Children in Disasters : Children in Disasters How Children Cope
and How Responders Can Help
Objectives : Objectives An overview of world events and their impact on children
Children’s reactions by developmental level
Special issues and their impact on children
Separation
Decontamination
Disease
How Responders can reduce the impact of disaster on children
Indian Ocean Tsunami December 26, 2005 : Indian Ocean Tsunami December 26, 2005 Overcrowded camps – abuse
Loss of one or both parents
6 months later bodies still
being recovered, others
will never be found
Narrowly escaped death
themselves, bodily injuries, disabilities
Loss of sense of security (the monster sea)
Loss of structure – families, homes, schools, shopping
Inequitable aid in aftermath The December 26th Tsunami: Impact and Damage Assessment
Psychosocial Impact of the Tsunami on Children: Sri Lanka, India and Indonesia Chaitanya, The Policy Consultancy
Indian Ocean Tsunami December 26, 2005 : Indian Ocean Tsunami December 26, 2005 Children separated, missing,
Lack of sound documentation &
reporting of unaccompanied children
hampers response & heightens risks
Child labor, sexual exploitation,
trafficking, recruitment to
Tamal Tigers
Traumatized adults
Large extended families that take in
multiple children may not be able to
provide the nurture and loving care critical
for child development
The December 26th Tsunami: Impact and Damage Assessment
Psychosocial Impact of the Tsunami on Children: Sri Lanka, India and Indonesia Chaitanya, The Policy Consultancy
A Wave of Reactions : A Wave of Reactions Avoidance of sea
Increased nightmares
Some may develop PTSD or other disorders such as depression
5% do not interact with peers or cry excessively
Some have developed disorders with no organic basis such as facial paralysis
Vast majority play in camps are not isolated and do not exhibit serious dysfunction
Risk by developmental age
Risk by Developmental Age : Risk by Developmental Age Under 5 = significant risk:
Overwhelmed young mothers;
children at risk of malnutrition
and disease
In care of relatives or friends while
mothers search for work; others left alone
while parents searched for potable water,
food
Lack attention to health & proper care
Separated children at risk of inappropriate
adoptions
Orphaned children placed in institutions
Risk by Developmental Age : Risk by Developmental Age School Age
In camps interact with peers, help parents, engage in play – some very rough
Loss of structures that provide normalcy destroyed
Orphans – risk of alienation & despair ever present
Separated children at
risk of institutionalization,
marginalized & subject to
child labor
Risk by Developmental Age : Risk by Developmental Age Teenagers:
Affected more severely compared to younger children (parental report)
Able to conceptualize the magnitude of the disaster, their mortality and the effects on their future
Teen girls at risk of sexual harassment, sexual exploitation & HIV/AIDS in centers/camps
Need to reduce household pressure could lead to early marriage for girls,
increasing domestic burdens
and threaten their schooling
Hurricane Katrina August 29, 2005 : Hurricane Katrina August 29, 2005
Katrina’s Impact : Katrina’s Impact
Loss of life – saw bodies in water, NO
Bodies still being recovered, others will never be found in 9th. ward
Narrowly escaped death themselves, bodily injuries,
Loss of sense of security
Loss of structure – families,
homes, neighborhoods,
schools, shopping
Katrina’s Impact : Katrina’s Impact
Inequitable aid in aftermath
Children separated, missing:
Last of separated children
reunited with family 8 months
later
Children relocated; uncertainty
about the future
Witnessing violence in dome
Overwhelmed parents/caregivers
Evacuation
Experiences Post Katrina : Experiences Post Katrina Secondary trauma due to situations in shelters: for example adults with m.i. and without their medications were with their children
Refugee families retraumatized from earlier experiences in Viet Nam
Emptying of schools – filling of others
Consent, confidentiality and continuity of care issues for children separated from families & moved from shelter to shelter
Some youth reported 5 – 6 weeks later: more serious symptoms of acute stress Pediatrics, Challenges in Meeting Immediate Emotional Needs: Short-term Impact of a Major Disaster on Children’s Mental Health: Building Resiliency in the Aftermath of Hurricane Katrina Madrid, Paula, Grant, Roy, Reilly, Michael, Redlener, Neil. Vol. 117 No. 5, May 2006, pp. S448-S453 (coi:10.1542/peds.
