A stepped-care model of post-disaster child and adolescent mental health service provision.
A stepped-care model of post-disaster child and adolescent mental health service provision.
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DOI：
10.3402/ejpt.v5.24294
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发表时间：
2014
影响因子：
5
通讯作者：
Cobham VE
中科院分区：
文献类型：
--
作者：
McDermott BM;Cobham VE
从全球范围来看，自然灾害是常见事件。已发表的研究强调，受影响的儿童和青少年中有相当一部分会出现与灾害有关的心理健康综合征和相关的功能障碍。与儿童和青少年在精神病理学方面相当大的未满足需求相一致，有强有力的证据表明，许多患有灾后心理健康表现的儿童和青少年没有得到充分的干预措施。批评现有的儿童和青少年精神卫生服务（CAMHS）的护理模式和这种模式的能力，以处理任何灾后激增的临床需求。此外，详细说明一种创新的服务反应;一种儿童和青少年分步照料服务提供模式。传统的CAMHS的叙述性审查。灾害应对的重要因素-个人与社区恢复，公共卫生方法，促进和预防的能力和服务范围进行了讨论，并与CAMHS的方法进行了比较。从提供预防性举措的能力到提供密集的专门创伤后应激障碍干预措施的能力，各个层面的干预都突出了传统护理模式的困难。作为回应，我们提倡过度干预的阶梯式护理模式。一般的反应进行了讨论，并提供了该模型的三个层次的细节：第1层的沟通策略，第2层的家长的有效性和教师培训，以及第3层的筛选与创伤为中心的认知行为疗法。在本文中，我们认为，传统的CAMHS是不是一个适当的护理模式，以满足这组在灾后环境的临床需求。最后，我们建议如何改善灾后儿童和青少年的心理健康成果可以通过应用创新的服务方法来实现。
From a global perspective, natural disasters are common events. Published research highlights that a significant minority of exposed children and adolescents develop disaster-related mental health syndromes and associated functional impairment. Consistent with the considerable unmet need of children and adolescents with regard to psychopathology, there is strong evidence that many children and adolescents with post-disaster mental health presentations are not receiving adequate interventions. To critique existing child and adolescent mental health services (CAMHS) models of care and the capacity of such models to deal with any post-disaster surge in clinical demand. Further, to detail an innovative service response; a child and adolescent stepped-care service provision model. A narrative review of traditional CAMHS is presented. Important elements of a disaster response – individual versus community recovery, public health approaches, capacity for promotion and prevention and service reach are discussed and compared with the CAMHS approach. Difficulties with traditional models of care are highlighted across all levels of intervention; from the ability to provide preventative initiatives to the capacity to provide intense specialised posttraumatic stress disorder interventions. In response, our over-arching stepped-care model is advocated. The general response is discussed and details of the three tiers of the model are provided: Tier 1 communication strategy, Tier 2 parent effectiveness and teacher training, and Tier 3 screening linked to trauma-focused cognitive behavioural therapy. In this paper, we argue that traditional CAMHS are not an appropriate model of care to meet the clinical needs of this group in the post-disaster setting. We conclude with suggestions how improved post-disaster child and adolescent mental health outcomes can be achieved by applying an innovative service approach.
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