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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

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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

early stages of mental health services
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”
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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
rationale for clinical mh services model
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
adapt model adaptation and development after persecution and trauma silove d 1999
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
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
community support and resiliency program csrp
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
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
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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
sbhc survey mental health needs of students 6 months post katrina
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
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%
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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
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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
special health considerations mental health
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”

lessons learned not yet
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
what else
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