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IN THE EYE OF THE STORM A Special Report About the Robert Wood Johnson Foundation’s Response to the 2005 Gulf States Disasters By Kelsey Menehan April 2008 Table of Contents 4 INTRODUCTION 6 KATRINA HITS 7 THE EARLY RESPONSE 7 Grappling With the Disaster’s Magnitude 8 The Emergency Response Grid 9 “Let’s Not Reinvent the Wheel.” 9 “We’re in Princeton. We Need to Find Out What’s Going On.” 11 UP CLOSE AND PERSONAL 11 RWJF Staff View the Post-Katrina Landscape 13 Reaching Out to RWJF Grantees 15 RWJF Clinical Scholars Get Involved 16 An Expanded Effort to Help Elderly People 16 Bolstering Community Health Centers in the Gulf States Region 19 AN EMERGING KATRINA RESPONSE STRATEGY 19 The Katrina Response Team Grows 19 Three Phases of Grantmaking 20 Recovery for Substance-Abuse Treatment Programs 21 Supporting Faith-Based Groups 23 Supporting Basic Health Infrastructure in Rural Areas 24 Housing: “It’s a Health Issue.” 25 LOOKING TOWARD THE LONGER-TERM RESPONSE 25 “What Are We Good At?” 26 Vulnerable Populations: A Focus on Youth and Substance Abuse 28 Public Health Infrastructure: Immediate Needs, Longer-Term Lessons 29 Healthy Rebuilding: Funding Local Community Development 31 Empowering Local Voices 31 Eyes and Ears on the Ground 31 Katrina Team Comings and Goings 33 KATRINA TEAM’S NEW ORLEANS SITE VISIT 33 “We Need to See for Ourselves.” 34 Post-Site Visit Recommendations 35 Confronting the Racial Divides…or Not? 37 NEXT ROUND OF GRANTMAKING 37 Mental Health a Priority 39 Recovery of Health Records: A Road Map for Electronic Medical Records 39 Redesigning Health Systems 2 IN THE EYE OF THE STORM: A SPECIAL REPORT ABOUT THE ROBERT WOOD JOHNSON FOUNDAtion’S RESPONSE TO THE 2005 GULF STATES DISASTERS 41 STAYING FOR THE LONG HAUL 41 Changing Systems to Improve Health and Health Care 41 Supportive Housing 42 Neighborhood Rebuilding 42 Planning for Disasters 44 THE KATRINA RESPONSE TEAM PHASES OUT 44 “There’s Still an Emergency.” 45 “There Are Real People Behind These Papers.” 46 THE LESSONS OF THE KATRINA RESPONSE 46 The Process 46 The Grantmaking Strategy 49 SIDEBARS: WORK AT GROUND LEVEL 49 CDC Foundation’s Flexible Funding Pays Off 51 Frustration Among RWJF Staff Members Turns to Action 54 An RWJF Communications Officer Discovers the Power of Good Information—On the Ground 56 Louisiana Public Health Institute: Rebuilding a Better New Orleans 58 When Communities Crumble: RWJF Clinical Scholars Confront the Issues 62 Coastal Family Health Center, Biloxi, Miss.: Health Care Workforce Shortage Stymies Rebuilding Post-Katrina 64 “The Other Shoe Has Dropped”: Addressing Post-Katrina Mental Health Problems in Jefferson Parish 67 Bridge House Recovers from Katrina “One Day at a Time.” 70 REJOICE, Inc.: Out of Tragedy, A Network of Caring 72 A Street, and a Ministry, Named Desire, Back From the Brink 74 Providence Builds Homes and Hope 77 Dancing Through the Tears: New Orleans Eight Months After Katrina 81 Katrina’s Kids: Helping the Region’s Most Vulnerable Come Back From the Trauma 83 DePelchin Children’s Center: Reaching Out to the “Hurricane Kids” in Houston 86 APPENDICES 86 APPENDIX 1: National Foundation for the Centers for Disease Control and Prevention, Subgrants 87 APPENDIX 2: Organizations Receiving RWJF Grants for Katrina Recovery as of December 2007 93 APPENDIX 3: Grantmakers in Aging, Subgrants 94 APPENDIX 4: National Association of Community Health Centers, Subgrants 95 APPENDIX 5: National Council for Community Behavioral Healthcare, Subgrants 96 APPENDIX 6: State Associations of Addiction Services, Subgrants 97 APPENDIX 7: Foundation for the Mid South, Subgrants 99 APPENDIX 8: Louisiana Rural Health Services Corporation, Subgrants 3 IN THE EYE OF THE STORM: A SPECIAL REPORT ABOUT THE ROBERT WOOD JOHNSON FOUNDAtion’S RESPONSE TO THE 2005 GULF STATES DISASTERS INTRODUCTION Katrina was one of the biggest disasters our country has experienced. It certainly exposed the fundamental flaws in our society, as well as many of the ways in which the system infrastructure for health care and public health was inadequate. At the Robert Wood Johnson Foundation, it also taught us several key lessons about who we are as an organization and how we can help make a difference. I still vividly recall the conversation John Lumpkin and I had the morning after the levees broke about what we should do to help with this unprecedented crisis. We quickly determined that RWJF needed to make a difference in the immediate suffering of people’s lives, but also that we would do something to prevent that kind of total population devastation in the future. Within 48 hours we committed several million dollars to disaster relief. What’s remarkable is that we were able to make that commitment and expedite payment following our existing governance structure. Over