Our Katrina Experience: Providing Mental Health ...

Professional Psychology: Research and Practice 2008, Vol. 39, No. 1, 18 –23

Copyright 2008 by the American Psychological Association 0735-7028/08/$12.00 DOI: 10.1037/0735-7028.39.1.18

Our Katrina Experience: Providing Mental Health Services in Concordia Parish, Louisiana Angeleque Akin-Little and Steven G. Little Walden University Responding to the call for psychologists to serve Louisiana and the Gulf Coast after Hurricane Katrina, 2 school psychologists spent almost 2 weeks in central Louisiana in early September 2005. They were located in a rural area and provided mental health services to evacuees from Hurricane Katrina in a number of small shelters, an RV park, and the schools. This article describes their experiences as mental health volunteers and the impact those experiences had on their professional and personal lives. Keywords: natural disaster, volunteerism, mental health, Hurricane Katrina, school psychology

became very frightened for the city and the people of the coast. Our imagination of what might happen, however, did not come close to matching the devastation that eventually occurred. That devastation would take us on a journey that changed our lives forever and brought an even greater respect for the resilience of people, even in the most calamitous of circumstances. Steve began his love affair with New Orleans in 1972, when he left his hometown of Boston and began his undergraduate career at Tulane University. He graduated from Tulane with his bachelor’s degree in psychology in 1976, obtained his master’s degree from the University of New Orleans in 1979, and, after several years working at Belle Chase State School in suburban New Orleans, returned to Tulane to earn his doctorate in school psychology in 1987. Angeleque is from Tupelo, in northern Mississippi, and her doctorate is from the University of Southern Mississippi. On Monday, August 31, New Orleans and the Mississippi gulf coast were hit hard by Hurricane Katrina. At first, the news regarding New Orleans was positive—that is, damage was not as bad as was originally predicted. Then, at 11 a.m. central standard time, the levees broke, and New Orleans was flooded. More than 1.5 million people were displaced. We were devastated by the pictures we saw on the news. They were surreal and unbelievable. On Tuesday through Thursday (September 1–3), we continued to be alternately angry, sad, and frustrated by what we saw on television. The views of the convention center were horrendous. Was this video really of an American city? Everything was confusing; what once meant up was now down. Two days after the storm, we were still viewing pictures of people, including children, stranded on rooftops. We both knew how hot it can be in New Orleans, and hearing there was no food and no water, that people were dying on the side of the road, was heart wrenching. How could something like this be happening in the United States? We decided we needed to go to the area and try to help. We believe thousands and thousands of other people made that same decision in those days, watching those images. We contacted the American Psychological Association (APA), and they put us in contact with a humanitarian organization, which had put out a call for psychologists and mental health workers. On Friday, September 4, 2005, we finally got our materials faxed to the Red Cross. The organization waived the usual disaster training

We are both school psychologists and licensed psychologists in both New York and California, and we spent 2 weeks in Louisiana providing psychological services as mental health volunteers in the immediate aftermath of Hurricane Katrina. We kept our activities documented in a journal form. This is our story.

Background On August 30, 2005, we monitored television weather reports from our home in Riverside, California. A huge Category 5 hurricane was headed straight for New Orleans and the Mississippi gulf coast. Hurricane Katrina appeared ready to make a direct hit on a city we both love very much. As we watched the news we

Editor’s Note. This article was submitted in response to an open call for submissions about psychologists responding to Hurricane Katrina. The collection of 16 articles presents psychologists’ professional and personal responses to the extraordinary impact of this disaster. These psychologists describe a variety of roles, actions, involvement, psychological preparation, and reactions involved in the disaster and the months following. These lessons from Katrina can help the psychology profession better prepare to serve the public and its colleagues.—MCR

