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"From Hurricane to Home" by Dr. Doug.Walker

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    "From Hurricane to Home" by Dr. Doug.Walker "From Hurricane to Home" by Dr. Doug.Walker Presentation Transcript

    • From Hurricane to Home: Evolving Trauma Treatment with Students and Families
      Douglas W. Walker, PhD
      Clinical Director
      Mercy Family Center
      Project Fleur-de-lis
    • Objectives
      1) Participants will be able to identify the rationale and programmatic challenges in creating this multi-stepped approach to addressing student’s mental health needs in the aftermath of a natural disaster.
      2) Participants will be able to identify the types and trends of psychological and educational problems of over 1,000 students who have been identified as needing intensive “third-tier” mental health services in the New Orleans community over the past three years via Project Fleur-de-lis’ weekly clinical triage.
    • TM
    • Background: Project Fleur-de-lis
    • Fleur-de-lis:
      Flower of light
    • Project Fleur-de-lis
      Project Fleur-de-lis™ is a comprehensive mental health care program for New Orleans area students designed as an intermediate and long-term school-based mental health service model for children who have been exposed to traumatic events as a result of natural and man-made disasters.
    • Best Practice: Stepped Care Approach to Mental Health Intervention
      Multi-tiered levels of care
      Pro-active focus is on addressing symptoms before they interfere with child’s educational or social emotional functioning
      Focus is upon working with child with emotional/behavioral issues in a “non-clinical” intervention model
      Utilize evidence-based treatment models and identified “best practice” in the field of child trauma
    • Mercy Family Center
      Established in 1992 as a Sisters of Mercy Outreach Ministry
      Managed by Sisters of Mercy Health System
      Provides outpatient psychological and psychiatry services for children and adolescents
      Offices in Mandeville, Metairie and Algiers
      NCQA Certified
      Non-profit, 501 (c) (3) organization
      Project Fleur-de-lis is owned and managed by Mercy Family Center
    • School Participation
      64 participating schools
      26,000 children under project’s umbrella of care
      Serving the Parishes of Orleans, Jefferson, St. John, St. Charles, St. Tammany, Washington and Plaquemines
    • Continued Success
      Project Fleur-de-lis is the largest school based mental health program in the
      Greater New Orleans Area
      Princeton University – Woodrow Wilson School of Public and International Affairs. (January 2007). Coping with Katrina: Mental health services in New Orleans.
    • Collaborative Partners
      American Red Cross
      RAND Health
      Louisiana Public Health Institute
      Catholic Charities – Archdiocese of New Orleans
      Tulane University – Department of Social Work & Psychology
      LA-YES
      Morehouse School of Medicine's Regional Coordinating Center for Hurricane Response (RCC)
      Louisiana Rural Trauma Services Center – LSUHSC
      All Participating Schools; counselors, social workers, administrators, teachers, families
    • Dual Programming
      School-Based Identification of All Mental Health / Learning Issues
      Trauma Specific Programming
      Community Based Interventions:
      Psychology, Psychiatry, Social Work
      Classroom – Community Consultation (C3):
      Triage Child Specific Issues for possible referral into Community
      School-Wide Issues:
      Collective Issues of Response and Recovery
    • History & Timeline for Project Fleur-de-lis
    • August 2005
      Hurricane
      Katrina
    • January 2006
      CCANO and Mercy Family Center form counselor team and divide 73 Archdiocesan schools among them for initial contact and needs assessment
      Because of the team’s success they are soon referred as
      “THE AWESOME SIX”
    • Needs Assessment
      6 counselors divided among 73 schools to collect data
      Obtained information to determine school’s interest in services and/or interventions, need for a school counselor, % of devastation to school, families, & community
    • March 2006
      Classroom Based Intervention© Training by Save the Children
      Proposal to LPHI for Funding to Support ERS Development and Implementation
    • Stepped Trauma Pathway
      Enables schools to reach all children exposed to a traumatic event and triage them “up” to higher, more appropriate levels of trauma intervention if needed
    • Stepped-Care Approach
    • Classroom Based Intervention (CBI®)
      Robert Macy, Ph.D.
      Boston Center for Trauma Psychology
      Trauma Informed,
      Developmentally Specificity,
      & Ethnocultural Specificity
      Evidence Based Methodological Framework
    • July 2006
      Training: Cognitive Behavioral Intervention for Trauma in Schools (CBITS)
    • Stepped-Care Approach
    • Cognitive-Behavioral Intervention for Trauma in Schools (CBITS)
      Lisa Jaycox, Ph.D.
