Promoting Recovery and Providing Trauma Treatment for Students and Their Families After Hurricane Katrina

On August 29, 2005, Hurricane Katrina devastated St. Bernard Parish, located southeast of New Orleans. The parish was hit first with the storm surge and winds and then with flooding from breached levees and flood walls. Virtually every home, church, and business was destroyed or damaged by heavy winds, rain, flooding, and a toxic oil spill that was mixed with the floodwaters. The population was dispersed and slowly returned over the ensuing months as the floodwaters receded. Most residents who returned lived in trailers, often with no water or electricity.

Despite being hit by the greatest national disaster in U.S. history, the St. Bernard Parish Public School System reopened in November 2005, thanks to the courageous leadership of the school superintendent and administration. Initially, only one temporary structure served as a school for 365 students, all of whom were living after the storm in trailers or commuting hours to get to the school. Most of the parish did not have infrastructure, and the school became "home" to many St. Bernard families and teachers, who lived in trailers on the school's parking lot for months until their homes could be repaired.

The administration of the public school system quickly realized the crucial need for mental health services, which led to the collaboration between the St. Bernard Parish Public School System and the Department of Psychiatry at the Louisiana State University Health Sciences Center (LSUHSC). It was this partnership that created the St. Bernard Family Resiliency Project (SBFRP).

The SBFRP recognized that mental health support could go hand in hand with the education system, which offered a broad, established network to assist with the trauma that all families (and school personnel) had experienced. Integrating mental health care in the schools minimized the stigma of getting care and facilitated acceptance of the interventions by the community. And the use of a strength-based approach allowed the SBFRP to address and support individual, family, and community postdisaster mental health and personal growth. Along with mental health support, the SBFRP trained teachers, administrators, and parents about trauma, the effects of trauma on children and families, and the importance of self-care.

The LSUHSC Department of Psychiatry was ideally suited for the role of assisting in the recovery of this devastated area. For many years, the department's trauma team (consisting of a child psychiatrist, psychologist, and social worker) had worked with children who were traumatized by domestic violence. The trauma team was also a member of the National Child Traumatic Stress Network (NCTSN). After Hurricane Katrina, clinicians from the LSUHSC Department of Psychiatry played key roles in providing leadership for Louisiana Spirit Hurricane Recovery (a federally funded crisis counseling assistance and training program), working with the NCTSN through its Louisiana Rural Trauma Services Center, and developing innovative prevention and intervention models for schools, children, and families. As such, they were well-positioned to respond immediately to St. Bernard Parish's urgent needs.

Thanks to the SBFRP, returning area residents were able to get the help that was desperately needed. The program provided critically needed behavioral health services for children and families of St. Bernard Parish who were returning home and rebuilding, and it continues to serve the community today, as the number of schools in the parish has grown from one to 11.

In recognition of successfully integrating mental health services into the school system and promoting resiliency and recovery in order to help children and families affected by Hurricane Katrina, the SBFRP was selected to receive an APA Gold Achievement Award in the category of academic or institutionally based programs. In the category of community-based programs, the program selected for a Gold Award is described on page 1042. Each Gold Award recipient will receive a plaque and a $10,000 prize made possible by a grant from Pfizer, Inc., on October 14 at the Institute of Psychiatric Services in Boston.

A school-based system of care

The program was funded through Baptist Community Ministries, a New Orleans-based foundation. In spring 2006, the foundation provided a three-year grant of $400,000 for the SBFRP that allowed the LSUHSC trauma team to work collaboratively with the St. Bernard Parish Public School System. And in 2010, the SBFRP received continued funding of $230,000 for a two-year grant. These funds have allowed the program to grow and provide schools and the community the help that they need.

The SBFRP is staffed with 3.5 full-time-equivalent mental health professionals. Also supporting the program are senior members of the LSU faculty, who serve on the school board and on key school committees. The program encourages continuous feedback from students, teachers, and administrators, and the SBFRP is served by an advisory council staffed by students and parents who offer suggestions for improvement of the program.

Every year in collaboration with the schools, the SBFRP provides a mental health screening. For children identified as having mental health needs, further evaluations are done, and if needed or requested, services are provided or referrals are made. SBFRP also provides evidence-based trauma training for teachers, administrators, and parents, teaching them how trauma affects children and teens. In addition, the program offers psychiatric medication management services at C. F. Rowley Alternative School (a school for high-risk students whose emotional and behavioral problems compromise their ability to learn) and assists with the Youth Leadership Program, a community service program that builds on students' strengths and encourages recovery.

Mental health screening and assessment

All students in prekindergarten to 12th grade are assessed annually for their need for mental health services. The NCTSN Hurricane and Assessment Referral Tool is used for screening purposes. The assessment is administered confidentially but not anonymously, so that LSUHSC faculty in collaboration with the schools can provide further evaluation for students in need.

