Mental health services in Louisiana school-based health centers post-Hurricanes Katrina and Rita.

Following Hurricanes Katrina and Rita, Louisiana school-based health centers (SBHCs) were called on to respond to a sharp increase in mental health needs, especially for displaced students coping with grief, loss, trauma, and uncertainty. To assess the impact of the hurricanes on the students and the needs of SBHC mental health providers (MHPs), we surveyed MHPs in each of the SBHCs under the auspices of the Louisiana Department of Health and Hospitals, Office of Public Health. SBHC practitioners from around the state reported that mental health service utilization rose during the 2005-2006 school year, but utilization of services increased most significantly in schools receiving the majority of displaced students. Anxiety and adjustment problems were noted as increasing the most following the hurricanes. A multitude of other conditions was also reported. By the time of this survey in April 2006, the reported prevalence of most symptoms had declined, but all remained above their pre-hurricane levels. Self-reported needs of SBHC MHPs are also discussed in light of the major natural disasters. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A tale of two studies of two disasters: Comparing psychosocial responses to disaster among Oklahoma City bombing survivors and Hurricane Katrina evacuees.

Purpose: An accumulation of disaster mental health research literature in the last few decades has contributed knowledge to direct disaster mental health interventions. However, no single set of principles can necessarily outline all anticipated mental health needs to be encountered in a particular disaster. Methods: To illustrate how different disaster scenarios may yield a divergence of mental health needs, this article compares mental health findings from two distinctly different studies of two very different populations affected by two very different disasters: directly exposed survivors the Oklahoma City bombing and sheltered evacuees from Hurricane Katrina. Results: Research on the two disasters reviewed illustrates many facets and complexities of postdisaster mental health needs in different populations in different settings after different types of disasters. The major findings of the Oklahoma City bombing study related to posttraumatic stress disorder and the main findings of the Hurricane Katrina study involved need for treatment of preexisting chronic mental health and substance abuse problems. Conclusion: The disaster studies in this review diverged in type of disaster, affected populations, setting, and timing of the study, and these studies yielded a divergence of findings. One disaster mental health model clearly cannot adequately describe all postdisaster scenarios. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Our Katrina experience: Providing mental health services in Concordia Parish, Louisiana.

Responding to the call for psychologists to serve Louisiana and the Gulf Coast after Hurricane Katrina, 2 school psychologists spent almost 2 weeks in central Louisiana in early September 2005. They were located in a rural area and provided mental health services to evacuees from Hurricane Katrina in a number of small shelters, an RV park, and the schools. This article describes their experiences as mental health volunteers and the impact those experiences had on their professional and personal lives. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Collaborating with African American churches to overcome minority disaster mental health disparities: What mental health professionals can learn from Hurricane Katrina.

The purpose of this qualitative study was to explore how mental health professionals and African American pastors and their churches could collaborate to overcome minority disaster mental health disparities. Forty-one African American pastors of churches located in south Mississippi, in counties directly affected by Hurricane Katrina, participated in semi-structured interviews approximately 1 year after the storm. The majority of participants reported being interested in collaborating with mental health professionals to: (a) develop educational and outreach opportunities, (b) lead assessment procedures, (c) offer consultation activities, (d) provide clinically focused services, and (e) utilize spiritual resources and support. Participants provided further insight into how these collaborative activities could be modified to meet post-disaster needs and offered novel applications. Following from these discussions, the article provides a number of recommendations that can be used to aid in the development of disaster collaborative activities between African American pastors and churches and mental health professionals to serve minority communities while also decreasing disparities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Meeting mental health needs following a natural disaster: Lessons from Hurricane Katrina.

Hurricane Katrina had a devastating impact on hundreds of thousands of Louisiana and Mississippi families. Housing was destroyed, jobs were lost, and family members were separated, sometimes in different states and without communication. Postdisaster stress reactions were common, with vulnerable individuals most affected. Mental health services were not adequate to meet immediate needs, and postdisaster mental health issues often emerge over time. This article describes the mental health needs of dislocated and evacuee children and families and the steps that were taken to develop mental health programs that would be sustainable over time to meet this new level of need. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

School-based disaster mental health services: Clinical, policy, and community challenges.

