Helping Students Cope With the Haitian Earthquake: Guidance for School Mental Health Professionals

Transcription

1 Helping Students Cpe With the Haitian Earthquake: Guidance fr Schl Mental Health Prfessinals The scale f the physical devastatin and the lss f life caused by the recent earthquake in Haiti can be expected t have a range f emtinal effects n children here in the United States. Mst children, like mst adults, will struggle t cmprehend the magnitude f the tragedy but will cpe well. Hwever, expsure t the hrrr f the earthquake and its aftermath, prvided by graphic media reprts, can increase emtinal prximity t this event, and cnsequently its emtinal impact, even fr children and yuth nt directly cnnected t unflding events. Children are particularly vulnerable t such expsure. Additinally, many schls thrughut the cuntry will be supprting students wh are directly linked t the disaster because they have lved nes in Haiti wh are missing, injured, dead, r struggling t survive. Mst are Haitian Americans, but there were als thusands f nn-haitian Americans in Haiti at the time f the earthquake, many f whm have family here. In sme cases whle cmmunities with large ppulatins f Haitian Americans are facing a state f uncertainty, grief, and extreme urgency t help their devastated native cuntry. Sme f these cmmunities are likely t receive rphans rescued frm Haiti wh will have extreme trauma needs (and NASP plans t ffer additinal guidance n this tpic in the cming weeks). The fllwing infrmatin prvides an verview fr schl mental health prfessinals, wh can wrk with ther schl persnnel and parents t mitigate serius emtinal reactins in children by being aware f risk factrs, trauma symptms, and strategies t strengthen prtective factrs. RISK FACTORS With supprt frm parents and teachers, mst students will successfully cpe with this tragedy and nt suffer significant emtinal cnsequences. Hwever, sme may be at risk fr mre extreme reactins. The severity f these reactins will depend n a variety f factrs, including: Persnal Circumstances Students wh cme frm, r may have lst lved nes in, Haiti are an especially high-risk grup. Trauma Histry Children wh have previusly been expsed t natural disasters (especially earthquakes), have already experienced significant lss, and/r are currently cping with ther critical incidents can be cnsidered a high-risk grup. Excessive Media Expsure Otherwise unaffected students may becme fearful f the earthquake fllwing excessive expsure t graphic media reprts. Parents Reactins and Family Supprt Altered family functining, separatin frm parents, and nging parental distress and preccupatin with the earthquake are risk factrs. Emtinal Reactivity Children wh tend t be anxius are thse mst likely t display trauma reactins. Mental Health Children wh have a preexisting mental disrder, particularly an anxiety disrder, are at greater risk. Cping Style The use f blame and anger as ways f cping may create mre distress fr children, and the primary use f avidance cping strategies can predict negative mental health utcmes. CRISIS REACTIONS Crisis reactins will differ depending n develpmental level and are generally marked by changes in typical behavir fr the specific child r adlescent. Sme specific reactins that may signal the need fr additinal supprt and assistance include: 1

2 Preschlers thumb sucking, bedwetting, clinging t parents, sleep disturbances, lss f appetite, fear f the dark, behaviral regressin, and withdrawal frm friends and rutines. Elementary Schl Children irritability, aggressiveness, clinginess, nightmares, schl avidance, pr cncentratin, behaviral regressin, and withdrawal frm activities and friends. Middle and High Schl Yuth sleeping and eating disturbances, agitatin, increase in cnflicts, physical cmplaints, delinquent behavir, and pr cncentratin. Psttraumatic Stress Disrder (PTSD) A minrity f students may even be at risk fr PTSD. This will primarily include children wh lst significant family members r wh have witnessed r experienced a severe trauma. In additin t the reactins mentined abve, symptms f PTSD include reexperiencing the traumatizing circumstances (which can include being ntified f the death f a lved ne and seeing caregivers in extreme emtinal pain); anticipating that the earthquake is happening again; aviding reminders f the earthquake; general numbness t emtinal tpics; and increased arusal symptms, such as inability t cncentrate and startle reactins. Althugh rare, sme adlescents may als be at increased risk f suicide if they suffer frm serius mental health prblems like PTSD r depressin. Students wh exhibit these symptms shuld be referred fr apprpriate mental health evaluatin and interventin. ISSUES AND CHALLENGES ASSOCIATED WITH THE HAITIAN EARTHQUAKE Haiti and Cultural Implicatins Haiti, a natin f 9 millin peple, is the prest cuntry in the Western hemisphere, with apprximately 80% f its ppulatin living in pverty and subsisting n less than $2 a day. The ppulatin