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Osofsky, Ph.D. Howard J. Osofsky, M.D., Ph.D. Louisiana Spirit Louisiana Rural Trauma Services Center (NCTSN) Carter Symposium on Mental Health November 8, 2006ĄB¨P5/3óv[Ÿ¨#Understanding Children in DisastersĄ$$Ÿ¨8Children of all ages were traumatized by the displacement, separation from family and friends, loss of homes & community The extent of traumatization relates to direct traumatic experience age and vulnerability of the child amount of support from family, school, and community previous trauma and loss history Ą<˘–˘–އ¤óR>Ÿ¨FObservations of Children returning to heavily impacted areas-PositivesĄGG(Ÿ¨ś Resilience (especially if parent or caretaker is emotionally available) Pleasure about returning to school and community Being with and communicating with friends is very importantĄ&ˇ˙˙ţó}aŸ¨Screening Children Post KatrinaĄ  Ÿ¨Since November 2005, LSUHSC, in collaboration with schools, has screened over 7,000 children on their experiences & feelings about Hurricane Katrina Age range from 1 to 19 Sex: Male (46%); Female (54%) Race: African-American (46%); Caucasian (44%); Hispanic (4%); Other (6%)Ą"—‚"ó~bŸ¨*NCTSN Hurricane Screen- Modified by LSUHSCĄ++Ÿ¨ĎChildren are surveyed using an adaptation of the NCTSN Hurricane Screening Tool for Children and Adolescents Used to identify children & provide feedback to schools for prevention, intervention, and servicesócŸ¨4 Living Situation Since Hurricane Katrina (N=5,000) Ą53(Ÿ¨ćNumber of moves: Average = 3 Number of schools attended: Average=2 Living situation 41% in own house; 27% in trailer; 20% in a new home/apartment; 12% at home of relative or friend; 1.3% reported living in a hotel or shelter. ĄVU‘U  "   ó€dŸ¨Traumatic Experiences Ą$Ÿ ň Did the child see hurricane-related damage 90% Did the child lose personal belongings? 72% Did the child transfer to a new school? 68% Was a parent unemployed? 50% Was the child s home destroyed? 45% Was the child separated from a caregiver 26%Ą ú ů"óeŸ¨Traumatic Experiences Ą$Ÿ¨Î Did the child live in a crowded shelter 18% Were family members or friends injured 16% Were family members or friends killed 12% Did the child witness injury? 12% Did the child witness death? 2.4% Ą6Ď"#,""Ą ó‚fŸ¨/Need for Mental Health Services- 4th-12th gradeĄ80"Ÿ¨49% of children in Spring 2006 sample met cut-off criteria for consideration for mental health referral 13% requested counseling 37% reported experiencing previous loss or trauma (placing them at higher risk) Over 30% endorsed feeling depressed or reported posttraumatic stress symptomsóƒgŸ 64th  12th Grades Fall 2006Ą8Ÿ¨I41% continue to meet NCTSN cut-off score for enhanced mental health services 5% reported receiving mental health treatment since the storm 7% would like to have counseling services Compared to this time last year (2-3 months following the hurricane), 52% reported feeling better; 37% feeling the same, and 11 % feeling worse Ą0FZZZJó„hŸ¨>Spring 2006 NCTSN Screen for Younger Children (parent report)Ą*?-((Ÿ €787 children, PreK-3rd grade 55% Caucasian, 37% African American, 3% Hispanic One Parent unemployed  77-80% Meets cut-off for referral-32% 44% of parents reported wanting counseling services Ą$ÁŤó†jŸ Preliminary Data on Matching Sample COMPARISON (3-5 MONTHS POST KATRINA VS 14  15 MONTHS POST KATRINA) PreK through 3rd grade Ąff" "    "ŞhŸ¨4 184 parents completed Time 1 and Time 2 surveys regarding their children There was no significant difference between percentage of children meeting the cut-off for further mental health services at Time 1 and at Time 2 Almost the same percentage of parents reported the desire for counseling services (40%) ĄfZIZ’ZYZI’X""  óŸ¨+Recent Observations and Continuing SymptomsŸ¨#Increasing in severity of clinical symptoms with extent of devastation, slowness of recovery and reality of losses Difficulty concentrating, doing school work Increase in fighting; risk taking