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COMMENTARY |
Pediatrics and Child Study, Subsection of Developmental-Behavioral Pediatrics, Yale University School of Medicine, New Haven, CT 06520-8064
The survey of pediatric practitioners by Laraque et al in this issue demonstrates the enormous emotional impact of the events of September 11, 2001: 23% estimated that >10% of their patients were presenting with mental health complaints related to September 11th,1 likely a conservative estimate, because adults tend to underestimate the impact of disasters on children.2 In a study using parental report also in this issue, Fairbrother et al3 illustrate the striking disparity between mental health needs of children in New York City post–September 11th and their receipt of counseling services: only 27% of children with severe or very severe posttraumatic stress reactions received any counseling. Together, these studies provide sobering insights into the psychosocial impact of crisis and should serve as a wake-up call to plan for the mental health needs of children in the setting of disaster or terrorism.
Fairbrother et al suggest a more active role for pediatricians in screening for mental health needs after a crisis and in providing services for less severe cases.1 However, the survey of Laraque et al demonstrates that most pediatric practitioners feel inadequately trained to identify, let alone treat, these mental health concerns.3 In the setting of a crisis, pediatricians need to be able to detect somatization, screen for adjustment problems, perform timely and effective triage, provide brief supportive interventions, and make appropriate referrals for mental health support and counseling as indicated.2
It is not surprising that children’s mental health needs after September 11th were not met fully, given the longstanding inadequacy of resources for quality mental health care for children throughout the United States and the formidable barriers to access and reimbursement constructed by the managed care environment. The primary medical care system has become the de facto mental health care system in the United States. Children are most likely to receive treatment, including psychotropic drugs, from primary care physicians for symptoms associated with mental disorders. Improving the skills of pediatricians to address the mental health needs of children and providing adequate reimbursement for these services therefore is critical not only to disaster preparedness, but because crisis is not uncommon in the lives of children, it is also vital to ensuring quality pediatric care even in the absence of a national crisis.
The events of September 11th hopefully will remain an unequaled tragedy in US history. This crisis, however, is not an isolated event but part of a growing concern related to terrorism; natural disasters continue to occur throughout the world as well. As such, the country is investing the resources to develop an unparalleled security system and initiate a much-needed rebuilding of its public health infrastructure. The events of September 11th are a tragic wake-up call regarding the chronically unmet mental health needs of our nation’s children and our lack of preparedness to meet the increased demands in times of crisis. It forces us to ask: What more will it take before we are ready to make the commitment to create the infrastructure needed to support the mental health of children, our most vulnerable citizens and our country’s future?
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FOOTNOTES |
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Address correspondence to David J. Schonfeld, MD, FAAP, Department of Pediatrics, Yale University School of Medicine, 333 Cedar St, PO Box 208064, New Haven, CT 06520-8064. E-mail: david.schonfeld{at}yale.edu
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REFERENCES |
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 TOP REFERENCES |
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This article has been cited by other articles:
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  J. A. Villalba and L. D. Lewis Children, Adolescents, and Isolated Traumatic Events: Counseling Considerations for Couples and Family Counselors The Family Journal, January 1, 2007; 15(1): 31 - 35. [Abstract] [PDF]
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 J. F. Hagan Jr, and the Committee on Psychosocial Aspects of Child, and and the Task Force on Terrorism Psychosocial Implications of Disaster or Terrorism on Children: A Guide for the Pediatrician Pediatrics, September 1, 2005; 116(3): 787 - 795. [Abstract] [Full Text] [PDF]
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