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Mental health service utilization by child victims of natural disasters

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Material Information

Title:
Mental health service utilization by child victims of natural disasters
Series Title:
Quick response research report ;
Running title:
Service utilization
Physical Description:
13 p. : ; 28 cm.
Language:
English
Creator:
Locke, Bill J., 1936-
University of Colorado, Boulder -- Natural Hazards Research and Applications Information Center
University of Colorado, Boulder -- Institute of Behavioral Science
Publisher:
Natural Hazards Research and Applications Center, University of Colorado
Place of Publication:
Boulder, Colo
Publication Date:

Subjects

Subjects / Keywords:
Child mental health services   ( lcsh )
Child health services -- Utilization   ( lcsh )
Mental health services -- Utilization   ( lcsh )
Child disaster victims -- Mental health   ( lcsh )
Disasters -- Psychological aspects   ( lcsh )
Genre:
government publication (state, provincial, terriorial, dependent)   ( marcgt )
bibliography   ( marcgt )
non-fiction   ( marcgt )

Notes

Bibliography:
Includes bibliographical references (p. 12-13).
Additional Physical Form:
Also issued online as part of a joint project with the Louis de la Parte Florida Mental Health Institute (FMHI) Research Library's disaster mental health initiative.
Statement of Responsibility:
Bill J. Locke.
General Note:
Cover title.

Record Information

Source Institution:
University of South Florida Library
Holding Location:
University of South Florida
Rights Management:
All applicable rights reserved by the source institution and holding location.
Resource Identifier:
aleph - 001985188
oclc - 38980443
usfldc doi - F57-00031
usfldc handle - f57.31
System ID:
SFS0001112:00001


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Full Text

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NaturalHazardsResearchandApplicationsInformationCenterCampusBox482UniversityofColoradoBoulder,Colorado 80309-0482 MENTALHEALTHSERVICEUTILIZATIONBYCHILDVICTIMSOFNATURALDISASTERSBi11J.Locke1988QuickResponseResearch Report#25... rt f the Natural Hazards ThispUbhcatA,on Information Center's ongoing Research&pp Ica Quick Response Research Report Series. http://wWWcolorado.edu/hazardsInstituteofBehavioralScience#6 (303) 492-6818

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Service 2 Threecomparableschool were from areas similarly byPsychological services in weremadeavailableduring weeks oneschoolandduringweeks six nine The wasgivenearlyaccess serviceswhose minimized whose serviceswereprovidedgroup group andexpressivecounselingsessions.Younger andfemales be referredmoreregardlessof degree which were by All of 183 referralscamefrom receiving as serviceand remaining came from givenearlier same Thefindingswerecompromised by failuresandonly wisdomon and labels may be overdrawn.

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Service 3 Service byChild of Noreso fear amongchildrenmaybe as whose canbe asa of alone. only hasbeendeemed inascribingclinicalsignificance achild'sfears(Graziano,DeGiovanni,&Garcia,1979).This seems fromsurvey evidence childfearsareresolved years or occursandregardlessof (Hampe,Noble,Miller,& 1973).However,when fearsderivefrom ofa a mayapply,Forexample, (1985,p.139) afour-yearcourseforsome fears.Theissueof how,andwhen has beenresolvedfor Hampe al(1973),some where isinvolved,childrenmay beamong psychological &Rosser,1974).Though

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ServiceUtilization4focaltochildrenandhardlyunanimous(Taylor,1978,p.271),thedisasterspecialisttendstoendorseprofessionalinterventionandadvocateitsapplication soon aftertheexperience(Wilkinson,1985).Earlyintervention is endorsed because behavioralandaffectivedysfunctionstendtosurface among children within hoursafterthedisaster(Boatright,1985,p.138).As a result,failuretointervene may perpetuateconditionswhich, in theory, might fosterincubationortheenhancementofconditionedanxietyintoanxietydisorderpathologies,particularlyphobias(Eysenck,1976;Seligman,1971)orpost-traumaticstressdisorder(Frederick,1985,pp.112-113).Thesepositionsderivemorefromjudgementandopinionthanfromthelimitedbodyofsystematicresearch with childdisastervictims.Even withinthat databasemethodologicaldifferencesyieldsubstantial discrepancies inreportedincidenceofdisaster-linkedpsychopathology(Perry,1979).Mostofourknowledge about childanxietydisordersremainslittlemorethananextrapolationfromthegreaterbodyofcumulative work withadults(Morris & Kratochwill,1983,p.144).Theadultliteratureadvisesthatclientsaremorelikelytoacceptinterventionsifweobscurethementalhealthcharacterofthoseservices and offerthem in waysthatdifferfromtheirtraditionalapplication(Farberow & Frederick,1978).Given the difficultyinrapidly instatingandmaking victimsawareofsuch

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Service 5services,perhapslow may be more a offailing servicesduring heroicperiodwhen are focusedupon needsof of services be morereadily for a referralprocessearlyin phase.ProblemandDesignThe research considered rate ofservicereferrals as a ofearly timing versusminimizing inannouncedpsychologicalservicesforchild of andreferral were independent publicschool inTexasduring (early)and the eachhadbeen bya major Services as health weredescribed of school andreferrals oneduring early periodand during later period.During earlyperiodonly,a school receiveda wasdevoidof obvious and, instead, emphasizedself-help andstressmanagementtraining. Thisyieldeda 2 X 3between-subjects designinvolvingsixcombinationsof timing (earlyvs. later) andprogram description(overtlytraditional vs.

