Immediate and Early Interventions for Children and Adolescents Post Terrorism

Terrorism generates a wider range of responses in children and adolescents than in adults. Although most children are not affected beyond temporary distress, some experience adjustment problems post terrorism that reach clinically significant levels. Given the need and desire to help diverse youth post mass events, intervention developers have created early intervention treatment packages in response to correlates or risk factors, specific problems and general children’s stress reactions. Interventionists must ethically balance the desire to provide help to youth after terrorism with any potential costs of interfering with natural recovery or creating iatrogenic harm. In general, four overall approaches are used in immediate and early interventions: psychological first aid (PFA), triage/screening interventions, general therapeutic approaches, and trauma-focused interventions. Interventions vary considerably with respect to whether they are conducted for all exposed youth, or only to youth with particular risks or symptom levels. The database to make evidence-based recommendations on the best early interventions for youth after terrorism is quite limited. PFA and early triage/screening interventions appear promising and feasible for the immediate period but have not been assessed. General therapeutic approaches, and trauma-focused interventions all have initial promising results in the few existing studies but the field requires far more information to indicate which interventions are best for what children at what time. The most salient point is that all early interventions with youth require evaluation, preferably well designed randomized control studies, but any formal evaluation is needed at this point to inform policy. Further, the need to enhance the quality and feasibility of evaluation of post terrorism studies of youth especially those delivered in the immediate post-event period is striking. Efforts may include grant funding, early planning, computer assisted applications, innovative methodology, and human ethics considerations. In the meantime, available evidence, strategies, and expert consensus should guide early intervention delivery and development for youth. The needs of children must be addressed with a clear understanding that youth of different ages may require different approaches at different time intervals. In the immediate response phase, interventions that address 5 empirically based principles to promote safety, calming, self and community efficacy, connectedness and hope appear reasonable. Thereafter, early interventions should carefully consider and match youth age with targeted goals and document the effect of the interventions, closely monitoring and documenting obstacles, successes, and failures. In addition to creating and evaluating a wide range of interventions for children that are developmentally appropriate, the way we approach adult immediate interventions post terrorism must become child-focused – immediate and early adult interventions should include components targeting ways to help youth. Relatedly, it may be useful to evaluate children of adults enrolled in early interventions to determine if helping parents cope with their own distress improves outcomes among their children.

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