Hurricane Katrina and the Gulf Oil Spill: Lessons learned about short-term and long-term effects.

The impact and lessons learned from Hurricane Katrina and the Gulf Oil Spill are described as an example of work done reflecting best practices and theory to gain a better understanding of risk and resilience for children and families. Hurricane Katrina, described as the worst natural disaster in the US history, resulted in traumatic separations of children and families and devastation of communities and schools. The impact was greater on families with fewer resources before the hurricane who were provided limited support to return and rebuild. Insufficient community support and economic resources contributed to prolonged traumatiaation and slow recovery. Many were still recovering from Hurricane Katrina when impacted by the Gulf Oil Spill. For families with multigenerational ties to the fishing and oil industries, the Gulf Oil Spill resulted in both cumulative trauma and increased risk. In implementing the behavioural health response, much was learned about promotive and protective factors for individual and community resilience. Services provided following the disasters were based on precepts of individual, family, and community resilience. To enhance recovery and support resilience, the development of regional coalitions across at risk areas provides important coordination before disasters occur for better preparation and response.

The Louisiana Mental and Behavioral Health Capacity Project Trauma-Informed Integrated Care Model and Improved Posttraumatic Stress Outcomes.

OBJECTIVE: The Mental and Behavioral Health Capacity Project in Louisiana has been addressing health disparities by increasing accessibility and availability through integrating services into primary care clinics. Integrated health is becoming the standard of care, providing an opportunity to address the trauma-specific needs of communities, and allowing for informed and less stigmatized services. The purpose of this study is to test the efficacy of the Mental and Behavioral Health Capacity Project in Louisiana model in the primary care settings to reduce posttraumatic stress symptoms and physical health complaints. DESIGN: A pre-experimental time series design was used on the basis of participants self-reporting at least 1 trauma at intake and follow-up collected at 1-, 3-, and 6-month intervals. The hypotheses were that posttraumatic stress and physical health complaints would significantly decrease over the course of treatment. SETTING: This study was part of a larger study to evaluate the effectiveness of the Mental and Behavioral Health Capacity Project in Louisiana-integrated health efforts. Sample parameters included (1) intake date from January 2013 through December 2015; (2) at least 18 years of age; and (3) presented at 1 of 5 primary health care clinics in Southeast Louisiana. PARTICIPANTS: A total of 235 patients were selected; the mean age was 44.7 years (SD = 13.6) and the majority were white (68%) and female (76%). INTERVENTION: Brief behavioral-based trauma treatment was delivered using both on-site and telemedicine therapies provided by a psychologist, psychiatrist, or through a combined treatment model. MAIN OUTCOME MEASURE: The main outcome measures were the Posttraumatic Stress Civilian Checklist (PCL-C) and the Patient Health Questionnaire (PHQ-15). RESULTS: The hypothesis was supported. Statistically significant decreases in posttraumatic stress symptoms and physical health complaints were shown over the course of treatment, with 63% of the group demonstrating clinically significant change. CONCLUSIONS: This study supports brief trauma treatment in primary care clinics as an effective method of reducing trauma and physical health symptoms in postdisaster environments.

Effects of Stress Related to the Gulf Oil Spill on Child and Adolescent Mental Health.

OBJECTIVE: To examine the interactive effects of stress related to the Gulf oil spill on mental health of children and adolescents on the Gulf Coast who were also affected by previous hurricanes. METHODS: A prospective design, with n = 1,577 youth (aged 3-18 years), evaluated pre-oil spill and again post-oil spill for posttraumatic stress disorder (PTSD) symptoms, previous hurricane exposure, and amount of oil spill stress. RESULTS: Stressors related to the spill were common and were associated with PTSD symptoms. Moreover, there was an interactive effect such that those with high preexisting PTSD symptoms, high previous hurricane exposure, and high oil spill stress had the most elevated post-oil spill PTSD symptoms. CONCLUSIONS: This study provides initial evidence linking stress related to the Gulf oil spill to youth mental health symptoms. The effects of the oil spill on youth mental health were most evident among those with cumulative risk.

Collaborative Health Care and Emerging Trends in a Community-Based Psychiatry Residency Model.

OBJECTIVE: This paper provides a report of an academic department of psychiatry's journey into the change process associated with addressing the new requirements in health-care delivery, the emphasis on person-centered treatment models, and the implications for residency training programs. Louisiana State University Health Sciences Center Department of Psychiatry's experience is based on responding to real-world shifts in which academic departments can play a leadership role. METHODS: Importantly, methods are based on person-centered collaboration being central to a successful change process and include a description of the training, with data supporting implementation of the model. RESULTS: The model demonstrates increased access to care and improved behavioral health symptoms. It indicates that with proper training and supervision, psychiatry residents can be an agent of change. CONCLUSION: This brief review of our experience offers to other departments of psychiatry examples of collaborative strategies substantially informed by the needs and preferences of both persons accessing services and local communities.

