[Senate Hearing 107-540]
[From the U.S. Government Publishing Office]
S. Hrg. 107-540
CHILDREN OF SEPTEMBER 11: THE NEED FOR MENTAL HEALTH SERVICES
=======================================================================
HEARING
BEFORE THE
COMMITTEE ON HEALTH, EDUCATION,
LABOR, AND PENSIONS
UNITED STATES SENATE
ONE HUNDRED SEVENTH CONGRESS
SECOND SESSION
ON
EXAMINING WHAT WE NEED TO DO TO HELP OUR CHILDREN HEAL FROM THE WOUNDS
LEFT BY SEPTEMBER 11
__________
JUNE 10, 2002
__________
Printed for the use of the Committee on Health, Education, Labor, and
Pensions
U.S. GOVERNMENT PRINTING OFFICE
80-498 WASHINGTON : 2002
_____________________________________________________________________________
For Sale by the Superintendent of Documents, U.S. Government Printing Office
Internet: bookstore.gpor.gov Phone: toll free (866) 512-1800; (202) 512-1800
Fax: (202) 512-2250 Mail: Stop SSOP, Washington, DC 20402-0001
COMMITTEE ON HEALTH, EDUCATION, LABOR, AND PENSIONS
EDWARD M. KENNEDY, Massachusetts, Chairman
CHRISTOPHER J. DODD, Connecticut JUDD GREGG, New Hampshire
TOM HARKIN, Iowa BILL FRIST, Tennessee
BARBARA A. MIKULSKI, Maryland MICHAEL B. ENZI, Wyoming
JAMES M. JEFFORDS (I), Vermont TIM HUTCHINSON, Arkansas
JEFF BINGAMAN, New Mexico JOHN W. WARNER, Virginia
PAUL D. WELLSTONE, Minnesota CHRISTOPHER S. BOND, Missouri
PATTY MURRAY, Washington PAT ROBERTS, Kansas
JACK REED, Rhode Island SUSAN M. COLLINS, Maine
JOHN EDWARDS, North Carolina JEFF SESSIONS, Alabama
HILLARY RODHAM CLINTON, New York MIKE DeWINE, Ohio
J. Michael Myers, Staff Director and Chief Counsel
Townsend Lange McNitt, Minority Staff Director
C O N T E N T S
----------
STATEMENTS
Monday, June 10, 2002
Page
Clinton, Hon. Hillary Rodham, U.S. Senator from the State of New
York........................................................... 1
Corzine, Hon. Jon, U.S. Senator from the State of New Jersey..... 3
Switzer, Anna, principal, P.S. 234; Scarlet Taveras, student,
High School for Leadership and Public Service; Mary Ellen
Salamone, Director, Families of September 11; Kerry Kelly,
M.D., Chief Medical Officer, FDNY; Dominick Nigro, Director of
Pupil Personnel Services, District 31, Staten Island; and Risa
Cullinane, Red Bank Regional School Based Youth Service
Program, Red Bank Regional High School, Little Silver, NJ...... 5
Levy, Harold, Chancellor, New York City Board of Education; Brad
Gair, Federal Recovery Officer, FEMA; Charles G. Curie,
Administrator, Substance Abuse and Mental Health Services
Administration; Chip Felton, New York State Associate
Commissioner and Director of the Center for Performance
Evaluation and Outcomes Management, New York Office of Mental
Health; and Thomas R. Frieden, M.D., New York City,
Commissioner of Health......................................... 22
Pfefferbaum, Betty, M.D., Professor and Chairman, Department of
Psychiatry and Behavioral Sciences, University of Oklahoma
Health Sciences Center; Christina Hoven, M.D., Mailman School
of Public Health, Columbia University, New York State
Psychiatric Institute; Harold Koplewicz, M.D., Director, NYU
Child Study Center; and Pam Cantor, M.D., Founder and
President, Children's Mental Health Alliance................... 40
Additional Material
Statements, articles, publications, letters, etc.:
Pam Cantor, M.D.............................................. 55
A New York City School District's Response to the WTC
Disaster................................................... 60
Schuster, M.A., B.D. Stein, L.H. Jaycox, R.L. Collins, G.N.
Marshall, M.N. Elliott, A.J. Zhou, D.E. Kanouse, J.L.
Morrison, S.H. Berry....................................... 63
The New York Academy of Medicine............................. 68
CHILDREN OF SEPTEMBER 11: THE NEED FOR MENTAL HEALTH SERVICES
----------
MONDAY, JUNE 10, 2002
U.S. Senate,
Committee on Health, Education, Labor, and Pensions,
Washington, D.C.
The committee met, pursuant to notice, at 9:10 a.m., in the
Auditorium, U.S. Customs House, One Bowling Green, New York,
NY, Hon. Hillary Clinton presiding.
Present: Senators Clinton and Corzine.
Opening Statement of Senator Clinton
Senator Clinton. The hearing is now called to order, and I
thank you all for attending this field hearing of the United
States Senate Committee on Health, Education, Labor and
Pensions. I am very honored that Chairman Kennedy was so
interested in this subject that he authorized this important
field hearing on the critical subject of Children and September
11th: The Need for Mental Health Services.
Immediately after September 11th, Senator Kennedy convened
a hearing to look at some of the long term mental health
problems, and he is very well aware of the needs that we have,
particularly here in New York. He was sorry that his schedule
did not permit him to actually be here in person, but I wanted
personally to thank him. I am, however, delighted that my
friend and colleague, Senator Jon Corzine from New Jersey could
join me today to look at what we need to do to help our
children heal from the wounds left by September 11th. We
obviously have to look at this problem comprehensively and to
make sure that we have a seamless delivery of services for
children in New York and New Jersey, anywhere that children
were impacted.
This hearing is the result of many months of hard work and
dedication by a group of individuals who have been advising me
on the needs of children post-9/11, and before we officially
get started I want to thank them. Larry Aber of the National
Center on Children and Poverty at Columbia University; Gail
Nayowith of the Citizens Committee for Children of New York;
Eric Brettschneider of The Agenda for Children Tomorrow; Ruth
Massinga and Whitney Williams of the Casey Family Program; Dr.
Irwin Redlener of the Children's Health Fund and two of the
individuals who will be testifying today, Pam Cantor of the
Children's Mental Health Alliance and Dr. Harold Koplewicz of
the NYU Child Study Center.
Now, tomorrow we will mark nine months since the day our
world was turned upside down and the worlds of many of our
children were changed forever. We cannot possibly understand
the impact that this has had on families and particularly
children, but today we are going to hear from people who have
been directly involved.
We know that, for example, the Fire Department has left 600
children behind who lost a parent. Cantor Fitzgerald estimates
that 1300 children lost a parent. I know that many of the
witnesses here today will speak to those particularly tragic
effects on our children.
There were also a large number of children who were in the
immediate area of the World Trade Center. They fled to safety
led by courageous and heroic teachers, principals, child care
providers and others, but they have not been able to flee from
the images of that terrible day.
We have other children in our community who were just
beginning to regain their own perspective on the world when we
had a plane crash in Belle Harbor, Queens. We lost many parents
of children left behind in New York City and elsewhere, and of
course there have been so many images of that terrible day that
have repeatedly played affecting children who were vulnerable
to begin with.
In New York, the community has banded together to assist
our children. We have had great leadership from Chancellor
Levy, who understood the importance of assessing the mental
health needs of children and we have had many nonprofit and
philanthropic organizations working specifically on this issue.
The Afterschool Corporation with funding from The New York
Times Neediest Fund started Downtown After 3 to insure that all
children in the downtown area had access to afterschool
programs. The M&B Donaldson Institute started the Permanency
Project to provide support services to children who lost a
parent. The Jewish Board of Family and Children's Services has
formed a partnership with Herzog Hospital in Jerusalem to learn
from one another in order to provide school-based services to
help create greater resilience in populations exposed to
chronic threats. Each of these organizations have submitted
written testimony that will become a record of this hearing.
Today's hearing will focus on three major themes:
Experiences of children, parents, schools and professionals who
suffered great losses and trauma on September 11th; response of
the public sector to mental health needs of both our children
and our families; and research and best practices-what are the
mental health needs that can be defined and what should we do
to meet them.
I hope that the hearing will help to illuminate an
understanding about our mental health infrastructure and
services available, how we can have a better public
understanding, how we can educate parents, teachers and others,
how we can improve our intergovernmental coordination to
provide comprehensive services, and what we need to do to be
prepared in the event of another terrible disaster.
Now I would like to ask my colleague, Senator Corzine, for
any opening comments he would like to make.
Opening Statement of Senator Corzine
Senator Corzine. Thank you, Senator Clinton. First of all,
I would like to thank you for convening this hearing today on
this very special and important topic. There is no one in
America who has shown more care and love for America's children
as a leader in their behalf for our nation than Hillary
Clinton, and I think this is just another statement of your
effort to care for America's children.
And I also appreciate Senator Kennedy offering us this
opportunity to hold this committee session here in New Jersey
and in the New York metropolitan area as we go through this
problem. There is no question our lives have changed
dramatically since September 11th. This is particularly true
for our most vulnerable, our kids. No matter how hard we may
try as parents, caretakers, teachers to shelter our children's
pain, the world has tragically altered. In fact, terrorism is
inherently a psychological phenomenon. That is the intent of
terrorism, and to not recognize it in the context of our
children I think is very, very mistaken, so I think that is
what we are here today to review and study.
While we have been increasingly vigilant to our nation's
security needs, we must not lose track of the needs of our
kids. The greatness of America is measured not just by the
might of the military, but also by the strengths of her
communities and the health of her children.
I was very concerned to read the recent report by the New
York City Board of Education which showed a significant number
of New York City students are suffering symptoms of post
traumatic stress disorder, generalized anxiety or depression.
This is a critical indicator of the trauma faced by children as
a result of the terrorist attacks and it is a clear warning
sign of both the ongoing mental health needs of our children
and the potential lifelong difficulties that they can face as a
result of the trauma. These are warning signs that our nation
cannot ignore.
As many of you know, New Jersey lost almost 700 people--
fathers, mothers, and loved ones, in the terrorist attack of
September 11th. That means that thousands of children in New
Jersey as well as in New York are dealing with the loss of a
loved one, many suffering silently. I know we will hear later
from a teacher at Red Bank Regional High School in Monmouth
County, which alone lost 160 people on September 11th.
I am pleased today that we will focus on the special needs
of those children that have been directly affected by the
attacks. We need to determine if we are doing all we can in
Government to help cope with this trauma and we cannot forget
the hundreds of thousands of children in New Jersey alone, and
many, many more in New York who, while not directly affected by
the attacks, have nevertheless been traumatized. They, too, are
vulnerable and their needs must also be addressed.
So let me thank the witnesses, the many witnesses that are
here, particularly the two from New Jersey; Mary Ellen Salamone
from North Caldwell who lost her husband on September 11th and
has three beautiful young children. She has worked tirelessly
with the group Families of September 11th and founded Children
of September 11th.
I also want to thank Risa Cullinane, who runs the school
based health clinic at Red Bank Regional High School in Little
Silver, New Jersey, and I, too, want to thank Harold Koplewicz
of the NYU Child Study Center. As Senator Clinton knows, I
served on the Board of the Child Study Center for a number of
years. He is a tremendous leader, a national leader on
children's health issues and I look forward to his comments and
those of all of the other panelists. You really have insights
on a subject that we all care dearly about, and I hope that out
of this hearing we may come to some practical suggestions with
regard to actions that our nation might take in the context the
Homeland Security Department has talked about and with regard
to making sure that we have the resources that we need to
address this issue in a serious and thoughtful manner so that
our children go forward in a better way.
So I congratulate, again, Senator Clinton, thank you very
much for having this. There is not a more important issue for
our metropolitan region than making sure that our children and
their health is attended to, their mental health is attended to
after September 11th and I look forward to this hearing.
Thank you.
Senator Clinton. Thank you very much, Senator Corzine.
In order to provide enough time for each of our witnesses
to offer his or her testimony, I will introduce the first panel
together and ask each to offer the testimony one right after
the other. Each has been given five minutes to present. That is
not enough time. One of the problems in these hearings is to
make sure we hear from a number of people that have something
to say, we must ask them to be brief. It is a great privilege
to have all of our witnesses here today and we will certainly
include their entire statements in the record. After the
witnesses, we will have a chance for questions.
Our first panel will help all of us to understand the
children's faces behind the statistics and the studies. Our
first witness will be principal Anna Switzer of P.S. 234. She
is one of the heroes who led all of her children to safety on
September 11th.
She will be followed by Scarlet Taveras, a high school
student at the High School for Leadership and Public Service,
who along with her classmates found herself running for safety
on September 11th.
Mary Ellen Salamone is the mother of three children who was
widowed when she lost her husband Don, a Cantor Fitzgerald
employee. She has become a very strong compelling voice on
behalf of families. She now directs Families of September 11th.
Dr. Kerry Kelly, who is the chief medical officer of the
New York Fire Department has been a constant advisor to the
Congress, particularly to my office, about what needs to be
done to make sure that the needs of firefighters and their
families, their children, are taken into account in everything
we do, and I thank her for once again being here to help.
Dominick Nigro is a community and school leader from Staten
Island. Staten Island was one of the places in the city that
was most tragically impacted by September 11th. Hundreds of
children lost their parents. Finally, Risa Cullinane is the
program director of the Red Bank Regional High School's Youth
Services Program in Little Silver, New Jersey.
So if we could, we will start please with principal Ann
Switzer.
STATEMENTS OF ANNA SWITZER, PRINCIPAL, P.S. 234; SCARLET
TAVERAS, STUDENT, HIGH SCHOOL FOR LEADERSHIP AND PUBLIC
SERVICE; MARY ELLEN SALAMONE, DIRECTOR, FAMILIES OF SEPTEMBER
11; KERRY KELLY, M.D., CHIEF MEDICAL OFFICER, FDNY; DOMINICK
NIGRO, DIRECTOR OF PUPIL PERSONNEL SERVICES, DISTRICT 31,
STATEN ISLAND; RISA CULLINANE, RED BANK REGIONAL SCHOOL BASED
YOUTH SERVICE PROGRAM, RED BANK REGIONAL HIGH SCHOOL, LITTLE
SILVER, NJ
Ms. Switzer. On behalf of the children of P.S. 234 I want
to welcome you to New York City and thank you for focusing on
the mental health needs of the children in our community.
My name is Anna Switzer and I am the principal of P.S. 234,
the closest elementary school to Ground Zero. I believe if you
listen to our story, you will understand that we are in dire
need of expanding and continuing mental health services for our
students.
At 10:30 a.m. on September 11th, my staff, children and I,
ran out of our school as smoke and debris rained down upon us.
Immediately before that, for a period of two hours, we waited
as frantic parents picked up their children one by one. While
waiting, we herded both children and adults together, finally
ending up in the basement in an effort to find a safe space
within our building. As this happened, teachers sang songs,
read stories, shut the blinds on the windows facing the Towers
and above all, remained calm as alarms went off, lights
flickered and the building trembled.
Without benefit of radio or news, we were open to the
terrible rumors that were circulating. We knew only that
something awful was happening in the place where our children
lived, went to school, played in the parks and thought of as
home. Finally, at 10:30 on or own without benefit of police or
any security, we decided we had to leave and walked our
remaining children two and a half miles north to P.S. 41. Most
of us managed to get out just as the second tower collapsed and
smoke turned our day into night. In total darkness our youngest
children and their teachers were told to run for their lives.
The remaining few of us watched them disappear into the black
opaque cloud. Those fleeing turned around to see the rest of us
pushed back into blackness, having no idea what befell us or
whether there was even a school still standing. Worse were the
other horrific scenes that too many children witnessed that day
as they fled from the towers.
It was one of our children that uttered that now famous
line, ``Look, the birds are on fire.'' The truth of what he was
seeing was too awful to understand.
Eventually, miraculously, we managed to find refuge. Over
the longest hours imaginable, we waited for our families to
safely claim their children. Thanks to the teachers, 8,000
school children were safely evacuated that day from downtown
New York schools.
We did not realize that this was the beginning of an
odyssey that would take over six months. For our school
community, this crisis has lasted well beyond the 11th. Our
families, many of them unable to return to their homes, began
to rely on the idea of our school as a safe haven and the
community's glue. We only slowly understood just how long and
how complicated it was going to be simply to go back to our
building.
What saved us during this year was our relationship we had
with our extraordinary school psychologist, Dr. Bruce Arnold,
and the services he was able to provide for us. Bruce, the
teachers, parents and I had worked together for ten years
helping our children and families in need. We had a very strong
relationship of mutual trust and respect. Bruce arrived on the
11th and has stayed close ever since, working with our
teachers, a counselor and parents, he gave us the tools which
enabled us to help our children. Through weekly parent
meetings, almost daily teacher meetings, support groups,
surveys, letters, he and the counselor supported our 600
children and families through the difficult times that were yet
to come.
For many months we were out the anchor of our community,
our school building. Exhausted and anxious, we set school up
for 600 children again and again. Our first new school, P.S. 41
was welcoming, but already at capacity. As many as 90 of our
kids were in one room without benefit of cafeteria, gym or
yard. After four weeks we moved to our next home, an abandoned
parochial school. The Board of Education was Herculean in its
efforts to get it ready for us, but, once again, the task of
making it ready for a school was primarily the job of an
unflagging, increasingly-tired staff and dedicated parent body.
We stayed at St. Bernard's for four months. We found we had
additional challenges to meet and I found I spent the next four
months as principal wearing the ever-changing hats of
negotiator, counselor, general contractor, goods purveyor,
mover, designer and even upon occasion educator.
It was our constant worry that our community would fragment
or fall apart on the issue of our return. Who could assure us
our beloved 234 was a safe place for children to be? Did each
of us have to become an expert in asbestos, lead and dioxide
poisoning? Again, thanks to Dr. Arnold, we found a way to build
consensus, allay fears and return home.
Our return on February 4th was the highlight of our year.
The joy was palpable. Unfortunately, it is become increasingly
clear that merely wanting the normalcy of our lives is not
enough to make it happen. We collectively experience the shock
of a loud noise, a plane too low, a sudden announcement over
the loudspeaker. We hear about kids' nightmares, their
unwillingness to go to large public places, their avoidance of
the subway, their fears of flying. Two weeks ago we found
ourselves unwilling to go on our annual field day. We canceled
all our subway trips for the rest of the year. In announcing
this, we found ourselves thrust right back into the fears and
terror of September 11th.
In school, many of our children appear to be coping.
However, in our own surveys 30 percent of our kids are asking
for additional support. They are very worried about their fears
for the upcoming year. The communities are suffering, families
are not doing well. At meetings in this charged atmosphere,
parents and teachers are looking for guidance about how to
relieve the stress and tension and how to help their kids. I
hear parents who are unwilling to allow their kids to go two
blocks to the movies, accompanied by their grandparents because
of fear of being separated. I know families that have mock fire
drills and escape routes at home to settle their children's
fears.
My kids write about the 11th when they do their summer
essays for camp. Before the 11th, Tribeca was a small village;
everyone knew each other. The children were always safe. This
was a result of pioneer New Yorkers willing to settle downtown
and actively pursuing urban life. I had the privilege of
watching the neighborhood grow its first library, soccer league
and even the first coffee shop.
In the shadow of so many tall buildings, a residential
Mecca was created. Our community and children and adults alike
need to learn how to regain our Mecca and the productivity of
their lives. Our children and families have the right to grow
up whole and go through their daily tasks without fear.
Please know at this time I have no commitment of funds for
mental health services for the fall. Thank you for listening.
Thank you for your efforts in supporting us and thank you for
your efforts in securing financial assistance for us and I am
happy to answer any questions that you have.