ANGELEQUE AKIN-LITTLE received her PhD in school psychology from the University of Southern Mississippi. She is currently a faculty member of Walden University and was formerly on the faculty of Hofstra University and the University of the Pacific. Her areas of professional interest include behavioral interventions, particularly the effects of extrinsic reinforcement on intrinsic motivation; resiliency and coping in children after natural disasters; overscheduling; and professional issues. STEVEN G. LITTLE received his PhD in school psychology from Tulane University. He is a full-time faculty member at Walden University and has held faculty positions at a number of land-based universities. He is a former president of the Division of School Psychology of the American Psychological Association (APA) and is a fellow of APA. His areas of research include behavioral interventions with children and adolescents, the influence of resiliency on children exposed to natural disasters, and professional issues. CORRESPONDENCE CONCERNING THIS ARTICLE should be addressed to Angeleque Akin-Little or Steven G. Little, 152 Shady Acres Road, Tupelo, MS 38804. E-mail: [email protected] or [email protected] 18

SPECIAL ISSUE: KATRINA EXPERIENCE

requirements for volunteers because it was desperate for help. We received an e-mail confirming receipt of our application on Sunday. This was moving quite fast, faster than we had imagined it would. At 11 a.m. Pacific time, Monday, September 5 (Labor Day), we received a call from the organization. They asked whether we could leave for Baton Rouge the next day. That was impossible for us, as we have animals (three cats and two dogs) and needed to make arrangements for their care. But Wednesday was acceptable. We took a 1-hr training session by conference call that afternoon. It was really not much of a training. We were told what we needed to bring and what we should expect. We worked hard to get everything in order so that we could leave on Wednesday. We packed, purchased items on the list sent to us, made travel arrangements, and got the house organized, all in a huge rush.

Deployment to Louisiana On Wednesday, we boarded a flight from Ontario, California, to Dallas/Fort Worth. At the airport, we met nurses, police officers, and construction workers on their way to volunteer. On the flight from Dallas/Fort Worth to Baton Rouge, all the passengers were humanitarian volunteers. The flight attendants were very kind to us, wished us well, and even thanked us. We arrived in Baton Rouge and waited about 3 hr until we were taken to the processing center (an abandoned Wal-Mart). We got a ride to the processing center in a church van. A local church, without being asked, was shuttling workers to the processing center without any compensation. If not for these individuals, we believe we would have been stuck at the airport for an even longer time. Also—and this is telling—the trip from the airport took about three times as long as usual because of all the traffic in Baton Rouge. The city had doubled in size. We attempted to make a donation to the men for the church. They refused to take our money. It seemed true that people sometimes do show the best part of being human during trying circumstances. We certainly saw a lot of that during the days to follow, and it did reinforce our faith in the goodness of humankind. The processing center was very confusing and very busy. No one seemed to know what to do with mental health workers, particularly psychologists. We finally got processed and had the option of spending the night on a cot at a church shelter or at the home of friends who live in the area. We decided to spend the night with our friends, as we were not sure where we would be sleeping the next 14 nights. On Thursday, we got to the processing center early, only to wait many hours for our assignment. We finally met other mental health workers, although none were school psychologists. The people we met were mostly social workers, marriage and family therapists, and counseling psychologists. Our first assignment was to pick up rental cars from the airport. On the trip to the airport we met German and Danish workers who had come to help, and we were impressed with the diversity of the volunteers. The Hertz Rent-ACar counter at the airport was very crowded, but the workers took us first. We felt badly for the people in the Hertz line who were not with our organization and had been in line before we arrived. These people were very patient, though, and did not seem to mind the inconvenience. We got the cars and drove back to the processing center.