speaks Haitian Crele and the literacy rate within the cuntry has been estimated t be abut 55%. Haiti was struck in 2005 and 2008 by multiple hurricanes, which displaced hundreds f thusands f peple. Even befre the earthquake, less than half the peple had access t clean drinking water, and malnutritin was prevalent. In additin, natural disasters typically have the greatest impact n thse with the least financial resurces. They have fewer resurces t prevent the prblems frm ccurring (that is, t build hurricane r earthquake resistant buildings) r t deal with tragedy after it has ccurred. Current estimates place the death tll a 200,000, with 3 millin peple likely t need internatinal aid fr the freseeable future. These numbers are likely t change in the cming weeks. The peple f Haiti and thse f Haitian descent living with the United States are prud, resilient, and hard wrking. Typically, Haitians are a reserved peple; they may appear nt t express emtin during the crisis, even if they have suffered a great lss (althugh the persnal grieving prcess can be very emtinal.) Generally, Haitians will nt speak unless prmpted. In additin, Haitians will nt necessarily seek ut supprt but will accept it if ffered. As is the case in any culture, in a crisis it is nt unusual fr children s emtinal needs t be neglected because f the necessity f adults t take care f ther cmpeting and mre pressing cncerns. Challenges fr Families in the United States One f the primary tasks fr the schl-based mental health prfessinal is t help children cpe with the challenges r prblems generated by a crisis event. T d s, he r she must first help the student identify the specific prblems generated by the crisis. It is likely that every Haitian American has been directly affected t sme degree by this disaster. Students within this cmmunity will likely be dealing with a range f issues, including: the inability t cmmunicate with lved nes and the crrespnding inability t determine the status f friends and families wrry and anxiety fr survivrs wh are cping with hrrific cnditins (including lved nes) grief fr lved nes wh have died distress ver identifying lved ne s bdies and btaining prper burials that prvide a sense f dignity and the inability t establish a sense clsure with their lved nes wh have died a deep sense f despair ver the ttal devastatin f a hme twn fr thse have nt traveled back t Haiti, a prfund sense f lss ver ever cnnecting t their hmeland and culture cncern abut the ptential fr vilence and significant disease and widespread health prblems 2

3 extreme frustratin ver nt being able t d mre t help an intense urgency t d smething practive parents wh are immersed in their emtinal reactins and attempts t cpe and/r lcate and help lved nes a strengthening r crisis f faith as they try t understand the tragedy a deepening sense f cmmunity and pride in being Haitian Students wh are nt part f the Haitian American cmmunity but wh have family members r ther lved nes in Haiti may als be dealing with many f the same issues mentined abve, in additin t experiencing a sense f islatin in their distress r grief because they are nt part f a larger cmmunity experiencing a similar situatin. Abut Earthquakes Althugh mst students being supprted here in the United States will nt have experienced the earthquake directly, sme will have family members wh did, and many will have seen images n televisin. As a mental health prfessinal, it is helpful t understand the unique nature f earthquakes. Aftershcks differentiate earthquakes frm ther natural disasters and the prfund devastatin f the entire infrastructure, including majr scial institutins, differentiates the Haitian earthquake frm similar disasters ccurring in ther regins. Since there is n clearly defined endpint, the disruptins caused by cntinued tremrs and devastated infrastructure may increase psychlgical distress. Unlike ther natural disasters (e.g., hurricanes and certain types f flds), earthquakes ccur with virtually n warning. This fact limits the ability f disaster victims t make the psychlgical adjustments that can facilitate cping. This relative lack f predictability als significantly lessens feelings f cntrllability. Prviding students in the United States, wh nw appear anxius abut earthquakes, with factual infrmatin abut the risk they face frm such a natural disaster may be indicated. T the extent these students live in earthquake prne areas, prviding them with adaptive respnses t this type f natural disaster has been suggested t reduce these negative feelings (as well as prmting adaptive behavirs if and when such students are cnfrnted with the reality f an earthquake). Guidance regarding such adaptive behavir can be fund n the U.S. Gelgical Survey website RESPONDING TO CHILDREN PERSONALLY IMPACTED BY THE EARTHQUAKE The fllwing infrmatin prvides guidance n hw t supprt students wh are directly cnnected t the earthquake. Fr detailed infrmatin abut helping students cpe with lss and grief, see