Senator Clinton. Thank you very much.
Ms. Taveras?
Ms. Taveras. Good morning, Senator Clinton, Senator
Corzine. Thank you for the opportunity to testify on behalf of
all New York City students.
My name is Scarlet Taveras. I am a student at the High
School for Leadership and Public services. The World Trade
Center concourse was our place to hang out. We had a beautiful
view from our classroom and just being down here made us feel
great.
On September 11th everything changed. The downtown area,
known for its beauty and economic status as well as its level
of safety became a very dark and scary place. Seeing the Towers
in flames, buildings collapsing, people running, crying,
bleeding, vomiting, dying and giving birth is more than I or
anyone should be asked to handle.
The events of the last nine months have not been easy for
New York City children and young adults. The effect of being
attacked by air and anthrax and seeing planes fall accidentally
have caused us to now experience what we now refer to as post
traumatic stress disorder. The lives of many of us have been
changed dramatically. One of my friends has moved from a high-
rise apartment where she lived on the 17th floor to an
apartment on the first floor because the sound of airplanes on
the high floors terrorized her every moment. I have seen
students go from an A average to a C average.
Many students are going through major depression and cannot
perform at school or home yet we are required to maintain the
same academic standards in school. Many are able to overcome,
but there are more who cannot. Are we considered failures?
Students at my school, including myself, have seen an
increase in anger and aggressive outbursts. Sleepless nights
are the norm. Sleeping instead means we have nightmares, so we
find solace on the Internet where we are able to continue
communicating with each other, sometimes many hours into the
night, which then makes it difficult to wake up in the morning
and get to school on time. Some call it irresponsible, but that
is how we cope.
Does anybody care? Are we considered important? What else
can we do when we cannot sleep? The worst is when some of our
peers avoid the situation and say they are all right when they
are not. What about our concerns about the air quality? I know
we hear everything is okay, but what about ten years from now?
Will anyone listen then?
Leadership and Public Service is a great school helping
students cope with the events. Some of our students have
participated in the Environmental Civics Club where they
planted trees and flowers in our local city parks as a sign of
rebirth. Many companies have supported us by donating things
such as books and computers. Local flower shops donated plants
in order to make our school feel more pleasant and to insure
clean air. We felt the need to give back, so we started a
knitting club and donated the garments we made to those less
fortunate than us in homeless shelters. These activities helped
us greatly, but we still need more.
We would like chiropractors to help relieve our stress,
more knitting supplies, more counselors to talk to, more
artistic activities for students to express themselves and
relieve their anxieties. Adults around Ground Zero are not the
only ones affected. All students and teachers need help and
services.
There were many heroes that day, but the news has not shown
the teachers who took us home, the students handing out towels
to the ashen refugees, our principal who evacuated us quickly
and safely. There are many campaigns to help the families of
firemen. Please do not forget the survivors who struggle every
time a plane flies buy.
I am happy to answer any questions.
Senator Clinton. Thank you very much.
Mary Ellen Salamone?
Ms. Salamone. Good morning, Senators. My name is Mary Ellen
Salamone and I am from North Caldwell, NJ. On September 11th my
husband was killed when Tower One of the World Trade Center
collapsed. He worked on the 104th floor for Cantor Fitzgerald.
John was daddy to our three beautiful children; our two sons,
aged 6 and 5, and our daughter who is 3. That is the hardest
part for me to get through.
Thank you, Senator Clinton, and Senator Corzine for the
honor of participating in this panel. I hope to call attention
to some of the issues and challenges facing our children that
are of great concern to us as parents.
I am a director of the organization called Families of
September 11th. We have launched an initiative entitled
Children of September 11th and have been meeting with parents,
schools, outreach programs and charitable organizations in an
effort to aid children affected by the attacks. As a group who
has family members in over 40 states we must aggressively
stress that while although this metropolitan area indeed
sustained the greatest loss of life, there are children all
over this nation suffering from the loss of a parent on
September 11th.
Abundant attention and money is being dedicated to areas
hardest hit, so to speak. Despite living in West Essex, a
community of six neighboring towns where a great number of
residents work in New York, my children are the only ones who
lost a parent. Certainly they along with a two-year-old boy in
Massachusetts and the teenager in California deserve the
benefits of all services and programs offered to aid children
effected by the attacks.
It is becoming clear to all that post traumatic symptoms
seem worse for the children now left behind. Grief over the
loss of their parent is exacerbated and prolonged due to the
violent nature of the cause of death and the persistent media
attention. While it is important for our nation to remember
these tragic events, incessant focus on the death and
destruction forces our children to relive September 11th every
day. They need to be able to take a step forward. Our children
need it to finally be September 12th.
So how do we help them heal? Besides working with purveyors
of the media to curtail the repeated broadcasts of the attacks,
which I stress, we must find what is effective to reach as many
children as possible. Traditional models of grief and
counseling are simply not working. Input we have received
consistently reports that families with children are not taking
advantage of available counseling services. Many factors
contribute to this reality, including time constraints, the
stigma of mental health counseling and grief overload. Many
newly widowed parents are still engulfed in their own grief,
rendering them unable to handle the commitment of counseling
intervention for their children and many kids just do not want
to go.
So if traditional modalities are not effective, then we
need to be inventive. Programs must be developed which are
interesting to children, yet convenient for parents, and
outreach in this instance is essential. A lot of the outreach
programs we have spoken to have said that there are federal
monies available to them, but have restrictions on the outreach
that they are allowed to do to families. Many parents have not
necessarily sought the services of a social worker, but have
spoken to and accepted services from case workers coming to
their home.
I can tell you what is not effective in an outreach program
and that is the introduction of an individual without adequate
experience or with less knowledge of available services than
the parent already possesses. This has been a huge error
committed by many well-intended post-9/11 programs and has
served only to alienate families further.
Outreach should also be an essential component of services
offered by our children's schools. School systems need to
realize the fragile state of many parents and they should take
the initiative to establish frequent contact with families, to
share information on the well-being of children, both at home
and at school. Otherwise, it is likely both parents and
teachers will assume that all is okay, when in fact we have
children that are suffering.
If families remain hesitant to pursue direct services, then
we must pursue indirect intervention. It is counterproductive
on any level to have a guidance counselor or crisis
intervention specialist in schools or programs that families
are choosing to avoid. It is necessary that children
traumatized by September 11th be handled with sensitivity by
all those who come in contact with them on a daily basis.
Symptoms of grief and traumatic stress do not necessarily
surface in a child when a counselor is present, nor do they
fade when a counselor is unavailable.
Traumatic loss education and crisis intervention training
should be offered and even required for all those responsible
for the care of children in schools or day care facilities. How
daily situations are handled will either cause or correct the
problems our children face every day. In-service education to
teachers, day care aides, coaches and even parents is a
necessary component of any plan to help heal our children.
Another area of special concern for parents is how
September 11th, 2002 will be addressed in schools. In
consideration of all the studies that demonstrate that symptoms
of traumatic stress increase with repeated exposure to the
triggering event, the mental health community, our Government
and schools must work collaboratively to issue guidelines for
all schools planning remembrance events and parents must
certainly be given an opportunity to know of these plans
beforehand so they may make an informed decision as to whether
or not to send their children to school that day.
There are many other children falling through the cracks,
such as children with special needs who lost a parents in the
attacks. Raising a physically or emotionally challenged child
is a difficult task for a two-parent home and simply
overwhelming for a newly widowed single parent. Many 9/11
families with children with special needs fall above income
requirements for State sponsored services, yet they do not fall
within the guidelines for additional assistance from charitable
organizations. Scholarships have been developed for college
educations, but there is no assistance currently available for
additional uncovered services a challenged child might require.
Children with attention deficit disorder and other disabilities
who have lost a parent are faring poorly in school, yet there
is no increase in supplemental services. We as an organization
cannot stress enough that the needs of all children suffering
from September 11th be fairly and adequately addressed
regardless of location, language or ability.
This hearing and this panel is a step in the right
direction and I am so honored to have an opportunity to
participate. I believe the needs of our children must be
addressed without delay. The terrorists have already stolen the
life of their parent or loved one, their security and their
innocence. If we leave them unattended, the terrorists will
have destroyed their chance at a productive future as well.
We are not going to get a second chance to do this right.
Thank you.
Senator Clinton. Thank you very much.
Dr. Kelly?
Dr. Kelly. Good morning and thank you for the opportunity
to appear before this committee today. I want to thank Senator
Clinton for all her efforts in the past and her continuing
interest in our Department.
As Chief Medical Officer of the New York City Fire
Department, I witnessed the devastation and human tragedy on
September 11th. When faced with the loss of 343 members, we
well understood that this tragedy would take a severe emotional
toll on our entire Department. The men we lost that day were
fathers, sons, brothers and friends and they left behind over
600 children, some just born.
In the days and months that followed, our surviving members
continued to remain committed to the rescue and recovery
efforts, working tirelessly to bring home their fellow members
and the thousands of innocent victims of the attacks. In
testimony before the Senate less than a week after the
disaster, I explained our need for funding to provide crucial
counseling services to our members and their families.
Today I would like to describe how we address these issues
over the past nine months and what challenges lay ahead for our
department. Through funding and assistance from various
agencies and organizations, we have been able to establish a
network of counseling and family assistance services. The
designation of the FDNY Counseling Services Unit as a
participant in Project Liberty was key in getting us the funds
we needed.
With this funding, our counseling services unit under the
direction of Malachy Corrigan has expanded its staff and
developed new sites. In addition, funding from the Silver
Shield Foundation has insured that every child of a deceased
New York City firefighter, police officer, EMT and Port
Authority police officer can be evaluated and treated through
the NYU Child Study Program with Dr. Robin Goodman.
We have also received assistance from renowned experts in
the field of childhood bereavement and family counseling
services, including Dr. Cynthia Pfeiffer from the New York
Cornell Weill Medical Center and Dr. Grace Christ from Columbia
University's Family Bereavement Program. They have been
providing assessments and counseling services and will continue
to serve our bereaved families in the months and years to come.
Clearly, the needs of families change as time goes on and
the impact of this event on a child of two months or a year
will not be felt at this moment, but will be felt differently
as time goes on. Funding from the Fallen Firefighters
Foundation has enabled us to send our families a bimonthly
counseling publication called ``The Link'' which provides
ongoing counseling information. The foundation has also funded
special programs for our families and continued education for
our counselors and family liaisons. These family liaisons are
firefighters who voluntarily help the families of the bereaved
with practical concerns.
In November, our Fire Department established a family
assistance unit with its own Assistant Commissioner to help
coordinate resources for our affected families. This unit
provides assistance wherever possible to families of missing,
deceased and active members and has developed a monthly
newsletter for families that contains information about events,
services and resources available to them. With the support of
FEMA, the New York State Office of Mental Health and the New
York City Department of Mental Health, we have also established
programs in the communities where our members and their
families live. Every member of our Department has received a
letter sent to their home, outlining available counseling
resources. We are expanding our efforts with a program called
``The Other Side of the Firehouse.'' This will address the
needs of spouses and with the funding from the United Way we
have developed a booklet called ``Helping America Cope,'' which
will serve as a tool to guide our families as they help their
children cope with the tragedy. This booklet has information
for parents side by side with activities for children that are
designed to help them explore their feelings about the attack.
Obviously, our surviving members, over 16,000 in number,
have been deeply affected by this event. For every firefighter
and EMT there is a family waiting at home wondering if their
loved one will return home safely. In the post 9/11 world, the
families of uniformed workers face new fears and have even
deeper concerns for their safety. They have seen the haunted
look of their loved ones after days of working tirelessly at
the site. Children have witnessed their mothers and fathers
standing on lines, saluting their fallen friends and they will
forever have the terrifying images from that infamous day in
mind.
Our health services and counseling units have been meeting
with experts from prior tragedies to better understand the
needs of our members and their families after this tragedy.
These experts include Dr. John Schorr, Dr. Betty Pfefferbaum
and Dr. Carol North from the Oklahoma City Research Project, as
well as Dr. Francis Murphy and Dr. Terry Keane from the
Veterans Administration. They have helped us shape a behavioral
health survey that will be given to all our members in the next
month. This survey will help us to continue to assess the needs
of individuals and the department as a whole.
Clearly, the Fire Department's recovery will be an ongoing
and lengthy process. The strengths and resilience of our
members has been extraordinary so far, providing inspiring role
models for the youngsters. Our members' mental and physical
health is critical to the successful rebuilding of this
Department and it is equally critical that we not forget the
children and families that nurture these members at home. We
must continue to support these families in every way possible.
I would like to thank you for this opportunity to present
this information and I would be happy to answer any questions.
Senator Clinton. Thank you very much, Dr. Kelly.
Mr. Nigro?
Mr. Nigro. Thank you for the opportunity to be here today.
We all have a story about September 11th, 2001; where we were,
with whom, how we felt, what we wished we could do. We all
remember the weeks after the tragedy, how we would greet
friends and associates, tentatively; ``Is your family okay?''
These were our experiences as adults, but what were the
experiences of children? This is a question we constantly ask
teachers, parents and children themselves. Consistently the
answer includes uncertainty, fear, sadness, anxiety, pessimism
and isolation.
I was asked to come here today to speak about the
initiatives that Community School District 31 has developed to
address the mental health needs that precipitated from the
World Trade Center disaster. Community School District 31
encompasses the whole borough of Staten Island. It is the
largest School District in New York City and it is the second
largest School District in New York State.
Presently we have 43,719 students, as of Friday. The
borough of Staten Island has 5 percent of New York City's
population, yet on September 11th, 28 percent of the
firefighters and police officers that lost their lives were
residents of this borough. 285 of our students sustained the
loss of a family member or loved one. 54 staff members also
sustained a similar loss. At one middle school, six boys lost
their fathers. At one elementary school, 28 children suffered a
direct loss.
As you can see, our School District is hurting. These
statistics, however, do not take into account the other 43,434
students, many of whom are struggling in a post-9/11 world,
with the security consciousness that has underlying fear and
anxiety. This was made very clear to me when I granted
permission for a five-year-old kindergarten girl to change her
school. She was fearful that an airplane was going to crash
into her school, it was four stories tall. We transferred her
to a single story building.
Her fears were compounded by her concern for her father,
who is a firefighter. We have seen from the art work, and I
brought some of the art work that is around here today, we see
it in the art work of a second grade boy who writes on his art
work in March, late March, six months after the attack and I
quote: ``I dreamed I fell off a building. Other people were on
the building. Someone was coming to save me and the people. She
saved the people. She was going to save me last, but I fell off
the building.''
We have many such students. It is our mission to help our
children, parents and staff deal with the many emotional and
social concerns that we now face.
Our approach to assist all students was supported by the
recent study completed by Applied Research and Consulting and
as I heard some of the witnesses say before me, and I think it
is very important, it is our challenge to walk that fine line
between overwhelming families with services, versus not
providing adequate services to meet their needs.
So what have we done?
Our first concern on September 11th was that some students
would come home to empty homes, so we developed a strategy to
insure that all students were released to a family member. We
set up two holding areas for students who were not picked up at
school or at bus stops. Their safety was our primary concern.
Fortunately, by 7:00 all students were appropriately released.
But this was only the beginning. We knew that any strategy that
we had planned would to have included interventions for
students, parents and staff, and we knew this from our work
confronting individual crisis. However, twelve members of the
District's crisis team would not go far in addressing the needs
of fifty schools.
Our approach was divided into three phases. This enabled us
to assist children and families in a variety of ways. Phase one
began on September 12th when an assortment of crisis management
resources were developed and distributed to our schools. These
materials also provided direction to each school, as to how to
assist students in understanding the confusion surrounding the
disaster. Schools were instructed to use these materials to
develop strategies that would address the needs of the
children. School teams first developed a plan of action to
assist all students and enable a plan to assist individual
students who expressed a greater need. These schools developed
age appropriate lesson plans, met with staff members and
designated a crisis room for those students who needed
counseling that day.
But on September 13th, Staten Island's problems were
compounded by a lockdown of the borough due to a report that
police were pursuing a terrorist that had entered Staten Island
via one of the three New Jersey bridges. This proved to be
false, but further inculcated fear and anxiety into our
families. 28 percent of our students attended school that day.
Normally 93 percent of our students are in attendance.
During October, phase 2 of the District's plan was
implemented in which we partnered with local mental health
community-based agencies. Mental health professionals from
these agencies were available to discuss any concerns that
parents and staff members may have had with respect to their
children or any other family member. A plan was formed and a
schedule developed so parents and teachers could meet with the
phase 2 professionals in a designated space within the school
building. Referrals were made to appropriate resources for
those students that needed further assistance. Materials and
resources were made available with our partnership with the
Educators for Social Responsibility and through our own
District's media library.
Phase 3 of the District's response is called Project Cope.
This was made possible through a federal serve grant. Project
Cope is composed of ten intermediate school guidance counselors
who are responsible for counseling all those children who
suffer indirect loss in the corresponding elementary schools.
Project Cope counselors receive crisis management training and
were given the resources necessary to respond to the tragedy.
These counselors began reaching out to their assigned schools
in early January. The Project Cope counselors contacted those
students who suffered a loss, but first they reached out to
their families. By February, the counselors updated the
District database to reflect the number of students in our
district that sustained direct losses and that was the number I
gave you before. Project Cope, of course, is ongoing.
The Office of Student Services within District 31 has been
in contact with a number of organizations throughout the
country that were eager to assist the District's students.
Organization and school districts donated the following items
which were distributed to our children: 16,000 teddy bears, art
supplies, musical instruments, gift packages, survival kits,
professional sports and theater event tickets.
Finally, we recently received a grant from The New York
Times Foundation to assist our students in the aftermath of the
World Trade Center disaster, because there were limitations on
some of the ways we could use the existing funding. The funding
from The New York Times will enable us to provide academic
support and tutoring for those students who suffered a direct
loss and have shown an academic decline compared to past years,
and in addition to that, to prepare our teachers for the
opening of school, we have contracted with a production company
to develop a bereavement video that specifically is designed
around the World Trade Center disaster. It will be shown to all
of our staff members prior to the arrival of students in
September, and it will help them to impart some of the skills
that are needed for dealing with the anniversary.
As you can see, we have attempted to address as many issues
as we can with limited resources. The public has demonstrated a
generosity that is beyond anything I could have ever imagined.
Unfortunately, at a time when identification budgets are being
cut nationwide, our School District is lacking the additional
resources to effectively confront the unmet mental health needs
that our students have developed as a result of the World Trade
Center disaster.
The anniversary of September 11th occurs five days into the
new school year. Our challenge is to provide all of our
students with the emotional, social and academic support that
will insure that they are not revictimized by our failure to do
so. This support will enable them to simply be children, not
citizens anxious or fearful about every passing airplane or
stranger.
The message that we are trying to impart to our students is
one of hope. Giving a sense that as the anniversary of
September 11th approaches, the situation is different. But we
are a stronger and more caring community as a result.
One of our second graders expresses this message of hope in
a poem called Spring and I would like to quote it now.
``Spring--''
``The sun comes out, so let's all shout. The flowers bloom,
so you have to make room. You can sing a tune and get ready for
June. Spring has arrived, and you do not have to hide.''
Thank you.
Senator Clinton. Thank you very much, Mr. Nigro.
And our final witness on this panel, Miss Cullinane,
welcome.
Ms. Cullinane. Good morning. My name is Risa Cullinane and
I am program director of our school-based clinic, The Source,
at Red Bank Regional High School in Little Silver, NJ.
I am pleased to be here today to talk about our school's
response to 9/11. I would first like to recognize my colleague
Mr. John Avella, who is here with me today. He's been our co-
leader in our program crisis intervention implementation and
development.
