Children’s Mental Health in the Aftermath of Disasters

Rebound & Recovery

A Florida State University Response to Hurricane Michael

Collaboration with Save the Children

December 20, 2019

Hurricane response and this webinar made possible by

Children’s Mental Health in the Aftermath of Disasters Rebound and Recovery

A Florida State University Response to Hurricane Michael

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Disasters have the potential to cause short- and long-term effects on the psychological functioning, emotional adjustment, health, and developmental trajectory of children. In this webinar you will learn about the adjustment difficulties in children in the aftermath of a disaster to how to promote effective coping strategies to mitigate the impact of the disaster as well as any associated bereavement and secondary stresses. We will also highlight the need for local and state governments to include in planning the mental health needs of children and their caregivers.

The Presenters:

James Clark

Dean and Professor

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College of Social Work

Tai Cole

Research Assistant

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Center for the Study & Promotion of Communities, Families, and Children

Tisha Holmes

Assistant Professor

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Department of Urban and Regional Planning

Savannah Smith

Program Associate

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Center for the Study & Promotion of Communities, Families, and Children

Ellen Piekalkiewicz

Director

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Center for the Study & Promotion of Communities, Families, and Children

*Resources for local governments, community organizations, school district and families are listed at the end of this webinar*

“How FSU �College of Social Work �Got Involved”

James Clark, Ph.D.

Dean and Professor

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Florida State University, College of Social Work

How FSU College of Social Work Got Involved

AFTER THE STORM

How FSU College of Social Work Got Involved

AFTER THE STORM

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• The most traumatic experiences are those in which their parents or caregivers are also traumatized or stressed,” says FSU College of Social Work Dean Jim Clark. “Children have also limitations in terms of their brain development and their sophistication and understanding something, for example, understanding that there’s a difference between a severe thunderstorm and a Category 5 hurricane.”

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• 12 to 15% of people who’ve been through a serious stressor like a hurricane or other natural disaster develop PTSD,” says Clark, who is also a licensed clinical social worker. “For those that are vulnerable to developing it, it literally becomes a wired response. It’s not something that simply psychologically can be conquered through just willing your way out of it.”

Tai Cole

Research Assistant

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College of Social Work

“What causes trauma?”

• According to the American Psychiatric Association, trauma is a persistent psychological and emotional response to a deeply distressing experience that has a significant negative effect on daily life.

What is Trauma?

• Child traumatic stress develops in children who have been exposed to one or more traumas over the course of their lives and develop reactions that persist and affect their daily lives after the events have ended.

What is Child Traumatic Stress?

• The Adverse Childhood Experiences Study was a landmark study conducted at Kaiser Permanente and the Center for Disease Control from 1995 to 1997. The study found a significant relationship between the number of ACEs a person experienced and negative outcomes in adulthood, including poor physical and mental health, substance abuse, and risky behaviors. The more ACEs experienced, the greater the risk for these outcomes
• ACEs (adverse childhood experiences) are traumatic events experienced by children before age 18. ACEs include all types of abuse and neglect as well as parental mental illness, substance use, divorce, incarceration, and domestic violence.

Adverse Childhood Experiences (ACEs) Study

• forming attachments
• regression or loss of previously acquired skills
• attention and academic difficulties
• nightmares
• difficulty sleeping and eating
• physical symptoms, such as aches and pains.

Children who have experience trauma or traumatic stress respond in a variety of ways

• intense and ongoing emotional upset
• depressive symptoms
• anxiety
• behavioral changes
• difficulties with self-regulation �(often misdiagnosed as ADD, ADHD, and or ODD)
• problems relating to others

Child Traumatic Stress Responses

• Demonstrate poor verbal skills
• Exhibit memory problems
• Scream or cry excessively
• Have poor appetite, low weight, or digestive problems

Children age 0-2 exposed to trauma may

Symptoms of trauma

• Have difficulties focusing or learning in school
• Develop learning disabilities
• Show poor skill development
• Act out in social situations
• Imitate the abusive/traumatic event
• Be verbally abusive
• Be unable to trust others or make friends
• Believe they are to blame for the traumatic event
• Lack self-confidence
• Experience stomach aches or headaches

Children age 3-6 exposed to trauma may

• using drugs or alcohol
• behaving in risky behaviors
• engaging in unhealthy sexual activity

Older children may experience any of the other responses in addition to

Child Traumatic Stress Responses

• Natural Disasters
• Environment Experiences

Traumatic events fall in two different categories:

What are traumatic events?

Natural Disasters

Earthquakes

Extreme Heat

Floods

Hurricanes

Landslides

Tornadoes

• Windstorms
• Winter storms

Tsunami

Wildfires

Windstorms

Winter Storms

Environmental Experiences

• Physical, sexual, or psychological abuse and neglect (including trafficking)
• Natural and technological disasters or terrorism
• Sudden or violent loss of a loved one
• Substance use disorder (personal or familial)
• Refugee and war experiences (including torture)
• Serious accidents or life-threatening illness
• Military family-related stressors (e.g., deployment, parental loss or injury)

Family Separations

Abuse

Physical, Sexual, Psychological, or Neglect

Technological Disasters & Terrorism

Family and Community Violence

Loss of a Loved One

Military Stress

Deployment, Parental Loss, or Injury

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Substance Use Disorder

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Accidents

&

Illness

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Immigration, Refugee, & War Experiences

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More than �half of U.S. families have been affected by some type of disaster (54%).

