Supporting adolescents in times of national crisis: potential roles for adolescent health care providers.

Before I address the topic of how health care providers can help adolescents cope with a national crisis, I would like to acknowledge that we all have been, and many continue to be, affected by the terrorist acts that began on September 11th and the ongoing war. Now that almost 6 months have passed, there is a wide spectrum in the degree to which people are still affected by these events. Some adults and children are still highly affected, whereas others are far less so. For some adolescents, such as those who witnessed firsthand the terrorist attacks or whose parents are in the armed forces, the comments that I make today may be relevant to ongoing attempts to help them adjust to the events of September 11th or ongoing war. For most adolescents, no further specific intervention may be needed; my comments should be seen as relevant to how to address future crises that may occur in their lives. It is also important to realize that although the terrorist attacks in our country are a shared experience at one level, it is fundamentally a very personal experience. The nature and degree of the impact varies individually, and in part, for this reason we will reach our own unique understanding of the events. For some individuals, the tragic, senseless, and random loss of life promotes a sense of carpe diem, a decision to look less to the past or the future, but to invest fully in the present. Other individuals may choose to focus on past events in order to search for ways to prevent similar occurrences. Others may adopt a future orientation to attempt to anticipate and mitigate the likely negative affect of this crisis. These are only a few of the many legitimate, although quite different, reactions that may be seen after a crisis event. Whatever the reaction may have been to date, join with me to look toward the future and to think about ways that we, as health care providers, can provide assistance to adolescents and their families in times of national crisis. I will begin by describing the roles that health care providers can take to help adolescents cope with the past crisis events, as well as future crises, and will point out some of the potential barriers to successfully fulfilling these roles. I will then outline some of the potential symptoms of adjustment reactions to terrorist events that health care providers may see and describe the factors that may adversely affect the nature and degree of reaction to a terrorist event for a particular adolescent. I will then offer more practical advice on how to facilitate discussion with adolescents about these topics in order to promote their adjustment and offer my views on some of the many reasons why these conversations often do not occur. One very important role for health care providers is to continue to do the work that we were doing before the crisis event. Shortly after the terrorist attacks, I again called the mother of a young child who was terminally ill. They live in New York and I had been calling the mother on an ongoing basis over the prior 9 months to offer support and assistance. It wasn’t until I called her for the second time after September 11th that she confided in me her concern From the Yale University School of Medicine and School Crisis Response Initiative, National Center for Children Exposed to Violence, Yale Child Study Center, New Haven, Connecticut Address correspondence to: David J. Schonfeld, M.D., Department of Pediatrics, Yale University School of Medicine, 333 Cedar St., P.O. Box 208064, New Haven, CT 06520-8064. E-mail: david.schonfeld@yale.edu. Portions of this lectureship were presented by the author within a plenary presentation at the 2001 National Conference and Exhibition of the American Academy of Pediatrics, October 22, 2001, San Francisco, California. JOURNAL OF ADOLESCENT HEALTH 2002;30:302–307