Immediately following the World Trade Center crisis,
children began streaming into our office. There were those who
were directly impacted and those who suffered the secondary
trauma of the event. Approximately thirty students suffered
direct losses; a parent, sibling or other family member. The
numbers were not immediately apparent.
We moved rapidly in our attempts to triage the students
according to their needs. We debriefed over 170 students in
total in the days following the tragedy. More than 100 of those
were students suffering from secondary fallout, traumatized by
the event on some level, although not suffering direct impact.
The focus of my presentation is to elaborate on the
application of critical incident stress debriefing in the
school setting and to give concrete examples of how this model
has continually been utilized as a needs assessment tool in our
school. We adapted our existing skills to the unique demands of
trauma and disaster response in the school-aged population.
Red Bank Regional High School is comprised of three diverse
sending districts. Local school districts can send their
children to Red Bank Regional and we have several academies,
including the Academy of Performing Arts and Information
Technology. Prior to September 11th our school had a small
crisis team in place, a diversity program and school-based
counseling center. We had a crisis team consisting of twenty
school employees trained in the critical incident response
model and a District-wide policy had been implemented.
We also had a pre-existing diversity program. In response
to the World Trade Center events, our team implemented the
following: We designed debriefing groups based on the impact of
the crisis. We provided triage to students in need. We
organized groups for students who were potential targets for
bias crime. We had faculty meetings based on the NOVA and FEMA
models. We sent letters home to parents to inform them of the
services that we had both at our school and in the community.
We gave our supplemental readings to our staff, families and
students. We requested assistance from our local community
agencies, including our churches, our mental health agencies
and local funeral homes. Donations were solicited for families
in need.
We provided memorialization activities to provide closure
for students and staff. One of the main reasons our crisis
response was so effective was we had a school-based program in
place. This program, known as The Source, is a haven for our
students. We offer all forms of counseling, preventive health
care, job coaching and recreational opportunities, all free of
charge to all students and their families. There is no stigma
and the program is well recognized by our students and our
staff.
On the day of the World Trade Center crisis, and during the
weeks following the event, The Source was a place where kids
knew they could receive care, counseling and help coping with
the tragedy. Being a fixture at our high school, we were there
every day for all kids affected directly or indirectly by this
and by other types of trauma. Additionally, in the aftermath of
9/11 I applied for a grant from the New Jersey Department of Ed
and this grant award which we received allowed us to implement
the following services for our affected students and staff:
We were able to train an additional 60 staff members and
community members in crisis response. We were able to implement
a crisis and antibias reduction plan. We were able to expand
our diversity training to include students and we were able to
provide continued counseling services for more than 170
students. Our staff worked diligently to meet our students'
needs in the aftermath of the World Trade Center crisis and in
doing so, we developed several hands-on programs and we did so
involving our students. We had a student drama troupe, we did
an art therapy program, we did the diversity training for our
kids. We had reading/writing workshops conducted by local
authors and we implemented a Tai Chi anger management program.
I would like to take a moment to recognize a very special
program developed by the students in our high school
facilitated by my colleague John Avella. This program, called
Teens for Teens, is a peer support group for students
throughout Monmouth County who have suffered a direct loss. It
is a support activities program seeking to provide some degree
of normalcy in our abnormal times. Some activities included
assisting parents who lost a spouse in the World Trade Center
and implementing a Big Brother/Big Sister program for younger
children who lost a parent.
I believe it is critical to acknowledge those teens who
have suffered indirect losses as well. The nature of
adolescence is such that throughout the teen years children may
experience several types of trauma. Any event which threatens
their security may awaken repressed trauma. These teens are at
high risk for post traumatic type reactions, including
depression, anxiety and substance abuse.
The counseling staff at Red Bank Regional is dedicated to
providing all possible services for our students and our
families. We are proud of our students our staff and the
response of our community leaders in the face of tragedy.
We live in a time of diminishing community resources and
continuing uncertainty. Our commitment to provide followup
services for all our affected youth must remain strong.
Thank you.
Senator Clinton. Thank you very, very much. I want to thank
the entire panel. Senator Corzine, do you have any questions
you would like to address to the panel?
Senator Corzine. First of all, I thank all the panelists
again for the specific comments. There is a lot of courage and
incredible effort on people's part.
I do have some questions. I would like to ask Ms. Salamone,
you mentioned the media coverage and concern about its effects.
This is not only to you, but other panelists you have worked
with, how serious a problem is this? We have seen a number of
quite highly publicized television programs and other events
that have brought forth issues. Is this a recurring issue, is
it something that is a concern among the community of the
grieving?
Ms. Salamone. It is a huge concern in the community, and I
think I can illustrate it best by giving you an example of how
the persistent media coverage affects the children directly
affected. I as a parent obviously do not choose to have my
children, I cannot watch coverage of the events and I do not
choose to have my children relive it by watching it. My son
came home from school one day in tears, saying that one--he
says one of the students in his class--please do not write this
in any of the papers--one of the students in his class had come
up to him and said, ``They are only finding body parts at the
World Trade Center and they are putting them in garbage bags.
Do you think that that is where your daddy is?''
When we found my husband in April and we buried him, my son
went to school and did not say a word about it to anybody. When
I asked him why he would not tell anybody, he said, ``Because
the kids all they want to know is what bones they found and I
do not think that is what I want to talk about, about my dad.''
Whether or not parents are letting children watch coverage
of the events and what is on TV all the time, by having adults
watching it all the time, it is always a topic of conversation,
and no matter where we go and what we do, you cannot escape
dramatic portrayals, either in the paper, in pictures,
verbally. We were at the diner on Saturday and the people
behind us were taking about the latest recovery of body parts
they found even though the Trade Center had shut and I was
there with my three children.
I understand that this is news and that it has to be
covered, but there has to be at some point some sort of line
that is drawn between covering the events and blasting it on
the front page of the paper all the time. There could be on the
news a recording of the events and in the background is the
picture over and over again of the plane going into the
buildings and the fire and the towers and as this poor student
here was talking about, I mean, it is not just my kids who have
to relive this every time they see it because they lost their
father, there are other students that have to relive it that
actually saw it themselves.
It is a big problem. Our organization has been trying to
work with the media and making sure that if they are going to
be showing shows that are portraying very realistic depictions
of the event, that there is some kind of warning prior to
showing that, so that families can make a judgment whether or
not they want their students to watch that.
You see it all the time. ``Please be aware that you might
want to change your channel.'' They do it for election results.
If you do not want to know, do not watch this until it is all
over. And the media has basically said, no. It is freedom of
speech and this is our right to do it, and I was speaking to
Senator Clinton before, the media has never really had to self-
edit themselves before and that is what they say, we have never
had to do this before, but something like September 11th has
never happened in our country before and certainly the
magnitude of this disaster is like no other and they compare it
to no other loss on our soil since the Civil War and certainly
we can handle it differently, I think.
I think persistent, and I am sure a psychologist can say
that persistent media coverage forces our children to stay in
the day that it happened and it does not let them move beyond
that.
Senator Corzine. Does anyone else want to comment from
their own experiences?
In addition to the children who sustained a direct loss, as
she pointed out, the issue is there for all of the children,
because they are extremely security conscious. We have the
Brooklyn Bridge that closed a few weeks ago, some of our school
trips were canceled. So the general student population in
addition to those who sustained a direct loss is also bombarded
in the media constantly.
We come to school with lots of questions, lots of fears and
lots of concerns. I agree wholeheartedly.
Ms. Switzer. Could I just add to that? What is so
interesting on the 11th is that as families were taking their
kids and fleeing, large numbers of families sat on the street
and watched the event, and we would go out and tell families to
take their kids home. My point is that in some ways it was so
compelling, these images are so compelling, that it was hard
for the families to filter out what kids should or should not
be seeing and I think that you cannot always depend on what the
media could do, but what we can possibly do is provide
guidelines for parents and really be proactive about what
parents should be encouraging their kids to look at and what
they should not be encouraging them to look at, because for
many parents it took them weeks to turn CNN off and there were
their kids watching it, and it was hard. So I think if we could
really explain to parents and give them guidelines for what is
going to happen, that would help with the anniversary.
Senator Corzine. There were a number of specific
suggestions that I think get translated potentially into public
policy initiatives. Dr. Kelly talked about a family assistance
unit. How do we go about knowing, from your view, how effective
these particular programs are, because we also heard sometimes
about responses that have interefered with families, I am not
talking about the family assistance unit, but there were people
who were well meaning but not necessarily delivering efforts
that were actually solving or at least helping aid in the
problem? How do we develop the checks and balances, the
accountability to make sure that our initiatives are operating
effectively?
Dr. Kelly. Well, some of our programs were in place to
begin with, because the nature of our job has always been one
of danger. In a given year we often have between, we average
between three and five deaths, so that unfortunately we have
had experience with violent and sudden deaths of our members,
so that some of the resources that were in place were pre-
existing because of that. What we found after this event is
there was such a tremendous need on so many different levels to
take care of this, that the family assistance unit was a
response to problems of communication, of bringing information
to so many different people.
Clearly one of the problems is really what you outlined,
that families at different times are ready for assistance and
we see this with our members or surviving members, that some
people were ready to talk and needed assistance on September
12th and others are just now reaching out for help. The closure
of the site has brought forth more people who need assistance
and are looking for help, so I think our focus needs to be on
long term, putting things into place that remain and stay
available for people, and offering people a variety of
resources, bringing those resources to the communities and
helping the individual schools develop programs, because we ran
into similar problems where some of the children who went to
school had questions or comments made about body parts to them
also and that is been an ongoing problem.
Senator Clinton. Well, thank you. I just want to ask each
of you to give us your top priority for us to follow up with,
because I have heard several different things, both from Ms.
Switzer and from Mr. Nigro. I have heard that you do not yet
know if you have got any resources in place for next school
year and that has to be a priority. If we could just quickly go
down the panel and have each of you summarize what your top
priorities are, especially in terms of what you think could be
provided to assist you in dealing with the issues that you
confront. Ms. Switzer?
Ms. Switzer. I think you said it, we want to have assurance
that we can continue our program. I also want to put a piece in
about the teachers. I do not know if anyone has thought about
what kind of services teachers might want to enable them to
help themselves as well as the children.
Senator Clinton. Scarlet, I have heard Ms. Cullinane refer
to a Teens for Teens program. Is that something that might be
helpful with you and your friends?
Ms. Taveras. Actually, yeah. What we would like is more
people to talk to. Because despite the fact there are some
people, counselors, it is hard for teenagers and young children
in my experience to open up to people, this might sound wrong,
but elderly, more younger people to talk to kind of like to
open up.
Senator Clinton. Well, maybe one of the things we can work
on is getting a better idea of how the Teens for Teens program
works in the Red Bank High School and see if there are some
models that we could use right here. Ms. Salamone.
Ms. Salamone. I think because the magnitude of this
disaster encompassed so many people, that it is easier to set
up programs where there are so many people that are directly
affected and more difficult where there is very few. I think
outreach and education would be my most important issues I
would think. Outreach to families who are at any stage of
bereavement right know and coping and education, I think it is
very important that not just counselors are trained, because
there are a magnitude of people who deal with these children,
all children every day and they all have to have some kind of
training and crisis intervention knowledge to be able to handle
these children. From the simple thing of a student who lost a
parent who cannot cope with the national anthem being sung in
his classroom. I think training is extremely important.
Senator Clinton. I think that is absolutely right, and I
especially like what you said in your testimony about training
for all those daily situations that come up that people need to
know how to respond to.
Dr. Kelly?
Dr. Kelly. Our challenge is I think to get continued
resources for our members who are survivors and who continue to
go about the work that they do as first responders facing
continued possible terrorist attack, and helping their
families, so The Other Side of the Firehouse, which is the
program we developed needs to be expanded, as well as continued
education for both the spouses and the children.
Senator Clinton. I really want to underscore that, because
clearly with the increased emphasis on preparedness and
homeland security our front line soldiers, who are our fire,
police, emergency first responders, are going to be expected to
do a lot, and if we do not have these programs in place, it is
not only going to be difficult on them, but as you so aptly
said, the other side of the firehouse is also going to be under
a lot of stress, so we need to focus on that.
Mr. Nigro. Senator Clinton, of course we would like to know
what the resources are for next year so we can plan to address
the unmet needs, mental health needs of our children. One of
the things I would like to get across is that we need some
flexibility. When I met with different people to try to come up
with a mechanism to try to address the academic needs of those
children who showed a decline in academic performance, I had to
go to the Foundation, The New York Times Foundation who were
able to fund that, but most of the other State and Federal
agencies did not have that in their description, so we felt
that was an important ingredient, which ties in, Senator
Corzine, to your statement, how do we monitor, and how do we
evaluate a program.
For us we monitor attendance, improvement or decline, we
also monitor improvement or decline in academic performance and
that is one way that we can gauge what those kids need in those
two areas.
The other thing I think is important is some kind of
coordination. There are a lot of people out there, well-
intentioned with lots and lots of resources. We need
coordination, otherwise we will be stepping over each other,
and I do not think that helps anyone, and we need do not have
the kind of dollars that we can afford that.
Finally, I would like to say, as I mentioned, we gave out
16,000 teddy Bears and loads and loads of gifts from across the
country. That is stopping now. And what we have to be cognizant
is what the needs of these kids are emotionally, we have to
come up with some kind of master plan that follows these kids
emotionally, because a teddy bear only lasts so long. So I
would like to leave you with that.
Senator Clinton. Thank you very much. Ms. Cullinane?
Ms. Cullinane. I think the most important lesson we learned
at Red Bank is we need to have something in place into adults'
conversations, the anxiety level increases and we need to make
this just a part of the daily lives of our children, so that
they can go someplace and talk to somebody, a parent can find
the resources that is needed of teachers feeling well trained.
So these posters that are up here were part of an effort to
begin that process, and we want to build on that and your
suggestions will be very helpful as we do that.
So let me thank you very much for being here and I look
forward to continuing, as I have been privileged to do already
for some of you, our work is being moved forward.
Senator Corzine. Thank you all. You were so helpful.
[Applause.]
Senator Clinton. I would like to go ahead and invite our
second panel to quickly come up and we can begin as soon as
they are in place. The first panel had so many compelling
stories and recommendations, that we obviously have gone over
the time, but I think it was certainly well worth it and very
important.
As the second panel gets set up, I want to acknowledge New
York City Council Member Alan Gerson. Alan, thank you very much
for being here. Alan represents downtown and has been a great
partner in our efforts to improve air quality. I thank Alan for
being here with us.
Mr. Gerson. Thank you, Senator.
Senator Clinton. Now, our second panel as they are moving
forward and taking their places are people who have many of the
responsibilities for dealing with the issues that we have heard
discussed on this first panel, and I would like to welcome
them. I have been very pleased to work either with them
directly or with many of their agencies as we have attempted to
deal with 9/11. And, again, I am going to introduce all the
panelists, at the same time so that we can hear from them.
Our first witness is Chancellor Harold Levy, the New York
City Board of Education, and I want to acknowledge and
recognize Chancellor Levy's superb leadership of the school
system in the wake of 9/11. He will specifically be addressing
the needs assessment that he had commenced, knowing full well
that we were going to face some of the problems that we have
already heard about, and it was a far-sighted and very
important decision.
Next witness will be Brad Gair, the FEMA Federal Recovery
Officer for the World Trade Center and I have to publicly thank
Mr. Gair, because he's been a friend and a true leader for all
of us in New York. He has worked tirelessly to insure that New
York gets the support that it needs from the federal
Government, and I also wish to thank Joe Allbaugh, the director
of FEMA who has been a partner as well, and I thank you for
everything you have done, Brad.
Charles Curie is the director of the Federal Substance
Abuse and Mental Health Services Administration, so-called
SAMHSA, that has been very helpful in giving us some of the
resources that we have needed to be able to deal with the
problems that we have heard discussed.
Chip Felton, who is the Associate Commissioner for Mental
Health is here representing the Governor and it has been a
tremendous effort and partnership with Federal, State and local
governments working together to try to deal with this
unprecedented disaster.
Finally, Dr. Thomas Frieden the City's new Commissioner of
Health. We welcome you, Dr. Frieden, and you are here on behalf
of the Mayor and I want to thank the Mayor and all those in
City Government for your willingness to work on some of these
issues and challenges we face.
Let me now ask Commissioner Levy to begin the second panel.
STATEMENTS OF HAROLD LEVY, CHANCELLOR, NEW YORK CITY BOARD OF
EDUCATION; BRAD GAIR, FEDERAL RECOVERY OFFICER, FEMA; CHARLES
G. CURIE, ADMINISTRATOR, SUBSTANCE ABUSE AND MENTAL HEALTH
SERVICES ADMINISTRATION; CHIP FELTON, NEW YORK STATE ASSOCIATE
COMMISSIONER AND DIRECTOR OF THE CENTER FOR PERFORMANCE
EVALUATION AND OUTCOMES MANAGEMENT, NY OFFICE OF MENTAL HEALTH;
AND THOMAS R. FRIEDEN, M.D., NEW YORK CITY COMMISSIONER OF
HEALTH
Mr. Levy. Thank you, Senator. This is an important
footnote, an important punctuation mark in our understanding of
what happened. I want to thank both Senator Clinton and Senator
Corzine for convening this hearing. I think it is an important
punctuation mark in how we think about what happened on 9/11
and what to do to make sure in the future that we handle these
kinds of situations in the most professional way, the most
careful and sensitive way we can. I also want to compliment you
on the panel that I just heard, quite extraordinary group. Very
poignant, very thoughtful and people have clearly given this a
lot of thought.
I want to thank you for the opportunity to discuss our
system's efforts to meet the mental health needs of our school
children in the wake of 9/11. I believe that the school system
has pursued an aggressive and thoughtful plan designed to
confront and overcome the many challenges posed by this single
horrific act of terrorism.
The testimony by Scarlet, Anna, Dominick, provide
compelling accounts of the many issues facing the New York City
public schools following this tragedy and their words speak to
the lingering impact on our school system on our children, as
well as on the staff, and I thought Anna Switzer's point was
absolutely well taken.
We focus on the children and we forget the children lean on
the teachers, on the guidance counselors and they themselves
are traumatized by what has happened and they themselves have
issues to deal with in their home lives of which this
exacerbates the moment.
I would be remiss if I were not to recognize the
outstanding performance of the entire school community in its
initial reactions to the events of 9/11. The school leadership
and staff took students through the streets to safety and
remained with many students into the early hours of the morning
to insure that all children were safe and accounted for. You
heard the testimony of the Deputy Superintendent for at Staten
Island. The same could be said all around the City. It was an
extraordinary day and people really rose to the occasion, and
it is something that brought the professionalism in the school
system really to bear.
I would make the observation as I think back on that day.
There were about 75 principals who, for whom this was their
third day on the job. A hell of a way to start your career as a
principal. What they did, interestingly, is they rose to the
occasion because they had a choice. I worried about how all of
these many, many new principals would be able to lead their
buildings on that day they learned how to lead their buildings.
They made decisions all day long.
Sure, I sent an e-mail saying today we will allow parents
to pick up their kids. Today, unlike other days, the parent
comes in in the middle of the day, give the kid. Today, unlike
other days, when the buses go around and deliver the kids, they
have to give them into the hands of an adult, not just to leave
them on a corner. Because we do not know when the parents will
be there.
The thing I learned was the strength of our family
structure. Much stronger than I think anyone might have
considered in advance.
I was worried about being left with orphans by the end of
the day, not children who had merely lost one parent where
there is a two-parent family, but children who had lost either
their only parent or both parents and all the children were
cared for by the families. Although we made provision
immediately talking with Family Services, we did not need to
avail ourselves of those services.
