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Children and disasters: A framework for mental health assessment

Betty Pfefferbaum, MD, JD, Anne K. Jacobs, PhD, J. Brian Houston, PhD

Abstract


Background: Providers serving children’s mental health needs face the complexities of tailoring assessments based on developmental stages, family characteristics, school involvement, and cultural and economic factors.This task is even more challenging in the face of a disaster, terrorist incident, or other mass trauma event. Traditional mental health knowledge and skills may not be sufficient to meet children’s needs in these chaotic situations. Unfortunately, disaster planning and response often overlook or only briefly address the unique mental health needs of children. While there is general agreement that children have specific vulnerabilities, few comprehensive plans exist for identifying and addressing children’s mental health needs predisaster and postdisaster.
Objectives/methods: Based on a review of the literature, the objectives of this article are to provide an overview of the central tenets of assessment with children throughout the course of a disaster and to propose a framework for disaster mental health assessment that can be used by a variety of providers in community disaster planning and response.
Results: Disaster-related assessments are described including surveillance, psychological triage, needs assessment, screening, clinical evaluation, and program evaluation. This article also identifies easily accessible resources for responders and providers who desire to become more familiar with child disaster mental health assessment concepts.
Conclusions: The framework described here provides an overview for understanding how assessment can be conducted to identify child and family needs and to inform the delivery of services following a disaster.


Keywords


assessment, children, disaster, disaster mental health, mass trauma, terrorism, trauma

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References


Committee on the Future of Emergency Care in the United States Health System: Emergency Care for Children: Growing Pains. Washington, DC: The National Academies Press, 2007. Available at http://books.nap.edu/openbook.php?record_id=11655. Accessed August 16, 2011.

National Advisory Committee on Children and Terrorism: Recommendations to the Honorable Tommy G. Thompson, Secretary, U.S. Department of Health and Human Services. Atlanta, GA: Centers for Disease Control and Prevention, 2003. Available at http://www.bt.cdc.gov/children/PDF/working/Recommend.pdf. Accessed January 30, 2012.

Pynoos RS, Schreiber MD, Steinberg AM, et al.: Impact of terrorism on children. In Sadock BJ, Sadock VA (eds.): Kaplan & Sadock’s Comprehensive Textbook of Psychiatry. 8th ed. Philadelphia, PA: Lippincott Williams & Wilkins, 2005: 3551-3564.

Saylor CF, DeRoma V: Assessment of children and adolescents exposed to disaster. In La Greca AM, Silverman WK, Vernberg EM, Roberts MC (eds.): Helping Children Cope with Disasters and Terrorism. Washington, DC: American Psychological Association, 2002: 35-53.

Balaban VF, Steinberg AM, Brymer MJ, et al.: Screening and assessment for children’s psychosocial needs following war and terrorism. In Friedman MJ, Mikus-Kos A (eds.): Promoting the Psychosocial Well Being of Children Following War and Terrorism. Fairfax, VA: IOS Press, 2005: 121-161.

Bryant RA: Recovery after the tsunami: Timeline for rehabilitation. J Clin Psychiatry. 2006; 67: 50-55.

Centers for Disease Control and Prevention: Updated Guidelines for Evaluating Public Health Surveillance Systems. Atlanta, GA: Centers for Disease Control and Prevention, 2001. Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5013a1.htm. Accessed January 30, 2012.

Garcia-Abreu A, Halperin W, Danel I: Public Health Surveillance Toolkit: A Guide for Busy Task Managers. Washington, DC: The World Bank, 2002. Available at http://siteresources.worldbank.org/INTPH/Resources/376086-1133371165476/PHSurveillanceToolkit.pdf. Accessed January 30, 2012.

Johns Hopkins University Center for Refugee and Disaster Response and the International Federation of Red Cross and Red Crescent Societies: Epidemiology and surveillance. In Public Health Guide in Emergencies. 2nd ed. Baltimore, MD: Johns Hopkins University Blumberg School of Public Health, 2007: 220-283. Available at http://www.jhsph.edu/bin/q/r/Chapter_6_Epidemiology_and_Surveillance.pdf. Accessed January 30, 2012.

Galea S, Norris FH: Public mental health surveillance and monitoring. In Norris FH, Galea S, Friedman MJ, Watson PJ (eds.): Methods for Disaster Mental Health Research. New York: The Guilford Press, 2006: 177-193.

