Operation Assist

Children’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 [email protected]

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”

OPERATION ASSIST

: Children’s 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

Rationale for Clinical MH Services

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& 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

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

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

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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.

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

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

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

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%

Negative Behaviors Among Students

100 80 60 40 20 0 M or e A rg um en ts M or e Fi gh ts M or e Tr ua nc y M or e C on du ct M D or O e P ar en t C on M or fli ct e S ex P ro m isc ui ty M or e W ea po ns Schools With Few Displaced Schools With Many Displaced

Perceived Needs Among SBHC Staff

80 60 40 20 0 P re v Sp ec ia lis t P sy ch ol og is t S W /L PC T ra in in g P ys ch ia R tri ef st C en te r-C hr on ic H an d O R ut ef s C en te r-A cu te Schools With Few Displaced Schools With Many Displaced

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

LA School-Based Health Center Training Program Adolescent 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

Special Health Considerations:

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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”

Lessons LEARNED? …Not Yet!

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Ensure access to a robust health care system & economic security

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Secure critical infrastructure

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Invest in relevant preparedness measures

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Learn from previous events

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Establish evidence-based preparedness protocols

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