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Disaster Relief and Crisis Counseling

Psychosocial Issues for Children
and Adolescents in Disasters

HELPING THE CHILD AND FAMILY

This section of the manual focuses on helping children and their families deal with the emotional aftermath of a disaster. Major disaster events irrespective of their origin impact all persons who experience the event. Evidence from numerous disasters clearly demonstrates that persons who are impacted by the event either directly or indirectly will experience a range of feelings and emotions regarding the effect of the disaster and its consequences.

While everyone interprets life events within the context of their experiences, children interpret their personal experiences within the limited context of their current stage of psychological development. As mentioned in the previous sections, the world of the child is defined by his or her stage of intellectual and emotional development, experiences with siblings and parents and extended family including grandparents, uncles, aunts, and cousins, the child's history and culture, and his or her school, peers, neighborhood, and community within which he or she lives. It is within the structure of these relationships that a child must cope with the impact of the disaster event.

Understanding the definition(s) of family for a child is essential to understanding the complexity of their emotional reaction to the disaster. Family in its most common definition is a group of persons consisting of parents and their children. However, in its broadest interpretation it can be defined as any class or group of related things. Thus given the appropriate context, a child's family can be as broad as their neighborhood, community, or school, or as narrow as their relationship to their parents. Considering the various definitions of family when trying to assess the depth of impact of a disaster on children is important and necessary to determine appropriate crisis counseling and disaster mental health recovery strategies.

Below are examples of some potential relationships that comprise the notion of family for children:

children to natural parent, direct caregiver, or guardian

children to brothers and sisters, living in the same and other households

children to grandparents (maternal and fraternal)

children to uncle, aunts, and cousins, within and distant from the impact area

children to significant non-related adults

children to the world of their school (teachers, staff, and students)

children to school friends and neighborhood friends - from their inner circle of very close confidants to casual acquaintances

children to community of worship (church, synagogue)

children to persons in the communities of reference, (e.g., local neighborhood, village, town, city, county)

A basic principle of working with children in disasters is that they are essentially normal children who have experienced great stress. Most of the problems that appear are likely therefore to be directly related to the disaster and transitory in nature.

The process recommended for helping children and families often starts with "crisis intervention," which trained and supervised paraprofessionals and volunteers can provide. The primary goal in crisis intervention is to identify, respond to, and relieve the stresses resulting from the crisis (disaster) and to reestablish normal functioning as quickly as possible. Sometimes the reaction is mild, but other times it is severe. Also, the workers must be trained to recognize when the condition is mild and can be handled by the families (with guidance), when referral to a helper, such as a school counselor is warranted, and when it is severe and requires intervention by a mental health professional.

The general steps in the helping process are:

1. ESTABLISHING RAPPORT
   • Let the children know you are interested in them and want to help.
   • Check with the children to make sure that they understand what you are saying and that you understand them.
   • Display genuine respect and regard for the children and their families.
   • Communicate trust and promise only what you can do.
   • Convey acceptance of the children and their families.
   • Communicate to the children and their families that you are an informed authority.
     
     
2. IDENTIFYING, DEFINING, AND FOCUSING ON THE PROBLEM
   • Identify and prioritize specific problems with the children, parents, and family.
   • Select a specific problem, define its characteristics, and focus on solving it first.
   • Achieve a quick resolution to the problem so that the members of the family experience a sense of success and control.
   • Evaluate the seriousness of each of the identified problems and the capacity of the family to deal with them.
     
     
3. UNDERSTANDING FEELINGS
   • Demonstrate your ability to see and feel as others do.
   • Display patience in trying to understand children's feelings, for children are frequently unable to express their fears.
   • Respond to the children's stories frequently by commenting on the events and affirming their feelings.
   • Express a nurturing positive regard for the children, to convey an appreciation for the kind and intensity of their feelings.
     
     
4. LISTENING CAREFULLY
   • Understand the disaster concerns from the point of view of the children.
   • Listen to the children's account of the disaster many times, in order to help children "work through" their feelings associated with the disaster.
   • Refrain from interrupting the children as they tell their stories.
   • Affirm children's feelings by giving them time to express themselves.
     