There are many unspoken heroes in this.
Within hours of the disaster, I spoke to the Oklahoma State
Commissioner because I thought about Oklahoma City and was
informed that based on their experience in Oklahoma City, the
students outside the immediate Ground Zero area would also be
psychologically impacted and furthermore, we could expect
mental health problems to manifest themselves months later. And
that conversation was really pivotal to my thinking and my plan
to carefully monitor the mental health needs of students.
We provided principals and teachers with guidelines for
identifying and addressing the immediate needs of students,
including recommendations for explaining the disaster to their
children. Guidance counselors and staffs sought to assure
students that they thought about their safety and well-being.
Within a day we had a listing of mental health providers
available for students and their families. With the help of
Fran Goldstein and her staff, I also convened an advisory
group, now called The Partnership for the Recovery of New York
City Public Schools, comprised of mental health experts that
continue to assist us; Harold Koplewicz, the NYU Child Study
Center, Dr. Edward St. Vincent, people from all around the
country who had volunteered their help and came forward
quickly, and really gave us the best advice that we could
possibly get from across the country.
And because of our system's diversity we worked to
implement strategies to reduce anger and violence in the
schools very early on, to stem any potential increase in bias
incidents. Materials on diversity, antibias and conflict
resolution were distributed to the schools immediately.
Interestingly, we also worked with Penny Harvest, this is the
Common Cents program, we collected $720,000 in pennies from
children in elementary schools primarily, but also the junior
highs, 940 schools participated.
It is not so much the quantity of money but the fact that
we were able to give other children an outlet to participate to
help to feel that they were not helpless in the face of an
anonymous terrorist.
We had very few incidents of bias or anger that occurred
that could be attributed to the events of 9/11, but an
interesting phenomenon there, too. In the days immediately
after the 9/11 attack, we had about 20 or 25 incidents a day
for two or three days, and I went around to all the schools
where this was occurring and specifically to the schools that
had significant Moslem population or children dressed in
traditional garb, or who came from the Middle East.
To make the point, these children have no sympathy for the
terrorist, any more so than any of the rest of us, and as
citizens, as Americans, our job is to ensure their safety and
to make sure that they feel supported in the face of these
threats, and a funny thing happened, because as soon as you
said it, whether I said it to the teachers or the students,
they said, ``Well, of course, we know that.'' But until you
said it, we had incidents. But the moment it was said, it was
as though they were innoculated and they took it in the form
of, ``This is our job as citizens, and as Americans.''
I took great pride in the way they responded. And I think
it also speaks to our diversity and our strengths in our
diversity that with this kind of horrendous act, we did not
have significant ethnic unrest. Quite the contrary. There was a
recognition that the terrorists have made a very bad error in
uniting us.
Prior to conducting any formal studies, we assessed the
immediate mental health issues facing our Moslem school
community by asking the Superintendent to survey the schools
and determine the number of staff or students who lost a family
member or relative or very close friend. This informational
survey revealed in 700 of our 1100 schools, a member of the
school community had lost a loved one. If you think about in
your office, if someone dies, a family member dies, everyone is
aggrieved by that, everyone feels the grief, feels the sense of
loss. Here we had a situation where in 700 of our 1100
buildings such a thing happened.
I was able to write letters of condolence, provide
information on accessing mental health services. But the data
also enabled us to direct $5 million emergency Federal funds to
schools near Ground Zero as well as to the districts with
significant numbers of students who experienced personal loss.
All superintendents in District level crisis response teams
were provided training by the National Center for Children
Exposed to Violence, Yale University and that was enormously
helpful.
After implementing these short-term strategies I wanted to
insure that the long-term decisions were made after carefully
examining research on the topic and not based on anecdotal
information and intuition alone, and I was particularly struck,
Senators, by the paucity of literature and the lack of research
on the impact of disasters on large communities.
There is actually a fair amount of literature about the
immediate victims and their families and people who immediately
escaped it. But not on the larger community, and that I think
is, it was quite surprising to me, and it helped push me in the
direction of the decision to insure that our experience in
dealing with the disaster was well documented to guide others
in the event of future tragedies.
We commissioned Dr. Michael Cohen and the Applied Research
and Consulting Group that he heads in collaboration with
Columbia University School of Public Health, which was just
wonderful in their quick and thoughtful and really very
professional response to conduct a comprehensive needs
assessment to determine the psychological impact of the attack
on City school children. Great care was taken to collect the
information in a scientifically validated manner six months
after the attack.
It was intentionally six months after, because what we
wanted to do was see what was the continuing grief, what was
the continuing psychological injury. A study was approved,
recognized by the Centers for Disease Control and looked at
psychological disorders beyond post traumatic stress disorder,
such as agoraphobia, which is significant in a city like New
York where hundreds of thousands of children travel to school
on mass transit each day.
The release of a study in May reported disturbing evidence
detailing the extent to which last fall's tragedy still
impacted school children across the city. The study found that
students in grades four through twelve are experiencing serious
mental health problems at a higher rate than expected after the
attacks. In fact, we now estimate 190,000 children in grades
four through twelve exhibit at least one mental health problem
which may inhibit their productivity in school, which
subsequently requires some form of intervention. These ailments
and the percentage of students estimated to be affected are
post traumatic stress disorder is about 10 percent; major
depression, about 8 percent; generalized anxiety disorder, 10
percent; separation anxiety, 12 percent; agoraphobia, 15
percent; panic attacks, 9 percent, and generalized panic
disorder, 10 percent.
I put this out there for the proposition, you have to press
how much of that data is background and how much of that
preexisted. At least, that was my initial reaction and the
answer to that seems to be these numbers are elevated,
significantly elevated beyond anything that has been seen to
the extent one has comparable studies, and there are not many,
but what it also says is that we have a larger problem
potentially in the country with these kinds of ailments among
children in large public school systems. I think it is clearly
more pronounced here and I think it is clearly the result of 9/
11.
I am looking forward to reading the full report when it is
published, but the question that comes to mind is the child who
has continuing nightmares about towers or about things which a
Freudian would not have trouble identifying too quickly. Or the
child who is thinking about these things all the time, or is
worried now about going into subways or does not really like
taking elevators anymore or who reports they think about the
towers and where are their parents repeatedly during the day.
These kinds of things invariably are distracting from their
school work, but much worse are the kind of ailment that we as
a society need to give recognition to, to support the children
and help them.
While not surprising, it is particularly important to note
that despite the students requiring mental health systems was
not limited to Ground Zero schools. As presaged by the
experience in Oklahoma City, students in schools outside of
Ground Zero were psychologically impacted as they were more
likely to have family members who were present at the World
Trade Center.
Unfortunately, too many students have not received a level
of mental health services needed due to inadequate resources.
Left untreated, these psychological ailments could compromise
long-term educational and personal development in these school
children. To bridge this gap we requested $40 million from FEMA
to expand our current efforts.
I want to join with Senator Clinton. FEMA director Joe
Allbaugh has expressed support for our proposal, working with
FEMA, New York State and New York City Department of Health to
secure these funds and I want to publicly thank the director
and his representative, Mr. Gair, for his commitment and the
progress made by the Agency in addressing the system's other
post 9/11 needs.
In implementing our mental health plan we have to look
beyond the traditional service models, and here I am a great
believer in the value of community-based organizations and in
the local school district being the one to contour how that
should work. Local school districts need to have the
flexibility to tailor individualized approaches that best fit
the needs of their communities, utilize a combination of
school-based health providers and mental health agencies. This
are areas where if a child is labeled as needing mental health
services, they will be reluctant. If you say to a parent in a
community, ``Your child has a mental health problem,'' that is
taboo they do not want to hear about it. However, if they say,
``We think your child should participate in an after school
program,'' and it happens there is counseling in the after
school program, that is a whole different approach and I think
in some instances of greater value.
The way services are delivered depends heavily on each
community's culture. Because some communities will not
participate in activities labeled counseling, districts have
sought some other approaches to develop programs. These include
recreation, art and music programs, all which allow children to
express themselves in more comfortable settings. You need only
look at the arts program to look at the sort of release we saw
in the poetry, the pictures and the music that came out of the
school system. I got mounds of them. Children needed to express
themselves, teachers needed to have them do it.
Still, today, if you have children of a young enough age,
you say, ``draw me a picture,'' the picture too often is of the
Towers and the planes. Our mental health community can assist
us by linking schools with community providers where
established partnerships currently do not exist.
While our capacity to implement these strategies requires
assistance from FEMA, these monies do not cover long-term
treatment. To provide the full range of services each child may
require, consideration should be given to broadening our
ability to use FEMA funding, child health insurance programs or
other sources of funding for these purposes.
As we move forward, we must insure that our students are
provided with services needed to help them heal and begin the
process of renewal. Each child must be given an opportunity so
they may achieve to their highest potential and ultimately lead
healthy and productive lives.
Senator Clinton in particular has consistently fought for
and delivered new resources to help fund many of our programs,
helping deliver a world class education to our poor students
and increasing the quality of our teachers. Your recent
efforts, along with Senators Schumer, Corzine, Representatives
Maloney, Nadler, Serrano and Sweeney to secure federal
assistance from FEMA to help us meet the mental health needs of
our students is another example of your strong commitment to
our School District, and we thank you.
This is what I have learned in the course of this
experience, is the extraordinary strength of the professionals
in the school system, the strength of the family structure in
the face of these kind of extraordinary challenges, and also
the depth of professionalism that we see in the school system
and in the community based and mental health provider community
generally.
I do not know that I share with the parents who spoke
before, I thought very eloquently, the issue, the need or the
belief she has that the press has to discipline itself, because
I think in that respect the press is responding to the societal
need for information and to balance that. I know what that need
to balance is about. I think what we need to do is to be
sensitive to the children in particular but also the adults who
are going to see these images, but not having assimilated it,
not having responded to it and understood the moment, are still
struggling with it. Those are people we need to be very
sensitive to, whether they are young ones or older ones.
I have seen children who responded by writing poetry and
talking about it, wanting to watch every single image on TV,
because that was the way they got into the news. This was their
eye-opening event. Then I have seen other children and other
adults who just do not want to talk about it still today. And
our society is both blessed and cursed with memory. Blessed to
have moments like this where we try to attempt healing and in a
sense cursed for those who relive this on a daily basis. That
in my judgment is the hard part.
I say again, I am very grateful to both of you for having
convened this. I think these are important moments for us to
try to assess how we do this. Thank you.
Senator Clinton. Thank you very much, Chancellor. I
apologize for our apparently irritated microphone. It has a
hard time being consistent today, but your testimony was
extremely eloquent and I know that it will help guide us and I
appreciate your being here with us.
Mr. Gair?
Mr. Gair. Thank you, Senator Clinton, Senator Corzine. On
behalf of our director, Joe Allbaugh, I do want to thank you
for inviting us to participate in this important hearing. You
have my official testimony for the record. I think I will just
summarize it, because we have a fairly simple role in this
particular issue. I think it is more important to hear from the
mental health experts and the subject matter experts.
At FEMA we are not mental health experts, we are emergency
managers, emergency responders. In this specific case,
essentially our role is we are your banker. So far you have
entrusted us with more than $6 billion of precious federal
resources. You are considering supplemental appropriations that
may give us another 2.75 billion and we want to assure you we
will be not only good and caring bankers, but try to be smart
bankers to help direct the funds to the programs that help all
people recover from the disaster, but of course especially the
children.
FEMA programs are not really children specific. The
children and families are direct beneficiaries of many things
we do. I will highlight a couple of those that we have done so
far. Through our normal programs we try to do everything we can
to restore the school system in New York City back to pre-9/11
conditions. We are working with the Board of Education, our
partners, to provide the millions of dollars of funding
necessary to clean the schools and continue to test the air in
the schools and continue to meet the other disaster-related
expenses that they incurred as a result of the disaster.
Beyond that, we are now working with our partners at the
EPA to begin to clean residences in lower Manhattan in order to
add another level of assurance to children and families that it
is safe to live here.
Beyond that, we are working with our partners in the City
and the State to restore infrastructure, hopefully improve
infrastructure so that life in Manhattan can return to normal
and perhaps even be better than it was before 9/11. Most
relevant to your hearing today is our crisis counseling program
and this is a program that we find is needed in almost every
disaster, but here even more so than ever. Shortly after the
disaster we awarded what we call immediate crisis counseling,
grants, in New York, New Jersey, Connecticut, Pennsylvania and
Massachusetts. This was to provide the very, very short-term
crisis counseling needs and in New York that allowed for the
establishment of Project Liberty and all the great work they
have done.
More recently in late May, we awarded and additional grant
to the State of New York for $132 million for what we call our
regular crisis counseling program. That will insure that the
process continues, that the needs continue to be met and the
services continue to be provided well into next year, and we
recognize that that is a start. We are looking to our partners
at the local, State and Federal level to tell us what else is
needed, what more we can do to look beyond not only the
deadlines for our normal programs, but to provide more
flexibility in our programs to meet the more therapeutic needs
that may be evident among our children of New York.
In closing, I would just like to tell you, remind you and
assure you, that children's issues are absolutely the primary
concern for Commissioner Allbaugh and to our Federal family and
we continue to working with you and cooperate amongst ourselves
to deliver these invaluable services. Thank you.
Senator Clinton. Thank you very much.
Mr. Curie? And thank you for your brevity as well, Mr.
Gair. You have done this before, I can tell. Thank you.
Mr. Curie. Good morning. Thank you, Senator Clinton, Senate
Corzine for inviting me to appear before the committee today
and thank you both for your abiding interest in children's
meant health.
It is my privilege and honor to serve this Administration
and Health and Human Services Secretary Tommy Thompson as the
administrator of Federal Substance Abuse and Mental Health and
Human Services, or SAMHSA. Over its ten year history, SAMHSA's
programs have shown that prevention, early intervention and
treatment for mental health and substance abuse disorders pay
off in terms of reduced health care costs, educational and job
losses, suicide, homelessness, crime and sometimes violence.
When it comes to the lives of children, SAMHSA-supported
programs are helping to fulfill the promise of productive
independent fulfilling adulthood for millions of children
experiencing or who are at risk for mental illness.
Today the need to achieve that mission can never be more
important. The opportunity has never been greater, particularly
when you focus on the mental health implications. In the wake
of September 11th, America's consciousness about the emotional
trauma of man made fear has been heightened as never before.
The number of children affected by trauma of this kind has
never been greater. Today we have the obligation to remind
parents and caregivers that seeking help to recover from the
mental health effects of trauma is not shameful. We have the
opportunity to help in the stigma surrounding mental illnesses,
such as depression, anxiety and post trauma stress disorder
that can result from trauma and we have a responsibility to the
children of New York that will strengthen their resilience and
promote their mental health today and tomorrow.
This hearing can be a very important part of that effort.
Already today hearing from the first panel, and it was very
moving I was humbled hearing from those individuals, the
parents, children and educators that are on the front line
teaches us a lot about lessons to learn that we need to apply.
The word ``trauma'' has meaning to both body and mind. Most
of the time we think of trauma as a critical or serious bodily
injury or wound. From my perspective as a social worker,
though, trauma means a something a bit different. When I speak
of trauma, it can have a lasting psychological effect.
Emotional trauma, just like physical trauma, can be caused
by nature or by human hands. It can be the result of natural
disasters like floods or earthquakes, or it can be the
emotional trauma from physical or sexual abuse or by physical
injury or chronic illness. But more than any other cause of
trauma today, I am talking about the potential severe and
lasting trauma of witnessing or experiencing violence, the
trauma of losing families, friends or even a sense of community
safety. In a word the trauma of terrorists.
When it comes to physical trauma, we treat it readily. We
set broken bones, stitch and bandage wounds, provide
rehabilitation to heal. We can and should do no less for
emotional trauma.
We have the scientific knowledge, the evidence base from
which to act. We know an increasing number of risks and
protective factors that help or hinder the ability to bounce
back from traumatic experience and we know how to help promote
resilience even for those at greatest risk, through mental
health service.
From both a physical and emotional perspective, children
have the greatest capacity for healing and the greatest
capacity for scarring as a result of this trauma.
The vast majority of children who experience trauma,
particularly catastrophic events, are able to cope with the
event and its consequences by themselves or with support from
family, peers or other adults. Other suffer worries and bad
memories that may fade with time, yet for some the trauma can
precipitate chronic, serious mental health issues, such as
depression, chronic anxiety, PTSD. Some youth may seek drugs or
alcohol to cope with these emotional difficulties.
When it comes to trauma related to September 11th, the
effects on children in New York City are starkly evident in a
the startling report in the New England Journal of Medicine,
Chancellor Levy quoted statistics from those studies. Based on
reports from parents, the study found 35 percent of children
had one or more stress symptoms--nightmares, sleep problems,
distractibility, withdrawal, anger that could point towards a
more serious problem such as PTSD. 47 percent were worried
about their own safety or the safety of a loved one.
We know PTSD has been present in more children than
previously believed. Three factors have been shown to increase
the likelihood children will develop PTSD. One, the severity of
the traumatic event; two, the parental reaction to the
traumatic event and three, the physical proximity to the event.
In general, all studies find that children and adolescents
who report experiencing the most severest traumas also report
the highest level of PTSD symptoms.
But post traumatic stress disorder isn't the only problem a
child may experience in the wake of traumatic experience. The
effects of trauma on the still developing body and mind can be
significant and result in depression, anxiety, drug abuse and
suicide attempts. That is why in the immediate aftermath of a
traumatic event in the weeks following, it is important to
identify the youngsters who are in need of more intensive
support and therapy because of profound grief or some other
extreme emotion.
We owe our children with emotional wounds no less the same
kind of support and caring, intervention and treatment that we
routinely provide to those with wounded bodies. And the faces
and the voices of children and adults from the first panel show
exactly why.
SAMHSA and the Department of Health and Human Services have
been working with New York City and New York State in the days,
weeks and months since the World Trade Center attacks. Within
24 hours of September 11th, thanks to hard work by Secretary
Thompson and departmental staff, both SAMHSA staff and $1
million from the Department of Health and Human Services mental
health specific resources were on the way. Within two weeks
additional personnel and $6.2 million was made available to all
nine affected jurisdictions. Within a month, another $20
million was awarded. These dollar specific to meet urgent
mental health needs were but a part of the much larger infusion
of federal dollars Mr. Gair talked about.
A few weeks later, SAMHSA convened a meetings for nine
directly affected jurisdictions to share their experiences and
to set an agenda for a national summit three weeks later. In
the national summit, Senator Clinton, you and your staff were
helpful in helping us find a place in New York City for a
meeting here in November. Representatives from 42 states, five
territories, the District of Columbia and two tribal
governments made progress towards developing their own disaster
emergency plans that include both mental health and substance
abuse.
At the same time, SAMHSA is identifying and disseminating
information about programs that can serve as models for
adoption or adaption in communities across the country.
SAMHSA's traumatic stress initiative, which was an initiative
begun in October 2001 provides federal support to include
treatment and services for children who experienced trauma.
Initially, that included trauma due to sexual abuse, physical
abuse, other types of abuse. We were able to build on that
network and on that program to incorporate the trauma now of
terrorism.
Here in New York the network includes the North Shore
University Hospital Adolescent Trauma Treatment Developmental
Center, Mt. Sinai Hospital's East Harlem Adolescent Traumatic
Services Community Practice Center and Safe Horizons, St.
Vincent's Child Trauma Center Continuing Care. And today I am
pleased to announce that SAMHSA is making $11.4 million in new
awards under this same initiative.
Here in New York three additional organizations can be
counted among the total of 18 grantees. New York University,
Westchester County Health Care Corporation and the Jewish acts
of terror and other disasters.
