Helping Families and Communities Recover from Disaster: Lessons Learned from Hurricane Katrina and Its Aftermath (Specific Approaches and Populations)

276 Pages·2009·17.41 MB·English

by  Ryan P. Kilmer

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SUPPORTING CHILDREN AFTER
HURRICANE KATRINA:
REFLECTIONS ON PSYCHOSOCIAL
PRINCIPLES IN PRACTICE
LESLIE SNIDER, YAEL HOFFMAN, MEGAN LITTRELL,
M. WHITNEY FRY, AND MYA THORNBURGH
Arriving in Baton Rouge with the international aid agency I had just
joined for Katrina relief work, 1 saw for the first time a familiar face from
beloved New Orleans. My friend looked rough—dirty T-shirt and over
alls, haggard face—as if she had trekked all the way to Baton Rouge
through the swamp. She had been cutting out sections of drywall from
the flooded homes of friends to prevent the creeping mold from rising up
and taking over the rest of their houses. She looked at me seriously when
I said I hoped to get to the city soon. "Brace yourself," she warned, "I mean
it. It looks like a war zone."
As aid workers and returnees after Katrina, we were faced with a com
plex challenge—a "complex emergency" in our own backyard. The scope
and severity of the destruction were unprecedented, and indeed, my friend
was right. It looked just like the war zones I had seen overseas. A huge
swath of devastation stretched from the Mississippi Gulf Coast to New
Orleans and beyond—you could drive for 3 hours and not get beyond the
damage. There were almost no basic services—few if any functioning gas
stations, restaurants, pharmacies, or grocery stores—let alone movie
theaters, churches, parks, or stretches of beach free enough of dangerous
debris to allow a child to play. There were large numbers of displaced per
sons, a sudden diaspora of New Orleanians and Mississippians crowding
into Baton Rouge and Jackson and scattering to all states in the Union.
Our "camps" were astrodomes, gymnasiums, tent cities, and eventually
trailer parks. Suddenly, after the storm, there were rampant violence, loot
ers, men with guns (legally and illegally), humvees carrying National
Guard troops, soldiers posted as guards in front of hospitals to protect
their drug supplies, and then an influx of the familiar white vehicles of
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government and nongovernmental relief organizations carrying busy
people with smart phones. The streetlights didn't work, phone and elec
tricity lines were down, and we were told not to bathe in (and certainly
not to drink!) the water. And, as in many developing countries where a
disaster or human-made emergency sweeps through, the veneer was gone
from our city, revealing the dark underbelly of preexisting poverty and
lack of social services and structures. As a popular bumper sticker used to
advertise on the back of New Orleans cars, "Third World and Proud of It."
But now we weren't so proud; we were shattered.
—Leslie Snider
"PRE-K": THIRD WORLD AT THE MOUTH OF THE MISSISSIPPI
Louisiana and Mississippi ate home to diverse cultures and rich tradi
tions. A strong sense of identity, history, place, and belonging among people
in both states forms the foundation for family and community bonds. The
states also share a history of poverty, with serious impacts on child and fam
ily well-being. Before Katrina, Mississippi and Louisiana had the highest
percentages in the nation of children living in poverty (31% and 28%,
respectively, vs. a national average of 19%); living in single-parent homes
(47% and 42%); living in homes in which no parent had full-time, year-round
employment (43% and 42%); and with the lowest family median incomes
($37,000 and $42,000, vs. the national average of $53,000). A composite
measure, based on Kids Count 2005 indicators, ranked Mississippi 50th and
Louisiana 49th nationally on child and family well-being (Annie E. Casey
Foundation, 2005).
Measures of educational attainment in these states have been equally
poor, and most children affected by Katrina were already struggling academ
ically. More than half (51%) of 4th graders in Louisiana could not read at
a basic level, only 1 in 5 possessed the literacy skills necessary to pass to the
next grade, and roughly 30% of children could read at grade level in both
states, far below national standards (Save the Children, 2006). Indeed,
before Katrina, the New Orleans public school system was widely consid
ered to be among the nation's worst, with only half of its students—96% of
whom were African American—graduating from high school (Abramson &
Garfield, 2006).