      RAND Corporation
      Identified as a Promising Practice by SAMSHA
    • August 2006
      Training: Trauma Focused – Cognitive Behavioral Therapy Training
      NCTSN Learning Collaborative
      Electronic Records System becomes fully operational
    • Stepped-Care Approach
    • Trauma Focused-Cognitive Behavioral Therapy (TF-CBT)
      Judith A. Cohen, M.D.
      Anthony Mannarino, Ph.D.
      Center for Traumatic Stress in Children & Adolescents
      Allegheny General Hospital, Pittsburgh, PA
      Esther Deblinger, M.D.
      CARES Institute
      University of Medicine & Dentistry of New Jersey School of Osteopathic Medicine
      Stratford , NJ
      Identified as a Model Program by SAMHSA
    • September 2006
      First C3 weekly staff meeting
    • Dual Programming
      School-Based Identification of All Mental Health / Learning Issues
      Community Based Interventions:
      Psychology, Psychiatry, Social Work
      Classroom – Community Consultation (C3):
      Triage Child Specific Issues for possible referral into Community
      School-Wide Issues:
      Collective Issues of Response and Recovery
    • Classroom - Community Consultation (C3)
      Enables schools and communities to identify children with all types of mental health and/or learning issues and triage them to appropriate care in the community
    • C3
      Community Based Interventions
      Psychiatry, Psychology, Psycho-educational Assessments, Wrap-Around Services
      Classroom – Community Consultation (C3)
      Weekly consultation meetings with school-based counselors to discuss students that may be in need of community based services. Goal is to support counselor interventions with students in schools to avoid decrease in adaptive functioning. Rely on Electronic Records System maintained by counselors and PFDL™ staff to promote continuity of care and quality improvement initiatives
      School-Wide Issues
      Brought to C3 by school counselors. School-wide issues and concerns addressed by peer consultation and shared community resources
    • What We Have Learned
    • Hurricane Assessment Instrument: Summer of 2007
      Survey based upon approximately 2,000 registered students summer 2007. Currently have over 4,000 registered students in ERS system.
    • Hurricane Assessment Instrument: Neighborhood Destroyed
    • Hurricane Assessment Instrument: Witnessed Injury or Death During Storm
    • Hurricane Assessment Instrument:Separated from Parent/Caregiver
    • Hurricane Assessment Instrument:Family or Friend Injured
    • Hurricane Assessment Instrument:Pet Lost/Dead
    • Hurricane Assessment Instrument:Trapped During Storm
    • Hurricane Assessment Instrument:Displaced From Home During Storm
    • Hurricane Assessment Instrument:Past Major Trauma
    • Hurricane Assessment Instrument:Home Badly Damaged
    • Hurricane Assessment Instrument:Belongings Destroyed
    • Number of StudentsTriaged Via C3
    • C3 Results
    • C3 Results Three-Year Totals
    • C3 Results Third-Year Projected*
    • Pediatric Symptom Checklist
      Utilized as one of multiple screening devices used during C3 meetings
      Includes all types of signs and symptoms that occur in school age children
    • Developmental Trauma Disorder
      PTSD is an adult diagnosis that does not capture developmental impairments in emotional regulation, attention, cognition, perception and interpersonal relationships
      DSM-V criteria will include:
      Exposure
      Affective and physiological dysregulation
      Attention and Behavioral dysregulation
      Self and Relational dysregulation
      van der Kolk, B. (March 19, 2009). Closing Plenary. NCTSN All Network Conference, Orlando.
    • Pediatric Symptom Checklist:
      Top Ten Symptoms 2006-2007
    • Pediatric Symptom Checklist:
      Top Ten Symptoms 2007-2008
    • C3 Referral Types and Trends
    • C3 Community Triage: By Type2006-2007 School Year
    • C3 Community Triage: By Type2007-2008 School Year
    • C3 Referrals: Followed Through with Services 2006-2007 School Year
    • C3 Referrals: Followed Through with Services 2007-2008 School Year
    • Combined 2006-2007 Triage by Month (268 total)
    • Combined 2007-2008 Triage by Month (549 total)
    • Autumn 2008 (143)
    • Significant Increase September to October 2008
      Only 2 C³ meetings in September (9/19/08 & 9/26/08)
      9/5 meeting cancelled because we were evacuated for Hurricane Gustav
      9/12 meeting cancelled due to extreme weather from Hurricane Ike
      October numbers above include 5 C³ meetings (10/3, 10/10, 10/17, 10/24, & 10/31)
    • What We Have Accomplished
    • Free Care Via C3
      675 Children Have Received No Cost Outpatient Mental Health Care Since 9/1/06
      $700,000
    • Trauma TrendsSeptember 1, 2006 to Present
      All New!!
