Psychological trauma and displacement of children after Hurricane Katrina

Katrina

Children Lost, Forgotten and Dispersed After Katrina

Natural disasters hit without prejudice, devastating the rich and poor, black and white, etc. (Kahlenberg, 2005). When a major disaster, such as Hurricane Katrina, hits, it has an enormous impact on everyone in the path of destruction. And children are no exception.

In the months following Katrina, the agency received reports of 4,710 children missing or displaced in Louisiana, 339 in Mississippi and 39 in Alabama. Hurricanes Katrina and Rita resulted in a total of 5,192 children. After Rita, another 28 children were reported missing or displaced in Louisiana; 76 were reported in Texas (Katrowitz and Breslau, 2005).

Of the cases reported to NCMEC, the most serious were those children arriving at shelters separated from parents/guardians with no adult supervision (Katrowitz and Breslau, 2005). There were a total of 45 unaccompanied children "found" and reported to NCMEC. As of October 7, 2005, all 45 cases were resolved. However, many children are still experiencing symptoms of trauma and depression even more than a year after the hurricane struck.

How Disasters are Different for Children

For adults, the aftermath of the hurricane involves dealing with lost homes, jobs and possessions (Callimachi, 2006). For children, it's a sense of security and lost toys. For adults, the hurricane's damage is the twisted houses, ripped from their foundations, and such things as bloated couches, spit out onto the street. For many children, a favorite toy is much more than a physical object. "If you lose a favorite teddy bear, you haven't just lost a toy. You've lost one of the means by which you keep yourself feeling safe," says Dr. Claude Chemtob, a clinical professor of psychology and pediatrics at Mount Sinai School of Medicine.

In addition, for Katrina's children, their destroyed homes are similar to Ground Zero (Callimachi, 2006). They return, sifting through the rubble, looking for tiny pieces of their rooms and favorite toys. They mourn each lost toy and each piece of a school art project. For example, 10-year-old Jasmine Lombard found a cheap pink barrette on the floor of her flooded room. She clings to it like it is a family heirloom. "This is the only memory I have of this entire neighborhood," she says.

Flooded by new cases, child psychologists in New Orleans say case loads have doubled, due to both the impact of the disaster and the loss of doctors in the area. "I used to be able to book a new child within two weeks. Now, I'm booking appointments two months out," says child psychologist Carlos Reinoso, author of the book "Little Ducky Jr. And the Whirlwind Storm," which addresses the hurricane (Callimachi, 2006).

Mental health professionals believe that the greatest impact has yet to be seen (Callimachi, 2006). The 1988 earthquake in Armenia killed 25,000 people. Tracking more than 200 children over five years, researchers at the University of California at Los Angeles' Trauma Psychiatry Program found that those who were given professional help early on had better outcomes and showed fewer symptoms at the end of the study that those who did not get help. Without professional help, children victims risk a future of drug and alcohol abuse, high blood pressure, crime and child abuse.

This crisis is foreseeable, and much of its destructive impact is preventable," Perry says (Callimachi, 2006). "Yet our society may not have the wisdom to see that the real crisis of Katrina is the hundreds of thousands of ravaged, displaced and traumatized children."

Long-Lasting Effects

In June 2006, when hurricane season began, Gulf Coast children became extremely anxious (Cass, 2006). According to day-care center workers in Gautier, Miss., the children would ask their caregivers every day: "Did you watch the Weather Channel? What does the Weather Channel say?" In a New Orleans trailer park, a 12-year-old boy who spent five days outside the convention center after Hurricane Katrina begged his mother every day to buy a car so they would have a chance to escape if another disaster struck.

This shows that nearly one year after Katrina, its emotional effect on children is long and lasting (Cass, 2006). Two studies of children affected by the hurricane have found high rates of depression, anxiety, behavioral problems and post-traumatic stress disorder. A Louisiana State University mental health screening of nearly 5,000 children in schools and temporary housing in the state revealed that 96% saw hurricane damage to their homes or neighborhoods; 22% had relatives or friends who were injured; 14% had relatives or friends who died; and 35% lost pets. Thirty-four percent were separated from their parents during the disaster.

