title: Characteristics of Project Liberty clients that predicted referrals to intensive mental health services.
abstract: OBJECTIVE
  The authors describe characteristics of Project Liberty crisis counseling recipients that predicted referral to more intensive professional mental health treatments over the two-year period after the terrorist attacks on the World Trade Center.
  
  
  METHODS
  Random-effects ordinal regression models were applied to data from 684,500 logs of Project Liberty service encounters for individual counseling sessions.
  
  
  RESULTS
  Overall, about 9 percent of individual counseling visits ended with a referral to professional mental health services. Individuals needing intensive mental health treatment continued to enter Project Liberty for two years after the World Trade Center attacks. The strongest predictor of referral was having reactions to the attack that fell into a greater number of the four domains assessed-behavioral, emotional, physical, or cognitive domains. Individuals with reactions in four domains were most likely to be referred. Those who had greater attack-related exposure were also more likely to be referred.
  
  
  CONCLUSIONS
  It is important to provide long-term access to brief counseling and triage services and to target these interventions specifically to individuals displaying greater distress or impairment and having more traumatic exposure.
authors.affiliation: James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA.
authors.forename: Nancy H
authors.initials: NH
authors.lastname: Covell
authors.forename: Susan M
authors.initials: SM
authors.lastname: Essock
authors.forename: Chip J
authors.initials: CJ
authors.lastname: Felton
authors.forename: Sheila A
authors.initials: SA
authors.lastname: Donahue
mesh_terms: D000342:Affective Symptoms / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D000359:Aftercare / Q000706:statistics & numerical data; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D003156:Community Mental Health Services / Q000706:statistics & numerical data*; D015897:Comorbidity; D003419:Crisis Intervention / Q000706:statistics & numerical data*; D003710:Demography; D005380:Financing, Government; D005500:Follow-Up Studies; D005610:Freedom; D006801:Humans; D008134:Long-Term Care / Q000706:statistics & numerical data; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D015233:Models, Statistical; D009519:New York City; D009784:Occupational Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D018635:Rescue Work / Q000706:statistics & numerical data; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy