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Abstract

Hurricane Maria made landfall in Puerto Rico on September 20, 2017, becoming the most devastating storm to impact the island in almost a century. Natural disasters have been shown to adversely impact children’s emotional, behavioral, and academic functioning and schools provide an ideal setting in which to implement wide-reaching interventions that can bolster resiliency and promote psychological recovery. Yet there is limited-to-non existent literature describing the actual implementation process of an evidence-based, trauma-informed intervention model within a school system after a natural disaster. This paper describes the process by which our team established a partnership with the Puerto Rico Department of Education (PR-DE) to implement the Puerto Rico Outreach Model in Schools-Esperanza (PROMISE), beginning shortly after Hurricane Maria made landfall. We describe our multi-phase, trauma-focused intervention model implemented with Puerto Rico school personnel using a Community Based Participatory Approach. PROMISE included 3 phases: 1) Phase 1 (three weeks post-hurricane): Providing Psychological First Aid training for school teachers and staff to meet the needs of all students affected by the hurricane through classroom-based intervention; 2) Phase 2 (six months post-hurricane): Providing Skills for Psychological Recovery training for school social workers and psychologists to meet the needs of students with sub-clinical trauma-related concerns and; 3) Phase 3 (one year post- hurricane): Providing Trauma-Focused Cognitive Behavioral Therapy training for school psychologists to address higher level and unremitting trauma-related symptoms in students. We describe the process by which key partnerships were established, the step-by-step implementation process of each phase, lessons learned from the field, and implications for practice, training, policy, and future research.

Key Take Away Points

  • Natural disasters adversely impact children’s emotional, behavioral, and academic functioning. Schools provide an ideal setting in which to implement wide-reaching interventions that can bolster resiliency and promote psychological recovery after a disaster.
  • A Community Based Participatory Approach, in which key stakeholders offer their concerns, needs, ideas, and help co-design a project together with the implementing team, offers a fruitful and respectful approach to post-disaster intervention planning.
  • Implementation of a multi-phase, trauma-focused intervention model within the school system of Puerto Rico post hurricane Maria was feasible and acceptable. The lessons learned outlined in the current paper can help inform future post-disaster intervention efforts.

Author Biography

Rosaura Orengo-Aguayo, PhD, is an Assistant Professor and Clinical Psychologist at the National Crime Victims Research and Treatment Center at the Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences. Dr. Orengo-Aguayo’s research focuses on addressing mental health disparities among underserved, trauma-exposed youth through innovative treatment dissemination methods, as well as on the cultural adaptation and international dissemination of trauma-focused assessment and intervention. She is the Director of the Puerto Rico Outreach Model in Schools-Esperanza (PROMISE), currently funded by SAMHSA. Regan W. Stewart, PhD, is an Assistant Professor and Clinical Psychologist in the Mental Health Disparities and Diversity Program at the Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences. Dr. Stewart’s research focuses on addressing mental health disparities for underserved trauma-exposed youth through community-based and telehealth technology. She is a national expert in telehealth delivery of trauma-focused treatment for children and adolescents and the Director of the Telehealth Outreach Program (TOP) at MUSC. Michael A. de Arellano, PhD, is a Professor at the National Crime Victims Research and Treatment Center at the Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences and Director of the Mental Health Disparities and Diversity Program at the Department of Psychiatry and Behavioral Sciences. Dr. de Arellano’s research focuses reducing mental health disparities, barriers in access to care, and cultural tailoring of trauma-focused treatments for Latino youth. Freddie A. Pastrana, PhD, is a postdoctoral fellow at the National Crime Victims Research and Treatment Center at the Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences. His research focuses on school-based screening and preventive interventions for at-risk children and integration of behavioral and mental health services within primary care settings. Bianca T. Villalobos, PhD is a postdoctoral fellow in the Mental Health Disparities and Diversity Program of the Medical University of South Carolina. She provides trauma-focused evidence-based interventions via telemental health and outreach services to underserved children and their families. Her overarching interest in research has been to understand help seeking within a cultural framework with the goal of reducing health disparities for the Latinx population. Joy Lynn Suárez-Kindy, PsyD, is a Clinical Psychologist and Assistant Professor at the University Carlos Albizu, San Juan Campus in Puerto Rico. She also served as a consultant to the Secretary of the Puerto Rico Department of Education on student socioemotional needs. Dr. Suarez has expertise in bullying prevention and intervention with youth within schools. Karen G. Martínez González, MD, is an Assistant Professor and Child and Adolescent Psychiatrist at the University of Puerto Rico, Medical Sciences Campus, Department of Psychiatry. She is currently the director of the University of Puerto Rico Center for the Study and Treatment of Fear and Anxiety where she performs research as well as directs an evidence-based clinic for anxiety disorders. Melissa Brymer, PsyD, PhD, is the Director of Terrorism and Disaster Programs at the UCLA/Duke University National Center for Child Traumatic Stress and its National Child Traumatic Stress Network. She is one of the primary authors of NCTSN/NCPTSD Psychological First Aid and Skills for Psychological Recovery. She has been a consultant for many federal, state, and local agencies across the country and internationally after disasters, terrorism, school shootings, and other mass violence tragedies. Dr. Brymer has extensive experience in post-disaster mental health response.

Acknowledgements

We are profoundly grateful to all of the Puerto Rico Department of Education leadership and staff who so generously shared their experiences, needs, and hopes for the children of Puerto Rico with us. We also thank Annette La Greca, PhD, Scott Sevin, and Alan Steinberg, PhD for their helpful post-disaster screening and intervention consultation and to the National Center for Child Traumatic Stress and its National Child Traumatic Stress Network partners for their generous consultation and support. Finally, we thank Edmarie Guzmán-Velez, PhD and Héctor De Jesús-Cortés, PhD for connecting us to the PR-DE and paving the way for this work.

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