“Mental health responses were good during the early part of the crisis, but most schools were not able to sustain their efforts,” said Lisa H. Jaycox, the study's lead author and a psychologist at RAND, a nonprofit research organization. “Schools need to respond not only in the weeks following a disaster, but for the months and years afterward when lingering mental health problems start showing up.”
Researchers from RAND Health found that schools in Alabama, Louisiana, Mississippi and Texas were quick to implement a comprehensive approach to assisting students immediately after the storms, enrolling displaced students, getting them books and uniforms, and providing other services, such as one-on-one counseling.
However, within six months of the storms, some schools determined there was no need for those additional services and returned to an emphasis on academics. Other schools felt there was a need for additional mental health services, but either did not have the funding or the properly trained staff, according to the study published in the October issue of Psychiatric Services.
Some schools were able to extend additional services to displaced students, but most schools reported facing barriers that kept them from continuing special services. Among the barriers cited were:Problems communicating with parents. Many families were living in government-provided trailers, with no phone service or reliable transportation routes.
Inadequate resources and insufficient staff training. Schools in larger cities tended to have the strongest mental health systems in place before the storms, but needed them to tend to the needs of their pre-existing students. Smaller, rural communities were less likely to have staff members trained to screen and assist troubled students.
Burnout among staff in charge of implementing and running the programs, because many staff members also were affected by the hurricanes. Difficulties balancing the needs of displaced students with the continuing needs of pre-existing students.
More than 196,000 students from kindergarten through grade 12 were displaced in Louisiana alone after Hurricane Katrina made landfall in August 2005. Students in Mississippi and Alabama also were affected by Hurricane Katrina, and students in Texas and Louisiana were affected when Hurricane Rita hit the coast in September 2005. Some reports found that nearly one-third of New Orleans children had elevated symptoms of posttraumatic stress disorder (PTSD).
Jaycox and her colleagues interviewed mental health professionals at 19 public and 11 private or parochial schools or school systems in Louisiana, Alabama, Texas and Mississippi in the spring of 2006 and again in the fall/winter of 2006. These schools had taken in large numbers of displaced students, increasing their populations by more than 10 percent.
“A lot of these children lived in inner city New Orleans and faced stress caused by poverty even before the storms hit,” Jaycox said.
Students with PTSD or anxiety might appear to be fine and might show up for school every day, but still struggle, Jaycox said. Many have nightmares, are hyper vigilant, easily startled, irritable, depressed or want to avoid things that remind them of the trauma, which can include the loss of family members, pets and their homes. These conditions can interfere with their ability to learn and form social relationships.
The study recommends that schools develop crisis plans that specify the roles, training and resources required to address longer-term mental health consequences following a disaster, not just for students, but also for staff members and their families.
Jaycox said the most effective mental health services for students after a crisis like Hurricane Katrina — cognitive-behavioral techniques that teach students how to develop coping and problem-solving skills to reduce anxiety and depression — also can be applied to other kinds of traumatic events such as earthquakes and shootings.
“Education is the primary mission of schools, but schools also serve as a community hub in a disaster, doing everything from providing shelter to mental health services,” Jaycox said. “Few people are able to access specialty mental health care. If they can get care in a community setting like a school, then many more can be served.”
Other authors of the study are Terri L. Tanielian, Priya Sharma, Lindsey Morse, and Bradley Stein, all of RAND, and Gretchen Clum with the Department of Community Health Sciences at Tulane University.
The research was conducted within RAND Health, under the auspices of the RAND Gulf States Policy Institute. RAND Health, a division of RAND, is the nation's largest independent health policy research program, with a broad research portfolio that focuses on health care quality, costs and delivery, among other topics.
The RAND Gulf States Policy Institute is helping government and the nonprofit and private sectors to develop a long-term vision and strategies for building a better future for Louisiana, Mississippi and Alabama in the wake of Hurricanes Katrina and Rita. The goal of RGSPI is to assist in long-term recovery efforts by providing evidence-based policy research and guidance to speed regional recovery and growth.
The study was funded by RAND's continuing program of self-initiated research, which is supported in part by donors and the independent research and development provisions of RAND's contracts for the operation of its U.S. Department of Defense federally funded research and development centers.
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