Child Disaster Mental Health Services: a Review of the System of Care, Assessment Approaches, and Evidence Base for Intervention
Several decades of research have informed our knowledge of children’s reactions to disasters and the factors that influence their reactions. This article describes the system of care for child disaster mental health services using population risk to determine needed services and a stepped care approach built on assessment and monitoring to advance children to appropriate services. To assess the evidence base for disaster interventions, recent reviews of numerous child disaster mental health interventions are summarized.
KeywordsAssessment Child disaster mental health interventions Children Disasters Disaster mental health services Disaster system of care Stepped care
A special thank you to Dr. Tami D. Benton for taking the time to review this manuscript.
Compliance with Ethical Standards
Conflict of Interest
Betty Pfefferbaum declares that she has no conflict of interest.
Carol S. North reports personal fees from Univ. of Missouri, Oxford University Press, and from American Entertainment International speakers bureau, outside the submitted work.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 1.Pfefferbaum B, Jacobs AK, Griffin N, Houston JB. Children’s disaster reactions: the influence of exposure and personal characteristics. Curr Psychiatr Rep. 2015; 17(7). Published online. doi: 10.1007/s11920-015-0598-5.
- 2.Pfefferbaum B, Jacobs AK, Houston JB, Griffin N. Children’s disaster reactions: the influence of family and social factors. Curr Psychiatr Rep. 2015;17(7). Published online. doi: 10.1007/s11920-015-0597-6.
- 3.••Forman-Hoffman VL, Zolotor AJ, McKeeman JL, Blanco R, Knauer SR, Lloyd SW, et al. Comparative effectiveness of interventions for children exposed to nonrelational traumatic events. Pediatrics. 2013;31:526–39. doi: 10.1542/peds.2012-3846. This review compares the effectiveness of interventions for children exposed to nonrelational trauma.CrossRefGoogle Scholar
- 5.Newman E, Pfefferbaum B, Kirlic N, Tett R, Nelson S, Liles B. Meta-analytic review of psychological interventions for children survivors of natural and man-made disasters. Curr Psychiatr Rep. 2014; 16(9). Published online. doi: 10.1007/s11920-014-0462-z.
- 8.•Pfefferbaum B, Sweeton JL, Newman E, Varma V, Nitiéma P, Shaw JA, et al. Child disaster mental health interventions, part I. Techniques, outcomes, and methodological considerations. Disaster Health. 2014;2:46–57. doi: 10.4161/dish.27534. This qualitative review describes the techniques used in child disaster mental health interventions and the outcomes used in evaluating the interventions, offers a preliminary assessment of the evidence base, and outlines recommendations for future research.PubMedCentralCrossRefPubMedGoogle Scholar
- 9.•Pfefferbaum B, Sweeton JL, Newman E, Varma V, Noffsinger MA, Shaw JA, et al. Child disaster mental health interventions, part II. Timing of implementation, delivery settings and providers, and therapeutic approaches. Disaster Health. 2014;2:58–67. doi: 10.4161/dish.27535. This descriptive review summarizes the literature to examine current knowledge about the timing of child disaster mental health interventions, the settings and providers for intervention delivery, and therapeutic approaches. Recommendations for future empirical research are outlined.PubMedCentralCrossRefPubMedGoogle Scholar
- 12.••Pfefferbaum B, Shaw JA. American Academy of Child and Adolescent Psychiatry (AACAP) Committee on Quality Issues (CQI). Practice parameter on disaster preparedness. J Am Acad Child Adolesc Psychiatr. 2013;52(11):1224–38. doi: 10.1016/j.jaac.2013.08.014. This practice parameter describes the disaster mental health system of care and identifies best practices in assessing and managing children in the disaster context.CrossRefGoogle Scholar
- 14.National Commission on Children and Disasters. 2010 Report to the President and Congress. AHRQ Publication No. 10-M037. Rockville, MD: Agency for Health Care Research and Quality; 2010Google Scholar
- 15.••North CS, Pfefferbaum B. Mental health response to community disasters. A systematic review. JAMA. 2013;310:507–17. doi: 10.1001/jama.2013.107799. This review summarizes the evidence on disaster mental health services and presents a framework for case identification, assessment, and triage.CrossRefPubMedGoogle Scholar
- 17.U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services. Emergency mental health and traumatic stress: an overview of the Crisis Counseling Assistance and Training Program. Publication Number SMA09-4373. Washington, DC: Author; 2009. Retrieved from http://store.samhsa.gov/product/Crisis-Counseling-Assistance-and-Training-Program-CCP-/SMA09-4373.
- 19.Ronan KR, Finnis K, Johnston DM. Interventions with youth and families: a prevention and stepped care model. In: Reyes G, Jacobs GA, editors. Handbook of international disaster psychology. Volume 2: practices and programs. Westport, CT: Praeger Publishers; 2006. p. 13–35.Google Scholar
- 21.Gordon R. An operational classification of disease prevention. In: Steinberg JA, Silverman MM, editors. Preventing mental disorders. Rockville, MD: U.S. Department of Health and Human Services; 1987. p. 20–6.Google Scholar
- 22.O’Connell ME, Boat T, Warner KE, Editors. Preventing mental, emotional, and behavioral disorders among young people. Progress and possibilities. Washington, DC: National Research Council and Institute of Medicine, The National Academies Press; 2009. Retrieved from http://www.nap.edu/catalog/12480/preventing-mental-emotional-and-behavioral-disorders-among-young-people-progress.