Institute of Medicine: Preparing for the Psychological Consequences of Terrorism: A Public Health Strategy. Washington, DC: The National Academies Press, 2003.Available at http://iom.edu/Reports/2003/Preparing-for-the-Psychological-Consequences-of-Terrorism-A-Public-Health-Strategy.aspx. Accessed January 30, 2012.

Health Metrics Network, World Health Organization: Disease surveillance. In Issues in Health Information. Geneva, Switzerland: World Health Organization. Available at http://www.who.int/healthmetrics/documents/hmnissue_diseasesurveillance.pdf. Accessed June 28, 2011.

Data Resource Center: National Survey of Children’s Health. Portland, OR: The Child and Adolescent Health Measurement Initiative. Available at http://nschdata.org/Content/Default.aspx. Accessed June 27, 2011.

National Child Traumatic Stress Network and National Center for PTSD: Psychological First Aid: Field Operations Guide. 2nd ed. National Child Traumatic Stress Network and National Center for PTSD, 2006. Available at http://www.nctsn.org/content/psychologicalfirst-aid. Accessed January 30, 2012.

Everly GS:Toward a model of psychological triage: Who will most need assistance? Int J Emerg Mental Health. 1999; 3: 151-154.

Meredith LS, Zazzali JL, Shields S, et al.: Psychological effects of patient surge in large-scale emergencies: A quality improvement tool for hospital and clinic capacity planning and response. Prehosp Disaster Med. 2010; 25(2): 107-114.

Parker CL, Everly GS, Barnett DJ, et al.: Establishing evidenceinformed core intervention competencies in psychological first aid for public health personnel. Int J Emerg Mental Health. 2006; 8(2): 83-92.

Jacobs GA, Kulkarni N: Mental health responses to terrorism. Psychiatr Ann. 1999; 29(6): 376-380.

Gold JI, Montano Z, Shields S, et al.: Pediatric disaster preparedness in the medical setting: Integrating mental health. Disaster Med J. 2009; 4(3): 137-146.

Schreiber M: Learning from 9/11: Toward a national model for children and families in mass casualty terrorism. In Danieli Y, Dingman RL (eds.): On the Ground After September 11: Mental Health Responses and Practical Knowledge Gained. Binghamton, NY: Haworth Press, Inc., 2005: 605-609.

Thienkrua W, Cardozo BL, Chakkraband ML, et al.: Symptoms of posttraumatic stress disorder and depression among children in tsunami-affected areas in southern Thailand. JAMA. 2006; 296(5): 549-559.

Hughes LE, Derrickson S, Dominguez B, et al.: Economical emergency response and lower profile states: A behavioral health reference for the rest of us. Psychol Trauma: Theory Res Pract Policy. 2010; 2(2): 102-108.

Centers for Disease Control and Prevention: General Considerations Regarding Health Education and Risk Reduction Activities. Atlanta, GA: Centers for Disease Control and Prevention, 2007. Available at http://www.cdc.gov/hiv/resources/guidelines/herrg/gen-con_community.htm. Accessed June 29, 2011.

Witkin BR, Altschuld JW: Planning and Conducting Needs Assessments: A Practical Guide. Thousand Oaks, CA: Sage Publications, Inc, 1995.

Guha-Sapir D, Lechat MF: Information systems and needs assessment in natural disasters: An approach for better disaster relief management. Disasters. 1986; 10(3): 232-237.

Pfefferbaum B, Sconzo GM, Flynn BW, et al.: Case finding and mental health services for children in the aftermath of the Oklahoma City bombing. J Behav Health Serv Res. 2003; 30(2): 215-227.

Franks BA: Moving targets: A developmental framework for understanding children’s changes following disasters. J Appl Dev Psychol. 2011; 32(3): 58-69.

Osofsky J: Young Children and Trauma: Intervention and Treatment. New York, NY: Guilford Press, 2007.

Pfefferbaum B, Houston JB, North CS, et al.: Youth’s reactions to disasters and the factors that influence their response. Prev Res. 2008; 15(3): 3-6.

McDermott BM, Palmer LJ: Post-disaster service provision following proactive identification of children with emotional distress and depression. Aust N Z J Psychiatry. 1999; 33: 855-863.

