Unmet Need for Counseling Services by Children in New York City After the September 11th Attacks on the World Trade Center: Implications for Pediatricians

Abstract

Objective. The objectives of this studywere to describe the prevalence of counseling services,contrasted with the need after the terrorist attacks ofSeptember 11, 2001, the types of counseling received, andthe predictors of receipt of counseling services.Methods. A cross-sectional, random-digit-dial surveywas conducted in New York City (NYC) of parents (N 434) of children who were 4 to 17 years of age 4 monthsafter the September 11th terrorist attacks on the WorldTrade Center.Results. Overall, 10% of NYC children received sometype of counseling after the September 11th attacks, accordingto parental report. Among these, 44% receivedcounseling in schools, 36% received counseling frommedical or professional providers, and 20% receivedcounseling from other sources. However, only 27% of thechildren who had severe/very severe posttraumatic stressreactions (PTSR) after the attacks received counselingservices. In a multivariate model, receipt of counselingbefore the September 11th attacks (odds ratio: 4.44) andhaving severe/very severe PTSR (odds ratio: 3.59) werethe most important predictors of use of counseling servicesafter the September 11th attacks. Minority statusand having a parent who experienced the loss of a friendor a relative were also associated with receipt of services.Conclusions. There was substantial disparity betweenapparent need (as indicated by severe/very severePTSR) for and receipt of mental health services for childrenafter the September 11th attacks. There is need forintensified efforts to identify, refer, and treat children inneed, especially for children who are not already in atherapeutic relationship. An enhanced role for pediatriciansis indicated