The consequences of Hurricane Katrina have far-reaching implications for the mental health system in the Gulf Coast region, with some of the most vulnerable survivors being children and adolescents. School-based services have been proposed as an ideal way to provide care; however, significant challenges remain in providing trauma-informed services in schools postdisaster. The authors discuss the consultation and training activities of the Los Angeles Unified School District Trauma Services Adaptation Center for Schools and Communities following Hurricane Katrina. Issues related to the dissemination of evidence-based treatment in schools following a disaster are discussed, as are the particular needs of providers and school staff and the importance of community collaboration in identifying ways to adapt implementation strategies for specific communities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reflections on Hurricane Katrina and its impact: One psychologist's experience.

What has it been like to experience Hurricane Katrina as a resident of New Orleans and a pediatric psychologist practicing in the area? This article provides a glimpse of 1 psychologist's experience before, during, and after Hurricane Katrina. The author not only details the impact of this storm on her professional and personal life but also provides practical recommendations for other psychologists who may encounter hurricanes or other natural disasters. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Helping African American clergy and churches address minority disaster mental health disparities: Training needs, model, and example.

Using an action participatory research approach, the authors conducted qualitative interviews with 41 African American clergy 1 year after Hurricane Katrina in severely affected areas of south Mississippi. These interviews revealed how mental health professionals can work with African American clergy and their churches by providing training that targets minority disaster mental health disparities. A 3-tier training model for equipping African American clergy and churches to respond to disasters in hopes of reducing minority disaster mental health disparities is offered. Identified training needs and suggested training delivery formats are discussed. A sample outreach and educational training project designed to equip African American clergy and churches in their response to minority disaster mental health disparities is also highlighted. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Hurricane Katrina Storm Surge Reconnaissance

Hurricane Katrina (August 23–30, 2005) was one of the costliest and deadliest hurricanes to ever strike the United States, impacting low-lying coastal plains particularly vulnerable to storm surge flooding. Maximum storm surges, overland flow depths, and inundation distances were measured along the Gulf Coast of Florida, Alabama, Mississippi, and Louisiana. The vehicle-based survey was complemented by inspections with the reconnaissance boat along the Gulf Coast and the Mississippi Barrier Islands. The survey covered both the impact on the built and the natural environments. The storm surge peaked to the east of Katrina’s path exceeding 10?m in several locations along the Mississippi coastline. The storm surge measurements show that the lower floors of specially designed buildings were damaged by the surge of seawater and associated wave action, while the upper floors sustained minimal wind damage. The storm surge measurements along New Orleans Lakeshore allowed the investigators to exclude overtopping as failure mechanism for the 17th Street outfall canal levee. Hurricane Katrina’s storm surge distribution (Category 3 at landfall) is compared against Hurricane Camille’s storm surge distribution (Category 5 at landfall). The land loss on the barrier islands and the increased vulnerability of the US Gulf Coast to future hurricane storm surges is discussed.     

Reestablishing mental health services in St. Bernard Parish, Louisiana, following Hurricane Katrina.

In August 2005, Hurricane Katrina struck the Gulf Coast causing widespread residential displacement, unemployment, and compromised social networks for the residents of St. Bernard Parish, Louisiana. Symptoms of grief, depression, anxiety, posttraumatic stress, adjustment disorders, and psychosis were anecdotally reported among clinic patients during the authors' deployment to the parish in December 2005 (4 months post-Katrina). These anecdotal reports were confirmed through the analysis of survey data that were collected during the authors' follow-up visit in August 2006 (11 months post-Katrina). In collaboration with the United States Public Health Service, the parish has prioritized restoring medical and mental health services to the parish in its efforts to rebuild and repopulate. Implications for mental health practice and public policy are summarized. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparison of federal definitions of severe mental illness among children and adolescents in four communities

