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Kid Fears 

Limited access to mental health care is a problem for many children in post-Katrina New Orleans

The daily grind can break you down in post-Katrina New Orleans. Walking every day past block after block of ravaged houses, you're not back in your old home or regular school, and many of your friends are moving away. It's tough — especially if you're just a kid. Area child mental health experts agree that Katrina transformed a bad situation into a crisis. Before the storm, many of the city's children, particularly those low on the socioeconomic ladder, had already experienced major trauma sometime in their lives, and required, but had limited access to, psychological care. Add in the storm and the area's lethargic recovery, and these same children are worse off, mental health resources are more limited, and a lot more kids need help. Every child in New Orleans has somehow been affected by the storm and its aftermath. It's a bad situation, and it could get worse.

"They talk about a mental health crisis now in the city, treating what we have," says psychologist Dr. Doug Walker, clinical director and founder of Project Fleur-de-lis. "Imagine all the untreated trauma that goes on with the kids now and what they'll look like as teenagers and maybe even adults."

There is some good news. Most kids affected by Katrina can be taught techniques that will alleviate some of the stress they're feeling. Parental compassion and protection can go a long way, too.

"Overall, children are resilient, particularly if they're in an environment where they feel safe and supported," Dr. Joy Osofsky, a professor in pediatrics and psychiatry at LSU Health Sciences Center in New Orleans. "If they're in a home setting where they're able to get support from parents or caregivers and are in a school setting with a routine, then you see children going back to learning and playing."

Unfortunately, as Osofsky points out, many children aren't currently living in a safe and supportive environment, and it has taken its toll. Parents are stressed by bills, rebuilding the family home and trying to get by with less money. Osofsky emphasizes that it's not the parents' fault, but often their anxiety can produce uncertain kids.

In younger children, the lack of support and a stable environment reveals itself in these symptoms: withdrawn behavior, separation anxiety, clinginess and a preoccupation with hurricanes. Kids in middle school to high school can exhibit all of the above plus depression, anxiety, difficulty concentrating and somatic symptoms such as persistent headaches. Additionally, as kids get older — in their teens — they may engage in risky behavior involving sex, drugs, alcohol and truancy.

Osofsky, who is also the director of the New Orleans Metropolitan Area Family Resiliency Project, and her staff of 20 mental health personnel have screened 12,000 children for mental disease, and 37 percent of these children indicated some need for follow-up and possible intervention.

In terms of intervention, it can be as simple as teaching kids ways to cope in their post-disaster world. In fact, Walker's Project Fleur-de-lis has adopted the "Save the Children" protocol, a classroom-based intervention that has been used in war-torn countries and after the Tsunami disaster. Project Fleur-de-lis — which is funded through Catholic Charities, Daughters of Charity Services of New Orleans and others — employs a three-tier approach for treating children. The first tier, the "Save the Children" protocol, is taught in classrooms and offered in workshops for parents and teachers. Some of the lessons include exercises where children are asked to visualize a "safe place" and are taught relaxation techniques.

Susan Fendlason, an administrator for the project, says that most children will benefit from the classroom program and won't require more therapy. If they do need more, the project provides for school-based counseling (the second tier) and will pay $1,000 per child for outside services (the third tier), if the child's needs necessitate it. To date, Project Fleur-de-lis has enrolled 43 schools in five parishes: 34 Catholic, eight charter and one private. More than 5,000 children are registered with parental consent for the project, and of these, 170 kids were referred for the third tier outside services with 110 of the kids actually receiving outside care. Even with these large numbers, Fendlason would like to see the program expand with the aid of federal dollars.

"This community is in great need," Fendlason says.

Caring for the child sometimes means caring for the parents. Dr. Charles Zeanah, vice chair of Tulane University's department of psychiatry and neurology, says that's why most treatment plans involve counseling the parents. If parents feel better about their circumstances and demonstrate this optimism to their kids, then their kids will model this behavior. The opposite is also true.

"When parents don't do well, kids don't do well," Zeanah says.

The double-edged sword of mental health services is that those who need it most are often those with the least access to it. Zeanah says that poverty is the culprit.

"There's always a socioeconomic component in the sense that the lower you are in terms of the socioeconomic scale, the more stressors there are, more risk factors, and the more likely that kids are going to have trouble."

The professionals at Tulane's Early Childhood Support Services (ECSS) do their best to make it easy on these parents. The program offers outpatient services at the Edna Pilsbury Health Clinic in Central City, so it is in close proximity for families living in the area. Eban Walker, an ECSS consultant, works with very young children and their families. Many of his patients stayed in the Convention Center during the storm, or were rescued. Because these kids don't have the language skills yet to talk about their experience, they will often become more aggressive, fighting with peers and siblings.

Walker reports that his approach to these kinds of cases is to work with the parents and use play therapy with the kids.

"I focus on helping parents manage the [child's] behavior and giving them a place to talk about how the storm has affected their family," Walker says.

Tulane has a combined staff of 33, which includes psychiatrists, psychologists, social workers and other mental health staff offering services to children and adolescents, but they are stretched thin. Zeanah says his team covers a region from Lafourche Parish to Lafayette to Mandeville, New Orleans and Baton Rouge.

There are other agencies that provide mental health care to kids. A recent report by Princeton University "Coping with Katrina: Mental Health Services in New Orleans" lists what appears on the surface to be a fair number of such groups, but then goes on to note: "Many staff predicted if their organization advertised and conducted other types of outreach, they would be overwhelmed by clients." Some of this can be attributed to the lack of funding, but there are also critical shortages in staffing with social workers being particularly in high demand.

Some groups are doing outreach. Osofsky's New Orleans Metropolitan Area Family Resiliency Project was recently awarded a grant for $749,695 from the Robert Wood Johnson Foundation. The boost in funding will go towards training mental health professionals such as school counselors so they too will be able to recognize, respond and provide services for kids. The group has already begun early intervention in schools — Plaquemines public schools, St. Bernard Unified School and New Orleans Public Schools — and Osofsky hopes to see at least 500 children in 12 schools through the grant.

Osofsky says that early intervention is critical so that teachers, counselors and parents can spot symptoms early before bigger problems appear. She thinks this is being sufficiently addressed in smaller parishes like Plaquemines and St. Bernard, but not in Orleans.

"We need a program in every school," Osofsky says. "We've even gotten phone calls from schools where we know there are better functioning students and better functioning teachers, and they have children who need services."

A Columbia University survey of evacuees in April 2006 revealed that for those displaced children living in hotels and trailers, 34 percent had conditions such as asthma, anxiety and behavior problems. Many of these children are now returning to the city. Currently, there are 28,000 kids in 56 New Orleans public schools. For the 2007-2008 school year, it is predicted that there will be as many as 40,000 students in 80 schools.

For those children, or adults requiring outpatient services, the American Red Cross Hurricane Recovery Program has teamed up with Link2Health, a subsidiary of the Mental Health Association of New York City, to provide "Access to Care." The program will assist those in need of mental health services who were affected by Hurricanes Katrina, Rita or Wilma. Each person is entitled to receive up to $2,000 in assistance, and Access to Care will help locate the chosen mental health service or professional. Funds also can be used to for psychotropic medications, and is retroactive to Aug. 30, 2005. Call (866) 794-4673 or visit www.a2care.org for more details.

Like so much of the storm and its aftermath, the lessons learned by the area's children mental health professionals will be used in future disasters. Zeanah says that Tulane child psychiatrist Dr. Michael Scheeringa is conducting one such study, which he hopes will make a difference for very young children, up to 3 years old, affected by a disaster. In the study, counselors use cognitive-behavioral therapy — administered jointly to parents and children — that's been shown to be effective in older kids.

"It's giving them a way to talk about what their experience is and learn techniques to manage their feelings about those experiences," Zeanah says.

He believes it's essential for mental health authorities to develop widespread disaster plans for treating children who suffer emotional distress from these events. After all, Zeanah says, "obviously disasters are going to happen somewhere." And as local mental health counselors are constantly reminded in treating these children, such disasters can live in the mind long after the actual catastrophe has occurred.

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