Can Obama Help New Orleans's Troubled Kids?

On Thursday, President Barack Obama was scheduled to visit a New Orleans school that was wracked by Hurricane Katrina and reopened only after residents of the Ninth Ward put in a lot of work. By day's end, he planned to leave. Critics and local officials have been quick to slam Obama for making such a brief visit. But the president doesn't need to be on the ground in New Orleans for long. "He's going there to make a statement, and he doesn't need more than a day to make it," says Irwin Redlener, president of the nonprofit Children's Health Fund and commissioner of the National Commission on Children and Disasters, a bipartisan panel appointed by the president and congressional leaders.

The more important statement Obama will make won't come in the form of a speech, and it won't be made on Thursday. It will consist of what his administration actually does over the next three years for the Gulf Coast's population, especially its children, who are still suffering mightily. "Kids get a lot of lip service in disaster planning, but they tend to get far fewer resources than they need," says Redlener. "The mantra of 'children are our most valuable resource' is almost never matched by actual funding."

Certainly, that's been the case in the gulf since Katrina. After years of bureaucratic haggling, recovery efforts are starting to get some momentum and some cash—Obama's administration has allocated more than $1 billion in aid for Louisiana alone. But "thousands of families have been falling through the cracks because it's been such a disorganized and disrupted safety net," says Redlener, who briefed the president's recovery team at the White House on Tuesday. "There's just too many of them in the gulf now who are still waiting for something to happen."

Redlener estimates that 20,000 Louisiana children "remain at some serious level of uncertainty with respect to stable housing and access to essential services." Researchers at Columbia University's Mailman School of Public Health, where he teaches, have been tracking thousands of people displaced or otherwise affected by the storm, and they've found that constantly shifting policies over the past four years—particularly with regard to housing—have left the storm's victims emotionally and financially adrift. "Every time we go and talk to these families, they're not sure which policies apply to them or what the deadlines are," says David Abramson, director of research at the National Center for Disaster Preparedness. "They'll be told, 'You have to move out of this'—a hotel, a FEMA trailer, an apartment, wherever they're staying—and then the deadline will be extended, and then later they'll really have to move, and then it all happens again. It's hard to plan what's going to happen with their lives when they keep getting buffeted like that."

The constant uncertainty is a particular problem for kids, who need stability far more than adults do. "When you compare these displaced kids living in unstable housing to those who have found stable housing, they're almost twice as likely to perform poorly in school," says Abramson. His team has found that a third of the Katrina kids in middle or high school are at least one grade behind where they should be, compared with the area's pre-Katrina rate of 18 percent. Many of the kids have been shuffled around to new schools and then pulled out. Joy Osofsky, a professor of pediatrics and psychiatry at Louisiana State University, says she's interviewed kids who have been enrolled in as many as nine different schools in four years. And almost all the Katrina kids are in overcrowded classrooms. (The school that Obama is visiting is one of just five to reopen in the area.) None of this bodes well for the kids' future, says Redlener: "There's only so much academic disruption that a young child can deal with before he just can't catch up."

The Katrina kids' health is suffering along with their academics. Last year Redlener's team reported some shocking numbers from the field: 41 percent of the poorest displaced kids were anemic, 42 percent had respiratory problems that might be linked to formaldehyde in FEMA trailers, and more than half had mental-health problems. Ronald Kessler, a professor of health-care policy at Harvard University who is tracking a much larger group of families affected by the hurricane, says that among adults affected by Katrina, "the rates of PTSD [posttraumatic stress disorder] are much higher than those in your garden-variety disaster. Compared to anything in living memory in the U.S., they're off the charts." Kessler's latest research focuses on children. In an upcoming article in The Journal of the American Academy of Child & Adolescent Psychiatry, he reports that 9.3 percent of kids in hurricane-affected areas have a "serious emotional disturbance … that is directly attributable" to the storm. Osofsky, the Louisiana State professor, says she's seen even higher percentages in heavily affected parishes.

These kids and their parents need help now. "The longer they go without real definitive fixes," says Redlener, "the more irreversible the consequences will be." But after allowing the situation in the gulf to disintegrate for four years, the government has a tremendous amount of work to do.

The first, and perhaps the greatest, challenge will be finding all the kids who need help. FEMA was supposed to track displaced families as they moved out of its ramshackle trailers; it was then tasked with providing those names to state officials, who could connect the families to local agencies. None of that happened. Now, after four years of moving around, it's going to be a lot harder to locate those families.

Once the kids in need (and their parents) are identified, they'll need case managers. Over the past four years, the federal government has set up at least three different case-management programs. "One of them expired without ever having taken care of a single kid," says Redlener. "It was funded for a year, and then it got extended, but not one dime was ever spent because they couldn't find the kids. The money was just put back in the Treasury." At the moment, FEMA is reassessing its strategy, trying to evaluate different types of case-management programs to see which one works best. That's not good enough, says Redlener: there's already been too much of a delay. Instead of having yet another endless debate over policy details, it's best to just get the case managers on the ground now.

Case managers, of course, can only identify people's needs. They can't fulfill them. There's a real need for dollars to translate into results, and quickly—particularly with regard to housing. "It seems like it's taking forever to get people back into stable housing," says Abramson, who estimates that it will take between six and seven years to get all the families represented by his study group—about 90,000 people—into permanent living situations. (For comparison, he notes, Japan managed to get roughly the same number of people rehabilitated in just four years after the 1995 Kobe earthquake.)

Even if the Obama administration meets these monumental goals, it will have a still larger task before it: ensuring that the next natural disaster doesn't result in another bureaucratic one. Planning for a long-term recovery "requires an extreme amount of coordination" among multiple agencies at the federal, state, and local levels. FEMA is working now on the National Recovery Framework, a comprehensive strategy that was mandated in 2006 and fast-tracked under Obama. (Advocates hope it will be finished by early next year.) Redlener says he'd also like to see two specific new provisions: one for a "disaster recovery bank that identifies certain funds so we don't have to do ad hoc appropriations next time," and a second for a sort of disaster-planning czar. "I know there's been a lot of criticism about the proliferation of czars [under Obama]," he says, "but this is one case where we need someone in charge to rein in the various and sundry agencies."

How likely is it that any of this will actually happen? Redlener says he found the White House to be "a very receptive audience in appreciating the complexity of the problems" on Tuesday. But, he adds, "to say that their plates are full in the White House may be understating the reality of it."

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