2006-0099U
Experiences Post Katrina : Experiences Post Katrina
Difficulty in connecting with treatment
providers – Doctors, mental health
providers, etc.
Increased suicidal ideation, suicidal attempts among children as young as 7 years old; parents had difficulty enforcing limits and controlling child behavior or identifying red flags
10 weeks out – Behavioral & emotional changes in children Pediatrics, Challenges in Meeting Immediate Emotional Needs: Short-term Impact of a Major Disaster on Children’s Mental Health: Building Resiliency in the Aftermath of Hurricane Katrina Madrid, Paula, Grant, Roy, Reilly, Michael, Redlener, Neil. Vol. 117 No. 5, May 2006, pp. S448-S453 (coi:10.1542/peds.
2006-0099U
Children and Youth Emotional Issues – Post Hurricane -NO : Children and Youth Emotional Issues – Post Hurricane -NO Returned to Homes
Appear to be more impacted
See & feel destruction “Big Hole”
Miss small things
Reminisce about good times at bad schools
Some in NO with other family members while parents away b/c of work or housing Have not returned Home
Still sense “It’s not real.” freeze frame of existing house
Do not want to see life “in shambles”
Start lives over other places
Children impacted by parental response
Some still in limbo/ not in control
Verbal Survey of workers in LA.: Vee Boyd, Federation of Families; Tracy Cormier
/CCANO; Carol Clement/VOA Reg 5
Children and Youth Emotional Issues – Post Hurricane -NO : Children and Youth Emotional Issues – Post Hurricane -NO Returned to Homes
Children’s response impacted by adults
Some elevation of domestic violence, child abuse
Elevated anxiety among all children regarding:
hurricane season
lack of fiscal resources for evacuation
Limbo of living/work situations in families
Children in trailers on home site have daily trauma of home damage
In trailers, small spaces, no privacy Have not returned Home
Parents returned to work/some form of housing but children are staying elsewhere
Children who have not returned are frequently seen as being sad & depressed – lack of friends at new schools; do not know where friends are.
Lack of activities/transportation to get to activities esp. rural areas
Elevated anxiety resulting in:
Shutting down or acting out
US vs THEM evacuees
Rural vs. Urban
The Caruthersville Tornado : The Caruthersville Tornado
April 2 tornado destroyed 60% of city
Middle School and High School destroyed
RESULTS
Students attend school at elementary school in shifts
Many families left town/friends due to lack of housing
Students are afraid for safety as they go back to school Sept. 5 in trailers
Man Made Disasters 9/11 : Man Made Disasters 9/11 New York City Board of Education (2002) study by Hoven: Assessed reactions: 8,266 students, Grades 4 - 12
Exposure rate of children throughout
city – high
Ground Zero children personally exposed
2/3’s children in other areas of city exposed
Many fled for safety
Had trouble returning home on Sept. 11
Continued to smell smoke (41%)
11% of public school children had a
family member or close friend exposed
to the attacks
1% had a family member killed The Mitigation & Recovery of Mental Health Problems in Children & Adolescents
Affected by Terrorism; Mollica, et al. April 24, 2003
Mass Violence : Mass Violence Research on children exposed to mass violence reveals that the devastating mental health effects are primarily due to:
Effects on parents
Unmet survival needs
Interference with developmental tasks
(UNICEF, UNHCR) p. 8
Media exposure
Disease : Disease Isolation
Quarantine
Separation
Stigma
Orphans
Children caring for adults
Pandemic Planning Issues:
What will children witness?
Who will care for children if adults are ill?
Will schools be in session?
