Psychological Risk & Resiliency: Children’s Adjustment Post-Katrina

1. Psychological Risk & Resiliency:Children’s Adjustment Post-Katrina Mary Lou Kelley, Ph.D. USPHS Scientific & Training Symposium June 21, 2011 Presented by the National Center for the Study of Coastal Hazards, A Department of Homeland Security Science and Technology Center of Excellence. This material is based upon work supported by the U.S. Department of Homeland Security under Award Number: 2008-ST-061-ND0001. The views and conclusions contained in this document are those of the authors and should not be interpreted as necessarily representing the official policies, either expressed or implied, of the US Department of Homeland Security.

2. Hurricane Katrina August 29, 2005 Levee breach flooded 80% of the city 1000 lives were lost 500,000 homes were destroyed Families lost homes, possessions, social support, and schools

3. Short-Term Distress Short-Term Mental Disorders Persistent Psychological Disorders Disaster-Related Mental Health Impact Number of Affected Individuals Greater MildTransitory Distress Fewer

4. Predicting PTSD in Children Post-Katrina: A Longitudinal Analysis Introduction Factors Related to Negative Outcomes in Children Post-Disaster • Degree of Disaster Exposure (loss and threat) • Female Gender • Pre-Disaster Anxiety • Low Socioeconomic Status • Parent PTSD symptoms • Parent Psychopathology

5. Predicting PTSD in Children Post-Katrina: A Longitudinal Analysis Limitations of the Research • Minimal focus on parenting behavior • Minimal focus on contextual variables • Lack of longitudinal studies • Use of measures with inadequate psychometric support • Limited treatment outcome studies

6. Predicting PTSD in Children Post-Katrina: A Longitudinal Analysis Purpose • To evaluate the adjustment of children and their mothers post-Katrina over a two year time span. • To examine variables impacting children from a family and community perspective. 3. To examine the effect of parent distress and lack of social support on parenting behavior and children’s PTSD symptom severity. Kelley, M.L., Self-Brown, S., Le, B., Vigna, J.F., Hernandez, B. C., & Gordon, A.T. (2010). Predicting Post- Traumatic Stress Symptoms in Children Following Hurricane Katrina: A Longitudinal Analysis of Child and Family Variables. Journal of Traumatic Stress.

8. Diagnostic Criteria for PTSD Must present with at least: • 3 Symptoms of Avoidance • Avoidance of places or persons, and feelings of detachment • 2 Symptoms of Arousal • Sleep problems, irritability, or outbursts of anger • 1 Re-experiencing Symptom • Recurring distressful recollection and/or dreams

9. Predicting PTSD in Children Post-Katrina: A Longitudinal Analysis Participants 381 Katrina affected mother-child dyads from New Orleans and surrounding parishes. The majority were from New Orleans and 74% were displaced by the storm. Sample primarily African American (68%) with 24% Caucasian and 8% other ethnicities. Average reported household income was under $25,000.

10. Predicting PTSD in Children Post-Katrina: A Longitudinal Analysis Procedure Participants were solicited from six reopened schools that served the entire parish. Children brought home flyers asking for participation and parent consent. Children completed questionnaires at their schools under the supervision of researchers. Parents completed questionnaires at home and returned them by mail. Families were compensated for participation.

11. Predicting PTSD in Children Post-Katrina: A Longitudinal Analysis Child Measures • Hurricane Threat and Loss (HURTE) • Community Violence Exposure (SAVE) • PTSD (UCLA PTSD Reaction Index) Mother Measures • Negative Coping (Brief Cope) • Social Support (ISEL) • Global Distress (SCL-90, Global Distress Index) Parenting Measures • Corporal Punishment (Alabama Parenting Questionnaire) • Family Routines (Family Routine Questionnaire)

13. Predicting PTSD in Children Post-Katrina: A Longitudinal Analysis • Exogenous Variables (Hurricane and Violence Exposure) equally predictive of child PTSD. • Exogenous Variables indirectly associated with higher levels of PTSD at T1 through the parenting distress and parenting variables. • Low Social Support and Negative Coping predicted parent distress. • Parent Distress positively related to corporal punishment and routines. • Parents’ use of Corporal Punishment predicted child PTSD at T1 & T2. • Children with severe PTSD symptoms at T1, 12 times more likely to have severe PTSD at T2. 13% had severe PTSD symptoms at T1.

