies 

and resources to fulfill the needs of the clients, and there is only 

so much government systems can do to fill these resources. Much 

of the work is filled by the voluntary agencies and the volunteer 

labor and donated dollars they bring with them. 

My point is this. The instinct to create further levels of bureaucracy is rarely appropriate given the power of voluntary agencies to 

complete the work faster, cheaper, and with a keener sense of the 

community’s underlying needs. The more resources that find their 

ways to these organizations and without having to pass several layers of red tape, the more real work that can happen for the people 

who need it. 

Thank you. This concludes my testimony, if there aren’t any 

questions. 

Senator LANDRIEU. Thank you very much. Dr. Redlener. 

TESTIMONY OF IRWIN REDLENER, M.D.,1 PROFESSOR, CLINICAL POPULATION AND FAMILY HEALTH, DIRECTOR, NATIONAL CENTER FOR DISASTER PREPAREDNESS, COLUMBIA 

UNIVERSITY MAILMAN SCHOOL OF PUBLIC HEALTH, AND 

PRESIDENT, CHILDREN’S HEALTH FUND 

Dr. REDLENER. Thanks, Chairman Landrieu. I am very happy to 

be here. I am actually wearing three hats. I am President of the 

Children’s Health Fund and I direct the National Center for Disaster Preparedness at Columbia University, and to avoid any unpleasant feedback from Chairman Mark Shriver, I am also a 

happy, active member of the National Commission on Children and 

Disasters. 

So in the years since Hurricanes Katrina and Rita devastated 

the Gulf Coastal region, we learned and are still learning that 

many already at-risk children, perhaps 20,000 or more, may have 
25 

survived the initial trauma of a major disaster only to find themselves 4 years hence still living with extraordinary uncertainty, 

chaos, and isolation from essential services. At the least, and as 

has been stated by others here, we need to learn from this unfortunate situation and make sure that future recovery efforts are not 

plagued, as Hurricane Katrina recovery has been, by similar levels 

of bureaucratic confusion and turf battles further complicated by a 

persistent inability to share critical information among relevant 

agencies, and I know you explored this in the last panel. But I 

would say that I would characterize this lack of sharing of information as really devastating to the needs of families and children, and 

we are still paying a heavy price for that. 

It is also important to appreciate the fact that the additional 

trauma related not to the storms and flooding, but to this mismanaged and dysfunctional recovery, will have significant and 

long-lasting consequences for thousands of highly-vulnerable children. 

So what happened? Well, in the first phase of this botched recovery, thousands of families needed help that never came. They needed obvious sustaining services that fall under the general rubric of 

what we have been referring to as disaster case management, and 

that was then. But now we are in a new phase of recovery where 

much more than access to basic services is needed because now we 

face far more difficult and, sad to say, entirely predictable challenges of restoring stability and structure and providing emotional 

and academic remediation when much of the damage has already 

been done. 

As you are aware, Senator, on October 7 of this year, Children’s 

Health Fund hosted a roundtable at LSU that involved participants from key Federal, State, and local agencies as well as many 

NGOs and local provider organizations. The focus of the day-long 

discussions was single-minded: How can we make sure that in future large-scale disasters we can do more to protect and stabilize 

families while they wait for renormalization of their lives and communities? And we all recognize that one of the key strategies to 

achieving this goal is to make sure that services and stability are 

provided by a cohesive and effective system of case management. 

Although the Post-Katrina Emergency Management Reform Act 

from 2006 established a Federal responsibility for disaster case 

management, it has become abundantly clear that much remains 

to be done to strengthen the Federal disaster case management 

structure and functionality. To that end, we are very happy to 

learn that just this morning, the interagency agreement was signed 

between FEMA and HHS, although I did actually think it was 

going to be HUD on board, as well, but apparently I heard that it 

was FEMA and HHS, and that is a great first step. 

