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Three Tiers of Mental Health Intervention

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

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Three Tiers of Mental Health Intervention

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  1. 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 7:195-210.

  2. Selected Intervention FociTier 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 7:195-210.

  3. Examples of InterventionTier 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 7:195-210.

  4. Five Foci of Trauma-Grief Focused InterventionTier 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 7:195-210.

  5. 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 7:195-210.

  6. 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 7:195-210.

  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 7:195-210.

  8. 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 7:195-210.

  9. 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 7:195-210.

  10. 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 154:536-542. • 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: 291-303. • 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 11:43-56. • 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, 445-471. • 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, 72-93. • 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 7:195-210.

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