Northwest Center for Public Health Practice CHILD & FAMILY DISASTER MENTAL HEALTH RESEARCH TRAINING...

Northwest Center forPublic Health Practice

CHILD & FAMILY

DISASTER MENTAL HEALTH RESEARCH TRAINING &

EDUCATION


Child & Family Disaster Mental Health Research Training & Education

• Federal Sponsors– National Institute of Mental Health (NIMH)– National Institute of Nursing Research (NINR)– Substance Abuse and Mental Health Services

Administration (SAMHSA)


Investigators

Betty Pfefferbaum, MD, JD University of Oklahoma Health Sciences Center

Alan M. Steinberg, PhD University of California, Los Angeles

Robert S. Pynoos, MD, MPHUniversity of California, Los Angeles

John Fairbank, PhDDuke University


Objectives

• To describe the National Child Traumatic Stress Network

• To present an overview of the Child & Family Disaster Mental Health Research Training & Education program

• To define and describe disasters and terrorism

• To provide a rationale for a focus on children in disaster mental health research


National Child Traumatic Stress Network


National Child Traumatic Stress Network (NCTSN)

• Funded by the Center for Mental Health Services of SAMHSA through Congressional initiative

• Network includes 70 member centers– 45 current grantees – 25 previous grantees


NCTSN Mission

• Raise the standard of care and improve

access to services for traumatized children,

their families and communities throughout

the United States


NCTSN Components

• National Center for Child Traumatic Stress• Treatment and Services Adaptation Centers• Community Treatment and Services Centers


NCTSN Category I Center

• Develop and maintain the Network structure

• Provide technical assistance to the Network grantees

• Oversee resource development and dissemination

• Coordinate national education and training efforts


Treatment and Services Adaptation Centers - Category II

• Provide national expertise on specific types of– Traumatic events– Population groups – Service systems

• Support the adaptation of effective treatment and service approaches for communities across the country


Community Treatment and Services Centers - Category III

• Implement and evaluate effective treatment and services in – Community settings – Youth-serving systems

• Collaborate with other Network centers on– Clinical issues– Service approaches– Policy– Financing– Training issues


Terrorism and Disaster Center TDC


Mission

• Improve the standard of care and access to culturally proficient mental health services for children and families affected by terrorism and disasters


Through Children’s Eyes, WHO


Disaster Research Training DRT


Disaster Research Training Program

• Funded by the– National Institute of Mental Health,

– National Institute of Nursing Research

– Substance Abuse and Mental Health Services Administration


Mission

• Enhance the nation’s capacity for conducting rapid post-event disaster mental health studies for children and families


Local Multidisciplinary Research TeamLMRT

• Ten Local Multidisciplinary Research Teamsare being established in sites across the United States based on their

–Previous disaster history–Geographical location–Metropolitan makeup–Unique issues for disaster research


LMRT: Members and Focus

• Each LMRT consists of professionals who will benefit from training in disaster mental health research related to children and families

• Each LMRT has a unique focus

• Geographic distribution is designed to address regional differences in hazards and potential natural disasters and to facilitate relationships in post-event response

• Diversity in focus is intended to ensure attention to a variety of research issues while at the same time reinforcing team building around areas of like interest


Miller Children’s Hospital

Fuller Theological Seminary

University of Washington

Oklahoma State Agencies

Melissa Institute

Vanderbilt University – School of NursingUniversity of Virginia School of Medicine

Boston College Graduate - School of Social Work Massachusetts Coalition for Disaster Education North Shore-Long Island Jewish Health System

