1. Leslie E. Lawrence, M.D. Tulane University School of Medicine Department of Psychiatry and Neurology 1

2. Helping Children Heal Project Introduction An innovative school-based community research developed post Hurricane Katrina Survey Type Research Medical Students, Residents, Faculty To assist in the post-disaster mental health recovery of children 2

3. Helping Children Heal Project Introduction Arnold P. Gold Foundation: advances humanism in medicine Katrina Assistance Fund Grant (2005): Mark Viron, M.D. and Janet Johnson, M.D. Mercy Corps- My personal Story of Hurricanes Katrina and Rita. 3

4. Helping Children Heal Project Introduction Monday, August 29, Hurricane Katrina made landfall in New Orleans metro area Levees Failed---Horrific Aftermath Submerging 80% of New Orleans One of the Greatest Tragedies in United States History 4

5. Helping Children Heal Project Introduction In Louisiana alone, over 1,000 people lost their lives Countless others lost their homes, their jobs, and their way of life Katrina left the people of New Orleans scattered across the country, with many, including school-age children, now in Houston, Texas 5

6. Helping Children Heal Project Introduction American Psychiatric Association and the Campaign for Mental Health Reform noted: “For an estimated 30 % of hurricane victims and relief workers, the magnitude and duration of the traumas they are experiencing place them at great risk for developing post-traumatic stress disorder (PTSD), other anxiety disorders (e.g. panic disorder), severe depression and other mental and emotional disorders.” 6

7. Helping Children Heal Project Introduction September, 2005, recognizing need and importance of providing continued education for the children of New Orleans Knowledge Is Power Program (KIPP) Teach for America Houston Independent School district 7

8. Helping Children Heal Project Introduction New Orleans West College Preparatory School (NOW) K-8 charter school in Houston exclusively for children displaced from New Orleans 8

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10. Helping Children Heal Project Introduction Student Population of NOW: 100% African-American Historically impoverished areas of New Orleans Homes destroyed by Katrina 10

11. Helping Children Heal Project Introduction Administrators of NOW: Structure Stability Support 11

12. Helping Children Heal Project Introduction Risk Factors for Children at NOW school: Witnessed Traumatic Events Trapped Lost their homes, belonging, pets, friends and family At the very least, all must start life over at a new school in a new city 12

13. Helping Children Heal Project Introduction Problem: Increased number of behavioral and emotional problems NOW administrators contacted Tulane University Department of Psychiatry & Neurology* Requested assistance in dealing with the psychological effects of Katrina 13

14. Helping Children Heal Project Introduction NOW administrators Teachers Tulane University Dept of Psychiatry & Neurology Helping Children Heal (HCH) project. 14

15. Helping Children Heal Project Research (NOW) OBJECTIVES: Determine the prevalence of PTSS among the children of a middle school in post-Katrina New Orleans Evaluate the effect of a guided-workbook intervention 15

16. Helping Children Heal Project Research (NOW) METHODS: The National Child Traumatic Stress Network Custom screening Tool The University of California at Los Angeles Child Post-Traumatic Stress Disorder Reaction Index (PTSD-RI) My Personal Story about Hurricanes Katrina and Rita: A Guided Activity Workbook for Children by Gilbert Kliman, et al. 16

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22. Helping Children Heal Project Research (NOW) RESULTS: For grades 6-8, post-traumatic symptom level scores declined 18.75% compared with pre- assessment scores (median of 32 to 26). This was statistically significant (p=.0001). 22

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27. Helping Children Heal Project Research (McDonogh #15) Same Research Different Location; New Orleans Same Administrators Different Population 27

28. Helping Children Heal Project Research (McDonogh #15) Objective Methods* Community Education on PTSD Results Arnold P. Gold Foundation; Poetry Books 28

29. Helping Children Heal Project Research (McDonogh #15) OBJECTIVES: Determine the prevalence of PTSS among the children of a middle school in post-Katrina New Orleans Evaluate the effect of a guided-workbook intervention 29

30. Helping Children Heal Project Research (McDonogh #15) METHODS: The National Child Traumatic Stress Network Custom screening Tool The University of California at Los Angeles Child Post-Traumatic Stress Disorder Reaction Index (PTSD-RI) My Personal Story about Hurricanes Katrina and Rita: A Guided Activity Workbook for Children by Gilbert Kliman, et al. 30

31. Helping Children Heal Project Research (McDonogh #15) COMMUNITY EDUCATION: PTSD Types of Stressors: During the Hurricane(Trapped In Superdome) Afterwards (Living in a trailer) PTSD Treatment 31

32. Helping Children Heal Project Research (McDonogh #15) RESULTS: Before the workbook, the median RI score was 24, and 54 students (46%) displayed moderate to severe PTSS. Post-workbook, 43 students (37%) displayed moderate to severe PTSS, and the median RI score decreased by 17% to 20 (p=.0096). 32

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41. Helping Children Heal Project Research Conclusions Guided workbook may be a simple and effective intervention to reduce post-traumatic stress in children exposed to hurricanes Numerous confounders need to be considered Home Environment Classroom Resilience of Each Child Supportive Factors Passage of Time 41

42. Helping Children Heal Project “Tell me and I’ll forget. Show me, and I may not remember. Involve me, and I’ll understand” Lakota Sioux 42

43. Helping Children Heal Project References Pynoos R, Rodriguez N, Steinberg A, Stuber M, Frederick C: The UCLA PTSD Reaction Index for DSM IV (Revision 1). Los Angeles, UCLA Trauma Psychiatry Program, 1998 Kliman G, Oklan E, Wolfe H, Kliman J: My Personal Story about Hurricanes Katrina and Rita: A Guided Activity Workbook for Middle and High School Students. San Francisco, The Children's Psychological Health Center, 2005 Mishkin, AD, Viron M, Lawrence LE, Johnson JE, Samples G, Kliman G. Reducing Post-Traumatic Stress after Hurricane Katrina: A School-Based Intervention. Poster presented at the 59 th Institute on Psychiatric Services Annual Meeting, New Orleans, LA, October 11-14, 2007 Lawrence LE, Viron M, Johnson JE, Hudkins A, Samples G, Kliman G: A school-based mental health recovery effort. Poster presented at the 58th Institute on Psychiatric Services Annual Meeting, New York, NY, October 5-8, 2006 43