In conclusion, I appreciate the opportunity and we
appreciate the yeoman's work that has been done here in New
York to help meet the crisis and determine the needs of
children, parents, grand parents and caregivers who are
affected by the World Trade Center attacks. Without question,
we are learning over and over as we work to heal New York's
children and families, that lesson that mental health is as
precious as physical health. It is as much a part of our
imperative as any physical communicable disease.
We look forward to working with you and your colleagues in
the Senate, not only to respond to the effects of trauma on
children today, but also recognizing that we are not, we are
far from finished yet that in the months and years ahead we
need to keep pressing ahead and addressing these needs because
we have only just begun seeing the evidence resolve. Thank you.
Senator Clinton. Thank you very much, Mr. Curie.
Mr. Felton?
Mr. Felton. Good morning, everyone. I would like to thank
Senator Clinton and Senator Corzine for the opportunity for me
to discuss what New York State is doing to meet the mental
health needs of children in the wake of the World Trade Center
disaster. My name is Chip Felton, I am Associate Commissioner
for the New York State Office of Mental Health and I currently
oversee what has become the largest mental health relief effort
in the history of nation. That is what is called Project
Liberty.
What I would like to do is begin my testimony by briefly
reviewing how the activities of the Office of Mental Health
have changed since September 11th and then I will speak in
detail about how we are addressing the mental health needs of
children through Project Liberty and also other related
initiatives.
The first part is really our traditional line of business
at the Office of Mental Health. We oversee a public mental
health system that serves approximately 400,000 adults and
100,000 children and adolescents each year. The majority of
these individuals require services because they are diagnosed
with a mental disorder that has led to serious impairment in
day-to-day functioning. For example, it is estimated that about
70 percent of the children we serve in our public mental health
system immediate criteria for serious emotional disturbance.
New York's public mental health system follows a full continuum
of care of children from the most intensive inpatient
hospitalization through self-help oriented family services with
a vast majority of children receiving mental health services in
community settings.
Also, the Office of Mental Health maintains an ongoing
planning function and the purpose of that is to insure a system
of care for children with severe mental health needs and we
also fund substantial ongoing research to advance the evidence
base for children's mental health services. The events of
September 11th, though, required us to expand this focus
dramatically beyond our traditional focus on individuals with
severe mental illness to include the entire general population
of New York City and the surrounding areas. Responding to the
broad-based mental health impact of the terrorist attacks
required the Office of Mental Health to mount a major new
public health intervention which we accomplished in a few short
weeks after the attacks. We are proud to have been able to
launch Project Liberty quickly while at the same time
maintaining our traditional roles and functions in overseeing
and providing services to individuals with severe mental
illness.
So now to talk a little bit about Project Liberty. Project
Liberty is a collaborative effort of the Office of Mental
Health, local governments and over 100 provider mental health
services. It is funded by the Federal Emergency Management
Agency with program assistance from Center for Mental Health
Services which is part of SAMHSA. In New York City, Project
Liberty is jointly administered by the Office of Mental Health
and the New York City Department of Mental Health, Mental
Retardation and Alcoholism Services. The New York City Board of
Education and also the Administration for Children's Services
are formal participants in Project Liberty of New York City.
And we really could not operate this program without the
tremendous cooperation and collaboration between our federal
partners and your City and County partners. This as well as all
the other collaborations that happened since 9/11 I think are
one of the outstanding reminders of the community resilience
and capacity that we have here in New York City.
Project Liberty provides free supportive counting to anyone
affected by the events of September 11th. It also funds a range
of public education activities, to help people identify,
understand and cope with their reactions to this traumatic
event. Project Liberty staff also help identify people who
would benefit from more specialized mental health services and
links them to those services. For instance, in terms of public
education, the posters that we have here that the mental health
administration has developed, this is an example of sort of a
public private partnership. I believe some of the funding has
come from the Hasbro Foundation and Project Liberty is helping
to underwrite the distribution of this child educational
campaign.
The scope of Project Liberty is truly enormous. To date
over 104,000 individuals have received direct face to face
counseling and educational services through the program. This
number is increasing rapidly. Three weeks ago, when we had our
wonderful announcement from FEMA of $132 million followup
grant, that number was about 80,000, so we are continuing to
serve many, many individuals with the outreach and service
delivery continues to grow.
People can get Project Liberty services wherever they want
them and the vast majority take place out in the community
wherever it is convenient to meet. There are many populations
that have special focus in Project Liberty, including school
age children, families of victims, survivors and their family,
emergency and recovery workers and the elderly, to name a few.
Another statistic that so far Project Liberty has provided
direct face-to-face services to over 4500 individuals who have
lost a family member in the attacks.
We are very focused on mental health needs of children and
adolescents for very good reason. Assessments we conducted for
our initial FEMA application in September found that the
largest group of individuals in New York City likely to
experience significant traumatic stress reactions following the
attacks were school-aged children. We know from studies of
prior disasters that communities and individuals are very
resilient and that most people will recover quickly. I think
this is a finding that is really worth emphasizing. This is not
in any way to downplay the mental health needs, but the factors
of resiliency and wellness are very abundant in the disaster
and are really our greatest allies in trying to mount an
effective response. The resiliency is true for both adults and
children, but nevertheless there is an impact and range of
response to trauma and some individuals do not recover quickly.
This can be due to the intensity of their exposure to the
event, it can also be compounded by prior trauma or other
personal or family risk factors, including for children the
reaction of their parents and other family members to the
traumatic event.
So, of course, it is important when treating children that
we have to think about the family and social context in which
they live. Highly traumatized children are at risk for a number
of mental disorders so here we are talking about the subset of
kids who have been so heavily traumatized that they may in fact
have developed or are at high risk for developing a diagnosible
condition like post traumatic stress disorder anxiety and
depressive disorders.
These conditions may surface weeks or months after a
traumatic event. Other anxiety disorders, such as panic
disorder or agoraphobia also develop and these can lead to
substantial impairment in a child's ability to function at
school and in home.
I know our speaker in the previous panel talked from her
own and classmates' experience about this kind of impact.
Regardless, though, of the level of impact, we know the ability
of a community to offer support is a critical part of the
child's recovery from trauma and this is where Project Liberty
comes most into play.
Project Liberty has provided a comprehensive disaster
response in New York City schools, including crisis counseling,
classroom education, support groups for parents and Board of
Education staff, and referral to other services when needed.
Children and their families are able to access Project Liberty
services through the schools or through Project Liberty
providers in their areas, and to date, we have about 40 mental
health agencies that are providing Project Liberty services to
New York City schools.
Project Liberty counselors have been very active in the
highly effective schools near the World Trade Center site and
continue to expand services into schools throughout New York
City. Clearly the needs assessment showed that the impact was
throughout the city and it is very important to continue the
extent the relief effort accordingly.
Agencies participating in Project Liberty have provided
hundreds of group crisis counseling and public education
sessions to school children, their parents, teachers and
administrative staff. These sessions review coping strategies
and skills, crisis management, stress reduction and management
and strategies for support of school children and sessions have
also been held to help students identify symptoms of distress
and to build a positive outlook for their future.
Let me just add a few more statistics. In New York City, 10
percent of the nearly 40,000 supportive counseling sessions
that have been provided in New York City have been delivered to
children and adolescents. 11 percent of all Project Liberty
services have been delivered right within schools and over
23,000 children, teachers and parents have participated in
these school-based Project Liberty activities.
Although time constraints preclude any fuller discuss of
this last point, it is important to note that Project Liberty
data indicate the program is reaching nonwhite, non-English
speaking children at rates that are proportional to New York
City's general population.
The cultural component of our outreach effort is pivotal to
its success. We are trying to reach every community in New
York. Although Project Liberty is helping many thousands of
children, we do recognize that the range of services funded to
date under Project Liberty may not be sufficient to meet the
full amount of health needs of all children. Office of Mental
Health is committed to helping New York meet these remaining
mental health needs and we are working on several fronts to
accomplish this.
Let me close by briefly highlighting some of these
activities. Next month the Office of Mental Health will be
awarded 300 million that we have received from SAMHSA to
providers with an expertise in specialist mental health trauma
treatment services. This initiative will bring Project Liberty
agencies together with other treatment providers and academic
experts. They will join forces to deliver effective treatments
to those children that have been so heavily traumatized by
September 11th that they have developed a diagnosable mental
illnesses or are at high risk of developing a serious mental
health condition. OMHS is committed to funding these services
for one year and we are very actively soliciting additional
funding from private foundations and other 9/11 charities and
it is our hope to expand the number of proposals that we can
fund and also to extend services for an additional year.
Just parenthetically, we have received 32 proposals from an
RFP. We are reviewing them now, we will be issuing awards on
July 1. These programs are expected to be operational by the
beginning of September in time for the school year. It is our
hope to expand the number of proposals that we can fund and
also extend services for an additional year. We also plan to
conduct a rigorous evaluation of this project to insure that we
learn as much as we can about delivery of trauma treatment to
children and adolescents with mental health needs.
In addition, we are working with the New York City Board of
Education and the New York City Department of Mental Health to
develop a comprehensive plan for expanding our Project Liberty
services to additional schools. During the coming several
months, Project Liberty will partner with city schools to
provide services in conjunction with summer school sessions and
after school programs. The summer programs will help prepare
children for the return to school just prior to the one-year
anniversary of the disaster and we hope to broaden the scope of
services we are able to provide under Project Liberty in
preparation for schools reopening and the obvious impact of a
one-year anniversary that will have on our city.
Elements of the plan being discussed include a curriculum
that will anticipate and deal with the impact of the
anniversary and also a screening protocol to insure that
children with ongoing traumatic symptoms related to September
11th are linked to all necessary supports.
So to close, I would like to thank the two Senators for
convening this hearing and bringing us together to discuss the
mental health needs of the children. The events of September
11th are unlike any our nation ever experienced and we have
created a mental health response unlike anything we ever
mounted before in response. We recognize that the mental health
impact of this terrible event is unprecedented; that those
impacts will continue to unfold over time and that we will need
to continually refine our interventions to meet those needs as
they unfold. The Office of Mental Health remains committed to
meeting the mental health needs of all New Yorkers who have
been affected by the events of September 11th.
Finally, I would just like to salute the compassion,
collaborative spirit and creativity of everyone in New York and
in particular the mental health community as well as the
educational service communities. It has really been a
tremendous pleasure and privilege to serve as part of this
unique effort and to see the wonderful creativity and
collaboration and resources that this City has.
Thank you.
Senator Clinton. Thank you very much, Mr. Felton.
Dr. Frieden?
Dr. Frieden. Good morning. I am Dr. Thomas Frieden. I am
Commissioner of Health and Mental Health for New York City.
Terrorism is intended to sow terror. Terror is a psychological
phenomenon which requires a societal response and in that
regard I am particularly grateful to you for convening these
hearings today and for the opportunity to address what has been
New York City's response to date and what are our plans for the
future.
As the recently released Board of Education report
indicates, many children continue to feel the effects of the
attacks in the form of increased anxiety and symptoms related
to the trauma. We know from research on previous disasters that
as we move farther away from the event, depression will be a
more prominent symptom confronting children.
We are concerned that children who are most effect by the
disaster, such as those that lost a close relative or witnessed
the event, are at greater risk of developing long-term mental
health symptoms if they do not receive adequate support in
coping with and mastering this intense experience. Children in
general are considered at risk for emotional and behavioral
symptoms following a disaster. This is because of their
developmental limitations in understanding the complexity of
the situation and their dependence on their family and their
contacts for help with the healing process.
Unfortunately, the intense media coverage following
September 11th, the country's ongoing state of alert and
incidents of bioterrorism helped produce a heightened state of
anxiety making it difficult for some children and families to
regain a sense of safety. A sense of safety is crucial for the
healing process. For all of these reasons, the Department has
made children and youth a priority in our plans and service.
Let me take a few minutes to describe the scope of the
activities. For directly bereaved children, immediately
following the event, the Department's crisis intervention
services unit provided mental health services at the Armory and
then as soon as it was set up, at the Family Assistance Center
at Pier 94. At these sites more than 85,000 mental health
contacts were made. In addition, following the President's
declaration of disaster, the State Office of Mental Health in
collaboration with the City's Department of Mental Health,
Mental Retardation and Alcoholism Services applied to FEMA for
funding to establish the crisis counseling assistance and
training program now known as Project Liberty.
The FEMA funding was intended to provide short-term
individual and group crisis counseling, outreach, education
services and referrals for longer term psychiatric or substance
abuse treatment. These interventions are aimed at assisting
individuals in coping with the extraordinary stress caused by
the disaster and its aftermath.
Project Liberty under the immediate services program grant
is providing free crisis counseling at more than 110 community
mental health sites, including all public hospitals throughout
the five boroughs of New York City. Providers were selected to
reflect the culturally diverse makeup of the city to offer
community-based services, to insure that every geographic area
is served and to provide quality crisis counseling and public
education in a variety of languages.
A recent New York Academy of Medicine survey found that one
in four New Yorkers know of Project Liberty. To access Project
Liberty services, families can all 1-800-LIFENET as featured by
the Citywide advertising campaign on radio, television, subways
and buses and in brochures. The hotline is also available in
Spanish, Chinese and other languages. Children and families can
receive services at a neighborhood based mental health center,
a selected community location or in their own home, depending
on what is comfortable for them. Many children who lost a
parent in the tragedy did have access to Project Liberty and
traditional mental health services in their school.
Part of the Department's ongoing services are contracts
with agencies to run more than 100 satellite mental health
clinics based in schools in every borough. In addition to their
usual function, these clinics have been treating children
affected by the disaster. They report a significant increase in
symptoms related to trauma as well as generalized anxiety.
Project Liberty has also earmarked $1 million for the
City's Administration for Children's Services or ACS, the
agency concerned with the welfare of children, including those
in foster care and out of home settings, to address the needs
of these vulnerable children. These children often have
extensive history of trauma and loss and are therefore at
higher risk than the general population. ACS is designing
specialized training for parents, foster parents and staff on
recognizing signs of increased trauma response and on how to
support children better. This Department, working closely with
other state and City agencies, created several initiatives to
respond to the needs of children. I will mention three in
particular.
First, we convened a children's advisory committee of
national and local experts on children's mental health after
disaster. The group has been helping the Department form its
plans for the future. These plans include a focus on school-
based services, bereaved children, children directly exposed to
the disaster, children in foster care directly affected by the
disaster and the general population.
Second, the Department continues to work closely with the
Board of Education and third, with the Agency for Children's
Services to finalize a plan to address children and families in
that system. The Department also has been working closely with
the Mental Health Association of New York and the 9/11 Fund to
develop a school-based poster and brochure campaign geared to
alert parents of young children and youth about the lingering
effect of the disaster on mood and behavior.
In fact, even before September 11th this Department in
partnership with the Mental Health Association was developing a
media campaign for parents and adolescents because of a
recognized need to focus on mental health issues that affect
adolescents. The campaign will be released soon and will help
with our further attempts to address emotional issues
adolescents are experiencing because of or independent of
September 11th.
As I and others have noted, the crisis counseling and
education program funded under Project Liberty have
accomplished a great deal and will continue to serve even more
people as the program continues. However, we know that some
adults and children need more intensive treatment beyond what
crisis counseling can provide. When Project Liberty providers
see individuals whose needs cannot be met by short-term crisis
counseling and education services, they must refer them to
licensed mental health professionals or appropriate agencies.
As you know, FEMA funding for crisis counseling cannot at
present be used for longer term mental health treatment. This
limitation should, we believe, be evaluated and a change in
policy should be considered. We believe that the need for
mental health clinic services may well exceed what can be
provided with the funds that have been provided so far.
Additional federal funding to increase the capacity of the
mental health system to assist those most in need of treatment
over the next 18 months would help. Intensive, well-structured
interventions have been shown to be effective in helping those
with disaster related symptoms to recover and return to their
normal lives. Funding to provide mental health treatment for
this population now will be most beneficial in the long run. In
addition, as you know, Senator Clinton, the New York City
Department of Health has been working with the U.S. Centers for
Disease Control and Prevention to develop the World Trade
Center registry. The registry would enable us to evaluate long-
term health and mental health effects as objectively and
comprehensively as possible. We urge our colleagues to avoid
any further delay in implementing this important project.
We know certain things from other experiences and from the
data that has accumulated to date in New York City. We know
that repeated contact of children with intense media images is
not helpful. We know that efforts to further strengthen the
associations and bonds of children with their families and
communities and to restrengthen the bonds of the communities is
helpful. And we know that many of the aspects that had to do
with the cultural construction of meaning go far beyond the
health and mental health sectors and are areas where the whole
society needs to be involved. We know that planning for the
anniversary on 9/11/2002 is critically important and for all of
these reasons we thank you for your interest and attention and
for this opportunity to be here this morning.
Senator Clinton. Thank you very much, Dr. Frieden.
Well, I am so grateful to each of you and the agencies and
institutions that you represent, because the collaboration and
the partnership is obvious. Do you have any questions, Senator?
Senator Corzine. In light of the time--
Senator Clinton. I am just going reiterate a point that was
made. Because this was such an unprecedented disaster in our
history and because we are now looking forward to determine how
we are better prepared in the future, it is important that we
recognize the long-term effects and the questions that have to
be asked about FEMA's ability to continue more long-term
planning about special funding that SAMHSA and others might
have for this kind of specific need will certainly be on the
table. We look forward to working with all of you and I cannot
thank each of you enough for the really terrific job you have
done of making it up as you went because we did not have any
blueprint or guideline to tell us how to deal with this.
So let me thank you for being here today.
Senator Corzine. Senator Clinton, I would like to make one
point which I believe I heard from at least two of the
witnesses, which I believe we can work on. It flows out of the
Board of Education study, which demonstrated that real data
actually is one of the bases on which we should be working. I
compliment you on working on this registry, but if there is any
message here that I can see, it is that we ought to be working
off of information that is scientific as opposed to anecdotal.
So if I have gained anything from this, it is underscoring the
importance of that and we should get on with that project.
Senator Clinton. Thank you very much. Well, we are going to
call up the third panel so that we can hear finally this panel,
some experts in this area both here in the New York area as
well as in other parts of the country.
[Pause.]
Senator Clinton. I will get on and introduce the panelists
and then ask each of them to provide their testimony and then
we will have time, I hope for questions. We are very pleased to
have with us Dr. Betty Pfefferbaum. Dr. Pfefferbaum is the
professor and Chairman of the Department of Psychiatry and
Behavioral Sciences, the University of Oklahoma Health Sciences
Center, and she has been a tremendous resource to many, many
people in the New York area following 9/11 and I personally
want to thank you, Doctor, because you have been so generous in
sharing your time and your expertise and experience coming out
of Oklahoma City. She will be outlining the research that has
been conducted on children in Oklahoma, and providing some
specific information about what has worked, which is very
critical to our future planning.
Next we will hear from Dr. Christina Hoven, the Mailman
School of Public Health at Columbia University, the New York
State Psychiatric Institute, who was the lead investigator for
the New York City Board of Education study. Earlier this
morning, I was with Dr. Larry Aber, who is also one of the
investigators. The team that was put together was really the
basis for the kind of factual analytic information, Senator
Corzine, that we are both looking for and we are very grateful,
Dr. Hoven, for your being here to outline the program and the
recommendations.
