In the aftermath of disaster: Challenges, successes, and lessons learned in community response

The devastation wrought by the Gulf Coast hurricanes of 2005 resulted in an unprecedented evacuation that left over 100,000 displaced people in the Houston/Harris County area. This population was predominantly low income African American females with children. Most were traumatized by the sudden evacuation, fracturing of families, loss of lives and property, and dissolution of their home communities. Some had pre-existing mental and physical health problems, and few were well prepared for rapid resettlement. In Houston, as in many metropolitan areas, mental health and social service systems were over capacity prior to the disaster, necessitating expansion within a brief timeframe. Experienced case managers generally were inexperienced in trauma psychology and long-term disaster recovery, and many novice caseworkers were themselves displaced. In conjunction with a collaborative of behavioral health organizations, we implemented a focused, responsive approach to training and service delivery. A pro bono behavioral health network of licensed professionals was established to supplement existing counseling services. Customized community training in disaster mental health was accomplished through a modular format of delivery based on focus group feedback from case managers. Lessons learned will be discussed, including the benefits of ongoing needs assessment employing multiple methods and repeated measures, and flexible training that is responsive to the changing needs of displaced people and their social service and mental health providers. Recommendations for disaster planning include education of community organizations and funders concerning the trajectory of disaster response, the variability of long-term psychosocial needs, and the need for systematic dissemination of training materials.