mental health needs in louisiana schools following hurricane katrina academy health june 3, 2007...
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Mental health needs in Louisiana schools following Hurricane Katrina
Academy Health
June 3, 2007
Paula A. Madrid, Psy.D.Director, The Resiliency ProgramNational Center for Disaster Preparedness Mailman School of Public Health [email protected]
Roy Grant, M.A.Director of ResearchChildren's Health [email protected]
School-Based Health Centers (SBHCs)
• Important health access points for medically underserved children
• Provide care to 2 million children in 44 states
• Reduce hospitalization and emergency room use for their patients
• School-based mental health interventions are as effective as community clinics– Intervention on-site bridges access to care barriers
SBHCs in Louisiana, Pre-Katrina
• Large school-based health center network
• 56 sites throughout the state
• ~ 42,000 enrolled students
In Louisiana, More Than Half of SBHCs Serve Rural Communities
54
46rural urban
In Louisiana, 3/4 of SBHCs Serve Elementary and Middle School Students
22
29
16
24
9
elementarymiddlemid-highhighK-12
The Impact of Hurricane Katrina
• Directly impacted 90,000 square miles– About the size of Great Britain
• Directly impacted ~1.5 million people in Louisiana, Mississippi, and Alabama
• In the aftermath, FEMA provided temporary housing to 85,000 households
• Current estimates place the number displaced children
at ~150,000
• More than 700 schools were damaged or destroyed
Operation Assist
• Special initiative of The Children’s Health Fund and National Center for Disaster Preparedness, Mailman School of Public Health (Columbia University)
• Direct delivery of medical and mental health services to affected regions– Use of mobile medical units to reach isolated and
underserved communities
• Public health assessment and planning in Louisiana and Mississippi
Study 1: SBHC Needs Assessment Immediately After Hurricane Katrina
• Focus group in Lafayette Louisiana held within 2 weeks of Hurricane Katrina– Co-led by a physician, a psychologist, and a school safety
specialist who had assisted in the evacuation of NYC schools on 9/11/01
• Open-ended questions
• Responses recorded in writing and analyzed for trends
• Three group trainings subsequently provided and evaluated
Participants
• 32 representatives from 24 Louisiana SBHCs located in the hurricane-affected area– Health and mental health providers, and administrators
• Some participants had lost their homes in the hurricane
• Most were from sites distant from the hurricane-impacted area
• Some had done rescue and recovery work immediately after the hurricane
• Most SBHC sites included evacuee children
Principal Findings: Training Needs of SBHC Staff
• Most powerful theme: Help the helpers– Provide support to professionals and volunteers caring for
families affected by a disaster
• Training on identification of trauma
• Training to work directly with traumatized children and families
• How to protect confidentiality and arranging consent for services when children are separated from their parents
• How to most effectively support teachers
Principal Findings: Training as Advocates
• Strong concerns about meeting new levels of need– One city grew in population from 21,000 to 24,000 in
under a week – One school enrolled 143 new students in 4 days – The affected communities had not been adequately
served for health or mental health care before Hurricane Katrina
– Access to specialists highlighted as a problem because this was difficult before Katrina
• Ensuring that service expansions are sustained– Requested training in fund raising and advocacy
Evaluation: What Worked Best in the Training?
• Interactive and experiential sessions
• Group discussions
• Allowing time for self-reflection
• Focus on stress management
Evaluation: Further Training Requested About…
• Child mental health problems– Depression– Posttraumatic stress disorder– Bipolar disorder– Self-injurious behavior– Eating disorders
• Appropriate clinical assessment tools • Child psychotherapy techniques
– Brief cognitive-behavior therapy – Videos of therapy sessions would be helpful
• How to deal with stigma associated with mental health problems• Different approaches based on child’s age and developmental level• How to best involve the family
Study Two: Student Needs ~6 months Post-Katrina
• Survey instrument distributed to 43 schools– Responses from 42 schools; 98% response rate
• 19 (45%) schools categorized as “high displacement” – > 100 displaced students, or – > 10% increase in enrollment
• 23 (55%) were categorized as “low displacement”
• Average school enrollment, 937 students– Most had a total enrollment of 500-800
Increase in SBHC Patient volume
• 12% of all students in the 42 schools were hurricane-displaced children– Range per school, 9 to 850
• 75% of the displaced were in 14 (33%) of the schools
• Half (53%) of SBHCs reported an increase in patient volume – 18% of those reporting an increase considered it to be
“large”
Reported Increase in Student Behavior Problems
• Student verbal arguments, 76%
• Physical fights, 64%
• Truancy, 55%
• Disruptive behavior, 43%
• Reported parental conflict, 36%
• Sexual promiscuity, 31%.
Also Reported as Increased
• Anger and grief
• Family disruption and domestic violence
• Somatic symptoms (non-specific headache and stomach ache)
• Sleep disturbance (hypersomnia and insomnia)
• Suicidal ideation
Negative Behaviors Among Students
0
20
40
60
80
100
Mor
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umen
ts
Mor
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hts
Mor
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ancy
Mor
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Mor
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ent C
onflic
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Mor
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Pro
misc
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Mor
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Pe
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SchoolsWith FewDisplaced
SchoolsWithManyDisplaced
Families Needed Concrete Services
• Mental health providers reported not being prepared to respond to basic family needs
– Locating housing
– Food assistance
– Financial resources
Conclusions
• A significant increase in students with problem behavior and other signs of emotional distress can be anticipated following a disaster
• Evacuation and relocation after a disaster increase its negative impact on child and adolescent mental status
• School and SBHC staffs require sufficient resources and support to do their work and to manage their own losses and trauma
• Training on assessment and treatment of psychological trauma is needed including for mental health professionals
• Sustained efforts are required to ensure that the availability of services meets the increased level of need following a disaster