But of greater significance is the fact that the National Recovery 

Framework and Stafford Act reform are now on the immediate horizon, and the goal of both of these efforts is straightforward. Let 

us use the experiences of the last 4 years to be certain that proposed legislative modifications and the new operational guidelines 

provide assurances that recovery from future disasters is much 

more effective and responsive to the critical needs of all survivors. 
26 

I also believe that, although local flexibility in implementing programs is clearly important, and it is, there must be overarching 

federally-designated case management principles which apply to all 

federally-funded programs. These programs need to be accountable 

and monitored with clear outcomes. 

I just want to conclude with the recommendations that came out 

of our roundtable, which really coalesced around three primary recommendations for the Subcommittee’s consideration in drafting any 

new legislation. I am going to add a fourth from my own work and 

experiences in the Gulf, which actually started just a few days 

after Hurricane Katrina. And some of these were already mentioned by Rev. Snyder. 

But I think it is important that—and maybe most important— 

a single lead Federal agency with experience and expertise in complex case management should be designated to coordinate and direct implementation of all Disaster Case Management Programs. I 

still actually am not clear why this has ever been FEMA’s responsibility, since it is not an area of expertise or experience that they 

have and we have other Federal agencies that could easily fit this 

into their ongoing agenda, so let us say AFC, for instance, at 

HHS—ACF, rather. And I know this is something that may or may 

not be taken up in the legislation on the table, but I think we 

should at least think about why FEMA in this. FEMA is a spectacularly good and capable organization, but is this a square peg 

in a round hole as far as case management is concerned? 

Second, a single Federal model, what I refer to as overarching 

principles, for case management should be established that is clearly defined, comprehensive, responsive to local conditions, accountable, and, of course, fully and appropriately funded. 

Third is we must have mechanisms, as you pressed hard on in 

the earlier panel, to ensure rapid, sufficient, and efficient sharing 

of client information among relevant agencies and provider organizations. 

So let me just say in bringing this to a close that while this next 

recommendation is not part of the formal roundtable consensus, it 

is based on what we actually know about disaster vulnerability, 

population resiliency, and the challenges associated with recovery. 

The fact is that populations with significant pre-disaster adversity, 

including poverty and chronic inadequacies in health care and education, consistently and predictably fare the worst in all phases of 

disasters as compared to less-disadvantaged populations. So I think 

it is, therefore, important that a clear commitment to alleviating 

social and economic disparities be a central mission of long-term 

disaster mitigation and recovery planning. 

Finally, there is much unfinished business with respect to the 

children of Hurricane Katrina. For example, what about those kids 

that were exposed to formaldehyde in the trailers? What are we 

doing for them? What is happening? And as we deliberate on strategies to improve recovery effectiveness in the aftermath of future 

disasters, that we not forget the ongoing, overwhelming challenges 

being faced by the children and families affected by the storms of 

2005. They are still waiting. 

Senator LANDRIEU. Thank you very much. 
27 

1The prepared statement of Mr. Carr appears in the Appendix on page 103. 

And I noticed some people are pulling their shawls a little tighter. I have noticed the room is cool. I have tried to get it warmed 

up. We will see if that happens. 

Mr. Carr. 

TESTIMONY OF STEPHEN P. CARR,1 PROGRAM DIRECTOR, 

MISSISSIPPI CASE MANAGEMENT CONSORTIUM 

Mr. CARR. Good afternoon, Senator Landrieu. My name is Stephen Carr. I am the Program Director for the Mississippi Case 

Management Consortium. On behalf of the leadership and field 

management teams of MCMC, I thank you for the opportunity to 

speak with you today about the topic of disaster case management. 

We are certainly proud of the accomplishments we have achieved 

to date and look forward to continuing our work with those individuals and families who continue to struggle toward recovery over 4 

years after the impact of Hurricanes Katrina and Rita. I am prepared and welcome the opportunity to answer any questions you 

might have with regard to MCMC and to discuss any information 

that was provided to you in my written testimony. 

In addition to that written record, I am thankful for the opportunity to present this opening statement to you, as well. We, the 

leadership team of MCMC, are often asked the question, why is it 

taking you so long to complete your work? This question is understandable when asked by someone who has never experienced a 

disaster of any form in his or her own life, and yet we know that 

that would be a very small group of people walking this earth. 