Local Multidisciplinary Research Teams


LMRT Teams - 1

Fuller Theological Seminary

Pasadena, California

Model for Faith-based Research

Miller Children’s HospitalLong Beach, California

Model for Children’s Hospital System Research

•

Oklahoma State AgenciesMental Health, Health,

Human Services, Education Oklahoma City, Oklahoma

Model for State Agency Research


Seattle Washington

Model for Research in Academic

Public Health

Melissa InstituteMiami, Florida

Model for Early Childhood and Child Care Organizations


LMRT Teams - 2

Boston College School of Social Work Boston, Massachusetts

Model for Social Work Research

Massachusetts Coalition for Family and Child Disaster Education

Boston, MassachusettsModel for Multi-Agency Disaster

Response Research

North Shore-Long Island JewishHealth System

Long Island, New York Model for Hospital System

Research

Vanderbilt University School of Nursing

Nashville, Tennessee Model for Nursing Research

University of Virginia School of Medicine

Charlottesville, VirginiaModel for Medical and Psychiatric

Response Research


Disaster Research Training Curriculum


Curriculum Modules - 1

• Clinical modules• Research modules• Clinical and research

modules• Public health modules• Team building modules• Supplemental modules



• Clinical Modules– The Psychosocial Impact of Disasters and Terrorism– Coping and Resilience– Early Childhood and Child Care Organizations

• Research Modules– Research Design and Methodology– Child Disaster Mental Health Research– Program Evaluation



• Clinical and Research Modules– Gaps and Challenges– Cultural Competence– Assessment– Ethics

• Public Health Modules– National Response and Incident Command

– Risk Communication



• Team Building Modules– Team Building and Action Planning– Funding and Grant Writing

• Supplemental Modules– Psychological First Aid– K-FLASH-II– Community Resilience Assessment


Disaster


NOAA

www.drgeorgepc.com


• Definition– A severe disruption, ecological and psychosocial,

which greatly exceeds the coping capacity of the altered community

World Health Organization 1992

Disaster


Disaster Typology

• Natural• Non-Intentional/Technological• Intentional Violence


Natural Disasters

• Hurricanes• Tornadoes• Floods• Droughts• Extreme Heat• Fires• Blizzards

• Earthquakes• Volcanoes• Tsunamis• Pestilence• Disease • Epidemics• Pandemics


Oklahoma City TornadoMay 3, 1999

Photo: http://www.fema.gov/kids/p_tor03.htm


Indian Ocean TsunamiDecember 26, 2004

Photo: http://usinfo.state.gov/usinfo/USINFO/Products/Photo_Gallery/tsunami.html


Hurricane Katrina August 28, 2005

Photo: http://www.nnvl.noaa.gov/cgi-bin/index.cgi?page=items&ser=109663&large=1


Pakistan EarthquakeOctober 8, 2005

Photo: United states department of defense Photo credits: Gregory Takats,http://www.defenselink.mil/home/feathures/2005/Pakistan?index/alt.html


Human-Generated Disasters

• Non-intentional/technological– Industrial accidents– Transportation accidents– Ecological/environmental destruction

• Intentional Violence– War– Civil strife– Ethnic conflict– Terrorism


Terrorism


• The unlawful use or threatened use of force or violence by a person or an organized group against people or property with the intention of intimidating or coercing societies or governments, often for ideological or political reasons

American Heritage Dictionary, Fourth Edition 2000

Terrorism


Other Definitions

FBI The unlawful use of force and violence against persons or property to intimidate or coerce a government, the civilian population, or any segment thereof, in furtherance of political or social objectives

State Department & CIA Premeditated, politically motivated violence perpetrated against non-combatant targets by sub-national groups or clandestine agents, usually intended to influence an audience

DOD The calculated use of unlawful violence or threat of unlawful violence to inculcate fear; intended to coerce or to intimidate governments or societies in the pursuit of goals that are generally political, religious, or ideological


http://dart2.arc.nasa.gov/Deployments/OklahomaCityBombing1995/Oklahoma.html#poem


Elements of Terrorism

• The use or threat of violence

• To create fear and intimidation

• To coerce a civilian population or government

• For political, social, or ideological goals


Photos: http://dart2.arc.nasa.gov/Deployments/OklahomaCityBombing1995/Oklahoma.html#poem; www.oklahomacitybombing.com

Alfred P. Murrah Federal BuildingOklahoma CityApril 19, 1995




September 11, 2001

Photos: Don,LC Art #2, The September 11 Digital Archive, December 16, 2003 http://911digitalarchive.org


Weapons of Mass Destruction

“CBRNE”Radiolog

ical

Chemical

Biological

Nuclear High Yield Explosive

The United States Army Medical Research & Materiel Command

(USAMRMC )


Are Disasters Increasing?

