Public Health Emergency Preparedness
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5. Disaster Case Management
Recommendation 5.1: Disaster case management programs should be appropriately
resourced and should provide consistent holistic services that achieve tangible, positive
outcomes for children and families affected by the disaster.
- The Executive Branch and Congress should provide sufficient funds to build, support,
and deploy a disaster case management system with nationwide capacity.
- DHS/FEMA should clarify the transition from Federal to State-led disaster case
- Government agencies and non-governmental organizations should develop voluntary
consensus standards on the essential elements and methods of disaster case
management, including pre-credentialing of case managers and training that includes
focused attention to the needs of children and families.
Children and families often require disaster case management223 services to help them regain self-sufficiency and address problems that a disaster has caused or exacerbated. Hurricanes Katrina and Rita demonstrated that in large-scale disasters the demand for disaster case management services may overwhelm the resources of voluntary, faith-based, and State and local organizations.224
In its Interim Report, the Commission concurred with the Government Accountability Office
(GAO)225 and recommended that the Federal Emergency Management Agency (FEMA)
establish a single Federal disaster case management program by the end of 2009.226 More
specifically, the Commission recommended that this program: be led by a single Federal
agency; be holistic, flexible, and sensitive to cultural, linguistic, and economic differences
in communities; place a priority on serving the needs of families and children; ensure that
case managers are rapidly deployed to affected areas; be adequately funded to support
infrastructure, capacity building, and all aspects of disaster case management service
delivery; and include a comprehensive evaluation component that measures and monitors
outcomes, especially in regard to children.
FEMA and the Department of Health and Human Services' (HHS) Administration for
Children and Families (ACF) signed an interagency agreement (IAA) in December 2009 to
allow the implementation of ACF's disaster case management program.227 Under this IAA,
following a Presidential disaster declaration and a FEMA-approved request from the affected
State(s) for disaster case management services, ACF can initiate the deployment of disaster
case management teams within 72 hours of notification from FEMA. Disaster case
management teams will remain deployed for 30 to 180 days, after which FEMA and ACF
will coordinate the transfer of all remaining clients to the State lead agency, enabling the
continued coordination of services.
The Commission recommends that the Executive Branch and Congress provide sufficient
adequate funds to build, support, and deploy a disaster case management program with
nationwide capacity. The Commission is concerned that the Federal Government has not
adequately funded development of the ACF Program. For Fiscal Year (FY) 2009, HHS
requested, but Congress did not approve, $10 million to build the program's capacity (e.g.,
training and credentialing of personnel, planning assistance to States) and develop a
comprehensive case management database for training and recovery planning. In FY 2010,
Congress approved just $2 million for disaster case management, and for FY 2011 the
President requested $2 million. Meanwhile, FEMA indicates that it does not have authority
to support funding for pre-event training or direct services to families through a disaster case
The GAO review of Federal disaster case management programs also found gaps that
"adversely affected" the delivery of case management services to some families and
illuminated the need for greater coordination and program evaluation.228,229 These gaps
include interruptions in funding and service delivery, as program responsibility transferred
from one agency to another, and delays in starting new State-level programs. Ultimately,
children and families deserve a smooth, uninterrupted transition from agency to agency and
from short- to long-term recovery. The Commission seeks clarity from FEMA regarding how
it will address the transition of survivors' cases to a State-run disaster case management
program, including contingency plans to continue Federal disaster case management
services if a State is unprepared to provide such services to its survivors.
Not all disasters will involve disaster case management assistance from the Federal or State
Government; local non-governmental agencies will often be assisting survivors in certain
circumstances. Therefore, the National Volunteer Organizations Active in Disasters
(NVOAD) collaborated with the Council on Accreditation230 to develop disaster case
management guidelines to provide their members with a standardized set of policies and
practices in the delivery of services to meet long-term recovery needs. However, these
guidelines may deviate from the parameters of the ACF case management program. For
example, under the NVOAD guidelines, disaster case managers may be employees or
volunteers, based on their life experience, skills, education, and training as determined by
the voluntary organization. Alternatively, the ACF model uses case managers who have a
bachelor's degree in a health care-related or human services field.231
The Commission recognizes the unique service delivery challenges associated with
disasters, especially in addressing the long-term recovery needs of families with children,
and that all case management programs may not implement identical service delivery
models. The Commission recommends that Federal, State, and non-governmental partners
develop voluntary consensus standards on the essential elements and methods of disaster
case management and case manager training, through research and evaluation, to reconcile
philosophical differences. Furthermore, the Commission recommends that case managers
be pre-credentialed and provided specialized disaster training to advocate for the full range
of necessary health, mental health, and other social services assistance for families with
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