Disaster Assistance: Greater Coordination and an Evaluation of Programs' Outcomes Could Improve Disaster Case Management
Published: 2009-07-08T00:00:00

Fast Facts:

Highlights:
section_title: Why GAO Did This Study
paragraphs: As a result of the unprecedented damage caused by Hurricanes Katrina and Rita in 2005, the federal government, for the first time, funded several disaster case management programs. These programs help victims access services for disaster-related needs. GAO was asked to review (1) steps the federal government took to support disaster case management programs after the hurricanes, (2) the extent to which federal agencies oversaw the implementation of these programs, (3) challenges case management agencies experienced in delivering disaster case management services, and (4) how these programs will inform the development of a federal case management program for future disasters. GAO reviewed relevant laws and guidance, obtained data from two programs, conducted site visits to Louisiana and Mississippi, and interviewed case management providers and officials from federal and state agencies involved in disaster case management.
section_title: What GAO Found
paragraphs: Federal agencies provided more than$209 million for disaster case management services to help thousands of households cope with the devastation caused by Hurricanes Katrina and Rita, but breaks in federal funding adversely affected services to some hurricane victims. The Federal Emergency Management Agency (FEMA) awarded a grant of $66 million for initial case management services provided by Katrina Aid Today (KAT) shortly after the hurricanes made landfall. When this program ended in March 2008, FEMA provided funds for additional programs to continue services. As a result of ongoing budget negotiations between FEMA and Mississippi, the state-managed Disaster Case Management Pilot (DCM-P) program in Mississippi did not begin until August 2008, approximately 2 months after it was scheduled to, and FEMA's DCM-P program in Louisiana was never implemented. Consequently, some victims most in need may not have received case management services. FEMA and the Department of Housing and Urban Development (HUD) provided some oversight of disaster case management programs, but monitoring of KAT was limited and coordination challenges may provide lessons for future disasters. As recovery continued, FEMA and HUD provided additional monitoring of subsequent programs. Coordination challenges contributed to implementation difficulties, such as a lack of timely information sharing. For example, client information provided by FEMA to the Mississippi state agency implementing the DCM-P program was invalid or out-of-date for nearly 20 percent of eligible clients. As a result of incompatible databases and inconsistent outreach efforts, some victims may have received services from multiple agencies while others may not have been reached. Case management agencies experienced challenges in delivering federally-funded disaster case management services due to large caseloads, limited community resources, and federal funding rules. Some case management agencies experienced high turnover, and some case managers had caseloads of more than 100 clients, making it difficult to meet client needs. KAT and HUD data indicated that the most frequently occurring needs among clients included housing and employment, but these resources were limited following the hurricanes. Further, case management agencies saw the ability to provide direct financial assistance for items such as home repair, clothing, or furniture as key to helping victims, yet only one federally funded program allowed case management agencies to use federal funds for direct assistance. FEMA and other agencies are evaluating disaster case management pilot programs to inform the development of a federal disaster case management program for future disasters, but some of the evaluations have limitations. For example, some evaluations will not assess program outcomes, such as whether clients' needs were met. In addition, FEMA did not include stakeholder input in designing its evaluation of multiple pilot programs. According to FEMA officials, the agency does not have a time line for developing the federal disaster case management program.

section_title: Letter
paragraphs: Hurricane Katrina made landfall on the Gulf Coast in late August 2005 and  caused more than $80 billion in estimated property damage, making the  storm the most expensive natural disaster in the history of the United  States. Approximately 300,000 homes were destroyed or rendered  uninhabitable. Less than one month later, Hurricane Rita struck the same  region, severely damaging or destroying more than 23,600 homes in  southwest Louisiana and southeast Texas and causing $10 billion in  estimated property damage. Together, Hurricanes Katrina and Rita  displaced more than 1 million people from some of the poorest  communities in the country. To help hurricane victims recover from the  unprecedented damage and displacement caused by the storms, the  federal government provided more than $209 million to states and  nonprofit organizations to support several disaster case management  programs. Disaster case management involves helping victims access  services for a range of needs, including employment, housing, and health  care.
In August 2009, nearly four years after the storms, the last federally funded  disaster case management program for victims of Hurricanes Katrina and  Rita is scheduled to end despite the thousands who still require assistance.  Given the unprecedented damage and displacement caused by the  hurricanes and the continuing recovery needs of victims, GAO was asked  to review the federal government’s efforts to leverage governmental and  nongovernmental resources to help victims with their recovery. GAO has  issued reports on housing, health care, the role of voluntary organizations,  and services for victims residing in Federal Emergency Management  Agency (FEMA) trailer group sites, among others. This report focuses on  federally funded disaster case management programs and addresses the  following key questions:  1.  What steps did the federal government take to support disaster case  management programs after Hurricanes Katrina and Rita? 2.  How did federal agencies oversee the implementation of these disaster  case management programs? 3.  What challenges did case management agencies experience in  delivering disaster case management services under federally funded  programs? 4.  How will previous or existing federally funded disaster case  management programs be used to inform the development of a federal  case management program for future disasters?
To address these questions, we reviewed the roles and responsibilities of  the federal government for disaster recovery services, as well as federal  laws, regulations, and guidance related to the federally funded case  management programs established to assist victims of Hurricanes Katrina  and Rita, including the federal government’s authority to establish or fund  post-disaster case management programs. We also reviewed prior GAO  work on best practices for coordination among federal agencies and  between federal and nonfederal stakeholders. We interviewed federal  officials from FEMA, the Department of Housing and Urban Development  (HUD), and the Department of Health and Human Services (HHS). We  focused our review on Louisiana and Mississippi, as those were the states  most directly affected by Hurricanes Katrina and Rita, and conducted site  visits to Baton Rouge and New Orleans, Louisiana; and Biloxi, Gulfport,  Moss Point, Jackson, and Pascagoula, Mississippi. We conducted, either in  person or by phone, interviews with organizations involved in disaster  case management in these states (see table 1 in app. I for a comprehensive  list of the organizations interviewed). During these interviews, we  obtained information on, among other topics, coordination between  government agencies and case management agencies and challenges to  helping clients meet their recovery needs. We selected interviewees to  ensure that we spoke to representatives from a range of appropriate  organizations serving Hurricane Katrina and Rita victims. In both states we  spoke to the majority of disaster case management providers for the  Katrina Aid Today (KAT) program and selected providers for the Disaster  Housing Assistance Program (DHAP). We also spoke with selected  providers for the state-managed Disaster Case Management Pilot (DCM-P)  program in Mississippi. We did not interview disaster case management  providers who served victims that relocated to other states. The views of  the disaster case management providers we spoke with cannot be  generalized to all organizations that provided disaster case management  services to victims of Hurricanes Katrina and Rita. In addition to the  interviews, we obtained summary data on KAT clients from the  Coordinated Assistance Network database maintained by the American  Red Cross and received record-level data from the Tracking-at-a-Glance  database used for DHAP. These data included, among other variables,  information on the needs of case management clients. We assessed the  reliability of these data sources and used only those elements we found to  be sufficiently reliable for the purposes of this report. For more  information on our scope and methodology, see appendix I. We conducted  this performance audit from May 2008 to July 2009, in accordance with  generally accepted government auditing standards. Those standards  require that we plan and perform the audit to obtain sufficient, appropriate  evidence to provide a reasonable basis for our findings and conclusions  based on our audit objectives. We believe that the evidence obtained  provides a reasonable basis for our findings and conclusions based on our  audit objectives.
subsections: section_title: Background
subsections: section_title: Federal Role for Funding and Coordinating Disaster Case Management Services
paragraphs: The federal role for funding and coordinating disaster case management  was not explicitly defined until the passage of the Post-Katrina Emergency  Management Reform Act of 2006 (Post-Katrina Act). The Robert T.  Stafford Disaster Relief and Emergency Assistance Act (Stafford Act), as  amended, is the primary authority under which the federal government  provides major disaster and emergency assistance to states, local  governments, tribal nations, individuals, and qualified private, nonprofit  organizations. FEMA is responsible for administering the provisions of the  Stafford Act. At the time of Hurricanes Katrina and Rita, the Stafford Act  contained no explicit authority to fund disaster case management services.  The Post-Katrina Act amended the Stafford Act and, among other things,  granted the President the authority to provide financial assistance for case  management services to victims of major disasters.