Silverman WK, LaGreca AM: Children experiencing disasters: Definitions, reactions, and predictors of outcomes. In LaGreca AM, Silverman WK, Vernberg EM, Roberts MC (eds.): Helping Children Cope with Disasters and Terrorism. Washington, DC: American Psychological Association, 2002: 11-33.

Bremner JD, Vermetten E, Mazure CM: Development and preliminary psychometric properties of an instrument for the measurement of childhood trauma: The early trauma inventory. Depress Anxiety. 2000; 12: 1-12.

Hacker KA, Myagmarjav E, Harris V, et al.: Mental health screening in pediatric practice: Factors related to positive screens and the contribution of parental/personal concern. Pediatrics. 2006; 118(5): 1896-1906.

Stallard P, Law F: Screening and psychological debriefing of adolescent survivors of life-threatening events. Br J Psychiatry. 1993; 163: 660-665.

Goldin S, Levin L, Persson LA, et al.: Child war trauma: A comparison of clinician, parent and child assessments. Nord J Psychiatry. 2003; 57(3): 173-183.

Jacobs AK, Vernberg EM, Lee SJ: Supporting adolescents exposed to disasters. Prev Res. 2008; 15(3): 7-10.

McDermott BM, Lee EM, Judd M, et al.: Posttraumatic stress disorder and general psychopathology in children and adolescents following a wildfire disaster. Can J Psychiatry. 2005; 50(3): 137-143.

Brewin CR: Systematic review of screening instruments for adults at risk of PTSD. J Trauma Stress. 2005; 18(1): 53-62.

Cochrane AL, Holland WW: Validation of screening procedures. Brit Med Bull. 1971; 27(1): 3-8.

Vernberg EM, Jacobs AK, La Greca AM, et al.: Measuring traumatic exposure to assess risk of post-disaster distress. In Kassam- Adams N (ed.): Assessing Early Predictors of PTSD in Children and Parents. Symposium presented at the 20th Annual Meeting of the International Society for Traumatic Stress Studies, New Orleans, LA, 2004.

Balaban V: Psychological assessment of children in disasters and emergencies. Disasters. 2006; 30(2): 178-198.

Steinberg AM, Brymer MJ, Decker KB, et al.: The University of California at Los Angeles Post-Traumatic Stress Disorder Reaction Index. Curr Psychiatry Rep. 2004; 6: 96-100.

Weiss D, Marmar CR: The Impact of Event Scale-Revised. In Wilson JP, Keane TM (eds.): Assessing Psychological Trauma and PTSD. New York, NY: The Guilford Press, 1997: 399-411.

Kovacs M: The Children’s Depression Inventory 2nd Edition (CDI-2) Technical Manual. North Tonawanda, NY: Multi-Health Systems, Inc., 2010. Available at http://www.mhs.com/product.aspx?gr=edu∏=cdi2&id=overview. Accessed August 15, 2011.

Birleson P: The validity of depressive disorder in childhood and the development of a self-rating scale: A research report. J Child Psychol Psychiatry. 1981; 22: 73-88.

Birleson P: Depression Self-Rating Scale (DSRS). In Corcoran K, Fischer J (eds.): Measures for Clinical Practice: A Sourcebook. New York, NY: The Free Press, 1987: 391-392.

Birleson P, Hudson I, Buchanan DG, et al.: Clinical evaluation of a self-rating scale for depressive disorder in childhood (Depression Self-Rating Scale). J Child Psychol Psychiatry. 1987; 28(1): 43-60.

Reynolds CR, Richmond BO: Revised Children’s Manifest Anxiety Scale. Torrance, CA:Western Psychological Services, 1985.

Reynolds CR, Richmond BO. Revised Children’s Manifest Anxiety Scale: RCMAS-R. 2nd ed. Torrance, CA: Western Psychological Services, 2008. Available at http://portal.wpspublish.com/portal/page?_pageid=53,234661&_dad=portal&=schema_PORTAL. Accessed August 15, 2011.

March J, Parker J: The Multidimensional Anxiety Scale for Children (MASC). In Maruish M (ed.): The Use of Psychological Testing for Treatment Planning and Outcome Assessment. 2nd ed. Hillsdale, NJ: Lawrence Erlbaum Associates, 1999: 299-322.

Knight LA, Sullivan MA: Preliminary development of a measure to assess children’s trauma attributions. J Aggression. 2006; 13(2): 65-78.