     
5. COMMUNICATING CLEARLY
   • Communicate in a language children understand.
   • Talk with children in groups or with siblings or other family members.
   • Seek the presence of family members to interpret code words used by the children.
   • Communicate with children in their dominant language.

As discussed earlier, many factors can influence the child's psychological definition of family. However, for purposes of the current discussion, the child's family is defined in terms of significant persons providing caregiving and support, who are also members of the child's nuclear and extended family structure. Since children live in family systems, both the experience of the disaster and recovery from its aftermath are most often mutually experienced. Consequently, children will share common aspects of the disaster event experience. The retelling of these experiences between the adults and children in the family can normalize the overwhelming rush of feelings associated with the disaster. For many families, the role of the outreach worker is simply to give them permission to share their feelings with each other and to communicate that having disaster related feelings is normal and sharing these feelings with each other is appropriate and healthy.

A function of the crisis counseling program is to convey information to parents about the common reactions of families to trauma and loss following a disaster. Often parents deny the need for this type of information for themselves, but will gladly participate in programs or gatherings where this type of information is provided for helping support their children. Typically parents will recognize stress reactions and accompanying behavioral changes in their children, before they recognize them in themselves. The disaster mental health worker helps all members of the family unit by sensitizing parents to the signs of stress in their children and suggesting strategies for helping their children.

Outreach workers can remind parents of these simple facts:

Parents should acknowledge the parts of the disaster that were frightening to them and other adults.

Parents should not falsely minimize the danger as it will not end a child's concerns.

The child's age affects how he or she will respond to the disaster. (A six-year-old may express his or her concerns by refusing to attend school, while an adolescent may express his or her concerns by arguing more with parents.)

The way the child sees and understands his or her parent's response is very important.

Parents should admit their concerns and also stress their abilities to cope with the situation.

Often the role of the family is simply to learn to work together to solve problems and actively recognize the needs and feelings of both the children and the adults. The identification of concrete issues that are problematic for the family unit, as well as for individuals within the family, is often the first step in the emotional recovery of the family. This is followed by crafting solutions to problems, resolving problems by implementing solutions, and celebrating the successes of positively resolving problems. Through this process, family members begin to reestablish mastery over their environment and bring back into equilibrium the role of each of the family members. By routinely repeating this process throughout the various stages of recovery, the family members will become closer as a unit and individually more autonomous, thus helping all members of the family reestablish their identity and proceed with their normal developmental roles.

In working with families of diverse backgrounds, outreach workers must be sensitive to language differences and cultural needs. Children are often thrust into the role of interpreter if their parents and relatives are not fluent in English. This responsibility may require skills beyond the child's current stage of development and be too stressful for the child. The outreach worker can relieve the child of this responsibility by seeking out adult interpreters for the family.

Children and adults express signs and symptoms to stressful events along four dimensions: cognitive, emotional, physical, and behavioral. Common reactions expressed by children along each of these dimensions include the following:

• trouble concentrating
• preoccupation with the event
• recurring dreams or nightmares
• questioning spiritual beliefs
• inability to process the significance of the event

• depression or sadness
• irritability, anger, resentfulness
• despair, hopelessness, feelings of guilt
• phobias, health concerns
• anxiety or fearfulness

• isolation from others
• increased conflicts with family
• sleep problems
• avoiding reminders
• crying easily
• change in appetite
• social withdrawal
• talking repeatedly about the event
• refusal to go to school
• arguments with family and friends
• repetitive play

• exacerbation of medical problems
• headaches
• fatigue
• physical complaints with no physical cause

Below are examples of the situations that confront children in the aftermath of a disaster event. These examples are from ice storms in Maine, tornadoes in Texas and Arkansas, and floods in Louisiana and Texas.

1. Separation Anxiety
   Katy, an eight-year-old girl, and her father were returning home from the video store one Saturday afternoon when a tornado struck. Katy and her father hunched down in the car, when suddenly the windows blew out and a tree fell across the hood. They crawled out of their demolished car shaken but miraculously unhurt. Katy's mom and two older brothers, who were in the home when the tornado struck, survived with only bumps, bruises, and one broken arm, but their two-story home was a pile of rubble.