In addition to its responsibilities under the Stafford Act, FEMA has  responsibility for administering and ensuring implementation of the  National Response Framework, which replaced the former National  Response Plan—a framework for managing the federal response to  disasters. Under the National Response Plan, in effect at the time of  Hurricanes Katrina and Rita, FEMA was responsible for coordinating the  delivery of human services to support state, regional, local, tribal  government, and nongovernmental organization efforts. This included  coordinating victim-related human services for recovery efforts such as  counseling, support for persons with special needs, and expediting the  processing of new federal benefits claims, among others. While the  National Response Plan did not explicitly include or exclude disaster case  management services, the Plan did state that close coordination is  required among those federal agencies responsible for response  operations and recovery activities, and other nongovernmental  organizations providing assistance.
In January 2008, the National Response Plan was revised and replaced  with the National Response Framework, which became effective in March  2008. The Framework maintains FEMA’s responsibility for coordinating  human services, and specifically includes disaster case management as  one of several categories of human services. The National Response  Framework recognizes the need for collaboration among the myriad of  entities and personnel involved in response efforts at all levels of  government and the nonprofit and private sectors and places increased  responsibility on FEMA for coordinating with voluntary organizations.  Moreover, the Framework requires federal agencies involved in mass care,  housing, and human services to coordinate federal response efforts with  the efforts of state, local, private, nongovernmental, and faith-based  organizations. In previous work, GAO has stated that these updated  requirements for coordination with voluntary organizations are more  extensive and specific than in the National Response Plan, and FEMA  officials have told GAO that voluntary agency liaisons, who are FEMA  employees, will fill this role.
section_title: The Federal Government Supported Disaster Case Management Programs for the First Time after Hurricanes Katrina and Rita, but Breaks in Federal Funding May Have Hindered Assistance to Victims
subsections: section_title: Through Varied Funding Mechanisms, FEMA, HUD, and HHS Supported a Variety of Disaster Case Management Programs for Victims of Hurricanes Katrina and Rita
paragraphs: Since the hurricanes nearly 4 years ago, more than $209 million of FEMA  and HHS funds have been used to support disaster case management  programs to assist victims of Hurricanes of Katrina and Rita, one of which  was administered by HUD. These programs overlapped and began at  different times, as federal agencies identified ongoing need for services  (see fig. 1). We estimate that, at most, nearly 116,000 families affected by  Hurricanes Katrina and Rita relied on federally funded disaster case  management services supported by FEMA, HUD, and HHS to obtain  assistance in rebuilding their lives.
In October 2005, during the immediate aftermath of Hurricane Katrina, the  Department of State transferred $66 million of international donations to  FEMA to finance disaster case management services for households  affected by Hurricane Katrina. Although FEMA had not previously funded  disaster case management, FEMA had proposed that international  donations be used for this purpose due to the unprecedented magnitude of  the damage and displacement caused by Hurricane Katrina. FEMA  awarded a $66 million, 2-year case management services grant to the  United Methodist Committee on Relief (UMCOR). UMCOR used the grant  to establish KAT, a national consortium consisting of nine social service  and voluntary organizations, to provide case management services to  victims of Hurricane Katrina. As part of its case management system, the  grant specified that UMCOR would initiate or support long-term recovery  committees in all disaster affected states and KAT consortium members  were to participate in these organizations. Furthermore, KAT consortium  members were required to use the Coordinated Assistance Network  database to track client information and case management activities.
Although case management services provided by KAT were scheduled to  end in October 2007, FEMA used interest accrued on the $66 million in  charitable international donations—about $2 million—to allow KAT  consortium members to continue providing disaster case management  services through March 2008. KAT ended its activities on March 31, 2008,  and according to program data, served more than 69,000 households.
To assist the thousands of victims of Hurricanes Katrina and Rita that  were still without permanent housing and continued to need case  management services as KAT ended, FEMA collaborated with the states of  Louisiana and Mississippi on a two-phase disaster case management  program that would continue until March 1, 2009. The first phase used  Cora Brown funds, given directly to Louisiana and Mississippi state  governments—$524,000 and $502,000, respectively—to continue providing  case management services to individuals and families affected by  Hurricanes Katrina and Rita. This assistance—referred to as the Cora  Brown Bridge Program or Phase 1—lasted from April 1, 2008 to May 31,  2008, and, according to FEMA officials, served 1,747 clients in Louisiana  and 1,314 in Mississippi who still had open KAT cases. Rather than giving  the funds to the KAT organization, the states distributed the funds directly  to the case management agencies that provided services under KAT, since  the KAT program had officially ended. The intent of the program was to  provide “bridge” case management services for clients while FEMA  developed the second phase.
For the second phase of the program, FEMA used funds from its Disaster  Relief Fund for a state-managed DCM-P program. Through this pilot, case  management services were intended for households in Louisiana and  Mississippi affected by Hurricanes Katrina and Rita with the primary goal  of helping them achieve sustainable permanent housing. Eligible families  included those living in FEMA temporary housing, those with health- related concerns living in FEMA-funded hotels or motels, and those whose  case management services were not fully completed in the Cora Brown  case management program. FEMA awarded a conditional grant of $25.4  million to Mississippi in July 2008 and the program became operational in  August 2008. The Mississippi Commission for Volunteer Services  administered the program in Mississippi and created the Mississippi Case  Management Consortium of 13 member organizations. The program was  scheduled to end March 1, 2009, however FEMA extended the program  until June 1, 2009. As of March 2009, the Mississippi Commission for  Volunteer Services reported that the consortium had served more than  3,000 families throughout Mississippi. According to FEMA officials, in  October 2008, FEMA awarded an initial grant of $32.5 million to Louisiana  to implement the DCM-P program, but the state was unable to implement  the program due to the withdrawal of a lead agency. According to the lead  agency officials, the agency withdrew due to the short time frame in which  services were to be provided and the lack of direct assistance funds. In  February 2009, FEMA provided an adjusted grant award of $8.4 million,  but Louisiana was unable to secure a contract with a different lead agency,  the Louisiana Family Recovery Corps (LFRC), according to FEMA  officials. According to LFRC officials, they declined to implement the  program because there was not sufficient time in which to provide  services, among other reasons. Because LFRC declined, the state of  Louisiana proposed using funds allocated for the DCM-P program for  construction instead. However, FEMA officials said this proposal was  declined because it does not fall within the case management services for  which the funds were originally intended. In addition, FEMA officials said  it is unlikely that the DCM-P program will be implemented in Louisiana.
Following the hurricanes, Congress appropriated emergency funding to  states to help affected individuals and families through two programs  administered by HHS, the Temporary Assistance for Needy Families  (TANF) and Social Services Block Grant (SSBG) programs. These  programs, through federal grants made to states, assist needy families with  children and provide social services to individuals. HHS distributed $32.7  million in emergency TANF funds to Louisiana, which entered into a  memorandum of understanding with LFRC to provide human services,  including case management, to victims of Hurricanes Katrina and Rita  residing in Louisiana. In October 2006, LFRC received approximately $18.5  million in emergency SSBG funds from the state. The contract between the  state of Louisiana and LFRC required that 70 percent of the TANF and  SSBG funds be used for direct assistance and 30 percent of the funds for  case management assistance. LFRC awarded grants to nonprofit agencies  to provide case management services across the state of Louisiana from  January 2006 through June 2007.
Due to federal eligibility criteria for these programs, LFRC could only use  TANF funds to support needy households with minor children and SSBG  funds could be used to support low-income households with or without  minors. In addition, program rules limited TANF-funded emergency  assistance to 4 months. According to an evaluation of LFRC, the program  provided case management services to more than 9,500 families in  Louisiana.
