Transcript Document

CHILD & FAMILY
DISASTER MENTAL HEALTH
RESEARCH TRAINING &
EDUCATION
Northwest Center for
Public Health Practice
Northwest Center for
Public Health Practice
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)
Northwest Center for
Public Health Practice
Investigators
Betty Pfefferbaum, MD, JD
University of Oklahoma Health Sciences Center
Alan M. Steinberg, PhD
University of California, Los Angeles
Robert S. Pynoos, MD, MPH
University of California, Los Angeles
John Fairbank, PhD
Duke University
Northwest Center for
Public Health Practice
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
Northwest Center for
Public Health Practice
National Child Traumatic
Stress Network
Northwest Center for
Public Health Practice
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
Northwest Center for
Public Health Practice
NCTSN Mission
• Raise the standard of care and improve
access to services for traumatized children,
their families and communities throughout
the United States
Northwest Center for
Public Health Practice
NCTSN Components
• National Center for Child Traumatic Stress
• Treatment and Services Adaptation Centers
• Community Treatment and Services Centers
Northwest Center for
Public Health Practice
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
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Public Health Practice
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
Northwest Center for
Public Health Practice
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
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Clinical issues
Service approaches
Policy
Financing
Training issues
Northwest Center for
Public Health Practice
Terrorism and Disaster
Center TDC
Northwest Center for
Public Health Practice
Mission
• Improve the standard of care and access to
culturally proficient mental health services for
children and families affected by terrorism and
disasters
Northwest Center for
Public Health Practice
Through Children’s Eyes, WHO
Northwest Center for
Public Health Practice
Disaster Research
Training DRT
Northwest Center for
Public Health Practice
Disaster Research Training Program
• Funded by the
– National Institute of Mental Health,
– National Institute of Nursing Research
– Substance Abuse and Mental Health
Services Administration
Northwest Center for
Public Health Practice
Mission
• Enhance the nation’s capacity for conducting
rapid post-event disaster mental health
studies for children and families
Northwest Center for
Public Health Practice
Local Multidisciplinary Research Team
LMRT
• Ten Local Multidisciplinary Research Teams
are being established in sites across the United
States based on their
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Previous disaster history
Geographical location
Metropolitan makeup
Unique issues for disaster research
Northwest Center for
Public Health Practice
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
Northwest Center for
Public Health Practice
Local Multidisciplinary Research Teams
Miller Children’s Hospital
Fuller Theological Seminary
University of Washington
Oklahoma State Agencies
Melissa Institute
Vanderbilt University – School of Nursing
University of Virginia School of Medicine
Boston College Graduate - School of Social Work
Massachusetts Coalition for Disaster Education
North Shore-Long Island Jewish Health System
Northwest Center for
Public Health Practice
LMRT Teams - 1
Miller Children’s Hospital
Long Beach, California
Model for Children’s Hospital
System Research
University of Washington
Seattle Washington
Model for Research in Academic
Public Health
•
Fuller Theological Seminary
Pasadena, California
Model for Faith-based Research
Oklahoma State Agencies
Mental Health, Health,
Human Services, Education
Oklahoma City, Oklahoma
Model for State Agency Research
Melissa Institute
Miami, Florida
Model for Early Childhood and Child
Care Organizations
Northwest Center for
Public Health Practice
LMRT Teams - 2
Vanderbilt University
School of Nursing
Nashville, Tennessee
Model for Nursing Research
Massachusetts Coalition for
Family and Child Disaster Education
Boston, Massachusetts
Model for Multi-Agency Disaster
Response Research
University of Virginia
School of Medicine
Charlottesville, Virginia
Model for Medical and Psychiatric
Response Research
Boston College
School of Social Work
Boston, Massachusetts
Model for Social Work Research
North Shore-Long Island Jewish
Health System
Long Island, New York
Model for Hospital System
Research
Northwest Center for
Public Health Practice
Disaster Research
Training Curriculum
Northwest Center for
Public Health Practice
Curriculum Modules - 1
• Clinical modules
• Research modules
• Clinical and research
modules
• Public health modules
• Team building modules
• Supplemental modules
Northwest Center for
Public Health Practice
Curriculum Modules - 2
• 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
Northwest Center for
Public Health Practice
Curriculum Modules - 3
• Clinical and Research Modules
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Gaps and Challenges
Cultural Competence
Assessment
Ethics
• Public Health Modules
– National Response and Incident Command
– Risk Communication
Northwest Center for
Public Health Practice
Curriculum Modules - 4
• Team Building Modules
– Team Building and Action Planning
– Funding and Grant Writing
• Supplemental Modules
– Psychological First Aid
– K-FLASH-II
– Community Resilience Assessment
Northwest Center for
Public Health Practice
Disaster
Northwest Center for
Public Health Practice
www.drgeorgepc.com
NOAA
Northwest Center for
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Disaster
• Definition
–
A severe disruption, ecological and psychosocial,
which greatly exceeds the coping capacity of the
altered community
World Health Organization 1992
Northwest Center for
Public Health Practice
Disaster Typology
• Natural
• Non-Intentional/Technological
• Intentional Violence
Northwest Center for
Public Health Practice
Natural Disasters
