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(Excerpted from Church World Service manual)

A carefully organized case management system empowers disaster survivors to move beyond their current condition towards recovery and maximizes benefits to those in need by avoiding duplication of services.  Case management encompasses:

• Assessment - collecting information about a person's situation to determine service needs.  Case managers cultivate close relationships with survivors, yet maintain a healthy professional distance from them to assure that all information about needs surfaces. The case manager often needs to get into the survivor's shoes to fully appreciate a problem.
   
• A recovery plan - an agreement between the survivor and case manager on problems, services required. The survivor and case manager collaborate in developing a recovery plan.
   
• Arranging for services - contacting service providers and negotiating delivery of needed services to the survivor.
   
• Follow-up - contacting service providers and survivors to assure service delivery has begun.
   
• Reassessment - re-examination of the survivor's situation to identify changes since the initial assessment and measure progress towards achieving service plan goals.  Case managers keep on top of service needs.
   
• Record Keeping - maintaining detailed files on contacts with survivors and service providers and progress in delivery of services. The records start on initial contact with the survivor. Anything pertaining to needs of the survivor and service delivery goes into the files. Case managers need to keep track of survivor needs such as furniture, household goods, appliances.

The Case Manager’s Job

An effective case manager:  

• Develops a sound knowledge of various relief programs
• Conducts door-to-door canvassing to identify needy survivors and makes return visits if necessary to encourage them to seek assistance
• Assesses individual needs
• Provides reassurance and emotional support to disaster survivors
• Determines the best resources for meeting needs of people
• Identifies individuals with needs exceeding the scope of existing programs and seeks ways to address those needs
• Provides for on-going support and assistance in returning people to normalcy
• Helps obtain disaster services at Disaster Recovery Centers
• Assists individuals in completing forms, negotiations, and appeals
• Obtains and helps provide interagency and public information
• Continues to conduct outreach efforts after Disaster Application Centers close
• Seeks to identify persons who have moved out of the disaster area so they can be notified of the opportunity to apply for services
• Escorts people to services and on housing searches
• Searches neighborhoods to find isolated or "hidden" survivors who need assistance
• Follows up on lists of affected persons received from other providers and agencies to assure needy persons receive services

The family advocate should have:  

• Enthusiasm and real interest in the job
• Commitment to help survivors receive maximum disaster assistance
• Ability to identify needs of survivors and match available services to the needs
• Ability to act as a third-party to deal with service providers
• Capacity to relate to people with warmth and concern

Case mangers do not merely respond to survivor needs on demand, but take the lead in helping survivors explore their full range of possible needs. With training and resources to bridge gaps between various service providers, they help meet survivor needs in a comprehensive manner.

The Case Work Process

The case management process encourages clients to control their own recovery. It starts with screening and interviewing:

1.  Screening determines whether or not a disaster- related need exists that fits the agency's requirements for assistance. Screening asks potential clients:

• Where were you and what happened at the time of the disaster?
• What damages did you experience as result of the disaster?
• Have you received assistance from FEMA?
• What other agencies have assisted you and for what?
• Were you a renter or an owner?
• Were you unemployed as result of the disaster? Have you returned to work?
• Do you have insurance?
• If you plan to rebuild/repair, have you obtained permits?
• What about mitigation measures?
• What are your home purchase, rebuilding, or repair plans? What do you expect it to cost?
• What are your recovery plans?
• Have you started your recovery plan? What has been done? What is remaining?

The Interview.  If a disaster need appears to exist and the client does not have a recovery plan, a case manager sets an appointment for a home interview to isolate needs and develop a preliminary action plan and goals that lead to recovery.   The interview helps clients decide on recovery plans by assisting in:

• Determining which problems are most immediate
• Considering possible approaches or solutions
• Considering resources
• Clarifying desires
• Estimating what can actually be done
• Indicating the help desired

If needs are of the type usually seen in the emergency stage -- food, rent, clothes, utilities, etc., the interview probes clients about what they would have done if there had not been a disaster and why they cannot do it at this time. The answer indicates whether this is a true disaster-related issue.  During the interview, clients set priorities and turn them into clear, realistic, measurable written-out goals that give them a "to do" list identifying responsibilities. Case managers help clients develop good recovery plans when they:

• Allow them enough time and provide as much privacy to them as possible
• Ask specific, although not difficult-to-answer questions about their losses
• Move in the direction clients desire
• Offer ready assistance with resources/contacts and program explanations
• Keep accurate written records of work done on the case to justify assistance

A checklist for the interview:

• Were necessary releases of confidential information signed?
• Was all necessary information shared?
• Were objectives of interview realized?
• Were points clients should remember summarized?
• Did interview seem to meet the client¹s needs?
• Did client or interviewer do most of the talking?
• Are any questions unanswered?
• Does client understand actions required?
• Was another meeting set if required?
• Does client have written copy of any referrals made?