When it became clear that existing housing efforts to assist victims of  Hurricanes Katrina and Rita would be insufficient, FEMA and HUD signed  an inter-agency agreement in July 2007 for HUD to design and implement a  pilot grant program known as the Disaster Housing Assistance Program  (DHAP). The main purpose of DHAP was for HUD to provide rental  assistance to eligible victims of Hurricanes Katrina and Rita from  September 1, 2007 to March 1, 2009. Eligibility for DHAP was determined  by FEMA and included anyone who was displaced from their homes as a  result of Hurricanes Katrina or Rita and consequently was either receiving  or was eligible to receive rental assistance administered by FEMA. To  participate, clients also had to receive case management services.
DHAP was funded by FEMA, using up to $585 million from its Disaster  Relief Fund. According to HUD officials, $63.8 million of these funds  supported the case management portion of the program. While HUD  worked through its existing network of local public housing authorities in  several states across the U.S. to implement DHAP, 59 percent of cases  were in Louisiana, and only 1 percent of cases were in Mississippi. In turn,  many public housing authorities contracted with other agencies to provide  the case management services required by the program. On August 5, 2008,  the Mississippi Case Management Consortium—the organization created  to implement FEMA’s state-managed DCM-P program—took over the case  management portion of DHAP for most new DHAP clients in Mississippi,  according to HUD officials. HUD data indicated that over 30,000 clients  received case management. Some DHAP clients will continue to receive  housing assistance through a DHAP transitional closeout program until  August 31, 2009. States may request to provide case management services  during the transitional closeout period. For clients in Louisiana, HUD  officials said they signed an agreement on March 20, 2009 with the  Louisiana Recovery Authority to provide case management to 16,000  clients in the DHAP transitional closeout program. According to HUD  officials, no other states have made similar requests to continue case  management services.
section_title: Breaks in Federal Funding Adversely Affected Disaster Case Management Services to Some Hurricane Victims
paragraphs: The discontinuous nature of the federally funded disaster case  management programs initiated after Hurricanes Katrina and Rita led to  breaks in funding that adversely affected case management agencies and  may have left victims most in need of assistance without access to case  management services. For example, as the first federally funded case  management program—KAT—drew to a close in March 2008, some case  management providers began to shut down their operations and case  managers were laid off. Officials from two KAT agencies noted that some  cases were closed not because clients’ needs were met, but because the  program was ending. It was not until 3 days before the official end of the  KAT program that FEMA announced the continuation of services through  FEMA’s Cora Brown Bridge Program. Because eligibility was limited to  those with open KAT cases, and since FEMA did not require case  management agencies to track clients who continued to have disaster- related needs, but whose cases were closed only because the KAT  program ended, it is unknown whether some clients still in need of case  management obtained assistance elsewhere or whether their cases were  eventually reopened when the case management agencies received the  Cora Brown Bridge program funding.
The break in federal funding after the Cora Brown Bridge program ended  also forced some case management agencies to shut down their programs  as they waited for the new federal program to start. Clients with open  cases under the Cora Brown Bridge program were supposed to transition  from the bridge program, which ended on May 31, 2008, to FEMA’s state- managed DCM-P program, which was supposed to begin in June 1, 2008.
As a result of ongoing budget negotiations between FEMA and Mississippi,  the state-managed DCM-P program in Mississippi did not begin until  August 2008, approximately 2 months after it was scheduled to, according  to officials from the Mississippi Commission for Volunteer Services. In  addition, while Louisiana received an award letter from FEMA for the  program in February 2009—8 months after the program was intended to  begin—the program never became operational in the state due to time  constraints. An official at one case management agency in Louisiana said  the organization used at least $225,000 of its own resources to keep  clients’ cases active while waiting for a decision on whether Louisiana  would receive funds for a state-managed DCM-P program. However, not all  case management agencies had the resources to continue to provide  services. According to the Mississippi Case Management Consortium,  many of the smaller case management organizations were unable to find  alternative resources to pay the case managers hired in June for FEMA’s  state-managed DCM-P program and had to lay off case managers with the  hope of hiring them back once they received federal funding.
The breaks in service after the bridge program concluded left additional  hurricane victims in need of services without access to case management.  Although FEMA guidance estimated that it would refer 8,378 people to the  state-managed DCM-P program in Mississippi, FEMA referred only 5,456  people to the Mississippi state agency administering the pilot program. Of  those, 3,432 had been served as of March 2009. According to FEMA, the  difference between the target estimate and actual number of clients  assigned to the Mississippi state-managed DCM-P program is accounted  for by the number victims in FEMA temporary housing that moved into  more suitable housing before the pilot program became operational. A  FEMA official also told us that the primary method for relocating  applicants to more suitable housing was DHAP, which required clients to  participate in case management services. However, data do not exist to  determine if victims who found more suitable forms of housing outside of  DHAP received disaster case management services. In addition, FEMA  guidance estimated that 18,820 clients were to be referred to the Louisiana  DCM-P program. However, because the program was never implemented  in Louisiana, it is likely that many of these clients did not receive services  since nonprofits throughout the state would not have been able to absorb  these clients, according to LFRC officials.
section_title: FEMA and HUD Provided Some Oversight of Disaster Case Management Programs, but Monitoring of KAT Was Limited and Coordination Challenges May Provide Lessons for Future Disasters
subsections: section_title: Although Initial Oversight of KAT Was Limited, FEMA and HUD Used a Variety of Methods to Monitor Subsequent Disaster Case Management Programs
paragraphs: In the aftermath of Hurricane Katrina and in the absence of explicit  authority to fund disaster case management, FEMA believed it had limited  responsibility for overseeing international donations allocated to UMCOR  and limited authority to ensure all aspects of the grant proposal for KAT  were carried out. When Hurricane Katrina made landfall, specific policies  and procedures for handling international cash donations to the federal  government had not yet been developed. According to a FEMA official,  FEMA acted as a pass-through for the international funds. FEMA approved  the grant proposal submitted by UMCOR and relied on reports of the  program objectives in the proposal to monitor the implementation of KAT.
As stipulated in the grant proposal, UMCOR submitted quarterly financial  and performance reports to FEMA that contained information on program  objectives, the number of referrals provided and utilized, and other  indicators. According to a FEMA official who had a key role in overseeing  the UMCOR grant, FEMA reviewed the reports, frequently participated in  discussions with KAT representatives, attended regular quarterly  management meetings with KAT members, and provided technical  guidance to KAT personnel. FEMA discussed challenges to implementing  KAT with UMCOR, but believed it was beyond the scope of its authority to  ensure that all aspects of the grant proposal were carried out. For  example, the grant proposal stated that UMCOR would initiate or support  the formation of long-term recovery committees, and representatives from  KAT agencies would participate. According to case management agencies,  these committees did not always operate effectively. While FEMA officials  were aware of this challenge, the agency did not believe it had authority to  take action.
Similarly, FEMA relied on the procedures specified in the approved grant  proposal for obtaining information on clients. The grant proposal  stipulated that KAT case management agencies would utilize the  Coordinated Assistance Network database to input case management data  and to provide for easy transfer of information between agencies. The  Coordinated Assistance Network—initiated and developed by charitable  disaster response organizations—is the national database used to  coordinate and manage service delivery for disaster relief organizations,  including KAT partners. According to KAT guidance, it is a tool for sharing  referral information and services, storing client information, and  transferring clients between partners without interruption to service. This  database is also used to extract client information, case management  services provided, needs, recovery plan outcomes, information on case  closings, and demographic information for reports and evaluation  purposes. KAT selected the Coordinated Assistance Network as the  database for coordinating case management services and reporting on  outcomes and indicators.
Data from the Coordinated Assistance Network database provided limited  information on overall program outcomes for KAT clients, in part because  the extent to which data were consistently entered into the system varied,  but recent changes will help case management agencies use the database  more consistently in the future. UMCOR provided FEMA with quarterly  reports from KAT that contained data generated from the Coordinated  Assistance Network, but FEMA did not assess the completeness or  reliability of the data because government agencies are not permitted to  access the database. In addition, because the Coordinated Assistance  Network does not receive federal funds, FEMA had no authority to audit  the system, according to a FEMA official. According to a third party  evaluation of KAT, many KAT staff and external stakeholders stated the  Coordinated Assistance Network database was successful in helping  agencies communicate with one another, track resources, and generate  progress reports. However, data on certain variables were missing for a  large number of clients because users of the system did not consistently  enter complete information. As a result, the database is of limited use in  understanding outcomes of the program as a whole such as the frequency  of certain client needs and the extent to which those needs were met.  Representatives of the Coordinated Assistance Network told us that  changes have since been made to the database to help case management  agencies enter data more consistently, which may help track outcomes in  the future. For example, according to the representatives, the database  now has the capability to require entry in certain data fields.
