Statewide Director, Project Liberty

1
Alarm vs.
Awareness
Building K-12 Understanding of
Environmental Health Risk

• .
• Statewide Director, Project Liberty
• New York State Office of Mental Health

April J. Naturale, ACSW
2
What is Project Liberty?

• The FEMA Crisis Counseling Assistance and
  Training Program of disaster mental health
  services providing crisis counseling, public
  education and training.
• FEMA funding for crisis counseling began in 1974
  as a mandate of the Stafford Act legislation.
  The funding is available to states for use in
  Presidentially-declared disaster areas (only
  state mental health authorities may apply for the
  funds).

3
(No Transcript)
4
The Purpose of the Crisis Counseling Program

• The purpose of the crisis counseling program is
  to help disaster victims recognize that, in most
  cases, their emotional reactions are normal and
  to develop coping skills that will allow them to
  resume their pre-disaster level of functioning
  and equilibrium.
•  
• Case Management and Advocacy within Crisis
  Counseling Programs
• CMHS Emergency Services and Disaster Relief
  Branch
• Revised 2000

5
Operations Project Liberty

• Organized training for mental health and other
  community workers in outreach-based (i.e.,
  out-of-office) short-term supportive counseling
  and public education techniques (over 5,000
  participants in State trainings).
• Contracted with over 100 mental health agencies
  to provide counseling services.
• Collect encounter data to document and evaluate
  mental health service delivery through Project
  Liberty.

6
Operations Project Liberty

• Delivery to many thousands of individuals (over
  560,000 unique individuals as of data processed
  by January 31, 2003) of direct face-to-face
  counseling services and/or public education
  sessions.
• Oversight of media-based public education
  campaign to include television commercials,
  radio, print materials, posters on subways and
  buses telephone surveys show that millions of
  New Yorkers now know about Project Liberty.

Please note that much of NYC Provider data has
yet to be included in these figures
7
Summary of Service Delivery

• Project Liberty is serving individuals with
  widely varying levels of 9/11 exposure and
  trauma.
• Approximately 16,000 individual and family crisis
  counseling sessions have been delivered to
  individuals identified in the risk category of
  family of deceased/missing in the attacks.

8
Summary of Service Delivery

• Commonly reported trauma reactions for
  individuals served through individual and family
  crisis counseling
• Extreme change in energy level (22.7)
• Sadness (47.5), Anxiety, fear (44.1)
• Difficulty sleeping (29.3), distressing dreams
  (20.4)
• Intrusive thoughts (24.5)
• Difficulty concentrating (26.3)
• A small number of individuals are referred to
  more intensive mental health services. Those
  referred tend to report greater numbers of trauma
  reactions and come from more highly exposed
  groups.

9
Common Features of Crisis Counseling Services

• Focus on supporting healthy coping skills and
  guiding each survivor back to a functional level
  of activity and emotional adaptation.
• Community-based service delivery (shelters,
  family assistance centers, places of worship,
  schools, workplaces), primarily through outreach
  efforts in a culturally competent manner.
• Rely on a mix of mental health professionals,
  paraprofessionals Ii.e. interns, residents,
  students), and indigenous community workers.
• Public health model of reaching people who
  typically do not see themselves in need of mental
  health services.

10
Normal Reactions To Stress Emotional Behavioral
People may feel and express their reactions
differently.
They may

• Feel very nervous, helpless, fearful, sad or
  angry
• Feel hopeless about the future
• Feel detached or unconcerned about others
• Feel numb and unable to experience love or joy
• Have an increased startle response
• Be irritable or have outbursts of anger
• Become easily upset or agitated
• Have frequent distressing dreams or memories
• Avoid people, places and things related to the
  disaster
• Have trouble concentrating
• Feel that things are unreal dissociate

11
Normal Reactions To Stress Physical Cognitive
How people may physically and cognitively react
to a disaster varies.
They may

• Have an upset stomach, eat too much or too
  little, or have other gastrointestinal problems
• Experience a pounding heart, rapid breathing,
  sweating, or severe headache when thinking about
  the disaster
• Have trouble falling asleep, staying asleep, or
  sleeping too much
• Be on guard and constantly alert
• Be jumpy and startle easily at sudden noises
• Have a worsening of chronic medical problems
• Be exhausted
• Have trouble concentrating
• Exhibit poor judgment
• Exhibit denial of emotions or lack memory of
  events

12
Impact on New York City Public Schools

• The attacks on the World Trade Center (WTC) took
  a heavy psychological toll on New York Citys
  public schools.
• More than 1,500 students and 800 staff members
  lost a family member or loved one as a result of
  the attacks.
• In addition, more than 9,000 students and staff
  in eight public schools that are in close
  proximity to Ground Zero were evacuated as a
  result of the disaster and the schools remained
  closed for extended periods of time.

