Narrative Exposure and Coping Skills with Children Three Years After Hurricane Katrina

Background/purpose: Trauma-focused CBT usually includes trauma exposure, yet exposure therapy is often not the preferred method for clinicians (Sprang, Craig, & Clark, 2008) and such methods can be labor intensive (Salloum, 2010). CBT, which focuses on children's coping rather than on trauma exposure, may be more easily applied, especially in post-disaster environments where trained clinicians are often limited. Post-disaster treatment needs to address a wide-range of traumatic experiences and be available immediately through long term (La Greca, 2008). This study compares the effectiveness of a 10-week grief and trauma intervention with coping skills and narrative exposure (GTI-CN; Salloum & Overstreet, 2009) to coping skills only (GTI-C) among children exposed to different types of traumatic events three years post-Hurricane Katrina.

Method: Four schools selected targeted grades and sent home parental consents (N = 587 children). Of the 131 children assessed, 72 met criteria. Criteria included exposure to violence, or hurricane-related stressors, or death/loss, and 25 or > on the UCLA-PTSD index. Suicidal ideation was the main exclusion. Children were: ages 7 to 12; 40 male; 70 African American, 2 Hispanic; and majority low-income. All of the children were exposed to disaster-related events and the majority was exposed to multiple traumatic events. The index traumas were as follows: 55.56% death, 20.83% hurricane, 19.44% violence and 4.17% loss/illness. Using an experimental design, children were randomly assigned to GTI-CN (n = 39) and GTI-C (n = 33). Treatment fidelity indicated high compliance. Pre, post and 3-month follow-up assessments were administered by blind evaluators (August 2008 to April 2009). Sixty-six children completed all measures (8% attrition). Measures of posttraumatic stress (UCLA-PTSD Index), depression (MFQ), traumatic grief (TG), global distress (GD) and perceived social support (MSPSS) were administered. Descriptive analysis, independent t test, 2x3 mix model ANOVA repeated measures, dependent t test, and effect sizes were used to analyze results.

Results: There were significant main effects of time on mean scores on the UCLA-PTSD index, (p < .001), MFQ (p < .001), TG (p < .001), GD, (p < .001) and MSPSS (p = .016). Post hoc analysis indicated significant decreases from pre-treatment to post-treatment, except for MSPSS, and from pre-assessment to follow-up. Results suggest that perceived social support increased from post-treatment to follow-up. There was not a significant group x time interaction for any of the measures suggesting improvements in both conditions overtime were the same. Effect sizes (Cohen's d) from pre to follow-up for all measures ranged from .44 to 1.26 for GTI-CN and .39 to .84 for GTI-C indicating moderate to large effects and consistently larger effects for GTI-CN.

Conclusions and Implications: GTI-CN and GTI-C may both be effective interventions for treating children post-disaster who have experienced a range of traumatic events. If clinicians are not trained in trauma exposure, coping-focused interventions may be more appropriate and could be provided to more children. Studies with larger samples are needed to learn if certain children may respond better to one approach versus another and to learn if treatment gains are sustained in the long-term.