Three Tiers of Mental Health Intervention Tier 1 General post-trauma support to a wide population of children through their schools, community agencies,

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Presentation transcript:

Three Tiers of Mental Health Intervention Tier 1 General post-trauma support to a wide population of children through their schools, community agencies, and religious institutions Tier 2 Identification of high risk children, adolescents and families – extreme exposures and losses, high levels of current distress and developmental risk Tier 3 Identification of children and adolescents with serious psychiatric disorders Adapted from: Pynoos RS, Goenjian AK, Steinberg AM: (1998) A public mental health approach to the post- disaster treatment of children and adolescents. Psychiatric Clinics of North America 7:

Selected Intervention Foci Tier One Mutuality of disruption of a protective shield Fears of recurrence Impact on developmental negotiation of danger, safety and protection Reactivity to danger cues Adapted from: Pynoos RS, Goenjian AK, Steinberg AM: (1998) A public mental health approach to the post- disaster treatment of children and adolescents. Psychiatric Clinics of North America 7:

Examples of Intervention Tier One Safety and restoring the protective shield Reduce unnecessary secondary exposures Focus on constructive responses Encourage and support help-seeking behaviors Create a supportive milieu for the spectrum of reactions and different courses of recovery Adapted from: Pynoos RS, Goenjian AK, Steinberg AM: (1998) A public mental health approach to the post- disaster treatment of children and adolescents. Psychiatric Clinics of North America 7:

Five Foci of Trauma-Grief Focused Intervention Tier Two Traumatic Experience(s) Trauma and Loss Reminders Traumatic Bereavement Adversities and Current Stresses Developmental Progression Adapted from: Pynoos RS, Goenjian AK, Steinberg AM: (1998) A public mental health approach to the post- disaster treatment of children and adolescents. Psychiatric Clinics of North America 7:

Traumatic Experience(s) Psycho-education regarding trauma-related stress reactions Reconstruction and reprocessing of the traumatic experience, including worst moments and attributions of meaning Clarification of distortions, including misattributions linked with excessive guilt and shame Address maladaptive behavior used to cope with distressing memories Increase tolerance for traumatic memories Exploration of intervention thoughts and traumatic expectations Adapted from: Pynoos RS, Goenjian AK, Steinberg AM: (1998) A public mental health approach to the post- disaster treatment of children and adolescents. Psychiatric Clinics of North America 7:

Trauma Reminders Identify current reminders of traumatic experiences Identify links between traumatic experiences, reactivity to reminders and current maladaptive behavior Increase cognitive discrimination between the present and the past Increase tolerance for expectable reactivity Develop / facilitate the appropriate use of support-seeking and other coping behavior to contend with reminders Increase pro-active measures to reduce unnecessary reminders Adapted from: Pynoos RS, Goenjian AK, Steinberg AM: (1998) A public mental health approach to the post- disaster treatment of children and adolescents. Psychiatric Clinics of North America 7:

Grief Identify grief reactions and provide psycho-education about the variable course of bereavement Promote acceptance of traumatic losses Facilitate mourning through construction of a non-traumatic mental representation of the deceased Identify and increase tolerance for current and future reminders of losses Address conflicts over past interactions that evoke regret, guilt, or shame Examine influence of losses on current choice of relationships Assist with skills to re-evoke and revise a mental relationship with a lost person, appropriate to needs of future developmental stages Adapted from: Pynoos RS, Goenjian AK, Steinberg AM: (1998) A public mental health approach to the post- disaster treatment of children and adolescents. Psychiatric Clinics of North America 7:

Post-Trauma Stresses and Adversities Identification of post-trauma difficulties, including family, work, health, and living circumstances Promotion of acceptance and adaptation to changes and losses Develop / facilitate the appropriate use of emotion coping and problem- solving skills to contend with adversities Assist with management of aggression Increase social skills for genuine disclosure about traumatic experiences and losses Assist family members and employee/co-workers with addressing practical/interpersonal problems that interfere with post-trauma recovery Adapted from: Pynoos RS, Goenjian AK, Steinberg AM: (1998) A public mental health approach to the post- disaster treatment of children and adolescents. Psychiatric Clinics of North America 7:

Developmental Impact Identify missed developmental opportunities Challenge maladaptive developmental expectations and coping Support resumption of compromised developmental activities Facilitate normal developmental progression through participation in age-appropriate activities Promote pro-social efforts, leadership skills and peer mentorship Support group behavior to create a more favorable recovery environment within the family, school, and community Adapted from: Pynoos RS, Goenjian AK, Steinberg AM: (1998) A public mental health approach to the post- disaster treatment of children and adolescents. Psychiatric Clinics of North America 7:

Selected References Goenjian, A, Pynoos, RS, Karayan, I, D, Najarian, LM, Steinberg, AM, Fairbanks, LA: (1997) Outcome of psychotherapy among pre-adolescents after the 1988 earthquake in Armenia. American Journal of Psychiatry 154: Saltzman, W.R., Pynoos, R.S., Layne, C.M., Steinberg, A.M., Aisenberg E: (2001). Trauma- and Grief- focused intervention for adolescents exposed to community violence: Results of a school-based screening and group treatment protocol. Group Dynamics: Theory, Research and Practice, 5: Saltzman WR, Steinberg AM, Layne CM, Aisenberg E, Pynoos RS: (2001) A Developmental Approach to School-Based Treatment of Adolescents Exposed to Trauma and Traumatic Loss. Journal of Child and Adolescent Group Therapy 11: Pynoos RS, Goenjian A, Steinberg AM: (1995) Strategies of disaster intervention for children and adolescents. In Hobfoll S.E. and de Vries M. (Eds.) Stress and Communities Dordrecht, The Netherlands: M. Kluwer Academic Publishers Publications, Pynoos RS, Steinberg AM, Wraith R: (1995) A developmental model of childhood traumatic stress. In: D. Cicchetti and DJ Cohen (Eds.), Manual of Developmental Psychopathology New York: John Wiley & Sons, Pynoos RS, Goenjian AK, Steinberg AM: (1998) A public mental health approach to the post-disaster treatment of children and adolescents. Psychiatric Clinics of North America 7: