Children in Disasters

1
Children in Disasters

• How Children Cope
• and How Responders Can Help

2
Objectives

• An overview of world events and their impact on
  children
• Childrens 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
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

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
Katrinas 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
Katrinas 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 Childrens 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 (coi10.1542/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 Childrens 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 (coi10.1542/peds. 2006-0099U
14
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 Its 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
15
Children and Youth Emotional Issues Post
Hurricane -NO

• Returned to Homes
• Childrens 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

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
• 2/3s 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

Teachers Guide for Using Painting as a Medium to
Develop Resiliency and Convey Hope at
http//ournationsresilience.org/teachers.shtml  B
yMaryam 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 hoursChildren/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 childrens 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 childrens feelings and help them
  label them
• Admit it if you do not know the answers to the
  childrens questions.
• Reflect childrens 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 childs 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_at_dmh.mo.gov
• Web www.dmh.mo.gov