Katrina's Children: Social Policy Considerations for Children in Disasters

Where Are They Now: The Narratives of Children Who Lost a Parent on 9/11

There is a paucity of literature examining the experiences of children who lost a parent on 9/11. The primarily quantitative research has not allowed for a deeper understanding of how children who lost a parent on 9/11 make meaning of their experiences, especially in the context of a national tragedy. This study investigates how eight children who were between the ages of 5 and 12 when they lost a parent on 9/11 developed a personal narrative about this loss in the context of the collective narrative about 9/11. Using narrative inquiry, cases demonstrated patterns of narrative development about grief, tragedy, and collective themes of American exceptionalism, patriotism, triumph, and resiliency. These cases highlight de-personalized narratives of grief, tension between the grand narrative provided to them and their personal story of loss, and distance between the reality of their loss and the collective meaning-making of the tragedy. This study extends Bronfenbrenner's (1977) ecological systems theory by highlighting how a lack of bidirectionality between larger social and cultural systems and the individual negatively impacts personal experiences of grief and loss.

Adolescent risk substance use behavior, posttraumatic stress, depression, and resilience: Innovative considerations for disaster recovery

Natural and technological disasters cause long-term psychological trauma and increase substance use in adults. It is unclear whether these problems also occur in children and whether trauma influences long-term psychological outcomes due to developmental stages at the time of trauma. One community of interest is located in southeastern Louisiana, where, as children, many locals were exposed to Hurricane Katrina in 2005 and the Deepwater Horizon Oil Spill in 2010. We hypothesized individuals exposed to these disasters in early childhood would exhibit higher rates of anxiety, depression, and alcohol use as adolescents than the general population. To test this, we developed a questionnaire with a focus on severity of disaster exposure, indicators of psychological resilience, and current levels of anxiety, depression, and alcohol use. This survey was administered to over 1000 adolescents in local high schools throughout southeastern Louisiana. Structural equation modeling was performed to test correlations and moderation effects. We found disaster exposure was positively associated with trauma-like symptoms and substance use and psychological resilience was negatively related to these outcomes. These findings demonstrate childhood disaster exposure has the potential to cause chronic psychological distress and predispose individuals to substance use later in life. They also suggest resilience may be protective for disaster survivors. Future studies should expand these concepts to other age groups and types of disasters. Whether resilience-focused psychotherapy may be beneficial in these populations is also a relevant topic for exploration.

Urgent engagement in 9/11 pregnant widows and their infants: Transmission of trauma

The potential effects of maternal trauma on mother-infant interaction remain insufficiently studied empirically. This study examined the effects of the September 11, 2001, trauma on mother-infant interaction in mothers who were pregnant and widowed on 9/11, and their infants aged 4-6 months. Split-screen videotaped interaction was coded on a one-second basis for infant gaze, facial affect, and vocal affect; and mother gaze, facial affect, and touch. We examined the temporal dynamics of communication: self-contingency and interactive contingency of behavior by time-series methods. We documented heightened maternal and infant efforts at engagement in the 9/11 (vs. control) dyads. Both partners had difficulty tolerating moments of looking away as well as moments of negative behavior patterns. Heightened efforts to maintain a positive visual engagement may be adaptive and a potential source of resilience, but these patterns may also carry risk: working too hard to make it work. A vigilant, hyper-contingent, high-arousal engagement was the central mode of the interpersonal transmission of the trauma to these infants, with implications for intervention.

Emotional, physical, and social needs among 0-5-year-old children displaced by the 2010 Chilean earthquake: associated characteristics and exposures

An 8.8-magnitude earthquake occurred off the coast of Chile on 27 February 2010, displacing nearly 2,000 children aged less than five years to emergency housing camps. Nine months later, this study assessed the needs of 140 displaced 0-5-year-old children in six domains: caregiver stability and protection; health; housing; nutrition; psychosocial situation; and stimulation. Multivariate regression was applied to examine the degree to which emotional, physical, and social needs were associated with baseline characteristics and exposure to the earthquake, to stressful events, and to ongoing risks in the proximal post-earthquake context. In each domain, 20 per cent or fewer children had unmet needs. Of all children in the sample, 20 per cent had unmet needs in multiple domains. Children's emotional, physical, and social needs were associated with ongoing exposures amenable to intervention, more than with baseline characteristics or epicentre proximity. Relief efforts should address multiple interrelated domains of child well-being and ongoing risks in post-disaster settings.

