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War And Terrorism Survey (March 2003)

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  • Using PracticeNet TM , a unique internet-based data collection infrastructure, the APA Practice Directorate conducted a survey of practicing psychologists regarding the impact of the beginning of the war with Iraq and the threat of terrorism on clinical practice. The survey was conducted March 20-24, 2003.

Transcript

  • 1. Administered: March 20-24, 2003
      • War and Terrorism: The Effect on Clinical Practice
  • 2. Survey Design
    • PracticeNet staff met to develop survey algorithm, specific questions developed in response to focus group concerns
    • Goals:
      • Fidelity to RTBS methodology
      • Smooth, logical flow of questions
      • Incorporate branching, skip patterns
      • Ensure relevance of questions for all practitioners
  • 3. PracticeNet War and Terrorism I Survey
    • Survey administered March 20-24, 2003
      • News of the first bombs falling on Iraq March 19 10pm EST
    • Total valid responses N = 225 (app. 56% response rate)
      • Providing direct clinical services to an individual within 72 hours of selected date n = 206 (%)
      • 51 seen before bombs fell, 154 seen March 20 (first day of war)
  • 4. Participating Psychologist Demographics
      • 54% Female
      • 46% Male
      • Average age 51.7, Range 25-78
      • 2% Hispanic
      • 3% Other people of color
      • 94% White
      • Primary Employment Setting
      • 111 private practice ONLY
      • 42 organizational setting ONLY
      • 72 divide practice time between private and organizational settings
  • 5. Client Demographics
    • Gender
      • 56% Female
      • 44% Male
    • Average age 36, Range 2 - 92
    • Race/Ethnicity
      • 5% Hispanic
        • 82% White
        • 5% Black/African American
        • 3% Multiracial
    • Marital Status
      • 25% Married
      • 53% Never married
      • 15% Divorced
  • 6. Discussion of War or Terrorism in Session
    • 42% of clients brought up war or terrorism in session
    • No differences between those seen before bombs fell and afterwards
    • Women much more likely to raise concerns in session than men (53% v 36%)
    • Women more likely to discuss a prior traumatic event that was triggered by current situation
    • Women discussed more emotional responses to the war than men
  • 7. Discussion of War or Terrorism in Session, cont.
    • Children much less likely to raise concerns (24% of children v 46% of adults)
    • Children less likely to discuss a prior traumatic event
    • Children expressed fewer emotional responses to events
    • No differences among racial/ethnic groups
  • 8. Implications of World Events on...
    • Priorities
      • 13% discussed in session the implications of war and threat of terrorism with 7% indicating positive implications, 41% negative and 52% mixed
    • Worldview
      • 26% discussed in session the implications of war and threat of terrorism with only 1 person expressing solely positive implications; the remainder were mixed (34%) or negative (64%)
  • 9. Symptom Onset or Worsening
    • 61 clients experienced the onset or worsening of symptoms in response to war or terrorism
      • Occurred more often in adults (93%) and females (70%)
      • No differences in onset or worsening in response to war or terrorism among racial/ethnic groups
    • Symptoms most likely to onset or worsen include
      • fear, anxiety or uncertainty about the future
      • hypervigilance
      • generalized fear
      • need to be physically near family
  • 10. Personal Impact on Patients and Psychologists
    • 69 patients reported to have some personal impact from the war and threat of terrorism such as…
      • Family or friends in the military or reserves (n=15 or 7.3%)
      • Live/ work in proximity to a possible domestic target (n=45 or 22%)
      • Family or friends in Middle East (n=6 or 2.9%)
    • 161 psychologists experienced some sort of personal impact
      • Family or friends in military or reserves (n=53 or 23.6%)
      • Live/ work in proximity to a possible domestic target (n=130 or 57.8%)
      • Family or friends in Middle East (n=30 or 13%)
  • 11. Personal Impact on Clients and Psychologists
  • 12. Overall Emotional Impact on Clients and Psychologists
  • 13. Cumulative Effect of Client’s’ Concerns on Psychologists
    • Many reported specific concerns about particular clients and their families
      • Client, spouse, or child in military or overseas
    • Psychologists reported the extent to which they have been affected overall by their clients’ concerns
      • 26% not at all
      • 40% a little bit
      • 25% somewhat
      • 9% quite a bit or a great deal
  • 14. Clinical Interventions
      • Clinical Interventions to Address Concerns about War and Terrorism (Not Mutually Exclusive)
    % n = Clients for whom war and threats of terrorism have become a focus of treatment n=27 37 10 Relaxation 63 17 Cognitive Restructuring 77.8 21 Stress Management 85.2 23 Developing active coping strategies 92.6 25 Exploration of concerns
  • 15. Psychologist Self Care Strategies n=225
      • Strategies Used to Cope with Personal and Client Concerns about War and Terrorism (Not Mutually Exclusive)
    92% 207 Communication with friends/ family 6.2 14 Personal therapy 38.2 86 Spiritual and/or religious involvement 38.2 86 Social activism/ political activity 52.9 119 Consultation with colleagues/ superiors 70.2% 158 Balancing activities
  • 16. Clinical Encounter Settings and Services
    • Independent/private practice – solo 49% or group 23%
    • Organizational health care setting – 22%
      • Mental health services setting – 31%
        • 79% Outpatient, 0% Residential, 7% Inpatient, 14% partial hospitalization
      • Primary health care setting – 11%
      • Medical center/ hospital - 44%
    • Individual therapy or counseling – 79%
    • Formal assessment or evaluation – 20%
    • Providing educational information and/or materials – 10%
    • Medication evaluation/management –2.4%
  • 17. Primary Source of Payment 55% of self-pay clients have insurance but are not using it
  • 18. DSM-IV Diagnosis
    • 86% of clients have been diagnosed
      • Predominantly Mood (37%), Anxiety (19%) and Adjustment disorders (12%)
      • 14% Axis II diagnosis
    • 5% diagnosis not yet completed
    • 8% no diagnosis
    • 1% not assessed
  • 19. Primary Axis I Diagnoses of All Clients
    • Diagnosis N= 206
    • Mood Disorders 76 37%
      • MDD (n=37), Dysthymia (n=22)
    • Anxiety Disorders 39 19%
      • PTSD (n=11), GAD (n=13)
    • Adjustment Disorders 24 12%
    • Childhood Onset Disorders 13 6.3%
    • Psychotic Disorders 9 4.4%
    • Substance Use Disorders 4 1.9%
  • 20. Primary Axis I Diagnoses of All Clients, cont.
    • Cognitive Disorders 5 2.4%
    • Eating Disorders 1 0.5%
    • Medical/ Psychological Issues 4 1.9%
    • Diagnosis not yet completed 10 4.9%
    • No DSM-IV diagnosis assigned 16 7.8%
  • 21. Suggested Citation
    • American Psychological Association Practice Directorate. (2003). PracticeNet survey:War and Terrorism: The Effect on Clinical Practice. Retrieved Month, Day, Year from: http://www.apapracticenet.net/results/
  • 22. Acknowledgements
    • PracticeNet’s original development has been underwritten by the Center for Substance Abuse Treatment (CSAT) as part of the agency’s effort to learn more about the ways in which psychologists are encountering and treating problems related to substance use.
  • 23. www.apapracticenet.net