- 24.Institute of Medicine (IOM). Healthy, resilient, and sustainable communities after disasters. Strategies, opportunities, and planning for recovery. Washington, DC: The National Academies Press; 2015. Retrieved from http://www.iom.edu/Reports/2015/Post-Disaster.aspx.
- 26.Brown EJ, McQuaid J, Farina L, Ali R, Winnick-Gelles A. Matching interventions to children’s mental health needs: feasibility and acceptability of a pilot school-based trauma intervention program. Education Treatment Children. 2006;29:257–86.Google Scholar
- 28.Layne CM, Saltzman WR, Poppleton L, Burlingame GM, Pašalić A, Duraković E, et al. Effectiveness of a school-based group psychotherapy program for war-exposed adolescents: a randomized controlled trial. J Am Acad Child Adolesc Psychiatry. 2009;47:1048–62. doi: 10.1097/chi.0b013e31817eecae.CrossRefGoogle Scholar
- 29.Martin JC, Garriga A, Egea C. Psychological intervention in primary care after earthquakes in Lorca, Spain. Prim Care Companion CNS Disord. 2015;17(1). Published online. doi: 10.4088/pcc.14m01691.
- 32.•Pfefferbaum B, North CS. Assessing children’s disaster reactions and mental health needs: screening and clinical evaluation. Can J Psychiatr. 2013;58:135–42. This paper presents a framework for assessing children’s disaster reactions and mental health needs through screening and clinical evaluation.Google Scholar
- 34.American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013.Google Scholar
- 39.Shaffer D, Fisher P, Lucas CP, Dulcan MK, Schwab-Stone ME. NIMH Diagnostic Interview Schedule for Children Version IV (NIMH DISC-IV): description, differences from previous versions, and reliability of some common diagnoses. J Am Acad Child Adolesc Psychiatry. 2000;39:28–38. doi: 10.1097/00004583-199607000-00012.CrossRefPubMedGoogle Scholar
- 40.Weiss DS, Marmar CR. The impact of event scale-revised. In: Wilson J, Keane T, editors. Assessing psychological trauma and PTSD. New York, NY: Guilford Press; 1997. p. 399–411.Google Scholar
- 42.Achenbach TM. Manual for the Child Behavioral Check-list/4-18 and 1991 profile. Burlington, VT: University of Vermont, Department of Psychiatry; 1991.Google Scholar
- 43.Reynolds CR, Richmond BO. Revised Children’s Manifest Anxiety Scale. RCMAS Manual. Western Psychological Services: Los Angeles, CA; 1985.Google Scholar
- 44.Spielberger CD. Manual for the State–Trait Anxiety Inventory for Children. Palo Alto, CA: Consulting Psychologists Press; 1973.Google Scholar
- 47.Reynolds CR, Kamphaus RW. BASC: Behavior Assessment System for Children. Circle Pines, MN: American Guidance Service Publishing; 1992.Google Scholar
- 48.Reynolds CR, Kamphaus RW. BASC-2: Behavior Assessment System for Children. 2nd ed. Circle Pines, MN: American Guidance Service Publishing; 2004.Google Scholar
- 50.Pfefferbaum B, Weems CF, Scott BG, Nitiéma P, Noffsinger MA, Pfefferbaum RL, et al. Research methods in child disaster studies: a review of studies generated by the September 11, 2001, terrorist attacks; the 2004 Indian Ocean Tsunami; and Hurricane Katrina. Child Youth Care Forum. 2013;42:285–337. doi: 10.1007/s10566-013-9211-4.PubMedCentralCrossRefPubMedGoogle Scholar
- 51.McDermott BM, Lee EM, Judd M, Gibbon P. Posttraumatic stress disorder and general psychopathology in children and adolescents following a wildfire disaster. Can J Psychiatr. 2005;50:137–43.Google Scholar
- 55.•Johnson VA, Ronan KR, Johnston DM, Peace R. Evaluations of disaster education programs for children: a methodological review. Int J Disaster Risk Reduction. 2014;9:107–23. doi: 10.1016/j.ijdrr.2014.04.001. This review examines the methodology and findings in the literature evaluating child disaster education programs.CrossRefGoogle Scholar
- 56.•Ronan KR, Alisic E, Towers B, Johnson VA, Johnston DM. Disaster preparedness for children and families: a critical review. Curr Psychiatr Rep. 2015;17(7). Published online. doi: 10.1007/s11920-015-0589-6. This review examines the literature on disaster preparedness for children and families.
- 57.Jacobs AK, Pfefferbaum B. The use of debriefing in children. Curr Psychiatr Rep. 2015; 17(6). Published online. doi: 10.1007/s11920-015-0578-9.
- 60.•Gillies D, Taylor F, Gray C, O’Brien L, D’Abrew N. Psychological therapies for the treatment of post-traumatic stress disorder in children and adolescents (review). Evidence-based child health. A Cochrane Review Journal. 2013;8:1004–16. doi: 10.1002/ebch.1916. This Cochrane Review assesses randomized controlled trials examining therapies for the treatment of PTSD in children.Google Scholar