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LTRCSI Case Manager Training
Tuesday, December 13, 2005,
9:00 am3:00 pm
Conducted
by Gordon Knuckey, the United Methodist Committee on Relief (UMCOR) staff from
Handbook Manual author
Assisted by Bob Babco,
Disaster Coordinator, State of
This training is recognized
by the American Red Cross as a Long-Term Training Course.
Definition: Case Management
link needs with available resources
Most people find solutions on
their own. There is much fear in the
terminology following a disaster (i.e., FEMA).
There are 10 regions within FEMA.
Betty Shumate, our Voluntary Agency Liaison, is from Region 3, which
covers
There are 12 things to know.
There are 2 ways to
help: Develop a long-term recovery plan
with individuals and families, and Disaster Assessment, or I & R
(Information and Referral).
There is risk becoming
involved.
Why the Methodists? UMCOR's involvement was spurred by the
national VOAD, Voluntary Agencies Active in Disasters. Formerly, the American Red Cross supplied
additional assistance. But now, the
Adventists do warehousing, the Salvation Army provides assistance including
clothing, and the Southern Baptist Men's Association provides feeding. UMCOR took over the long-term assistance
function from the American Red Cross.
Disasters are divided into 3
parts: Rescue, Relief, and
Recovery. When a disaster happens, the
non-insured and the underinsured will find forgotten losses bring the pain back. For example, a spring disaster may drive the
lost Christmas decorations from mind until they are needed. The loss returns as fresh as yesterday.
RESCUE 1st
Responders These are people trained in rescue and first aid. Police, Fire, Ambulance, etc.
RELIEF The M.A.S.H. Concept (which is now called
C.A.S.H. for
RECOVERY Now the effort has moved from the M.A.S.H.
(or C.A.S.H.) to Tokyo General for long-term care. LTRCSI is to transition folks to enable
them to restore their lives after the disaster.
A disaster robs individuals
of their VALUES of Privacy and Freedom/Independence. Disasters are, by nature, invasive! As Case Managers, we need to be a little bit
invasive as well. We will check out
their identities, their finances, and even look in their closets, medicine
cabinets, and kitchen cupboards. However, at all times, we will continue to HONOR their dignity and RESPECT their confidentiality.
As a Case Manager, you MUST keep your big mouth
shut! It is okay to share case details
with your Case Supervisor, but not with another Case Manager. Everyone else is on a
"need-to-know" basis.
Even GOOD news cannot be
shared!! Not even at the dinner
table. Not in public with your Case
Supervisor where you might be overheard.
If vouchers are issued, any
vendor accepting them falls under the Privacy Act law, too!
The Privacy Act is a very
strict law. Vendors need to be reminded
they cannot discuss any redemptions!
Always remember we are not
there to reform people!! Everyone has
their own set of values, beliefs, faith.
Do not share your faith, beliefs, or values in an effort to
"convert" clients. Meet them
where they are.
After a case has been closed,
when and if you meet one of your clients in public DO NOT acknowledge them
at all unless they speak to you first.
Even your relationship with them must be kept private!!
A Release of Information is
REQUIRED in order to share client information with your member agencies. ALL Clients must agree to sign the Release of
Information.
Above all
VERIFY VERIFY VERIFY
Verify their identity.
Verify their pre-disaster
address as a disaster-affected address. [www.mapquest.com
or other site]
Verify what assistance they have received. The American Red Cross will tell you whether
or not a case is or was opened for any client.
The Salvation Army has obtained a Release to Share Information from
every open case for the F-3 tornado of Nov. 6, 2005.
Verify their current
belongings, what they have and won't need.
Verify their income and
outflow using pay stubs, bank statements, receipts, etc.
Verify their insurance
policy.
Verify everything until you,
as their Case Manager, are comfortable.
A Release of Information must
include the agencies involved in LTRCSI and the client must be given the right
to exclude any one of them.
Cases should be handled by
Case # only.
Absolutely Always Avoid
the temptation to keep them dependent upon you.
Even if they want you to. This is
called Transference and Counter-Transference.
Projecting your goals, values, needs onto another. In other words,
Don't forget to cut the
apron strings!!
