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80–498 PDF 2002

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 THE IMPLEMENTATION OF THE NO CHILD LEFT BEHIND

ACT (P.L. 107–110), FOCUSING ON THE READING FIRST AND OTHER

LITERACY-RELATED PROGRAMS AND STRATEGIES

JUNE 10, 2002

Printed for the use of the Committee on Health, Education, Labor, and Pensions

(

(II)

COMMITTEE ON HEALTH, EDUCATION, LABOR, AND PENSIONS

EDWARD M. KENNEDY, Massachusetts, Chairman

CHRISTOPHER J. DODD, Connecticut

TOM HARKIN, Iowa

BARBARA A. MIKULSKI, Maryland

JAMES M. JEFFORDS (I), Vermont

JEFF BINGAMAN, New Mexico

PAUL D. WELLSTONE, Minnesota

PATTY MURRAY, Washington

JACK REED, Rhode Island

JOHN EDWARDS, North Carolina

HILLARY RODHAM CLINTON, New York

JUDD GREGG, New Hampshire

BILL FRIST, Tennessee

MICHAEL B. ENZI, Wyoming

TIM HUTCHINSON, Arkansas

JOHN W. WARNER, Virginia

CHRISTOPHER S. BOND, Missouri

PAT ROBERTS, Kansas

SUSAN M. COLLINS, Maine

JEFF SESSIONS, Alabama

MIKE DeWINE, Ohio

J. MICHAEL MYERS, Staff Director and Chief Counsel

TOWNSEND LANGE MCNITT, Minority Staff Director

(III)

CONTENTS

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

(1)

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.

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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 schoolbased 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.

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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

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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

5

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 unVerDate 11-MAY-2000 09:10 Nov 07, 2002 Jkt 000000 PO 00000 Frm 00009 Fmt 6633 Sfmt 6633 80498 SLABOR2 PsN: SLABOR2
6

able 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

7

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

8

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.

9

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

10

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 underVerDate 11-MAY-2000 09:10 Nov 07, 2002 Jkt 000000 PO 00000 Frm 00014 Fmt 6633 Sfmt 6633 80498 SLABOR2 PsN: SLABOR2
11

stood 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

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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.

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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

14

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

15

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.

16

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

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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

18

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

19

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.

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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

21

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.

22

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

23

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

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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

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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.

26

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 longterm 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.

27

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-openVerDate 11-MAY-2000 09:10 Nov 07, 2002 Jkt 000000 PO 00000 Frm 00031 Fmt 6633 Sfmt 6633 80498 SLABOR2 PsN: SLABOR2
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ing 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

29

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

30

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

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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 parVerDate 11-MAY-2000 09:10 Nov 07, 2002 Jkt 000000 PO 00000 Frm 00035 Fmt 6633 Sfmt 6633 80498 SLABOR2 PsN: SLABOR2
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ents 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.

33

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 schoolaged 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

34

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.

35

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

36

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

37

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

38

Department also has been working closely with the Mental Health

Association of New York and the 9/11 Fund to develop a schoolbased 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.

39

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.

40

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

41

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 schoolbased 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

42

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

43

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,

101⁄2 percent of New York City public school children, have multiple symptoms consistent with post traumatic stress disorder,

PTSD, and that 190,000, 261⁄2 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 deterVerDate 11-MAY-2000 09:10 Nov 07, 2002 Jkt 000000 PO 00000 Frm 00047 Fmt 6633 Sfmt 6633 80498 SLABOR2 PsN: SLABOR2
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mined 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

45

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 developVerDate 11-MAY-2000 09:10 Nov 07, 2002 Jkt 000000 PO 00000 Frm 00049 Fmt 6633 Sfmt 6633 80498 SLABOR2 PsN: SLABOR2
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ment 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

47

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

48

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

49

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

50

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,

51

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 EduVerDate 11-MAY-2000 09:10 Nov 07, 2002 Jkt 000000 PO 00000 Frm 00055 Fmt 6633 Sfmt 6601 80498 SLABOR2 PsN: SLABOR2
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cation. 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

53

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 longterm 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

54

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.]

55

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 ‘‘ar- ranged 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 longterm 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

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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

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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

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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 afterschool 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 exVerDate 11-MAY-2000 09:10 Nov 07, 2002 Jkt 000000 PO 00000 Frm 00062 Fmt 6633 Sfmt 6621 80498 SLABOR2 PsN: SLABOR2
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ample 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

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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.

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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.

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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.

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