Child and adolescent trauma treatments and services after September 11: Implementing evidence-based practices into complex child services systems

Introduction: The September 11th attacks were an act of terrorism beyond what the USA had ever experienced, and represented a challenging venue for mental health professionals to respond to. Previous studies of the effects of terrorism on children largely centered on examination of frequent exposure to violence, such as war. The Oklahoma City bombing was one of the first investigations of how terrorism affects children who live in a country relatively free from large-scale acts of violence. The number of lives lost in this act were large and research results indicated far-reaching ripple effects and delayed responses. Interestingly, data from Oklahoma also demonstrated that television exposure appeared to be a significant risk factor in the development of Post-traumatic Stress Disorder (PTSD) symptoms (Pfefferbaum et al., 1999; Pfefferbaum et al., 2001). Although data such as these are useful in guiding the response to September 11th, there remains a grave dearth of information on how to respond to children in the aftermath of terrorism. The destruction of the World Trade Center (WTC) was massive, and the damage shattering on the heavily populated island of Manhattan and surrounding boroughs. Early screening efforts showed that as many as 75,000 children (10.5%) had symptoms that were predictive of PTSD (Hoven et al., 2002, Board of Education Study). In addition, high percentages of children presented with other psychiatric symptoms predictive of a range of disorders, including depression (8.4%), anxiety (12.3%), agoraphobia (15.0%), separation anxiety (12.3%), and conduct disorder (10.9%).