What is not understandable is when this question is asked by 

members of the disaster recovery community itself or even those inside Federal and State agencies whose job it is to support the efforts of projects like MCMC. 

I offer in response to that particular question a very straightforward answer. The job of recovery is simply not complete. 

The cases that we are currently working include the most vulnerable populations among us who have the most severe barriers to 

recovery to overcome. The work that we do as disaster case managers is what I refer to as messy casework. This work requires us 

to get our hands dirty, so to speak, and it is not work that is done 

by the faint of heart. The barriers that could be overcome easily 

have been cleared. What are left are the barriers that take the 

most time and coordinated effort to navigate. Easy solutions, if 

there ever were any, are a thing of the past, and disaster case 

managers are working harder now at this point in time to find creative solutions to a complex mix of problems facing disaster victims. 

There were many critics of the leadership team of MCMC as we 

began to set up the infrastructure that would be necessary to implement the program according to the FEMA program guidance. 

The main source of that criticism was that the program guidance 

included no funding for direct services that would be used to assist 

case managers in meeting clients’ recovery needs. And yet, as I 

have witnessed time and again over the last couple of years, the 
28 

most successful case management is done often in the absence of 

easily obtained resources. 

Creativity, determination, and a true belief that every problem 

presents an opportunity for excellence to emerge are the hallmarks 

of high-quality disaster case managers, and those are the traits 

that are representative of the men and women who make up the 

ranks of MCMC case mangers. We have shown that in spite of the 

many obstacles that are the legacy of Hurricane Katrina, progress 

can be made and recovery can be achieved, even without the presence of direct service dollars for case managers. 

The leadership team of MCMC believes that striving toward perfection is a much better approach than waiting on perfection to 

manifest itself before acting. Had we waited for the perfect program or the perfect program guidance, we would not have been 

able to facilitate the recovery of so many individuals and families 

and we would have been standing on the sidelines watching. This 

was simply not an acceptable alternative. 

MCMC continues to look forward and hopes to leave the State 

and the affiliates a platform to continue their work with clients 

once our period of service come to an end. To that end, we recently 

launched the Adopt a Family Program in order to continue to raise 

awareness and needed resources for the clients we all serve. More 

information about this program can be found on the MCMC 

website, www.mc-mc.org. 

In closing, I want to share this story. One affiliate supervisor recently told me that she had never been a part of such an exciting 

and professional program in her entire 27-year career as a social 

worker in the public sector. She challenged me to think of ways 

that this model could be duplicated within the larger social service 

sector in order to address many of the social problems facing our 

country today. Indeed, a collaborative and coordinated program like 

the one that MCMC has been able to establish presents the possibility for States and communities all around the country to address 

issues like school drop-out rates, the rising number of homeless 

veterans, and the challenges presented as a result of illiteracy. 

While that work may loom on the horizon, our immediate concern continues to be on disaster recovery. The leadership and field 

management teams, our affiliate organizations, and all of our case 

managers will not rest until we have done all that we can not only 

to overcome the barriers to recovery that we experience, but also 

to shape future programs so that when disaster strikes again, we 

will be ready to respond in a systematic, organized, and professional fashion that is worthy of this great nation. 

Senator Landrieu, thank you once again for your time and attention to this important aspect of disaster recovery. 

Senator LANDRIEU. Well, thank you, Mr. Carr, for that very passionate and inspirational testimony. We appreciate it. 

Mr. Sizer. 
29 

1The prepared statement of Mr. Sizer appears in the Appendix on page 161. 

TESTIMONY OF MONTEIC A. SIZER, PH.D.,1 PRESIDENT AND 

CHIEF EXECUTIVE OFFICER, LOUISIANA FAMILY RECOVERY 

CORPS 

Mr. SIZER. Thank you, Chairman Landrieu, for the opportunity 

to speak with you today about the challenges faced by Louisiana 

survivors, specifically those families impacted by Hurricanes 

Katrina, Rita, Gustav, and Ike. 