Dr. Harold Koplewicz from the NYU Child Study Center, has
been a partner in the efforts to reach out and assist children
from the very beginning. He has provided a lot of support to
many, many people and institutions and has been a source of
great good advice to my staff. And finally, Dr. Pam Cantor from
the Children's Mental Health Alliance, who will be discussing
models of best practices for making systemic improvement to our
mental health system to try to address our challenges. Of
course I have to put in a plea for the mental health parity law
that we passed in the Senate, it died in the House, we are
going to bring it back up in the Senate. The President has now
said he supports it, and I hope that our friends in the House
of Representatives will pass it, because if there wasn't any
doubt about the need for mental health parity before September
11th, it is even clearer now. So, I thank all of our witnesses
for being here and Dr. Pfefferbaum, if we can start with you.
STATEMENTS OF BETTY PFEFFERBAUM, M.D., PROFESSOR AND CHAIRMAN,
DEPARTMENT OF PSYCHIATRY AND BEHAVIORAL SCIENCES, UNIVERSITY OF
OKLAHOMA HEALTH SCIENCES CENTER; CHRISTINA HOVEN, M.D., MAILMAN
SCHOOL OF PUBLIC HEALTH, COLUMBIA UNIVERSITY, NEW YORK STATE
PSYCHIATRIC INSTITUTE; HAROLD KOPLEWICZ, M.D., DIRECTOR, NYU
CHILD STUDY CENTER; PAM CANTOR, M.D., FOUNDER AND PRESIDENT,
CHILDREN'S MENTAL HEALTH ALLIANCE
Dr. Pfefferbaum. Thank you. I appreciate the opportunity to
share with you some of my experiences that might have
application to your efforts here. Exposure to trauma occurs
directly through the physical presence or indirectly through
relationship with victims or through the media. There are no
studies of the long-term impact of the Oklahoma City bombing on
direct child victims, but research from other disasters
indicate that many children who are directly exposed to severe
trauma will develop diagnosable psychiatric disorders. Many
more will develop symptoms which, while not qualifying for
diagnosis, may be disabling. Symptoms typically decrease over
time, but in some individuals they persist. That would be
particularly true in those children who are most directly
impacted or who have the strongest initial reactions. The
children of direct victims and of rescue populations in
Oklahoma City have been followed clinically, but they, too,
have not been systematically studied.
We are currently conducting a study of the long-term impact
of the bombing on the adolescent children of Oklahoma City
victims, so hopefully by the end of the year we will have some
information that will shed light on the developmental services
here.
It is remarkable to those of us in Oklahoma City that some
victims and their family members are only now beginning to
access mental health treatment, seven years after the bombing.
Late occurring problems in children may be triggered by
developmental factors or by exposure to secondary adversities,
such as economic hardship or disruptions in the social support
network. In some situations, we simply do not recognize that a
late occurring problem which may present as a learning problem
or a behavior problem had its origin in the disaster, or that
the disaster aggravated some underlying vulnerabilities or
predisposed the child to later problems.
Children in the general community are also likely to
experience emotional reactions that have been discussed
previously, that is a population in Oklahoma City that has
received a great deal of research attention. We were able to
document the emotional reactions of children in the greater
community and also the reactions of children who live some
distance from Oklahoma City.
Perhaps most interestingly, we also documented a small but
significant relationship between media exposure and post
traumatic stress reactions. Now, it is very important to note
that it may be impossible to distinguish the impact of media
exposure and the impact of the event itself. It is also true
that the positive relationship between media exposure and post
trauma stress reaction does not establish a causal connection.
It is quite likely that children who are most distressed will
be drawn to media coverage and it is also possible that other
factors underlie this association.
Parents and other adults tend to underestimate the impact
on children. Many impacts are not readily observable. In
addition, parents tend to be consumed with many other problems
in the face of chaos and disaster such as occurred here and
children who may be attuned to the distress in their parents
may conceal their reactions to avoid further burdening them.
Therefore, it is essential that children be evaluated directly.
In Oklahoma City, most of the services for children were
provided in the schools. Schools provided access to children
and school-based services minimized stigma and tend to
normalize the experiences of children. In addition, teachers
and other school personnel are aware of development issues and
are natural sources of support for children. It is imperative,
however, and I underscore, that school-based interventions not
supplant efforts to identify, refer and treat children who have
greater needs. Those in need of more comprehensive and
intensive services.
The mental health needs of children in the current
environment of terror are compelling. We have heard much
evidence of that. The goal of terrorism, evident in the word
itself, is measured not only in the death and injury of direct
victims, in the grief and sorrow of family members, in the
wreckage of property or in the disruption of Government,
commerce and travel, it includes as well the fear and
intimidation that accompany a new way of life for all of us.
Therefore, the mental health implications, and I applaud
you for conducting this hearing, must be included in the
general response that addresses security, preparedness,
intelligence and public health. Thank you.
Senator Clinton. Thank you very much, Doctor.
Dr. Hoven?
Dr. Hoven. Thank you, Senators, for inviting me here today.
As the principal investigator of the New York City Board of
Education study and the primary author of the report entitled
``Effects of the World Trade Center Attack on New York City
Public School Students, Initial Report to the New York City
Board of Education, May 6, 2002,'' which has been submitted as
Appendix one to this written testimony, I am honored to appear
before you to discuss significant implications of our findings
and to suggest possible responses by policy makers such as
yourselves, who control the resources and have the
responsibility to adequately address the current mental health
needs of New York City's public school children.
First, however, I want to acknowledge the contribution of
the many people who made this groundbreaking study possible.
Their individual names appear in the written testimony. Let it
suffice here to say this study was truly a collaborative effort
by the New York City Board of Education, Applied Research and
Consulting, the Centers for Disease Control and Prevention, the
Columbia University Mailman School of Public Health, the New
York State Psychiatric Institute, numerous expert consultants
and of course the brave Superintendents, principals, teachers
and students who made this study possible through their
participation.
Before presenting our results, I want to put the findings
important as our country enters an era of ongoing conflict with
potential for future acts of terrorism in our cities and homes,
on our waterways and to our power plants.
As in the years following the explosion of the first atom
bomb, the youth of America are under new stress, potentially
lowering the threshold for the onset of mental illnesses. To
better appreciate the complexity and challenges faced by the
New York City Board of Education as they struggle to assess
this situation, I want to identify a few issues contributed to
our conceptualizing the study the way we did, that is, to view
the aftermath as a probable citywide phenomena, not just a
Ground Zero event.
One, there are approximately 1.2 million children enrolled
in the New York City public schools. Two, approximately 750,000
of them take public transportation every day, including
subways, buses and boats, passing through tunnels and going
over bridges on their way to school.
Three, whereas only 35,000 people reside in the area
surrounding Ground Zero, more than twenty times that number
commute there to work each day. Similarly, the schools near
Ground Zero, especially the specialized middle and high schools
are attended primarily by students living outside the area,
coming every day from each of the boroughs of New York City. To
put this study into context, it is important to also understand
the following:
One, 8,266 children participated in the study from public
schools located throughout all five boroughs of New York City;
the Bronx, Brooklyn, Manhattan, Queens and Staten Island.
Two, classrooms were selected using probability samples, so
that every public school child in New York City, in grades four
through twelve, had an equal chance of being selected to
participate in our study. This is important, as the
participants were not self selected and therefore were not
biased in the direction of having more problems than the
average student.
Most importantly, this methodology allows us to project our
findings back to the entire New York City school population,
including all students in grades four to twelve, excluding the
public education district.
Three, an assessment of mental health problems was
conducted six months post 9/11, meaning the disorders do not
reflect simply an immediate post-disaster condition, but a
persistent disturbance, a fact which has very significant
service delivery implications.
Because I have submitted a complete copy of our initial
report, I will only briefly summarize our findings. We observed
throughout the City a higher than expected prevalence of a
broad range of mental health problems or psychiatric disorders
among New York City public school children. It is estimated
that as many as 75,000, 10\1/2\ percent of New York City public
school children, have multiple symptoms consistent with post
traumatic stress disorder, PTSD, and that 190,000, 26\1/2\
percent, have at least one of the seven assessed mental health
problems, excluding alcohol abuse, which we also assessed. Each
of the probable psychiatric disorders assessed, not just PTSD,
exceeded expected rates, based on pre-9/11, non-New York City
community estimates. It is also important to emphasize that the
prevalence of mental disorders are elevated throughout the
City, the effects not being limited only to PTSD or only to
children at the Ground Zero schools.
New York City public school students were exposed to the
effects of the attack in different ways. Almost all of students
of Ground Zero and two-thirds of children in the remainder of
the City experienced some type of personal physical exposure to
the attack, such as being near a cloud of smoke and dust,
having fled to safety, having had difficulty getting home that
day, and/or continuing to smell smoke after 9/11. Having a
family member exposed to the attack, that is, having a family
member killed, injured or in the World Trade Center at the time
of the attack but who escaped unhurt was more frequent in
schools outside of Ground Zero than among students in schools
near Ground Zero.
We know the previous exposure to trauma elevates an
individual's response to any new trauma. We found that nearly
two-thirds of the New York City school children had been
exposed to one or more traumatic events prior to 9/11,
including seeing someone killed or seriously injured, seeing
the violent accidental death of a close friend or family
member. Again, a disproportionate number of the children with
previous exposure go to schools outside the Ground Zero area.
Exposure to the media was also very high. Almost two-thirds
of the surveyed population spent a lot of their time learning
about the attack from television. For the preliminary report of
May 6, 2002 we concentrated on factors that were associated
with increased risk for PTSD. Each of the different types of
exposures just described, including personal, family, previous
trauma and media, were found to be associated with this
disorder. However, exposure of a family member and previous
exposure to a traumatic experience were more important than
personal physical exposure in who developed PTSD. Being
younger, female and Hispanic also increased one's risk for the
disorder.
According to our findings, one of every seven children, 15
percent, has agoraphobia. Rates for the other psychiatric
disorders are as follows: 8 percent with major depressive
disorder, 10 percent with generalized anxiety disorder, 12
percent with separation anxiety disorder, 9 percent with panic
disorder 11 percent with conduct disorder and 5 percent with
alcohol abuse in grades nine through twelve. All of these
reported mental health problems were determined to be
associated with impairment, that is, they were so severe as to
indicate need for an immediate intervention. Yet at least two-
thirds of children with probable PTSD following the 9/11
attacks have not sought any mental health services from school
counselors or from mental health professionals outside of
school.
We expect to find similar rates of not seeking help for the
remaining seven disorders we measured.
Currently we are analyzing the data to understand issues
such as depression and bereavement and reasons for possible
heightened vulnerability among specific populations, such as
Hispanics. It is important to emphasize again that the
prevalence of psychiatric disorders are elevated all across the
city. Ameliorating these conditions and preventing them from
developing into disorders in the future requires actively
reaching out to the nearly 1.2 million students enrolled in the
New York City public schools.
As a child psychiatric epidemiologist who has spent my
career concerned with the delivery of mental health services, I
take the liberty to present here an overview of issues that I
believe are critical to address the child and adolescent mental
health needs identified by the New York City Board of Education
study. To effectively address the mental health needs of
children and adolescents will require more than isolated and
piecemeal actions. However, it is crucial to consider the child
mental health services as a comprehensive system of care. That
implies recognizing the central role that should be played by
the school system, the place where most children can be found
and where services can most easily be delivered.
First, about treatment: We may confidently infer that many
children have developed a psychiatric disorder as a consequence
of what happened on September 11th. The most critical issue
facing us today is developing a strategy regarding how do we
engage these children in treatment. Children do not ordinarily
seek treatment themselves and in the case of internalizing
disorders, which are the majority of disorders assessed in this
study, parents and teachers may not even recognize them.
Therefore, intensive outreach strategies must be employed.
Research tells us that many children as well as parents may
also not be receptive to the idea of seeking care for mental
health problems. Once children enter services, the next
important step is keeping them in treatment, as most children
drop out after just a few sessions. Therefore, when treatment
issues are considered, we conclude that the school setting may
well be the best place to provide mental health treatment since
outreach, stigma and service dropout can be handled there more
directly. Moreover, the school setting is one of the most
important places where education about the possible mental
health sequela from terrorism and terrorist attacks can be
taught to all children.
I believe the leadership for improving child mental health
services must come from the great medical institutions within
New York City, which must accept the responsibility for
increasing their collaboration with the Board of Education
through school-based clinics.
Second, referral and screening, or screening and referral:
Children respond best to treatment when a problem is identified
and treated in its early stages. About 25 percent of the
children and adolescents presenting with a mental disorder will
go on to develop more severe conditions and therefore will be
in need of more intensive care. An important percentage of
those who passed through their school years without being
identified as needing mental health services will go on to a
life of pain, anguish and dysfunction, including violent and
aggressive behavior towards themselves, others and society in
general.
While we are not able to avoid every personal tragedy such
as the ones that have become so common in our society today, we
can certainly do better through routine screening and treatment
intervention. Previous studies have shown that fewer than 50
percent of adolescents with significant treatable mental
disorders are correctly identified as having any problem by
school counselors and teachers. Similarly, pediatricians
correctly identified only 25 percent of those with diagnosable
mental disorders. Parents, the most important gatekeepers, like
the professionals, tend to identify external sign such as
disruptive behaviors, rather than depression and anxiety. There
is a need, therefore, to systematically screen and identify the
considerable number of students with previously unrecognized
treatable mental disorders.
Screening alone, however, is not enough. It must be coupled
with the provision of treatment. In the multilingual, multi-
ethnic communities of New York City, where 85 percent of the
total public school student population is non-white, every
effort must be made to insure that culturally competent
screening and treatment interventions are available to every
student.
Third, education and training: Parents, caregivers and
teachers must be taught how to be alert to signs of significant
impairment in their children so that the education of parents
is integrated into the existing system of care for all
children. The media can be a useful partner in this outreach.
The interest already exists. Our studies showed that after 9/
11, school children dramatically increased their reading of
newspapers and magazines and consulted the Internet to learn
more about world terrorism. Surely they would want to know more
about themselves and their emotions if interesting, engaging
material were developed and made available to them.
I must add that the mental health professionals, too, must
be retrained to provide state of the art, evidence-based
treatments, particularly for those disorders likely to arise in
the aftermath of a disaster.
I must say something about the role of schools in mental
health services. Every school in New York City already has some
kind of mental health service capacity. Although the quality
and extent of these services differs considerably. Individual
school structure their mental health services differently. For
example, some schools have mental health clinics, others have
health clinics with a mental health component. Still others
schools may provide space where non-school-based mental health
professionals can provide interventions, whereas other schools
refer their students to the professionals in the community.
Strengthening the Board of Education's mental health delivery
capacity is extremely important that the schools receive
adequate financial support to advance the development of
school-based clinics. In the existing school system, what is
needed first is a better recognition that the educational
mission and the mental health agenda are intimately related. A
service system that separates them artificially is at best
inefficient or can actually do harm by failing to meet the
needs of children and adolescents, particularly in difficult
times such as these.
Even when the need to provide mental health services in
schools is recognized and accepted, the implementation of
school-based mental health services faces many difficulties.
First, need greatly exceeds capacity. In fact, while all
schools have counseling support, fewer than 10 percent of New
York City schools currently have a formal on-site mental health
clinic. They urgently need help, financial help, to change
this.
Implementation of an effective service model is very likely
to have broad impact, including the strengthening of the
ability of children and adolescents to perform well
academically, thus reducing the number of children placed in
special education due to emotional disturbance.
In summary, on that new day of infamy, September 11th,
2001, the New York City schools were in full session at the
very moment of the attack on the World Trade Center. For most
public school students, their first knowledge of this
calamitous incident came from their teachers and principals.
These messages were carefully scripted and followed guidelines
set down by the American Psychological Association and other
experts.
In the handling of the immediate aftermath of 9/11, the New
York City schools administration, staff and teachers, as well
as its 1.2 million student body can justly be proud. A study of
the Chancellor's memos, the principals and Superintendents
messages and most significantly of all the web pages and
activities of students themselves, show clearly the message
that the response of the entire New York City community to this
crisis of enormous proportions was strong and adaptive.
However, we have only just begun to try to understand what this
new post-9/11 world means to children and how it will influence
their beliefs, behaviors and outlook into the long run.
I have attempted to provide you here with limited,
documented evidence of what to date has been a most pernicious
and challenging assault on the lives, hearts and minds of New
York City's public school children. The study we conducted for
the New York City Board of Education is unique in its scope and
value, and has alerted us all to the vast unmet mental health
need among our city's public school students six months post 9/
11. After studying its findings, I strongly believe that an
effective and coherent response should be grounded within
school-based mental health services which can utilize state of
the art screening, assessment and evidence-based treatment
approaches.
Specifically, I recommend, one, the development of a
flexible mental health system of care for children based on a
localized coordination system of clinical responsibility,
insuring that each school receive crisis intervention services
and support immediately after any future terrorist threats or
events.
Two, the development of a comprehensive school-based mental
health service system developed in collaboration with all of
the major medical centers, as well as private and public mental
health providers in New York City, such that every single
school and every individual child has ready access to quality
clinical care.
Three, develop a permanent enhancement of school-based
mental health resources, including screening and treatment for
children and adolescents with persistent needs. It should be
noted that this type of therapeutic service is specifically
excluded from Project Liberty funding.
Four, establishment of an ongoing research and monitoring
agenda to further understand the nature and effects of 9/11 on
New York City public school children, to assess if optimal
treatment is being provided to those most in need, both today
and in the years to come, as the long-term sequela of 9/11
unfolds.
Finally, I must add, that none of the people involved in
this study, including myself, from Columbia University, Mailman
School of Public Health or from the New York State Psychiatric
Institute has received any remuneration for their efforts.
However, as I tell my students, being an epidemiologist will
not earn you very much money, but if you are lucky, you will
have the good fortune to conduct a study that truly makes a
difference.
All of us have been proud to do this investigation, humbled
by the dedication of the senior administration of the New York
City Board of Education, impressed by the strong commitment and
efforts of all our collaborators, and very proud that you,
Senator Clinton, are taking the leadership to use this
information to help meet the mental health needs of New York
City's public school children. Thank you for allowing me this
time. I am happy to answer any questions.
Senator Clinton. Dr. Hoven, I have to thank you for that
absolutely extraordinary testimony.
[Applause.]
Senator Clinton. And I am well aware that your written
testimony includes many other significant points that place
this particular set of issues into the broader context of our
failure to provide adequate financing for mental health as well
as all kinds of health, and the other related issues that
surround this. But I wasn't aware until you just said that you
received no remuneration for this ground-breaking work, and it
is something that we need to address, because, as Senator
Corzine said, if we do not have good work like this on which to
base the decisions we make, then we are once again acting on
the basis of what we believe or feel or think rather than the
evidence, and all too often I am sometimes fond of saying
Washington is an evidence-free zone, and the more we can try to
fill that evidence-free zone with some real evidence like you
have presented us today, the better off we will be.
I am going to ask our next two witnesses to try to
summarize their testimony, because Senator Corzine has to leave
and he very much wants to hear both of you, and he will want to
have some closing comments about New Jersey and answer any New
Jersey questions and larger questions as well.
So Dr. Koplewicz?
Dr. Koplewicz. First I would like to thank both of you,
Senator Clinton and Senator Corzine, you are great friends of
America's kids, and today's Senate hearing is an example of
that. I would also like to thank you for the opportunity to
present to you the current public health problem facing
children and adolescents throughout the entire New York
metropolitan area.
On September 11th, 2001 or world changed and the world of
our children changed as well. Nine months later we are trying,
and fortunately most of us are succeeding in living with a new
sense of normal. A vital part of this adjustment is the
realization that our children are now growing up in a very
different world from the one we knew. In a single day the
illusion of our nation's invincibility was shattered for them.
And the overwhelming majority of children are handling that
sense of vulnerability. Their parents, other children and
teachers can help them handle that eventual outcome. However, a
small but significant group of children are at risk.