As recovery continued and FEMA’s role in funding disaster case  management became explicit, FEMA and HUD used various methods— such as reviewing disaster case management data, conducting site visits,  and providing technical support—to oversee later disaster case  management programs. FEMA reviewed reports from the Mississippi state  agency that administered the state-managed DCM-P program. The  Mississippi state agency was required to report to FEMA on a quarterly  basis on all state-managed DCM-P program activities and costs, and  include a narrative summary of the program’s status, accomplishments,  and challenges. In addition, FEMA assigned a DCM-P coordinator to  Mississippi to provide coordination and technical assistance. FEMA  reviewed the quarterly reports and conducted site visits. FEMA’s DCM-P  program also provided funding for monitoring staff, which were  responsible for testing data reliability, according to a FEMA official. To  monitor the implementation of DHAP, HUD produced weekly reports from  its case management database and hired a contractor to monitor and  provide technical assistance to DHAP grantees, according to HUD  officials. The contractor also reviewed data quality and followed up with  DHAP grantees on the case management program, irregularities in DHAP  reports, and any implementation challenges. HUD also established  monitoring tasks for DHAP grantees based on caseloads, as well as scores  on various key processes and output and outcome metrics.
section_title: Challenges to Coordination Among Federal Agencies and Case Management Agencies Contributed to Implementation Difficulties
paragraphs: Federal agencies and case management agencies faced challenges in  following key practices for coordination in delivering disaster case  management services. In previous work, GAO has identified key practices  to enhance and sustain coordination among federal agencies, and has  since recommended these same key practices to strengthen partnerships  between government and nonprofit organizations. Key practices for  coordination include establishing mutually reinforcing or joint strategies  and compatible policies, procedures, and other means of operating across  agency boundaries. While FEMA had a lead role in coordinating other  types of disaster assistance after Hurricanes Katrina and Rita, their role for  coordinating disaster case management was not explicit. Initial  coordination activities among federal agencies and case management  providers were minimal following the hurricanes. As a result, some victims  may not have received case management services while others may have  received services from multiple providers. Challenges faced by federal  agencies and case management providers in following key practices for  coordination may provide lessons for disaster case management services  in future disasters.
subsections: section_title: Lack of Accurate and Timely Information Sharing
paragraphs: Difficulties in coordinating disaster case management services resulted in  a lack of accurate and timely information sharing between federal  agencies and case management providers. State and local agencies  providing federally funded disaster case management services faced  challenges in obtaining timely and accurate information from the federal  agencies overseeing the programs. For example, the Mississippi state  agency administering the FEMA state-managed DCM-P program faced  challenges receiving complete and accurate information from FEMA.  According to officials in Mississippi who managed the program, FEMA  provided clients’ names with addresses or phone numbers, but these were  often invalid or out-of-date. According to a FEMA official, FEMA has no  method for tracking clients, and clients voluntarily contact FEMA to  provide updated information. Program managers reported that case  management providers in Mississippi were unable to contact more than  1,000 clients, out of a total of more than 5,000 clients, due to disconnected  phone numbers or incorrect addresses. According to the FEMA official,  FEMA’s information sharing policies under the Privacy Act precluded the  agency from providing registration numbers that would have allowed the  agency to match cases with clients served through previous programs and  more easily identify and contact eligible individuals. While FEMA  attempted to update information on these clients, a FEMA official told us  the work was time consuming because client contact information could be  stored in various FEMA databases. In addition, officials from a public  housing authority in Mississippi told us they were notified by HUD that  they would receive DHAP clients only 5 days prior to the deadline for  processing housing assistance payments for the clients, which was a  difficult timeframe to meet.
In addition, some case management providers faced difficulties in  obtaining information from FEMA that may have facilitated the  coordination of service delivery. To protect the privacy of disaster victims,  FEMA shared limited client information, potentially resulting in some  eligible hurricane victims not receiving services. For example, according  to an official of a case management agency operating in Louisiana and an  HHS official, FEMA approached HHS about serving some victims of  Hurricanes Katrina and Rita under its pilot disaster case management  program for Hurricanes Gustav and Ike. The potential clients were  residing in FEMA-provided travel trailers and mobile homes but may not  have been receiving case management services because the state-managed  pilot program never became operational in Louisiana. However, when the  case management agency implementing the HHS pilot requested client  information from FEMA to determine whether it was already serving any  of these disaster victims and to assess its capacity to serve additional  clients, FEMA only provided aggregate data on the number of mobile  homes and travel trailers in each parish. The case management agency  found this information unusable. According to FEMA officials, its routine  use policy specifies that for an organization to obtain client-level  information, it must indicate a specific service it intends to provide to the  disaster victims for which information is requested. As FEMA officials  explained to us, such a request for client-level information from the case  management agency implementing the HHS pilot would have been denied  based on this policy.
section_title: Incompatible Databases
paragraphs: Many of the databases used by case management agencies—including  those used by KAT, LFRC, and agencies that provided case management  services under DHAP—were not compatible, leading to confusion  regarding the services clients may have received. As GAO has reported, to  facilitate coordination, agencies need to address the compatibility of data  systems to operate across agency boundaries. The incompatibility of the  databases made it difficult to track clients across agencies, and some  hurricane victims who applied to more than one program may have  received duplicate services. For example, clients who received case  management services through KAT may have also received services  through LFRC, but because the KAT and LFRC databases—the  Coordinated Assistance Network database and ServicePoint,  respectively—are not compatible, some case management agencies for  these two programs may not have be able to screen for duplication of  services.
While case management agencies that operated under KAT and FEMA’s  state-managed DCM-P program used the Coordinated Assistance Network  database in an effort to facilitate consistent data collection across case  management agencies and to report information on their programs,  government agencies could not access the system, creating inefficiencies.  The database, which offers tools for case management, allows disaster  relief organizations to communicate about clients’ needs and services  offered. However, because government agencies administering case  management programs are not given access to the system, officials from  Mississippi who administer FEMA’s state-managed DCM-P program told us  they had to incorporate a nonprofit agency as an intermediary in its  management structure to access and collect data for the state to report to  FEMA. The Mississippi DCM-P program officials considered this process  inefficient.
section_title: Inconsistent Outreach
paragraphs: Many case management agencies conducted little coordinated outreach, if  any, and as a result, those most in need of case management—such as  those residing in FEMA group trailer sites—may not have received  services. GAO has reported that to achieve a common outcome, partner  agencies need to establish strategies that work in concert or are joint in  nature to help align their activities and resources. Case management  agencies we spoke to acknowledged that victims residing in FEMA group  sites needed a range of services and may have been those most in need. In  addition, we previously reported that FEMA officials said that those who  remained in group sites were the hardest to serve people including the  elderly, persons with disabilities, and unemployed people. According to  LFRC officials, there was no coordinated approach for providing case  management services among federally funded programs, and without a  coordinated approach to case management, residents in these group sites  may not have received needed case management. According to a KAT  official, KAT case management agencies were not required to conduct  outreach to residents in FEMA group sites. In addition, we have previously  reported that federal efforts to assist victims of Hurricanes Katrina and  Rita with employment, services for families with children, and  transportation generally did not target group site residents. FEMA’s state- managed DCM-P program specifically targeted those in FEMA-funded  temporary housing, including group sites. However, in Mississippi, for  example, FEMA’s housing advisors were not always aware of FEMA’s  DCM-P program, and this lack of coordination led to confusion and  frustration among FEMA housing advisors, case managers, and clients,  according to Mississippi officials.
section_title: Case Management Agencies Experienced a Range of Service- Delivery Challenges, and As A Result, Those Most in Need of Services May Not Have Been Helped
subsections: section_title: Staff Turnover and Large Caseloads Were Barriers to Meeting Clients’ Needs
paragraphs: According to various sources, some case management agencies  experienced high turnover in case managers, which made it difficult to  meet clients’ needs. For example, one case management agency reported  100 percent turnover in its case managers during the KAT program. An  official at this agency said turnover was high because case managers  expected a short-term assignment or found the work too emotionally  draining. While KAT partners tried to reduce staff turnover through  incentive systems such as flex time and bonuses and through staff  meetings to determine how best to share resources to support case  managers, according to a KAT summary of its quarterly reports, the  retention of case managers was an ongoing challenge for maintaining the  capacity to serve clients. Similarly, an evaluation of LFRC showed that, in  one focus group, six out of nine participants did not know who their  current case manager was because of staff changes; others described their  replacement case managers as lacking knowledge about available  resources.
