title: Outreach and screening following the 2005 London bombings: usage and outcomes.
abstract: BACKGROUND
  Little is known about how to remedy the unmet mental health needs associated with major terrorist attacks, or what outcomes are achievable with evidence-based treatment. This article reports the usage, diagnoses and outcomes associated with the 2-year Trauma Response Programme (TRP) for those affected by the 2005 London bombings.MethodFollowing a systematic and coordinated programme of outreach, the contact details of 910 people were obtained by the TRP. Of these, 596 completed a screening instrument that included the Trauma Screening Questionnaire (TSQ) and items assessing other negative responses. Those scoring ≥6 on the TSQ, or endorsing other negative responses, received a detailed clinical assessment. Individuals judged to need treatment (n=217) received trauma-focused cognitive-behaviour therapy (TF-CBT) or eye movement desensitization and reprocessing (EMDR). Symptom levels were assessed pre- and post-treatment with validated self-report measures of post-traumatic stress disorder (PTSD) and depression, and 66 were followed up at 1 year.
  
  
  RESULTS
  Case finding relied primarily on outreach rather than standard referral pathways such as primary care. The effect sizes achieved for treatment of DSM-IV PTSD exceeded those usually found in randomized controlled trials (RCTs) and gains were well maintained an average of 1 year later.
  
  
  CONCLUSIONS
  Outreach with screening, linked to the provision of evidence-based treatment, seems to be a viable method of identifying and meeting mental health needs following a terrorist attack. Given the failure of normal care pathways, it is a potentially important approach that merits further evaluation.
authors.affiliation: Clinical, Educational and Health Psychology, University College London, UK. c.brewin@ucl.ac.uk
authors.forename: C R
authors.initials: CR
authors.lastname: Brewin
authors.forename: N
authors.initials: N
authors.lastname: Fuchkan
authors.forename: Z
authors.initials: Z
authors.lastname: Huntley
authors.forename: M
authors.initials: M
authors.lastname: Robertson
authors.forename: M
authors.initials: M
authors.lastname: Thompson
authors.forename: P
authors.initials: P
authors.lastname: Scragg
authors.forename: P
authors.initials: P
authors.lastname: d'Ardenne
authors.forename: A
authors.initials: A
authors.lastname: Ehlers
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy; D015331:Cohort Studies; D003159:Community-Institutional Relations; D003863:Depression / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D019317:Evidence-Based Medicine; D057169:Eye Movement Desensitization Reprocessing; D005260:Female; D006801:Humans; D008131:London; D008297:Male; D008403:Mass Screening; D008605:Mental Health Services; D008875:Middle Aged; D020380:Needs Assessment; D011320:Primary Health Care; D012017:Referral and Consultation; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D023481:Terrorism; D014947:Wounds and Injuries / Q000523:psychology