I would also like to publicly thank you, Chairman Landrieu, for 

the remarkable support you have shown to the Louisiana Family 

Recovery Corps, as well as to so many disaster recovery-related organizations and nonprofits across the State of Louisiana. You have 

certainly been a friend to those Louisianans impacted by the various hurricanes. 

Again, my name is Monteic Sizer. I am the President and CEO 

of the Louisiana Family Recovery Corps. The Recovery Corps was 

founded after Hurricane Katrina by the State of Louisiana in 2005. 

Since 2005, we have served more than 30,000 households, and that 

equates to approximately 100,000 individuals across the State of 

Louisiana. We have been a part of every case management program in the State of Louisiana since 2005, that the Federal Government has launched. 

The Recovery Corps is on record for its advocacy on behalf of 

Louisiana citizens, especially the most vulnerable populations, 

which are comprised of children, the elderly, persons with disabilities, people with mental illness, etc. I have submitted for the 

record, Madam Chairman, extensive detail regarding both problems, as well as the solutions associated with what we need to do 

in order to help so many people who are still struggling to recover. 

So for the brief time I have remaining, Madam Chairman, I 

would like to focus on a few things, and I would also like to talk 

about a few common challenges that ran across the three Federal 

case management programs. 

Namely, there was always—and I think this has been mentioned 

before—late and inconsistent program guidance that came down 

from the Federal Government. I think it was mentioned that there 

is a need for an organized, systematic, outcome-based IT platform 

that is uniform. There are certainly challenges all of us faced, such 

as: Data sharing challenges, late payment for services rendered on 

behalf of Louisiana citizens, and cost reimbursement challenges. 

Considering the fact that everything we received from the Federal Government came in late, and the fact that we were given an 

unreasonable timeline with stringent time frame to operate. The 

situation was very uncomfortable and we were not able to help people who had significant needs and multiple challenges. I would also 

say there was limited oversight provided, and the abrupt ending of 

programs essentially left Louisiana citizens in limbo. Many of them 

came to rely on the case managers they had, but the Federal programs had a tight time frame by which they were to end. Consequently, the case managers had ethical dilemmas; namely they 

had families under their care, and yet the programs were ending, 

so they had to let these individuals go. We continue to hear over 

and over again the challenges that were posed to many case man-
30 

agement providers, as well as licensed social workers, psychologists, and others who rendered services on behalf of these wonderful Louisiana citizens. 

It was mentioned that success was not clearly defined as to what 

it is the Federal Government wanted to achieve by way of helping 

Louisiana, Mississippi, and Texas citizens. Many clients certainly 

fell through the cracks. I think you identified the time frame here. 

Certainly, we are one of the few organizations that provided case 

management, and while that money came from the Department of 

Social Services, we were also later involved in some of the Federal 

projects. We closed out Katrina Aid Today on behalf of the Federal 

Government. We were going to be part of D.C.M.P. phase two, but 

it never got off the ground. 

We were one of the few organizations that actually received client data from FEMA. We had all the individuals in each trailer 

park disaggregated by the name, disability, age, race, you name it. 

We developed a rapid deployment model, with which we were ready 

to move froward, but the money never came. Therefore, we could 

not provide the services in which we were dubbed by the State of 

Louisiana to provide. With no money, we couldn’t provide the service. We had information, we knew where people were, and we had 

relationships with nonprofits throughout the State due to our earlier involvement with money from the Department of Social Services. 

So now that I have discussed some of the common programmatic 

challenges, I would like to talk about some of the structural recommendations. I guess the bottom line is, you can have wonderful 

things on paper, but if you don’t have the proper systems and 

structures in place, then you are likely to receive the same results 

as the ones we had with the previous three case management models. 

Senator LANDRIEU. You have got an additional 30 seconds to a 

minute, but go ahead. 

Mr. SIZER. Thank you, ma’am. I will be quick. There needs to be 

a lead coordinating case management entity with human services 

experience. There needs to be a standard definition of case management. Certainly, there needs to be an identified, selected IT platform, and a modification of the Stafford Act to support case management services. 