Helping Children Cpe With Death, Lss, and Grief. Recgnize ptential grief, anxiety, and stress. These students may be grieving fr lved nes, anxius abut family members wh are injured r unaccunted fr, r cncerned abut the future f family members whse cmmunities were destryed. In sme cases, family members here may be traveling verseas t help relatives in need r perhaps t bring rphaned children frm the family back t the United States. This level f distress may be very disruptive and result in inattentin in class, prer grades, changes in behavir, r even schl absences. The situatin may als take a gd deal f time t reslve. Wrk with parents, teachers, and ther caregivers t determine what extra supprt r leniency students need, and t develp a plan t help students keep up with their wrk. Identify children and yuth wh are high risk and plan interventins. Risk factrs are utlined in the abve sectin n children s reactins. Interventins may include individual cunseling, small grup cunseling, r family therapy. Frm grup crisis interventins, and by maintaining clse cntact with teachers and parents, the schl crisis respnse team can determine which students need supprtive crisis interventin and cunseling services. A mechanism als needs t be in place fr self-referral and parental referral f students. Determine the needs f families. Whle families may be impacted by the crisis, and parents may have difficulty fcusing n r meeting the needs f their children. Parents adjustment is an imprtant factr in children s adjustment, and the adjustment f the child in turn cntributes t the verall adjustment f the family. As mentined abve, altered family functins, separatin frm parents, and nging parental preccupatin with the trauma are mre predictive f trauma symptmatlgy in children than is the level f expsure. Recgnizing these stressrs and helping t prvide r t identify family supprt is imprtant t helping the children cpe. Understand that displaced families may require help meeting practical needs, such as clthing, meals, and child care. 3

4 Maintain an accurate and evlving list f current cmmunity resurces available t help impacted families. It is imperative t cmpile a list f cmmunity resurces. This shuld include the name, telephne number, website (if available), cntact persn (if apprpriate), a descriptin f services, and fees if charged. Try t determine if supprt grups are being prvided at lcal churches r cmmunity agencies. Supprt teachers and ther schl staff. Prvide staff members with infrmatin n the symptms f children s stress reactins and guidance n hw t handle class discussins and answer children s questins. As indicated, ffer t help cnduct a grup discussin. Additinally, schl staff members (teachers, supprt staff, administratrs, cafeteria wrkers, bus drivers, maintenance persnnel, secretaries, etc.) may have family members wh are missing, injured, r dead in Haiti. Wrk with schl administratrs t identify and prvide supprt fr affected staff. Prvide students the pprtunity t express their feelings. This culd include participating in general class discussins and activities, but ding s may nt be apprpriate fr everyne. Students shuld als have the pprtunity t meet in small grups r individually with a schl-based mental health prfessinal as deemed necessary. Students directly impacted and/r with higher risk factrs shuld be cnsidered fr these mre targeted, prfessinally facilitated discussins. In sme instances simply giving lder students a chance t be with and cmfrt each ther can be a pwerful and imprtant crisis interventin. Maintain as much cntinuity and nrmalcy as pssible. Allwing students t deal with their reactins is imprtant, but s is prviding a sense f nrmalcy. Regular classes, after-schl activities, and friends can help students feel mre secure and better able t functin. Strengthening students friendships and peer supprts is imprtant as well. Enable students t take actin. Even mre than students nt directly impacted, children wh have suffered a lss may feel cmpelled t d smething t make a difference. Their fcus is likely t be n family as well as the larger affected cmmunity. They can help rganize fundraisers within the schl r at least wrk with classmates wh are, prvide infrmatin t classmates abut specific cmmunity needs, write articles fr the schl newspaper, and mre. Ding smething psitive and knwing that their classmates want t help as well can strengthen students sense f hpe and belnging. Make mental health services available. Depressin, anxiety, and stress are natural reactins t crisis and lss. These symptms can emerge ver time. Fr many immigrant families, schl is the nly place where they have access t mental health services. Wrk with the crisis team t assess students nging mental health needs. Services can include grup and individual cunseling, referrals t cmmunity services, and a prcess fr keeping track f students at risk. T be mst effective, services must be culturally apprpriate. Understand cultural views regarding