OBJECTIVE: Using data from an epidemiological survey, the study compared existing definitions of severe mental illness and serious emotional disturbance among children and adolescents to demonstrate the range of prevalence rates resulting from application of different definitions to the same population. METHODS: Three definitions of severe mental illness and serious emotional disturbance were applied to data from the Methods for the Epidemiology of Child and Adolescent Mental Disorders survey, with a sample of 1,285, conducted in 1991-1992 by the National Institute of Mental Health. The resulting proportions of cases identified, demographic characteristics, service use, and perceived need for services were compared. RESULTS: From 3 to 23 percent of the sampled youth met criteria for severe mental illness or serious emotional disturbance. From 40 percent to as many as 78 percent of the defined youth used a mental health service in the year before the survey. School and ambulatory specialty settings were used most frequently. Generally, more than half of the parents of children with severe mental illness or serious emotional disturbance thought that their child needed services. CONCLUSIONS: The prevalence and characteristics of severe mental illness and serious emotional disturbance among children are sensitive to the definition used and its operationalization. Care should be taken by policy makers and service planners to avoid either over- or underestimating the prevalence of impaired youth in need of intensive interventions.     

After the storm: Katrina's impact on psychological practice in New Orleans.

The impact of Hurricane Katrina on 4 senior New Orleans-based psychologists, both professionally and personally, is described. The authors are pediatric, adult, and family therapists and neuropsychologists; by employment, they are medical center academics, independent practitioners, administrators, and staff/consulting psychologists at medical and psychiatric hospitals. Their diverse experiences following Katrina are similar to the experiences of many individuals in the professional community of the Gulf Coast. In the face of the storm, they departed New Orleans and afterward returned at varying intervals. The homes of all of the 4 New Orleans authors were damaged or destroyed. All of their practice locations were closed for varying periods, and 2 were closed permanently. Of the 4 who returned to New Orleans, only 2 remained 18 months after the storm; the others had relocated to other states. This article reflects on their collective experience as mental health professionals living in New Orleans after Katrina and lessons learned from that experience. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Youth psychotherapy change trajectories and outcomes in usual care: Community mental health versus managed care settings.

Objective: The authors compared symptom change trajectories and treatment outcome categories in children and adolescents receiving routine outpatient mental health services in a public community mental health system and a private managed care organization. Method: Archival longitudinal outcome data from parents completing the Youth Outcome Questionnaire (Y-OQ) were retrieved for children and adolescents (4–17 years old) served in a community mental health system (n = 936, mean age = 12 years, 40% girls or young women, 28% from families of color) and a managed care organization (n = 3,075, mean age = 13 years, 45% girls or young women, race and ethnicity not reported). The authors analyzed Y-OQ data using multilevel modeling and partial proportional odds modeling to test for differences in change trajectories and final outcomes across the 2 service settings. Results: Although initial symptom level was comparable across the 2 settings, the rate of change was significantly steeper for cases in the managed care setting. In addition, 24% of cases in the community mental health setting demonstrated a significant increase in symptoms over the course of treatment, compared with 14% of cases in the managed care setting. Conclusions: These results emphasize the need for increased attention to negative outcomes in routine mental health services and provide a stronger foundation for identifying youth cases at risk for treatment failure. In addition, given the overall differences observed across treatment settings for average rate of change and deterioration rates, results suggest that setting-specific model heuristics should be used for identifying cases at risk for negative outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mental health services for children: The state of the art.

Throughout this century, people in the United States have been concerned about the serious deficiencies in the mental health care of our children. Despite eloquent needs assessment and recommendations for remediation, most of the unserved needs and deficiencies of our mental-health-care-delivery system remain the same. This article reviews the current status of mental health services to children, youth, and families to highlight the necessity of an integrated system of mental health care. The development of a continuum of care that is coordinated across the mental health and non-mental-health systems that naturally occur in all children's lives has the potential to vastly improve mental health services to children, youth, and families. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A preliminary investigation of family coping styles and psychological well-being among adolescent survivors of Hurricane Katrina.

The relation between family coping styles and psychological well-being was compared for adolescents (12-17 years) displaced by Hurricane Katrina and currently living in a relocation camp (n = 50) and nonaffected adolescents (n = 31) matched on age, race, and socioeconomic status. Adolescents in the Katrina sample reported a family mobilizing strategy that reflected an increased reliance and seeking of extra-familial, community-based support but lower self-esteem and more symptoms of distress and depression. Follow-up analyses suggested that the relations between group differences in participants' hurricane-related trauma experiences and greater psychological distress may be mediated in part by the family coping strategy; exposure to increased levels of community-provided support may have unintended consequences on adolescents' psychological health. These results highlight the importance of future research on both potential benefits and costs of family coping styles in adolescents affected by a large-scale disaster. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Great Smoky Mountains Study of Youth. Goals, design, methods, and the prevalence of DSM-III-R disorders

BACKGROUND: The Great Smoky Mountains Study of youth focuses on the relationship between the development of psychiatric disorder and the need for and use of mental health services. METHODS: A multistage, overlapping cohorts design was used, in which 4500 of the 11758 children aged 9, 11, and 13 years in an 11-county area of the southeastern United States were randomly selected for screening for psychiatric symptoms. Children who scored in the top 25% on the screening questionnaire, together with a 1 in 10 random sample of the rest, were recruited for 4 waves of intensive, annual interviews (n = 1015 at wave 1). In a parallel study, all American Indian children aged 9, 11, and 13 years were recruited (N = 323 at wave 1). RESULTS: The 3-month prevalence (+/-SE) of any DSM-III-R axis I disorder in the main sample, weighted to reflect population prevalence rates, was 20.3% +/- 1.7%. The most common diagnoses were anxiety disorders (5.7% +/- 1.0%), enuresis (5.1% +/- 1.0%), tic disorders (4.2% +/- 0.9%), conduct disorder (3.3% +/- 0.6%), oppositional defiant disorder (2.7% +/- 0.4%), and hyperactivity (1.9% +/- 0.4%). CONCLUSIONS: The prevalence of psychiatric disorder in this rural sample was similar to rates reported in other recent studies. Poverty was the strongest demographic correlate of diagnosis, in both urban and rural children.     

In the aftermath of Hurricane Katrina: A personal story of a psychologist from New Orleans.

The author, a psychologist living in New Orleans and specializing in trauma work, describes her personal story in the aftermath of Hurricane Katrina. The immediate response to the crisis, her personal feelings related to the devastation of her community, and ways to organize a mental health response are elaborated. The author describes the work of the trauma team from the Louisiana State University Health Sciences Center in providing immediate outreach and mental health services on the cruise ships set up to house first responders in New Orleans, in schools, and in the community. The author describes psychological first aid in crisis response and provides vignettes illustrating the experiences of first responders, children, and families. Finally, the lessons learned by the author are elaborated. Along with negatives, positive lessons can be learned with such a life-transforming experience. The importance of recognizing vicarious traumatization is emphasized as well as the crucial need for self-care for victims, survivors, and mental health providers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

After the storm: Recognition, recovery, and reconstruction.

On August 29, 2005, when Hurricane Katrina made landfall near the Louisiana-Mississippi border, it exposed a large number of people to extraordinary loss and suffering. The enormous swath of physical devastation wreaked across the marshes of Louisiana's Plaquemines Parish to the urban communities of New Orleans and the coastal landscape of Mississippi and Alabama caused a notable change to the demographics of the Gulf Region, making it the most expensive natural disaster in U.S. history. This article describes a disaster responder's experiences of working with displaced survivors of Hurricane Katrina, providing crisis and mental health support in the acute phase of the disaster. This is followed by a discussion of the importance of a multicultural approach to helping survivors of a natural disaster; several guidelines to improve multicultural competence are proposed. In particular, the importance of attending to survivors' racial, socioeconomic, language, and religious differences is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)