In New York City groups of children were exposed to trauma
in various ways. Hours after the attack the NYU Child Study
Center began working with the Chancellor's office of the New
York City Board of Education. Within 24 hours of the attack,
our faculty prepared and distributed two manuals on helping
children and teens cope with this event. First, to public,
private and parochial schools in New York City and then
educational, medical and religious organizations throughout the
nation and on September 12 we met with principals from schools
that had been evacuated and then with teachers and eventually
with parents and students. In the following weeks we
established a child and family recovery program which sent
teams of specially trained mental health professionals into
schools where children had been evacuated and we continue to
work with the schools their families and the school staff.
Working with the Silver Shield Foundation, we have been
evaluating and treating any child of a fireman, policemen, Port
Authority worker or medical emergency worker who lost their
lives on 9/11. And we have committed to being available to
these families for the next three years and are conducting the
only treatment study that is evaluating the effectiveness of
our interventions with these groups.
But I sadly have to tell you nine months later many of
these high risk children and teens are getting worse, not
better. The needs assessment conducted that Dr. Hoven just
discussed suggests we are only dealing with the tip of the
iceberg. According to the Surgeon General's Report on Mental
Health in 1999, 12 percent of the population 18 and under had a
diagnosable psychiatric disorder. With approximately 1.1
million students in New York City public school systems we
would expect that 130,000 students would have a mental health
disorder. The Board of Education survey estimates that we have
nearly 190,000 students with a mental disorder. That means not
only are the students with existing problems suffering and at
risk for increased difficulties, but it suggests that an
additional 60,000 students who are well are now showing
significant symptoms due to this horrific event.
Unfortunately, the epidemic does not stop at the City line.
Many people who died that day have lived outside of New York
City and their families are suffering. Many children in New
Jersey schools had a bird's eye view of the attack that day. In
addition, the images of the event were repeatedly present on
television and available for children everywhere. The bad news
is that children who are suffering rarely identify themselves
and usually are silent sufferers, going unnoticed by teachers
and parents. We actually have a good idea which children are at
greater risk: Those whose parents are symptomatic and those
with previous history of trauma. However, that information is
generally not known by the educational or medical communities
or the general public.
We have a public health problem that is not being
addressed. In a public health crisis with physical illness like
polio or tuberculosis, we know what to do and we do it. But we
have forgotten that we are now 60 years after the first
outbreak of polio. Now we are at the first outbreak of the
potential psychological epidemic of the aftermath of this
terror and that requires us to identify, treat and develop
interventions for prevention all at the same time.
First, we must immediately educate the general public,
teachers and pediatricians about the signs and symptoms of
anxiety disorders, depression and post trauma stress disorder
in children and adolescents. This campaign has to include
television, radio and print, but it has to have the same type
of importance as the AIDS National Education Campaign or the
Breast Cancer Awareness campaign and has to be done now. We
need to screen every child in the New York metropolitan area.
Those who have symptoms will receive a full evaluation and
specialized treatment will be made available. That is the same
way we would address tuberculosis and we need to train a corps
of mental health professionals to provide evidence-based and
specific treatments for traumatized children.
Currently, we do not have enough specially trained
individuals for this work. LifeNet, which the number you can
see all over here, is doing a great job referring patients.
However, we need quality control and we must monitor outcomes.
We need to know what treatments work so we have more knowledge
if this ever occurs again anywhere in our nation. The CDC
trains local health care workers when a special outbreak occurs
of physical illness. We need their help now to help us with
this training and we need a system with fewer barriers.
Currently, the FEMA funding is for crisis counseling. We need
more flexible funding for evaluation and treatment and for
systematic studies to evaluate the best treatments for these
children.
The child mental health system was overburdened on
September 10th. It is now incapable of adequately addressing
the current public health problem that we face and we know that
the anniversary of this event will be a difficult day for all
of us, but it will reinfect these children who are most
vulnerable. A plan of action has to be put into effect now for
the weeks surrounding September 11, 2002. Our wish that
everything goes back to normal is understandable, however, we
are warned almost daily of the potential for future attacks.
Those warnings alone are enough to trigger symptoms. This level
of uncertainty scares all of us, but it has the greatest effect
on the most vulnerable, our children. Therefore, while we all
know that we are going to die some day and we take precautions
- we try to eat healthy, exercise and avoid too much risk, we
go forward and work, love and have fun and most of us do that
quite effectively. We want the same for all kids.
While most of them are doing just that, a significant
minority is still suffering and if ignored, their symptoms will
get worse. They are at high risk for substance and alcohol
abuse, poor school attendance, suicidal thoughts, attention
depletion. Their world has changed and therefore the strategy
for dealing with these real psychiatric problems has to change
as well. Thank you for your attention.
Senator Clinton. Thank you very much, Dr. Koplewicz.
Dr. Cantor?
Dr. Cantor. I have to apologize in advance for the state of
my voice. Actually, Larry--
Senator Clinton. I hope that did not happen this morning?
Larry Andrews to the rescue. Do you want to add a few points,
because I want to ask Senator Corzine to ask questions.
Mr. Andrews. Do you want me to read her statement?
Senator Clinton. Read it or just summarize it.
Mr. Andrews. Well, the highlighting of the vulnerability of
children in the City and in the region and the nation really
needs to have a focus, as several panelists have said on the
nature of this as a public health crisis involving the mental
health of our youngest citizens.
You heard about the numbers, that 200,000 children have
diagnosable trauma-related mental health problems and this
situation, because of its scope, demands a public health
response. The vast majority of these children have not received
any help to date by their own report, so if three quarters of
the children do not report getting help inside or outside of
the school system despite the heroic efforts of everyone
described, so it is a bigger problem than understood.
Dr. Cantor has long written testimony that will be
available for the Committee, and I know you will take a look at
it. She wanted to focus today on how to move from things we did
in the face of an emergency to what we really need to do now in
terms of the long-term challenge and reiterates the call for
adopting a public health model. In that model, complete
information on an infrastructure by which needs assessments,
not just for fourth through twelfth graders, but for kids zero
based to third grade; screening of the type that Dr. Koplowicz
and Dr. Hoven and others encouraged, and ongoing tracking and
surveillance system would all be part of what we were doing.
To insure that professionals are properly trained in the
psychoeducational supportive and evidence-based treatments, a
lot more training is required and a public education campaign
to do that as well. The crisis response teams that have been
begun in selected school districts can be expanded
dramatically.
In her written testimony she describes a lot of work in two
districts, District 2 at Ground Zero and District 31 in Staten
Island, in which extensive work has been done and could be a
model for the future. And it was funded by multiple sources:
Federal, state, local, public, private and that sort of
consortium of funding is going to be important.
In the immediate aftermath of September 11th the governance
and planning structure for the mental health response came from
the Board of Education and many people emphasize how important
the Board of Education is, in a group called the Partnership
for Recovery in New York City Schools. Dr. Cantor believes, and
I do too, that we now have the knowledge in the face of this
magnitude and scope to really create new planning and
governance structures to address the needs of children both in
a public health context and a public education context, a new
level of coordination between health and education is required.
This structure must include the Board of Education, who has
provided great leadership. They must also continue to receive
advisory reports, but leadership for the advisory of the mental
health approach should resolve with the Mental Health
Department of the City. This work should build upon the
accomplishments of the first five structures, to incorporate
City, State and Federal agencies that already share the
responsibility for meeting the needs of mental health of the
City's children.
If leadership from the City can bring education, health and
mental health together, the challenge in front of all of us to
really develop a partnership for recovery of New York's
children can happen.
She asks you to end by imagining a health contagion that
was affecting 200,000 children in a serious way with many more
subclinically affected. If we faced a clinical contagion like
that mit would be clear we have no choice but to pool our
knowledge, our experience and resources to create a partnership
for recovery of New York City's children. There is no other
choice for mental health for our children today.
[The prepared statement of Dr. Cantor may be found in
additional material.]
Senator Clinton. Thank you very much for pinch hitting.
Thank you, Dr. Cantor.
Dr. Hoven. I feel compelled to respond to something that
was said that is incorrect and I do not want to have you misled
about the numbers. The number, approximately 200,000 children
having a disorder and needing intervention is only based on the
eight disorders, actually, that number is based on the seven
disorders. There are approximately 30 disorders that affect
children's mental health, so the example that was given about
the small discrepancy I think it was 60,000 between what would
be expected based on the Surgeon General's report and these
data is a true undercount. It only reflects seven disorders out
of the 30 possible.
Senator Clinton. Thank you, Dr. Hoven.
Senator Corzine?
Senator Corzine. I would take Dr. Hoven's lead, first of
all, I want to compliment both you and the Board of Education
for the study, but the 200,000 includes kids in the New York
City school system. If you took those same studies and applied
them to the kids in Jersey City and Hoboken and Bayonne, and
other places, or Monmouth County, or those scattered children
around the nation that Ms. Salamone talked about in her opening
testimony, I think we have far more than 200,000 children
impacted by these, but I would certainly love to hear your
comments with respect to what you would think if we had that
evidence-based analysis for other children in other venues and
how far does that reach.
Dr. Hoven. It is a complicated question, but in fact,
people from New Jersey have been meeting with Dr. Michael Cohen
at Applied Research and Consulting and with me about actually
doing the study in New Jersey similar to the New York City
Board of Education. The day after the New York City Board of
Education report was released, I was inundated with phone calls
from people, particularly from Westchester County where I do a
lot of work, and they were castigating me, ``What are you doing
there in New York City? This is just an artificial border. How
can you be looking at New York City, what about us? And what
about us? This is not only a phenomenon in the metropolitan
area.''
I think because of the nature of this disaster which many
people have talked about, we are having responses from all
over, not only the United States, but all over the world. I
have received phone calls from people all over the world, and
in fact, tomorrow, for example, the Chilean national television
is coming to do a story, and I asked them why, and they said
because at about the same time that our data was released, they
had done a national survey in the Chilean national schools and
they found that the issue that most concerned students was fear
that an event like 9/11 was going to happen to them.
We are talking about a worldwide problem, a worldwide
perception that terrorism is at all of our doors. It is not
just a problem of the metropolitan New York City area that we
are here to talk about today, but you as senators, leaders of
our country, have to think about the mental health policy that
is almost nonexistent for children. We have to do something
about mental health policy. We have to do something about
parity. We have to do something about supporting research that
would give us the kind of data that we need to answer the
questions that you have asked. What does it look like here,
what does it look like in Indiana? What does it look like pre-
9/11, what does it look like post 9/11? We do not know.
Research in this area is very, very underfunded. Thank you.
Senator Clinton. Dr. Pfefferbaum, could I ask you, you
mentioned in your testimony that for the first time in seven
years some people were coming in asking for services. Did the
events of 9/11 trigger that, do you believe or is there some
other explanation?
Dr. Pfefferbaum. Well, I think there are a number of
explanations, but our impression in Oklahoma City certainly our
delivery of care much between Oklahoma and New York City, we
are very reactive and we haven't thought about this in a new
thinking out of the box of how do schools and how do we prepare
for instance, for September 11, 2002. We know that is going to
be a difficult week for the 1.2 million kids in the New York
City public schools, but it is going to be difficult for kids
throughout the United States.
Senator Corzine. I think, first of all, the testimony from
all of you dramatically underscores how little we are investing
in mental health. Carrying that back to Senator Clinton's first
comment before this panel, parity does not hack it, we are just
not there with treating these kinds of problems on an
equivalent basis with physical illnesses. So I hope that we can
get specific suggestions for training the folks that would be
delivering these programs. And we need to make sure that we are
providing the kinds of dollars and resources to conduct
research so that we can move forward in an evidence based
effort. Without that, I think we are truly underserving our
people, because terrorism is really trying to strike at the
psychological well-being of our nation. So, I would like to
tear apart some of the studies, but I think we have got a job
to do to get the resources and the focus and the parity that we
need on these efforts as well as other efforts of homeland
security.
Dr. Koplewicz. Do you think the topic that Dr. Hoven raised
about Project Liberty's mission and what it can be used for
funding and FEMA using it only for crisis counseling really has
to be addressed at some level so that we have more flexibility.
These kids need more than just crisis counseling.
Senator Clinton. Well, in fact, Senator Corzine and I,
based on your previously submitted testimony and the work that
we and our staffs have done, have put together six points that
we would like to try to work on in the upcoming months.
First, to establish an office for the protection of
children in whatever the newly created Department of Homeland
Security will be, because I think without a specific focus of
responsibility for children, their physical well-being, their
mental well-being, the technology, the equipment, the vaccines,
the antidotes, everything that children need, it will not be a
top priority. So that is our first recommendation.
Secondly, we do want to encourage the launching of a
children's mental health public education campaign, to get that
up and going by the end of June, to do more to link resources
up with training of parents, teachers, child care providers and
others. We want to include mental health tracking of children
and adults in the CDC World Trade Center Registry that was
mentioned by the previous panel. We also are going to be
advocating for the release of FEMA funds to insure quality
comprehensive mental health screening and referral for all New
York City school children based on this study, but of course we
want to go beyond that. Obviously, Senator Corzine wants to
make sure those resources are available in New Jersey. We want
to make them available, as we heard earlier, to everyone who
would need them and we are going to be working with Mary Ellen
Salamone and others who are trying to represent all the
families, because really they represent the country, if you
will, and the needs that are out there.
We also believe strongly that we should guarantee access to
long-term mental health services for victims of terrorism. That
would speak to the point Dr. Hoven and Dr. Koplewicz made about
the problem in our emergency crisis response-that it is
supposed to be short-term. That is what it is designed to do,
but clearly, many of these problems have much longer term
effects. We want to try to begin to put an emphasis on the
terror trauma that can come not only for an event, but from the
constant warnings, the media images, some of the other issues
that you have raised for us, and a mental health disaster
response program between New York and New Jersey which would be
regional, could serve as a model for how to go about doing
this.
Many of the issues we are looking at now in trying to
prepare for future potential attacks on our vulnerabilities
have no borders, they cross all borders, and we need to do a
better job. We are going to ask the HHS to assist all the
states and all of you in working with us to facilitate this
better coordination in response to disaster.
So we have six points coming out of this. I know the press
and maybe the public has some questions. I am going to invite
all the witnesses from the previous panels who are still here
to join these witnesses and Senator Corzine and I on stage.
Again, I think we owe a great round of applause to these
witnesses.
[Whereupon, at 12:28 p.m., the committee adjourned.]
ADDITIONAL MATERIAL
Prepared Statement of Pamela Cantor, M.D.
The terrorist attacks on September 11, 2001 have highlighted the
vulnerability of children and their families, as well as the vital
systems on which they depend. We have just heard about how trauma has
affected children throughout the city. What we are faced with in New
York City is a public health crisis involving the mental health of our
city's youngest citizens. Two hundred thousand children in the city
meet criteria for at least one major psychiatric disorder. Children who
are affected by a few to several symptoms those with sub clinical
syndromes will number in the thousands and they too are experiencing
impairment in their ability to learn and to function positively in
their lives.
The majority of these children have not received help of any kind.
In addition, the Needs Assessment demonstrates what literature from
other communities facing catastrophes have observed: that is, that the
effects are felt in a wide perimeter beyond the geographical area of
the event. Children were exposed to this tragedy throughout the region
and the nation. They were faced with questions about their personal
safety and that of their parents. If they or their parents had exposure
to any other traumas or losses in their lives they would be
particularly at risk for the onset of new or recurring psychiatric
symptoms. The experience that we are having in New York to fully
understand the emotional impact of this event on children and families,
as well as our schools, will have much to offer other communities in
the tri-state region and the nation.
aftermath of 9/11
From the very first minutes of the terrorist attacks, the Board of
Education in New York City recognized the urgent health and mental
health concerns that were going to be facing the population of children
and families that it serves. It reached out to many local and national
figures experts on child mental health issues, trauma, as well as those
organizations and communities that had faced catastrophic events
before. In a short time it became clear that coordination and
collaboration were going to be essential tasks to bring about an
effective response to an event of this scale. In many instances this
meant a series of often uncomfortable ``arranged marriages'' among
scientists, clinical providers, community organizations, and funders.
Competitive issues had to be overcome for the benefit of children and
to accomplish this the Partnership for Recovery in the New York City
Schools was established. With the Children's Mental Health Alliance, a
non profit organization in New York playing the facilitating and
coordinating role, institutions such as the National Center for
Children Exposed to Violence at the Yale Child Study Center, Columbia
University School of Public Health, NYU Child Study Center, the
Department of Public Health, the Office of Mental Health, Mt Sinai
Medical Center, Jewish Board of Family and Children's Services, Saint
Vincent's Hospital, the Center for Social and Emotional Learning,
Applied Research and Consulting and many many others joined with the
Board of Education to develop and implement the Partnership Mission.
The goals and progress of the Partnership to date have included:
Goal:
Identifying the needs of different populations of children
throughout the city using the scientifically valid screening instrument
which has been developed by the Partnership.
Progress: Separate testimony is being provided about the Needs
Assessment study conducted by Applied Research and Consulting (ARC),
Columbia University School of Public Health, and the New York State
Psychiatric Institute.
The report written from the Needs Assessment data allows all of us
to better understand how children have been affected, and guide us in
making thoughtful and appropriate decisions about how to meet those
needs and how to allocate resources. The report makes a powerful case
for a coordinated, broad-based response to a public health crisis
involving the mental health needs of our children. In the NYC Public
Schools alone, there are an estimated 200,000 children whose daily
functioning is impaired by mental health issues.
Goal:
Develop the capacity of the New York City schools to meet the short
and long-term emotional needs of its children.
Progress: a pre-K through 12th grade Social Emotional/Health
Education curriculum, in addition to a related series of training
manuals is in development stages. Some of this curriculum developed by
the Partnership will be available as a resource to schools as early as
September in the form of September 11th Anniversary related guidelines,
training manuals, and related education/trainings (awareness sessions
to ongoing technical assistance). These materials are intended for use
by educational administrators, school security officers, parent
leaders, and heads of after-school settings who want to create safer,
and more responsive settings that foster learning with an attunement to
children in distress in particular. Social and Emotional Education can
increase the resiliency of children and reduce risky behaviors.
Goal:
Improve the process by which schools respond in times of crisis
enhancing the mechanisms for a coordinated and effective response.
Crisis response model should incorporate critical partnerships between
schools and mental health providers, law enforcement, and other
community based services and organizations.
Progress: As of this past Friday, Dr. David Schonfeld and his team
from the National Center for Children Exposed to Violence at Yale
(NCCEV) have completed their training calendar for this school year.
All NYC BOE Superintendents, district offices and 12 school district
crisis teams have now received training in the NCCEV model for school
system crisis response.
These trainings have begun to lay the groundwork for a system-wide
architecture of crisis response which will allow schools, districts and
the central office to manage crisis situations in a more effective,
consistent, and integrated manner. Crisis response teams are instructed
in an organizational model which delineates team structure and roles.
The training team also provides information on staff support and
bereavement issues.
These trainings have offered an opportunity for district and school
level personnel to create partnerships and develop networks in
surrounding communities to efficiently implement crisis response.
School level teams have been asked to identify local mental health
providers with whom they wish to partner and invite them to the
trainings. Representatives from the NYPD, who play a crucial role in
crisis response and school safety, also attended the training sessions
in an effort to strengthen their partnerships with districts and
schools.
In addition to the team trainings, a Citywide Crisis Response
Steering Committee met throughout the school year on a monthly basis.
The steering committee met to address system-wide crisis response
policy (e.g., revising the School Safety Plans to incorporate mental
health representation), facilitate implementation of the training
schedule, and discuss city-wide crisis issues such as the plans for the
one year anniversary.