behaviors Increase in abuse, sexual exposure, domestic violence, stresses while living in trailersĄ$$óx]Ÿ¨Clinical ObservationsĄ6Ÿ VYoung children (PreK through early school years) Separation anxiety Clinginess Regression Fears Behavior problems  If I had my old room back, I d be good. 5 year old Ąp#B* #C*  Ş–óy^Ÿ¨Clinical ObservationsĄ6Ÿ¨źElementary and Middle School Behavior problems Emotional dysregulation (mirroring environmental chaos) High School Avoidance Depression Suicidality Learned helplessness Anxiety AggressionĄtJ "J "Ş,9 B *óz_Ÿ¨Clinical ObservationsĄ6Ÿ¨PChildren with previous trauma are most likely to exhibit symptoms and be referred for services The trauma of Hurricane Katrina and its aftermath has led to the resurfacing of previous traumas The chaos and deprivation of the living environment following the hurricane has exacerbated the problems of daily living that many families faceĄ&_ň_ňó|`Ÿ¨?Lessons Learned about Disaster Policy for Children and FamiliesĄ@@(Ÿ¨RMost children will be resilient- especially with support from adults For prevention and intervention, it is crucial to build capacity and to provide intervention and supportive services in settings accessible to children and families (i.e. preschools, schools, community centers, clinics) to prevent short and long term negative effectsĄ,SwC˙˙ţ™óS?Ÿ¨+Lessons Learned about Children in DisastersĄ,,Ÿ ŇChildren of all ages are likely to be traumatized by a disaster Some behavioral and emotional reactions to trauma may be  normal or represent a new  normal with wide spread disaster and continuing anxiety It is crucial to recognize & address, in culturally sensitive ways, mental health needs of children of all ages and their families after a major disasterĄjZjóP<Ÿ¨,Lessons Learned About Children in Disasters Ą--Ÿ DThe need for a  national plan that is implemented at local levels to meet the needs of children and families Impact over time of long term devastation, slowness of recovery, economic loss, concerns about safety Impact of children s severe traumatic experiences at the time of the disasterĄ<#Z' ˙˙ţ˙˙ţáóQ=Ÿ¨4Lessons Learned about Disaster Response and RecoveryĄ55(Ÿ \The importance of gathering data, using evolving knowledge in disaster response, rebuilding infrastructure, and providing evidence-based services Importance of recognizing needs of treaters, volunteers, health and mental health professionals --  compassion fatigue and continual need for self care ĄH-“šŞśqó“wŸ¨Resilience Building ActivitiesĄŸ¨WCamp Carnival Celebrating Halloween October 2005 Youth Leadership Program Summer 2006Ą*$%X(ó’vŸ¨EMAIL & WEBSITEĄŸ¨+ WWW.FU91ĘÓĆľREUNLIMITED.ORG JOSOFS@LSUHSC.EDUĄ,,'ňósJ0ßęř.ď 0`đ r˙˙˙˝77˙Ě˙fĚ3÷Ě/ÇĆą`đ f˙˙˙™ęęęfĚ˙f˙˙˙̙Ě`đ K–˙˙˙fĚÍ×ߙ™˙xPşĚ˙–ł`đ 7_/˙˙˙U†<ŃďłĚfŽŹf´ďřöŹ`đ Hgh˙˙˙X€sÝÝÝ3Ě̈q̙¨¨¨`đ WXc˙˙˙klu˙˙Ěgti~^éçÓ¤O`đ ÄÖžďűđ3™fÝÝÝĚ˙™™3f`đ ÖÚä˙˙˙™żŢăŔŔŔ33Ě^“É`đ ÂŔşJ%ôôěx…iáßÁĽ§Żœ˜ff3Ł>˙ý?" dd@˙˙ď˙˙˙˙˙˙,Ł¤˙ý?nFdŘ@˙˙ď˙˙˙˙˙˙ ú dÔ únFĐ@ú dđ`únF€ Łn˙ý?" d˙d@˙˙ď˙˙˙˙˙˙   @@``€€PŁP   @ ` €`Ł pŁ>€Ł> Ŕđ¸pđÜđPđ( đ đÜđ6 đT đ~ŕ đÜ đˆ"ńżđ~ŕđ đÜ c đÄB@CW DEÁFÁ"€ƒ‹Ś˙ŒdŽ—Áœ@ż˙ ˆđ˙W @W @W W @ŹŹŹŹŹŹ`€"ńżđ.‰~ŕđ đÜ c đÄB,CW DEÁFÁ"€ƒ‹ŒdŽ—Áœ@ż˙ ˆđ˙W ,W ,@ŹŹŹŹŹŹ`€"ńżđ‰.ŕđž đ\ đ~ŕ đÜ đˆ"ńżđ~ŕđ đÜ c đÄB CˇDEÁFÁ"€ƒ‹ŒŽ—Áœ@ż˙ˆđ˙ ˇ ˇ @ŹŹŹŹŹŹ`€"ńżđ(4ťđ đÜ c đÄB C‰ DEÁFÁ"€ƒ‹ŒdŽ—Áœ@ż˙ˆđ˙‰ ‰ ‰ ‰ @ŹŹŹŹŹŹ`€"ńżđ(W4ŕđ đÜ c đÄBtC DEÁFÁ"€ƒ‹Ś˙ŒdŽ—Áœ@ż˙ˆđ˙t t tt@ŹŹŹŹŹŹ`€"ńżđűƒ~đ đ Ü c đÄB CüDEÁFÁ"€ƒ‹ŒŽ—Áœ@ż˙ˆđ˙ü ü üü@ŹŹŹŹŹŹ`€"ńżđ([4Wđ đ Ü c đÄB CüDEÁFÁ"€ƒ‹ŒdŽ—Áœ@ż˙ˆđ˙ ü ü @ŹŹŹŹŹŹ`€"ńżđ(ť4ˇđ đ Ü c đÄB C¤DEÁFÁ"€ƒ‹Œ2Ž—Áœ@ż˙ˆđ˙¤ ¤ @ŹŹŹŹŹŹ`€"ńżđ(ˇ4[đ đ Ü c đÄBűC DEÁFÁ"€ƒ‹Ś˙ŒdŽ—Áœ@ż˙ˆđ˙ ű ű@ŹŹŹŹŹŹ`€"ńżđƒ_đ đ Ü c đÄBűC DEÁFÁ"€ƒ‹Ś˙ŒŽ—Áœ@ż˙ˆđ˙ű ű űű@ŹŹŹŹŹŹ`€"ńżđ˙ƒűđ đÜ c đÄB˘C DEÁFÁ"€ƒ‹Ś˙ŒÎ˙˙˙Ž—Áœ@ż˙ˆđ˙ ˘ ˘@ŹŹŹŹŹŹ`€"ńżđ\ƒ˙đě đÜ ł đB€¤‘’‡żƒżŔ˙ ?"ńżđŔ 0FđĂ ’ đTŸ¨ Click to edit Master title style˘!Ş !đ$ đÜ ƒ đ0€”’ƒżŔ˙ "ńżđŕ 0đĂ ’ đžŸ¨RClick to edit Master text styles Second level Third level Fourth level Fifth level˘!    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