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Two Weeks in Rural Louisiana After that assignment, we were given a rental car and a cell phone and told we should report to the manager of the shelter in Ferriday, Louisiana. We were given no map or directions and had to find Ferriday (about a 2-hr drive from Baton Rouge) on our own. We arrived at the shelter in Ferriday late that afternoon. Ferriday is a small, rural town in the MissLou area, across the river from Natchez, Mississippi. The shelter was housed in the recreation center of the Concordia Parish Jail, and there appeared to be about 100 people there. It was a typical shelter situation, with mattresses on the floor, little personal space, and a constant hum of noise. The manager and the other staff and volunteers, including five nurses, seemed very happy to see us. That Thursday night, we attended an impromptu, outdoor church service in the back of the jail. Not many evacuees attended those services. Friday was the first of some very busy days for us. Angeleque went on an outreach trip with the nurses. The first stop was an RV park where a social worker, Sharon Marie Chester, from Metairie (a suburb of New Orleans), had set up a command center in a warehouse located at the site. Sharon Marie was living in a tiny trailer in the park. She was coping with not knowing what might have happened to her home or her children, who were with her ex-husband. Still, she held daily evacuee meetings, set up a distribution center with donated food and clothes, and was trying hard to make sure all the other evacuees got their medications. Again, we were witness to the best of a person appearing in the midst of disaster. Sharon Marie asked the nurses to help her with some medication problems and asked Angeleque to talk to some of the evacuees. Many of these people had lost their homes. All the possessions they had were with them in their RV. They could not reach their doctors to obtain refills on their prescriptions, most were running out of money, and they did not have access to their bank. To further exacerbate their problems, many of their bank’s computers were down as a result of the storm. Of particular concern was a man who had lost both his mother and his aunt in the storm. He was forced to tie his dead mother’s body to a tree, and his aunt drowned as he was trying to get the two of them away from their flooded home. He reported a lot of posttraumatic stress disorder symptomatology (e.g., intrusive, distressing recollections; feelings of detachment; difficulty sleeping), as specified in the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; American Psychiatric Association, 2000). Angeleque talked to him and discussed coping skills such as thinking and planning about what needed to be done, thinking about pleasant things, and reframing his language to reduce the negative impact (Holaday & Smith, 1995; Smith, 2006) as well as relaxation techniques (e.g., deep breathing, progressive muscle relaxation, visualization; Alvord & Graydos, 2005). She mostly just allowed him to talk about whatever he wanted. She agreed to return at a later date. When she came back the next week, she found out that the family had left. Before we volunteered, we had some concerns about our lack of training in responding to disasters. By this time in our work in Louisiana, we knew we were learning by doing. Some additional training might have been helpful, but we also realized that the training we received in our graduate programs, our continuing education training, and our experiences from our practice and student supervision gave us the foundation to do what needed to be

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done. We now realize that we generally followed suggested approaches that are mentioned in the literature for meeting the needs of people after a disaster (e.g., Mukherjee & Alpert, 2006; Murray, 2006; Watson et al., 2003), on the basis of our training and common sense. Angeleque also traveled to Ferriday High School and visited with a 16-year-old girl who had been expelled from the Ferriday shelter for being disrespectful to a police officer the previous evening. After a discussion with the girl and then her family, it appeared that she had a psychiatric diagnosis, was not taking her medication, and was anxious to return to the shelter to be with her family. It further appeared to us that the workers at the shelter had overreacted and might even have violated the girl’s rights as specified in the Americans With Disabilities Act of 1990. Angeleque advised the aunt to see a psychiatrist in Natchez, the only psychiatrist in the area, to obtain medication (a requirement of the shelter for her return), and she promised to work on getting permission so that the girl could return to the shelter. Since being removed from the shelter, the girl had been living with 20 people in a small house in Vidalia. We went to the home later that day. The people who lived there appeared to be coping and functioning well. They provided Steve with a large selection of home-cooked food, and we found them to be very kind and grateful for our help. For us, this was yet another instance of the grace and courage of people even when they are under a great deal of stress. Steve spent the morning talking to people in the main Ferriday shelter and a secondary shelter at Ferriday Baptist Church. He was directed to people whom the staff had labeled as depressed. Depression seemed to us to be a normal reaction to losing all of one’s possessions, possibly members of one’s family, and not knowing exactly what the future held. These people included a young mother of four children, one a newborn, and the family of a multihandicapped 3-year-old boy. Both of these families were residing in the Ferriday Baptist Church shelter, about a mile from the main shelter. Steve attempted to talk to the young mother, but she was unresponsive. She was exhibiting compulsive cleaning behavior, but the shelter was somewhat dirty. He thought, given the conditions and the responsibility of caring for a newborn, he might also have been cleaning. Steve also believed this was an attempt by this woman to affect some control on her environment. Next, he talked to the father of the 3-year-old and indicated to him that he would try to find the appropriate services or agency in the parish and facilitate contact. Many of the people with whom we worked had preexisting conditions that were exacerbated by the storm and subsequent relocation. For example, the mother discussed above indicated that she was seen regularly on the “third floor.” That meant she had received psychiatric care from Charity Hospital in New Orleans. Steve knew that from his previous experience living and working in New Orleans. Steve’s knowledge of New Orleans and its culture were invaluable in his work with these individuals. Later that afternoon, we went together to the Concordia Parish School District. The superintendent met with us even though we did not have an appointment. She contacted the special services staff of the district (e.g., psychologists, social worker, behavioral specialist) and set up a meeting for later that afternoon. The staff were very concerned about the evacuee children in the district. They also seemed very appreciative of our help and did not act as if we were invading their territory, which is a possible occurrence in these

