1. Mental health needs in Louisiana schools following Hurricane Katrina Academy Health June 3, 2007 Paula A. Madrid, Psy.D. Director, The Resiliency Program National Center for Disaster Preparedness Mailman School of Public Health pam2109@columbia.edu Roy Grant, M.A. Director of Research Children's Health Fund rgrant@chfund.org

2. 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

3. SBHCs in Louisiana, Pre-Katrina Large school-based health center network 56 sites throughout the state ~ 42,000 enrolled students

4. In Louisiana, More Than Half of SBHCs Serve Rural Communities

5. In Louisiana, 3/4 of SBHCs Serve Elementary and Middle School Students

6. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. Evaluation: What Worked Best in the Training? Interactive and experiential sessions Group discussions Allowing time for self-reflection Focus on stress management

14. 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

15. 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

16. 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”

17. 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%.

18. 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

20. Families Needed Concrete Services Mental health providers reported not being prepared to respond to basic family needs –Locating housing –Food assistance –Financial resources

21. 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