This article presents considerations for marriage and family counselors assisting children and adolescent clients who have witnessed or survived an isolated traumatic event or who have family members who have witnessed or survived an isolated traumatic event. Direct emotional outcomes in children and teens related to isolated traumatic events, such as separation anxiety disorder and PTSD, also are presented. In addition, specific clinical interventions -- including the use of play therapy, psychoeducational groups, and cognitive-behavioral therapy -- are presented as specific methods for assisting children and teenagers coping with traumatic events in a variety of settings. [Author Abstract] KEY WORDS: trauma witnesses; PTSD; natural disasters; children and adolescents; play therapy

In recent years, the World Health Organization in general, and Israel in particular, have dealt with mass casualty events (MCEs) resulting from terrorism. Children are the casualties in many of these events-a reality that forces hospitals to prepare to deal with such a scenario. A literature review designed to identify unique recommendations regarding pediatric MCEs highlights both a lack of existing training programs and uncertainty on the part of health care staff when dealing with these events. The purpose of the study was to examine the preparedness level of emergency department staff to deal with MCEs involving pediatric casualties. The study included 104 physicians and nurses working in, or responding to, the emergency department at a hospital in Israel. The study included a 41-item questionnaire examining perception, approaches, and staff knowledge regarding dealing with pediatric MCEs versus those involving adults. The reliability of all sections of the questionnaire ranged between Chronbach's alpha coefficient 0.6 alpha-0.94. The preparedness levels for MCEs involving children were found to be low. Study participants ranked the likelihood of a pediatric MCE lower than one involving adults, while ranking significantly higher (P = .000) their ability to cope mentally and the knowledge and skills required when treating adults involved in MCEs. While nurses ranked higher than physicians regarding their knowledge and skills in dealing with pediatric MCE casualties, the level of knowledge for MCEs involving children was low in all subjects. Staff agreement for the parent of an MCE victim to be present during treatment was medium-low. On the basis of these findings, additional research involving a larger number of individuals and hospitals is indicated to determine if these results are consistent throughout the region.

We assess emergency department (ED) utilization by a population whose health care encounters can be tracked and quantified for behavioral and mental health conditions in the aftermath of the terrorist attacks of September 11, 2001. We assessed presentations to EDs by using Medicaid analytic extract files for adult New York State residents for 2000 and 2001. We created 4 mutually exclusive geographic areas that were progressively more distant from the World Trade Center and divided data into 4 periods. All persons in the files were categorized by their zip code of residence. We coded primary ED diagnoses for posttraumatic stress disorder, substance abuse, psychogenic illness, severe psychiatric illness, depression, sleep disorders, eating disorders, stress-related disorders, and adjustment disorders. There was a 10.1% relative temporal increase in the rate of ED behavioral and mental health diagnoses after the September 11, 2001, terrorist attacks for adult Medicaid enrollees residing within a 3-mile radius of the World Trade Center site. Other geographic areas experienced relative declines. In population-based comparisons, Medicaid recipients who lived within 3 miles of the World Trade Center after the September 11, 2001, terrorist attacks had a 20% increased risk of an ED mental health diagnosis (prevalence density ratio 1.2; 95% confidence interval 1.1 to 1.3) compared to those who were non-New York City residents. The complex role that EDs may play in responding to terrorism and disasters is becoming increasingly apparent. To the best of our knowledge, this is the first report of a quantifiable increase in ED utilization for mental health services by persons exposed to a terrorist attack in the United States.

Background--Terrorist attacks can have psychological effects on the general public. Aims--To assess the medium-term effects of the July 2005 London bombings on the general population in London and to identify risk factors for persistent effects. Method--We telephoned 1010 Londoners 11-13 days after the bombings to assess stress levels, perceived threat and travel intentions. Seven months later, 574 respondents were contacted again and asked similar questions, and questions concerning altered perceptions of self and the world. Results--'Substantial stress' (11%), perceived threat to self (43%) and reductions in travel because of the bombings (19%) persisted at a reduced level; other perceived threats remained unchanged. A more negative world view was common. Other than degree of exposure to the bombings, there were no consistent predictors of which people with short-term reactions would develop persistent reactions. Conclusions--A longer-term impact of terrorism on the perceptions and behaviour of Londoners was documented. (PsycINFO Database Record (c) 2016 APA, all rights reserved) (Source: journal abstract)

Focus groups with 23 New York City children examined their reactions to the September 11 terrorist attacks, their parents' reactions, and their expectations about the future. We identified an initial set of six topics; these topics were reviewed and assigned to a final set of thematic categories -- understanding the events and motives, emotional responses, boredom, and coping. This final set was used to independently code the transcripts. The children reported using distraction and avoidant emotion-focused coping strategies. They were confused about some aspects of the events, but they understood the magnitude and gravity of what had occurred. [Author Abstract]

