The 9/11 experience: Who's listening to the children?

This article has identified barriers to and difficulties in the implementation of mental health efforts for children following 9/11. It also has suggested characteristics of program and implementation plans to reduce these difficulties. Recognition of the role of the traumatized parent and parental involvement in the child's (and their own) recovery has been highlighted. Treatments need to be flexible and address the many possible manifestations of psychological disturbance resulting from trauma, with sensitivity to age, ethnicity, and community setting. Treatments need to be accessible and offered in places that parents and children know and in which they feel comfortable. The role of the relationship between the traumatized community and the relief agencies has been emphasized throughout. Traumatized communities need to have equal say, if not take the lead, in determining the help they need and when and how they should receive it. Program planning should, from its inception, emerge from a dialog between those who need help and those who wish to and are able to give it. Lastly, the article identified the critical need to create programs that build bridges to acute post-trauma mental health services and the importance of evaluating the effectiveness of each of these program components in regards to their relative contributions in reducing distress and enhancing resilience. Large-scale acts of violence such as the attack on the World Trade Center are community traumas, and as such, the unit of analysis is the community. With this in mind, as a final caveat, the authors note the observations made by Wallerstein [47] in her synopsis of innovative community mental health provisions in "Helping the Helpers Not to Harm: Iatrogenic Damage and Community Health." This synopsis describes the way in which she, a historian, and her father, a Harvard psychiatric researcher involved in the 1950s preventative programs for youth at risk, retrospectively view these efforts and their presence today. The translation of innovative programming into community practices went awry. "Now in his late eighties," the abstract describes, "he returns to take a long second look at how the models of preventative interventions that were designed to rescue vulnerable children from serious sequelae have become the mundane bread-and-butter interventions for child protective agencies." The description goes on to note how the undifferentiated application of findings from social research to clinical settings has had a significant negative impact on programs. The material and financial resources directed to those suffering from the effects of 9/11 have been astounding and at times overwhelming. Indeed, the high, driving energy behind good intentions occasionally has road rough-shod over real but unheeded needs, particularly those of children, who are often the silent and under-represented members of the community. There is no substitute for compassion, good judgment, and interest in listening to those psychiatrists seek to serve.