A report prepared for Congress last November estimated that 189,000 children were displaced by Katrina; many never returned to their original homes (Cass, 2006). Some children have attended several different schools since Katrina. Many who returned to school in New Orleans were unable to attend the same schools with the same students or teachers as before.

Disasters like Oklahoma City and 9/11 were time-limited," said Irwin Redlener, director of Columbia University's National Center for Disaster Preparedness and president of the Children's Health Fund (Cass, 2006). "The children who were affected psychologically could go to a place of normalcy. The difference here is not only the scope of devastation but the prolonged dislocation with an uncertain timeline. The trauma has not yet ended."

In a study by Columbia University and the Children's Health Fund of 665 displaced families, nearly half of the parents said that at least one child in their household had emotional or behavioral difficulties that did not exist before the hurricane. Symptoms involve sadness, depression, nervousness, fear, and personality problems. Compared with children surveyed in Louisiana in 2003, Katrina's victims were more than twice as likely to have behavioral problems.

The younger children lack the cognitive ability to grasp the idea of a once-in-a-hundred-year storm," said Elmore Rigamer, a psychiatrist (Cass, 2006). "For them, if it happened once, the world is an unsafe place."

Experts believe that efforts to help Katrina children should focus not just on the children but also on their families (Cass, 2006). Numerous charities and nonprofit organizations have established programs that aim to help families, such as free family mental health screening, trauma counseling in schools, and summer programs for children who have fallen behind in school or are living on government aid.

Positive Outcomes

Many of the frightening stories had happy endings. For example, twelve-year-old Emil, 8-year-old Ronell, 8-year-old Ronald and 3-year-old Treneka were separated from their parents when the family left the New Orleans Superdome just after the hurricane (Brown, 2005). The parents prayed that children were with friends but were unable to find them for two weeks. Finally a social worker located the children, who were safe and sound with family friends in Dallas. Those children were reunited with their parents in a relatively short period, but some children remain missing.

According to Bob O'Brien, director of NCMEC Missing Children's Division, the number of missing children was extremely high after the disaster because of the unprecedented circumstances surrounding Katrina (Brown, 2005). The NCMEC typically allows only parents and legal guardians to register children. However, due to the chaos of the relief effort, the organization allowed other relatives, such as aunts, uncles and grandmothers, to register children.

Negative Outcomes

Before Hurricane Katrina, New Orleans was home to more than 130,000 children. The disaster left these children lost, confused, and displaced (Katrowitz and Breslau, 2005). The lucky families lost everything -- houses, cars, possessions -- but stayed together. The less fortunate were left searching for their loved ones, not knowing whether they were dead or alive.

Even the children who were reunited with their parents are not completely safe and sound. Therapists advise that children victims of the storm could suffer for years from the physical and emotional effects of their trauma. "Kids have lost their homes, their schools, their neighborhoods, connections with friends," says David Fassler, a psychiatrist at the University of Vermont (Katrowitz and Breslau, 2005). "I would expect to see an increase in anxiety, sleep difficulties, fears."

For young children, behavior changes may include clinginess or regression (Katrowitz and Breslau, 2005). Older children are more likely to experience depression or rebel. Natural disasters are very difficult for children to handle, according to experts. Robin Gurwitch, a member of the American Psychological Association's Disaster Response Network, says: "When you're talking about a man-made disaster, you can get angry at somebody because they bombed the Trade Center or they bombed the Murrah Building. With a natural disaster, who do you get mad at?"

Many children were forced to stay in temporary shelters as their families tried to recover from the disaster (Katrowitz and Breslau, 2005). Technology was somewhat of a relief. At the Reliant Center and the Astrodome in Houston, local companies donated computers and reading glasses so victims could search Web sites that listed the missing and the found. At the Astrodome, volunteers dedicated their time to help families find their missing loved ones. For families who had lost everything, any return to normalcy helped. For children, going to school, even a new school, provided a sense of order. It also gave parents time to plan for the future. Wealthier parents were able to enroll their children in private schools. Poorer families faced a greater struggle.