Chart: Swiss Re, Sigma No 2/2006, page 4


Reasons for Increase in Disasters

• Poverty and Vulnerability

• Climate Change

• Urbanization

• Poor Building and Land Use

• Environmental Destruction

Briefing on World Conference on Disaster Reduction, January 18-22, 2005, Kobe, Japan


Why Focus on Children?Photo: Centers for Disease Control and Prevention


Why Focus on Children - 1

• Children are not immune to the effects of disaster– Reactions may be

enduring and may influence later development

– Children’s reactions may parallel those of their parents


Shipping Disaster 1988

• Long-term effects of a shipping disaster which occurred 5 to 8 years earlier

• Sample– 217 survivor participants – Comparison sample of 87 participants nominated by students as

same age, sex, and school

• Clinician administered PTSD scale

Yule et al. 2000


Psychiatric Effects

52

41 38

57

3

18 17

35

0

10

20

30

40

50

60

survivors

controls

Bolton et al. 2000; Yule et al. 2000

>200 young adult survivors: 74% female, 97% Caucasian Studied 5-8 years after a shipping disaster

Mean age at disaster = 14.7 yrs.Mean age at follow up = 21.3 yrs.


September 11: Children Upset

61

55 57

48

0

10

20

30

40

50

60

70

NYC

DC

Other

Rest of US

Schlenger et al. 2002

Percent adults reporting at least 1 child upset 10/12 – 11/12


Upset Children’s Reactions

20

30

27

0

5

10

15

20

25

30

35

Trouble sleeping

Irritable

Separation fears

Schlenger et al. 2002

Of the most upset child in each household:20% had trouble sleeping

30% were irritable, grouchy, or easily upset27% had separation fears


Exposure to Television Coverage

86 87

48

77

87

0

10

20

30

40

50

60

70

80

90

100

airplane hit

buildings collapse

people running

people falling or jumping

3 or more images

Fairbrother et al. 2003

443 NYC parents 4 months after September 11


Posttraumatic Stress

86

44

68

95

68

87

0102030405060708090

100

buildingscollapse

people fall orjump

3 or 4 images

doubtful/mild/moderate

severe

Fairbrother et al. 2003

Seeing television images was associated with severity of posttraumatic stress



• Adults tend to underestimate the reactions of children– Parental preoccupation with other

issues– Parental denial– Failure of children to express

themselves


World Trade Center 1993

• Children’s symptoms at 3 and 9 months• Exposure

– 9 trapped in elevator– 13 on observation deck– 27 controls

• Measures– Child self report – Parent report on children and selves

Koplewicz et al. 2002


Posttraumatic Stress

29.6

26.3 25.5

21.819.6

18.1

13.6

9.3

0

5

10

15

20

25

30

35

3 months 9 months 3 months 9 months

Exposed

Comparison

Child report* Parent report*+*Exposure significant+Time significant


No significant decrease over time on child self report


Incident-Related Fear

28 27.729.2

26.4

23.2 22.6

19.718.7

0

5

10

15

20

25

30

35

3 months 9 months 3 months 9 months

Exposed

Comparison

Child report* Parent report*+


*Exposure significant+Time significant*

No significant decrease over time on child self report



• Children are a source of anxiety for adults– After September 11, adults with

children were more distressed than adults without children

• It is possible to reach adults, families, and communities through children– Many people can be accessed in

the school setting– Parents may be receptive to

services for their childrenStuber et al. 2002


The Daily Oklahoman


Pacific Northwest Local Multidisciplinary Research Team

School of Nursing


School of Public Health and Community

Medicine

Northwest Center for

Public Health Practice

Alaska State Dept. of Health & Social Services

State of Oregon Public Health Division

WA State Department of

Health

Region X US Public Health Service


For more information:

www.tdc.ouhsc.eduwww.nctsnet.orgwww.nwcphp.org

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