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Children in Disasters

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  1. Children in Disasters How Children Cope and How Responders Can Help

  2. 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

  3. Indian Ocean TsunamiDecember 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

  4. Indian Ocean TsunamiDecember 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

  5. 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

  6. 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

  7. 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

  8. 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

  9. Hurricane KatrinaAugust 29, 2005

  10. 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

  11. 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

  12. 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

  13. 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

  14. 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 Children and Youth Emotional Issues – Post Hurricane -NO Verbal Survey of workers in LA.: Vee Boyd, Federation of Families; Tracy Cormier /CCANO; Carol Clement/VOA Reg 5

  15. 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 Children and Youth Emotional Issues – Post Hurricane -NO

  16. 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

  17. Man Made Disasters9/11 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

  18. 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

  19. 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?

  20. 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

  21. 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

  22. 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

  23. 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

  24. 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

  25. 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)

  26. 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

  27. 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

  28. 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

  29. 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

  30. 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

  31. 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

  32. 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

  33. 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

  34. 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