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Abstract

Given the increasing regularity with which severe (named) hurricanes arise, there is a need for valid, practically useful measures that facilitate child-centered post-hurricane situation analysis and needs assessment. Measures that accurately assess the most potent hurricane-related risk factors are essential to identifying youth at risk for developing posttraumatic stress reactions and providing them with effective post-disaster support. With feedback from community stakeholders (e.g., school personnel, physicians and hospital staff, community clinicians), we developed the Hurricane Exposure, Adversity, and Recovery Tool (HEART), a 29-item self-report measure of hurricane risk factors. Test development procedures included: (1) Reviewing the literature regarding hurricane exposure-related risk factors in youth; (2) Generating a developmentally-informed test item pool; (3) Conducting interviews with clinicians, as well as youth impacted by Hurricane Harvey, to evaluate the comprehensibility and acceptability of candidate items; and (4) evaluating endorsement rates for hurricane exposure-related risk factors among (N = 107) youth in an outpatient clinic specializing in the treatment of childhood trauma and loss. Disaster-related exposure, pre-existing indicators of risk, and ongoing post-disaster adversities were correlated with posttraumatic stress and depressive symptoms. These results provide support for an integrative approach to post-hurricane screening for both hurricane-specific (e.g., witnessing injuries) and non-specific (e.g., prior trauma) factors.

Key Take Away Points

  • The Hurricane Exposure, Adversity, and Recovery Tool (HEART) is a 29-item child self-report measure designed to screen for hurricane exposure-related risk factors in a developmentally- and culturally-informed manner.

  • We examined HEART item endorsement and criterion-referenced validity with measures of posttraumatic stress and depressive symptoms in a clinic-referred sample of youth impacted by Hurricane Harvey.

  • Observing caregivers in distress, perceptions of danger, damage to the family home, history of trauma, and bereavement were among the most frequently endorsed items.

  • Hurricane-specific experiences, pre-existing indicators of risk (prior trauma, loss, and emotional problems), and ongoing adversities (i.e., current socioeconomic problems, emotional problems, and barriers to social support) were all associated with concurrent scores on measures of posttraumatic stress and depressive symptoms.

Author Biography

Cody G. Dodd is a clinical psychology postdoctoral fellow with the Psychology Section of the Department of Pediatrics at Baylor College of Medicine. Ryan M. Hill is a clinical psychologist and Assistant Professor with the Psychology Section of the Department of Pediatrics at Baylor College of Medicine. Benjamin Oosterhoff is a developmental psychologist and Assistant Professor with the Department of Psychology at Montana State University. Christopher M. Layne is the Director of Education in Evidence-Based Practice at the University of California, Los Angeles/Duke University National Center for Child Traumatic Stress, and Research Psychologist with the Department of Psychiatry and Biobehavioral Sciences at the University of California, Los Angeles. Julie B. Kaplow is a board certified clinical child psychologist, Associate Professor and Head of the Psychology Section of the Department of Pediatrics at Baylor College of Medicine. She is also the Director of the Trauma and Grief Center at Texas Children's Hospital.

Acknowledgements

Acknowledgements. This work was supported in part by grants from the Substance Abuse and Mental Health Service Administration (SM-062111), Children’s Health Fund, JPB Foundation, the Hurricane Harvey Relief Fund of the Greater Houston Community Foundation, Rebuild Texas Fund, and Johnson and Johnson Foundation, provided to Dr. Kaplow. The authors wish to thank participating children, caregivers, and community stakeholders including providers and staff of the Department of Pediatrics, Texas Children’s Hospital, and members of the School-Based Health Collaborative of Mental Health America for their valuable feedback regarding the HEART. We also greatly appreciate the expertise and guidance of colleagues throughout the National Child Traumatic Stress Network including Melissa Brymer, Ph.D., Laura Danna, LCSW, Robin Gurwitch, Ph.D., Joy Osofsky, Ph.D., Howard Osofsky, M.D., Ph.D., Robert Pynoos, M.D., M.P.H., & Alan Steinberg, Ph.D. Address correspondence to Julie B. Kaplow, Associate Professor and Head, Section of Psychology, Department of Pediatrics, Baylor College of Medicine, Mark Wallace Tower, 6701 Fannin, Suite 1630, Houston, TX 77030. E-mail: Julie.Kaplow@bcm.edu

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