types of instances. The school population had increased by approximately 500 students in 1 week, but these people seemed to be coping. We decided to organize group meetings of evacuee children at all the middle and high schools in the district. We scheduled another meeting for further planning for early the next week. The staff then invited us out for a drink at Fat Mama’s in Natchez, but we had more to do and were very tired. However, we did think that was a sign that we were accepted by this group. On Saturday, we were asked to drive to Jonesville, about 30 miles from Ferriday. The two nurses at the shelter in Jonesville were concerned about several people, including a young man who was exhibiting some behaviors that suggested posttraumatic stress disorder. He readily talked to us about his experience. He was from St. Bernard Parish, and he stated that he had stayed there throughout the storm. St. Bernard was one of the areas hardest hit by the hurricane. As we write this, more than a year later, it is still not clear whether St. Bernard will ever return to pre-Katrina living standards. In late fall 2006, we traveled to New Orleans and drove to St. Bernard Parish. There were a few houses that were occupied, and it appeared that most people who had returned to St. Bernard were still living in trailers provided by the Federal Emergency Management Agency. This young man stated that he had been evacuated to a local high school. As the water level rose, the evacuees moved to the second floor of the high school, then the third floor, then the roof. He said that at one point he left the school to rescue an old man and his dog from a nearby house. While trying to break the window to gain entry, he cut himself severely. Still, he managed to save the man and his dog. He stated that he was experiencing sleep problems, nightmares, and a lot of anxiety because of this traumatic experience. He also stated that he wished he could have done more to help more people. We listened to his story and told him that he had a lot of which to be very proud, that when it came to a point where he had to choose to be brave or to save himself, he showed tremendous courage. We also told him we did not know whether we would have been that fearless. This seemed to help him reframe his experience somewhat. We also bought him a Walkman and a CD, as he said music helped him relax and sleep. The more he slept, he stated, the better he could cope. When we saw him again a week later, he had made plans to leave the shelter to visit friends in Texas and said that he felt much better. He was just one of the amazingly resilient and brave people we met on this trip. The rest of this Saturday was spent checking in on other clients. Sunday was the anniversary of September 11, 2001, but thoughts of that disaster were far from our mind. There was so much to do, and we found ourselves being stretched very thin. We began the day at the main Ferriday shelter and then went to the Ferriday First Baptist Church for services. The preacher presented a comforting sermon about how Christ-like behavior involves helping others, particularly in a time of great need. Most of the members of the church are White and most of the evacuees Black, but the church truly opened its arms to them. That was something we saw over and over again, how the churches provided such loving care to the evacuees, and the church shelters were often a better place to be than the official shelters. We write this while still strongly supporting the important work of the humanitarian organization that we served. However, this disaster was different than anything the organization had witnessed. It appeared to us that the bureaucracy sometimes got in the