Trajectories of post-traumatic stress disorder symptoms among youth exposed to both natural and technological disasters.

BACKGROUND: Theorists and researchers have demonstrated multiple trajectories of symptoms following disasters (Ecology and Society, 13, 2008, 9), highlighting the importance of obtaining more knowledge about exposed youth who demonstrate resilience as well as those who suffer chronic difficulties. This paper examines trajectories of post-traumatic stress disorder (PTSD) symptoms following exposure to hurricanes and the Deepwater Horizon Oil Spill to increase understanding of resilience and chronic reactions to both natural and technological disasters. METHODS: A multiwave longitudinal design was used to follow N = 4,619 youth who were evaluated for PTSD symptoms, hurricane exposure, and oil spill exposure/stress at four time points over a period of 4 years. Trajectories were identified with cluster analyses and multilevel modeling. RESULTS: Individual trajectories were statistically identified consistent with theory. The largest group exhibited stable-low symptoms (52%), a second group showed steep declines following initial symptoms (21%), a third group exhibited increasing symptoms (18%), and a fourth group showed stable-high symptoms (9%). Both hurricane exposure and oil spill stress predicted trajectories and overall levels of PTSD symptoms. CONCLUSIONS: Results identified an effect of oil spill stress and hurricane exposure on symptom levels and trajectories of exposed youth. Results provide prospective data to support theories of multiple symptom trajectories following disasters and reinforce the importance of research that utilizes a developmental perspective to consider the long-term effects of disasters in youth. Findings highlight the importance of identifying symptoms and predictors of resilience as well as factors that contribute to resilience.

Factors Contributing to Mental and Physical Health Care in a Disaster-Prone Environment.

Environment as a contextual factor plays an important role in southeastern Louisiana, as this area represents a major economic hub for the United States port, petroleum, and fishing industries. The location also exposes the population to both natural and technological disasters, including Hurricane Katrina and the Gulf oil spill. This study explored associations among hurricane loss, oil spill disruption, and environmental quality of life on mental and physical health on over 1,000 residents (N = 1,225) using structural equation modeling techniques. Results showed that oil spill distress was associated with increased symptoms of mental and physical health; Hurricane Katrina loss; and decreased environmental quality of life. Findings also indicate that mental health symptoms explain the association among oil spill distress and physical health symptoms-specifically, those that overlap with somatic complaints. These findings provide important support of the need for mental health assessment and service availability for disaster recovery.

The effect of long-term relocation on child and adolescent survivors of Hurricane Katrina.

The current study is designed to increase knowledge of the effects of relocation and its association with longer-term psychological symptoms following disaster. Following clinical observations and in discussions held with school officials expressing concerns about relocated students, it was hypothesized that students who relocated to a different city following Hurricane Katrina in 2005 would have more symptoms of posttraumatic stress compared to students who returned to New Orleans. The effect of Hurricane Katrina relocation was assessed on a sample of child and adolescent survivors in 5th through 12th grades (N = 795). Students with Orleans Parish zip codes prior to Hurricane Katrina were categorized into relocation groupings: (a) relocated to Baton Rouge, (b) returned to prior zip code, and (c) moved to a different zip code within Orleans Parish. Overall results revealed more trauma symptoms for relocated students. Results also revealed that younger relocated students had fewer symptoms compared to older students. The opposite was found for students who returned to their same zip code, with older students having fewer symptoms. This study supports the need for school-based services not only in disaster areas, but also in schools where survivors tend to migrate.

The importance of adverse childhood experiences during the perinatal period.

The Adverse Childhood Experiences (ACEs) study (Felitti et al., 1998) has led to an understanding of how exposure to abuse, neglect, and family dysfunction in childhood are related to subsequent physical and mental health problems. These issues are important to consider during the perinatal period, with studies indicating that pregnant women who report adverse experiences in childhood may be at risk of experiencing mental health and substance use problems. This study examined the association of pregnant women's ACEs with symptoms of depression, anxiety, posttraumatic stress, and substance use, and examined the potential buffering effect of women's resilience against the deleterious effects of ACES on mental health and substance use. Women reported on ACES, mental health symptoms, substance use, and resilience when they were screened for participation in a perinatal psychosocial support intervention, which was integrated into obstetrical clinics in a Southern academic medical center. Almost a quarter of the 303 women in this sample reported four or more ACEs, indicating significant risk. Those reporting more overall ACEs also reported more symptoms of depression, posttraumatic stress, and increased risk of tobacco use. Unique effects of specific ACEs subtypes were also found. Women exposed to child maltreatment reported more anxiety, depression, and posttraumatic stress symptoms, and were at risk for tobacco, cannabis, or opioid use during pregnancy. Women exposed to household dysfunction reported more posttraumatic stress symptoms and were at increased risk of tobacco and alcohol use during pregnancy. Women's resilience attenuated effects of household dysfunction on posttraumatic stress symptoms. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Children of Katrina: lessons learned about postdisaster symptoms and recovery patterns.