The interview encourages clients to assume ownership of their cases by providing assistance in a uniform and empathetic manner that enables individuals to become independent and self-sustaining. Sometimes contracts must be developed with clients. A written letter to clients on needs and deadlines may be needed so they will provide information in a timely manner. If clients appear unwilling to accomplish tasks or make decisions, referral for mental health or financial counseling may be necessary.

No promises should be made to clients and they need to understand that it may not be possible to get them back to pre-disaster conditions. Not all needs can be satisfied. This is not the fault of the recovery organization, the client, or other agencies.

Determining Survivor Needs

An organization can turn to a variety of sources for information on unmet needs. Damage assessments begin in the disaster relief phase-initially with a windshield survey of the area affected by the American Red Cross (ARC). As recovery proceeds, more detailed and accurate surveys are conducted. Building inspectors, for example, will look at each damaged structure and make decisions about safety and the cost effectiveness of repairs.

Disaster survivors who have received the maximum assistance available from the federal government's Individual Family Grants Program represent a major proportion of the population that will face unmet needs. Yet, some survivors -- the undocumented, and homeless, for example -- will not even qualify for assistance from many agencies. A door-to-door survey will give the recovery group the fullest possible picture of needs and will equip it do case work most effectively by:

• Fully pinpointing survivor needs
• Demonstrating it is there to assist and can offer pastoral care
• Establishing a universal case file unlike Red Cross and FEMA case files which include only people who have applied
• Documenting needs as described by survivors that can later be useful in advocacy if disputes occur between survivors and helping organizations
• Immediately showing need patterns and areas that will require assistance
• Assessing emotional and spiritual needs (the recovery group may be the only organization able to discover these needs)
• Finding survivors who have been missed through neighbors, family, and friends
• Providing time for listening and initial interventions if necessary

A door-to-door survey is time-consuming and requires involvement of many persons. It may be possible to work with local government to develop a survey process and use survivors who have lost their jobs.

Devote one-hour on the survey day to training the door-to-door interview volunteers before they begin their work and provide one hour for debriefing them when they have completed the task.  Interviewers conducting the survey don't meet with survivors just to complete forms, but allow them to share their stories with someone who cares.

Survey success depends on ability of interviewers to establish a climate of trust with survivors. Although some survivors may have already gone to the American Red Cross or the Federal Emergency Management Agency for assistance, many of them will be dealing with a care-giving agency for the first time and feel uneasy about asking for help, showing their mess, or revealing their sorrow. Guidelines for interviewers:

• Meet the disaster survivor with a smile and love in your heart. A climate of trust must be established in the first 15 seconds.
• Appear to have all the time in the world for the interview. Don¹t rush it.
• Give the disaster survivors privacy.
• Don't tell your story. Focus on the survivor.
• Provide strength & support by feeling the survivor's pain without showing pity.
• Demonstrate genuine non-condemning, non-judgmental love for people with different lifestyles & values
• Motivate & encourage

Survivors may be reluctant to share information and say they need assistance.  A major reason for this reluctance: the stigma society attaches to "welfare." The advocate must often explain that disaster assistance is not welfare, but rather a way government uses tax dollars to provide important services to a broad segment of the population.  Grief over losses of property or deaths of friends and loved ones also immobilizes people. A case manager must take seriously even what seems like the most insignificant losses of grieving persons and demonstrate care and understanding for them so they will overcome the inertia of grief and seek help.

To find people who are not seeking assistance, case managers employ a variety of tactics:

  1.  Making contacts with:

• Social service agencies that work with vulnerable population groups in the areas affected by the disaster
• Persons outside the disaster area who may know survivors
• Local politicians who have names of needy people on file
• Mail carriers who know people on their routes
• Local government officials who administer programs dealing with vulnerable population groups
• Law enforcement officers who know people in their neighborhoods
• Public and private transportation services that often have contact with vulnerable people
• Churches and ministers
• Clubs and social organizations which vulnerable people join
   
1. Visiting the disaster area and making personal contact with survivors
    
2. Sound trucks that broadcast messages in neighborhoods

On initial contact with a survivor, the case manger should have official identification and be prepared with a brief introductory speech. An effective introduction:

“Hello. My name is _____________________________.

I am a case manager for _____________________________.   It is my job to help persons utilize a number of services that may be useful to you in recovering from this disaster. I would like to take a few minutes of your time to explain the process.  I can help you in getting help if you have suffered damage to your home or some other loss. It is my job to help you get all the help you can so you can get your life back to normal.”

