Factors Predicting Crisis Counselor Referrals to Other Crisis Counseling, Disaster Relief, and Psychological Services: A Cross-Site Analysis of Post-Katrina Programs

  • Craig S. Rosen
  • Monica M. Matthieu
  • Fran H. Norris
Original Paper


An important aspect of crisis counseling is linking survivors with services for their unmet needs. We examined determinants of referrals for disaster relief, additional crisis counseling, and psychological services in 703,000 crisis counseling encounters 3–18 months after Hurricane Katrina. Referrals for disaster relief were predicted by clients’ losses, age (adults rather than children), and urbanicity. Referrals for additional counseling and psychological services were predicted by urbanicity, losses and trauma exposure, prior trauma, and preexisting mental health problems. Counseling and psychological referrals declined over time despite continuing mental health needs. Results confirm large urban–rural disparities in access to services.


Disaster mental health services Hurricane Katrina 



This project was supported by an interagency agreement between the Substance Abuse and Mental Health Services Administration and the Department of Veterans Affairs National Center for Posttraumatic Stress Disorder (NCPTSD), Executive Division, White River Junction, VT and the National Consortium for the Study of Terrorism and Responses to Terrorism (START; grant number N00140510629), a Center of Excellence in the Social and Behavioral Sciences funded by the Department of Homeland Security. Opinions, findings, and conclusions in this document are those of the authors and do not necessarily reflect the views of SAMHSA, the VA, or DHS.


