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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


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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

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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

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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

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  • 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.

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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 … ActivitiesWe 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

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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

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Reported increase in Student Behavior Problems Post-Katrina

  • Student verbal arguments, 76%

  • Physical fights, 64%

  • Truancy, 55%

  • Disruptive behavior, 43%

  • Reported parental conflict, 36%

  • Sexual promiscuity, 31%

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So… Post-Katrina

  • 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 Program Post-KatrinaAdolescent 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

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Special Health Considerations: Mental Health Post-Katrina

  • 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”

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Lessons LEARNED? …Not Yet! Post-Katrina

  • 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

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What else? Post-Katrina

  • 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