Medical Education Petal but project a part of the Global Health Pathway

Specialty (if any):

Child & Adolescent Mental Health

Keywords:

Trauma, Triage, TF-CBT

Background:

Following the 2023 catastrophic flooding in Derna, Libya, 6,900+ children were triaged using the Psychological Simple Triage and Rapid Treatment (PsySTART) tool. Results revealed widespread exposure to trauma. In a post-conflict context with limited mental health infrastructure, there was a critical need for a scalable, evidence-based intervention that could be deployed and matched to severity of need.

Objectives:

To design and model scalable mental health intervention strategies for trauma-affected children using a stepped-care approach built around Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). The intervention is adaptable to triage thresholds, provider availability, and delivery modality (individual/ group-based care).

Design:

Grounded in Schreiber’s National Children’s Disaster Mental Health Concept of Operations and the PsySTART algorithm, this project modeled three flexible intervention pathways: 1. A high-threshold approach (e.g., children with ≥5 PsySTART variables) to prioritize those most affected. 2. A floating threshold strategy that starts with the most severely affected (e.g., ≥7 variables) and expands downward over time. 3. A school-based stepped-care model, adapted from Murray and Redlener, in which children first receive group-based TF-CBT PRAC skills (Psychoeducation, Relaxation, Affect-modulation, and Cognitive-coping), followed by referral to full TF-CBT delivered individually through TICE (Individual Care Extension) if symptoms persist. Each model was evaluated for both individual and group therapy formats across triage levels from 3-7 variables.

Impact/Effectiveness:

Each model was evaluated for provider burden, delivery timelines, and reach. For example, using a cutoff of five variables reduced eligible children from 1,191 to 327 and decreased provider hours by over 60%. Group-based PRAC followed by selective TICE referral was the most scalable model under current constraints.

Lessons Learned:

Flexible triage thresholds and task-shifting to trained teachers offer rapid, efficient delivery. Provider capacity strongly affects intervention timelines.

Summary:

This adaptable triage-to-care model aligns with international mental health response frameworks and offers a viable strategy for post-disaster care in Libya and similar humanitarian contexts.