Assessing children's disaster reactions and mental health needs: screening and clinical evaluation

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

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.

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.

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.