Don't fix their problems for
them!!
Recovery (or not) is
ultimately THEIR choice!!
Healing from Loss &
Grief
TASK Theory 4-Step Process
all must go through this to overcome loss and grief:
Ψ
to ACCEPT the Reality (from stunned
disbelief)
Ψ
to EXPERIENCE the Pain (shock = numb; will
comes in doses over time; pain will be felt each time)
Ψ
to ADJUST to a New Situation (the empty
chair over holidays)
Ψ
to WITHDRAW emotion energy from was
to invest in the new; to not dwell on the loss; to laugh again
Clients may lash out at YOU
in anger and grief! This happens more
often in males as anger is often a mask for fear and to prevent showing
vulnerability. After Hurricane Andrew,
recovery was best-received by Haitians and worst-received by Anglo (Caucasian)
Men.
___
(Morning Break)
___
It will be very hard to say
NO, but that may be a part of your job as their Case Manager, especially when a
need cannot be met or has been determined to be more of a "want" than
a "need" and is denied.
There will also be those who
are "poor & desperate" who have learned how to "work the
system." But not all who are
"poor & desperate" will take advantage of your assistance.
Most people live in an ONION
environment, surrounded by caring family and friends. For example, rural
BUT rural
"Onions" only need
information. They need information about
the system how does it work, where do I start, what do I do next, etc. and
they will take the journey.
"Pea Pods" must be enticed
to apply. It may be helpful to tell them
they are not going on welfare, but accepting a "tax refund." Most folks think they pay way too much in
taxes anyway. FEMA is funded entirely by
the tax system. They should accept their
refund as it won't keep someone else from receiving help, neither will it
reduce or affect their neighbor's refund in any way, shape or form. This may sound like a gimmick, but then they
will apply.
Another obstacle to accepting
or applying for assistance is the emotional turmoil that clients face by "becoming"
one who needs. They themselves may have
disdained others for needing or accepting assistance and they are unwilling to
admit they now need help.
They may be helped by
pointing out that most folks are only 1-2 paychecks away from
"needing" help.
Disasters are great
equalizers.
People recover at different
speeds and slower people tend to feel isolated.
Or they feel as if they are not recovering as fast as they should
be. They may wonder why they still feel
"hurt."
Advertising Your Efforts
To gain attention and focus
on your long-term recovery efforts, your group may choose to involve more than
the usual media. Press can be increased
by involving any or all of the following groups:
Lions
Club
Kiwanis
Club
Rotary
Club
Elks
Other
Social Clubs
Churches
Chamber
of Commerce
Politicians
Political
Groups
Media
Goal: LOTS of press!!
Interviewing Clients
Remember: You are interviewing people who feel robbed,
isolated, and are hurting. What can you
do to gain their trust?
Eye Contact? Some groups
will actually distrust anyone who makes eye contact, like the Plains Indians.
Sit Across from them? Here again,
groups like the Plains Indians will prefer you to sit beside them.
Shake Hands? Muslim men are actually forbidden any
physical contact and cannot even shake hands with a female.
Hugs? Not with some people, especially Muslim
men. Even some Caucasian men mistrust
those who hug.
So
what can you do? Most of the time, you
can read a situation and use your best judgment. When meeting with a known ethnic client,
their cultural differences can be explored by research ahead of the
interview. The best ways to gain a
client's trust are:
Empathy Remember: Trust is established slowly
Ask Questions so
don't promise to fix what you don't have the power to fix!!
Listen Broken
promises break the bonds of trust.
Other
ways to gain a rapport with your client, and thus gain their trust, are:
Introduce
yourself (show your ID badge)
Introduce
your group
Ask,
"How are you doing?"
Ask
open-ended, leading questions that will elicit more than a Y/N response
(See p. 49 in your handbook)
When
listening to your client's answers, remember they will not tell you how they
are doing psychologically if they are hungry or have other, more basic unmet
needs. So ASK, "Can I wash my
hands?" This will tell you whether
or not they have running water. It will
also pull you further into their home, and thus further into their trust. ASK, "Are you eating?" ASK, "Are you sleeping?" One lady kept telling workers and volunteers
she was doing fine over and over. Yet
her basement was full of water! She lied to try and keep her home and her
independent living.
