I'm very pleased today to have you meet Joy Osofsky. Joy is one of the worlds leading authorities on how children respond to disaster and interventions with children after disaster. She is on the faculty at Louisiana State University in New Orleans. And because of that location, she experienced herself Hurricane Katrina and the Deepwater Horizon Gulf oil spill, and she's done a lot of research on those two disasters and their relationship as well over the years. She's a professor of pediatric psychiatry and public health and a very distinguished leader in the field on. Children's health and development. Welcome Joy. >> Hello, it's great to be with you. >> You have studied disasters first and observed first hand the effects they have on children and families and I wonder if we could begin with you just telling us from your experience with Hurricane Katrina. Why was that. Disaster so devastating. And had such long term effects? >> That's an excellent question. And, we thought a lot about that too. So, people, in this part of the country, in the gulf region of the United States are. Usually, relatively prepared and know the possibility of disaster striking is high and so most people make that preparations for hurricanes and if it seems like it's going to be storm they plan to evacuate or they find ways that they're going to. Be able to be safe when a hurricane comes, which is expected in this part of the country. The problem with Hurricane Katrina was, first of all, it was a huge hurricane, larger than one that people had experienced before. And then the second part of it was that as bad enough as. The hurricane Katrina was, it was so strong that it broke the levy. So there were very much unexpected events in the, in New Orleans and the region that nobody was prepared for, neither people who had to go through it, families nor frankly, the people who do disaster preparedness and response. It was an unexpected. Unexpectedly devastating and an event that put people into a situation where lives were being lost, there were very few ways to immediately help people. Which we usually can do after a hurricane. This of course isn't the only. Area in the world where this has occurred but, but that was the issue with Hurricane Katrina and the usual responses weren't going to work. >> Tell us what you think did work based on both your research and your observations, because you were part of the recovery. What helped the children most immediately and then over time, as time went by, what were the things that were most helpful to the children? >> Well one of the things that we learned a great deal about with Hurricane Katrina is first of all to pay attention to both. Developmental and psychological issues that occur over time. Next week, actually, we're going to be celebrating the ninth anniversary of Hurricane Katrina on August 29th. And in terms of long term, we continue to be very, very concerned about children. In, in general, but also in the age range of 8 to 12. That, just because families have been able to get back together in some sort of way following Katrina, in fact, the effects have been long term and devastating, not just because of the effects of, of Hurricane Katrina itself. But other traumas and other losses and other, very difficult events and traumatic events that have occurred in the children's lives. So, the first response after a disaster is first of all to try to keep people safe and try to keep families together and try to. Help children get back to some sense of stability in their lives. What we sometimes have called the new normal. Some kind of routine, some kind of things that they can expect in general. But one of the things that happens, and of course happens with a lot of the children and families that went through Katrina, is that. It caused such disruption in their lives that they were dislocated for a long period of time. They lived in very crowded positions. The parents had caregivers who usually helped support children were also very distressed and went through a great deal of difficulty. So that it was hard to have the recovery you often expect following a disaster. In that occurs within about a, a three year period where things sort of get back to some sense of normality. With Katrina that did not happen. And then of course the children were impacted by, by subsequent events. And I think that's what we need to pay more attention to is not just the particular disaster but then. The adverse, events that can follow and how to follow it and that's where we see the, most devastating effect on children. >> Would an example of that be the combination of Katrina followed later on by families who have experienced the impact of the Gulf oil spill. Yes, absolutely. Absolutely. And then, a few after Katrina, there was hurricane Gustaf. >> Mm-hm. >> Which was which actually ended up, not impacting as much on at least the New Orleans area. But did cause an evacuation and all of the kinds of reexperiencing and retraumatization and triggers related to that. But the Gulf oil spill has been devastating in many areas that were already heavily impacted by Katrina. And what the oil spill brought, the technological disaster as compared with the natural disaster. Is much more of a sense of uncertainty for families. So even though Katrina was very devastating for so many people, people knew what to do after a disaster of that magna, magnitude. They knew they had to try to get back and try to rebuild. After the oil spill. With the economic impact, the stress on families, not knowing if they would have a way to support themselves and their families, not, not knowing if families that have been doing various kind of occupations like fishing for generations, not knowing if they would be able to do that. And so, it was really a disruption, not just of community, but really of a way of life for families. And so, for those families that also experienced Hurricane Katrina, it's been extremely difficult for, for many of the children and families to recover. >> You have studied, I know, different patterns of recovery. Could you describe what your learning from your longitudinal data. >> Yeah, well we have been very excited about the opportunity to have been able to gather longitudinal data. Really with the enormous collaboration and commitment of schools in the area as well. Where we have collaborated to be able to gather the data. But as you know very well. We all know. You rarely have pre-disaster data to compare with post disaster data. Because the fact that we have been working in the area since, well before Katrina, but related, disaster related since Katrina and the gulf followed. Five years later, we've been able to have pre-disaster and post-disaster data. And have collected screening in collaborations in schools every year since 2005. So, we've been able to look at a longitudinal sample. Obviously the whole sample is not longitudinal, but there are large, there's a large longitudinal sample to look at these trajectories over time, that you and others have theorized about. Look at the empirical data. And, it is very interesting that the data supports. The theoretical notations about projectory and change over time. Most children, the majority of the children show, if we want to call it resilience. i like to call it resilience. The majority of the children are able to somehow bounce back and cope under those circumstances. And then the next largest proportion of children shows some symptoms and we often look at mental health symptoms that's what we concentrated on post traumatic stress symptoms, and symptoms of depression and symptoms of anxiety. Some children show a high level of those symptoms but then are able to, with the support of families getting back into school, getting back into their, quote, new normal environment the symptom level goes down. So that, that's the majority of the children and that supports the theory. What's of more concern from a point of view of long term recovery are the other two categories that we also found in the empirical data. One of them, for those children who don't show that many symptoms to begin with, and then there's an increase in symptoms over time. And, for those children what seems to contribute to that increase in symptoms, is other traumas that have occurred in their lives, other losses, lack of support, lack of community support, a variety of different thing. So that category is of some concern, and then the smallest category and the greatest concern is what we call chronic. Those people who have a lot of symptoms to begin with and then continue to have a lot of symptoms. And there's very clear evidence in that group these children request mental health services more, they have more difficulties in, in general, coping, there's less support in families, they're exposed to more traumas. So, I guess the positive message is that most children are able to recover with the usual support. But, we really need to pay attention to both the developmental and psychological implications over time for children who not only experience disasters but then experience other serious traumatic, events in their lives. That really interfere with their ability to move forward both on the normal developmental trajectory as well as a recovery directory tra trajectory related to psychological symptoms. You know, one more thing related to that that I think would be a direction for the future to look at. One of the things we're seeing right now with our work following the gulf oil spill is we're working also in primary care clinics. There's a relationship between physical health symptoms and mental health symptoms. And one of the most interesting findings coming out of that, we're finding it with adults, but we're also finding it with children, is that as the mental health symptoms are drastic attention to, where we're integrating mental and behavioral health and primary care, the physical health symptoms go down. I think this intervention, this type of availability of services and recognition of the need is going to be extremely important. In terms of preparedness and prevention, related to disaster response. >> Well I think that's a wonderful place to stop. And I just want to express, my appreciation. Not only for you, coming to do this meeting for this course, but also for all of the work that you, and your husband Howard do. To understand and promote resilience in children after disaster. Thank you. >> I thank you very much.