Widespread destruction and dislocation caused by Hurricane Katrina
added further risk to child and family well-being. Thousands of families and
children lost everything, including homes, personal possessions, pets, liveli
hoods, friends, and family members. Individual and family losses were com
pounded by the disruption of whole communities and the very fabric of life.
Historical landmarks were laid to waste; places of business, worship, educa-
26 SNIDER ETAL.
tion, and recreation were damaged beyond repair; and feelings of safety,
familiarity, and normalcy were gone for all who remained as well as for those
displaced.
In assessing resources on which to ground recovery and rebuilding
efforts, the strong local value placed on community was a key asset. Although
a lack of housing and services and the absence of many friends and family
members provided challenges to "community," those who remained had a
passion to rebuild and found strength in their shared experience and vision.
A more difficult constraint, however, was that many of these communities
had already long struggled to meet their children's needs. Interventions for
children after the storm therefore sought not just to restore preexisting sys
tems but also to bring indicators of child well-being and protection up to a
higher standard; this need made the Katrina context similar to emergencies
in developing countries.
We were on the Gulf Coast as psychosocial support personnel, our mis
sion to implement programs to promote the recovery of children. Reflecting
on this disaster and the role of psychosocial support personnel in the response,
the following questions merit consideration:
• How is psychosocial programming for children who are affected
by disasters to be understood?
• What specifically were the impacts of this hurricane on chil
dren and caregivers, and how did the context influence support
personnel's understanding of their needs?
• Were principles of best practice as learned from previous emergen
cies followed?
• How well was the wisdom of best practices balanced with orga
nizational pressures to scale up and demonstrate results quickly?
Was quality sacrificed for quantity?
• Whose priorities were truly served—those of beneficiaries, or
those of outside agencies?
In this chapter, we describe elements key to children's recovery, plac
ing their well-being in the context of individual factors, their environment,
and the well-being of important adults in their lives. Using a bioecological
framework (Bronfenbrenner, 2000), we examine challenges to psychosocial
recovery for children and caregivers in the Katrina context, in which the
compromised safety and stability of home, school, and family environments
were implicated in negative outcomes (Abramson & Garfield, 2006). The
ways in which a large-scale disaster destroys the sustaining fabric of social and
cultural life and formal and informal safety nets—particularly for already vul
nerable children and families—deserves focus in our discussion of Katrina's
impact and the design of our responses (Abramson & Garfield, 2006; Salloum
SUPPORTING CHILDREN AFTER HURRICANE KATRINA 27
& Overstreet, 2008; Salmon &. Bryant, 2002). The bioecological model is a
useful approach for examining the interrelated contextual factors surround
ing children at various levels (proximally, such as family, and distally, such as
political factors and access to services) and reminds us of guideposts for our
work in chaotic environs (Weems & Overstreet, 2008; see also Introduction,
this volume).
We also share personal reflections as aid workers. Each unique disaster
affords the opportunity for an honest accounting of successes, challenges, fail
ures, and, most importantly, lessons learned so we can do a better job the next
time around. As a test of best practices, Katrina offers fertile ground for exam
ining real-life pitfalls in implementing psychosocial programs and underscores
the importance of maintaining the standards and principles that keep us from
doing harm.
COLLECTIVE WISDOM
Psychosocial assistance in emergency settings has received growing
attention from aid agencies over the past 2 decades, resulting in an evolving
evidence base to guide interventions. The collective experience and litera
ture include work with children and families affected by armed conflict (e.g.,
Apfel & Bennett, 1996; Dawes & Cairns, 1998) and by natural disasters (e.g.,
Belter & Shannon, 1993; Pynoos, Goenjian, & Steinberg, 1995; Vernberg,
1999), including large-scale devastation such as that wrought by the 2004
Indian Ocean tsunami (e.g., Kostelny & Wessells, 2005).
In this chapter, we wish to add our collective wisdom to the knowledge
base and to measure our approach against knowledge gained by our predeces
sors from years of work with children in emergencies. We first examine the
determinants of psychosocial risk and resilience in emergency contexts, then
explore the evolution of psychosocial assistance in these settings and reminders
for appropriate intervention.