Also,
older folks may not hear you as well.
Make sure they aren't simply nodding their head and smiling in
agreement. Make sure they hear and
understand what you say.
Psychological
needs will absolutely not be admitted by entire groups of people. For example, Hispanics notoriously believe
that mental needs are hereditary, making their unmarried children
unmarriageable now. People who seem to
be this way will respond more positively to a comment like, "Can I arrange
someone to talk with you?" and avoid completely all mention of the
words "mental health."
Hispanics
also tend to believe that tragedy comes as punishment. This didn't work during Hurricane Wilma,
which hit
When
meeting with clients, pairs are always best for home visits one to take the
lead, the other to listen for the unsaid.
An
average interview should take about 1 hour.
Find
THEIR agenda, not yours. Prayer is okay,
if they lean toward similar faith, but don't proselytize (preach). You may offer to call their pastor or someone
in your group to meet with and/or pray with them.
Listening
Effectively
Rephrase
what they have said, or ask them what they mean if you don't understand
something.
Don't
assume the first thing you hear is always what they mean. Logos (logorrhea) = diarrhea of the
mouth. Some people TALK to simply sort
out their thoughts. If you want to
"test the waters" about a particular subject, you could say,
"What do you think about thus and so?"
Some
peoples' processors run at different speeds.
We are like a flower in which all the petals overlap:
Whatever
we are in a crisis, we become more of it.
So
If
we are RELATIONSHIP oriented we would call ALL of our friends.
If
we hare PHYSICAL we would exercise more.
Non-Talkers
will talk LESS during a crisis
Talkers
will talk even MORE
Physical
people often can't sit still or even sit down.
Teens
often do therapy while walking because most teens are very physical.
If
you love rocking chairs, you will rock faster.
These
differences become very important when you are in INTELLECTUAL Case Manager
interviewing and trying to gain the trust of an EMOTIONAL client, who talks
through their tears or talks too much, in your opinion. You'd like to tell them to pick themselves up
by their bootstraps, but they think they don't have any bootstraps, or if they
do they can't find them. You will still
need to relate in order to gain their trust.
In
a worst case scenario, it may mean a change of Case Managers to someone who can
better relate to a client. Please don't
be offended or take this personally, you may even want to watch for signs that you
need to suggest this option.
GOAL
So
1) You've given your name; 2) You've
introduced your organization; 3) You've established trust, asking, "How
are you doing?" and now you are ready for 4) Your GOAL get down to
business.
Anger Shock
Sadness Sadness
Fear Anger
Regret Fear
Love
3
Ingredients of Depression
RAGE deeper and longer-lasting than just anger
Self-Pity
A thinking of, "I don't need this now!"
Sense of Loss of Control Can't control the disaster OR all
that happens after FEMA, insurance companies and insurance adjusters, Red
Cross, etc.
ALL
of us feel depressed during times of change even if the change is a good
change!! Why? Because you have to "give up" to
"get."
So
where are our intervention points? All
Three!!! At the Rage Stage, you can
diffuse it simply by LISTENING. With
some, you will notice the rage turns inward.
At Self-Pity and Loss of Control perceptions, you can help RESTORE their
sense of control by involving them in developing their own plan of recovery.
Which
is your ultimate GOAL they write their own Recovery Plan. They make the phone calls to get the ball
rolling.
VERIFY
ASK QUESTIONS ADVOCATE (to speak for)
___
(Lunch Break)
___
FEMA
FEMA
(Federal Emergency Management Association) is really a very small
organization. Its 2,500 employees meet
nationwide disasters for infrastructure and individual needs assistance. VAL means Voluntary Agency Liaison.
Upon
occurrence of an "incident," the State sends out people for PDA =
Preliminary Disaster Assessment. If the
State determines its resources are insufficient to handle an incident, that
State's governor will notify the President, in writing.
First
Responders are usually supplied by the local government and agencies in the
"Emergency Phase."
During
the "Relief Phase," insurers, and NFIP (flood insurers) begin their
efforts.
