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
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
SBHCs in Louisiana, Pre-Katrina
• Large school-based health center network
• 56 sites throughout the state
• ~ 42,000 enrolled students
In Louisiana, More Than Half of SBHCs Serve
Rural Communities
46
rural
54
urban
In Louisiana, 3/4 of SBHCs Serve Elementary
and Middle School Students
9
22
elementary
middle
mid-high
high
K-12
24
29
16
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
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
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
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
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
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
Evaluation: What Worked Best in the Training?
• Interactive and experiential sessions
• Group discussions
• Allowing time for self-reflection
• Focus on stress management
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
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
Increase in SBHC Patient volume
• 12% of all students in the 42 schools were hurricanedisplaced 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”
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%.
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
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Percent
Negative Behaviors Among Students
100
80
Schools
With Few
Displaced
60
40
20
0
Schools
With
Many
Displaced
Families Needed Concrete Services
• Mental health providers reported not being prepared to
respond to basic family needs
– Locating housing
– Food assistance
– Financial resources
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