TENTS guidelines: development of post-disaster psychosocial care guidelines through a Delphi process

TLDR

Planning and delivering psychosocial care after disasters remains a debated challenge. The study aims to develop evidence‑informed guidelines for post‑disaster psychosocial management. A three‑round web‑based Delphi with 106 experts rated and revised statements on a 1–9 scale to reach consensus. Consensus was reached on 80 of 111 statements, leading to guidelines that call for multi‑agency planning, general support, and targeted interventions such as trauma‑focused CBT for acute stress disorders, with other evidence‑based treatments for chronic PTSD offered if CBT is not tolerated.

Abstract

Background How best to plan and provide psychosocial care following disasters remains keenly debated. Aims To develop evidence-informed post-disaster psychosocial management guidelines. Method A three-round web-based Delphi process was conducted. One hundred and six experts rated the importance of statements generated from existing evidence using a one to nine scale. Participants reassessed their original scores in the light of others' responses in the subsequent rounds. Results A total of 80 (72%) of 111 statements achieved consensus for inclusion. The statement ‘all responses should provide access to pharmacological assessment and management’ did not achieve consensus. The final guidelines recommend that every area has a multi-agency psychosocial care planning group, that responses provide general support, access to social, physical and psychological support and that specific mental health interventions are only provided if indicated by a comprehensive assessment. Trauma-focused cognitive–behavioural therapy (CBT) is recommended for acute stress disorder or acute post-traumatic stress disorder, with other treatments with an evidence base for chronic post-traumatic stress disorder being made available if trauma-focused CBT is not tolerated. Conclusions The Delphi process allowed a consensus to be achieved in an area where there are limitations to the current evidence.