A Stepped-care Model of Post-disaster Child and Adolescent Mental Health Service Provision

Overview

Journal Eur J Psychotraumatol

Date 2014 Jul 22

PMID 25045422

Citations 20

Authors

Brett M McDermott

Vanessa E Cobham

Affiliations

Soon will be listed here.

Abstract

Background: From a global perspective, natural disasters are common events. Published research highlights that a significant minority of exposed children and adolescents develop disaster-related mental health syndromes and associated functional impairment. Consistent with the considerable unmet need of children and adolescents with regard to psychopathology, there is strong evidence that many children and adolescents with post-disaster mental health presentations are not receiving adequate interventions.

Objective: To critique existing child and adolescent mental health services (CAMHS) models of care and the capacity of such models to deal with any post-disaster surge in clinical demand. Further, to detail an innovative service response; a child and adolescent stepped-care service provision model.

Method: A narrative review of traditional CAMHS is presented. Important elements of a disaster response - individual versus community recovery, public health approaches, capacity for promotion and prevention and service reach are discussed and compared with the CAMHS approach.

Results: Difficulties with traditional models of care are highlighted across all levels of intervention; from the ability to provide preventative initiatives to the capacity to provide intense specialised posttraumatic stress disorder interventions. In response, our over-arching stepped-care model is advocated. The general response is discussed and details of the three tiers of the model are provided: Tier 1 communication strategy, Tier 2 parent effectiveness and teacher training, and Tier 3 screening linked to trauma-focused cognitive behavioural therapy.

Conclusion: In this paper, we argue that traditional CAMHS are not an appropriate model of care to meet the clinical needs of this group in the post-disaster setting. We conclude with suggestions how improved post-disaster child and adolescent mental health outcomes can be achieved by applying an innovative service approach.

Citing Articles

A pilot study of a brief and scalable psychosocial intervention for children and adolescents following disasters.

Strauven S, Dennison M, ODonnell M, Cowlishaw S, Gibson K, Pedder D Br J Clin Psychol. 2024; 64(1):6-35.

PMID: 38868927 PMC: 11797151. DOI: 10.1111/bjc.12484.

'School-based screen-and-treat': An effective blueprint for expediating access to care in children experiencing PTSD following disasters.

Cobham V, McDermott B Br J Clin Psychol. 2024; 64(1):47-62.

PMID: 38766924 PMC: 11797145. DOI: 10.1111/bjc.12475.

Stepping Together for Children After Trauma (ST-CT): Feasibility and Predictors of Outcome of a Parent-led, Therapist Assisted Treatment.

Ormhaug S, Skjaervo I, Dyrdal G, Fagermoen E, Haabrekke K, Jensen T Res Child Adolesc Psychopathol. 2024; 52(9):1413-1425.

PMID: 38739305 PMC: 11420321. DOI: 10.1007/s10802-024-01199-5.

Community-based screening and triage connecting First Nations children and youth to local supports: a cross-sectional study.

Young N, Anderson M, Wabano M, Trudeau T, Jacko D, Mallick R CMAJ Open. 2023; 11(6):E1148-E1154.

PMID: 38086558 PMC: 10721333. DOI: 10.9778/cmajo.20220119.

Parent-led stepped care for traumatised children: parental factors that predict treatment completion and response.

Fagermoen E, Skjaervo I, Jensen T, Ormhaug S Eur J Psychotraumatol. 2023; 14(2):2225151.

PMID: 37366166 PMC: 10304435. DOI: 10.1080/20008066.2023.2225151.

References

van Straten A, Seekles W, van t Veer-Tazelaar N, Beekman A, Cuijpers P . Stepped care for depression in primary care: what should be offered and how?. Med J Aust. 2010; 192(S11):S36-9. DOI: 10.5694/j.1326-5377.2010.tb03691.x. View

Cobham V, McDermott B . Perceived parenting change and child posttraumatic stress following a natural disaster. J Child Adolesc Psychopharmacol. 2014; 24(1):18-23. DOI: 10.1089/cap.2013.0051. View

Ruf M, Schauer M, Neuner F, Catani C, Schauer E, Elbert T . Narrative exposure therapy for 7- to 16-year-olds: a randomized controlled trial with traumatized refugee children. J Trauma Stress. 2010; 23(4):437-45. DOI: 10.1002/jts.20548. View

Giannopoulou I, Dikaiakou A, Yule W . Cognitive-behavioural group intervention for PTSD symptoms in children following the Athens 1999 earthquake: a pilot study. Clin Child Psychol Psychiatry. 2006; 11(4):543-53. DOI: 10.1177/1359104506067876. View

