Testimony
Before the Health, Education, Labor and Pensions Committee
Subcommittee on Children and Families
United States Senate

The Mental Health Needs of Children Subject to Terrorism

Statement of
Bernard S. Arons, M.D.
Director
Center for Mental Health Services
Substance Abuse and Mental Health Services Administration
Department of Health and Human Services

For Release on Delivery
Expected at 10:00 am
on Friday, November 2, 2001

Thank you, Senator Dodd and members of the Subcommittee, for the opportunity to testify regarding the mental health needs of children amid ongoing terrorist threats to safety and security. I am Bernard S. Arons, Director of the Center for Mental Health Services (CMHS) at the Substance Abuse and Mental Health Services Administration (SAMHSA), Department of Health and Human Services (HHS).

We are learning together in the aftermath of the September 11 attacks and the subsequent bioterrorist incidents. We face enormous new challenges as a nation, but we are building on a strong legacy of disaster mental health work and children's mental health programs.

No one agency or department will address these new challenges alone. Just as the President has discussed the need to be prepared for a long-term war on terrorism, we as a nation will need to be prepared for a long-term effort to restore a sense of safety, security, and healing for America's children and families.

The effects of violence and trauma constitute a major public health problem for all Americans, with consequences of severe psychological and social dysfunction as well as injury and death. Moreover, children and adolescents appear to be disproportionately at greater risk than other age groups for violence victimization.

In addition to the terrorist attacks on New York City and Washington, D.C., other major acts of violence that have been felt across the country include the 1995 bombing of the Alfred P. Murrah Federal Building in Oklahoma City and the 1999 shootings at Columbine High School in Littleton, Colorado. While these disastrous events have caught the Nation's attention, they are only a fraction of the many tragic episodes that affect children's lives. Each year many children and adolescents sustain injuries from violence, lose friends or family members, or are adversely affected by witnessing a violent or catastrophic event. Each situation is unique, whether it centers upon a plane crash where many people are killed, automobile accidents involving friends or family members, or natural disasters such as the Northridge, California, earthquake (1994) or Hurricane Floyd (1999) where deaths occur and homes are lost. But these events have similarities, as well, and cause similar reactions in children. Even in the course of everyday life, exposure to violence in the home or on the streets can lead to emotional harm.

We know from years of experience in disasters and criminal acts across the country that children can be remarkably resilient in the face of terrible events. We also know that children have unique vulnerabilities and need special attention. Children and adolescents look to their parents, their teachers, and other caring adults for guidance on how to make sense of the frightening events they are seeing and hearing about.

Many adults may feel uncertain about how to respond to children's questions, particularly when we have very little recent experience with a traumatic event of this scale and may feel anxious ourselves. There are no easy answers, but there are some simple guidelines that may be helpful.

For example, adults should not be afraid to communicate with children about the terrorist acts. We need to be reassuring to children without giving false assurances. We can assure children that many people are working to protect them and keep them safe.

Parents can seek to maintain some family rituals where possible, involve children in family and community activities, and spend time with children and answer their questions honestly and thoughtfully. Children need to be assured that there are no bad thoughts and feelings and that it is normal to feel scared.

We have posted a number of other suggestions and materials on our web site, which is www.mentalhealth.org. We have also established web site links and posted materials with several of our partnership agencies, such as the Federal Emergency Management Agency (FEMA), the Department of Justice, the Department of Education, and the National Institute of Mental Health.

While we seek to provide assurance in addressing the current crisis, we need to continue thinking and organizing for a long term effort to assure our children's mental health and well being. As we begin this effort, we have some very important building blocks.

Substance Abuse and Mental Health Services Administration Efforts

As you may know, the Center for Mental Health Services has a longstanding and highly successful interagency agreement in place with FEMA. For over 25 years, CMHS and HHS have worked with FEMA to help administer the Crisis Counseling Assistance and Training Program. In the aftermath of the September 11 attacks, this program has already funded crisis counseling projects in New York, New Jersey, Connecticut, Massachusetts, and Virginia.

In addition, SAMHSA has awarded new supplemental funds related to the September 11 attacks to all of the States that received FEMA grants as well as to Pennsylvania, Maryland, the District of Columbia, and Rhode Island.

The largest of the new mental health projects, known as Project Liberty, will begin a public education and outreach campaign in upcoming weeks.

CMHS also recently launched a new $10 million initiative focusing on children and trauma. Grants have recently been awarded, and we will be working with some of the best experts from around the country to build and learn about services for children exposed to a wide array of traumatic events.

National Institutes of Health Activities

Our fellow HHS agency the National Institutes of Health (NIH) also has a long history of supporting research and research training on a wide range of topics related to the effects of violence and traumatic stress. Principally conducted through the National Institute of Mental Health (NIMH) and the National Institute of Child Health and Human Development (NICHD), this includes support for examining the nature, extent, and consequences of exposure to violence, including human-caused and natural disasters and terrorist attacks.