  1. Abraham, I. L., Buckwalter, K. C., Snustad, D. G., Smullen, D. E., Thompson-Heisterman, A. A., Neese, J. B., et al. (1993). Psychogeriatric outreach to rural families: The Iowa and Virginia models. International Psychogeriatrics, 5, 203–211.PubMedCrossRefGoogle Scholar
  2. Anderson, R. (1995). Revisiting the behavioral model and access to medical care: Does it matter? Journal of Health and Social Behavior, 36, 1–10.CrossRefGoogle Scholar
  3. Boscarino, J. A., Adams, R. E., Stuber, J., & Galea, S. (2005). Disparities in mental health treatment following the World Trade Center Disaster: Implications for mental health care and health services research. Journal of Traumatic Stress, 18, 287–297.PubMedCrossRefGoogle Scholar
  4. Caplan, G. (1964). Principles of preventive psychiatry. New York: Basic Books.Google Scholar
  5. Centers for Disease Control and Prevention. (2006). Assessment of health-related needs after Hurricanes Katrina and Rita—Orleans and Jefferson Parishes, New Orleans area, Louisiana, October 17–22, 2005. MMWR. Morbidity and Mortality Weekly Report, 55, 38–41.Google Scholar
  6. Connor, K. M., & Davidson, J. R. (2001). SPRINT: A brief global assessment of post-traumatic stress disorder. International Clinical Psychopharmacology, 16, 279–284.PubMedCrossRefGoogle Scholar
  7. Covell, N. H., Essock, S. M., Felton, C. J., & Donahue, S. A. (2006). Characteristics of Project Liberty clients that predicted referrals to intensive mental health services. Psychiatric Services, 57, 1313–1315.PubMedCrossRefGoogle Scholar
  8. Creamer, T. L., & Liddle, B. J. (2005). Secondary traumatic stress among disaster mental health workers responding to the September 11 attacks. Journal of Traumatic Stress, 18, 89–96.PubMedCrossRefGoogle Scholar
  9. Flynn, B. W. (1994). Mental health services in large scale disasters: An overview of the Crisis Counseling Program. NCP Clinical Quarterly, 4, 1–4.Google Scholar
  10. Ford, J. D., Adams, M. L., & Dailey, W. F. (2006). Factors associated with receiving help and risk factors for disaster-related distress among Connecticut adults 5–15 months after the September 11th terrorist incidents. Social Psychiatry and Psychiatric Epidemiology, 41, 261–270.PubMedCrossRefGoogle Scholar
  11. Galea, S., Brewin, C. R., Gruber, M., Jones, R. T., King, D. W., King, L. A., et al. (2007). Exposure to hurricane-related stressors and mental illness after Hurricane Katrina. Archives of General Psychiatry, 64, 1427–1434.PubMedCrossRefGoogle Scholar
  12. Gibson, L. E., Ruzek, J. I., Naturale, A. J., Watson, P. J., Bryant, R. A., Rynearson, T., et al. (2006). Interventions for individuals after mass violence and disaster: Recommendations from the roundtable on screening and assessment, outreach, and intervention for mental health and substance abuse needs following disasters and mass violence. Journal of Trauma Practice, 5, 1–28.CrossRefGoogle Scholar
  13. Hamblen, J. L., Norris, F. H., Pietruszkiewicz, S., Gibson, L. E., Naturale, A. J., & Louis, C. (2009). Cognitive behavioral therapy for postdisaster distress: A community based treatment program for survivors of Hurricane Katrina. Administration and Policy in Mental Health and Mental Health Services Research. doi: 10.1007/s10488-009-0213-3.
  14. Jayasinghe, N., Giosan, C., Difede, J., Spielman, L., & Robin, L. (2006). Predictors of responses to psychotherapy referral of WTC utility disaster workers. Journal of Traumatic Stress, 19, 307–312.PubMedCrossRefGoogle Scholar
  15. Kasprow, W. J., Rosenheck, R. A., Frisman, L., & DiLella, D. (2000). Referral and housing processes in a long-term supported housing program for homeless veterans. Psychiatric Services, 51, 1017–1023.PubMedCrossRefGoogle Scholar
  16. Kessler, R. C., Galea, S., Gruber, M. J., Sampson, N. A., Ursano, R. J., & Wessely, S. (2008). Trends in mental illness and suicidality after Hurricane Katrina. Molecular Psychiatry, 13, 374–384.PubMedCrossRefGoogle Scholar
  17. Lam, J. A., & Rosenheck, R. (1999). Street outreach for homeless persons with serious mental illness: Is it effective? Medical Care, 37, 894–907.PubMedCrossRefGoogle Scholar
  18. Lesaca, T. (1996). Symptoms of stress disorder and depression among trauma counselors after an airline disaster. Psychiatric Services, 47, 424–426.PubMedGoogle Scholar
  19. McGuire, J., Rosenheck, R. A., & Kasprow, W. J. (2003). Health status, service use, and costs among veterans receiving outreach services in jail or community settings. Psychiatric Services, 54, 201–207.PubMedCrossRefGoogle Scholar
  20. Naar-King, S., Bradford, J., Coleman, S., Green-Jones, M., Cabral, H., & Tobias, C. (2007). Retention in care of persons newly diagnosed with HIV: Outcomes of the outreach initiative. AIDS PatientCare and STDs, 21(Suppl 1), S40–S48.Google Scholar
  21. Norris, F. H., & Belamy, N. (2009). Evaluation of a national effort to reach Hurricane Katrina survivors and evacuees: The Crisis Counseling Assistance and Training Program. Administration and Policy in Mental Health and Mental Health Services Research. doi: 10.1007/s10488-009-0217-z.
  22. Norris, F. H., Friedman, M. J., Watson, P. J., Byrne, C. M., Diaz, E., & Kaniasty, K. (2002). 60,000 disaster victims speak: Part I. an empirical review of the empirical literature, 1981–2001. Psychiatry, 65, 207–239.PubMedGoogle Scholar
  23. Norris, F. H., Donahue, S. A., Felton, C. J., Watson, P. J., Hamblen, J. L., & Marshall, R. D. (2006). A psychometric analysis of Project Liberty’s adult enhanced services referral tool. Psychiatric Services, 57, 1328–1334.PubMedCrossRefGoogle Scholar
  24. Norris, F. H., Hamblen, J. L., Brown, L. M., & Schinka, J. A. (2008). Validation of the short post-traumatic stress disorder rating interview (Expanded Version, Sprint-E) as a measure of postdisaster distress and treatment need. American Journal of Disaster Medicine, 3, 201–212.PubMedGoogle Scholar
  25. Norris, F. H., Hamblen, J. L., & Rosen, C. S. (2009). Service characteristics and counseling outcomes: Lessons from a cross-site evaluation of crisis counseling after Hurricanes Katrina, Rita, and Wilma. Administration and Policy in Mental Health and Mental Health Services Research. doi: 10.1007/s10488-009-0215-1.
  26. Norris, F. H., & Rosen, C. S. (2009). Innovations in disaster mental health services and evaluation: National, state, and local responses to Hurricane Katrina. Administration and Policy in Mental Health and Mental Health Services Research. doi: 10.1007/s10488-009-0218-y.
  27. Shepherd, M., & Hodgkinson, P. E. (1990). The hidden victims of disaster: Helper stress. Stress Medicine, 6, 29–35.CrossRefGoogle Scholar
  28. Smedlye, B. D., Stith, A. Y., & Nelson, A. R. (2003). Unequal treatment: Confronting racial and ethnic disparities in health care. Washington, DC: The National Academies Press.Google Scholar
  29. Stiffman, A. R., Striley, C., Horvath, V. E., Hadley-Ives, E., Polgar, M., Elze, D., et al. (2001). Organizational context and provider perception as determinants of mental health service use. Journal of Behavioral Health Services Research, 28, 188–204.PubMedCrossRefGoogle Scholar
  30. Stiffman, A. R., Pescosolido, B., & Cabassa, L. J. (2004). Building a model to understand youth service access: The gateway provider model. Mental Health Services Research, 6, 189–198.PubMedCrossRefGoogle Scholar
  31. Wang, P. S., Gruber, M. J., Powers, R. E., Schoenbaum, M., Speier, A. H., Wells, K. B., et al. (2008). Disruption of existing mental health treatments and failure to initiate new treatment after Hurricane Katrina. American Journal of Psychiatry, 165, 34–41.PubMedCrossRefGoogle Scholar

Copyright information

© US Department of Veterans Affairs 2009

Authors and Affiliations

  • Craig S. Rosen
    • 1
  • Monica M. Matthieu
    • 2
  • Fran H. Norris
    • 3
    • 4
  1. 1.National Center for Posttraumatic Stress DisorderStanford University School of MedicinePalo AltoUSA
  2. 2.St. Louis VA Medical Center, Center for Mental Health Services ResearchWashington University in St. Louis, George Warren Brown School of Social WorkSt. LouisUSA
  3. 3.National Center for Posttraumatic Stress DisorderWhite River JunctionUSA
  4. 4.Dartmouth Medical SchoolHanoverUSA

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