Mental Health Services Post Hurricane Katrina:

1
Operation AssistChildrens Health Fund and the
National Center for Disaster Preparedness at
Columbia University

• Mental Health Services Post Hurricane Katrina
• The Community Support and Resiliency Program
• Rosalynn Carter Symposium on Mental Health Policy
• Nov. 8-9, 2006
• Paula A. Madrid, Psy.D.
• Director, Operation Assist - Mental Health
  Services
• Associate Research Scientist, Department of
  Population and Family Health
• Mailman School of Public Health - Columbia
  University
• pam2109_at_columbia.edu

2
Early Stages of Mental Health Services

• NCDP meeting. What can we do? How can we help?
• Houston Astrodome (Reliant Park and George R.
  Brown Center)
• Rotating in mental health providers from our
  National Network to work on MMU
• Focus groups in Lafayette and meetings in Baton
  Rouge, NOLA, and Gulfport/Biloxi (MS) to assess
  needs and areas for rapid intervention
• Order Mental Health Mobile Unit Community
  Support and Resilience Program

3
(No Transcript)
4
OPERATION ASSIST Childrens Health Fund and the
National Center for Disaster Preparedness at
Columbia University

• Clinical Response
• Disaster-oriented primary care on
  state-of-the-art mobile clinics
• Mental health services
• Advanced communications electronic data
  collection
• Working with local officials and providers
• Short and long-term objectives

• Public Health Agenda
• Survey/document medical mental health needs
• Environmental assessment
• Household re-entry guidance
• Evaluation of preparedness and response issues
• Collaborate with local, state, federal officials
• Partner with Tulane, LSU

5
(No Transcript)
6
Rationale for Clinical MH Services Model

• Based on successful 9/11 program
• Informed by Research and Marist Data
• Culturally appropriate interventions
• Staff Diversity
• Professional and Staff Training and Support
• Case Management Referrals
• Flexible and Relevant Services

7
ADAPT MODEL Adaptation and Development after
Persecution and Trauma- (Silove, D., 1999)

• Key psychosocial domains that are threatened by
  disasters
• Security and safety
• Interpersonal bonds
• Networks
• Protection from continued threat
• Mental Health Areas of Focus
• Key identities and roles
• Institutions that confer cultural meaning
• Coherence traditions, religion, spiritual
  practices, political and social participation

8
Currently.

• The Mississippi Gulf Coast Childrens Health
  Project in Biloxi/Gulfport, MS Health Partner
  Coastal Family Health Center, Inc.
• The Baton Rouge Childrens Health Project in
  Baton Rouge, LA Health Partner Louisiana State
  University, Health Sciences Center School of
  Medicine
• The New Orleans Childrens Health Project in New
  Orleans, LA Health Partner Tulane University
  School of Medicine

9
Community Support and Resiliency Program (CSRP)

• To meet the widespread, long-term, post-Katrina
  mental health needs of children and their
  families.
• Traumatized children are especially vulnerable to
  medical and mental health difficulties.
• It is essential to help parents through
  psychoeducation, stress management and direct
  counseling.
• Clinical- goal is to treat symptoms, help
  individuals process their traumatic experiences,
  foster resilience and empowerment.
• Public Health Goal-add to mental health
  infrastructure by providing training, support and
  resources for professionals.

10
Community Support and Resiliency Program-
Clinical Activities

• Intervention strategies based on mental status
  and comprehensive needs assessment.
• Direct services
• Individual, Family, and Group
• Parent support
• Modalities can include play therapy, art therapy
  and traditional psychotherapy
• Case management, Testing Psychiatric
  consultations
• Training and support to other providers
• Culturally Relevant Interventions
• Services take place on Community Support Unit

11
(No Transcript)
12
(No Transcript)
13
Coping Boxes We all need a tool box of
coping skills and resources that we can draw upon
when in need

• Boxes containing toys and other transitional
  objects and materials considered to have
  potential therapeutic value to children.
• Children (ages 6-11 years old)
• Offers a tangible way to self-sooth
• Encourage projective play
• Encourages discussion about coping
• Enhance resilience (within a therapeutic
  environment)
• Disaster Preparedness tools
• FUN

14
SBHC Survey Mental Health Needs of Students 6
Months Post-Katrina

• Fall, 2005-February 2006 Design of SBHC survey
  instrument
• February-March 2006 Survey instrument
  distributed to 43 SBHCs
• Responses from 42 SBHCs
• Data coded for input to Excel and analyzed in
  EpiInfo
• Comparisons made between schools with more or
  fewer displaced students

15
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

16
(No Transcript)
17
(No Transcript)
18
So

• SBHCs can be an important resource in meeting
  student needs following a disaster
• Staff 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
• Sustained efforts are required to ensure that the
  availability of services meets the increased
  level of need following a disaster

19
LA School-Based Health Center Training
ProgramAdolescent School Health
Initiative/Office of Public Health- Operation
Assist __________________________________________
__________________________________________________
_____

• There are 55 SBHCs in Louisiana providing
  services to nearly 50,000 students.
• Many children served by SBHCs traumatized,
  underserved, at risk.
• Enhance the capacity of SBHCs MHP to serve
  children, adolescents and their families.
• Opportunity for peer support and consultation
  among MH professionals.
• Already trained over 300 providers
• Recently begun a series of monthly trainings in 6
  different cities in LA

20
(No Transcript)
21
Special Health Considerations Mental Health

• Identify children with pre-Katrina concerns
• Early screening
• Determine and provide appropriate intervention
• Build Resilience!
• Pay attention to trigger moments
• Understand/ minimize educational problems
• Care for caregivers
• Understand Culture
• Study how to encourage posttraumatic growth
• Understanding how to best care for impacted
  populations
• these are extremely urgent issues diagnosis,
  support and establish normalcy

22
Lessons LEARNED? Not Yet!

• Ensure access to a robust health care system
  economic security
• Secure critical infrastructure
• Invest in relevant preparedness measures
• Learn from previous events
• Establish evidence-based preparedness protocols

23
What else?

• Provide Training Incentives for ethnically
  diverse MH Providers
• Access to training on Trauma Treatment
• Mental Health Competencies for Delivery of
  Services post-trauma
• Care for Caregivers to prevent Compassion Fatigue