In Texas, officials reported enrolling19,000 children displaced by the storm (Katrowitz and Breslau, 2005). They were able to waive normal rules, such as proving residency or providing immunization records. The opportunity to start over was critical for thousands of families, including Kathy Jemison and her daughter, Sarah McClelland, 17. The night before the storm hit, they gathered their clothes, keepsakes and important documents (such as birth certificates and Social Security cards). As the storm was destroying their home, they drove 15 hours to a friend's house in San Antonio. Sarah began her senior year at San Antonio's MacArthur High School, and Kathy, who worked for a bank in New Orleans, was able to find a new job.

Making the transition to a new school can be very difficult, especially during the first few weeks. "School gives kids structure," says Lynne Tan, a psychiatrist at Montefiore Medical Center in the Bronx, N.Y (Katrowitz and Breslau, 2005). "You have adults around to process with the kids: teachers, volunteer parents, school counselors. There are people who can answer questions." Ultimately, a child's psychological fate is dependent upon numerous factors, says Tan. "You have to take into account genetics, maturity level, the environmental situation prior to the disaster. If you have a more stable parental structure in place before the disaster, then you're probably going to have a better outcome." Still, while some researchers believe that the stress of going through trauma may permanently damage developing brains, others believe that children are resilient for reasons that even science cannot explain.

Katrina and the Government

In New Orleans, the government proved unable to prevent the city from flooding. It then failed to successfully evacuate the city, ignoring the area's poor residents, who lacked cars to flee and money for hotels (Kahlenberg, 2005). Finally, the government failed to provide adequate schooling to the children who evacuated to other parts of Louisiana, to neighboring states, and to other parts of the country.

Considering everything that New Orleans' children went through, it is only fair that they should at least receive a quality education, with great teachers, active parents, and supportive peers (Kahlenberg, 2005). For the first time in their lives, thousands of poor students who were previously taught in high poverty public schools in New Orleans could be given the opportunity to attend middle class, high achieving schools. Alternatively, they may be assigned to other failing schools.

On one level, many public and private schools in the area have been generous, making sacrifices to provide space for new students (Kahlenberg, 2005). However, the situation is far from perfect. The Wall Street Journal reported that private schools opened their doors mostly to sister private schools. In the Houston area, most of the children of New Orleans ended up in high-poverty urban schools, rather than in the suburbs, where middle-class students are educated.

A study from Columbia University's Mailman School of Public Health and the Children's Health Fund has found that many of the children whom Hurricane Katrina displaced are suffering physically and mentally (Gelinas, 2006). However, the problem is not lack of long-term "disaster" healthcare infrastructure. Rather, the finding of certain evacuees' poor health demonstrates that the Bush administration's Federal Emergency Management Agency (FEMA) houses too many of Katrina's underclass families in desolate "FEMA-villes," creating pre-fab ghettos for emergency housing.

To conduct this study, researchers interviewed 650 Louisiana families who were displaced by Katrina, and then compared the results of these findings with results of pre-Katrina health studies of Louisiana's urban populations (Gelinas, 2006). Six months after Katrina, the Katrina children studied suffered from high rates of depression or anxiety, with many parents reporting that children started exhibiting behavioral problems since Katrina. In addition, fourteen percent of Katrina children who need medication for chronic illnesses (such as asthma) had gone without that medication, compared with 2% of kids studied before Katrina.

Nearly one-fifth of Katrina children were not enrolled in school at all or continued to take long periods of time off school (Gelinas, 2006). Nearly half of parents did not have health insurance, in many cases because they had lost their jobs in the storm and were unable to find work. Many parents reported that they were in only fair or poor health, and more than half did poorly on a mental-health test, which could be dangerous for their children's future.

