A stepped-care model of post-disaster child and adolescent mental health service provision

Abstract

BackgroundFrom a global perspective, natural disasters are common events. Published research highlights that a significant minority of exposed children and adolescents develop disaster-related mental health syndromes and associated functional impairment. Consistent with the considerable unmet need of children and adolescents with regard to psychopathology, there is strong evidence that many children and adolescents with post-disaster mental health presentations are not receiving adequate interventions.ObjectiveTo critique existing child and adolescent mental health services (CAMHS) models of care and the capacity of such models to deal with any post-disaster surge in clinical demand. Further, to detail an innovative service response; a child and adolescent stepped-care service provision model.MethodA narrative review of traditional CAMHS is presented. Important elements of a disaster response – individual versus community recovery, public health approaches, capacity for promotion and prevention and service reach are discussed and compared with the CAMHS approach.ResultsDifficulties with traditional models of care are highlighted across all levels of intervention; from the ability to provide preventative initiatives to the capacity to provide intense specialised posttraumatic stress disorder interventions. In response, our over-arching stepped-care model is advocated. The general response is discussed and details of the three tiers of the model are provided: Tier 1 communication strategy, Tier 2 parent effectiveness and teacher training, and Tier 3 screening linked to trauma-focused cognitive behavioural therapy.ConclusionIn this paper, we argue that traditional CAMHS are not an appropriate model of care to meet the clinical needs of this group in the post-disaster setting. We conclude with suggestions how improved post-disaster child and adolescent mental health outcomes can be achieved by applying an innovative service approach.

Communicating with children and adolescents about the risk of natural disasters

“…Most interventions following disasters use a public health approach to reach many. They often start with less intensive interventions, such as information to all affected individuals, and then use a stepped care model, where reactions are monitored and help is aligned to their needs and requirements (McDermott & Cobham, 2014). …”

Adaptive Interventions in Child and Adolescent Mental Health

“…R. Pliszka et al, 2006), which focus on individualized sequences of pharmacotherapy, and stepped-care interventions (Bower & Gilbody, 2005; Haaga, 2000; Sobell & Sobell, 2000), which focus on providing gradually more intensive services in a sequence that begins with a lower-intensity (and typically lower initial cost) intervention (McDermott & Cobham, 2014). Adaptive interventions are more general in that they may involve a combination of sequences of psychosocial and pharmacological interventions; and they may step-up or step-down the intervention (or components of an intervention) over time.…”

Cognitive therapy as an early treatment for post‐traumatic stress disorder in children and adolescents: a randomized controlled trial addressing preliminary efficacy and mechanisms of action

“…In the light of the current lack of data concerning efficacious, brief universal interventions for trauma‐exposed youth, new models for managing early traumatic stress reactions have been proposed. These have included contexts such as large‐scale disasters (McDermott & Cobham, ) and accidental injuries seen in emergency departments (Cobham et al., ; Kassam‐Adams, ). Stepped‐care approaches have, in particular, shown to be efficacious in young children (Salloum et al., ).…”