Caseloads were generally significantly higher than suggested by program  guidance for earlier programs, which adversely affected the assistance  provided to clients. KAT guidance suggested that one case manager could  handle an average of 20 to 30 cases, and LFRC caseloads were to be  limited to 25 clients; however, several case management agencies we  spoke with that operated under these programs reporter much higher  caseloads. For example, some KAT case managers said they had 40 open  cases at a time, while other KAT case managers said caseloads were as  high as 300 clients per case manager. KAT’s summary of its quarterly  reports also states that senior management became concerned that new  cases were not being opened fast enough and agreed that the pace needed  to be accelerated despite case managers’ already high caseloads. In  addition to KAT, LFRC case management agencies also reported having  heavy caseloads; for example, case managers at one LFRC partner agency  reported caseloads ranging from 60 to 100 clients. Several factors may  have contributed to high caseloads including the magnitude of the disaster  and a shortage of case managers. Multiple case management agencies said  the number of hurricane victims outnumbered case manager capacity, and  some case management agencies had to turn clients away or had waiting  lists as a result. For victims who did receive services, case managers may  not have been able to build more personal relationships to fully  understand clients’ recovery needs in order to provide assistance. Case  management agencies operating under later programs such as DHAP and  the Mississippi DCM-P program have not exceeded required caseload sizes  of 50 and 25 cases, respectively. According to a Mississippi DCM-P official,  this is because staffing for the program was based on a fixed number of  clients.
section_title: Clients Had Multiple Needs Including Housing, Employment, and Transportation; However, These Community Resources Were Limited
paragraphs: Case managers said one of the main needs of clients was and continues to  be housing; however, housing resources have been limited following the  hurricanes. According to program data, approximately 67 percent of KAT  clients were displaced from their primary residence as a result of  Hurricane Katrina. As GAO previously reported, Hurricane Katrina  destroyed or made uninhabitable an estimated 300,000 homes, and more  than 82,000 rental housing units in Louisiana and more than 20,000 rental  housing units in Mississippi had major or severe damage following the  2005 Gulf Coast Hurricanes, according to statewide HUD data. We  previously reported that under HUD’s Community Development Block  Grant program—a key program providing federal funds to rebuild housing  in Louisiana and Mississippi—the states have used the majority of funding  to assist homeowners rather than renters. For example, while Louisiana  allocated $8 billion of $10.4 billion in Community Development Block  Grant funding to establish the Road Home program to help homeowners  rebuild, $1.7 of the $10.4 billion went to rental, low-income housing, and  other related housing projects. Further, for the Road Home program,  Louisiana estimated a $2.9 to $5 billion shortfall in funding to help  homeowners. In addition, we reported that through the Gulf Opportunity  Zone Act, which provided low-income housing tax credits to help finance  the development of rental housing, only 17 percent of the rental housing  units with major or severe damage in the state of Louisiana, and 45 percent  of the similarly damaged units in the state of Mississippi, would be  addressed. The limited availability of housing following Hurricanes  Katrina and Rita has made it difficult to help some clients with their  recovery needs. For example, HUD officials estimate that approximately  12,000 former DHAP clients may need and be eligible for long-term  housing assistance through the Housing Choice Voucher program. HUD  is in the process of transitioning families to this program.
Case managers said that client needs also included employment and  transportation, but these community resources were limited. According to  the Bureau of Labor Statistics, between August 2005 and August 2006,  almost 128,000 jobs were lost in eight areas of Louisiana and Mississippi  that were heavily affected by Hurricane Katrina. In addition, an Urban  Institute report stated that several hundred thousand former residents of  New Orleans and the Gulf Coast lost their jobs as a result of Hurricane  Katrina. Despite some job recovery since Hurricanes Katrina and Rita,  some DHAP case managers recently stated that employment was still a  common need among their clients. We previously reported that  transportation services can provide a vital link to other services and  employment for displaced persons; yet multiple sources stated that  clients, particularly those living in FEMA group sites, needed  transportation following Hurricanes Katrina and Rita. For example, case  management officials said lack of access to transportation made it difficult  to connect clients living in remote group sites to services such as  employment, education, and child care. Federal agencies developed the  LA Moves program to provide free, statewide transit service for residents  in Louisiana group sites; however, LA Moves service was limited to FEMA  defined “essential services,” specifically, banks, grocery stores, and  pharmacies and did not include transportation to welfare-to-work sites,  employment, and human and medical services. Data from KAT and DHAP  indicated the types of resources clients needed to aid in their recovery  (see fig. 2).  (see fig. 2).
section_title: Case Managers Faced Challenges in Meeting Client Needs Due to Federal Funding Rules on Direct Assistance and Difficulties in Accessing Needed Resources Through the Long-Term Recovery Committee Process
paragraphs: Case management agencies saw the ability to provide direct financial  assistance for items such as home repairs, clothing, or furniture as key to  helping clients with their basic needs; yet such assistance was not always  available. An official from a case management umbrella organization said  without direct service funds, short-term needs ultimately can become long- term issues because individuals have to rely on the social service system  to fulfill their needs and may become dependent on government assistance  rather than becoming self sufficient. For example, a family might come  into a case management program with a need for money to fix their roof,  but they may not qualify for government assistance outside of disaster  case management to repair their home. Direct assistance funds to repair  their roof might help them stay on track, but if these funds are unavailable,  the family could require long-term housing assistance at a much greater  cost. In addition, case management officials said that referrals to other  resources were not always available or had waiting lists. For example, an  official administering the FEMA state-managed DCM-P program in  Mississippi said there were minimal resources available for clients to  obtain assistance for needs such as rental and utility deposits. In addition,  according to an Urban Institute report, many nonprofit social service  organizations that existed before the storms were no longer operating  while others may not have been able to operate at their previous capacity  due to sustained damage.
Depending on the funding source, some case management agencies could  provide direct assistance to clients while others could not. Using  emergency TANF and SSBG funds provided by HHS through the state of  Louisiana, LFRC case management agencies were allowed to give up to  $3500 in financial assistance to a client. LFRC stipulated in contracts with  its case management agencies the types of goods and services allowed as  direct assistance, such as living accommodations and transportation.  However, according to an evaluation of LFRC, the case management  agencies did not have a shared understanding about how funds could be  used, which affected a client’s ability to access needed items. For example,  some LFRC case management agencies allowed case managers to provide  funds for medical costs or labor and material costs to rebuild homes,  whereas other LFRC case management agencies did not. Case  management agencies that were part of KAT were not allowed to use  dollars from international donations distributed by FEMA on direct  assistance to clients. However, KAT case management agencies could  refer clients to other organizations or use private funds to provide direct  assistance to clients. Case management agencies providing services under  FEMA-funded programs, including the state-managed DCM-P program in  Mississippi and the DHAP program, could not provide direct assistance.  According to a FEMA official, direct assistance was not part of these  programs because FEMA already provided direct service funding through  the Individual and Households Program. The maximum amount that an  individual or household may receive through the Housing Assistance and  Other Needs Assistance programs within the Individual and Households  Program is statutorily capped at $25,000, adjusted annually to reflect  changes in the Consumer Price Index. In addition, there are caps on the  amount of assistance that can be provided to individuals and households  for some items within these programs. For example, FEMA can provide up  to $5,000, also adjusted annually, for home repair assistance. According to  case management officials, not all clients qualify for the maximum amount  of assistance available through the Individual and Households Program,  and a FEMA official noted that the maximum amount may not be enough  to meet all disaster-related needs.