Trauma symptoms, recovery patterns, and life stressors of children between the ages of 9 and 18 (n = 387) following Hurricane Katrina were assessed using an adapted version of the National Child Traumatic Stress Network Hurricane Assessment and Referral Tool for Children and Adolescents (National Child Traumatic Stress Network, 2005). Based on assessments 2 and 3 years after the hurricane, most children showed a decrease in posttraumatic stress and depression symptoms over time. Students were also classified into outcome trajectories of stress resistant, normal response and recovery, delayed breakdown, and breakdown without recovery (A. S. Masten & J. Obradovic, 2008). Age, gender, and life stressors were related to these recovery patterns. Overall, the findings highlight the importance of building and maintaining supportive relationships following disasters.

Attention to process and clinical outcomes of implementing a rural school-based trauma treatment program.

The Louisiana Rural Trauma Services Center was established to provide, improve, and enhance urgently needed assessment, treatment, crisis management, and consultation services for children and adolescents exposed to traumatic events in three rural southeastern Louisiana parishes. The purpose of this study is to describe the process of implementing the rural school-based trauma treatment program and to evaluate its effectiveness in 115 students. Through attention to process including the three-tiered approach of relationship building, trauma training, and trauma services, the school-based trauma treatment program proved effective in reducing trauma symptoms. This study is important to support the widespread implementation of school-based mental health services.

Psychological and social impact of COVID-19.

The high numbers of COVID-19 infections and deaths, economic difficulties, uncertainty about the future, as well as the approaches needed to contain the spread of the virus are all playing critical roles in the short and long-term social and psychological impact of the COVID-19 pandemic. Inequities based on race and socioeconomic status influence the rates of infection and deaths and steps that are needed to achieve recovery. This commentary focuses on similarities and differences after other disasters and efforts being initiated to provide support and recovery. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Posttraumatic stress symptoms in children after Hurricane Katrina: predicting the need for mental health services.

The purpose of this study was to examine factors related to the development of posttraumatic stress symptoms in children and adolescents after Hurricane Katrina. It was hypothesized that a positive correlation would exist between trauma exposure variables and symptoms indicating need for mental health services experienced 2 years after Hurricane Katrina. Specifically, the authors hypothesized that experiences associated with natural disaster including personal loss, separation from family and/or community, and lack of community support as well as previous loss or trauma would be related to increased symptomatology in both children and adolescents. This study included 7,258 children and adolescents from heavily affected Louisiana parishes. Measures included the Hurricane Assessment and Referral Tool for Children and Adolescents developed by the National Child Traumatic Stress Network (NCTSN, 2005). Results were generally supportive of our hypotheses, and specific exposure and demographic variables were found to be strongly related to posttraumatic stress symptoms in children and adolescents.

Perceptions of Resilience and Physical Health Symptom Improvement Following Post Disaster Integrated Health Services.

OBJECTIVE: Theorists and researchers have linked resilience with a host of positive psychological and physical health outcomes. This paper examines perceptions of resilience and physical health symptoms in a sample of individuals exposed to multiple community disasters following involvement in integrated mental health services. METHODS: A multiwave naturalistic design was used to follow 762 adult clinic patients (72% female; 28% minority status), ages 18-92 years (mean age=40 years), who were evaluated for resilience and physical health symptoms prior to receiving services and at 1, 3, and 6 months' follow-up. RESULTS: Data indicated increases in perceptions of resilience and decreased physical health symptoms reported over time. Results also indicated that resilience predicted physical health symptoms, such that resilience and physical health symptoms were negatively associated (ie, improved resilience was associated with decreases in physical health symptoms). These effects were primarily observed for those individuals with previous exposure to natural disasters. CONCLUSIONS: Findings provide correlational evidence for behavioral health treatment provided as part of a stepped-care, collaborative model in reducing physical health symptoms and increasing resilience post-disaster. Controlled trials are warranted. (Disaster Med Public Health Preparedness. 2019;13:223-229).

Identifying trajectories of change to improve understanding of integrated health care outcomes on PTSD symptoms post disaster.