13
Impact on New York City Public Schools

• Many more public school students and staff
  witnessed the disasters events first hand or had
  a family member at the site, and it is estimated
  that many more students and staff who were not
  directly impacted may also experience
  psychological difficulties as a result of the
  attacks.
• The New York State Office of Mental Health (OMH)
  conducted Needs Assessments as part of its
  applications to the Federal Emergency Management
  Agencys (FEMA) Crisis Counseling Program. It is
  estimated that as many as 40 of New York Citys
  1.7 million school children have mental health
  needs resulting from the disaster.

14
Probable Mental Health Problems

• 60,000 children (8.4) with symptoms of major
  depression.
• 73,000 children (10.3) with symptoms of
  generalized anxiety.
• 107,000 children (15.0) with symptoms of
  agoraphobia (fear of going out or taking public
  transportation).
• 88,000 children (12.3) with symptoms of
  separation anxiety (fear of separation from
  parents).
• 78,000 children (10.9) with symptoms of conduct
  disorder.

Information from NYC DOE Needs Assessment
15
PTSD Risk Factors
Information from NYC DOE Needs Assessment
16
Criteria for Determining Need
Information from NYC DOE Needs Assessment
17
Children 5 years of age and younger

• Typical reactions include fear of being separated
  from a parent, fear of the dark, increased
  crying, clinging to a parent, and a return to
  younger behavior such as thumb sucking and
  bedwetting.

18
Children from ages 6 to 11

• Common responses may include withdrawal,
  disruptive behavior, trouble paying attention,
  avoidance of school, sleep problems,
  irritability, outbursts of anger, and
  stomachaches.

19
Adolescents

• Teens show symptoms more like those of adults,
  including flashbacks, nightmares, emotional
  numbing, depression, substance abuse, and
  antisocial behavior.
• They may also feel extreme guilt because of a
  failure to prevent injury or loss of life.

20
Helpful Guidelines for Planning Age-Appropriate
Counseling ServicesAuthored by Dr. Lynette
Rentoul

• Help should take into account of the age of the
  child...

Children need us to listen to them. Combining
psycho-education and supportive counseling is
helpful to parents and children. Reaching out to
children and their families in their communities
is recommended. Activities in the classroom that
remind children of their strengths and resources,
and enhance their sense of safety are helpful.
21
Younger Children (grades K-3)

• Usually, the best way to help young children feel
  secure is by supporting their parents to help
  them.

Parents often need help themselves to feel safe,
and not to communicate their fears to their
children. The protective instinct in parents is
heightened following traumatic events. This may
lead parents to become overly protective and
fearful for their childrens safety. Parents may
need support and guidance in finding ways of
helping their children to feel secure.
22
Supporting A Younger Child

• Listening and understanding the nature of their
  childrens fear.
• Reassuring children about their safety and the
  safety of others.
• Allowing children to be more clingy, while
  encouraging them to find their way back to
  earlier established patterns of safety.
• Playing with their children more.
• Protecting children from extensive media coverage
  of terrorist events.
• Helping children find new strategies for coping
  with their fears.

23
Older Children (grades 4-7)

• These children are also likely to experience
  higher levels of anxiety

Common fears include fears about being away from
the safety of home and family about public
transport about the dark. They may just feel
more afraid, more irritable, angry or sad and not
know why. They may find it hard to understand
their feelings or even put a name to them. It is
important to watch out for any changes in the
normal patterns of behavior in children in this
age group. Parents and teachers can help
children by assuring them about safety, and by
helping them return to their previous levels of
functioning.
24
Supporting An Older Child

• Helping children name and understand their
  feelings better.
• Helping parents to support their children manage
  their feelings constructively.
• Helping parents and children develop new coping
  skills.
• Helping children and families build upon their
  resources and resilience.
• Helping children and families move forward and
  take on new challenges.

25
Adolescents (grades 8-12)

• Adolescents may be developing new fears or
  experience a great sense of worry.

In addition, adolescents may experience
depression, (sometimes leading to acts of
deliberate self-harm, or suicidal behavior),
increased irritability and anger, and/or abuse
alcohol or other substances. Their anger may get
them into trouble at home or at school.
26
Supporting An Adolescent

• Careful assessment of risk (for example, of
  self-harm or suicidal thinking).
• Counseling to help young people understand their
  feelings better.
• Helping young people develop ways of managing
  their emotions (e.g. anger/ blame).
• Counseling to help young people develop new,
  positive coping strategies.
• Helping adolescents develop positive and
  constructive ways of thinking about events.
• Helping young people draw upon their resources
  and resilience.

27
Environmental Awareness

• Include Environmental Awareness in your routine
  curriculum
• Each child needs a role in planning.
• What is their job at home?
• What is their job at school?
• Give each child a job that is very simple and
  highlights their strengths.
• For example Who is good at making lists? Who is
  good at counting? Who likes to be the leader of
  the line?

28
Comments or questions?