There needs to be identification and a blending of human services dollars in order to be able to assist with case management provision. Again, we need to work through the data sharing agreements between Federal agencies and State agencies. 

There certainly needs to be money advanced quickly to the State 

to begin services after a declared disaster. Furthermore, we need 

to prepare and have these things in place prior to disasters, especially in disaster-prone areas. 

I would also say that at the State level, we have to have integrated agency functions that work across human services entities, 

and have those plans tied to the Governor’s Office of Homeland Security’s plans. We need this because the bottom line is, these programs end. If there is nothing in place to be able to receive these 

individuals post-closing of programs, our citizens are likely to be in 

limbo. I also believe that it is part of the State’s responsibility, due 
31 

1The chart referred to by Senator Landrieu appears in the Appendix on page 43. 

to receiving taxpayers’ money, to provide efficient and effective programs and services to the citizens they serve. 

With that, Madam Chairman, I will be respectful of the time and 

conclude my remarks and welcome any questions that you may 

have. 

Senator LANDRIEU. I have several questions, and unfortunately, 

we are only going to have another 10 or 15 minutes, and I am 

going to have to close the hearing slightly early. 

But let me begin with you, Doctor, and also with you, Ms. RotheSmith. I tell my staff I love charts, because when you put them out 

in the right way, it is so clear and you just can’t fudge it. And 

when you look at this chart,1 there were two entities in the entire 

country that stood up to help people as the Federal Government 

just didn’t have any case management systems in place, and that 

was, according to this, Katrina Aid Today, which stood up in December 2005, and you all did that by marshaling the resources of 

the 30 or so largest nonprofits in the country and put your good 

resources together and built a model where there was none. 

And then under—because I remember when this was done under 

the extraordinary work of Governor Blanco in the face of having 

nothing offered in this particular area—the Louisiana Family Recovery Corps, which was stood up primarily with State funding, as 

I recall. 

Mr. SIZER. Yes. 

Senator LANDRIEU. Do you remember how much initial funding 

the State put up? Do you know how much it was? 

Mr. SIZER. Through the Department of Social Services, it was 

about $22 or $26 million. 

Senator LANDRIEU. Twenty-six-million dollars toward this effort. 

So I am going to rely on your two efforts, to really give some good 

information about the early days because you all were there, what 

people really needed in the very early days. 

I am extremely impressed with what Mississippi has done, as 

well. Your work, from what I can tell, and from your passionate 

testimony, has really added a tremendous amount to this debate as 

we shape this program that is going to have to work much better, 

much more quickly, much more comprehensively. 

So let me ask you, Ms. Rothe-Smith, how should we define when 

a case should be closed, or maybe I should say, how do we define 

success when we are dealing with families? Or how did you all define success so that you could report to your own donors a proper 

evaluation of the work that you did? How would you explain this 

definition and these conclusions to your donors or contributors? 

Ms. ROTHE-SMITH. Our definition of success or what we define as 

recovered is completely determined based upon the local community and the needs of the individual client and family. So the term 

‘‘recovered’’ is determined between the client, his or her family, and 

the case manager that is working with them. 

Senator LANDRIEU. And what they asked for—— 

Ms. ROTHE-SMITH. Yes. 

Senator LANDRIEU [continuing]. If they walked in and said, we 

need a refrigerator, you got them one, that was success? 
32 

Ms. ROTHE-SMITH. Yes. 

Senator LANDRIEU. OK. If they walked in and said, we need an 

apartment, you got it for them, that was success? 

Ms. ROTHE-SMITH. Yes. A recovery plan is developed right in the 

beginning between the client and the case manager, and then the 

process by which it is achieved is what determines success. 

Senator LANDRIEU. And how about you, Mr. Sizer? How did you 

all frame your success or your goals when you started the program? 

Mr. SIZER. Yes, ma’am. We determine it in three ways. Namely, 

clients come in and identify what it is they believe, based on an 

assessment, their needs are. 