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.

Looking for the Silver Lining: Benefit Finding after Hurricanes Katrina and Rita in Middle-Aged, Older, and Oldest-Old Adults

Looking for potentially positive outcomes is one way that people cope with stressful events. In two studies, we examined perceived "silver linings" after the 2005 Hurricanes Katrina and Rita among indirectly affected adults. In Study 1, middle-aged (ages 47-64 years), older (ages 65-89 years), and oldest-old (ages 90-95 years) adults in the Louisiana Healthy Aging Study (LHAS) responded to an open-ended question on perceived silver linings in a longitudinal assessment carried out during the immediate impact (1 to 4 months after landfall) and post-disaster recovery phase (6 to 14 months post-storm). Qualitative grounded theory methods were employed to analyze these narrative data. Team-based coding yielded three core themes: (1) learning experience and better preparedness for future disasters, (2) having improved cities (Baton Rouge and New Orleans), and (3) an increase in "Good Samaritan" acts such as strangers helping one another. Responses were similar across age groups, although older adults were the least likely to report positive outcomes. Study 2 was a conceptual replication using a different sample of adults (ages 31 to 82 years) tested at least five years after the storms. A learning experience and preparedness core theme replicated Study 1's findings while improved social cohesion amongst family and friends emerged as a new core theme in Study 2. These data indicate that identifying lessons learned and potentially positive outcomes are psychological reactions that may facilitate post-disaster coping and foster resilience for indirectly affected adults in the years after disaster.

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.

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.

Psychosocial effects of disaster in children and adolescents: significance and management

This article provides a synthesis of the literature addressing the psychological and social effects on children and adolescents after disasters, and the factors that contribute to protecting this population from experiencing related symptoms. Clinical implications are presented for health care providers to reduce the possibility of long-term psychopathologies based on the National Commission on Children and Disasters 2010 Report.

Academic Effects of the Prestige Oil Spill Disaster

The effect of a large scale oil spill disaster on the academic achievement and classroom behavior of children and adolescents who lived on the Galician coast (Spain) is studied from an ecological perspective. 430 participants divided into three age groups of 5, 10, and 15 years of age, were studied. The participants came from three areas differently affected by the disaster. Dependent variables were academic achievement and classroom behavior of the participants after the Prestige disaster. Degree of exposure and other protective or risk factors were investigated as well. Repeated measures ANOVA to assess the main effects of the oil spill and hierarchical regression analyses to assess the contribution of the protective/vulnerability factors were performed.

The results indicate that the effects of the disaster were relatively scarce. Some protective factors accounted for a certain degree of variance of different schoolroom behaviors. These results point to the intervention of protective factors in the adaptation to the disaster.

Parenting After a Natural Disaster: A Qualitative Study of Norwegian Families Surviving the 2004 Tsunami in Southeast Asia

How do parents support their children after a high-impact disaster? To answer this question, face-to-face interviews were conducted with 51 Norwegian parents. These parents and children were all severely exposed to the trauma of the tsunami disaster. The analyses show how parents interpret their children's signs of distress, as well as their own strategies of support in the aftermath. The main strategies described by the parents were watchful waiting, careful monitoring of the children's reactions and a sensitive timing when providing support. Such monitoring, and interpretation of signs of distress, served as an aid for the parents in determining what needs their children had and what support they therefore needed to provide. A range of support strategies were employed, including re-establishing a sense of safety, resuming normal roles and routines, and talking to their children. Parents who were themselves severely impacted by the disaster reported a reduced ability to assess their children's reactions and thereby were unable to provide optimal care in the aftermath. Interestingly, the parents' support strategies mirror the early intervention recommendations put forward in the NICE guidelines and in the Psychological First Aid guidelines which is a well accepted and promising practice for helping children after disasters.