According to case managers, the different funding rules on direct  assistance resulted in clients “shopping around” for services. Case  managers we spoke with stated that some clients went to more than one  agency for services to find one that could provide direct assistance,  particularly in Louisiana where multiple agencies were providing disaster  case management at the same time in the same communities. Since  disaster case management programs used different and incompatible  databases to record client information, some clients likely received  duplicate services since case managers could not track clients across  programs. As a result, some hurricane victims may have gone through the  intake process more than once with different case managers affiliated with  different case management programs, creating additional work for case  managers with already high caseloads and preventing them from helping  other victims who had not yet received assistance.
While long-term recovery committees were a resource for case managers  to obtain direct assistance to address clients’ unmet needs, in some cases,  utilizing these committees was unsuccessful. Some committees were  unable to help clients since the member agencies were depleted of goods  or donations to pass on to clients. In addition, case managers also cited  challenges in the process of working with these committees. For example,  a third- party evaluation of the KAT program and officials at one case  management agency we interviewed stated that cases received intense  scrutiny from committee members, which left case managers intimidated  and humiliated. Further, the evaluation of the KAT program indicated  there was confusion associated with the long-term recovery committee  process because there may have been multiple committees operating in  the same area. For example, according to a case management official, if  there were several committees in the same county, case managers did not  know whether they had to present their cases to each committee  individually. Case management officials we interviewed also said long- term recovery committees were organized differently. For example, one  case management official said some committees combined money from all  organizations and used the pooled money to assist clients while other  committees did not combine funds; without one common funding source,  clients could receive assistance from multiple organizations in the same  committee, but they did not always receive money in a timely matter since  they had to wait on checks from multiple sources.
section_title: Case Managers Said that Program Eligibility Requirements Were a Barrier to Providing Disaster Case Management Services
paragraphs: Eligibility requirements to receive disaster case management services also  varied depending on the funding source. Federal funds provided by FEMA  for KAT could only be used for victims of Hurricane Katrina, even though  a portion of the disaster affected area included victims of Hurricane Rita  as well. LFRC officials said they could not help other hurricane victims  such as the elderly residents in FEMA trailer sites because the emergency  TANF funds they used restricted their agencies to serving families with  children. LFRC eventually received SSBG funds that were not restricted to  families with children, which widened eligibility for disaster case  management assistance. However, according to an evaluation of the LFRC  case management program, expansion of client eligibility was not clearly  communicated outside of LFRC, and key stakeholders were not aware that  services were available to a wider population; these stakeholders  identified this as a shortcoming of the program.
Eligibility guidelines that restricted disaster case management programs to  serving those residing in FEMA temporary housing or receiving FEMA  housing assistance may have prevented some programs from assisting  other individuals or families in need of case management services. Case  managers at an agency in Mississippi said they were aware of at least 200  households who needed assistance but were not eligible for services  through the FEMA state-managed DCM-P program because they were not  in FEMA housing. In addition, officials at a case management provider in  Louisiana said there were thousands of families deemed ineligible for  FEMA’s Louisiana DCM-P program that would have benefited from  disaster case management. Data are not available to determine whether  ineligible individuals ultimately received services.
section_title: FEMA Plans to Use Evaluations of Pilot Programs to Inform the Development of a Federal Disaster Case Management Program for Future Disasters; However, Some Evaluations Have Limitations
paragraphs: FEMA and other agencies are conducting evaluations of disaster case  management pilot programs. FEMA hired a contractor to evaluate the  implementation of two FEMA-funded programs––the state-managed DCM- P program in Mississippi and Louisiana and the HHS disaster case  management pilot program for victims of Hurricanes Gustav and Ike. The  contractor will submit its evaluation to FEMA by June 30, 2009. In  addition, a FEMA official said the contractor will likely evaluate, at a later  date, the disaster case management portion of the DHAP programs for  victims of Hurricanes Katrina, Rita, Gustav and Ike and a DCM-P program  in Texas. In addition to FEMA’s evaluation of their programs, HHS  provided FEMA with an evaluation of the disaster case management pilot  program it administered. HUD and the agency managing the DCM-P  program in Mississippi will also provide FEMA with evaluations of the  disaster case management pilot programs they administered (see fig. 3).  These evaluations vary in scope. For example, the Mississippi Case  Management Consortium, the agency managing the Mississippi DCM-P  program, is conducting an evaluation that will adhere to program guidance  and examine whether the targets and objectives of the state-specific  strategies were met. The Consortium will also evaluate financial and  programmatic performance to ensure that appropriate disaster case  management outcomes were provided for clients of Hurricanes Katrina  and Rita. The HUD evaluation of DHAP case management for victims of  Hurricanes Katrina and Rita will include, among other areas, an  assessment of implementation challenges and successful case  management activities.
Neither FEMA’s evaluation nor the HHS or HUD evaluations will provide  information on the outcomes of case management services. Unlike an  outcome evaluation, which assesses the extent to which a program  achieved its outcome-oriented objectives, the FEMA and HHS evaluations  are process or implementation evaluations. According to the statement of  work for the FEMA evaluation, the contractor will assess program  implementation from the time FEMA funded the programs to the time case  management services began. For example, the contractor will evaluate  whether funds granted were administered within guidelines and compare  the planned costs versus actual costs of the programs. However, the  contractor will not examine program results, such as whether clients’  needs were met and what factors contributed to client outcomes. A FEMA  official said the evaluation only focuses on overall implementation rather  than the provision of services because they believe the case management  process is very similar for all programs. HHS’ evaluation examined the  early implementation of the disaster case management pilot during the  first 2 weeks of the program and developed recommendations regarding  this period. According to a HUD official, the data analysis completed by  the contractor conducting the evaluation, which was intended to provide  information on client outcomes, did not allow HUD to derive substantial  conclusions. Based on its evaluation and those already provided by HHS  and HUD, FEMA will not have information on program outcomes for its  DCM-P program, the HHS pilot, or DHAP case management services,  which could provide information on the results of the various programs  such as the extent to which clients’ disaster-related needs were met.  However, FEMA said that the agency expects to receive other evaluations  of the Mississippi DCM-P program and HHS pilot that may provide  information on individual program outcomes. Further, these evaluations  will provide limited information to assess the causes and results of  challenges we have identified, including barriers to coordination and  information sharing.
In addition, FEMA’s evaluation of all of the disaster case management pilot  programs is limited in that stakeholders were not asked to provide input  regarding the evaluation design. According to the American Evaluation  Association’s Guiding Principles for Evaluators, evaluations should  include relevant perspectives and interests of the full range of  stakeholders. The statement of work for FEMA’s evaluation required that  the contractor consult FEMA and other stakeholders in identifying  performance measures, setting performance standards, and designing the  evaluation. FEMA officials said they contacted HHS officials early on in  the development of the evaluation; however, officials at HHS and at the  case management provider implementing the HHS pilot said they had no  involvement in designing FEMA’s evaluation and had not been contacted  to provide input. FEMA officials also stated that they did not ask other  organizations for input on their evaluation design. As a result,  stakeholders that likely had more intimate knowledge about the programs  evaluated by FEMA’s contractor were not able to provide input that may  have strengthened the evaluation.
Using information from its evaluation and those from other agencies,  FEMA will develop a model for a federal disaster case management  program for future disasters. However, a FEMA official said FEMA does  not have a time line or goal for developing this program. Establishing a  time line that includes major activities that need to take place and  completion dates for all activities leading up to them can help to identify  potential problems that could arise during program development and  determine whether the time line is realistic and achievable. Until FEMA  develops its disaster case management program, providing federal funds  for disaster case management services will be done on a case-by-case  basis, depending on the magnitude of the disaster. In addition, while  stakeholders were not involved in designing FEMA’s program evaluation,  FEMA officials told us they will have stakeholder meetings when they  develop the future federal disaster case management program.
section_title: Conclusions
paragraphs: Federally funded disaster case management programs following  Hurricanes Katrina and Rita faced unprecedented challenges, in part  because of the sheer size of the disaster, yet they played a key role in  assisting individuals and families in their recovery and will remain a  component of future disaster recovery efforts. The scarcity of significant  community resources has continued to limit the ability of case  management agencies to make referrals and connect clients to needed  resources. More than 3 years after Hurricanes Katrina and Rita made  landfall on the Gulf Coast, many individuals and families remain in  temporary housing, have yet to regain employment, and continue to need  other services to rebuild their lives.