the following weeks we developed an expedited system of grant making and appointed a special internal team to manage the grants and process related to relief along the Gulf Coast. Recognizing that our expertise in disaster relief and the region were limited, we focused on making grants to intermediary organizations with in-depth knowledge of the Hurricane affected area. These intermediaries in turn made grants at the ground level to organizations and individuals. The Foundation’s commitment didn’t, and hasn’t, ended with immediate relief. We made a long-term commitment to rebuilding that primarily focuses on three different approaches—targeting health care issues in which we have some expertise, including mental health and information systems; informing how to rebuild; and then being a part of a larger collaborative that is making an ongoing investment in the rebuilding itself. Our goal is to build capacity within local organizations and use what we have learned about creating healthy environments to inform the rebuilding effort. Robert Kennedy once said, “Each of us can work to change a small portion of events, and in the total of all those acts will be written the history of this generation.” As you read the following report, and revisit not just the devastation and massive human suffering, but the total failure of public and private systems to meet people’s most basic needs, I hope you will also be inspired as I have been by the many acts of individuals and organizations that are rewriting the history of Katrina and the Gulf Coast. Risa Lavizzo-Mourey, M.D., M.B.A. President and CEO 4 IN THE EYE OF THE STORM: A SPECIAL REPORT ABOUT THE ROBERT WOOD JOHNSON FOUNDAtion’S RESPONSE TO THE 2005 GULF STATES DISASTERS Hurricane Katrina heading to the Gulf Coast. 5 IN THE EYE OF THE STORM: A SPECIAL REPORT ABOUT THE ROBERT WOOD JOHNSON FOUNDAtion’S RESPONSE TO THE 2005 GULF STATES DISASTERS KATRINA HITS Residents in the Gulf States region have learned to live, however uneasily, with the threat of hurricanes. But, by most accounts, the gigantic storm looming in the Gulf of Mexico during the last days of August 2005 was scarier than most. In Princeton, N.J., Calvin Bland, the Robert Wood Johnson Foundation’s chief of staff, watched televised newscasts into the wee hours Monday, August 29, as Hurricane Katrina gathered strength and took aim at New Orleans. “At some point I realized, this was the first time that a hurricane was seriously threatening an American city,” Bland recalls. He watched, knowing that whatever happened, the Foundation would need to quickly assess the situation and marshal its resources for a response. Katrina made landfall just after 6 a.m., 60 miles southeast of New Orleans. By that time the storm had been downgraded from Category 5 to Category 3. “It appeared we had dodged it,” Bland recalls. The images on the television were telling a different story. “Everything was flooded and people were in great distress,” Bland recalls. “I remember watching this black man in Mississippi saying, ‘She’s gone, she’s gone.’ His wife had slipped out of his hand. She said, ‘Take care, take care of the babies,’—his grandchildren—because he couldn’t hold onto her hand, and the water pulled her away. “It was the most traumatic scene, the most painful scene of many painful scenes that week.” New Orleans after Katrina 6 IN THE EYE OF THE STORM: A SPECIAL REPORT ABOUT THE ROBERT WOOD JOHNSON FOUNDAtion’S RESPONSE TO THE 2005 GULF STATES DISASTERS THE EARLY RESPONSE GRAPPLING WITH THE DISASTER’S MAGNITUDE RWJF President and CEO Risa Lavizzo-Mourey was returning from a trip to Iceland as Katrina roared ashore. On the plane for the better part of a day, she was shocked when a taxi driver told her that the levees had broken in New Orleans and 80 percent of the city was under water. And that was just the beginning. She soon learned that in Gulfport, Biloxi and other Gulf Coast towns, Katrina had swept entire communities right off the map. At RWJF headquarters early Tuesday for her usual morning workout, Lavizzo-Mourey ran into John Lumpkin, senior vice president and director of the Foundation’s Health Care Group, in the gym. The two began to discuss how to quickly mobilize the Foundation’s response to Katrina. “I want you to get a team together and start looking at it,” Lavizzo-Mourey said. Lumpkin, trained as an emergency medicine doctor, had directed the Illinois State Health Department and spearheaded the state’s public health emergency response planning, before joining RWJF. While in state government, he had led Illinois’ response to the Great Flood of 1993, where the Mississippi and Missouri Rivers and their tributaries did $15 billion damage in nine Midwest states. “Obviously, that was nothing of this magnitude,” he said.

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