Research has shown that children who experience catastrophic events show a wide range of reactions. Some suffer only worries and bad memories that fade with emotional support and the passage of time. Others are more deeply affected and experience long-term problems. Research on post-traumatic stress disorder (PTSD) shows that children who have witnessed violence in their families, schools, or communities are vulnerable to serious long-term problems. Their emotional reactions, including fear, depression, withdrawal, or anger, can occur immediately or some time after the tragic event. Youngsters who have experienced a catastrophic event often need support from parents and teachers to avoid long-term emotional harm. Most will recover in a short time, but the few who develop PTSD or other persistent problems need treatment. Examples of past NIMH-supported research include:

• PTSD in Children with Burns - A Longitudinal Study

A team of investigators are evaluating 100 children between the ages of seven and seventeen who are hospitalized for an acute burn. This study aims to determine the influence of a variety of biopsychosocial variables on the emergence and persistence of post-traumatic symptoms in these children. Such knowledge can facilitate the early identification of children "at risk" for PTSD and functional impairments.

• Predictors of Child and Family Postdisaster Functioning

The primary purpose of this project is to investigate the impact of a tornado disaster on the psychological functioning of 1,500 adolescents and their families The first goal of this study is to identify predictors of adolescents' posttraumatic stress symptoms following a natural disaster. Another goal of this study is to identify predictors of adolescents' behavior problems and predictors of parents' psychological response to the disaster. In this study, adolescents who were exposed to a severe natural disaster will be surveyed. Severity and degree of disaster exposure, symptoms of PTSD, parent-report of child behavior problems, coping strategies, and parent and family functioning will be evaluated.

• Child Exposure to Violence and PTSD Across Urban Settings

Six thousand males and females, ages 1 to 16, in Chicago are being assessed, along with their care givers, to ascertain the source, frequency, and severity of their exposure to violence and the consequences of such exposure for subsequent psychiatric disorder, social, psychological, physiological, and academic functioning.

• Mental Health Consequences of Violence Victimization

This is a prospective study examining the mental health consequences of exposure to intentional interpersonal violence. Six hundred individuals, ages 16 to 25, are being recruited for participation from a Los Angeles medical center following treatment for penetrating- or blunt-injury trauma stemming from community violence. The major purpose of this study is to advance understanding of both the psychological impact of violence victimization and the coping resources and mechanisms that promote successful adjustment.

NICHD also has a strong portfolio of research concerning children exposed to traumatic events. Researchers supported by the Institute are examining a broad range of biobehavioral factors, such as which social factors can serve as predictive of child well-being (neighborhood support), and whether life stressors (violence) affect children's immune system function.

In addition, efforts are already being made to assess the effects of the September 11 attacks on children and families. One of NICHD's grantees, during the week following the terrorist attacks, conducted a random survey of U.S. adults to look at symptoms of distress, beliefs about terrorism, coping, and television viewing related to the attacks, including the effects on children in the household. The results will shortly be published, and NICHD is planning to fund a resurvey of the same sample to analyze the effects of these events and media coverage on children.

A Look to the Future

As we look to the future, SAMHSA is fortunate to have strong interagency agreements with other key Federal agencies such as the Department of Justice, Office for Victims of Crime, and the National Center for Post Traumatic Stress Disorder within the U.S. Department of Veterans Affairs.

For the last few years, CMHS has also developed strong collaborative partnerships with NIMH, the Health Resources and Services Administration, and the Administration for Children and Families within HHS, the Department of Education, and the National Transportation Safety Board.

There are many other key Federal, State, and local partners too numerous to mention, but we know from experience that these partnerships are critical. In the end, the message of reassurance and coping assistance need to come from sources that people trust and look to in their daily lives. For that reason, our disaster mental health efforts have always worked through existing community-based agencies and involve strong partnerships with voluntary agencies, faith-based organizations, schools, and community leaders.

Because of the severity of trauma-really a "war trauma" in some areas-I expect that some people, children and adults, have had more difficulty coping than others and may need longer term follow up. For many years, the field of "disaster mental health" has been a sub-specialty in the larger mental health field. As we look to the future, I expect that the challenges we face may draw upon the resources from throughout our mental health systems. In addition, I have not even touched on the increase in substance abuse that accompanies a severe traumatic event that will further tap the resources of our substance abuse prevention and treatment system.

To begin organizing for a long term effort ahead, SAMHSA will be hosting a National Summit on the Nation's Mental Health and Substance Abuse Needs. The National Summit, which will take place from November 14-16, 2001, will bring together State and local mental health authorities from around the country to meet in New York City. We are learning together, and by working together, we will help communities cope and will look to the future to begin healing and recovery.

Mr. Chairman, once again I appreciate the opportunity to testify about this very critical and important issue, and I am available to answer any questions you may have.