    • Total Trauma Referrals by Year
      2006 – 2007 2007-2008 2008-2009*
      *To date.
    • Types of Trauma Referrals
      September 2006 to Present
    • Referrals for Trauma Treatment by Year & Month:
      Hurricane
      2006 – 2007 2007-2008 2008-2009
    • Referrals for Trauma Treatment by Year & Month:
      Divorce / Separation
      2006 – 2007 2007-2008 2008-2009
    • Referrals for Trauma Treatment by Year & Month:
      Incarceration of Parent
      2006 – 2007 2007-2008 2008-2009
    • Referrals for Trauma Treatment by Year & Month:
      Death of Parent
      2006 – 2007 2007-2008 2008-2009
    • Referrals for Trauma Treatment by Year & Month:
      Death/Illness of Relative or Close Friend
      2006 – 2007 2007-2008 2008-2009
    • Referrals for Trauma Treatment by Year & Month:
      Community Violence
      2006 – 2007 2007-2008 2008-2009
    • Referrals for Trauma Treatment by Year & Month:
      Domestic Violence
      2006 – 2007 2007-2008 2008-2009
    • Referrals for Trauma Treatment by Year & Month:Physical Illness/Injury Student
      2006 – 2007 2007-2008 2008-2009
    • Referrals for Trauma Treatment by Year & Month:Sexual Abuse
      2006 – 2007 2007-2008 2008-2009
    • Percentage Referrals for Trauma Treatment /
      Total Trauma Referrals by Year
    • Total Trauma Referrals by Year
      2006 – 2007 2007-2008 2008-2009*
      *To date.
    • Types of Trauma Referrals
      September 2006 to Present
    • Percentage Referrals forHurricaneTrauma Treatment /
      Total Trauma Referrals by Year
      2006 – 2007 2007-2008 2008-2009
      Percentage %
    • Percentage Referrals forDivorce / SeparationTrauma Treatment /
      Total Trauma Referrals by Year
      2006 – 2007 2007-2008 2008-2009
      Percentage %
    • Percentage Referrals forIncarcerationTrauma Treatment /
      Total Trauma Referrals by Year
      2006 – 2007 2007-2008 2008-2009
      Percentage %
    • Percentage Referrals forDeath of ParentTrauma Treatment /
      Total Trauma Referrals by Year
      2006 – 2007 2007-2008 2008-2009
      Percentage %
    • Percentage Referrals forDeath/Illness of Relative or Close FriendTrauma Treatment / Total Trauma Referrals by Year
      2006 – 2007 2007-2008 2008-2009
      Percentage %
    • Percentage Referrals forCommunity ViolenceTrauma Treatment / Total Trauma Referrals by Year
      2006 – 2007 2007-2008 2008-2009
      Percentage %
    • Percentage Referrals forDomestic ViolenceTrauma Treatment / Total Trauma Referrals by Year
      2006 – 2007 2007-2008 2008-2009
      Percentage %
    • Percentage Referrals forPhysical Illness/Injury StudentTrauma Treatment / Total Trauma Referrals by Year
      2006 – 2007 2007-2008 2008-2009
      Percentage %
    • Percentage Referrals forSexual AbuseTrauma Treatment / Total Trauma Referrals by Year
      2006 – 2007 2007-2008 2008-2009
      Percentage %
    • Future Directions
      Adding and dropping schools. Maintain 65 schools
      Continue to add schools who seek our program
      Additional care managers
      Expand third-tier preferred provider list
      Plan implementation of Stepped Trauma Pathway post future evacuation
    • Future Directions
      Add trauma informed evidence-based treatments (i.e., Psychological First Aid for Schools)
      Add Child Advocacy and Family Law representation to C3 meetings
      Offer C3 expertise via telehealth to other programs/regions
    • Future Directions
      Establish CBITS Learning Community in New Orleans
      June 11-12
      Then offer training spring/fall each year
      Support school counselors in screening and implementation
      Consistent peer consultation throughout school year
    • Future Directions
      Compile data from three years of program into comprehensive paper for publication
    • Future Expansion
      Adapt program to meet the needs of other communities along the Gulf Coast
      Become intermediate and long-term mental health response of choice to future disasters through membership in NCTSN
    • Special Thanks to:
      Kate Gegenheimer
      Mimi Pecot
      John Hill
      Laura Danna
      Jayme Bensel
      Sharon Heno
      Beth Cooney
    • Douglas W. Walker, PhD
      Clinical Director – Mercy Family Center
      Project Director – Project Fleur-de-lis
      dwalker1@mercyfamilycenter.com
    • TM
      TM