mental health. It is imprtant that mental health prfessinals be aware f attitudes tward mental illness when prviding assistance t Haitian American students. Sme Haitian Americans may believe there is stigma assciated with depressin and mental illness. If the student has belief in Vdu, depressin might be viewed as pssessin by malevlent spirits, as punishment fr nt hnring gd prtective spirits, r pssibly as a hex put n by a jealus r envius individual (Clin & Paperwalla, 1996). Understand cultural issues assciated with religin and death. In general, Haitians are a deeply religius peple. Even in the face f such enrmus tragedy, the peple f Haiti, bth survivrs and thse here in the United States, seem t be drawing heavily n their faith and their faith cmmunities t cpe, grieve, and take actin. The fficial state religin f Haiti is Cathlicism, but Prtestant missinary activity has recently increased identificatin with that belief system. In additin, Haiti is knwn fr its ppular religin, referred t by the utside wrld as Vdu. Hwever, it is imprtant t acknwledge that Haitian Cathlics and Prtestants, while they may have sme belief in Vdu, might cnsider them demns t be avided. While Cathlics and Prtestant denminatins may believe in the existence f reward r punishment after death, this may nt be the case fr practitiners f Vdu (Cuntries and their Cultures, n.d.). It is nt unusual fr death t generate uncntrllable crying r even hysteria, and thus, these reactins shuld nt be verly pathlgized. Haitians have a deep respect fr the dead, and death can mbilize the entire extended family. There are specific rituals and practices assciated with burial, which makes the difficulty dealing with the deceased fllwing the Haitian earthquake especially prblematic (Clin & Paperwalla, 1996; see als Cultural Issues in Death and Culturally Cmpetent Crisis Respnse: Infrmatin fr Schl Psychlgists and Crisis Teams). 4

5 Be willing t discuss the cncept f death. Students may be cncerned abut dying r a lved ne dying, given that large numbers f children are amng the earthquake deaths. Talking with them is imprtant. Outside resurces can be very helpful (e.g., bks geared t different ages that explre death and dying, grief and hspice rganizatins, r yur faith cmmunity). If a child cmes frm a hme with a resilient belief system r faith, it will likely prvide a pwerful surce f supprt when it cmes t dealing with these issues. Respect cultural issues and bundaries regarding crisis and death. Many Haitian American families are part f a clse-knit, ften faith-based cmmunity. Determine what supprt system students have access t and what are apprpriate frms f supprt frm schl persnnel r members f the brader cmmunity. Schls may be able t help link islated students r families t relevant cultural supprt systems. (See Cultural Issues in Death and Culturally Cmpetent Crisis Respnse: Infrmatin fr Schl Psychlgists and Crisis Teams.) Understand the grief prcess. Grieving is a prcess, nt an event. Everyne grieves differently, and nt all students within a develpmental age grup understand death in the same way r with the same feelings. A student s view f death is shaped by his r her unique view f the wrld and experiences. Expressins f grief include emtinal shck, srrw, withdrawal, regressive behavir, anger r acting ut, and disbelief/denial. (See Helping Children Cpe with Death, Lss and Grief.) Students shuld be given the pprtunity t express their grief thrugh playacting r arts and crafts (fr yunger children) and thrugh art, drama, music, and writing (fr lder elementary children, adlescents, and yuth). Help students supprt their friends. Seeing a friend cping with a lss may scare r upset students wh have had little r n experience with death and grieving. Yunger students need help understanding the cncept f death and why their friend is sad. Students f any age may need help t cmmunicate cndlences r cmfrt messages. Help them t decide what t say and reassure them that simple expressins f sympathy and ffers f supprt are fine. Help students anticipate sme changes in friends behavir. It is imprtant that they understand that their grieving friends may act differently, may withdraw frm their friends fr a while, might seem angry r very sad, etc., but that this des nt mean a lasting change in their relatinship. Encurage them t invite their friend t d regular activities like ging t the mvies r playing sprts. Spending time with friends may ffer a much needed distractin and sense f nrmalcy. Encurage children wh are wrried abut a friend t talk t a caring adult. This can help alleviate their wn cncern r ptential sense f respnsibility fr making their friend feel better. Students may als share imprtant infrmatin abut a friend wh is at risk f mre serius grief reactins. Additinally, fr students wh have experienced their wn lss (previus death f a parent, grandparent, sibling), bserving the grief f a friend can bring back painful memries. These students als are at greater risk fr