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 Children of all ages were traumatized by the displacement, separation from family and friends, loss of homes & community The extent of traumatization relates to 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) Resilience (especially if parent or caretaker is emotionally available) Pleasure about returning to school and community Pleasure about returning to school and community Being with and communicating with friends is very important 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 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%) Age range from 1 to 19 Sex: Male (46%); Female (54%) Race: African-American (46%); Caucasian (44%); Hispanic (4%); Other (6%) 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 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 Used to identify children & provide feedback to schools for prevention, intervention, and services

6. Living Situation Since Hurricane Katrina (N=5,000) Living Situation Since Hurricane Katrina (N=5,000) Number of moves: Average = 3 Number of moves: Average = 3 Number of schools attended: Average=2 Number of schools attended: Average=2 Living situation 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 see hurricane-related damage 90% Did the child lose personal belongings?72% Did the child lose personal belongings?72% Did the child transfer to a new school? 68% Did the child transfer to a new school? 68% Was a parent unemployed?50% Was a parent unemployed?50% Was the child’s home destroyed?45% Was the child’s home destroyed?45% Was the child separated from a caregiver26% Was the child separated from a caregiver26%

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

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

10. 4 th – 12 th Grades Fall 2006 41% continue to meet NCTSN cut-off score for enhanced mental health services 41% continue to meet NCTSN cut-off score for enhanced mental health services 5% reported receiving mental health treatment since the storm 5% reported receiving mental health treatment since the storm 7% would like to have counseling services 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 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-3 rd grade 787 children, PreK-3 rd grade 55% Caucasian, 37% African American, 3% Hispanic 55% Caucasian, 37% African American, 3% Hispanic One Parent unemployed – 77-80% One Parent unemployed – 77-80% Meets cut-off for referral-32% Meets cut-off for referral-32% 44% of parents reported wanting counseling services 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 3 rd grade 184 parents completed Time 1 and Time 2 surveys regarding their children 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%) 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 Increasing in severity of clinical symptoms with extent of devastation, slowness of recovery and reality of losses Difficulty concentrating, doing school work Difficulty concentrating, doing school work Increase in fighting; risk taking behaviors Increase in fighting; risk taking behaviors Increase in abuse, sexual exposure, domestic violence, stresses while living in trailers Increase in abuse, sexual exposure, domestic violence, stresses while living in trailers

14. Clinical Observations Young children 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 5 year old

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

16. Clinical Observations Children with previous trauma are most likely to exhibit symptoms and be referred for services 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 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 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 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 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 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 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 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 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 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 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 Camp Carnival Celebrating Halloween Celebrating Halloween October 2005 October 2005 Youth Leadership Program Summer 2006 Youth Leadership Program Summer 2006

22. EMAIL & WEBSITE WWW.FUTUREUNLIMITED.ORG WWW.FUTUREUNLIMITED.ORG WWW.FUTUREUNLIMITED.ORG JOSOFS@LSUHSC.EDU JOSOFS@LSUHSC.EDU