FEMA
helps the non-insured or the under-insured and non-NFIP insured. However, there is minimal money for
help. $5,400 is the maximum grant for
repairs, and not everyone will receive this maximum.
The
process begins when the governor's written assessment is "declared" a
federal disaster by the President. FEMA
processors arrive and survivors begin the "Registration Process." Their damaged property is then inspected by
FEMA. The amount of assistance is then
determined at FEMA's national center, not by the local FEMA employees.
If
a damaged property is determined to be "destroyed," the client is
then eligible for rental assistance. IF
the entire FEMA process is followed correctly, rental assistance may be
provided for up to 18 months. In smaller
communities where no rental properties are available, mobile homes or RVs may
be brought in while people are rebuilding.
The
deadline for FEMA registrations is 60 days from the date of declaration. (For the Nov. 6, 2005 tornado, the date of
declaration was 11/7/05 so the deadline for registering is January 7, 2006.)
ONLY
the head of household or spouse may register for FEMA assistance, and the other
spouse must be listed on the application.
FEMA's software will automatically "freeze' both registrations when
duplicate addresses/phone numbers/bank account numbers are submitted.
SBA
is available regardless of insurance. If
people do not apply, however, the FEMA process could be stopped. SBA loans are based on repayment
ability. But regardless of perceived
repayment ability
low-income, high-debt, etc
.this application MUST BE
submitted for the FEMA process to continue.
The
SBA loans are almost always low interest loans.
For this disaster (11/6/05) the rate is 2.7% APR. There are some definite situations that will
prevent approval of an SBA loan child support in arrears, student loan
default, or IRS debts but still the application must be submitted to be
considered for additional FEMA grants if/when an SBA loan is approved or
denied. NOTE: Approval of an SBA loan does not mean that
loan must be accepted.
When
reviewing clients' insurance policies, do NOT act as an agent! Insurance law is very strict!
As
for crisis counseling, for this disaster, the State of
Disaster-caused
unemployment is available for up to 26 weeks following a disaster. The deadline for applying at Work One (in
Food
Stamps are deductible on your client's taxes.
USDA assists with rural needs.
FSA is also available for low-income clients. For people 62 and over, a grant of up to
$7,500 may be available for repairing a well and/or sewer.
The
City Extension Agent is someone you can refer your clients to.
If
clients are denied an SBA loan and have no insurance or are under-insured for
their contents, they may be eligible for ONA (Other Needs Assistance) through
FEMA. This applies to essential property
only (furniture, appliances, and other disaster-related needs like a
humidifier, de-humidifier, chain saw, generator, etc.)
Medical
and Dental expenses are not usually covered by a homeowners policy, and these
may be available through FEMA.
A
vehicle with only liability insurance may be eligible for repair/replacement
monies of up to $5,000. This is
SBA-dependent.
If
a client had a loved one die without burial coverage, FEMA does cover this
cost. To date, 17 have been helped with
7 donated plots. Funeral expenses are
covered up to $7,000. Funeral assistance
is not SBA-dependent.
Two
(2) maximum grants have been presented to date in this disaster the maximum
grant is $27,200. They have also approved
13 replacements and 12 maximum $5,400 repair grants.
ONA
is funded 75% by FEMA and 25% by your State.
The State of
Phone
numbers:
1-800-621-FEMA (3362)
Susan Jensen Phone: 312-408-5337
Regional Fax: 312-408-5599 (to fax signed Release forms)
Bob LeGrange Phone: 317-233-0939
Fax: 317-232-4987
There
is always an appeal process if a client is unhappy with FEMA's assistance.
Good
documentation is very important.
The
Long-Term Recovery Committee of Southwest Indiana (LTRCSI) is here because
insurance and FEMA is not enough.
___
(Afternoon
Break)
___
Caveats
Not
all contractors are above-board (see list of licensed contractors, now
available on the LTRCSI website)
Older
people are more likely to be preyed upon by the unscrupulous and by their own
adult children
Conclusion
Send
in I&R (Information and Referral) to go house-to-house after a
disaster. Do a welfare inquiry
"How are you doing?" ASK,
"Did you register with FEMA?"
SHARE, take a gift if you'd like.
We'd like to let them know the Community Cares.
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