The researchers concluded that the solution to this "emerging humanitarian crisis" is a federal "Health Care Marshall Plan," which would include Congressional hearings, long-term Disaster Relief Medicaid with a transition to "permanent" Medicaid, and the deployment of 1,500 National Health Service Corps professionals to communities in Louisiana and Mississippi (Gelinas, 2006).

Unfortunately, these solutions would treat symptoms while ignoring the real source of the problem: FEMA's ineffective "temporary" housing solution for Katrina's poor families (Gelinas, 2006). Katrina's poorest families have so few financial and social resources that, months after Katrina, they are still forced to live in ghetto-like shelters rather than in decent homes, despite available government aid.

FEMA built many of its shelters in isolated locations because residents of middle-class neighborhoods vetoed such trailer parks in their area, not wanting to live near housing-project conditions (Gelinas, 2006). However, the remote locations only exacerbate the underclass nature of these shelters. Because the parks are extremely remote and removed from public transportation, adults have a hard time finding jobs, suitable housing and decent schools.

To worsen the situation, thousands of Katrina victims who were forced from their New Orleans neighborhoods are led to believe that their displacement is temporary. For this reason, many parents fail to enroll their children in school or find new jobs that might provide them with the health insurance that their children need. However, FEMA continues to provide "temporary" shelter for these underclass families. This undoubtedly contributes the negative outcome of Katrina's child victims.

Conclusion

Hurricane Katrina scattered their friends across the United States and forced them to attend new schools in new communities and sometimes even new states (Pope, 2006). Fortunately, many children whose lives were turned upside down by the hurricane have hope. Researchers believe that children can regain their psychological equilibrium if they can settle into familiar routines and surroundings, maintain connections with family members and friends, and get professional help if they need it.

Acknowledging symptoms such as anxiety and frequent weeping, and then seeking aid for a child, are important if the child is to make any progress, said Dr. Howard Osofsky, chairman of psychiatry at LSU Health Sciences Center (Pope, 2006). "When we cover over the symptoms, the kids suffer. We must work with resilience. There may be scars... But that doesn't mean that people can't be resilient."

Osofsky, an LSU professor of pediatrics and psychiatry, believes that children seek support when they need it, have adaptable temperaments, can read their environment, set goals and reach them, and have self-esteem (Pope, 2006). In the right circumstances, children can bounce back from distress, even when that distress is caused by the trauma of a natural disaster.

The Louisiana Child and Family Health Study surveyed 665 families that had been displaced by hurricanes Katrina and Rita and were living in FEMA-subsidized housing communities on issues related to their health, well-being, and access to health care (Abramson and Garfield, 2006). In the report, study findings on the status of children's health is compared with pre-hurricane statewide data collected as part of the 2003 National Survey of Child Health. The report discusses the key factors negatively affecting children's welfare, including parents' poor mental health, disengagement from school, and the lack of a primary medical provider, as well as families' important social service needs.

The report highlights the major challenges faced by the recovery efforts in the areas destroyed by Hurricanes Katrina and Rita, in addition to the flooding of New Orleans (Abramson and Garfield, 2006). Many evacuees remain in extended shelter status, especially those with limited economic means. Many of the New Orleans pre-Katrina population of nearly 500,000 have not yet returned. Some relocated to other parts of Louisiana and resettled with some success. However, for many, prospects for resettlement are not so good. Housing reconstruction in damaged areas has not yet begun, destroyed communities are covered in rubble, decisions about re-establishing health care facilities and schools are on hold and displaced, economically fragile children and their families are stuck in situations that undermine access to health care, social support and opportunity for livelihood.