Abdeen Z, Qasrawi R, Nabil S, et al.: Psychological reactions to Israeli occupation: Findings from the national study of schoolbased screening in Palestine. Int J Behav Dev. 2008; 32(4): 290-297.

Kenardy JA, Spence SH, Macleod AC: Screening for posttraumatic stress disorder in children after accidental injury. Pediatrics. 2006; 118(3): 1002-1009.

Nixon RDV, Ellis AA, Nehmy TJ, et al.: Screening and predicting posttraumatic stress and depression in children following single- incident trauma. J Clin Child Adolesc Psychol. 2010; 39(4): 588-596.

Winston FK, Kassam-Adams N, Garcia-España F, et al.: Screening for risk of persistent posttraumatic stress in injured children and their parents. JAMA. 2003; 290(5): 643-649.

Stallard P, Velleman R, Baldwin S: Psychological screening of children for post-traumatic stress disorder. J Child Psychol Psychiatr. 1999; 40(7): 1075-1082.

American Academy of Child and Adolescent Psychiatry: Practice parameters for the psychiatric assessment of children and adolescents. J Am Acad Child Adolesc Psychiatr. 1997; 36(10 Supplement): 4S-20S.

American Academy of Child and Adolescent Psychiatry: Practice parameter for the assessment and treatment of children and adolescents with posttraumatic stress disorder. J Am Acad Child Adolesc Psychiatr. 2010; 49(4): 414-430.

Fairbrother G, Stuber J, Galea S, et al.: Unmet need for counseling services by children in New York City after the September 11th attacks on the World Trade Center: Implications for pediatricians. Pediatrics. 2004; 113(5): 1367-1374.

Lewis M, King RA: Psychiatric assessment of infants, children, and adolescents. In Lewis M (ed.): Child and Adolescent Psychiatry: A Comprehensive Textbook. 3rd ed. Philadelphia, PA: Lippincott, Williams, and Wilkins, 2002: 525-544.

Rosen CS, Young HE: Mental health services and evaluation research: Precepts, pragmatics, and politics. In Norris FH, Galea S, Friedman MJ, Watson PJ (eds.): Methods for Disaster Mental Health Research. New York: The Guilford Press, 2006: 194-207.

Rosen CS, Young HE, Norris FH: On a road paved with good intentions, you still need a compass: Monitoring and evaluating disaster mental health services. In Ritchie EC, Watson PJ, Friedman MJ (eds.): Interventions Following Mass Violence and Disasters. New York: The Guilford Press, 2006: 206-223.

McNamara C: Basic Guide to Outcomes-Based Evaluation for Nonprofit Organizations with Very Limited Resources. Minneapolis, NM:Authenticity Consulting.Available at http://managementhelp.org/evaluatn/outcomes.htm. Accessed June 9, 2011.

Milstein RL,Wetterhall SF: Framework for program evaluation in public health. MMWR. 1999; 48: 1-40.

Bliss MJ, Emshoff JG: Workbook for Designing a Process Evaluation. Atlanta, GA: Georgia Department of Human Resources, Division of Public Health, 2002. Available at http://health.state.ga.us/pdfs/ppe/Workbook%20for%20Designing%20a%20Process%20Evaluation.pdf. Accessed January 30, 2012.

Henley R, Marshall R,Vetter S: Integrating mental health services into humanitarian relief responses to social emergencies, disasters, and conflicts: A case study. J Behav Health Serv Res. 2011; 38(1): 132-141.

McNally RJ, Bryant RA, Ehlers A: Does early psychological intervention promote recovery from posttraumatic stress? Psychol Sci Public Interest. 2003; 4(2): 45-79.

National Center for PTSD: Evaluating and Monitoring the Reach, Quality, and Consistency of Crisis Counseling Programs: Manual and Toolkit. Version 1.3. White River Junction, VT: The National Center for PTSD, 2006. Available at http://www.dmh.ca.gov/disaster/docs/Grants/ISP/3-TRAINING/2-CCP_TrainingHandouts/Handout6.pdf. Accessed July 5, 2011.

Houston JB, Pfefferbaum B: Using Data and Services to Meet the Disaster Mental Health Needs of Children and Families: A Planning and Resource Guide. Oklahoma City, OK: Terrorism and Disaster Center, University of Oklahoma Health Sciences Center, 2010. Available at http://tdc.ouhsc.edu. Accessed January 30, 2012.




DOI: https://doi.org/10.5055/jem.2012.0112

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