19% of injured and �12% of physically ill youth have �post-traumatic stress disorder.

“Equity Dimensions of Vulnerability to Disasters”

Tisha Holmes, Ph.D.

Assistant Professor

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Department of Urban and Regional Planning

Equity Dimensions of Vulnerability to Disasters

Disasters disrupt the day to day functioning of communities causing:

• Physical damage to people, infrastructure and property, business interruption, mental trauma, evacuation, displacement, economic losses, income losses, closure of community facilities
• It may take years to return to “normal” if at all, pressures to recovery quickly can lead to influxes of money/attention which can leave certain groups out of the process / behind

Some populations / groups are more vulnerable to these impacts than others

• Physical location, income, race, age, chronic/pre-existing health issues, housing status, housing type and quality, immigration status, physical, mental, cognitive disabilities, household status,

other environmental stressors

Equity Dimensions of Vulnerability to Disasters

• Some populations / groups have less capacity to cope and recover from these impacts as well
• Sources of income / savings to cope
• Access to transportation / money to evacuate
• Access to insurance to rebuild
• Access to information
• Social connections with others / community based services for support, shelter, recovery assistance
• Access to health care and insurance
• Quality and location of housing
• Quality of community infrastructure, amenities and infrastructure
• Lack of representation in decision making
• Health and mental conditions

The special case of children / youth as the one of the most vulnerable:

• Developmental impacts
• Mental, cognitive and physical trauma
• Susceptibility to infection
• Loss of family, community connections
• Loss of sense of place, predictability
• Vulnerability in temporary shelters
• Loss of schools, recreational spaces, places of worship

Equity Dimensions of Vulnerability to Disasters

Reducing distributional impacts and vulnerability:

• Surveillance: Identification of who is vulnerable
• Mitigation: Building codes, education, outreach, drills, targeted communication, infrastructure, household emergency plan
• Response: Warnings, evacuation, alternative forms of transportation, survival kits
• Recovery: Funding assistance, reestablishment of community facilities / organizations, youth mobilization, play therapy, relocation, housing security

Equity Dimensions of Vulnerability to Disasters

Focus on equity as an organizing principle:

• Inclusive recovery planning
• CERTS, CATS
• Community engagement and visioning
• Community Based Agreements
• Integrated collaboration and partnerships
• Planning
• Mental health
• Housing
• Emergency management
• Healthcare
• Education

Equity Dimensions of Vulnerability to Disasters

Resources

https://www.ready.gov/kids

https://www.planning.org/communityassistance/teams/

https://www.planning.org/resources/disaster/

Cases

https://www.baltimoresustainability.org/plans/disaster-preparedness-plan/

https://www.talgov.com/publicsafety/resplan.aspx

http://dhss.alaska.gov/dph/wcfh/Documents/disability/CYSHCNBookletWebAccessible.pdf

http://mrsc.org/Home/Explore-Topics/Public-Safety/Emergency-Services/Emergency-Management-and-Disaster-Planning.aspx

International

https://media.ifrc.org/ifrc/wp-content/uploads/sites/5/2018/06/DRR-in-Action-Case-Studies-FULL-Final-v2-1.pdf

“Resources and Interventions”

Savannah Smith

Program Associate

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The Center for the Study & Promotion of Communities, Families, and Children

Resources and Interventions

• Many regions will see an increase in the intensity and/or frequency of weather-related extreme events—therefore, steps must be taken to mitigate the profound impact that disasters have on children and youth, which influence their health and well-being throughout adulthood
• It is crucial that we, as adults and trusted supports in children’s life, are knowledgeable and proactive in accessing resources to help children cope with the stressors of a disaster because they are dependent on us to provide these resources
• Resources targeted towards the four areas discussed, surveillance, mitigation, response, and recovery, must be utilized to respond and minimize the negative impacts.

Surveillance and Mitigation

• Build schools, facilities, and houses that can better withstand disasters
• Federal Emergency Management Agency (FEMA) has a free builder guide for schools, families, and organizations
• Access the Readiness and Emergency Management for Schools (REMS) Center for free high-quality resources on best practices for developing emergency operation plans
• Utilize developmental level appropriate curriculum to educate children and youth on disasters and basic preparedness skills
• Focus on teaching children what disasters are from an educational, exploratory perspective through play, activities, and reading

1. Utilize social-emotional developmental books

Surveillance and Mitigation

2. Utilize activity workbooks, web-based courses, disaster educational games, and multidisciplinary lessons

Save the Children Preparedness Rally

ReadyKids.gov

Center for Disease Control (CDC)

Sesame Street Emergency Preparation Toolkit and App

Response

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• Focus on meeting immediate needs and helping children understand what has happened
• Provide Psychological First Aid (PFA): an evidence-informed approach for assisting children, youth, adults, and families in the aftermath of a disaster
• 6-hour free PFA training online on the National Child Traumatic Stress Network (NCTSN) AND mobile phone app