According to test results, the percentage of children needing mental health services has steadily declined each year: from 47% in 2005–2006, to 39% in 2006–2007, to 35% in 2007–2008, to 24% in 2008–2009, to 23% in 2009–2010. Posttraumatic stress disorder (PTSD) and depression were the most common conditions seen, and the proportion of students with these disorders has decreased consistently over time; however, the number of students who are in need of mental health services remains significant. In all, 11,424 screening assessments have been administered to 6,502 students, and 2,968 students have been referred for further evaluation.

Direct services

Behavioral health services provided through the SBFRP include individual, group, and family therapy, along with specialized techniques recommended by NCTSN and the Substance Abuse and Mental Health Services Administration. These services include trauma-focused cognitive-behavioral therapy, Cognitive-Behavioral Intervention for Trauma in Schools, Strength After Trauma Group, and child psychiatry evaluations and management, with special attention to the children at C. F. Rowley Alternative School.

SBFRP services also include developmentally specific, evidence-based training and consultations for teachers, administrators, and parents to help them learn about the signs of trauma among children aged 0 to 17 years. Specifically, teachers and administrators are provided with training and information on addressing trauma symptoms and resultant behaviors, strength-enhancing behavior, evidence-based services, and referring youths for mental health services. Parents receive information and support sessions focusing on identification of trauma signs and symptoms, self-care, and ways to help themselves and their children. Training sessions allow school personnel and parents to be more attuned to "red flags" and to be better able to intervene and seek help when needed. SBFRP services assist the St. Bernard community in decreasing the maladaptation that persists from a disaster of this magnitude and in enhancing growth-promoting patterns of resilience and recovery.

More than 800 parents and school personnel have participated in trauma training, and more than 200 students with complex needs have received long-term individual and group treatment. After youths received treatment, their trauma and PTSD symptoms decreased significantly.

C. F. Rowley Alternative School services

The C. F. Rowley Alternative School currently serves 123 students from sixth to 12th grade whose needs cannot be met in a mainstream, special education, or vocational school because of emotional or behavioral problems. SBFRP on-site evaluations and services, as described above, have become an integral, supportive part of the C. F. Rowley Alternative School environment. In addition to the evidenced-based therapeutic interventions, psychiatric and medication management services assist in addressing the many biopsychosocial etiologies that lead to placement in alternative schools. Here, SBFRP services focus on providing screening, behavioral health evaluations, and treatment and on promoting adaptive patterns and successful return to regular schools. A total of 127 Rowley students have received a total of 701 treatment sessions (mean of 5.52 sessions per student). As a result of these interventions, many students were able to successfully return to their mainstream school. The school's administration also reported an improved academic climate and fewer disruptive behaviors.

Youth Leadership Program

An important lesson learned since Hurricane Katrina is the importance of a strength-based approach to aid recovery and future growth. The aim of the Youth Leadership Program, developed collaboratively with the St. Bernard Parish Public School System, is to build on the students' strengths and improve their resilience and self-efficacy in order to support individual growth and active contributions to schools and the community. Recent Youth Leadership Program projects include volunteer activities in the community, rebuilding homes with other volunteers, planting trees, and peer substance abuse education and prevention. The diverse group of students in the initial program (including school dropouts) continues to demonstrate increases in self-efficacy, a major component of resilience.

A model program

The SBFRP has demonstrated that its innovative approach of providing mental health care within the school system, stressing strengths, and focusing on building and maintaining supportive relationships is a highly effective intervention that can be used as a national model. In addition, given the extent of the devastation and the complexity of recovery seen in this parish, the many successes of the SBFRP can be used as an opportunity to learn more about recovery and continuing symptomatology among children, adolescents, and families.

Recognition

The LSUHSC Department of Psychiatry has a long history of providing quality mental health care to the children and families of Louisiana and working collaboratively in schools. On the basis of these efforts, Howard Osofsky, M.D., Ph.D., chairman of the LSUHSC Department of Psychiatry, and Joy Osofsky, Ph.D., professor of pediatrics and psychiatry at LSUHSC, were awarded special commendation by the St. Bernard Parish School Board. In 2009, the LSUHSC Department of Psychiatry received the Distinguished Partners in Education Award by the Board of Elementary and Secondary Education of the State Department of Education for its work in schools after Hurricane Katrina. The St. Bernard Parish Public School System was also recognized for its improvement in LEAP scores (a standardized test for advancement) after Hurricane Katrina. This amazing achievement was accomplished while homes and schools were being rebuilt and school supplies were scarce.

Conclusions

The SBFRP arose at a time when there was chaos and uncertainty after Hurricane Katrina in order to help persons who experienced catastrophic losses. The efforts of the SBFRP have been essential in promoting recovery, resiliency, and long-term growth. However, the program is still needed. The children and adolescents of St. Bernard Parish and their parents were making steady progress in their recovery from Hurricane Katrina until the Deepwater Horizon oil spill in April 2010. The SBFRP is now assisting the community in dealing with this catastrophe, the lingering effects of recurrent hurricanes, destruction of property and habitats, and fears of toxic exposure.

For more information, contact Howard J. Osofsky, M.D., Ph.D., director of SBFRP, at LSUHSC Department of Psychiatry, 1542 Tulane Ave., 2nd Floor, New Orleans, LA 70112 (e-mail: [email protected]).