Scheeringa M, Cobham V, McDermott B . Policy and administrative issues for large-scale clinical interventions following disasters. J Child Adolesc Psychopharmacol. 2014; 24(1):39-46. PMC: 3926165. DOI: 10.1089/cap.2013.0067. View

Wickrama K, Kaspar V . Family context of mental health risk in Tsunami-exposed adolescents: findings from a pilot study in Sri Lanka. Soc Sci Med. 2006; 64(3):713-23. DOI: 10.1016/j.socscimed.2006.09.031. View

Kemp M, Drummond P, McDermott B . A wait-list controlled pilot study of eye movement desensitization and reprocessing (EMDR) for children with post-traumatic stress disorder (PTSD) symptoms from motor vehicle accidents. Clin Child Psychol Psychiatry. 2009; 15(1):5-25. DOI: 10.1177/1359104509339086. View

Roussos A, Goenjian A, Steinberg A, Sotiropoulou C, Kakaki M, Kabakos C . Posttraumatic stress and depressive reactions among children and adolescents after the 1999 earthquake in Ano Liosia, Greece. Am J Psychiatry. 2005; 162(3):530-7. DOI: 10.1176/appi.ajp.162.3.530. View

Kronenberg M, Hansel T, Brennan A, Osofsky H, Osofsky J, Lawrason B . Children of Katrina: lessons learned about postdisaster symptoms and recovery patterns. Child Dev. 2010; 81(4):1241-59. DOI: 10.1111/j.1467-8624.2010.01465.x. View

10.

Seekles W, van Straten A, Beekman A, van Marwijk H, Cuijpers P . Stepped care for depression and anxiety: from primary care to specialized mental health care: a randomised controlled trial testing the effectiveness of a stepped care program among primary care patients with mood or anxiety disorders. BMC Health Serv Res. 2009; 9:90. PMC: 2700097. DOI: 10.1186/1472-6963-9-90. View

11.

Broberg A, Dyregrov A, Lilled L . The Göteborg discotheque fire: posttraumatic stress, and school adjustment as reported by the primary victims 18 months later. J Child Psychol Psychiatry. 2005; 46(12):1279-86. DOI: 10.1111/j.1469-7610.2005.01439.x. View

12.

Landolt M, Vollrath M, Gnehm H, Sennhauser F . Post-traumatic stress impacts on quality of life in children after road traffic accidents: prospective study. Aust N Z J Psychiatry. 2009; 43(8):746-53. DOI: 10.1080/00048670903001919. View

13.

Cohen J, Bukstein O, Walter H, Benson S, Chrisman A, Farchione T . Practice parameter for the assessment and treatment of children and adolescents with posttraumatic stress disorder. J Am Acad Child Adolesc Psychiatry. 2010; 49(4):414-30. View

14.

Ollendick T, Ost L, Reuterskiold L, Costa N, Cederlund R, Sirbu C . One-session treatment of specific phobias in youth: a randomized clinical trial in the United States and Sweden. J Consult Clin Psychol. 2009; 77(3):504-16. DOI: 10.1037/a0015158. View

15.

Kilic C, Kilic E, Aydin I . Effect of relocation and parental psychopathology on earthquake survivor-children's mental health. J Nerv Ment Dis. 2011; 199(5):335-41. DOI: 10.1097/NMD.0b013e3182174ffa. View

16.

McDermott B, Palmer L . Post-disaster service provision following proactive identification of children with emotional distress and depression. Aust N Z J Psychiatry. 2000; 33(6):855-63. DOI: 10.1046/j.1440-1614.1999.00611.x. View

17.

Stallard P, Law F . Screening and psychological debriefing of adolescent survivors of life-threatening events. Br J Psychiatry. 1993; 163:660-5. DOI: 10.1192/bjp.163.5.660. View

18.

Papadatou D, Giannopoulou I, Bitsakou P, Bellali T, Talias M, Tselepi K . Adolescents' reactions after a wildfire disaster in Greece. J Trauma Stress. 2012; 25(1):57-63. DOI: 10.1002/jts.21656. View

19.

Satcher D . Executive summary: a report of the Surgeon General on mental health. Public Health Rep. 2000; 115(1):89-101. PMC: 1308561. DOI: 10.1093/phr/115.1.89. View

20.

La Greca A, Silverman W, Lai B, Jaccard J . Hurricane-related exposure experiences and stressors, other life events, and social support: concurrent and prospective impact on children's persistent posttraumatic stress symptoms. J Consult Clin Psychol. 2010; 78(6):794-805. DOI: 10.1037/a0020775. View