Psychosocial Needs Assessment of the Haitian children in the Child in Hand Affiliated Orphanages.

Srihari Cattamanchi1,2, Moira Hennessy2, Sara Carson2, Majed Aljohani1,2, Abdulrahman S. Alqahtani1,2, Michael S Molloy1, Gregory R. Ciottone1,2

OBJECTIVES

1.Harvard Affiliated Disaster Medicine Emergency Medicine Fellowship, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA 2.Department of Emergency Medicine, Beth Israel Deaconess Medical Centre, Boston, MA

RESULTS

METHODS

Official hospital of theBoston Red Sox

• An observational study, conducted at 6 CiH affiliated orphanages in August 2012.

• Quantitative and qualitative data was gathered from children, caregivers and orphanage managers.

• We employed the Strengths and Difficulties Questionnaire (SDQ), to assess the presence of mental health problems and prosocial behavior; the Perceived Social Support Scale, to evaluate the experience of social support by vulnerable youth; and the Kidcope Questionnaire, to assess the use and helpfulness of coping techniques used by children.

• Key informant interviews were conducted with staff and management at each site.

CONCLUSION

RESULTSINTRODUCTION• Psychosocial distress and mental illness impacts the

health around the world, affecting the well-being and productivity of people, communities and societies.

• Mental health vulnerability is high for people and communities experiencing crisis/disaster, particularly for vulnerable groups such as children and orphans who rely heavily on adult others and community stability to support their resilience and coping

To create and evaluate the mental health profile of the vulnerable youth in post disaster Haiti.

• Substantial mental health concerns were detected, yet a majority of children also showed helping or pro-social behavior.

• Confidants were most often friends, but also included teachers, family members, staff and community members, as illustrated in Figure 2.

• With regard to social support, 85% of children had a confidant who they would be able to talk to about things happening in their personal life.

• Perceived social support was absent for a minority (15%) of children, further detailed in Table 1.

• It is concerning, however, that 30% of children reported that caregivers (as well as friends) do not have confidence in them or let them know that they are worthwhile.

• Sleep disturbance, enuresis and social isolation seem to be priority areas of intervention.

• A high-level of trauma exposure was detected among 80% of children.

• Children described a wide range of coping behaviors (i.e. distracting, self-blame, and expressing emotion, social withdrawal, and social support).

• However these were inconsistently used / helpful for children.

• Findings from the staff interviews support quantitative findings, which indicate that an important subgroup of children are experiencing emotional, behavioral or interpersonal difficulties.

• Beginning to intervene by targeting concerns shared by staff is recommended.

• Specifically, education and intervention for staff surrounding bedwetting; the use of ritual and mood regulation practices to support healthy sleep practices; and providing adequate access to feminine hygiene products is suggested.

• Notably, in order for staff to begin to address these concerns they must be supported and empowered to do so.

• Collaborating with management to establish self-care and support activities for staff is recommended (In conjunction with self-care education workshops).

• Capacity building seminar to enhance awareness and understanding of child mental health, child development and communication is recommended (and requested by staff).

• Priority areas to address include staffing policies that support best use of staff strengths and allow for self care, practices that allow for regular one-on-one interaction with children when possible, and aging-out expectations and services for older youth.

• With regard to child participants, approximately 56% of participants were male and 44% were female.

• Mean age of 11.49 years (SD, 3.26; range 3-19 years of age).

• Strengths and Difficulties Questionnaire (SDQ), found 15% of the children having clinically elevated emotional distress in past month.

• Conduct Problems were found in 26% of the children, experiencing clinically significant behavior problems during past month.

• About 16% of children endorsed clinically significant problems with peers during the past month, as illustrated in Figure 1.

• Overall 20% of children had significant overall distress or impairment in functioning.

• In terms of prosocial behavior, 77% of children engaged in adaptive normal prosocial behavior over the past month and only 3% of children were in a high risk range in this area.