title: Service utilization and event reaction patterns among children who received Project Liberty counseling services.
abstract: OBJECTIVE
  This study examined service utilization and event reaction patterns among children who used crisis counseling services provided under Project Liberty for 27 months after the September 11, 2001, terrorist attacks on the World Trade Center.
  
  
  METHODS
  The authors analyzed logs of 681,318 service encounters submitted by Project Liberty counselors, paying particular attention to demographic characteristics and reported event reactions.
  
  
  RESULTS
  Nine percent of service recipients reached by community-based Project Liberty providers were children, whereas census data for the 15 counties and boroughs served by Project Liberty indicated that children constituted 25 percent of the population. Service use as a function of race or ethnicity and of gender was consistent with census data. Similar to findings for adults, the most common emotional event reactions reported for children were experiencing sadness and tearfulness, being anxious and fearful, having difficulty concentrating, experiencing irritability and anger, having intrusive thoughts or images, and having difficulty sleeping. Behavioral event reactions listed on service logs suggested that older children (12 to 17 years) were more likely to use drugs whereas elementary school-age children were more likely to display signs of anxiety, isolation and withdrawal, and difficulties with concentration and memory.
  
  
  CONCLUSIONS
  Sensitivity to differences in the event reaction patterns shown by younger and older children may be useful in refining treatments to help reduce the psychological impact of children's trauma after terrorist incidents.
authors.affiliation: Department of Psychiatry, Division of Health Services Research, Mount Sinai School of Medicine, New York City, USA.
authors.forename: Nancy H
authors.initials: NH
authors.lastname: Covell
authors.forename: George
authors.initials: G
authors.lastname: Allen
authors.forename: Susan M
authors.initials: SM
authors.lastname: Essock
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Pease
authors.forename: Chip J
authors.initials: CJ
authors.lastname: Felton
authors.forename: Carol B
authors.initials: CB
authors.lastname: Lanzara
authors.forename: Sheila A
authors.initials: SA
authors.lastname: Donahue
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003156:Community Mental Health Services / Q000706:statistics & numerical data*; D015897:Comorbidity; D003419:Crisis Intervention / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D003710:Demography; D005260:Female; D005500:Follow-Up Studies; D005610:Freedom; D006801:Humans; D007223:Infant; D008297:Male; D009519:New York City; D047851:September 11 Terrorist Attacks / Q000523:psychology* / Q000706:statistics & numerical data; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D014600:Utilization Review / Q000706:statistics & numerical data