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AAMC Reporter: August 2007Viewpoint:
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Two years after one of the worst disasters in U.S. history, much devastation remains in the New Orleans metropolitan area, and recovery continues to be slow. Children and families who have returned, while pleased to be back, continue to react to the ongoing stress, continuing hardships, and uncertainties. So perhaps not surprisingly, mental health programs are increasingly apparent.
The slow recovery of our community along with such factors as overcrowding, economic loss, and rebuilding difficulties contribute to a sense of demoralization. Although we recognize the importance of family structure and support, members of the New Orleans community, including first responders, are living with continuing family stresses and what appears to be an increase in family conflict and divorce. Drugs are a significant problem in our community. Drug dealers have returned, bringing with them complex problems compounded by anger and repeated retaliation. From a psychiatric perspective, there is a desperate need for a crisis intervention unit, inpatient psychiatric beds (especially those that can address co-occurring disorders of substance abuse and mental health), and a fuller system of care within the community.
The New Orleans Police Department, whose ranks continue to be somewhat reduced, ends up handling a large percentage of suicidal or severely mentally impaired patients. Officers frequently drive the patients to an emergency room 30 minutes away, where the patients then wait as long as six hours for transfer. Without a system of care and full family participation, the likelihood of recidivism is much greater.
Furthermore, there is a pressing need to address the problems of our gravely traumatized young people. Thousands of children have lost their homes, neighborhoods, and sense of community, as extended families move away. Youth is generally quite resilient, but 45 percent of children and adolescents here meet criteria for mental health services. At least 10 percent of older children continue to request services, with even higher percentages of parents of younger children (35 percent) expressing the need for services. Alarmingly, a considerable number of adolescents are living on their own away from parents in order to be back in the community and attend schools. Frequently, they are separated from parents as a result of overcrowding in trailers and parents not being able to return because of employment, both of which result in inadequate supervision. With overcrowding, children and adolescents are also exposed to more fighting and family disputes.
Adolescents describe being unable to talk to alreadyoverwhelmed parents or other adults. Returning students often sit in reconstituted schools with fewer consistent friends and teachers. Rival groups of children and adolescents are frequently brought together under one roof with little to do after school or on weekends. Summer programs are few. School administrators report more fighting, bullying, and risk-taking behaviors.
The problems are clear. But help does exist. Examples include Cops for Kids, a program sponsored by the New Orleans Police Foundation with collaboration from LSUHSC's psychiatry department, and the Youth Leadership Program developed collaboratively last summer by our psychiatry department and the St. Bernard Unified School System and designed to promote adolescent growth and community involvement. There is also a need for more "destigmatized" mental health services for children and adolescents delivered in school settings. We must address prevention as well as intervention to allow children and adolescents who have endured so much in the past two years to fulfill their potential.
That is why we are pleased to be leading the new New Orleans Metropolitan Area Family Resiliency Project (NOFRP), funded by a $750,000 grant from the Robert Wood Johnson Foundation and also overseen by the LSUHSC psychiatry department. A major goal is to enhance, provide, and evaluate critically needed, evidence-based behavioral and mental health services for children and their families, and for first responders and their families in Orleans, St. Bernard, and Plaquemines parishes. The program will advance knowledge and skills in delivering trauma-focused services by establishing learning collaboratives for mental health professionals and others on evidence-based intervention protocols. Another goal of the program is to developing youth leadership summer and year-long programs to support youth resilience, build self-sufficiency, and decrease risky behaviors.
Success will be measured in terms of outcomes for children related to improvement in psychological symptoms, school-related behavior problems, and increase in school performance. Outcomes for families will be measured by decrease in marital and family problems. Effectiveness of the learning collaboratives will be evaluated in terms of numbers of mental health professionals trained, increases in knowledge, and impact on practice. Through this program, it is anticipated that mental health resources and infrastructures will be rebuilt, and mental health services will become more available, accessible, and sustainable.
Overall, the NOFRP project relates to the Robert Wood Johnson Foundation's objective of improving the health and health care of all Americans. The project will identify the behavioral and mental health needs of children, first responders, and families traumatized by the extreme devastation and slow recovery as a result of Hurricane Katrina and improve accessibility and the quality of behavioral and mental health services. What is learned through this project about post-disaster prevention and intervention strategies can be used as a knowledge base for future disasters and to inform the public on policy decisions.
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