Emergency Preparedness and the Katrina Experience
By all accounts, Hurricane Katrina constituted the largest natural disas
ter in U.S. history. Although warning systems tracked the storm's path and
strength as it moved toward the southern United States, Katrina overwhelmed
both the imagination and experience of Gulf Coast residents and emergency
preparedness plans (to the extent that they existed) for evacuation and cop
ing. The lack of readiness at all levels of government to provide rapid and safe
evacuation before the storm, to rescue victims, and to coordinate critical sur
vival and emergency medical care—as well as the absence of a recovery plan
28 SNIDER ET AL.
for the population—is considered the real, human-made disaster (Cooper &
Block, 2006).
Poverty and Vulnerability
In accordance with the bioecological model, the well-being of persons and
communities is threatened not only by the immediate risk of injury and fatal
ity in a disaster but also by profound changes to the landscape in which they
attempt to recover their former lives. Hurricane Katrina destroyed infrastruc
ture, halted services, and severely damaged the economic bases of Mississippi
and Louisiana (Time, 2005). Furthermore, the ability of families to cope with
threat and recover is related to their socioeconomic, cultural, and political sta
tus, in terms of both their available resources and access to emergency services
(Berkman & Kawachi, 2000; Krieger, 1994). Poor families have fewer options
for evacuation and resettlement, experience greater risk during the event, and
encounter extended hardship in rebuilding their lives (Masozera, Bailey, &
Kerchner, 2006). These observations are consistent with our experience in the
aftermath of Hurricane Katrina.
The Personal Meaning of Disaster
The bioecological model frames children's and families' exposure to
traumatic events in the context of personal circumstance and the social, eco
nomic, and political environment (Abramson & Garfield, 2006). Consistent
with the model, these same forces influenced the meaning children and fam
ilies placed on the Katrina experience by affecting their perceptions of harm
exposure. As Weems and Overstreet (2008) noted, "Prejudice, discrimina
tion, and lack of social support represent factors .. . that pose a powerful
threat to one's sense of physical safety, self-worth, self-efficacy, and social
relatedness" (p. 489) For example, local persons were aware of the difference
in experiences of residents of the Mississippi Gulf Coast and of those from
urban New Orleans, with its history of violence, inner-city poverty, and racial
tensions. Accusations that the failed government response for the largely
African American victims in the city was rooted in racial discrimination were
further fueled by rumors that evacuees at the convention center ran in fear
when helicopters finally arrived to drop food and water. According to the
documentary When the Levees Broke: A Requiem in Four Acts (Lee, 2006),
many believed the government was trying to rid New Orleans of its Black
population. Whether true or false or manipulated for political purposes, the
meaning of the experience for inner-city families—perhaps perceiving them
selves abandoned by their government—may profoundly affect their course
of recovery.
SUPPORTING CHILDREN AFTER HURRICANE KATRINA 29
In contrast, although also severely affected, Mississippi Gulf Coast res
idents neither expressed the same distrust of government motives nor faced
or perceived the problems with looting and violence seen in New Orleans
(Weems et al., 2007). Although the impact of perceived discrimination on
recovery from trauma remains unclear, one study found that high levels of
extrafamilial support among Black participants may have mitigated the neg
ative effects of societal prejudices (Pina et al., 2008). This finding lends
emphasis to the importance of the social aspect of psychosocial interventions
in promoting healing and buffering risks to recovery, described further in the
next section.
Context and Recovery: Protective Factors
Emergencies clearly affect individuals, families, and communities differ
ently depending on the nature of the emergency and the resources available
to cope. Viewed through the lens of the bioecological model, the Katrina
experience dramatically highlights the role of contextual factors as risk deter
minants in psychosocial outcomes. However, contextual factors such as avail
able natural supports and community resources can also mitigate negative
outcomes (Weems & Overstreet, 2008; see also Introduction, this volume).