Second to that, we place accountabilities on agencies we work 

with to ensure they help the clients meet their need objectives. 

And third, we determine success by what clients actually contributed towards their own success because oftentimes, it takes some 

creative initiative on behalf of people who have been impacted to 

also do things in accordance with their desired recovery goals. So 

it is what individual families bring to the table. It is what the case 

provider does on behalf of the clients, and also what those entities 

do in conjunction towards the success of an identified plan. That 

is done between an impacted family and a case manager. 

Senator LANDRIEU. Mr. Carr, let me ask you. How did you all, 

when you started your program, or how do you currently define 

success? 

Mr. CARR. Sure. I want to clarify one thing, and that is that the 

Katrina Aid Today model had a presence in Mississippi throughout 

its tenure. 

Senator LANDRIEU. And they had a presence in all the States, I 

think. 

Mr. CARR. Correct. We had five affiliate agencies in Mississippi 

throughout the length of its operation. I began as Program Director 

for MCMC during phase one and then continues on to phase two. 

So there has not been a break in case management activity in Mississippi. What I will say is that as time goes on, the case management has gotten better. We have done a better job because we are 

able to focus locally. At the height of Katrina Aid Today, we had 

somewhere around 50 case managers in Mississippi. At the beginning of phase one for the MCMC, we had almost 300 because the 

need was there and we were able to document the need and be able 

to procure funds. 

We define success based on the recovery plan. We use a holistic 

model. For me and what we teach in our training is that when a 

client is self-determined, that is a good indication of recovery. 

When that client is able to access resources and services on his or 

her own, that is a point at which case managers should consider 

that case for closure, when they don’t need us to take them or advocate for them to HUD or for a voucher or for a refrigerator or 

for an apartment. When they show signs that they are able to function in that arena on their own, that is what we call self-determination, and that is when we look at case closure. We leave the 

client with a recovery plan that they use as a road map well beyond our involvement with that case. 

Senator LANDRIEU. OK. We covered this in the first panel, but 

I would like your individual impressions on this privacy issue and 
33 

just some brief—each a brief suggestion as to how we might approach it, I don’t know, maybe starting, Rev. Snyder, if you have 

something you want to add on this privacy issue, but anyone that 

wants to speak to it, because we have got to solve this as we move 

forward. Does anybody have a suggestion about how it could be 

done or something we should look to? Ms. Smith, would you like 

to comment, or Rev. Snyder? 

Rev. SNYDER. I do not have a suggestion to show how we could 

actually solve that other than to say that, in fact, I mean, it is 

something that is very critical and that we do need to find a way 

to be more effective with how we do that. But I do not personally 

have a suggestion. 

Ms. ROTHE-SMITH. I don’t have a suggestion for the Federal family, but the way it is resolved through the voluntary agencies is 

usually through a technology solution called the Coordinated Assistance Network, and it is a way that the voluntary agencies provide information to one another about a client in the family 

through shared mechanism so that the duplication is diminished, 

but also the need for the client to share that information again and 

again, as well. 

Mr. CARR. Senator Landrieu, if I could add, the sharing of a 

FEMA number is critical for de-duplicating effort. In the State of 

Mississippi, when we were asked to set up phase one, we requested 

data from FEMA. We got names, addresses, telephone numbers. 

We didn’t get FEMA numbers. Identifying information such as that 

is critical for us. We requested information from our affiliates. We 

got 17,000 names. We compared that to the information that we 

got from FEMA, 5,000 names. Do you know how many John 

Smiths there are in the State of Mississippi? And a lot of them we 

got that didn’t have phone numbers or addresses. A key identifier, 

a FEMA number, is critical for especially contractors. 

So for me, a suggestion is that once FEMA or HHS or HUD enters into a contractual agreement with a service provider, that they 

give that information to that contractor, and then it is our responsibility to hold that information confidential, not sell FEMA numbers, etc. But when we are not given the trust to handle information in a way that helps us serve clients more efficiently, quite 

frankly, it is irresponsible. 