Longitudinal Assessment of Cognitive and Psychosocial Functioning After Hurricanes Katrina and Rita: Exploring Disaster Impact on Middle-Aged, Older, and Oldest-Old Adults

The authors examined the effects of Hurricanes Katrina and Rita (HKR) on cognitive and psychosocial functioning in a lifespan sample of adults 6 to 14 months after the storms. Participants were recruited from the Louisiana Healthy Aging Study (LHAS). Most were assessed during the immediate impact period and retested for this study. Analyses of pre-and post-disaster cognitive data confirmed that storm-related decrements in working memory for middle-aged and older adults observed in the immediate impact period had returned to pre-hurricane levels in the post-disaster recovery period. Middle-aged adults reported more storm-related stressors and greater levels of stress than the two older groups at both waves of testing. These results are consistent with a burden perspective on post-disaster psychological reactions.

Child development in the context of disaster, war, and terrorism: pathways of risk and resilience

This review highlights progress over the past decade in research on the effects of mass trauma experiences on children and youth, focusing on natural disasters, war, and terrorism. Conceptual advances are reviewed in terms of prevailing risk and resilience frameworks that guide basic and translational research. Recent evidence on common components of these models is evaluated, including dose effects, mediators and moderators, and the individual or contextual differences that predict risk or resilience. New research horizons with profound implications for health and well-being are discussed, particularly in relation to plausible models for biological embedding of extreme stress. Strong consistencies are noted in this literature, suggesting guidelines for disaster preparedness and response. At the same time, there is a notable shortage of evidence on effective interventions for child and youth victims. Practical and theory-informative research on strategies to protect children and youth victims and promote their resilience is a global priority.

Sex differences in salivary cortisol, alpha-amylase, and psychological functioning following Hurricane Katrina

The study examines group and individual differences in psychological functioning and hypothalamic-pituitary-adrenal and sympathetic nervous system (SNS) activity among adolescents displaced by Hurricane Katrina and living in a U.S. government relocation camp (n = 62, ages 12-19 years) 2 months postdisaster. Levels of salivary cortisol, salivary alpha-amylase, depression, anxiety, distress, aggression, and self-esteem for this group were contrasted with a demographically matched no-trauma control group (n = 53). Results revealed that hurricane exposure and SNS activity moderated the relations between lower cortisol and higher internalizing behaviors. Sex-related differences were observed in behavioral adjustment and stress regulation. Implications of sex differences in biobehavioral adjustment to loss, displacement, and relocation are discussed in relation to evolutionary and developmental theory.

After Hurricanes Katrina and Rita: gender differences in health and religiosity in middle-aged and older adults

We examined health-related quality of life in adults in the Louisiana Health Aging Study (LHAS) after Hurricanes Katrina and Rita (HK/R) that made landfall on the U.S. Gulf Coast region in 2005. Analyses of pre- and post-disaster SF-36 scores yielded changes in physical function and bodily pain. Mental health scores were lower for women than men. Gender differences were observed in religious beliefs and religious coping, favoring women. Religious beliefs and religious coping were negatively correlated with physical function, implying that stronger reliance on religiosity as a coping mechanism may be more likely among those who are less physically capable.

Exploring posttraumatic growth in children impacted by Hurricane Katrina: correlates of the phenomenon and developmental considerations

This study explored posttraumatic growth (PTG), positive change resulting from struggling with trauma, among 7- to 10-year-olds impacted by Hurricane Katrina. Analyses focused on child self-system functioning and cognitive processes, and the caregiving context, in predicting PTG at 2 time points (Time 1 n = 66, Time 2 n = 51). Findings suggest that rumination, both negative, distressing thoughts and constructive, repetitive thinking, plays an important role in PTG. Hypotheses regarding future expectations and perceived competence were not fully supported, and, unexpectedly, coping competency beliefs, realistic control attributions, and perceived caregiver warmth did not contribute to PTG models. With 1 exception (positive reframing coping advice), caregiver-reported variables did not relate to PTG; no caregiver variable reached significance in final models. Relevant theory, developmental considerations, and future directions are discussed.