To maximize impact, recovery interventions must consider the influence of
these factors on distress and resilience and must recognize and foster inher
ent strengths. Although some within the population will have specific vul
nerabilities, psychosocial aid workers must remember that those affected are
not merely helpless, passive victims. Rather, they have individual and collec
tive strengths rooted in local cultural, religious, and family traditions that can
promote recovery in the face of adversity (Shultz, Espinel, Flynn, Cohen, &
Hoffman, 2007).
Evolution of Psychosocial Assistance in Emergencies
Ensuring basic survival and population safety is of primary concern fol
lowing an emergency. Attention to psychosocial interventions within crisis
response evolved from a growing recognition of the socioemotional effects of
trauma (Barron, 1999). The ability of those affected by extreme events to
recover, reorganize internally and socially, and adapt and survive in a very
changed environment depends on their psychosocial functioning in real
ways. In 1946, the World Health Organization (1948) defined health as "a
state of complete physical, mental and social well-being and not merely the
absence of disease or infirmity" (p. 2). This holistic definition underscored the
significance of psychosocial aspects of health (in addition to physical aspects)
and the dynamic interplay of these elements in a person's functioning and
30 SNIDER ET AL.
well-being (UNICEF, 2002). Psychosocial assessments in emergencies aim to
describe the impacts of events on the thoughts, feelings, behaviors, relation
ships, and functioning of affected persons—critical elements of their stabi
lization and recovery (Duncan & Amtson, 2004).
Psychosocial interventions emerged from an understanding of humans
as multidimensional beings, whose tesponse and recovery go beyond physical
and security concerns. Psychosocial approaches, however, have not been
clearly defined and may include broad-based community support as well as
specific, trauma-focused, individual therapies. The recently released Inter-
Agency Standing Committee (IASC; 2007) guidelines use the composite
term mental health and psychosocial support to encompass the range of comple
mentary interventions in emergencies and define this support as "any type of
local or outside support that aims to ptotect or promote psychosocial well-
being and/or prevent or treat mental disorder" (p. 1).
As the field matures, debates persist regarding the appropriateness and
usefulness—or harm—of some types of "local or outside support" (Becker,
1995; Summerfield, 1996). Some debates center on psychopathology-focused
interventions with "traumatized persons" that ignore the coping strategies
and inherent resilience of those affected (Loughry & Eyber, 2003; Van
Ommeren, Saxena, & Saraceno, 2005). Many interventions are further
criticized for focusing on individuals to the exclusion of communities
(Ager, 2002; Eyber, 2002; Summerfield, 1996; Wessells & Monteiro, 2003).
Indeed, beyond individual pain, disasters bring a shared sense of loss—
for community, traditions, ways of life, and identity. Although mental
health professionals come from a field traditionally focused on the inter
nal lives of persons, many realize the importance of understanding how
community members perceive traumatic events and how they communally
grieve and recover (Snider et al., 2004; Summerfield, 1996; Wessells &
Monteiro, 2003). Inherent in this debate is the importance of cultural
competence—appreciating the values, beliefs, and history of persons affected
by emergencies—in the design of interventions (e.g., Dougherty, 1999;
Duncan & Arntson, 2004).
The societal dimension of psychological wounds is reflected in the fol
lowing excerpt from a Save the Children Alliance (1996) publication, Pro
moting Psychosocial Well-Being Among Children Affected by Armed Conflict and
Displacement: Principles and Approaches:
Knowledge in child development and psychology ... is not a sufficient
basis for psychosocial programs. It needs to be combined with knowledge
about culture, history, traditions and political realities where the program
is to take place, as well as consequences of different aid methods and
techniques. No individual discipline can claim to have expertise in all
these areas; the point is that all are relevant and inter-related, (p. 5)
SUPPORTING CHILDREN AFTER HURRICANE KATRINA 31
Specialized mental health care for the small proportion of seriously
affected individuals is one aspect of mental health and psychosocial support in
emergencies (IASC, 2007). The "specialist approach" described by Richman
(1996) focuses on treating trauma and symptoms through technical knowledge
and support, usually by foreign mental health experts. However, generalist aid
agencies, rooted in public health models and the humanitarian imperative for
stabilization of large populations, most often implement psychosocial support
programs geared toward restoration of social and emotional functioning for the
majority of the affected population (Loughry & Eyber, 2003; Psychosocial
Working Group, 2003). Mental health treatment for those with severe reac
tions or disorders may be beyond their technical capacity and mandate. How
ever, it is our experience that such organizations inevitably interface with
individuals requiring specialized mental health care and may be challenged by
a lack of clinical expertise within their staff. Damaged or nonexistent mental
health infrastructure in disaster-affected areas further stymies their ability to
refer individuals to local professional support services. Thus, aid agencies must
take care that their initiatives do not overreach the capacities of their staff and
volunteers—who are themselves often affected, local persons (Richman,
1996)—and that they have adequate clinical backup and support.