Slide20 : Bioterrorism and Children Emotional/Behavioral Considerations:
Agents may cause reactions that mimic
psychiatric symptoms
Less ability to escape physically
Greater reliance on caregivers who may
be injured or dead
Fewer or less developed coping skills
Greater anxiety over reported incidents,
hoaxes, media coverage
Difficulty adequately describing
symptoms
Problems understanding commands
from safety personnel
Afraid of responders dressed in
protective suits Teacher’s Guide for Using Painting as a Medium to Develop Resiliency and Convey Hope at
http://ournationsresilience.org/teachers.shtml
By:Maryam Mohensi, Age 17
Decontamination : Decontamination Issues for children
Frightened of PPE
May have prior trauma: child abuse, sexual abuse, rape
Developmental issues with sexuality
Develop protocols for decontaminating children when caregivers may not be present
i.e. accompaniment by same sex person through process
Separate showers for males/females
Warm showers: so children are not retraumatized by hyperthermia
Lessons Learned : Lessons Learned Develop improved means of protection
Carefully monitor orphaned children in family placements vs. institutionalizing
Develop tracing and reunification plans/programs even to extended family
Plan for immediate psychosocial support for children and families
Evaluate privacy restrictions of responding agencies that may prevent reunification
Lessons Learned : Lessons Learned Plan for availability of physicians care and medications in shelters such as psychiatric medications
Assist parents with parenting
Transitory work force (volunteers) complicated the relief effort in Katrina in emergency medical centers –lack of continuity of care
Routine and predictability should be established quickly
Adult Issues That Affect Children : Adult Issues That Affect Children Adults may not recognize distress in children
Children may be compliant in the aftermath of an event
Adults may be
preoccupied with
their own issues Marleen Wong, Director School Crisis & Intervention Unit, UCLA and Duke
Goals at Disaster Site : Goals at Disaster Site PROTECT - shield children from:
Bodily harm
Exposure to traumatic stimuli (sights, sounds, smells)
Media exposure
DIRECT - ambulatory children in shock, dissociative
Use kind and firm instruction
Move away from danger, destruction, severely injured
CONNECT
To you - be a supportive presence
To caregivers
To accurate information
(Young, Ford, Ruzek, Friedman & Gusman, National Center for PTSD)
Crisis Response : Crisis Response Triage for signs of stress that jeopardize safety
Segregate survivors based on exposure level
Control flow of information and limit
unnecessary re-exposure
Begin psychological first aid (reestablish the
perception of security and sense of power)
The majority of children will
display normal
stress reactions
What not to do : What not to do Force children/youth to talk about
feelings
Avoid all discussion about
traumatic event
Be a poor role model
Allowing your personal resources to be drained
Using negative coping
Showing uncontrolled
emotions in front of children/youth
The first few hours: Children/Youth will need to know : The first few hours: Children/Youth will need to know Adults are in control and will help keep them safe
That what they are feeling in response to the disaster is normal
The first few hours: What to Do: : The first few hours: What to Do: Safety and Security first
If evacuating children from daycare or school, keep each room grouped together if possible
Keep children near familiar peers and adults
Do not allow children to detach themselves from the group – unless
Child is having very difficult time & needs personal attention
Sibling is with another group and you can reunite the siblings
The first few hours: What to Do: : The first few hours: What to Do:
Shield children from seeing damage or severe injuries if possible
Use distraction techniques
If a child becomes distraught, have an adult who knows her provide comfort
Model good coping.
Meet children’s physical needs
The first few hours: What to say : The first few hours: What to say Provide clear simple explanations for what happened and what will happen (reunification with caregivers)
Acknowledge children’s feelings and help them label them
Admit it if you do not know the answers to the children’s questions.
Reflect children’s feelings
but, redirect from talking about gruesome details
Praise children and youth
Following instructions
Helping others
Being brave
Summarize the disaster and its
resolution
Referrals : Referrals When:
The child’s thoughts and
feelings are so overwhelming
they interfere with his daily living.
A child hints or talks openly about suicide
There is child abuse
The child has socially isolated himself
The problem is beyond your training or capability From Nebraska Psychological First Aid Curriculum, University of Nebraska Public Policy Center
Referrals : Referrals
The child develops imaginary ideas or feelings of persecution (delusions, hallucinations)
There is difficulty in maintaining real contact with the person
Use of alcohol or drugs
Engaging in risk or threatening behaviors
You cannot disengage from the child From Nebraska Psychological First Aid Curriculum, University of Nebraska Public Policy Center
Contact Information : Contact Information Jenny Wiley, MSW, LCSW
Assistant Coordinator, Disaster Readiness
Department of Mental Health
1706 E. Elm
Jefferson City, MO 65102
573-751-4730
Email: jenny.wiley@dmh.mo.gov
Web: www.dmh.mo.gov