MODULE IX. The Emotional Impact of Disasters on Children and their Families

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1 MODULE IX The Emotional Impact of Disasters on Children and their Families

2 Financial Disclosures none

3 Outline Disaster types Disaster Stages Risk factors for emotional vulnerability Emotional response Interventions

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7 Stages of Disaster Predisaster IMPACT Rescue and Response Recovery T I M E

8 C H I L D S T R E S S L E V E L Trauma is a Process, Not an Event fear of loss of parent change in parenting ability Change in home/community Fear of parental Separation death of family members Separation anxiety hospital visits move from community Health facility exposure Change in parent/family Cascade of Events Post Parental Injury T I M E (months)

9 Emotional Vulnerability: Resilience vs. Psychopathology Most disaster victims recover without the development of psychopathology or the need for treatment Possibility for posttraumatic growth

10 Resilience Variability in Trauma Response functioning subject 1 subject 2 subject 3 subject 4 functional illness time Time of trauma

11 Trauma related risk factors for emotional vulnerability Direct victims (e.g., those injured) Direct or indirect witnesses to the event Children and staff who felt at the time that their life was in jeopardy Children and staff exposed to horrific scenes (e.g., bloody children or those severely injured), including those indirectly exposed through the media Children and staff who may experience feelings of guilt associated with the incident

12 Child and family risk factors risk factors for emotional vulnerability History of prior psychopathology or traumatic experiences Children who experienced separation from parents/caregivers, loss of home or belongings Children whose parents are experiencing difficulty in coping and may be distracted, emotionally unavailable Children whose families have difficulty communicating openly about the event, its aftermath, and associated feelings or who lack resources and supportive services

13 Community related risk factors for emotional vulnerability Disruption in schedules and routines (school closings Induction of fear and erosion of safety Opportunism that undermines safety

14 Emotional response: immediate Anxiety and trauma-related fears, including concerns about recurrences Sleep problems (trouble falling or staying asleep; nightmares) Separation anxiety (refusal to separate from family members) and school avoidance Difficulties with concentration Feelings of guilt and self-blame

15 Emotional response: immediate Feelings of emotional numbing, being in a daze, A sense of what has occurred is not real or that one doesn t feel like oneself, Lack of memory for some aspects of the experience (amnesia).

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18 Emotional response: weeks, months, years Persistent guilt Anger Deterioration in academic performance Regression, both developmental and social Depression Avoidance of previously enjoyed activities

19 Emotional response: weeks, months, years Pessimistic thoughts about the future Repetitive play enactment of the trauma Substance abuse Somatization (i.e., physical complaints that are due to underlying psychological distress, such as stomach aches or headaches) Reactions to domestic violence, which may be more frequent post-disaster

20 MOST FREQUENT EMOTIONAL DISORDERS Acute stress disorder Post-traumatic stress disorder Depression Anxiety Oppositional Defiant

21 Developmental Considerations Children may express distress differently than adults Behavioral manifestations may be misunderstood Limited communication skills Younger children may harbor cognitive distortions especially around causation

22 Interventions: must understand social environment National Community Local Community Parents and Family Individual Child Child is contained within layers of support Transactional interplay between layers Interaction may be mutually constructive or detrimental Family is the closest social support Encourage recovery by supporting role functioning

23 Interventions: possible caregivers in community Hospital staff personnel Child care workers, Day care providers Teachers and teacher s aids Secretarial staff (e.g., can assist with communication and reunification services) Traditional mental health providers (e.g., psychiatrists, psychologists, social workers, etc.) Other healthcare providers (e.g., pediatricians, nurses, etc.)

24 Interventions: caregivers A. Understand emotional reactions Pay attention to behaviors at home and at school or daycare Recognize that adjustment problems are common Don t underestimate children s distress Screening tools for ptsd and depression may be helpful B. Reduce the emotional impact Provide support, comfort, and time for play and discussion Model healthy coping behavior Direct parents to seek help, if needed C. Facilitate recovery Normalize routines as soon as possible Listen to children and validate their feelings Encourage activities that help them express their feelings

25 Interventions: parents Return to normal routines, with additional supports and appropriate accommodations Be patient and supportive Set normal and appropriate limits to children Allow children to talk about their worries and feelings Encourage children to spend time with friends Encourage children to resume their developmental tasks Parents should get support and treatment if indicated Help teachers see the problem and show understanding

26 Principles of Psychological First Aid ALGEE Assess for suicide Listen non-judgmentally Give reassurance and info Encourage self-help and other support strategies Encourage professional help

27 Explaining death to children Ask children their understanding of death Explain death using simple and direct terms. It is best to present both the facts about what happens to the physical body after death, as well as the religious beliefs that are held by the family After explanations have been given to children, it is helpful to ask them to review what they now understand about the death

28 Saying Goodbye It is also helpful for children to find their own unique way of saying goodbye to someone they have lost- this can be achieved through painting, planting and caring for a tree, praying, lighting a candle, or any other suitable expression.

29 CRITERIA TO SEEK MENTAL HEALTH ASSISTANCE 1. Suicidal or homocidal ideation 2. Symptoms that persist > 3 months and interfere with everyday life Behavioral changes Behavioral school problems Withdrawal behavior that interferes with social life Frequent nightmares that persist over time Persistent somatic complaints Avoiding behavior or anxiety symptoms that interfere with everyday life Alcohol or substance abuse 3. Consider risk factors: recent parental divorce, death of a significant close relative, having moved or changed school recently

30 draw1.jpg Disaster type: Hurricane Disaster stage: four months later Emotional vulnerability/risk factors: witnessed death of relatives, friends, loss of home and school, poverty, separation from father Emotional response: Separation anxiety, sleep difficulty, nightmares Headaches, sadness, fear of bad weather, Intrusive thoughts Interventions:3 months temporary safe place to stay, reunification with family, food, clothing, school, support groups, recreation Result: symptom improvement, hope mixed with tears

31 References National Institute of Mental Health: Mental health first aid: / Disaster Mental Health Training: Care of Children Exposed to the Traumatic Effects of Disaster: Jon A. Shaw, M.D., Zelde Espinel, M.D., M.A., M.P.H., James M. Shultz, M.S., Ph.D. Washington, DC, American Psychiatric Publishing, 2012, 243 pp.