The nonpartisan Urban Institute publishes studies, reports, and books on timely topics worthy of public consideration. The views expressed are those of the authors and should not be attributed to the Urban Institute, its trustees, or its funders.

The anniversaries of Hurricane Katrina and the attacks of 9/11 will likely bring renewed attention to our nation’s preparedness to address large-scale disasters, whether natural or man-made. Indeed, in the years since these events, the media, policymakers, and the public have given considerable attention to this topic. However, attention has generally focused on preparedness for immediate and short-term responses to disaster. Such responses are, of course, critical. We suggest that attention also should be focused on longer-term recovery assistance following major disasters. Those who are directly involved in such traumatic events and suffer associated personal and property loss are likely to need assistance for years after the disaster—long after immediate and short-term response has ended. Much of the continued assistance needed falls within the realm of social services, such as mental health services, case management, and, for some, employment-related services.

An Urban Institute study of American Red Cross’s provision of longer-term recovery services following 9/11 provides a sense of the need for such services and an approach to providing them. The Red Cross used a portion of the substantial charitable donations received in the wake of the terrorist attacks to create the September 11 Recovery Program (SRP), which supported provision of longer-term assistance, including case management and financial assistance for health and mental health treatment, to people who continued to have 9/1l-related needs. Services were initially provided by the Red Cross, which subsequently provided grants to community-based nonprofit organizations for continued provision of selected services. (See our reports, “Findings from a Survey of 9/11-Affected Clients Served by the American Red Cross September 11 Recovery Program” and “An Assessment of Services Provided under the American Red Cross September 11 Recovery Grants Program.”)

A survey of 1,501 individuals who received SRP services from the Red Cross indicated that service recipients continued to have service needs and emotional issues long after the disaster, underscoring the need for longer-term recovery services. More than two in five service recipients (43 percent) said they or their families still needed services approximately four years after 9/11 to help with their recovery. Mental health services were most frequently mentioned as a continued need (by 63 percent of service recipients). Despite the continued need for services, a high proportion (79 percent) of respondents felt they were somewhat or much better off as a result of the assistance they received, an indication of the effectiveness of such services.

Long-term social services are needed because the emotional and practical effects of disaster cannot be resolved quickly and because problems may reemerge over time. Additionally, those affected do not always seek services in the immediate aftermath of disaster for a variety of reasons. For example, the stigma associated with mental health services was repeatedly cited by organizations providing post-9/11 services as affecting participation in such services. Many individuals affected by 9/11 lacked personal experience with mental health services, likely contributing to their reluctance to seek help. Cultural barriers deterred some groups from using the services. For others, such as police, fire, and EMS personnel, concerns about possible job implications of receiving mental health services affected their decision.
Other factors may affect participation in recovery services. Programs need to be culturally appropriate for their target audience—whether a particular racial, ethnic, or occupation group—and need to adapt their services in ways that are appealing and reassuring to clients. Making services accessible at convenient times and locations also facilitates the use of services. Outreach is important to inform potential clients of the availability of services.

Service provision after a major disaster can be visualized as a continuum ranging from an immediate response to longer-term services. The latter have not been commonly available, although our assessment of the September 11 Recovery Program indicates that they are a highly valued and much-needed part of the disaster relief and recovery system. To ensure the availability of longer-term recovery services, policymakers need to integrate such services into disaster plans.

One key mechanism to accomplish this is to plan to set aside some portion of disaster funds for longer-term services. For private donations, establishing a grant program to distribute the funds to community-based nonprofit organizations to provide specific services, as the Red Cross did after 9/11, appears to be a useful model. Advance designation of an entity (such as a private foundation or large nonprofit organization) to manage such grants in the disaster plan can serve to reduce implementation delays in the wake of a disaster. Other steps to promote inclusion of longer-term services in disaster plans follow (see “Preparing for the Next Disaster” in After Katrina: Shared Challenges for Rebuilding Communities for more detailed suggestions):

• Include faith-based and community nonprofit organizations as part of the disaster preparedness planning process.
• Identify the types of longer-term services likely to be needed after a disaster and potential eligibility criteria for such services.
• Compile a directory of potential recovery service providers.
• Address longer-term recovery services in written plans and agreements developed to address disaster response.
• Seek and disseminate lessons learned and promising practices from other communities that have provided long-term services following disasters.
• Encourage communication and collaboration among service providers before and after disaster strikes.

Ideally, disaster preparedness planners should ask, “What do we want the post-disaster service system to look like?” and then build a system that reflects that vision. Disasters such as 9/11 and Hurricane Katrina can serve as a wake-up call about the importance of including longer-term services in that vision.

Research for our study of 9/11 services was funded by the American Red Cross. The views expressed here are those of the authors and do not necessarily reflect those of the Urban Institute, its board, or its funders.

The nonpartisan Urban Institute publishes studies, reports, and books on timely topics worthy of public consideration. The views expressed are those of the authors and should not be attributed to the Urban Institute, its trustees, or its funders.

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