way of doing what was best for individuals. This was an issue we found ourselves grappling with many times during our stay in Louisiana. However, in making the choice between following the standards of the organization and best serving the needs of the individuals with whom we were working, we always opted for meeting the needs of the individual first and trying to follow the standards second. We also made handouts and notices for support groups that we were scheduling for the next week. We continued meeting with clients and had our first group meeting at the Ferriday Baptist Church. After the group session, around 5 p.m., the pastor of the church asked us to speak at the 6 p.m. service. We agreed but were nervous about it. It turned out to be very enjoyable. We gave the church members a lot of reinforcement for what they were doing in terms of aid for evacuees and also gave them basic information about coping with a disaster, signs of disturbance, and so on. This was a very long day, but we felt we might have done some good work. We found ourselves having a hard time keeping track of days of the week. When one is working 12–14 hr a day, 7 days a week, the actual day becomes less meaningful. We were aware that if we were feeling this way, our clientele might be experiencing something similar. Many of them had little to do but sit all day, try to make sense of what had happened the past few weeks, and, if possible, try to make plans for the future. On Monday we began at the two Ferriday shelters. The woman with the four children appeared to be functioning better, and we spent some time consulting with the nurses about the best treatment for her (e.g., she did not like it when the nurses hovered over her or told her she had to take her medications). We recommended they decrease their attentiveness and talk to her in a very supportive, gentle manner. This seemed to work, as she reported to us later that she was feeling more confident in regard to her coping and parenting skills and was making plans to move out of the shelter. We were also able to tell the father of the 3-year-old multihandicapped boy that we had been in contact with school personnel and that a social worker would be by to arrange services for him. This did indeed happen on Wednesday, thanks to a caring, competent school social worker. We were certainly most impressed by the Concordia Parish School personnel. To us, they rated as highly as the churches in the area in terms of unselfish service. Later that day, we met at the RV park and told them we had scheduled a group for Wednesday night. The afternoon was spent at a planning meeting with school district personnel. We also stopped by a private counseling group, the only mental health professionals in the parish outside of the schools, but we were not sure how much help they could be to evacuees. The lack of mental health services in this rural area was disturbing, but this is a common occurrence in the United States (Mohatt, Bradley, & Adams, 2005). In the early evening, we went back to the shelter in Ferriday and met with a woman from Slidell who was having difficulty making choices regarding her future. She had not liked living in Slidell but, prior to Katrina, had not been able to make the choice to leave. Some days, she stated, she felt happy that the hurricane had occurred because it made her choice easier. Then she admitted feeling terrible guilt about those thoughts. Steve counseled her, emphasizing that she had a right to choose what was best for her; the storm did not choose for her. That appeared to calm her

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somewhat. Also, we checked out the staff to make sure that they were adequately handling the stress. That was the original purpose of having mental health workers serve on teams: to help the staff with any mental health issues. We then conducted our second group and ended the day with margaritas at Fat Mama’s in Natchez with the staff from the shelter. Later, we reflected on our work. It was true that we were providing a lot of adult counseling, which is not our area of expertise. As our practice focuses on children, we had to make many adaptations, but we think we did a good job. On Tuesday, we finally got a chance to check our e-mail at the Vidalia library. The day was reserved primarily for Jonesville and Jena, towns in a neighboring parish with shelters. First, however, Angeleque met briefly in Ferriday with the 16-year-old girl who was forced to leave the shelter. She seemed to be doing well. The shelter in Jena was the best shelter we saw. It was at the local Baptist church, and a church member named Miss Bobbie ran it. It was clean, with a lot of homemade food and personalized touches (e.g., partitions to provide personal space) to make the evacuees feel more comfortable. Miss Bobbie also arranged trips to local malls for people and did not make adults go to bed at 10 p.m. She did many things that we thought helped people from a psychological perspective, although, from her perspective, she was just doing what made sense. We gave her a lot of positive reinforcement for her work. Steve met with a family from lower St. Bernard Parish. Steve had worked with this family’s son during the 1986 –1987 school year, when he was doing his internship in St. Bernard Parish. That son was now in his 30s. This family had lost everything, and, more than any other evacuees with whom we worked, we bonded with them. This perception of creating a bond with them was at least partially due to the fact that they treated us as family. For example, they invited us to visit them when they resettled and told us what great gumbo they made. The wife, a nurse, stayed behind at her hospital in New Orleans East along with her husband, a diabetic. They were in the hospital trying to care for patients with no food, electricity, or water. After 3 days they were evacuated to the interstate in Metairie, a New Orleans suburb. They spent one night on the interstate (no toilets, no food, no shelter) before they were able to get transportation out of the disaster area. They were in amazingly good spirits, and the husband already had plans to rebuild his home. Unfortunately, they had also lost the wife’s mother in the nursing home tragedy in St. Bernard Parish, which made national news. They were upset because they had been unable to locate her remains. We both felt honored to be around them, and we had a very good time just talking. We hoped that our discussions gave them some sort of respite from the memories of the nightmare they had faced. Angeleque met with an older man who was reportedly suicidal. He was there with his wife, and before moving to this shelter they had stayed at a local 4-H camp that was not well organized and had become noisy and dangerous. His wife needed specific medical care, and they were having a very difficult time arranging for that and getting information from the Federal Emergency Management Agency and the other organization. Angeleque talked to him and determined that he was more frustrated than suicidal, although she decided he should be closely monitored. We came away from Jena having a great respect for these people also, most of them from St. Bernard Parish. They exhibited amazing resilience, like so many of the people for whom we were able to provide services.

