Assessing Children's Disaster Reactions and Mental Health Needs: Screening and Clinical Evaluation

By Pfefferbaum, Betty; North, Carol S. | Canadian Journal of Psychiatry, March 2013 | Go to article overview

Assessing Children's Disaster Reactions and Mental Health Needs: Screening and Clinical Evaluation


Pfefferbaum, Betty, North, Carol S., Canadian Journal of Psychiatry


Objective: To present a framework for assessing children's disaster reactions and mental health needs.

Methods: We reviewed the relevant literature and clinical experience to identify information on assessment approaches in children and to construct an assessment framework based on disaster exposure.

Results: Child disaster mental health assessment includes 2 components-screening and clinical evaluation-but these have not been fully explicated or distinguished in the literature. Screening can be used to assess large numbers of children across exposure groups. Clinical evaluation is appropriate for children who are directly exposed to a disaster, for those whose family members and (or) close associates are directly exposed, and for those who are identified through screening as being at risk for psychiatric disturbance. Clinical evaluation includes a full diagnostic assessment (posttraumatic stress disorder and other disorders) with the goals of identifying psychopathology, determining the need for clinical care, and guiding intervention planning and referral. Children with psychiatric conditions should be referred to treatment, while those with psychological distress but without psychiatric illness may benefit from psychosocial interventions.

Conclusions: Screening is appropriate to identify children at risk for psychiatric disturbance who will need further evaluation to determine diagnosis. Screening should not be used to dictate treatment decisions. Children who screen positive for psychiatric risk should receive a full clinical evaluation. Children determined to be suffering from psychiatric disorders should receive, or be referred for, formal treatment. Children without psychiatric disorders may benefit from psychosocial interventions.

Evaluer les réactions des enfants à une catastrophe et leurs besoins de santé mentale : dépistage et évaluation clinique

Objectif : Présenter un cadre d'évaluation des réactions des enfants à une catastrophe et de leurs besoins de santé mentale.

Méthodes : Nous avons examiné la littérature pertinente et l'expérience clinique afin de relever l'information sur les méthodes d'évaluation chez les enfants et d'élaborer un cadre d'évaluation fondé sur l'exposition à une catastrophe.

Résultats : L'évaluation de la santé mentale des enfants exposés à une catastrophe comprend 2 éléments : le dépistage et l'évaluation clinique, mais ceux-ci n'ont pas été bien expliqués ou distingués dans la littérature. Le dépistage peut servir à évaluer un nombre imposant d'enfants dans divers groupes d'exposition. L'évaluation clinique est appropriée pour les enfants qui sont directement exposés à une catastrophe, pour ceux dont les membres de la famille et (ou) les personnes qui leur sont associées de près sont directement exposés, et pour ceux dont le dépistage révèle qu'ils sont à risque de perturbation psychiatrique. L'évaluation clinique comprend une évaluation diagnostique complète (trouble de stress post-traumatique et autres troubles) afin d'identifier la psychopathologie, de déterminer le besoin de soins cliniques, et de guider le plan d'intervention et l'aiguillage. Les enfants souffrant d'affections psychiatriques doivent être adressés à un traitement, alors que ceux qui souffrent de détresse psychologique mais pas de maladie psychiatrique peuvent bénéficier d'interventions psychosociales.

Conclusions : Le dépistage est approprié pour identifier les enfants à risque de perturbation psychiatrique et il faut les évaluer plus à fond pour déterminer le diagnostic. Le dépistage ne devrait pas être utilisé pour dicter les décisions quant au traitement. Les enfants dont le dépistage d'un risque psychiatrique est positif devraient recevoir une évaluation clinique complète. Les enfants évalués souffrir de troubles psychiatriques devraient recevoir un traitement officiel ou y être adressés. Les enfants exempts de troubles psychiatriques peuvent bénéficier d'interventions psychosociales.

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