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Service 6 de-emphasis)whose of referrals forservice were compared. Pool Mid-Novemberin Texasproduced damage in 24 andin 11of weremade officials the of disaster reliefareas.Oneresponsive was the individual designatedtocoordinatedisaster relief mentalhealth servicesfor thetwocountiesmostextensivedevastation andcasualties,Cherokee and Anderson County. The stormsin eachof areasincluded and least 50injuries inadditionto major property damage.As a resultthethreeand demographically comparableschool districts from thosetwo countieswereapproached.Theschool systems were in andserved communities of12,000 15,000people.The availability ofpsychologicalservicesforallpublicschool wasannouncedinamanner consistentwithassociatedexperimentalconditions. Eightindividualsvolunteeredandweretrainedto conduct theplannedservicesalong the senior investigator. Theseindividualsincludedthreefemalepublicschoolcounselorsandfivepsychology graduate studentsincounseling and clinical

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Service Utilization 7 trainingprograms,two male andthree female.Allwere trainedattheMasterls degreelevelor itsequivalent. In addition, afemale volunteerassisted in administering fear surveypre-tests.Each of the professionals volunteering was the leaderofgroupsof students assembledforpsychologicalservicesinnumbersrangingfromsix tofifteen persons. MaterialsParentalconsent forms solicitedretrospectivereports on the child1sfearsbeforeand afterthetornado along nature of the child'sexposure thestorm. A 91-item surveyoffear and intensitywas all whoappearedforservices.Thescalehadbeenusedinprevious studies ofchild disaster and was called the Children'sFears & WorriesScale(CFWS). is an informal of items from existing commercialscales,drawnsoas to accordequal eight classesoffear couldbe categorized as eitherHealth,Safety andAnimals)or (supernatural, social,home,andschool).An additional eleven wereusedasa"liescale" to assess distorting response sets or responding. Subjectsratedtheintensity of indicated fearsona Likert scaleanchoredby little"at 1and "alot"at 5.All itemsrejected asfearedwerescoredzero.Finally,

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Service 8open-ended Allowed idiosyncraticfearsorworries specified in the survey. wasasapaper and pencil atelementary grade levelswhereoneof volunteersreadandexplainedeachitemfor subjects.ProcedureDuring initial weeks todeclarationasdisasterareas, toschoolofficialsweresecuredthroughthe plan's Mental HealthCoordinator.Atthistimeandinallsubsequent indicationsoftraditionalmentalhealthinterventionsweregivenoneschoolwhile sameproceduresweredescribedtoasecondschoolintermsofself-managementand .tress training. withthethirdschoolwereinitiatedatthesametimebutformalservice weredevelopedfourweekslaterinwritten ofreferralsemphasizingtraditional health Identicalgroup werethenmadeavailabletoallwhorequestedthem.EarlysessionsconsistedinadministrationoftheCFWSandrelaxationtraining.TheCFWSresultswereusedtoassessthe ofageneralized hierarchyformedalong a progressionofeventsleadinguptoandaccompanyingthetornadoexperience.Thiswas followedbyabbreviatedrelaxation thatwas,standardizedinthemeandmusclegroupbutadjustedtoaccomodate

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Service 9majordifferenoesin age levels(Ollendick & Ceray,1981,pp.67-75). Home-based inrelaxationexerciseswas assignedsessionsas well.Relaxation all wereable successfully of a ofmusclegroupstrained. No. more muscle groups were inasession.Succeedingsessionsbegan anabbreviatedrepriseof exercises.Group trainingwas then begun.Theprocessfollowedtheclassic pattern ofprogressingthroughincreasinglystressfulimagesaslongasrelaxationcouldbeestablished (Morris & Kratochwill,1983,pp.152-154).Therateofprogressionthroughthesuccessiveimageswasgeared to therelaxationabilitiesoftheslowestchildineachgroup.Aportionofeachsessionallowedfortheexpressionoffeelingsaboutandreactions the experiencebyeachchild who wished to doso.Sessionswereusually45min.in andoccurredduringschoolhoursovera twoto threeweekperiod.ResultsandDiscussionA of183 werereferredforpsychological and somereliabletrendsdidemerge.Thereweremorefemales(104) andmoreyounger students (elementary werereferredthanolderones(middleschool,n=30).

