title: Outcomes of enhanced counseling services provided to adults through Project Liberty.
abstract: OBJECTIVE
  Project Liberty provided brief crisis counseling to 753,015 residents of New York City and surrounding counties after the attacks on the World Trade Center. Most regained predisaster functioning after counseling. For those who did not, Project Liberty provided enhanced services by specially trained, licensed mental health professionals. Individuals receiving crisis counseling and enhanced services responded to confidential telephone interviews about 18 and 24 months, respectively, after the attacks. Impairment was compared between groups to determine whether enhanced services recipients reported improved functioning and fewer symptoms of depression, posttraumatic stress, and complicated grief.
  
  
  METHODS
  Crisis counseling recipients (N=153) were interviewed once and enhanced services recipients (N=76) were interviewed twice about symptomatology and daily functioning.
  
  
  RESULTS
  The samples did not differ in age or gender. Significantly greater proportions of enhanced services recipients reported knowing someone who died as a result of the attacks, having been involved in rescue efforts, or having lost their job because of the attacks. Compared with crisis counseling respondents, enhanced services recipients at their first interview reported significantly more symptoms of depression, grief, and traumatic stress and significantly poorer daily functioning in five life areas. At follow-up, enhanced services respondents reported significant improvement in three of five functioning domains, significantly fewer symptoms of depression and grief, and marginally less traumatic stress.
  
  
  CONCLUSIONS
  Recipients of enhanced services were more impaired than people who received only crisis counseling. On the basis of reports from service recipients, meaningful improvements in functioning and symptoms may be associated with the receipt of enhanced services.
authors.affiliation: Center for Information Technology and Evaluation Research, New York State Office of Mental Health, Albany, USA.
authors.forename: Sheila A
authors.initials: SA
authors.lastname: Donahue
authors.forename: Carlos T
authors.initials: CT
authors.lastname: Jackson
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Shear
authors.forename: Chip J
authors.initials: CJ
authors.lastname: Felton
authors.forename: Susan M
authors.initials: SM
authors.lastname: Essock
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000223:Adaptation, Psychological; D000328:Adult; D000359:Aftercare / Q000458:organization & administration*; D015928:Cognitive Behavioral Therapy / Q000458:organization & administration*; D003131:Combined Modality Therapy; D003156:Community Mental Health Services / Q000458:organization & administration*; D003419:Crisis Intervention / Q000458:organization & administration*; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D005610:Freedom; D006117:Grief; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009519:New York City; D009784:Occupational Diseases / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D017063:Outcome Assessment, Health Care; D018635:Rescue Work; D047851:September 11 Terrorist Attacks / Q000523:psychology*; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D011795:Surveys and Questionnaires