Senator LANDRIEU. Let me ask, Rev. Snyder, if I could, because 

you all have the contract for responding now, Catholic Charities 

does, and if this issue of privacy is not worked out, I am not sure 

how effective that next response will be. But also, or a different 

subject, how do you protect against secondhand trauma to case 

managers, because in some instances when the situations are very 

difficult, we found that some of the people that needed the most 

help after the first couple of weeks or months were the first responders themselves, the nurses who just collapsed, or the case 

workers that just couldn’t take it anymore. So are we thinking 

about how to deal with that in this whole response, psychological 

support and case management for the case managers? 

Rev. SNYDER. I think that is an excellent point, and I guess I 

would go back to what our experience was after Hurricanes 

Katrina and Rita in that, fortunately, we did have a large network 

of case managers to draw upon and many of them came from 
34 

throughout the country to Baton Rouge or to New Orleans, to Biloxi. An agency would send—Albany, New York, for example, sent 

four or five people on a rotating basis for 6 months to Baton Rouge, 

which allowed the local folks, who were dealing with their own 

trauma, to have that time, that space. 

I look at the days just beyond Hurricane Katrina at how the 

folks who themselves were affected also could not help themselves 

from working and reaching out. Until they knew there was someone else who was qualified to come in and take their place and give 

them the space, they wouldn’t rest. So I think that is something 

that we have to make sure is there. 

We also had some mental health services that we brought in for 

whole agencies that would deal with case managers. There was 

take a day, just 1 day a month, to try to address that. So I agree 

with you that is a critical piece to help prevent that burnout. 

Senator LANDRIEU. And, Dr. Redlener, do you want to comment 

about that at all? I know your focus has been children, but it has 

also been mental health. 

Dr. REDLENER. Yes. And actually, I would like to comment about 

the previous question, if I might, also, Senator. 

Senator LANDRIEU. Go ahead. 

Dr. REDLENER. OK. So this issue about the privacy is extraordinarily important. We face this all the time in medical practice, 

as well, obviously. And I think the key—there are three steps, really, that I would suggest. One is that we really have to have the 

concept ingrained of a one-stop shop for Federal services. That 

means that you enter the system and you enter then the service 

purview of any major agency of the Federal Government that you 

might need. 

And second, along with that would go this standardized database, so there is one time where people fill out the data forms and 

that is it, and that form is shared among people. 

But the third and critical step, I think, is to simply at intake ask 

parents for permission to share data. That is the end of the privacy 

problem. All you have to do is you have to sign, obviously, an appropriate form that is readable that is explained to families that 

says, in order to help you, we would like to be able to share your 

information with relevant agencies. These are the safeguards. 

Ninety-nine-point-nine percent of families will sign it, and to me, 

that is a very simple solution to what otherwise is a very complex 

problem that would require law changes and regulations and all 

sorts of things that might be very long in coming. So I would just 

recommend that. 

Senator LANDRIEU. OK. I have got to, unfortunately, end, but I 

am going to give each of you 30 seconds. If there is something I 

didn’t cover, something you want to mention, this would be the 

time to do it. We will start with you, Dr. Sizer. 

Mr. SIZER. Again, thanks, Chairman Landrieu, for the opportunity. I will just mention the issue of reintegration. Many of our 

citizens were deported to other parts of the country and have yet 

to return. I think trying to find a way in which to identify those 

individuals and bring them back home and help them get reestablished will be critically important. 
35 

The second issue I will raise is the issue of cultural competency. 

I certainly welcome the national model to descend on the State, especially when there is a catastrophic event. However, I will also 

mention that understanding the local players, what transpires and 

what takes place, is critically important because you could have 

well-meaning efforts and unintended negative consequences. 

So those are the other two points I would like to raise. 

Senator LANDRIEU. Thank you. Mr. Carr. 

Mr. CARR. Senator Landrieu, I wanted to circle back to the question that was raised with HUD about duplication of benefits. I use 

the term duplication of effort because that is what we are trying 

to prevent. And the issue that you raised was, I believe, in my 

written testimony where I talked about silos. Whatever we can do 

to prevent silo behavior, either within an agency or within Federal 

programs altogether, the better off we are. 

The issue of one case manager per program is an example of 

HUD having DHAP case managers, FEMA having MCMC case 

managers, and others trying to serve the same client. 

Senator LANDRIEU. We need one case manager per family. 

Mr. CARR. Per family, that has access—— 

Senator LANDRIEU. One case manager per family. 

Mr. CARR [continuing]. To all resources. Correct. So that was the 

issue that—whatever we can do to prevent silos. Families benefit. 

We have a consistent, systematic structure. And that is what is 

needed most in order to be cost effective and most impactful on the 

families that we are serving. Thank you. 

Senator LANDRIEU. Thank you. Dr. Redlener. 

Dr. REDLENER. A cautionary note about defining when a case is 

closed because it is a very dynamic situation and I wouldn’t necessarily depend on a decision made between a family and a case 

manager at point X that at X-plus-6 months, the situation will be 

the same. And what we are learning from this prolonged dislocation and recovery is that the definition is clear. You need a stable, 

safe home. You need access to essential services, schools and health 

care. And you need some way of getting into a livelihood, returning 

to a livelihood. 

Those should be the criteria. Those are objective criteria that 

could be combined with a family’s understanding of what they 

think they need. But if they don’t have stability and structure, 

even if today they say, things are fine, we don’t need you, we have 

already got the refrigerator, 6 months from now, you could have a 

family struggling with horrible problems of poor access to health 

care, academic failure, and a lot of other stress and mental and 

emotional health issues that will need to be taken care of down the 

road. So I think we should be very clear about what we mean by 

a reestablished, renormalized situation for families. 

Senator LANDRIEU. Thank you. Ms. Rothe-Smith. 

Ms. ROTHE-SMITH. I want to highlight a comment that Rev. Snyder illustrated earlier, and that is that while Katrina Aid Today 

started in December 2005, the organizations that were part of that 

used a model that had been in existence for quite a long time, and 

the organizations like Catholic Charities USA, UMCOR, Lutheran 

Disaster Response, and the American Red Cross and others have 

been providing disaster case management for decades. So I would 
36 

strongly encourage to really look and to continue to look to them 

as the experts that have been doing this work and will continue to 

do this work regardless of the models that come out. 

Senator LANDRIEU. Thank you very much. Rev. Snyder. 

Rev. SNYDER. Thank you. I have already talked about my concern for the funding of a national infrastructure, so I guess I would 

like to end with saying that let us not lose sight of the need for 

flexibility, that even though we are saying 18 months of case management should be enough, in some cases, it is not. I know our 

local providers right now who are working on Hurricanes Gustav 

and Ike have written a letter and, I think, made a good case on 

the fact that because case management did start a little late or 

whatever, that it still might need a little more time. So just, again, 

the need for flexibility in whatever services we are trying to provide. 

Senator LANDRIEU. OK. I really want to thank our FEMA Director for staying, the HUD Director for staying and listening to the 

testimony. We really appreciate the way these agencies are really 

leaning forward to work better and faster, with all the other pressures that the Administration and Congress has before it. But this 

Subcommittee is focused on staying on the job until the job is done, 

to get better laws in place, better procedures in place, better overall 

response and recovery. 

And in that, I will announce I will be sending several staffers to 

the international conference on disaster response and recovery. I, 

myself, can’t attend, but we will be sending several staffers and we 

will ask the Administration to send people to Kobe, Japan, which 

will be hosting an international conference on this and other subjects related to recoveries from disasters. That city will be celebrating its 15th year of recovery from a great earthquake. So there 

will be high-level individuals, elected officials, community leaders, 

I am assuming from all over the world. 

So what we are doing here is going to help frame what we do 

in the United States, but we are hoping to share that information, 

of course, internationally to help victims of major disasters everywhere. So we thank you for your testimony and we will put it to 

good use. 

The hearing is adjourned. 

[Whereupon, at 4:29 p.m., the Subcommittee was adjourned.] 
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