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Hurricanes
Tornadoes
Floods
Droughts
Extreme Heat
Fires
Blizzards
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Earthquakes
Volcanoes
Tsunamis
Pestilence
Disease
Epidemics
Pandemics
Northwest Center for
Public Health Practice
Oklahoma City Tornado
May 3, 1999
Photo: http://www.fema.gov/kids/p_tor03.htm
Northwest Center for
Public Health Practice
Indian Ocean Tsunami
December 26, 2004
Photo:
http://usinfo.state.gov/usinfo/USINFO/Products/Photo_Gallery/tsunami.html
Northwest Center for
Public Health Practice
Hurricane Katrina
August 28, 2005
Photo: http://www.nnvl.noaa.gov/cgi-bin/index.cgi?page=items&ser=109663&large=1
Northwest Center for
Public Health Practice
Pakistan Earthquake
October 8, 2005
Photo: United states department of defense Photo credits: Gregory
Takats,http://www.defenselink.mil/home/feathures/2005/Pakistan?index/alt.html
Northwest Center for
Public Health Practice
Human-Generated Disasters
• Non-intentional/technological
– Industrial accidents
– Transportation accidents
– Ecological/environmental destruction
• Intentional Violence
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War
Civil strife
Ethnic conflict
Terrorism
Northwest Center for
Public Health Practice
Terrorism
Northwest Center for
Public Health Practice
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
Northwest Center for
Public Health Practice
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
Northwest Center for
Public Health Practice
http://dart2.arc.nasa.gov/Deployments/OklahomaCityBombi
ng1995/Oklahoma.html#poem
Northwest Center for
Public Health Practice
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
Northwest Center for
Public Health Practice
Alfred P. Murrah Federal Building
Oklahoma City
April 19, 1995
Photos: http://dart2.arc.nasa.gov/Deployments/OklahomaCityBombing1995/Oklahoma.html#poem;
www.oklahomacitybombing.com
Northwest Center for
Public Health Practice
September 11, 2001
Photos: Don,LC Art #2, The September 11 Digital Archive, December 16, 2003
http://911digitalarchive.org
Northwest Center for
Public Health Practice
Weapons of Mass Destruction
Chemical
Radiological
The United States Army
Medical Research &
Materiel Command
(USAMRMC )
Nuclear
“CBRNE”
Biological
High Yield Explosive
Northwest Center for
Public Health Practice
Are Disasters Increasing?
Chart: Swiss Re, Sigma No 2/2006, page 4
Northwest Center for
Public Health Practice
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
Northwest Center for
Public Health Practice
Why Focus on Children?
Photo: Centers for Disease Control and Prevention
Northwest Center for
Public Health Practice
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
Northwest Center for
Public Health Practice
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
Northwest Center for
Public Health Practice
Psychiatric Effects
>200 young adult survivors: 74% female, 97% Caucasian
Studied 5-8 years after a shipping disaster
60
57
52
50
41
38
40
30
18
20
10
35
17
3
survivors
controls
gy
A
ny
Mean age at disaster = 14.7 yrs.
Mean age at follow up = 21.3 yrs.
P
A
ny
sy
ch
op
at
h
A
ffe
ct
ol
o
iv
e
ty
A
nx
ie
A
ny
P
TS
D
0
Bolton et al. 2000; Yule et al. 2000
Northwest Center for
Public Health Practice
September 11: Children Upset
Percent adults reporting at least 1 child upset 10/12 – 11/12
70
61
60
50
40
30
55
57
48
NYC
DC
Other
20
Rest of US
10
0
Schlenger et al. 2002
Northwest Center for
Public Health Practice
Upset Children’s Reactions
35
30
30
27
25
Of the most upset child in each household:
20% had trouble sleeping
30% were irritable, grouchy, or easily upset
27% had separation fears
20
20
Trouble sleeping
Irritable
15
Separation fears
10
5
0
Schlenger et al. 2002
Northwest Center for
Public Health Practice
Exposure to Television Coverage
100
90
443 NYC parents 4 months after September 11
86 87 87
77
80
70
airplane hit
60
50
48
buildings collapse
40
people running
30
people falling or jumping
20
3 or more images
10
0
Fairbrother et al. 2003
Northwest Center for
Public Health Practice
Posttraumatic Stress
Seeing television images was associated
with severity of posttraumatic stress
100
90
80
70
60
50
40
30
20
10
0
95
87
86
68
68
44
doubtful/mild/moderate
severe
buildings
collapse
people fall or 3 or 4 images
jump
Fairbrother et al. 2003
Northwest Center for
Public Health Practice
Why Focus on Children - 2
• Adults tend to underestimate the
reactions of children
– Parental preoccupation with other
issues
– Parental denial
– Failure of children to express
themselves
Northwest Center for
Public Health Practice
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
Northwest Center for
Public Health Practice
Posttraumatic Stress
No significant decrease over time on child self report
35
30
29.6
26.3
25.5
25
21.8
19.6
20
18.1
Exposed
13.6
15
Comparison
9.3
10
5
0
3 months
*Exposure significant
+Time significant
9 months
Child report*
3 months
9 months
Parent report*+
Koplewicz et al. 2002
Northwest Center for
Public Health Practice
Incident-Related Fear
No significant decrease over time on child self report
35
30
29.2
28
27.7
26.4
25
23.2
22.6
19.7
20
18.7
Exposed
Comparison
15
10
5
0
3 months
9 months
Child report*
*Exposure significant
+Time significant*
3 months
9 months
Parent report*+
Koplewicz et al. 2002
Northwest Center for
Public Health Practice
Why Focus on Children - 3
• 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 children
Stuber et al. 2002
Northwest Center for
Public Health Practice
The Daily Oklahoman
Northwest Center for
Public Health Practice
Pacific Northwest Local Multidisciplinary Research Team
University of Washington
School of
Nursing
School of Public
Health and
Community
Medicine
Alaska State Dept. of
Health & Social Services
Northwest
Center for
Public Health
Practice
WA State
Department of
Health
State of Oregon Public
Health Division
Region X US Public Health Service
Northwest Center for
Public Health Practice
For more information:
www.tdc.ouhsc.edu
www.nctsnet.org
www.nwcphp.org
Northwest Center for
Public Health Practice