As the federal government seeks to improve its overall disaster response, a  critical component in doing so is FEMA’s development of a single, federal  disaster case management program. However, the time line for creating  this program has not yet been established. Providing disaster case  management services on a case-by-case basis will likely result in many of  the same problems we identified for Hurricane Katrina and Hurricane Rita  programs; however, establishing a single program may address some of  these challenges—such as those related to gaps in funding and insufficient  coordination—and also help ensure that scarce resources are used  effectively. Developing a time line for this program is critical to help  FEMA and other organizations better plan given the uncertainty of when  and how large the next major disaster will be.
Given the magnitude of devastation caused by Hurricanes Katrina and  Rita, we recognize the efforts made by multiple federal agencies to meet  the overwhelming need for disaster case management services. But  difficulties in coordinating various stakeholders, both federal and  nonfederal, may provide lessons learned for providing services following  future disasters. FEMA’s role for coordinating disaster case management  was not explicit at the time of Hurricanes Katrina and Rita, and initial  coordination activities among federal agencies and case management  providers were minimal following the hurricanes. This lack of  coordination contributed to a lack of timely information sharing and  uncoordinated outreach, which was exacerbated by incompatible  databases. In addition, absent sufficient coordination, case management  agencies experienced challenges in delivering services. Improving  coordination among federal and nonfederal stakeholders that provide  disaster response and recovery services, such as state governments,  voluntary agencies, and community-based recovery organizations, could  help overcome these challenges and help ensure that those most in need  of services are reached, that federal and state entities and case  management agencies have accurate client information to provide timely  service delivery and avoid duplication of services, and that victims receive  the specific services and assistance required for recovery.
Although significant federal resources were expended to provide disaster  case management services to victims after Hurricanes Katrina and Rita,  there remain important gaps in our understanding of how well these  programs worked and what could be done to improve future case  management programs. While existing evaluations will address some of  these gaps, a better understanding of program results—including whether  those most in need received services, client outcomes, factors that  contribute to those outcomes, and the role of specific services such as  direct assistance and long-term recovery committees—may require further  study. It is only by conducting additional evaluations that not only cover  these issues, but also involve all stakeholders and address limitations of  existing data sources, that policymakers will have the information they  need to identify and quantify needs and develop more effective case  management programs for future disasters.
section_title: Recommendations for Executive Action
paragraphs: We recommend that the Secretary of the Department of Homeland  Security direct the Administrator of FEMA to take the following three  actions:  1.  Establish a realistic and achievable time line for designing and  implementing a single, federal disaster case management program for  future disasters. 2.  Ensure that the federal disaster case management program FEMA  develops includes practices to enhance and sustain coordination  among federal and nonfederal stakeholders. 3.  Conduct an outcome evaluation to determine the results of disaster  case management pilot programs that have assisted victims of  Hurricanes Katrina and Rita, as well as pilot programs for victims of  subsequent disasters. Such an evaluation will further inform the  development of the federal disaster case management program for  future disasters.
section_title: Agency Comments and Our Evaluation
paragraphs: We provided a draft of this report to HHS, the Department of Homeland  Security’s (DHS) FEMA, and HUD for review and comments. HHS’  Administration for Children and Families reviewed the report on behalf of  the department and provided a technical comment, which we incorporated  into the report. FEMA provided comments that are reproduced in  appendix II. HUD’s Office of Public and Indian Housing provided  comments on behalf of the department that are reproduced in   appendix III.
FEMA agreed with our recommendations and is taking steps to address  them. FEMA said the agency is actively pursuing all program development  requirements for the single, federal disaster case management program,  and once those requirements are identified, will create a work plan to  assist in addressing the challenges GAO identified and to establish a time  line for developing the program. FEMA also stated that it will coordinate  with stakeholders to ensure that the future program includes practices to  enhance or sustain coordination by establishing a disaster case  management program team with HHS that will develop plans for the future  program. In addition, FEMA said it will host stakeholder meetings to  discuss the results of the evaluations of disaster case management pilot  programs and long-range program planning. Further, FEMA said it is  modifying its existing evaluation of disaster case management pilot  programs to include a detailed review of the results of the independent  evaluations of the pilot programs and to also evaluate the Texas DCM-P  program and the case management portion of DHAP. However, we  continue to believe FEMA should conduct an outcome evaluation to  determine the results of disaster case management pilot programs; such an  evaluation would assess whether those most in need received services,  client outcomes, factors that contribute to those outcomes, and the role of  specific services such as direct assistance and long-term recovery  committees. FEMA also provided technical comments, which we  incorporated into the report as appropriate.
HUD generally agreed with our recommendations but requested that our  recommendation to include practices to enhance and sustain coordination  in the new federal disaster case management program include additional  detail about the role of HUD. However, we did not revise our  recommendation as HUD’s role in disaster case management remains  unknown pending FEMA’s development of this program. Regarding our  report findings, HUD disagreed with our characterization of the  department’s monitoring of disaster case management services after  Hurricanes Katrina and Rita. We revised the report to better reflect HUD’s  efforts in this area. Further, HUD provided additional information on its  efforts to evaluate the case management portion of DHAP for victims of  Hurricanes Katrina and Rita, and for victims of Hurricanes Gustav and Ike,  as well as its efforts to collect qualitative information during its evaluation  process. We also incorporated this information in the report. HUD  provided additional comments to enhance or clarify information in the  report, which we incorporated as appropriate.
As agreed with your offices, unless you publicly announce the contents of  this report earlier, we plan no further distribution until 30 days from the  report date. At that time, we will send copies to appropriate congressional  committees, HHS, the Department of Homeland Security, HUD, and other  interested parties. The report will also be available at no charge on the  GAO Web site at http://www.gao.gov.
If you or your staff have any questions about this report, please contact me  at (202) 512-7215 or brownke@gao.gov. Contact points for our Offices of  Congressional Relations and Public Affairs may be found on the last page  of this report. Key contributors to this report are listed in appendix IV.
section_title: Appendix I: Objectives, Scope, and Methodology
paragraphs: The objectives of this report were to determine (1) what steps the federal  government took to support disaster case management programs after  Hurricanes Katrina and Rita, (2) how federal agencies oversaw the  implementation of these disaster case management programs, (3) the  challenges case management agencies experienced in delivering disaster  case management services under federally funded programs, and (4) how  previous or existing federally funded disaster case management programs  will be used to inform the development of a federal case management  program for future disasters.
For our study, we limited our review of federally funded disaster case  management programs to Louisiana and Mississippi as these were the  states most directly affected by Hurricanes Katrina and Rita, and we  conducted site visits to Baton Rouge and New Orleans, Louisiana; and  Biloxi, Gulfport, Moss Point, Jackson, and Pascagoula, Mississippi. To  inform our findings, we interviewed federal agencies and state government  agencies involved in disaster case management, case management  providers, and academic organizations. See table 1 for a comprehensive  list of the organizations we interviewed. We conducted these interviews in  person or by phone. We focused our interviews on disaster case  management providers who served clients in Louisiana and Mississippi  and selected interviewees to ensure that we spoke to representatives from  a range of appropriate organizations serving victims of Hurricanes Katrina  and Rita. We spoke to the majority of disaster case management providers  in both states for the Katrina Aid Today (KAT) program, selected  providers in both states for the Disaster Housing Assistance Program  (DHAP), and selected providers for the state-managed Disaster Case  Management pilot program in Mississippi. We did not interview disaster  case management providers who served victims that relocated to other  states. The views of the disaster case management providers we spoke  with cannot be generalized to all disaster case management organizations  that served victims of Hurricanes Katrina and Rita.
