Psychosocial intervention for postdisaster trauma symptoms in elementary school children: a controlled community field study.
BACKGROUND
Natural disasters negatively affect children's emotional and behavioral adjustment. Although treatments to reduce psychological morbidity following disasters are needed, it has been difficult to conduct treatment research in postdisaster environments because of the sensitivity of victims to perceived intrusiveness and exploitation.


OBJECTIVE
To evaluate the efficacy of a public health--inspired intervention combining school-based screening and psychosocial treatment to identify and treat children with persistent disaster-related trauma symptoms.


METHODS
To identify children with continued high levels of trauma-related symptoms 2 years after a major disaster, we conducted a community-wide school-based screening of disaster-exposed public elementary school children. Children with the highest levels of trauma-related symptoms were randomly assigned to 1 of 3 consecutively treated cohorts. Children in the cohorts awaiting treatment served as wait-list controls. Within each cohort, children were randomly assigned to either individual or group treatment to allow comparison of the efficacy of the 2 treatment modalities.


METHODS
All 10 public elementary schools on the island of Kauai (one of the Hawaiian Islands) 2 years after Hurricane Iniki.


METHODS
All 4258 children in second through sixth grade were screened. The 248 children with the highest levels of psychological trauma symptoms were selected for treatment.


METHODS
Children were randomly assigned to either individual or group treatment provided by specially trained school-based counselors. Treatment comprised 4 sessions.


METHODS
The Kauai Reaction Inventory, a self-report measure of trauma symptoms, and the Child Reaction Inventory, a semistructured clinical interview for posttraumatic stress disorder symptoms.


RESULTS
After treatment, children reported significant reductions in self-reported trauma-related symptoms. This symptom reduction was maintained at the 1-year follow-up. Clinical interviews also indicated that treated children had fewer trauma symptoms compared with untreated children.


CONCLUSIONS
School-based community-wide screening followed by psychosocial intervention seems to effectively identify and reduce children's disaster-related trauma symptoms and may facilitate psychological recovery. While group and individual treatments did not differ in efficacy, fewer children dropped out of the group treatment. This approach may be applicable to screening and treating children exposed to a variety of large-scale disasters.
Chemtob
Claude M
CM
Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1230, New York, NY 10028, USA. claude.chemtob@mssm.edu
Nakashima
Joanne P
JP
Hamada
Roger S
RS
D000704:Analysis of Variance; D002648:Child; D002662:Child Health Services / Q000458:organization & administration*; D015331:Cohort Studies; D003156:Community Mental Health Services / Q000458:organization & administration*; D016001:Confidence Intervals; D004190:Disasters; D005260:Female; D005500:Follow-Up Studies; D006254:Hawaii; D006801:Humans; D008016:Life Change Events; D008297:Male; D008403:Mass Screening; D011336:Probability; D011613:Psychotherapy / Q000379:methods*; D011615:Psychotherapy, Group / Q000379:methods; D012572:School Health Services / Q000458:organization & administration*; D012944:Social Support; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis* / Q000628:therapy*; D013315:Stress, Psychological / Q000517:prevention & control / Q000628:therapy; D016896:Treatment Outcome