Stepped Triage-to-Care Using PsySTART and TF-CBT for Pediatric Trauma Response Following the 2023 Derna, Libya Flood
1
Department of Psychiatry, Bronx Care Health System, New York, United States
Popul. Med. 2026;8(Supplement Supplement 1):A3438
ABSTRACT
BACKGROUND:
The September 10, 2023, flooding in Derna, Libya, caused catastrophic loss of life and mass displacement, with children bearing the greatest psychological impact. Preliminary screening of 67 children revealed severe trauma exposure—93% reported personal loss, 91% experienced direct life threats, and 95% exceeded clinical risk thresholds for posttraumatic stress.
METHODS:
A stepped triage-to-care framework was deployed using the Child Disaster Mental Health CONOPS and PsySTART systems. A total of 6,932 children were triaged, of whom 1,191 met criteria for trauma-focused cognitive behavioral therapy (TF-CBT). Service demand was estimated in hours for resilience skills training (PRAC) and full TF-CBT sessions (TICE), while provider capacity was assessed to determine delivery feasibility.
RESULTS:
Projected service needs included approximately 7,146 hours of PRAC and 5,005 hours of TICE, contrasted with only five available trained providers. To address this shortfall, scalable delivery models were developed, incorporating school-based group interventions, lay counselor task-shifting, and adaptive triage prioritization to maximize care coverage under resource constraints.
CONCLUSIONS:
This stepped triage-to-care framework demonstrates a feasible, scalable approach to pediatric trauma response in resource-limited, disaster-affected settings. Implementing hybrid group-based TF-CBT and resilience education can provide rapid, broad-based support while reserving intensive therapy for persistent or severe cases. This initiative represents the first large-scale integration of PsySTART with TF-CBT pathways in a conflict-affected disaster context.
The September 10, 2023, flooding in Derna, Libya, caused catastrophic loss of life and mass displacement, with children bearing the greatest psychological impact. Preliminary screening of 67 children revealed severe trauma exposure—93% reported personal loss, 91% experienced direct life threats, and 95% exceeded clinical risk thresholds for posttraumatic stress.
METHODS:
A stepped triage-to-care framework was deployed using the Child Disaster Mental Health CONOPS and PsySTART systems. A total of 6,932 children were triaged, of whom 1,191 met criteria for trauma-focused cognitive behavioral therapy (TF-CBT). Service demand was estimated in hours for resilience skills training (PRAC) and full TF-CBT sessions (TICE), while provider capacity was assessed to determine delivery feasibility.
RESULTS:
Projected service needs included approximately 7,146 hours of PRAC and 5,005 hours of TICE, contrasted with only five available trained providers. To address this shortfall, scalable delivery models were developed, incorporating school-based group interventions, lay counselor task-shifting, and adaptive triage prioritization to maximize care coverage under resource constraints.
CONCLUSIONS:
This stepped triage-to-care framework demonstrates a feasible, scalable approach to pediatric trauma response in resource-limited, disaster-affected settings. Implementing hybrid group-based TF-CBT and resilience education can provide rapid, broad-based support while reserving intensive therapy for persistent or severe cases. This initiative represents the first large-scale integration of PsySTART with TF-CBT pathways in a conflict-affected disaster context.
| eISSN: | 2654-1459 |
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