FEMA funds questionable crisis counseling program in Florida

According to this South Florida Sun-Sentinel investigative report, a Florida FEMA program sounds more like a circus than a crisis counseling program:

At the Pinitos Learning Center in Boca Raton, disaster workers dressed as "Windy Biggie" and "Sunny" teach 30 preschoolers a song about how the wind is good, even during a hurricane.

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This is FEMA tax money at work. It's also paying for Hurricane Bingo, puppet shows, "salsa for seniors," and yoga on the beach.

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The job is stressful, Project H.O.P.E. officials say. Counselors regularly attend "stress management" sessions that have included collecting shells on the beach, "silly string and art therapy," and "the toilet paper game."

According to the article, the program is funded by a $22.6 million FEMA grant to counsel victims of hurricanes Wilma and Katrina. The program employs 450 people who perform skits and conduct games for Florida residents "regardless of whether they're in crisis or even experienced the storms."

FEMA has spent millions on the program since 2004:

Since 2004, Florida has received $46.8 million for crisis counseling for six hurricanes. The grant for Hurricane Charley, which ravaged the west coast in August 2004, paid for almost 700 performances of a puppet show called "Heroes of the Storm," a DCF report says.

With each grant, teams spend days creating scripts, rehearsing, and making costumes and props.

Other Project H.O.P.E. creations have included "yoga relaxation on the beach," the Un-electric Cooking Show with Chef Sunshine, and a workshop called "Planting for Inner Peace."

The article says that one of their problems is finding victims who need help because FEMA won't provide names and addresses of victims because of confidentiality concerns, so they spend time driving around looking for blue tarps or going to events and asking people if they need crisis counseling.

Although officials cite a few individual successes, the program may be doing more harm than good according to a mental health professional:

Charles Figley, a psychologist and director of the Traumatology Institute at Florida State University, said federal officials should be spending the grant money on mental health professionals to counsel actual victims of the disaster. Instead, "they guide the state into hiring these folks and having these bogus and untested programs that potentially do more harm than good."

For some, especially children, "forcing them to focus on frightening memories" from the storm can be overwhelming, Figley said.

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FSU's Figley said the crisis counselors appear to be "in way over their head."

"There could be people suffering from psychosis, various types of anxiety disorders," Figley said. "Someone who is not trained in diagnosis would never be able to tell."

Counselors are supposed to refer anyone showing signs of psychiatric problems to mental health agencies. Project H.O.P.E. also offers a 24-hour crisis hotline, but it has been fraught with problems, records show.

According to the article, the crisis hotlines are being run mostly as "suicide hotlines" and are manned by people who have never heard of Project H.O.P.E.

Perhaps there is more to the story, but you have to read the entire report to get a sense of how ineffective and poorly managed the program appears to be. According to the Orlando Sentinel, the report has sparked interest in a Congressional review of the program:

In response to inquiries from the Sun-Sentinel, U.S. Sen. Bill Nelson, D-Fla., sent an e-mail to FEMA on Thursday, asking for a review of the program.

"The way some of the money reportedly is being used raises some red flags with me," said Nelson, who has criticized FEMA in the past for wasteful spending.

Reading the report, one can't help but think of the very real and very serious mental health issues affecting many New Orleans residents in the aftermath of Katrina.

As reported in the Gulf Coast Reconstruction Watch's Katrina: One Year After study, the New Orleans Police Department Mobile Crisis Unit receives 180 mental illness related calls each week, but only 80 of 450 psychiatric in-patient beds remain available after the hurricanes. The report also says there are 300,000 estimated cases of post-traumatic stress disorder in the state of Louisiana, and that the suicide rate in New Orleans has tripled since Katrina.

Puppet shows and bingo aren't going to help these people. But, FEMA is funding a a similar crisis counseling program in Louisiana:

Dr. Fred Cerise, secretary of the Louisiana Department of Health and Hospitals (DHH) and Jim Stark, director of the Louisiana Transitional Recovery Office are in agreement that the $34.7 million awarded by FEMA will benefit persons in Louisiana needing crisis counseling due to the stress resulting from this destructive hurricane.

"Stress and depression are constant companions for many hurricane affected residents. They have been through a great ordeal and we want everyone in Louisiana who was impacted by the storm to take advantage of this grant funding crisis counseling for Hurricane Katrina affected residents," said Jim Stark.

The purpose of the crisis counseling program is to help people understand their current situation and their emotional reactions to it. In doing so, it helps victims grieve their losses, reduce stress, review their options, and develop coping skills that will allow them to make the necessary adjustments needed to move forward with their lives. It also encourages links to others in their community, and helps identify and refer people who may need services outside the scope of the crisis counseling program.

According to this New Orleans Times Picayune article, the Louisiana program appears to be better managed than the Florida program. At least there is no mention of puppet shows, bingo, or yoga on the beach.

But similar to the Florida program, mental health professionals also question some aspects of the Lousiana program:

[L]ittle research supports such programs, which rarely involve medical doctors and often resort to combing through the local population in search of patients or victims, according to critics of the philosophy behind such counseling.

Simon Wessely, director of the King's Centre for Military Health Research and a professor of psychiatry at King's College London, cautioned that although the programs were set up and run by people with "noble motives," they are as likely to cause harm as they are to help. In an e-mail message to The Times-Picayune, Wessely, an international expert on post-traumatic stress and crisis counseling, accurately summed up Louisiana Spirit's methods and said there is no scientific proof such steps are worthwhile.

Another area of concern involves the types of services are allowed under the program and those that aren't:

As a licensed physician, Speier's involvement with people traumatized by Katrina is sharply limited. Louisiana Spirit's Web site explicitly notes that while its focus is on mental health, it's not providing doctors.

"The (program) does not support long-term, formal mental health services such as medications, office-based therapy, diagnostic services, psychiatric treatment, substance abuse treatment or case management," the organization says.

Instead, it provides "disaster mental health interventions, which include outreach and education for disaster survivors, their families, local government, rescuers, disaster service workers, business owners, religious groups and other special populations."

There are other concerns about the program's outreach and who they are targeting:

Louisiana Spirit materials identify 16 "priority populations" for its crisis counseling program. Included among those groups are people diagnosed with HIV/AIDS, gay and lesbian people and transgender people.

The categories also include several demographic groups that are commonly associated with social work but are not necessarily afflicted by conditions caused by the storm, such as people with impaired vision or developmental delays, or those involved in the justice system.

Both the Florida and the Louisiana programs are probably best summed up by Ty Bartel, who is supervising Volunteers of America's work in St. Tamminy Parish:

"So what should the policy be?" he said. "Not to waste resources giving ineffective treatments to large numbers of people who don't need it, but to target resources on the far smaller numbers of people who do need treatment."

While there is little doubt that such programs are needed and are helping some people, this appears to be another example of good intentions gone awry as a result of FEMA waste and mismanagement.