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We also dropped by Jonesville and had dinner at the local church there. Then we held a group at Ferriday Baptist Church and got back to our room around 8:30 p.m. We received a phone call at 10 p.m. There was a problem at the Ferriday shelter. The 16-year-old’s aunt had taken her to the psychiatrist and had a letter stating that the shelter should allow her to return. Angeleque went to the shelter and handled the situation. She and the girl made a contract regarding her behavioral expectations, which everyone signed. Everyone was happy except for one nurse, who did not want to see the girl readmitted. This nurse had stated earlier that people from this disaster were acting ungrateful in comparison with tsunami survivors with whom she had worked. We were offended by some of her comments but attributed them to stress. When she decided to leave Louisiana and return home early, we told the manager of the shelter that that was probably a good idea for her in terms of her own mental health functioning. As Wednesday began, we noticed that fatigue was starting to play a bigger role. We did our first school visit at a rural kindergarten–12th grade school and met with 14 students from the New Orleans area. The meeting was more for triage and organization than actual therapy. Students were given the opportunity to discuss their experience and how they were coping. The meeting seemed to go well. Later that day, we had another school meeting with students at Vidalia Junior High School, where 44 evacuee children attended. We followed the same general procedure, except that we divided the students into smaller groups for discussion. We talked by phone with Dr. Bob Motta, a colleague from Hofstra University, to get advice. Bob is a Vietnam veteran and is an expert on posttraumatic stress disorder in terms of both research and clinical treatment. He reassured us that we were doing the right things. That was a relief to us. We went by the RV park again and met with a few families. One family’s children were having problems in school, and the oldest had decided not to return. Other families we talked with were still attempting to cope and appeared to be in shock over what had happened. We made contact with the school for the first family. With the others, we just listened to their stories. We went by Ferriday Baptist Church and met with the mother of four one last time. We decided that there was little more we could do for her in her situation, so we gave her contacts and closed services with her. She was, as mentioned above, making positive plans for her future. The day ended with a large group session at the RV park. Sharon Marie, the evacuee social worker mentioned earlier, had arranged for burgers to be served in conjunction with the group meeting. We had 37 people show up. Was it the burgers, or was it us? We think it was definitely the food! Steve spoke individually with one woman who had lost her mother in the nursing home in St. Bernard. She was, as one could understand, feeling a lot of guilt. The group session (can we really call it that when there were 37 people?) might have been therapeutic, but we were not sure. One thing we noticed was the high level of support and caring offered within the evacuee community. That was definitely therapeutic. On Thursday we had two school meetings, one at Ferriday Junior High School and one at Vidalia High School. Ferriday was almost all African American, and there were approximately 40 evacuee students there. The meeting went well. Vidalia High School was racially mixed but had a majority White student population. There were signs of possible problems developing at Vidalia High School. Local students and staff were talking of New

