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Psychosocial Intervention for Postdisaster Trauma Symptoms in Elementary School Children
A Controlled Community Field Study
Claude M. Chemtob, PhD;
Joanne P. Nakashima, MEd;
Roger S. Hamada, PhD
Arch Pediatr Adolesc Med. 2002;156:211-216.
Context Natural disasters negatively affect children's emotional and behavioral
adjustment. Although treatments to reduce psychological morbidity following
disasters are needed, it has been difficult to conduct treatment research
in postdisaster environments because of the sensitivity of victims to perceived
intrusiveness and exploitation.
Objective To evaluate the efficacy of a public health–inspired intervention
combining school-based screening and psychosocial treatment to identify and
treat children with persistent disaster-related trauma symptoms.
Design To identify children with continued high levels of trauma-related symptoms
2 years after a major disaster, we conducted a community-wide school-based
screening of disaster-exposed public elementary school children. Children
with the highest levels of trauma-related symptoms were randomly assigned
to 1 of 3 consecutively treated cohorts. Children in the cohorts awaiting
treatment served as wait-list controls. Within each cohort, children were
randomly assigned to either individual or group treatment to allow comparison
of the efficacy of the 2 treatment modalities.
Setting All 10 public elementary schools on the island of Kauai (one of the
Hawaiian Islands) 2 years after Hurricane Iniki.
Participants All 4258 children in second through sixth grade were screened. The 248
children with the highest levels of psychological trauma symptoms were selected
for treatment.
Intervention Children were randomly assigned to either individual or group treatment
provided by specially trained school-based counselors. Treatment comprised
4 sessions.
Main Outcome Measures The Kauai Reaction Inventory, a self-report measure of trauma symptoms,
and the Child Reaction Inventory, a semistructured clinical interview for
posttraumatic stress disorder symptoms.
Results After treatment, children reported significant reductions in self-reported
trauma-related symptoms. This symptom reduction was maintained at the 1-year
follow-up. Clinical interviews also indicated that treated children had fewer
trauma symptoms compared with untreated children.
Conclusions School-based community-wide screening followed by psychosocial intervention
seems to effectively identify and reduce children's disaster-related trauma
symptoms and may facilitate psychological recovery. While group and individual
treatments did not differ in efficacy, fewer children dropped out of the group
treatment. This approach may be applicable to screening and treating children
exposed to a variety of large-scale disasters.
From the Departments of Psychiatry and Pediatrics, Mount Sinai School
of Medicine, New York, NY, and the National Center for Posttraumatic Stress
Disorder, Pacific Islands Division, Honolulu, Hawaii (Dr Chemtob); Kauai District,
Hawaii Department of Education, Lihue, Hawaii (Ms Nakashima); and Kapi'olani
Medical Specialists, Honolulu (Dr Hamada).
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