1. Katrina’s Children in the Aftermath of the Disaster: What Have We Learned?
Joy D. Osofsky, Ph.D.
Howard J. Osofsky, M.D., Ph.D.
Louisiana Spirit
Louisiana Rural Trauma Services Center (NCTSN)
Carter Symposium on Mental Health
November 8, 2006

2. Understanding Children in Disasters
Children of all ages were traumatized by the displacement, separation from family and friends, loss of homes & community
The extent of traumatization relates to
direct traumatic experience
age and vulnerability of the child
amount of support from family, school, and community
previous trauma and loss history

3. Observations of Children returning to heavily impacted areas-Positives
Resilience (especially if parent or caretaker is emotionally available)
Pleasure about returning to school and community
Being with and communicating with friends is very important

4. Screening Children Post Katrina
Since November 2005, LSUHSC, in collaboration with schools, has screened over 7,000 children on their experiences & feelings about Hurricane Katrina
Age range from 1 to 19 Sex: Male (46%); Female (54%)
Race: African-American (46%); Caucasian (44%); Hispanic (4%); Other (6%)

5. NCTSN Hurricane Screen- Modified by LSUHSC
Children are surveyed using an adaptation of the NCTSN Hurricane Screening Tool for Children and Adolescents
Used to identify children & provide feedback to schools for prevention, intervention, and services

6. Living Situation Since Hurricane Katrina (N=5,000)
Number of moves: Average = 3
Number of schools attended: Average=2
Living situation
41% in own house; 27% in trailer; 20% in a new home/apartment; 12% at home of relative or friend; 1.3% reported living in a hotel or shelter.

7. Traumatic Experiences
Did the child see hurricane-related damage 90%
Did the child lose personal belongings? 72%
Did the child transfer to a new school? 68%
Was a parent unemployed? 50%
Was the child’s home destroyed? 45%
Was the child separated from a caregiver 26%

8. Traumatic Experiences
Did the child live in a crowded shelter 18%
Were family members or friends injured 16%
Were family members or friends killed 12%
Did the child witness injury? 12%
Did the child witness death? 2.4%

9. Need for Mental Health Services- 4th-12th grade
49% of children in Spring 2006 sample met cut-off criteria for consideration for mental health referral
13% requested counseling
37% reported experiencing previous loss or trauma (placing them at higher risk)
Over 30% endorsed feeling depressed or reported posttraumatic stress symptoms

10. 4th – 12th Grades Fall 2006
41% continue to meet NCTSN cut-off score for enhanced mental health services
5% reported receiving mental health treatment since the storm
7% would like to have counseling services
Compared to this time last year (2-3 months following the hurricane), 52% reported feeling better; 37% feeling the same, and 11 % feeling worse

11. Spring 2006 NCTSN Screen for Younger Children (parent report)
787 children, PreK-3rd grade
55% Caucasian, 37% African American, 3% Hispanic
One Parent unemployed – 77-80%
Meets cut-off for referral-32%
44% of parents reported wanting counseling services

12. Preliminary Data on Matching Sample COMPARISON (3-5 MONTHS POST KATRINA VS 14 –15 MONTHS POST KATRINA) PreK through 3rd grade
184 parents completed Time 1 and Time 2 surveys regarding their children
There was no significant difference between percentage of children meeting the cut-off for further mental health services at Time 1 and at Time 2
Almost the same percentage of parents reported the desire for counseling services (40%)

13. Recent Observations and Continuing Symptoms
Increasing in severity of clinical symptoms with extent of devastation, slowness of recovery and reality of losses
Difficulty concentrating, doing school work
Increase in fighting; risk taking behaviors
Increase in abuse, sexual exposure, domestic violence, stresses while living in trailers

14. Clinical Observations
Young children
(PreK through early school years)
Separation anxiety
Clinginess
Regression
Fears
Behavior problems
“If I had my old room back, I’d be good.”
5 year old

15. Clinical Observations
Elementary and Middle School
Behavior problems
Emotional dysregulation (mirroring environmental chaos)
High School
Avoidance
Depression
Suicidality
Learned helplessness
Anxiety
Aggression

16. Clinical Observations
Children with previous trauma are most likely to exhibit symptoms and be referred for services
The trauma of Hurricane Katrina and its aftermath has led to the resurfacing of previous traumas
The chaos and deprivation of the living environment following the hurricane has exacerbated the problems of daily living that many families face

17. Lessons Learned about Disaster Policy for Children and Families
Most children will be resilient- especially with support from adults
For prevention and intervention, it is crucial to build capacity and to provide intervention and supportive services in settings accessible to children and families (i.e. preschools, schools, community centers, clinics) to prevent short and long term negative effects

18. Lessons Learned about Children in Disasters
Children of all ages are likely to be traumatized by a disaster
Some behavioral and emotional reactions to trauma may be “normal” or represent a new “normal” with wide spread disaster and continuing anxiety
It is crucial to recognize & address, in culturally sensitive ways, mental health needs of children of all ages and their families after a major disaster

19. Lessons Learned About Children in Disasters
The need for a “national plan” that is implemented at local levels to meet the needs of children and families
Impact over time of long term devastation, slowness of recovery, economic loss, concerns about safety
Impact of children’s severe traumatic experiences at the time of the disaster

20. Lessons Learned about Disaster Response and Recovery
The importance of gathering data, using evolving knowledge in disaster response, rebuilding infrastructure, and providing evidence-based services
Importance of recognizing needs of treaters, volunteers, health and mental health professionals -- “compassion fatigue” and continual need for self care

21. Resilience Building Activities
Camp Carnival
Celebrating Halloween
October 2005
Youth Leadership Program Summer 2006

22. & WEBSITE