Orleans gangs, guns, and violence encroaching on their community, and there was some anger on the part of the local students and staff. That morning there had been a locker search, the first time ever at this school. There definitely appeared to be animosity developing between the rural students and the new students coming in from New Orleans. We talked about this at length with the school psychologists and tried to problem solve. In addition to singling out the evacuee students, the school psychologists were planning on conducting meetings with the entire student body to try to defuse these tensions. We drove to Ferriday, and Angeleque checked on the 16-yearold again. She appeared to be doing well and was a very sweet girl. It was hard to believe that she had been thrown out of the shelter. We spent the rest of the day at Jena and met with a number of people. One of the most popular things we did was to get on the Internet and help individuals find information on their houses. That evening we held a group session at Jena, and by then the man who was thought to be suicidal had returned. Angeleque spoke with him, and his frustration level had decreased. He appeared to be doing much better. He had made contact with the Federal Emergency Management Agency and had a doctor’s appointment for his wife in Alexandria. People really seemed to like this shelter. We began to grow concerned about possible cocooning (i.e., people not wanting to leave the shelter). For some people, particularly one homeless woman with whom Angeleque spoke, life in the shelter was better than their existence in New Orleans had been. This particular woman stated that she did not want to leave. We then talked about this with Miss Bobbie and suggested to her that she encourage people to start thinking about the future and trying to plan accordingly. Our last school visit was scheduled for Friday morning at Ferriday High School. It was the largest group with which we met (almost 80 people), and the participants were all African American. Almost all of the students were living with family in the area and not in shelters. Angeleque introduced the 16-year-old girl to Carrie, a school psychology intern, who would keep meeting with her once we left. We found out at a later date that this girl moved away a few weeks after we left. We were now slowly trying to transition everyone, as we knew we would be leaving soon. We went back to Jonesville. Steve met with a woman who was verbalizing guilt for leaving her husband in St. Bernard when he refused to evacuate before the storm. She traveled to Dallas with her adult daughter and had only recently joined her husband at the shelter in Jonesville. Steve told her that she had needed to do what was best for her, and she was also taught some relaxation techniques. We met with a number of other people, and, overall, they appeared to be doing well considering what they had experienced. The acute crisis seemed to be over. We worried, however, about how long services would continue and what would be available when people began to actively try to rebuild, reclaim, and readjust. This was rural Louisiana, and available mental health services were not and still are not readily available. That was true prior to Katrina, and it was true after Katrina. On Saturday we took a day off. We did our laundry and went to a local music festival. We called our supervisor and were told that they would like us to travel to Alexandria to work at a shelter that was short on mental health workers. We were happy to comply but wondered whether we would be replaced in Ferriday. We believed it was possible that we had been placed in this area accidentally,


and we doubted that any other mental health workers would be sent to such a rural location without any large shelters. We drove to Alexandria Sunday morning and checked in at the headquarters. We were assigned to a shelter at an old Wal-Mart in Pineville. We met with two families. One was very dysfunctional, and every member had preexisting conditions, including major psychiatric diagnoses, sexual abuse, violent and aggressive behavior, and low intellectual functioning. They were facing constant threats from local law enforcement regarding their shelter behavior. The other family had custody problems. The man’s ex-wife had taken his children in the confusion surrounding the hurricane. The ex-wife was wanted by federal marshals on drug charges, and the man was, as we could understand, concerned for the children’s safety. His current wife’s ex-husband was reportedly violent, and she was afraid he would come to the shelter and hurt her and their children. These people also had been forced to leave behind a beloved pet. We spent time helping them develop coping strategies, and we tried, to no avail, to locate their pet online. At the end of the day we found out we could go home the following day instead of Wednesday. It took us hours to get through to the travel agency to change our flight to Monday. We were able to get reservations on a 6:55 p.m. flight from Alexandria to Houston and then back to Ontario, California. Monday morning we went to the shelter to talk to both families again. The young boy in the dysfunctional family was already back at the shelter, having been sent home from school for fighting. Other than that, they seemed to be coping. The other family was depressed but seemed to be developing coping strategies as well. We went back to the headquarters to be processed out, but after that we decided to go back to the shelter one more time to say goodbye. While we were there, all hell broke loose for the dysfunctional family. A member was arrested, and the other members became hysterical and angry with one another. We talked to the police, and they agreed to release the arrestee on our recommendation. We then had a large family discussion with the shelter manager and the psychologist who was replacing us. Luckily, she was a family psychologist. Among the four of us, we managed to stabilize the situation, but we do not know how long the peace lasted. We would never find out because we had to leave for the airport. When we finally got back to Ontario (around midnight, Pacific time), our car would not start, but the American Automobile Association came quickly, and we got home shortly before a major rainstorm hit, a rarity for Southern California in September.