Although some people will be happy to see them, case managers may have to return four or five times before survivors are comfortable with them and believe they are really interested in assisting them. Although case managers need to persuade survivors to seek assistance, they are often more effective when they do more listening than talking, allowing persons affected by the disaster to release stress by "talking out" their problems.

The outreach component of case mangement should move as rapidly possible so agencies can plan disaster aid more efficiently and the people affected don¹t become prey for exploiters - i.e. -- unscrupulous contractors who do shoddy repair work at outrageous prices.

Meeting Needs

Often basic budgets must be developed to show that clients do not have sufficient resources to complete recovery.  Homeowner deeds and tax returns may also be required.  Once verifications are completed, an organization can begin to help clients through its services or it may present a case to other human service agencies through a community resource coordinating committee or organization.

A case manager must develop a good working knowledge of resources and skills available -- legal, property appraisal, repair/rebuilding, emotional and medical care, religious -- to refer survivors for assistance required.

Major sources of assistance become available in the following order:

1. Voluntary agencies such as the American Red Cross provide food, clothing, shelter, and medical aid.
2. Homeowners and National Flood Insurance cover losses
3. FEMA housing programs may provide funds to owners for repairs that restore safety, sanitary conditions, and security to homes, rental assistance for up to 18 months (recertified monthly), or temporary housing (three months for owners, two months for renters)
4. Other government assistance - consumer services, disaster unemployment, legal, IRS, crisis counseling, assistance to veterans and older persons, and farm aid
5. SBA Disaster home, personal property, and business loans for which applications must be completed to be eligible for further assistance
6. FEMA Individual Family Grant Program (administered by the states) for personal property, transportation, home repair, occupationa/medical/dental/funeral expenses
7. Faith-based organizations provide assistance in cleanup, "mucking out," repair and rebuilding
8. Additional Assistance Programs of American Red Cross and others.
9. FEMA Cora Brown Fund - a last resort source of assistance for a variety of needs

To assure necessary follow-up, the recovery organization should establish an internal tracking system recording names of clients, their needs, commitments made by care-giving agencies, and closure dates of cases.  Commitments solicited (i.e. -- through letters of intent) from assisting agencies should state dates for delivery of funds or services. The case is closed when commitments have been met.

Confidentiality is vital. Clients should provide signed releases to authorize a case manager to talk with specific agencies, businesses, or individuals about them.

Clients should understand that information about them will not be shared with others -- nor can information about other families be shared with them. They should also understand that information will be divulged to other helping agencies involved in assisting them.

If a case manager or case manager's family is affected by the disaster, the case should be transferred to another case manager. Case managers should not impose their morals or standards on survivors. They should not become overly involved with clients or attempt to "do it all" for them.

Life Intervention

How case manager intervenes in the lives of survivors makes a difference in how quickly they recover - or even if they successfully recover.

On one hand, case managers must work to achieve a reasonable balance between their jobs and desires to respond to needs some survivors have for friendship. The advocate must learn to distinguish between problems related to the disaster and those that already existed.  They must also be alert to attempts by some persons to establish dependency and other kinds of relationships with them.

At the same time, a case manger must discern problems of individual survivors that can hamper their recovery and take appropriate intervention measures. Among these problems:

• Communication deficits - the capacity to hear or see well - may make a disaster more threatening and harder for the advocate to develop a relationship with the survivor.
• Learning impairments may make it difficult for the survivor to understand the meaning or intent of the advocate's questions and explanations.
• Problem-solving deficiencies require the case manager to exercise more patience in explaining alternative strategies for solving problems vs. the old ways the survivor might utilize.
• Slow memory function means it may take more time for the survivor to remember things that were lost in the disaster.
• Limited formal education places a greater burden on the advocate to explain why programs exist, how they work, and what they mean to the survivor.
• Psychological depression - evidenced by sadness, lack of interest, pessimism, and difficulty in making decisions - should suggest need for spiritual and mental health care that goes beyond the economic and physical assistance.
• Values - independence and self-reliance - may give the survivor doubts about the appropriateness of participating in government disaster programs.
• The welfare stigma may be the biggest challenge for an advocate to overcome in assuring that survivors seek and accept assistance. Advocates should not force disaster programs on survivors, but rather demonstrate interest and concern for them while employing strategies that address the varied problems that keep them from seeking assistance.

In working with survivors, case managers should be wary of giving advice except when they have the expertise to provide guidance.  The job of the case mangers is not to know all the answers, but to know where to obtain reliable information for survivors. Nor is it the job of the case manger to be all things to all people. Rather, the case manger facilitates, assuring resources at the proper time.