The short or medium term outcomes for many of these internally displaced families are grim (Abramson and Garfield, 2006). Many child victims are subject to severe long-term stress and worsening chronic health conditions. Most of them were already at social and medical risk prior to September 2005. When Hurricane Katrina ravaged the Gulf Coast on August 29, 2005, it clearly brought with it the worst devastation from a natural disaster in our country's history. It also revealed longstanding problems that continue to afflict many of our nation's cities and states, especially their poorest communities. As the recovery and rebuilding from Katrina progresses, we have the opportunity to address underlying problems that pre-dated the hurricane and undermine the health and well-being of the nation's most vulnerable, medically underserved children. A series of telephone surveys and structured observations by health and social services professionals over the past few months have underscored some of the major concerns emerging among displaced individuals.

A new study, the first comprehensive face-to-face field survey of residents in FEMA shelters based in Louisiana, conducted in February 2006 by David Abramson PhD, MPH and Richard Garfield RN, DrPH, has documented a series of extremely urgent needs which must be evaluated and addressed as quickly as possible (Abramson and Garfield, 2006). Failure to address these needs will potentially lead to permanent, highly significant consequences on the health, mental health, education and well-being of thousands of children and their families. The study, "On the Edge: Children and Families Displaced by Hurricanes Katrina and Rita Face a Looming Medical and Mental Health Crisis," was part of an ongoing needs assessment by Operation Assist, a collaborative effort of the Children's Health Fund and the National Center for Disaster Preparedness at the Columbia University Mailman School of Public Health.

According to Zedlewski (2006): "The most vulnerable populations in New Orleans -- the elderly, people with physical and mental disabilities, and single mothers out of the labor market -- arguably were hit hardest by Katrina. These groups had the highest poverty rates and the fewest assets. Most were African-American. Many depended on the social safety net for survival and on others to avoid the storm's catastrophic effects."

While the majority of residents were able to evacuate, many still have not been able to return home (Zedlewski, 2006). Research suggests that they will need the strong networks established pre-Katrina (Hill 1993). However, vulnerable populations also need a functioning safety net, as well as housing and health care. Rebuilding presents New Orleans with a unique opportunity to strengthen its safety net for these vulnerable populations in the future.

"one size fits all" approach simply will not work when it comes to helping vulnerable populations (Zedlewski, 2006). Children need a safe place to live near other family members and services to keep them healthy and educated. Single parents need employment, as well as temporary basic income support, safe housing, health care, and child care.

According to Zedlewski (2006): "New Orleans can take advantage of new ideas for building assets among its poorest citizens, facilitating independence among people with disabilities, retooling its welfare system, and reducing out-of-wedlock pregnancy as it rebuilds its social infrastructure. Many of the new ideas for reducing vulnerability can be implemented relatively inexpensively by leveraging federal and private dollars, especially if they are built into the planning process now."

Many see Katrina's redevelopment plan as an opportunity to improve the failing conditions of many schools before the storm (Keaney, 2006). Some lower-class schools did not have enough books or even enough toilet paper before Katrina. Constant turnover was another huge issue. Since 1996, nine temporary or permanent superintendents have run the public schools in New Orleans. While there were some great schools, there were many more failures. Above all, there were disparities.

Some schools prospered at the expense of others," says Riedlinger, a 20-year veteran of the New Orleans schools (Keaney, 2006). "We called it the 'haves' and 'have nots.'... There was never a sense of equity in the school district."

The system was just corrupt and terrible from top to the bottom," says Carter Guice, an assistant U.S. attorney (Keaney, 2006). "It was a dog's breakfast of negligence to criminality."

Most people in New Orleans expect a smaller school system in the years ahead. And educators say turning the schools around will take years, and they know many residents -- including those who want to return -- will be looking for signs of progress.

In conclusion, children proved to be especially vulnerable to the physical and emotional traumas of a major disaster, such as Hurricane Katrina (Abramsom and Garfield, 2006). Katrina in particular highlighted that vulnerability by the scale of the disruption, the effect on parents and the instability in children's lives, and the major levels of disadvantage and stress that many children in New Orleans had experienced before the hurricane. However, with the right resources and guidance, Katrina's child victims can bounce back from the disaster, hopefully even gaining better education as a result.