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Service 10Theverbal ofsome or allowed forwhom could be considered orheavy.Among anageand which were by Allof olderreferrals hadexperienced orheavy from By 87% of elementarylevelfemalereferralsand 50% oftheelementarylevelmalereferralswereonlyslightlyaffected by thestorm.Obviously,parentsweremorecautiousandconcernedwithstormeffectsonyoungerfemalechildrenregardlessoftheknownimpactwhileolderchildrentendto be referredonlywhentheadverseimpactofthestormwaswellestablishedandmoremarked.Theaboveconstitutesecondaryelementsoftheanalysis.Themajorimpetustothisstudyinvolvedissuesoftimingandmentalhealthlabeling.Incontrasttoourspeculations,allofthe183studentswerefromschoolsgivenatraditionalmentalhealthcharacterizationoftheintervention.Evenmorestriking,181ofthosestudentswerereferredoutoftheschoolsforwhomthesolicitationsweredelayed.Clearly,generalizations endorsing avoidanceofamentalhealthemphasiswerenotsupportedbythepresentfindings. did findingsfollowmostspeculations about theimportanceofearliertiming.Takenat

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Service UtilizAtion 11 face value, theseresults wouldseem to refute and evendirectlycontradictconventionalwisdom.Notasingle referralemerged fromtheschoolsystem given earlyinformationaboutassistancethat avoidedmentalhealthlabels. At the sametime,there was also a highlylimitedresponsefromthesystemgivenearlyinformation that didnotguise its mental health character.Despitethosefindings,thereisamplebasisforcaution.Onlytheresponsive school system'swrittencommunicationswithparentscould be directlyverifiedasfollowingtheintendedmentalhealthemphasis.Theremainingsystemsusedoralannouncementsthatmayormaynothaveretainedtheintendedcharacter.Intheabsenceofamanipulationcheckorsomeconfirmationthattheintendedcharacterizationswereactuallyimplemented,the two systems that wereunresponsivemaywellhave been sosolelyonthe basis ofthelesserenthusiasmfelt by theschoolcontactsforthosesystems.Inviewofthefindings,itcertainlyseemspossible that thoseindicatingtheservices'availabilitytoparentsintheunresponsiveschoolssimplyfailedtovigorouslysolicitreferrals.Conversely,theresponsiveschoolsystem'spersonnelseemedenthusiasticfromtheoutsetanditisthisdifferentialenthusiasmfortheassistancethat,inthisinvestigator'sview,constitutes the mostplausibleaccount.GiventhequestionableImanipulations,inferencesabouttimingandmentalhealthemphasismust await futurereplicationsofthesecomparisons.

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Service 12 References C.J.(1985).Children as victimsof InJ. Laube& S.A.Murphy(Eds.),Perspectives on Recovery(pp.131-149).Norwalk, CNI Eysenck,H.J.(1976).Thelearningtheorymodelofneurosis:Anewapproach.BehaviorResearchandTherapy,14,252-268.Farberow,N.L. & Frederick,C.J.(1978).TrainingManualforHumanServiceWorkersinMa;orDisasters.Rockville,Md.: ofMentalHealth,DHHSPublicationNo.(ADM)86-538.Frederick,C.J.(1985). fociin spectrumof stressdisorders.InJ.Laube & S.A.Murphy(Eds.),PerspectivesonDisasterRecovery(pp.110-130).Norwalk,CN:Appleton-Century-Crofts.Graziano,A.M.,DeGiovanni,1.5., & Garcia,K.A.(1979).Behavioraltreatmentofchildren'sfears:Areview.PsychologicalBulletin,86,804-830.Hampe,E.,Nobel,H.,Miller,L.C., & Barrett,C.L.(1973).Phobicchildren:1and 2 years JournalofAbnormalPsychology,82,446-453.Kingston,W. & Rosser,R.(1974).Disaster:Effectson andphysical JournalofPsychosomaticResearch,18,437-456.

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Service 13 Morris,R.J. & T.R.(1983). Children'sFearsandPhobias:ABehavioralApproach.NY:Pergamon.Ollendick,T.H. & Cerny,J.A.(1981)ClinicalBehaviorTherapy Children.NY:PlenumPress.Perry,R.W.(1979). A note. SocialBehaviorand Personality, 1,173-177.Seligman,M.E.C.(1971).Phobiasandpreparedness.BehaviorTherapy,2,307-320.Taylor,V.A.(1978). directions forstudy.InE.L. (Ed.), TheoryandResearch.BeverlyHills,CA:Sage Publications, 251-280.Wilkinson,C.(1985).CitedinR.Londer, a Parade,


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