Women's and children's exposure to mass disaster and terrorist attacks

Published documents were used to identify women's and children's exposure experiences following two mass disasters and two terrorist attacks that occurred in the United States. Research reports, clinical needs assessments, and a case study were analyzed to determine the type and severity of women's and children's exposure. Research reports were given priority if pre-event/post-event data were reported, if the study reported was longitudinal in design, and if samples were representative of the populations from which they were drawn. Clinical needs assessments were included because these documents provide evidence of need for services by disaster victims. The case study selected was unique in the literature reviewed. The results showed that both the women's and children's severity of exposure was related to posttraumatic stress disorder (PTSD), depression, separation anxiety, and generalized anxiety. In studies that made gender comparisons, data collected from women and girls showed more negative mental health outcomes than data collected from men and boys. Implications for clinical practice and traumatic event policy are addressed. Longitudinal, prospective studies of potentially traumatic events (PTE) are needed to better understand the longer term plight of children, especially girls.

Responding to the needs of children and families after a disaster: linkages between unmet needs and caregiver functioning

Disasters may negatively influence caregivers' ability to respond to the needs of their families. In this context, service organizations' response to families' needs may affect caregivers' symptoms and parenting. Interviews were conducted with caregivers affected by Hurricane Katrina approximately 1 year (T(1); N = 68) and 2 years posthurricane (T(2); N = 52). Caregivers reported high levels of service needs and unmet needs for themselves and their child(ren) and family at both time points. Regression analyses indicated that after accounting for hurricane exposure: (a) child unmet service needs significantly contributed to T(1) caregiver distress, (b) caregiver service needs and child unmet needs were associated with higher levels of posttraumatic stress symptoms, and (c) caregiver unmet needs related to greater strain at T(1). At T(2), after accounting for T(1) scores, service need variables did not contribute to distress or posttraumatic stress symptoms. Caregiver strain at T(1) and T(1) child service needs were associated with greater T(2) strain. These findings highlight the importance of extending the availability of services beyond the initial postdisaster recovery period to better meet the needs of caregivers and families.

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.

Young children's responses to September 11th: The New York City experience

Although the knowledge base regarding very young children's responses to trauma has been expanding, descriptions of their responses to terrorism remain sparse. Yet, their vulnerability makes this an important group to study. Recent events in the United States (9/11, Hurricane Katrina) make this question highly relevant. This study aims to provide extensive descriptions of how children 5 years or younger on September 11th who were living in close proximity to Ground Zero responded that day and in the following months. Sixty-seven New York City parents (with 104 children) participated in focus groups between November 2001 and May 2002. Focus groups also provided a foundation for an in-depth study examining young children's adaptation following 9/11 and changes in parenting behaviors after the disaster. Findings on children's behavioral and emotional reactions on 9/11 and in the 8 months after as well as their need to return to normalcy are reported. Consistent with current understanding of trauma symptoms in young children, parents reported behaviors including chronic sleep disruptions, fearful reactions, development of new fears, and increased clinginess and separation anxiety following the disaster. On the actual day, children's responses were described as ranging from calm and cooperative to difficult and panicky. Implications for working with parents and young children affected by terrorism or community-level trauma and directions for future research are discussed.

The traumatic impact of Hurricane Katrina on children in New Orleans

This article reviews the traumatic impact of Hurricane Katrina on the children of New Orleans. After describing the events comprising the trauma, it reviews the historical context of hurricanes in New Orleans and the social and political challenges that affected the area's response. It then considers the consequences of Hurricane Katrina in terms of disruption of services and governmental and nongovernmental responses to the psychologic needs created by the storm. The authors review preliminary studies about the affects of the hurricane on children and adolescents and conclude with a consideration of the lessons learned from both practice and policy perspectives.

From research to policy and back

Although science policy and social policy have distinct cultures, there are overlapping influences on both. Science policy decisions across the spectrum of basic and applied research are influenced by perceived social utility and the potential for solving current social problems. With the advent of evidence-based policy requirements, social policymakers increasingly use scientific information, although it constitutes only 1 factor in a mix of ideology, interests, and institutional constraints. The spread of early childhood intervention programs in the United States and elsewhere is one example in which strong, cumulative evidence has contributed to a policy consensus. Developmental scientists can contribute to better science policy and better social policy by strengthening the scientific quality of their evidence and communicating research-based knowledge more effectively.