Access to and Need for Counseling Among Children after the September 11th Attacks on the World Trade Center

1
Access to and Need for Counseling Among Children
after the September 11th Attacks on the World
Trade Center
Gerry Fairbrother, PhD New York Academy of
Medicine

• Jennifer Stuber, PhD
• Sandro Galea, MD, MPH
• Betty Pfefferbaum, MD, JD
• Alan R. Fleischman, MD

Presentation to the 2003 Pediatric Academic
Societies Annual Meeting May 3-6, 2003 Seattle, WA
This research was supported by grants from the
National Institute of Mental Health (MH66385 and
RO1 MH66081-01) and the William T. Grant
Foundation.
2
Background

• Children often need mental health support after a
  traumatic event
• But childrens access to services depends on
• Availability of services
• Ability of adults to recognize need
• Ability of adults to find the service
• Often, ability to pay
• The experience of September 11th offers lessons
  for the future about service provision

3
Objectives

• To describe childrens need for and receipt of
  counseling after September 11th
• To describe sources of counseling
• To determine predictors of counseling

4
Methods

• Cross-sectional Random Digit Dial survey
• Population-based in New York City
• 2,011 respondents of whom 434 were parents of
  children 4-17 years old
• 60 cooperation rate
• Conducted January, 2003 (four months after the
  September 11th attacks)

5
Instrument Assessed

• Behavior Problems
• Counseling Received
• Crying in Front of Child
• Disaster Exposure

• Children
• Disaster Exposure
• PTSR
• Parents
• PTSD
• Depression
• Demographic Information
• Family Structure
• Income
• Borough of Residence

6
(No Transcript)
7
(No Transcript)
8
Childrens Disaster Exposure/Experiences
9
Most Children Were in School or Day Care at Time
of Attacks and Learned About Them From a Teacher
Yes
100
90
80
70
60
50
91
40
64
30
20
22
14
10
9
0
Were at Home at Time of Attack
Were at School/Day Care at Time of Attack
Learned From Parent
Learned From Teacher
Learned From Other Source
Source Fairbrother G, Stuber JP, Galea S,
Fleishman AR, Pfefferbaum B. (2003)
Post-Traumatic Stress Reaction in New York City
Children after the September 11th Terrorist
Attacks. Report to the W.T. Grant Foundation.
New York Academy of Medicine. New York City.
10
Few Children Saw the Disaster in Person, But
Almost All Saw Vivid Images on TV
In Person
On Television
100
90
80
70
60
50
87
87
86
40
30
48
20
10
8
0
Saw Disaster In Person
Saw Building Collapsing
Saw Airplane Hitting the Building
Saw People Running From a Cloud of Smoke/Debris
Saw People Falling or Jumping From Towers
Source Fairbrother G, Stuber JP, Galea S,
Fleishman AR, Pfefferbaum B. (2003)
Post-Traumatic Stress Reaction in New York City
Children after the September 11th Terrorist
Attacks. Report to the W.T. Grant Foundation.
New York Academy of Medicine. New York City.
11
Approximately 18 of New York City Children had
Severe or Very Severe Post-Traumatic Stress
Reactions (PTSR) Following the September 11th
Attacks
Source Fairbrother G, Stuber JP, Galea S,
Fleishman AR, Pfefferbaum B. (2003)
Post-Traumatic Stress Reaction in New York City
Children after the September 11th Terrorist
Attacks. Report to the W.T. Grant Foundation.
New York Academy of Medicine. New York City.
12
Approximately 10 of New York City Children
Received Some Type of Counseling following the
September 11th Attacks, Over Half in the Schools
Source Fairbrother G, Stuber JP, Galea S,
Fleishman AR, Pfefferbaum B. (2003) Use of
Counseling Services by Children in New York City
Following the September 11th Attacks on the World
Trade Center Report to the W.T. Grant
Foundation. New York Academy of Medicine. New
York City.
13
Counseling Services after September 11th Divided
Fairly Evenly between Children with Severe/Very
Severe PTSR and Children with Moderate PTSR
Source Fairbrother G, Stuber JP, Galea S,
Fleishman AR, Pfefferbaum B. (2003) Use of
Counseling Services by Children in New York City
Following the September 11th Attacks on the World
Trade Center Report to the W.T. Grant
Foundation. New York Academy of Medicine. New
York City.
14
Only 27 of Children with Severe/Very Severe PTSR
Received Any Type of Mental Health Services, and
Only 14 of Those With Behavior Problems Did
Percent Receiving Counseling
Source Fairbrother G, Stuber JP, Galea S,
Fleishman AR, Pfefferbaum B. (2003) Use of
Counseling Services by Children in New York City
Following the September 11th Attacks on the World
Trade Center Report to the W.T. Grant
Foundation. New York Academy of Medicine. New
York City.
15
Having Counseling Before 9/11 and Severe/Very
Severe PTSR were Major Predictors of Counseling
After 9/11
Counseling before 9/11

Severe/Very Severe PTSR

plt .001
16
Multivariate Model Showing Relationships between
Receipt of Mental Health Services and Covariates
of Interest Adjusted Odds Ratios and 95
Confidence Intervals (n 434)
Odds Ratio (Adjusted)
Odds Ratio (Adjusted)
p-value
p-value
Child's Mental Health Experiences Before Disaster
Child and Family Demographic Characteristics
Black, Hispanic and Other
3.59
0.020
Received counseling before September 11
Single-parent household
4.44
0.005
1.87
0.13
Parent's Reaction to/ Experience with the Disaster
Child's Post-Traumatic Stress After Disaster
Child's PTSR is severe or very severe
3.59
0.002
Model adjusted for borough of residence
17
Limitations

• We could not describe the intensity of mental
  health services
• We relied on parental report for both counseling
  services and PTSR for children
• We did not measure functional impairment as a
  result of PTSR, instead we relied on presence of
  PTSR to indicate need

18
Conclusions

• There was a substantial disparity between
  apparent need (PTSR) and receipt of counseling
  services
• There is a need for enhanced effort to identify,
  refer, and treat children in need
• This need is particularly acute for children not
  already in a therapeutic relationship
• An enhanced role for pediatricians is indicated