Guiding Principles for Psychosocial Interventions
for Children and Families
On the basis of the extant literature and aid agencies' experience from
different emergencies, certain principles and approaches have emerged as psy
chosocial good practice. The following basic tenets are practical, tested strate
gies that can help agencies implementing psychosocial programs minimize
their risk of doing harm, ensure relevant and appropriate programs, and maxi
mize effectiveness (Shultz et al., 2007; U.S. Department of Health and Human
Services, 2004):
• No one who experiences a disaster is unaffected, and disaster
impacts can be defined at the level of both individuals and the
community.
• Individual and community resilience, normal recovery, and
positive adaptation in the face of adversity are the rule, not the
exception.
• Psychosocial services must be tailored to communities and must
tap into a wide range of supports for survivors to cope with loss
of, and change in, family, friends, and community.
• Psychosocial interventions must recognize survivors' strengths
and resilience, assume they are competent, and help them to
master the disaster experience.
32 SNIDER ET AL.
Other publications support these guidelines; for example, the Save the
Children Alliance (1996) underscored the "need for community-based solu
tions to problems; for genuine participation of affected groups in decision
making and implementation; [and for] understanding of and drawing upon
local culture, tradition and resources." (p. 11). These reflections highlight the
potential creativity and strength of emergency-affected families and commu
nities in adapting to very changed circumstances.
Caregivers can promote the personal and social attributes that help chil
dren cope, recover, and reclaim the joys of childhood after a disaster. They
can also reduce the unpredictability and chaos related to disasters and post-
disaster life. The following sections detail some essential components in pro
moting the care, protection, and healthy development of children following
extreme events (Amtson & Knudsen, 2004; Duncan & Arntson, 2004;
Loughry & Eyber, 2003; Save the Children Alliance, 1996; UNICEF, 2002),
including stable and secure attachments to caregivers; physical and economic
security; opportunity for intellectual, physical, and spiritual development;
meaningful peer relationships and social connection; sense of belonging;
sense of agency, trust, and control; self-esteem; and hope.
Stable and Secure Attachments to Caregivers
A close connection to a primary caregiver—one who provides consis
tent and competent care—is essential to children's physical, emotional, and
social development (e.g., Masten & Coatsworth, 1998). For children exposed
to traumatic events, the presence of a stable caregiver to provide comfort and
protection is a key factor in mitigating stress responses and ensuring longer
term positive outcomes. Best practices in emergencies include reunifying chil
dren with primary caregivers (or with other stable, caring adults when pri
mary caregivers are unavailable), supporting caregivers in their own recovery
and increasing their capacity to cope with their own reactions, and transfer
ring skills and knowledge to caregivers to support their own children after the
disaster (Amtson &. Knudsen, 2004; Duncan & Amtson, 2004; Loughry &.
Eyber, 2003; UNICEF, 2002; see also chaps. 2 and 3, this volume).
Physical and Economic Security
The first priority following a disaster is ensuring that people's safety
and basic survival needs are met. As recovery progresses, empowering families
to meet their own needs is key to their sustainable restoration (Amtson &
Knudsen, 2004; UNICEF, 2002). Families unable to regain control and stabil
ity face the potential for further displacement, stress, and rupture. At the
community level, recovery is fostered by the existence of social and eco
nomic safety nets for vulnerable families and by the re-creation of livelihood
SUPPORTING CHILDREN AFTER HURRICANE KATRINA 33