Barbara Forresi

Impact, psychological sequelae and management of trauma affecting children and adolescents.

Purpose of review In this review we examine the most recent literature on the impact, psychological sequelae and management of trauma affecting children and adolescents. We focus on consequences of early traumatic events in childhood, adolescence and adulthood; mediating variables (risk and protective factors) intervention strategies and available treatments. Recent findings Increasingly often, mental health professionals are being asked to address the needs of children and adolescents who have been exposed to traumatic events, either as individuals or in groups. Studies on a wide range of age groups, populations and types of trauma revealed that traumatized children and adolescents are at high risk for developing a range of different behavioural, psychological and neurobiological problems. Social support may have a protective effect on the relationship between exposure to traumatic events and psychosocial symptoms. Summary Several recent studies analyze a wide range of early traumatic events that may be directly or indirectly experienced by youth. These studies raise many fundamental questions such as validity of current diagnostic criteria for post-traumatic stress disorder, comorbidity with anxiety, depressive disorders and childhood traumatic grief symptoms. Vulnerability and protective factors, mainly gender, age and social support are considered. A common problem in research into the impact of trauma on children is the presence of many limitations: studies are often retrospective, use self-report questionnaires and the results may not be generalizable (i.e. they are trauma or population specific). There is a lack of well designed studies, addressing in particular treatments for post-traumatic symptoms in children and adolescents.

Promoting resilience and psychological well-being in vulnerable life stages.

vices, even in high-income countries [16] ; t he majority of young people with mental health problems are still not getting the help they need. A major reason for this is the worldwide gaps in child and adolescent mental health policy and services well identified by the World Health Organization through its Atlas project [17] . T he degree of coverage and quality of mental health services for the youths are generally worse compared with the ones pro-vided for adults [18] . Little information is now available about health and social investment into child and ad-olescent mental well-being. However, as denounced in the Florence Declaration – developed during the 13thEuropean Society for Child and Adolescent Psychiatry (ESCAP) Congress and signed by WHO and by EACAP (European Academy for Child and Adolescent Psychia-try) – as regards Europe, all indicators strongly suggest that child and adolescent mental health in most countries is receiving a relatively small proportion of funding, with, in turn, a typically low investment for general health, on average only 5.6% (see appendix). The median percentage of governments’ health budget earmarked for mental health is as little as 1% in low income countries [19] T . he gap is not limited to the quantity, as the quality of ser-vices is often extremely poor, even in high income coun-tries [19] . Nevertheless, the mental well-being of children still remains a major public health priority and a prominent area of international debate. Scientists and researchers from all over the world are focusing on how to improve Mental health and emotional and psychological well-being are fundamental for all children, enabling them to meet their potential, to experience life as meaningful and to be active citizens. Unfortunately, current estimates indicate that at least one out of every four to five young people in the general population will suffer from at least one mental disorder in any given year [1] . Similar data have been previously reported by WHO, showing that worldwide up to 20% of children and adolescents suffer from a mental illness with at least mild functional impairment: one adolescent in five has behavioural, cognitive and emotional difficul-ties and one adolescent in eight suffers from a mental dis-order [2]. C omorbidity is very common and can occur at three levels: with other mental disorders, with substance abuse and with chronic diseases [1] . Developmental psychiatric disorders rarely have a spontaneous remission and may cause difficulties in so-cial adaptation or mental disorders in adult life [3–12] . There is evidence that adult mental disorders usually be-gin during youth [13, 14] , although they are often first detected later in life [1] . Besides personal suffering, stigma and discrimina-tion, mental disorders may have a high social impact, in terms of treatment and support costs, reduced or lost pro-ductivity, and the expenditure of criminal justice (e.g. conduct and behavioural disorders) [15] . De spite these data, only a minority of vulnerable chil-dren and adolescents have access to mental health ser-

Innovative Interventions in the Community

This chapter describes three different services in three different countries that have two things in common: 1. They are directly addressed to and based in a community. 2. They are innovative in terms of the addressed population, in terms of methodology and also in terms of funding.