develping mre serius stress reactins and shuld be given extra supprt as needed. GENERAL TIPS TO SUPPORT ALL STUDENTS Talk t yur students. Take the time t discuss events factually. Use a map r glbe and prvide relevant infrmatin abut seismlgy, gegraphy, cultural issues, emergency and public health services, and mre. Allw students t discuss their feelings and cncerns, and encurage questins. Even students wh d nt knw anyne wh has been hurt may experience a sense f lss r grief, feel at risk themselves, r be cncerned that such majr disasters can happen with little t n warning. Acknwledge and nrmalize their feelings. Being a caring listener is imprtant. Let them knw that thers share their feelings and that their reactins are cmmn and expected. Be a gd listener and bserver. Let students guide yu as t hw cncerned they are r hw much infrmatin they need. If they are nt fcused n the earthquake, dn't dwell n it, but be available t answer their questins t the best f yur ability. Yung students may nt be able t express themselves verbally. Pay attentin t changes in their behavir r scial interactins. Mst schl-age yuth can discuss their thughts and feelings, althugh they may need yu t prvide an "pening" t start a cnversatin. Mnitr the news. It is imprtant t stay infrmed, but expsure t endless news may nt be helpful. Images f the disaster itself and the resulting human suffering frm injury, hunger, and disease can becme verwhelming. Yung students in particular may nt be able t distinguish between images n TV and their persnal reality. Older 5

6 students may chse t watch the news, but be available t discuss what they see and t help put it int perspective. They may als prefer t ignre the news and t watch music vides r t engage in ther ageapprpriate activities and such a chice shuld be respected. Make a cncerted effrt nt t steretype students r cultural grups in a negative way. Emphasize that the Haitian peple are nt t be blamed fr the devastatin that ccurred. Emphasize the ingenuity, creativity, and resiliency f the citizens f Haiti. Refrain frm giving any kind f religius explanatin fr the disaster, but instead ffer supprt. If vilence erupts in Haiti, this shuld be seen as the result f desperate peple trying their best t get their essential needs fr fd, water, shelter, medical care, safety, and security met. Desperate behavir is cmmn when peple are placed in dire circumstances fr any length f time after a disaster and fear there is n clear sense f hpe fr rescue r recvery. Highlight peple s cmpassin and humanity. The Haitian earthquake has generated a tremendus utpuring f caring and supprt frm arund the wrld. Fcus n the aid being prvided by gvernments, nnprfit aid agencies, and individual dnrs. Discuss the enrmus lgistical prcess f getting aid t the mst impacted areas and the cperatin between leaders and peple f s many natins. (Many nn-haitian Americans have been emtinally impacted by this crisis. Adults shuld be cgnizant f their reactins and needs as we all try t deal with this prfund disaster.) D smething psitive with students t help thers in need. Taking actin is ne f the mst pwerful ways t help students feel mre in cntrl and t build a strnger sense f cnnectin. Suggestins include making individual dnatins t internatinal disaster relief rganizatins, hlding a schl r cmmunity fundraiser, r even wrking t supprt families in need within the cmmunity. Emphasize peple s resiliency. Help students understand the ability f peple t cme thrugh a tragic event and t g n with their lives. Fcus n students wn cmpetencies in terms f their daily lives and in difficult times. In age-apprpriate terms, identify ther disasters frm which cmmunities r cuntries have recvered. Be hnest. Acknwledge yur feelings abut the event. Be sure yur cmments are age-apprpriate, but even yung students will feel mre reassured and clser t yu if yu are hnest. Fr lder students in particular, it is kay t admit that yu feel sad, perhaps a little helpless that yu cannt d mre t make a difference, r even awed at the sheer pwer and vilence f nature. Balance statements f cncern with infrmatin abut ur wn emergency preparedness and respnse systems here at hme. REFERENCES Clin, J. M., & Paperwalla G. (1996). Haitians. In J. G. Lipsn, S. L. Dibble, & P. A. Minarik (Eds.), Culture & nursing care: A pcket guide (pp ). San Francisc: UCSF Nursing Press. Cuntries and their Cultures. (n.d.). Haiti. Retrieved January 16, 2010, frm It/Haiti.html#ixzz0csutEML RESOURCES All handuts referenced abve can be accessed at There are many rganizatins and agencies with helpful infrmatin abut helping children and families cpe with natural disasters and ther crises. There are als numerus ways t dnate t internatinal relief agencies nline. American Red Crss Federal Emergency Management Agency Natinal Assciatin f Schl Psychlgists U.S. AID Agency, U.S. State Department, U.S. Gelgical Survey , Natinal Assciatin f Schl Psychlgists, 4340 East West Highway #402, Bethesda, MD 20814, 6