Mental Health Services Post Hurricane Katrina: The Community Support and Resiliency Program

Rosalynn Carter Symposium on Mental Health PolicyNov. 8-9, 2006

Paula A. Madrid, Psy.D.Director, Operation Assist - Mental Health ServicesAssociate Research Scientist, Department of Population and Family Health Mailman School of Public Health - Columbia Universitypam2109@columbia.edu

Operation AssistChildren’s Health Fund and the National Center for Disaster

Preparedness at Columbia University

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 Community Support and Resilience Program”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 & 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

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

FUN

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

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SchoolsWith FewDisplaced

SchoolsWithManyDisplaced

Perceived Needs Among SBHC Staff

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Schools WithManyDisplaced

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 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 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! 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?

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