14. Predicting PTSD in Children Post-Katrina: A Longitudinal Analysis Public Health Implications • Findings indicate that parents’ maladaptive coping is related to negative parenting and exacerbates risk for psychopathology. Screen for distress and negative coping soon but not immediately after a disaster. • Routines employed by distressed parents may be implemented more harshly or differently than non-distressed parents. The recommendation to reestablish routines to aid in disaster recovery may need to be looked at more closely.

15. Predicting PTSD in Children Post-Katrina: A Longitudinal Analysis Public Health Implications • Parents who reported less social support and use of negative coping had more psychological distress. Re-establishing social support systems should be a paramount priority for aiding disaster victims. • Children with significant PTSD symptoms several months after a disaster were 12 times more likely to have significant symptoms one year later. Screen for PTSD symptoms several months after a disaster and offer treatment to those with significant symptoms.

16. Adapting well in the face of adversity or trauma: • Positive outcome despite high risk status • Sustained functioning under threat • Recovery from trauma Multidimensional, dynamic construct: • Displayed in one environment but not another • Displayed in one psychological domain but not another Sources: (American Psychological Association; Luthar & Crachetti, 2000;Masten, Best, & Garmezy, 1990; O’Donnell, Schwab-Stone, & Muyeed, 2002; Watson et al., 2006) • Psychological Resiliency

17. Positive Adjustment in Youth Post-Katrina: Impact of Child & Maternal Social Support and Coping Background Lack of research on children’s post-disaster positive adjustment Positive adjustment: Possessing attributes such as interpersonal skills, self-reliance, and self-esteem Maternal and child coping and social support related to adjustment in non-disaster literature and act as buffers against PTSD symptom severity post-disaster Purpose To examine possible predictors of positive adjustment post-Katrina, emphasizing personal and maternal factors Vigna, J. F., Hernandez, B. C., Paasch, V., Gordon, A.T., & Kelley, M. L. (2009). Positive Adjustment in Youth Post-Katrina: The Impact of Child and Maternal Social Support and Coping. K. E. Cherry (Ed), Lifespan Perspectives on Natural Disasters: Coping with Katrina, Rita and other Storms.  NY: Springer. Vigna, J. F., Hernandez, B. C., Paasch, V., Gordon, A.T., & Kelley, M. L. (2009). Positive Adjustment in Youth Post-Katrina: The Impact of Child and Maternal Social Support and Coping. K. E. Cherry (Ed), Lifespan Perspectives on Natural Disasters: Coping with Katrina, Rita and other Storms.  NY: Springer.

18. Positive Adjustment in Youth Post-Katrina: Impact of Child & Maternal Social Support and Coping Hypotheses Heightened hurricane and violence exposure will predict fewer positive outcomes Children’s positive coping strategies will predict greater positive adjustment; negative coping strategies will predict less positive adjustment Mothers reporting greater social support will have children with greater positive adjustment Mothers using positive coping strategies will have children with greater positive adjustment

19. Positive Adjustment in Youth Post-Katrina: Impact of Child & Maternal Social Support and Coping Participants 142 mother-child dyads from Orleans, Jefferson, and EBR parishes (Mean child age = 11.67 years; 58% female; 59% African American) Procedure Youth completed measures of hurricane (HURTE) and community violence exposure (SAVE) 3 – 7 months post-Katrina. Youth completed measures of social support (SSSC), coping (YCRI), and positive adjustment (BASC-2) 25 – 28 months post-Katrina. Parents completed measures of social support (ISEL), coping (COPE), and their perception of their children’s positive adjustment (BASC-2) 25 -28 months post-Katrina.

20. Positive Adjustment in Youth Post-Katrina: Impact of Child & Maternal Social Support and Coping Results Hurricane-related life-threatening experiences were positively related to positive adjustment Parent-provided social support was the strongest predictor of child-reported positive adjustment Coping style using Diversion (re-establishing routines, alternate activities, and spirituality) was the second strongest predictor of positive adjustment 4. Destructive coping negatively predicted positive adjustment 5. Ameliorative coping was not associated with positive outcomes

21. Positive Adjustment in Youth Post-Katrina: Impact of Child & Maternal Social Support and Coping Conclusions Parent support is paramount in youths’ positive adjustment post-disaster. Programming should emphasize to parents their critical role in determining their children’s long-term adjustment in times of crisis. Providing children distracting activities may be integral to post- disaster adjustment. Problem-focused coping may not be helpful to children in situations in which they cannot control the outcome.

22. Psychological Risk & Resiliency:Children’s Adjustment Post-Katrina Thank you! Mary Lou Kelley, Ph.D. 236 Audubon Hall Department of Psychology Louisiana State University Baton Rouge LA 70803 mkelley@lsu.edu