INTRODUCTION: Addressing life stressors is an important function for integrated care, especially for health care homes located in disaster prone environments. This study evaluated trajectories of change for patients with postdisaster posttraumatic stress disorder (PTSD) who were seen in integrated care. In addition to describing the results, this article provides the methods of subgroup analyses as this may be useful for others working in real-world practice. METHOD: Patients (N = 340) receiving services at 5 rural health clinics self-reported PTSD symptoms as part of an ongoing evaluation to study the effectiveness of integrated health. Analysis of variance was used to assess differences overtime and trajectories were identified with cluster analyses. Disaster and trauma related factors associated with these trajectories were assessed using logistic regression. RESULTS: Significant overall decreases in PTSD symptoms overtime were found; individual trajectories were identified and include stable low, steep declines, stable high symptoms, and increasing symptoms. Stress related to disaster and the number of other traumas patients experienced correctly classified trajectory membership. DISCUSSION: Trajectories indicate that patients have differing treatment needs and cluster analysis as an evaluation technique may be useful in identifying what treatment works and for whom. The present study addresses a major concern for health care providers serving disaster prone communities and emphasizes the importance of identifying pre incident and disaster related risk vulnerabilities that contribute to mental health outcomes. Subgroup analyses are a useful tool for developing more targeted treatment within integrated care and may be an accessible research strategy for others working in such settings. (PsycINFO Database Record

Gulf Coast Resilience Coalition: An Evolved Collaborative Built on Shared Disaster Experiences, Response, and Future Preparedness.

OBJECTIVE: For close to a decade, the Gulf Coast of the United States has been in almost constant disaster recovery mode, and a number of lessons have been learned concerning disaster recovery and behavioral health. The purpose of this report was to describe the natural development of a Gulf Coast Resilience Coalition (GCRC). METHODS: The GCRC methods began with state-specific recovery goals following Hurricane Katrina in 2005 and transitioned to a shared multistate and multidiscipline coalition. The coalition's effectiveness is demonstrated through continuation, procurement of funding to provide response services, and increased membership to ensure sustainability. RESULTS: The coalition has enhanced response, recovery, and resilience by providing strategic plans for dissemination of knowledge; post-disaster surveillance and services; effective relationships and communication with local, state, and regional partners; disaster response informed by past experience; a network of professionals and community residents; and the ability to improve access to and efficiency of future behavioral health coordination through an organized response. CONCLUSIONS: The GCRC can not only improve readiness and response, but work toward a shared vision of improved overall mental and behavioral health and thus resilience, with beneficial implications for the Gulf South and other communities as well.

The psychological experience of security officers who work with executions.

Open-ended interviews were conducted with members of the "Execution Team" in Louisiana in order to understand the roles, experiences, and effects of carrying out the death penalty. Fifty of a potential 52 correctional officers who work with executions were interviewed and asked to complete mental health inventories. While emphasizing the importance of security and their professional responsibilities in carrying out the death penalty, the officers stress their respect and decency toward the inmates and all others involved with the process. Although expectably reporting high incidences of exposure to trauma and death, they generally are not clinically depressed. They rely upon religious beliefs, group identity, administrative support, and their capacity to dissociate and rely on diffusion of responsibility to suppress painful emotions. Nevertheless, the officers experience conflicted feelings and frequently report having a hard time carrying out society's "ultimate punishment."

Integrated care: meeting mental health needs after the Gulf oil spill.

This column describes an integrated behavioral health initiative in primary care clinics in Louisiana parishes affected by the Deepwater Horizon oil spill. The Louisiana Mental and Behavioral Health Capacity Project is an integral part of the Gulf Region Health Outreach Program and is funded from the Deepwater Horizon Medical Benefits Class Action Settlement. Using a public health approach, the Department of Psychiatry of the Louisiana State University Health Sciences Center developed an interprofessional collaboration model of care to provide culturally tailored and time-sensitive on-site and telemedicine services to adults and children affected by the disaster. Results indicate a high level of acceptance of the services and reductions in both mental health symptoms and general medical symptoms. Primary care clinic staff also report increased confidence and resilience to meet future disasters. The approach could be used by communities at risk of disasters and by rural communities with limited mental health resources.

Hurricane Katrina and the Gulf oil spill: lessons learned.

Education and training about immediate responses are important for all mental health providers of immediate and continuing services to assist children, adolescents, adults, and families in the aftermath of disasters. To sensitively help with evacuations and return to normalcy, responders must also be trained to understand the culture and traditions of affected communities. It is important to provide knowledge about available resources and to emphasize the need for routines and self-care for both victims and responders in an environment that, with recovery, will reflect a new normal.