Response

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• After immediate needs are met, address intermediate and longer-term needs
• Provide Skills for Psychological Recovery (SPR): an evidence-informed skill-building approach for assisting survivors gain skills to manage distress and cope with post-disaster stress and adversity
• 6-hour free SPR training online on the National Child Traumatic Stress Network (NCTSN)
• Core components: (1) Prioritize needs/concerns, (2) Build problem solving skills, (3) Promote positive/pleasurable activities, (4) Skills to cope, (5) Promote helpful thoughts, (6) Rebuild positive social connections

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• SPR introduces skills necessary to improve resiliency and coping mechanisms needed to facilitate recovery of function and to prevent maladaptive behaviors following traumatic stress
• SPR places a greater emphasis on teaching specific skills to meet survivors’ needs, as well as on following up to reinforce the use of taught skills. In contrast, PFA is delivered in settings where follow-up may not be possible
• Both PFA and SPR are forms of a crisis response. Therefore, an additional step is needed for treatment beyond this crisis phase

Recovery

• The longer-term reconstruction and healing phase that encompasses treatment
• Utilize evidence-based best practices to treat post-traumatic stress for children and youth post-disaster in a setting that addresses barriers to providing mental health treatment, ensuring populations more at-risk receive needed services
• Schools are ideal settings to significantly reduce barriers and increase the likelihood of youth receiving needed mental health treatment
• Evidence-based best practices for treating childhood trauma in the school setting are known as Cognitive-Behavioral Intervention for Trauma in Schools (CBITS) and Bounce Back

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• Find any evidence-based intervention that is proven to be successful in helping children and youth with post-traumatic symptoms and get trained in it now before a disaster occurs in your community

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Resources Utilized for FSU’s Disaster Rebound and Recovery Initiative

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Ellen Piekalkiewicz

Director

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Florida State University Center for the Study & Promotion of Communities, Families, and Children

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• Disaster recovery is generally planned and implemented at the local level. 

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• Emergency managers make use of pre-disaster drills with local hospitals to be prepared for injuries from disasters, yet few local governments have plans in place to address the short- and long-term mental health recovery needs of their residents, sometimes compounded by an additional influx of traumatized families who are turned into domestic refugees by the disasters.

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• Vulnerable population is experiencing significant gaps in mental health care post disaster.

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• The behavioral health sector consists of a fragmented collection of federal, national, state, and local (public and private) resources.

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• Mental distress from disasters affects all restorative and rehabilitative efforts. 

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• Almost everyone in a community struck by a disaster will feel some type of emotional effect. For most, the acute reactions will be transient, and functional recovery will occur without intervention.

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• An agile and resilient system for delivery of behavioral health services, and a process for evaluating the needs for those services and ensuring that those in need are receiving timely and effective treatment is needed.
• Recovery strategies for the behavioral health sector that should cut across all phases of the disaster cycle:
• Integrate behavioral health activities and programming into other sectors (e.g., education, health care, social services) to reduce stand-alone services, reach more people, foster resilience and sustainability, and reduce stigma.
• Maximize the participation of the local affected population in recovery planning with respect to behavioral health, and identify and build on available resources and local capacities and networks (community, families, schools, and friends) in developing recovery strategies.
• Promote a sense of safety, connectedness, calming, hope, and efficacy at the individual, family, and community levels. Vulnerability in many of these populations stems from barriers to their access to behavioral health services such as inadequate finances, lack of health care coverage, language impediments, and difficulties arranging for transportation or daycare. Bridging the language and cultural barriers of different minority groups is a special challenge for successful response and recovery efforts.

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• Conclusion: Mental health is indispensable to personal well-being, family and interpersonal relationships, and contribution to community or society. US Surgeon General, 1999

Resources

Feeling Safe, Being Safe (State of California, Department of Developmental Services)

Free Builder Guide (FEMA)

Bounce Back Training (Bounce Back)

Cognitive-Behavioral Intervention for Trauma in Schools Training (CBITS)

Develop Emergency Operation Plans (Readiness and Emergency Management for Schools)

Talking to Children About Disasters (American Academy of Pediatrics)

Tips for Talking With and Helping Children and Youth Cope After a Disaster or Traumatic Event (SAMHSA)

How to Help Children Cope with Disasters (Save the Children)

Help Kids Cope App (NCTSN)

Helping Children with Disabilities During an Emergency (CDC)

Disaster Resources (CDC)

Disaster Readiness Curriculum (ReadyKids.gov)

The National Center for Child Traumatic Stress 

National Center for School Crisis and Bereavement 

Skills for Psychological Training (NCTSN)

Sesame Street Emergency Preparedness Toolkit (Sesame Street)

Psychological First Aid Training (NCTSN)

Preparedness Rally (Save the Children)

Social-Emotional Booklist (Save the Children)

Using Books to Teach Children about Disasters (Primrose Schools)

Journey of Hope (Save the Children) 

Children and Disasters (American Academy of Pediatrics) 

Helping Children Cope After a Disaster (FEMA Accessible)