To determine what steps the federal government took to support disaster  case management programs after Hurricanes Katrina and Rita, we  reviewed the roles and responsibilities of the federal government for  disaster recovery services. We also reviewed federal laws, regulations, and  guidance related to the federally funded disaster case management  programs established to assist victims of Hurricanes Katrina and Rita,  including the federal government’s authority to establish or fund post- disaster case management programs. We interviewed officials from the  Federal Emergency Management Agency (FEMA), the Department of  Health and Human Services (HHS), and the Department of Housing and  Urban Development (HUD), as FEMA and HHS funds were used for  disaster case management programs to assist victims of Hurricanes of  Katrina and Rita, and HUD administered one of these programs. We also  interviewed disaster case management providers to determine what  impact breaks in federal funding had on their agencies and on the disaster  victims.
To determine how federal agencies oversaw the implementation of  federally funded disaster case management programs, we reviewed  program guidance for federally funded disaster case management  programs for victims of Hurricanes Katrina and Rita and interviewed  officials from FEMA and HUD regarding their oversight responsibilities,  including their review of disaster case management data. We also analyzed  the reliability and completeness of data on KAT clients from the  Coordinated Assistance Network database, and we spoke to officials who  were knowledgeable about the database. We reviewed FEMA’s National  Response Plan and National Response Framework to determine what role  the federal government had in coordinating the delivery of human services  following a disaster. We also reviewed previous GAO work to identify best  practices for coordination among federal agencies, practices to sustain  coordination, and the importance of information sharing. We interviewed  officials from federal agencies and case management providers to  determine whether they adhered to best practices and what challenges  they faced in coordinating and sharing information.
To determine what challenges case management agencies experienced in  delivering federally funded disaster case management services, we  conducted a content analysis of interviews with federal agencies, case  management providers, and academic organizations regarding disaster  case management services for victims of Hurricanes Katrina and Rita.  Some interviews were conducted by other GAO teams doing work related  to Hurricanes Katrina and Rita. Through an iterative process we developed  a general list of challenges, grouped them, and assigned them a specific  category of challenge such as agency resource constraint or community  resource constraint. We reported on commonly identified challenges and  provided relevant examples of each. We also reviewed evaluations of the  federally funded disaster case management programs, relevant federal  laws, and previous GAO work to support our findings. In addition, to  obtain information on the needs of disaster case management clients, we  obtained summary level data on KAT clients from the Coordinated  Assistance Network database maintained by the American Red Cross, and  we received record-level data on DHAP case management clients from  HUD’s Tracking-at-a-Glance database. To assess the reliability of the data  needed to address this objective, we checked the data for obvious errors  in accuracy and completeness, reviewed existing information about these  data, and interviewed officials knowledgeable about the data. We  determined that the data we used for this objective were sufficiently  reliable.
To determine how previous or existing federally funded case management  programs will be used to inform the development of a federal case  management program for future disasters, we interviewed officials from  FEMA, HUD, HHS, and case management providers regarding the  evaluations of disaster case management programs. We also spoke with  officials from the contractor hired by FEMA for its evaluation of disaster  case management pilot programs. We reviewed documentation, such as  program guidance and statements of work on agencies’ evaluations of  disaster case management programs.
We conducted this performance audit from May 2008 to July 2009, in  accordance with generally accepted government auditing standards. Those  standards require that we plan and perform the audit to obtain sufficient,  appropriate evidence to provide a reasonable basis for our findings and  conclusions based on our audit objectives. We believe that the evidence  obtained provides a reasonable basis for our findings and conclusions  based on our audit objectives.
section_title: Appendix II: Comments from the Department of Homeland Security
section_title: Appendix III: Comments from the Department of Housing and Urban Development
section_title: Appendix IV: GAO Contacts and Acknowledgments
subsections: section_title: Staff Acknowledgments
paragraphs: Kathryn A. Larin, Assistant Director; Melinda Bowman; Nisha R. Hazra;  and Charlene M. Johnson made significant contributions to this report.  Molly Traci also made key contributions. In addition, Doreen Feldman and  Sheila McCoy provided legal assistance; Cynthia L. Grant and Walter K.  Vance analyzed and assessed the reliability of data; Susan Aschoff assisted  in report development; Mimi Nguyen developed the report’s graphics; and  Carolyn Blocker, Beth Faraguna, Lise Levie, Suneeti Shah, Barbara Steel- Lowney, and Nyree Ryder Tee verified our findings.
section_title: Related GAO Products
paragraphs: Gulf Coast Disaster Recovery: Community Development Block Grant  Program Guidance to States Needs to Be Improved. GAO-09-541.  Washington, D.C.: June 19, 2009.
Hurricanes Gustav and Ike Disaster Assistance: FEMA Strengthened Its  Fraud Prevention Controls, but Customer Service Needs Improvement.  GAO-09-671. Washington, D.C.: June 19, 2009.
National Preparedness: FEMA Has Made Progress, but Needs to  Complete and Integrate Planning, Exercise, and Assessment Efforts.  GAO-09-369. Washington, D.C.: May 7, 2009.
Office of the Federal Coordinator for Gulf Coast Rebuilding: Perspectives  and Observations. GAO-09-411R. Washington, D.C.: April 10, 2009.
Emergency Management: Actions to Implement Select Provisions of the  Post-Katrina Emergency Management Reform Act. GAO-09-433T.  Washington, D.C.: March 17, 2009.
Disaster Recovery: Past Experiences Offer Recovery Lessons for  Hurricanes Ike and Gustav and Future Disasters. GAO-09-437T.  Washington, D.C.: March 3, 2009.
Disaster Recovery: FEMA’s Public Assistance Grant Program  Experienced Challenges with Gulf Coast Rebuilding. GAO-09-129.  Washington, D.C.: December 18, 2008.
Disaster Assistance: Federal Efforts to Assist Group Site Residents with  Employment, Services for Families with Children, and Transportation.  GAO-09-81. Washington, D.C.: December 11, 2008.
Actions Taken to Implement the Post-Katrina Emergency Management  Reform Act of 2006. GAO-09-59R. Washington, D.C.: November 21, 2008.
Disaster Recovery: Past Experiences Offer Insights for Recovering from  Hurricanes Ike and Gustav and Other Recent Natural Disasters.  GAO-08-1120. Washington, D.C.: September 26, 2008.
Mass Care in Disasters: FEMA Should Update the Red Cross Role in  Catastrophic Events and More Fully Assess Voluntary Organizations’  Mass Care Capabilities. GAO-08-1175T. Washington, D.C.: September 23,  2008.
Voluntary Organizations: FEMA Should More Fully Assess  Organization’s Mass Care Capabilities and Update the Red Cross Role in  Catastrophic Events. GAO-08-823. Washington, D.C.: September 18, 2008.
Gulf Opportunity Zone: States Are Allocating Federal Tax Incentives to  Finance Low-Income Housing and a Wide Range of Private Facilities.  GAO-08-913. Washington, D.C.: July 16, 2008.
National Response Framework: FEMA Needs Policies and Procedures to  Better Integrate Non-Federal Stakeholders in the Revision Process.  GAO-08-768. Washington, D.C.: June 11, 2008.
Catastrophic Disasters: Federal Efforts Help States Prepare for and  Respond to Psychological Consequences, but FEMA’s Crisis Counseling  Program Needs Improvements. GAO-08-22. Washington, D.C.: February  29, 2008.
National Disaster Response: FEMA Should Take Action to Improve  Capacity and Coordination between Government and Voluntary Sectors.  GAO-08-369. Washington, D.C.: February 27, 2008.
Emergency Transit Assistance: Federal Funding for Recent Disasters,  and Options for the Future. GAO-08-243. Washington, D.C.: February 15,  2008.
Gulf Coast Rebuilding: Observations on Federal Financial Implications.  GAO-07-1079T. Washington, D.C.: August 2, 2007.
Homeland Security: Observations on DHS and FEMA Efforts to Prepare  for and Respond to Major and Catastrophic Disasters and Address  Related Recommendations and Legislation. GAO-07-1142T. Washington,  D.C.: July 31, 2007.
For more GAO products related to disaster preparedness, response, and  reconstruction visit the Topic Collections page on GAO’s Web site,  www.gao.gov.