Proven resources for foster children are My Personal Life History Book and the accompanying Manual to guide parents, caregivers, teachers and therapists in the use of this resource. Because it is provided with a Manual which guides adult facilitation of the work, the Personal Life History Book (PLHB) is considered a treatment method in its own right. The use of the PLHB method has been scientifically studied and shown to reduce the number of multiple sequential placements for foster children, resulting in improved stability in their lives. Link: Personal Life History Book

My own disaster work goes back to crises such as helping schoolchildren deal with the death of a president. As a clinical analyst, I learned from my individual child patients at the time and reported on Oedipal themes I observed being activated among them. How­ever, it was a formative experience to realize I learned even more of practical public health value from a psychoanalytically informed behavioral survey of teacher observations about the behaviors of 800 schoolchildren. Through that study, it was learned that on the fateful afternoon of John F. Kennedy’s death, teachers and administrators who avoided immediate discussion of the assassination with their in-school pupils experienced behavioral deterioration in their classroom populations as measured by behavioral checklists. The pupils of teachers who initiated discussion with their children had markedly better classroom behav­ioral outcomes.

I kept applying this knowledge about the value for children of adult leadership during times of crisis. Adult-augmented ego execu­tive function and use of adult superego mod­eling could be essential factors. This clue proved useful in later systematic population-based research I undertook with foster children. Controlled studies of a pro-active approach to having foster children create written nar­ratives about their personal life histories led to a significant public health breakthrough. The method produced a sharp reduction of a psychologically malignant phenomenon—already vulnerable children bouncing among foster homes.

Questions arise which can help in future crises: What are the psychoanalytic principles that make a difference; why is it that creating a written narrative of a foster child’s life, one that is authored by the child with the aid and input of a network of current caregivers, results in a statistically significant lowering of “bounc­ing” to another foster home and in a qualita­tively improved experience of life for the child?

Since Kennedy’s death, many large-scale crises have provided the impetus to produce psychoanalytically-informed guided activity workbooks for children, families, and teachers, similar to those that helped foster children. My colleagues and I have authored workbooks concerning the Loma Prieta earthquake, the first and second Gulf Wars, the attack on America, floods, fire storms, the Kosovo refugee experience, terror attacks in Israel, and we are starting one for Lebanese children who have been caught in the war in Lebanon. A Guatemalan mudslide book was produced with the leadership of Leah Fisher. A tsunami storybook is being developed with Sombat Tapaya in Thailand.

EVALUATION EFFECTIVENESS

Research is underway to help determine what is helpful about psychoanalytic resources of this type in the aftermath of a disaster. When Hurricane Katrina made landfall in New Orleans on August 29 2005, causing extensive flooding, immense destruction, and human suffering, Mercy Corps and the San Francisco-based Children’s Psychological Health Center began collaborating on production and distri­bution of a new guided activity workbook within a week after the disaster.

To evaluate the effectiveness of the inter­vention, the American Psychoanalytic Foun­dation and Mercy Corps jointly funded a study of the resource. The objective of the resource was to decrease post-traumatic symptoms in several hundred among the evacuated fifth to eighth grade children attending a displaced school, temporarily based in Houston. The formerly New Orleans student population was 100 percent African-American, the majority (82 percent) from impoverished areas of New Orleans that were widely devastated by Katrina. The Uni­versity of California at Los Angeles Child Post-Traumatic Stress Disorder Reaction Index (PTSD-RI) was administered to the children prior to beginning work on the Hurricane Workbook and again after three months of working with the specially designed psycho­analytically informed workbooks. My Personal Story About Hurricanes Katrina and Rita:A Guided Activity Workbook for Children, Families and Teachers was given to each child. Each worked on it in class for 30 minutes weekly for three months. Post-traumatic symp­tom level scores among 100 twice-tested ado­lescents declined sharply. The improvement was statistically highly significant (p=.000 1). It confirmed compelling clinical observations that even classes of highly agitated and overactive inner city children quickly grew very calm when using the activity workbooks. My Personal Story About Hurricanes Katrina and Rita appears to have contributed to decreasing PTSD symp­toms

Alas, there will never be a time when chil­dren are exempt from disasters. The creation and use of psychoanalytically informed public health measures, as well as further study in this area, are essential. We have some ten­tative hypotheses about the rea­sons children improve through use of such adult-recommended meas­ures. The use of guided activity workbooks shows children that honestly facing the disaster is sup­ported rather than avoided by their teachers and families. The use of drawings and encouragement of narrative writing advances a subli­mative and witnessing process in which the child feels respected and useful within the child’s human network. The child’s personal locus of control and sense of personal history are enhanced. These factors all can easily be absent in a disaster. Current and future research will augment our understanding of how psychoanalytically-based resources make an important difference.