Two studies examined how non-interpersonal forgiveness (when there is no social relationship between the transgressor and forgiver) related to coping and involuntary responses to stress, psychological distress, and religiosity. Three to six weeks after September 11th, 2001, forgiveness had non-linear associations with other responses to the terrorist attacks. Among college students (N = 488), those who were trying or had forgiven (pro-forgiveness) the terrorists reported less involuntary engagement, more primary and secondary control coping, and more meaning finding than those who were unsure about forgiveness (ambivalent) and those who did not believe the perpetrators should be forgiven (anti-forgiveness). Ambivalent students reported the most distress, even after controlling for religion. Anti-forgiveness students reported less religiosity than ambivalent and pro-forgiveness students. Most findings were consistent among middle schoolers (N = 154), particularly regarding psychological distress and responses to stress. Also, forgiveness of strangers for acts against one's community functioned separately from religion. [Author Abstract] KEY WORDS: Forgiveness; coping; stress; terrorism; religion; adolescents

Compared to most types of criminal violence, terrorism poses special data collection challenges. In response, there has been growing interest in open source terrorist event data bases. One of the major problems with these data bases in the past is that they have been limited to international events--those involving a national or group of nationals from one country attacking targets physically located in another country. Past research shows that domestic incidents greatly outnumber international incidents. In this paper we describe a previously unavailable open source data base that includes some 70,000 domestic and international incidents since 1970. We began the Global Terrorism Database (GTD) by computerizing data originally collected by the Pinkerton Global Intelligence Service (PGIS). Following computerization, our research team has been working for the past two years to validate and extend the data to real time. In this paper, we describe our data collection efforts, the strengths and weaknesses of open source data in general and the GTD in particular, and provide descriptive statistics on the contents of this new resource. (PsycINFO Database Record (c) 2016 APA, all rights reserved) (Source: journal abstract)

Exposure to terrorism seriously threatens the well-being of children and adolescents. Israeli citizens have witnessed massive ongoing terrorist attacks during the last few years. The present research, conducted among 330 Israeli adolescents, examined coping strategies in relation to terrorist attacks. We found that adolescents utilize more productive than non-productive coping strategies when dealing with terrorist attacks. Moreover, they rarely seek professional help. Male adolescents use more non-productive coping strategies and female adolescents seek more social support as a coping strategy. The impact of exposure to media reports and life satisfaction on adolescents' use of coping strategies is discussed, and potentially effective approaches to coping with terrorist attacks are proposed. (PsycINFO Database Record (c) 2016 APA, all rights reserved) (Source: journal abstract)

In July 2004, the U.K. Government launched an 8.3 million pound campaign to inform the public about how to respond to emergency situations, disseminating an advice booklet to 25 million households. The specified objective of the campaign was to relay information about what members of the public should do to prepare for major emergencies, such as a terrorist attack. Although the booklet provides generic advice about a range of emergency situations, at the time of distribution, media and political attention became firmly fixed on the sections containing information about chemical, biological and radiological (CBR) strikes. In this paper, we present the findings of questionnaire-based research into public perceptions of emergency advice. Based on responses from 116 participants, we reflect on the efficacy of Government communications, the impact of the advice booklet on behavioural intentions and the fit between interpretations of the guidance offered and wider attitudes towards terrorism. Qualitative methods of analysis are deployed to explore individual fears about terrorism and collective levels of trust in Government. Our research raises prescient questions about future communication strategies and public policy making. Drawing upon risk society and governmentality perspectives, the paper examines the extent to which citizens are responding to Government information and the way in which the individualization of the terrorist risk meshes with an extant process of responsibilization articulated through policies on crime control, security and welfare. In conclusion, we outline the potentialities and the pitfalls of a burgeoning politics of risk that appears to be driving contemporary policy initiatives in the U.K. (PsycINFO Database Record (c) 2016 APA, all rights reserved) (Source: journal abstract)

Mildly injured and "worried well" patients can have profound effects on the management of a mass-casualty incident. The objective of this study is to describe the characteristics and lessons learned from an event that occurred on 28 August 2005 near the central bus station in Beer-Sheva, Israel. The unique profile of injuries allows for the examination of the medical and operational aspects of the management of mild casualties. Data were collected during and after the event, using patient records and formal debriefings. They were processed focusing on the characteristics of patient complaints, medical response, and the dynamics of admission. A total of 64 patients presented to the local emergency department, including two critical casualties. The remaining 62 patients were mildly injured or suffered from stress. Patient presentation to the emergency department was bi-phasic; during the first two hours following the attack (i.e., early phase), the rate of arrival was high (one patient every three minutes), and anxiety was the most frequent chief complaint. During the second phase, the rate of arrival was lower (one patient every 27 minutes), and the typical chief complaint was somatic. Additionally, tinnitus and complaints related to minor trauma also were recorded frequently. Psychiatric consultation was obtained for 58 (91%) of the patients. Social services were involved in the care of 47 of the patients (73%). Otolaryngology and surgery consultations were obtained for 45% and 44%, respectively. The need for some medical specialties (e.g., surgery and orthopedics) mainly was during the first phase, whereas others, mainly psychiatry and otolaryngology, were needed during both phases. Only 13 patients (20%) needed a consultation from internal medicine. Following a terrorist attack, a large number of mildly injured victims and those experiencing stress are to be expected, without a direct relation to the effectiveness of the attack. Mildly injured patients tend to app