Factors impeding delivery of interventions
Some school personnel did not perceive a need for any mental health approaches for students beyond the immediate stabilization phase. Students were described as doing well (resilient, flexible, and well adjusted), and additional services were seen as unnecessary. One interviewee believed that any trauma that manifested itself after Katrina and Rita had existed before the hurricanes and may have been exacerbated by the storms but was not directly related. In contrast, other schools saw a high level of need among the students, and one school district that screened displaced students found 31% had a high level of posttrauma anxiety and depressive symptoms. In fact, some school personnel reported a high level of need among their regular students as well as among the displaced students and thus saw a need to balance what they could offer the displaced students with the need to continue to offer services to their regular student body.
Other school personnel described a desire to provide some type of services to the displaced students but noted that their efforts were hindered by a variety of factors, including the need to refocus on academics as the school mission, a lack of prior training, scarcity of resources, competing priorities, and other implementation issues. Each of these types of problems is described in more detail below.
Academics as the school mission. Many school districts reported refocusing on academics as the priority, in line with schools' main mission of education, in the postacute phase of recovery. In some instances, this shift in emphasis was reinforced by the approach of mandatory testing in early spring 2006 in Louisiana and Mississippi. At the same time, interviewees in some systems reported flexibility; for example, some systems did not count standardized tests toward student placements, and one school whose entire student body was living in trailers instituted a no-homework policy. In other schools, administrators specifically asked mental health personnel to allow students to "move on" from the topic of the hurricanes. Other interviewees reported that teachers wanted to get "back to normal" and wanted the counselors to stop coming into class to talk about the hurricanes.
Some interviewees noted that additional stress came from educational delays among some of the displaced students, and they saw it as a priority to assist these students in reaching the host school's academic standards. For example, some schools hired school counselors to help older students track down records and finish their credits so that they could graduate, and others described implementing tutoring and educational support to level the playing field between some of the displaced students and the regular student population.
Prior training. Implementing programs in the acute recovery phase appeared to be partly driven by prior training and availability of materials. Many interviewees described having ready access to materials and handouts about the mental health consequences of trauma that they found on Web sites of national organizations, and many had crisis teams that were trained and ready to help in that phase.
In contrast, few interviewees described their schools or districts as having the capacity to deliver interventions for children exposed to trauma who had lingering symptoms of PTSD and depression in the postacute phase. The interventions that tended to be used during the 2005–2006 school year were already "on the shelf" and used previously by counselors to address previous school crises or loss. For example, one counselor described finding the materials for a particular trauma program floating in a sealed plastic bag in her living room, when all her other counseling materials had been destroyed. She was able to implement that program. Training that was provided to counselors in the aftermath of the hurricane was described as being very general and not providing the details necessary to choose what to implement or how to go about it.
Scarcity of resources. School personnel expressed frustration at the lack of funding for services to displaced students. They believed that these funds had been promised, which left them feeling "abandoned" when the funding never came. Another interviewee mentioned applying for a grant to hire another counselor and having the request denied by the funding agencies without justification. Resources that were available may not have been allocated evenly. One interviewee noted that some schools had more resources than they could use, whereas just across town there were schools still scrambling to find the same supplies. Those that did receive funding reported that it came late in the school year, making it very difficult to launch services during that year.
Competing priorities. School personnel also discussed other competing priorities, many of which were related to pressing needs in the community to repair structural damage and staff needs in regard to rebuilding their homes. Several interviewees emphasized that staff burnout was a large issue in the schools. Many personnel described frustration and a general level of stress in their communities, with disrupted services, traffic congestion, and extra residents in many homes. These types of issues were not cited as interfering with service delivery per se but were described more as a general hassle that affected everyone and limited energy during the work day. Schools that were damaged and whose entire student bodies were displaced struggled with restaffing issues and rebuilding the school community, which often meant that remaining staff were asked to address multiple school needs.
Other implementation challenges. Interviewees also discussed barriers that impeded their implementation of mental health interventions. One issue they identified frequently was difficulty communicating with parents, both to gain consent for mental health interventions and to include them in educational or outreach programs. They reported enormous challenges both in intact communities, where jobs and cell phone numbers had changed, and in displaced communities, where many people were living in trailers and temporary housing. Similarly, transportation posed an obstacle for many displaced families who had no cars, some of whom were living in trailer areas that were not served by bus routes or other forms of public transportation. Interviewees also described extremely stressful living conditions for families in trailers, which reduced energy and motivation for participation in interventions or outreach services.
Some school personnel interviewed wanted to refer students to community mental health providers, but they found many of the usual providers were no longer available in the area or had long waiting lists. Thus school personnel had to develop a new list of referral options.