Operation Assist Children’s Health Fund and the National Center for Disaster Preparedness at Columbia University

1. Operation AssistChildren’s 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@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”

4. 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 OPERATION ASSIST:Children’s Health Fund and the National Center for Disaster Preparedness at Columbia University

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 Children’s Health Project in Biloxi/Gulfport, MS Health Partner: Coastal Family Health Center, Inc. • The Baton Rouge Children’s Health Project in Baton Rouge, LA Health Partner: Louisiana State University, Health Sciences Center School of Medicine • The New Orleans Children’s 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

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%

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 SBHC’s in Louisiana providing services to nearly 50,000 students. • Many children served by SBHCs – traumatized, underserved, at risk. • Enhance the capacity of SBHC’s 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

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