Reflections Looking back at our experiences more than a year later brings back many of the emotions we felt during our time in Louisiana in September 2005. There is no question that we have changed. We frequently wonder what happened to the people with whom we worked. Are they back in the New Orleans area? Are their families intact? Have they been able to rebuild their lives? We have also developed an increased interest in working with individuals who have experienced trauma. We have both taken a continuing education course in trauma-focused cognitive behavior therapy offered by the Medical University of South Carolina (http:// tfcbt.musc.edu/), and Angeleque has joined the new trauma division of APA. We submitted two small grant proposals to allow us to go back to Concordia Parish and do follow-up work. Al-

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though neither was funded, we still have plans to seek funding to look at the role religion and religiosity play in resilience to traumatic experience. This research interest is a direct result of our experience working in both church- and nonchurch-based shelters. Most significant, Steve has taken a new job with an online university, which allows us to live anywhere we like. We thought about moving to New Orleans, but the unavailability of housing there makes that an impossibility at present. We decided to move to Mississippi, where we can get to New Orleans fairly easily and, we hope, get involved in the rebuilding of the schools. Our time in Louisiana pushed us to our limits. We faced challenges every day, and we believe we met them and exceeded even our own expectations. We saw limitations in the system but recognized that our country had never faced a crisis of this magnitude before. We think we are lucky to be a husband and wife team who were sent to a rural area and given the freedom to do what we thought was necessary. We did much of our work outside the auspices of the humanitarian organization, leaving the shelters and doing outreach in the community, but we do think this was where we had some of our greatest impact. It is our hope that others will be given similar autonomy in the future. The constraints of the shelters made them, in our humble opinion, not always as conducive to good mental health functioning as the church shelters were. Yes, it was indeed a very exhausting 2 weeks, but we would do it again. Here’s hoping, however, we never have to.

References Alvord, M. K., & Graydos, J. J. (2005). Enhancing resilience in children: A proactive approach. Professional Psychology: Research and Practice, 36, 238 –245. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author. Americans With Disabilities Act of 1990, 42 U.S.C.A. § 12101 et seq. (West 1993). Holaday, M., & Smith, A. (1995). Coping skills training: Evaluating a training model. Journal of Mental Health Counseling, 17, 360 –367. Mohatt, D. F., Bradley, M. M., & Adams, S. J. (2005). Rural mental health: Challenges and opportunities caring for the country. In N. A. Cummings, W. T. O’Donohue, & M. A. Cucciare (Eds.), Universal healthcare: Readings for mental health professionals (pp. 127–150). Reno, NV: Context Press. Mukherjee, P. P., & Alpert, J. L. (2006). Overview of psychological interventions in the acute aftermath of disaster. In L. Barbanel & R. J. Sternberg (Eds.), Psychological interventions in times of crisis (pp. 3–35). New York: Springer. Murray, J. S. (2006). Addressing the psychosocial needs of children following disasters. Journal for Specialists in Pediatric Nursing, 11, 133–137. Smith, H. B. (2006). Providing mental health services to clients in crisis or disaster situations. In G. R. Walz, J. C. Bleuer, & R. K. Yep (Eds.), Vistas: Compelling perspectives on counseling 2006. Alexandria, VA: American Counseling Association. Watson, P. J., Friedman, M. J., Gibson, L. E., Ruzek, J. I., Norris, F. H., & Ritchie, E. C. (2003). Early intervention for trauma-related problems. In R. J. Ursano & A. E. Norwood (Eds.), Trauma and disaster responses and management (pp. 97–124). Washington, DC: American Psychiatric Publishing.

Received September 11, 2006 Revision received January 31, 2007 Accepted February 5, 2007 䡲