Goal:
Coordinate an effort to guarantee that the children who are
affected by a catastrophe have access to appropriate clinical
interventions. This will include a review of best practices and models
for working with children and staff following a disaster.
Progress: The Partnership is creating a comprehensive database of
mental health resources currently working with or willing to work with
schools, after-school programs, and other child-serving organizations.
This information is being collected from various data sources and
detailed interviews with District Superintendents, Principals, and
Pupil-Personnel Directors about the relationships they have or want to
have with mental health providers and community-based organizations.
This database will be district specific but in and of itself will not
guarantee access to care. A major effort will need to take place to
facilitate new relationships between these resources and schools, as
well as to strengthen existing ones. There are many hurdles to the
actual utilization of mental health services that will need to be
overcome. The mapping process has begun in three pilot school
districts.
The Partnership is committed to creating a multi-layered approach
to meeting the mental health needs of children. In the immediate
aftermath of September 11th, members of the Partnership met with The
New York Times 9/11 Neediest Fund. This collaboration resulted in the
initiation of The Times' Strength in Schools program, which issued
immediate grants to three providers that had pre-existing relationships
with the schools in and around Ground Zero and additional grants to
other districts. Through funding by The New York Times, augmented
direct services have been provided in Districts 1, 2 and 31. Plans are
underway to expand the list to include District 6 and 27.
a new public health model
Using a public health model to look at mental health need we can
view the children of our city and region have been exposed to a serious
toxin. The Needs Assessment has told us how children were affected, the
disorders that resulted, the levels of severity, the numbers of
children affected, and the pre-existing conditions which increase the
vulnerability of children. We know this by means of the study's
methodology. The presence of a representative sample of New York City
Public School Children grades 4-12--allows us to make inferences about
children throughout the city. This study has confirmed what many
professionals feared in terms of the very large numbers of children
affected and the very large numbers of children who have not received
help. The mental health infrastructure before September 11th was not
sufficient to meet the pre-existing needs which existed. This
infrastructure has suffered serious erosion in recent years. Both
school-based and community based resources are now faced with a demand
and an urgency which has never been greater.
From the point of view of the Needs Assessment there is still
information missing. We do not know about children K-3rd grade. We do
not know about children who are not in the public schools and we do not
know about children under the age of 5. In addition, school staff that
have also experienced multiple traumas (plane crash, bioterrorism,
etc.) have not been assessed. This work must be done.
The information the Needs Assessment does not give us it does not
tell us which children are suffering. This is a very complicated
problem from many dimensions. Children exposed to trauma are not easy
or obvious to identify. They often do not stand out in a classroom and
at home, the initial subtle changes in their behavior may not be
noticed especially by parents who are suffering themselves. Even
programs designed for aggressive parent and staff outreach will not
identify all of these children. In a public health model screening is
essential to identify these children and to insure their access to
treatment. Screening has not been done on any appropriate scale in New
York following this event. There are many examples that we can draw
upon in which public health issues, such as HIV, were dealt with (e.g.
confidentiality of carriers, the confidentiality of partners and a
parent's inalienab le right to decide upon treatment for their
children). Screening of children to identify cases and provide proper
treatment must be done. The cost of not doing it will be huge and risky
in terms of the serious impairment and suffering children will endure.
Children with untreated depressive and anxiety disorders as well as
PTSD are at much greater risk for self destructive and other risk
taking behaviors.
In addition to screening children, there must be a methodology for
tracking the outcome of interventions. Only through an ability to track
can we see the effectiveness of what we are doing and make
modifications along the way. Contagious diseases like TB or sexually
transmitted diseases have had the benefit of ongoing government
surveillance through the Department of Health. Using care and great
sensitivity to confidentiality, it has been possible track what happens
to people who have been exposed or who have these conditions. The
mental health emergency which exists among our young people carries
enormous risks for them and those around them. The same kind of public
health surveillance should be carried out for mental health issues.
public education--primary prevention
Mental Health issues still labor under a tremendous burden of
stigma which hinders access to treatment. This is even more the case
when children are affected. Parents do not want to have their children
labeled as having a psychiatric illness. In a city where 175 different
languages are spoken reflecting huge cultural diversity, the obstacles
to access to treatment grow larger. In situations like September 11th,
many people regard whatever reaction they are having as not indicative
of a mental illness, but rather a normal response to a highly abnormal
stress. For all of these and many other reasons, a public education
campaign which reaches out to parents and children helping them to
understand what they are feeling, when they may need additional help
and what can be done about it is crucial to insuring access to
services.
Even if we are successful in the daunting task of increasing our
capacities to offer mental health services we will need to make an
equally huge effort in insuring that these services are offered in a
way which is ``user-friendly'' and culturally acceptable or they may
not be utilized.
The Mental Health Association of New York City is working with its
partners in the community, local government and private philanthropic
organizations with the vision of a collaborative city-wide, multi-
dimensional public education campaign promoting mental health for
children and families. There are currently two campaigns under
development. The first is a broad scale children's mental health
``anti-stigma'' print campaign. The other campaign is a disaster-
related public education campaign focusing directly on how the events
of 9/11 impacted children ages 14 and under, and speaks directly to
parents and adult caregivers.
preventive services/healthy social emotional development
School and home can and need to be places where students can learn
to face the tests of life. The Partnership for Recovery in NYC Schools,
The New York Academy of Medicine and the Center for Social and
Emotional Education (CSEE) are now developing a five-year educational/
training plan to:
Develop a pre-K through 12th grade Social Emotional/Health
Education curriculum and related series of training manuals,
educational forums that will range from introductory awareness sessions
to ongoing technical assistance.
Synthesize and create guidelines, the creation of training manuals
and related education/trainings (awareness sessions to ongoing
technical assistance) for educational administrators, school security
officers, parent leaders, and heads of after-school settings who want
to create safer, more caring and responsive settings that foster
learning in general and an attunement to children in distress in
particular.
Organize SEL/Child Development Resource Center. This Resource
Center will be web-based and/or available on CD-ROM
Supporting, educating and nurturing the healthy social and
emotional development of children promotes academic success, reduces
violence and increases the ability to recognize others in distress. It
is one of the most powerful tools that we have to promote the recovery
from traumatic events and enhance resilience.
Education in Trauma Treatment
There is a body of knowledge of evidence-based practice available
to us for preventing and treating the disorders which people experience
following a trauma. Much more needs to be done to create a knowledge
base about effective practices, especially with younger children.
Across the country organizations like the National Center for Child
Traumatic Stress, The National Center for Children Exposed to Violence
at the Yale Child Study Center and here in New York the Consortium for
Trauma Treatment and Safe Horizon have begun the work of training many
different kinds of professionals in trauma and grief treatment. There
needs to be a huge expansion of training in effective models of
treatment for school based as well as community based professionals. If
professionals working in all different kinds of settings received
training in their abilities to identify affected children, provide
psychoeducational supports to children, staff and parents (which in
many instances will be a sufficient treatment) and where appropriate,
provide more extensive treatment, our true capacity for addressing
trauma-related mental health problems would be greatly increased.
capacity of mental health services
The first objective in augmenting the capacity to prevent and treat
the mental health problems associated with trauma, is the creation of a
multi-layered continuum of settings in which children in distress will
be reco gnized and identified, receive supportive and counseling
services and where it is appropriate, receive longer term treatment.
The first layer might be schools, after-school programs, Project
Liberty Sites. At this layer the conditions for success would be the
ability to correctly identify a trauma related mental health problem,
to provide immediate counseling support to child and family, to provide
a correct referral to a setting appropriate and acceptable to a child
and family for more in- depth evaluation and treatment.
To establish the second layer a comprehensible system of resources
to schools or Project Liberty providers as well as to families directly
a massive organization and coordination task is ahead to insure access.
key elements of success
Over the last several months through the work of the Partnership,
we have begun to understand some of the many problems and potential
solutions to the mapping and linking of resources. The conditions for
success rely upon three key components:
District leadership at the Superintendent and Principal level
Provider Leadership
Strong Leader for Coordination and Collaboration
In the districts where we have worked, which include Districts
1,2,6,27 and 31 there are models in which the success achieved so far
in meeting the demand for mental health services is being significantly
affected by the presence or relative absence of one or more of these
factors.
Among the more successful examples are District 2 and 31. In these
districts there has been very strong leadership at the district level
and very active involvement of this leadership in mental health issues.
In District 2, which is in Ground Zero, there is also strong Provider
Leadership. The NYU Child Study Center, Saint Vincent's and the Jewish
Board for Family and Children's Services as well as a visionary funder
in the New York Times 9/11 Neediest Fund, which augmented the funding
for services already received through FEMA and Project Serve, are an
example of a public private financial and service partnership which
supported the many needs of teachers, parents and children in that
area. In District 31, the accomplishments were led by the work of Dom
Nigro, Director of Pupil Personnel Services, who created the District's
own network of four providers to address the needs of the largest
number of children who had lost at least one parent and the needs of
many staff members who had losses as well.
In many other districts the leadership and organization from the
superintendents and principals less effective. They may not regard
mental health as a priority or do not feel they have ability to
establish relationships with providers and community based
organizations. The central leadership at the Board of Education has
made crisis response, safety and preparedness an absolute priority and
now with the Crisis Trainings being conducted by the team from the
National Center for Children Exposed to Violence, under the leadership
of Dr. Steven Marans, they have firmly put health and mental health on
the school safety map.
But from there, the linkages to mental health service providers and
other types of mental health supports are not reliable at best and non-
existent at worse. There is an opportunity and a challenge to take a
system which has itself been traumatized and build
a coordinated network of mental health resources and community
resources with strong active relationships to our schools. Because
future trauma cannot be anticipated and we are told every day that we
may expect more, the rapidity with which this type of stable structure
is established is of critical importance to the restoration of safety.
Capacity cannot be increased overnight. One of the simplest and
fastest ways to increase capacity is to strengthen, coordinate and
better use what we already have.
This can be done with the creation of a properly designed and
conceived resource map, a coordination team whose exclusive job is to
develop the relationships between potential community resources, the
district leadership and the schools and the kind of outreach, advocacy
and public education campaign that insures access to these services.
The work in progress on district resource mapping and relationship-
building:
Based on information gathered from our pilot work the following
strengths and limitations of the Districts are apparent:
The key limiting factors in some Districts include:
Overwhelming need for children's mental health services
Limited capacity and overburdened staffing (in both school and
community)
Only the most severe behavioral cases get addressed
Inability to assess and identify children at risk
Limited understanding of school community mental health needs
Inadequate funding
Insurance caps on service provision limit effectiveness and
outreach
Shortage of culturally sensitive services
Absence of focus on primary prevention strategies
Stigmatization of mental health
The positive factors found in some Districts include:
Focus on social and emotional health of children as a component of
academic success
Administrative buy-in on district and school levels
Staff development, training, and support for identifying at- risk
behaviors
Established, effective relationships with community mental health
providers
Active school-based health and social service centers
governance, planning and collaboration
In the immediate aftermath of September 11th, the governance and
planning structure for mental health response came from the Board of
Education in the form of the Partnership for Recovery in the New York
City Schools. With the knowledge we now have of the magnitude and scope
of the mental health crisis facing our city's children, a new planning
and governance structure is needed.
To address mental health within a public health context there must
be governance and a pla nning structure in which the critical agencies
involved in health and mental health are well represented. This
structure must include the Board of Education and the Board must
continue to receive the advisory support it has had. Responsibility for
this new mental health approach should reside within the mental health
authority of the City.
This work should build upon the accomplishments of the first
collaborative structure but must expand its scope to incorporate the
many City, State and Federal agencies that already share the
responsibility for meeting the health and mental health needs of the
city's children. Leadership from the City can bring education, health
and mental health together working to find an integrated approach to
meeting children's health and mental health needs. The challenge to all
of us at this moment is to face up to this urgent situation through the
creation of the Partnership for Recovery of all of New York City's
Children.
If it were know that a health contagion was affecting 200,000
youngsters in a serious way and many thousands more sub-clinically, in
a single city, there would be no choice, no alternative than to pool
our knowledge, our experience and our resources together to create the
Partnership for Recovery of New York City's Children.
Attachment I
BENEFITS CAN BE EXPORTED TO OTHER COMMUNITIES IN THE REGION AND
BEYOND
The Key Elements of a Public Health Model
1. Information Infrastructure
a. Needs Assessment Instruments all ages
b. Screening instruments all ages
c. Tracking and surveillance techniques
2. Crisis Response Training
a. Models available for all communities
3. Prevention/Social and Emotional Learning Curriculum
a. In development stages, will be available to schools and
communities across the country
4. Resource Mapping/Advocacy, Outreach and Public Education
a. Once we develop the technique for doing this in NY City, other
communities can use it as well
5. Training in Trauma Treatment
a. Many models available now but more work needs to be done to
develop age appropriate models for children
6. Continuum of Services
a. Multi-layered model can be replicated in other settings
7. Governance, Planning and Collaboration
a. ``The ultimate arranged marriage''
A New York City School District's Response to the WTC Disaster
Good morning, and thank you for the opportunity to discuss this
important issue. We all have a story about September 11, 2001. Where we
were, with whom, how we felt and what we wished we could do. We all
remember the weeks after the tragedy, how we would greet friends and
associates tentatively asking, ``Is your family okay?'' These were our
experiences as adults. What were the experiences of children?
This is a question we ask teachers, parents and children.
Consistently the answer often includes uncertainty, fear, sadness,
anxiety, pessimism, and isolation.
I was asked to come here today to speak about the initiatives that
Community School District 31 has developed to address the mental health
needs that precipitated from the WTC disaster. Community School
District 31 is the largest school district in New York City and the
second largest in NY State. Presently, we have 43,719 students. The
borough of Staten Island has 5% of New York City's population, yet on
September 11th, 28% of the firefighters and police officers that lost
their lives were residents of this borough. Two hundred and eighty-five
(285) of our students sustained the loss of a family member or loved
one. Fifty-four staff members also sustained a similar loss. At one
middle school six boys lost their fathers. At one elementary school, 28
children suffered a direct loss. As you can see, our school district is
hurting. These statistics do not take into account the other 43,434
students, many of whom are struggling in a post 9/11 world of security
consciousness, underlying fear and anxiety. This was made very clear to
me when I granted permission for a five-year-old kindergarten girl to
change her school. She was fearful that an airplane was going to crash
into her school, since it was so large, and it had four stories. We
transferred her to a single story school. Her fears were compounded by
her concern for her father, who was a firefighter. We see it in the
artwork of a second grade boy who writes on his artwork in late March,
``I dreamed I fell off a building. Other people were on the building.
Someone was coming to save me and the people. She saved the people. She
was going to save me last, but I fell off the building.'' We have many
such students. It is our mission to help our children, parents and
staff deal with the many emotional and social concerns they now face.
Our approach was supported by the recent study completed by Applied
Research and Consulting.
It is our challenge to walk the fine line between overwhelming
families with services, versus not providing adequate services to meet
their needs.
what have we done?
Our first concern on September 11th was that some students would
come home to empty homes . . . so we developed a strategy that ensured
that all students were released to a family member. We set up two
holding areas for students who were not picked up at school or bus
stops .their safety was our primary concern . . . by 7:00 pm all
students were appropriately released. This was only the beginning. We
knew that our strategy had to include interventions for students,
parents and staff. We knew this from our work confronting other
individual crises, however, the twelve members of the District's Crisis
Team would not go far in addressing the needs of all of our fifty (50)
schools.
Our approach was divided into three phases. This enabled us to
assist children and families in a variety of ways.
phase i
Phase I began on September 12th when an assortment of crisis
management resources were developed and distributed to all our schools.
These materials provided insight into the disaster and the grief
process. The materials also provided direction to each school as to how
to assist students in understanding the confusion surrounding this
disaster. Schools were instructed to use these materials to develop
strategies that would address the needs of the children. School teams
first developed a plan of action to assist all students, and later a
plan to assist individual students who expressed a need. These teams
developed age-appropriate lesson plans, met with staff members, and
designated a ``crisis room'' for those students who needed counseling.
On September 13, 2001 Staten Island's problems were compounded by
the ``lockdown'' of the borough due to a report that police were in
pursuit of a terrorist that had entered the island via one of the three
NJ bridges. This proved to be false, but further inculcated fear and
anxiety into our families. Twenty-eight percent (28%) of our students
attended school that day. Normally, 93% of all students are in
attendance.
phase ii
During October, Phase II of the District 31 Crisis Plan was
implemented in which we partnered with local mental health community-
based agencies. Mental health professionals from these agencies were
available to discuss any concerns that parents and staff members may
have had with respect to their children or any other family members.
Mental health professionals met with each principal to get an
understanding of the school's needs. They collected information from
various sources in order to get an overall picture of the impact of the
WTC tragedy at the school. A plan was formed and a schedule developed
so parents and teachers could meet with Phase II professionals in a
designated space in the school. Referrals were made to the appropriate
resources for those students who needed further assistance. The Phase
II professionals may return to each school for a follow-up visit at a
later date if the school needs further assistance. Materials and
resources were made available from The Educators for Social
Responsibility (ESR) and the District Office Media Library. Parents
contacted principals to find out the dates and times the Phase II
professionals were available and appointments were scheduled for those
requesting services.
phase iii
Phase III of the district's response to the WTC tragedy is called
Project Cope. This was made possible through our federal SERV funding.
Project Cope is comprised of 10 intermediate school guidance counselors
who are responsible for counseling all those children in their own
schools, as well as elementary schools that have been assigned to them,
who suffered a loss of a family member. Project Cope counselors
received Crisis Management training and were given the resources
necessary to respond to this tragedy.
These counselors began reaching out to their assigned elementary
schools in early January. They introduced themselves to staff and the
PTA.
The Project Cope counselors contacted those students who suffered a
loss, but first they reached out to each of their families.
By February, the Project Cope counselors updated the district
database to reflect the number of students in our district sustaining a
loss of a loved one.
Further training is taking place during the Spring Term and is
being provided by The Educators For Social Responsibility. This
training will be for Project Cope counselors and district staff members
who are providing grief counseling to our students.
additional interventions
The Office Of Student Services has been in contact with a number of
organizations throughout the country that were eager to assist the
district's students.
Organizations and school districts donated the following items,
which were distributed to students: Sixteen thousand teddy bears, Art
supplies, Musical instruments, Gift packages, Survival kits,
Professional Sports and Theater Event tickets.
Finally, District 31 received a $100,000 grant from the NY Times to
assist our students in the aftermath of the WTC. The NY Times funding
will drive an initiative that will:
Provide students in need of academic support with tutoring services
during the summer months.
Provide for the development of bereavement training videotape for
school staff. The video will give an inside look at how four children
have experienced loss in the September 11th attack.
As you can see we have attempted to address as many issues as we
can with our limited resources. The public has demonstrated a
generosity that is beyond anything I could ever have imagined.
Unfortunately, at a time when education budgets are being cut
nationwide our school district is lacking the additional resources to
effectively confront the unmet mental health needs that our students
have developed as a result of the WTC tragedy.
The anniversary of September 11th occurs five days into the new
school year. Our challenge is to provide all of our students with the
emotional, social and academic support that will insure that they are
not re-victimized by our failure to do so. This support will enable
them to simply be children, not citizens anxious or fearful about every
passing airplane or stranger.
The message we have been trying to impart to our students is one of
hope, giving a sense that as the anniversary of September 11th
approaches, the situation is different, but we are a stronger and more
caring community as a result. One of our second grade students
expresses this message in a poem called ``Spring":
``The sun comes out
So let's all shout.
The flowers bloom
So, you have to make room.
You can sing a tune
And get ready for June.
Spring has arrived
And you don't have to hide.''
Thank you.
[GRAPHICS OMITTED]