   The next few weeks after the tornado were difficult for Katy. She did not want to go to school and had difficulty sleeping at night. She had dreams about the tornado and feared leaving her mom, dad, and brothers. The teachers at school were supportive and understanding of Katy's needs. The first few weeks after the tornado Katy felt anxious and worried about her parents. School personnel allowed Katy to call and "check-in" with her parents at recess so she was assured that they were okay. Katy's family also held a family meeting and discussed what they should do to be safe at home, school, or work in the event of another disaster. After a few weeks, Katy could sleep in her own room again and go to school without much anxiety.

2. Acting Out
   Tommy, an eleven-year-old fifth grader, had been receiving mental health treatment for disruptive behavior and defiance in the classroom prior to the tornado. He was responding well to treatment and receiving positive reports from his teacher. Tommy, who had never experienced any kind of disaster, was at a friend's house when the tornado struck and several trees came smashing through the windows. Tommy was not hurt physically by the tornado, but both his teachers and parents reported an increase in his disruptive and defiant behavior even though he continued in treatment. Upon review of Tommy's situation with the school and an interview with his parents, it became clear that no one had offered Tommy any opportunity to deal with his disaster related experience and with the subsequent stress he was trying to manage due to fears associated with the occurrence of another tornado. A series of visits by the disaster outreach workers to Tommy's home and school helped Tommy normalize his experience and feel more open about discussing his fears. Both his parents and teacher reported a lessening of Tommy's disruptive and defiant behavior.

3. Anxiety
   Jill, a six-year-old, was at home with her mother and father on the afternoon when the tornado struck. The family escaped with no injuries. Jill started having problems within the next few days, scared that another tornado would strike. Jill would frequently question her parents about the weather and often became tearful.

   Jill's mother called the 1-800 tornado coping line and asked for advice. The crisis counselor suggested that Jill's parents explain tornadoes to her, discuss the warning signs for a tornado in their community, and develop and practice its own family safety plan. The crisis counselor sent the family some informational materials about tornadoes. The crisis counselor called Jill's parents several days later to see how they were doing. Jill's parents reported that her fears had lessened by learning about tornadoes and knowing how to protect herself.

4. Disruptive Behavior at School
   Following a major ice storm, Jason, age eight, was displaced from his home to a Red Cross shelter for eleven days waiting for power to be restored to his home. Greg, age eleven, was displaced from his family for thirteen days and spent this time with relatives in a very crowded house. Both children exhibited disruptive behaviors upon returning to school. Jason was constantly talking and appeared very anxious. Greg was inattentive in class and presented an angry and defiant manner. The outreach crisis counselor spoke with the teacher and offered to come to the weekly health class to talk about the ice storm and to tie the conversation with the classroom material about the five senses. The crisis worker first encouraged the children to share their personal experiences with the storm (i.e., What did you see? What did you smell? What did you hear? What did you feel?). This was a creative way of discussing the effects of the storm, providing assurance and information, and for the students to hear from their peers that they shared many of the same feelings. Within a few days both Jason and Greg settled back into their daily routines.

5. Adolescent Aggression
   Patrick, a sixteen-year-old, became verbally aggressive and threatened other youths after only one night in a large urban shelter following a major flood. Patrick had a history of petty crimes, homelessness, and drug use, and was well known to the local police. Given Patrick's history and current behavior, the shelter manager and local police seriously considered removing him to a juvenile detention center. His mother met with the crisis counselor, the shelter manager, and a law enforcement official to work out an alternative plan. They asked Patrick to assist the National Guard in their duties distributing water and other food supplies. He readily agreed, helped the community, and with this more structured level of adult guidance was able to maintain good behavioral control and remain at the shelter.

6. Reactions Three to Six Months Post-Disaster
   Several months following the floods, many children remained in temporary living situations. Roger, an eight-year-old third grader, continued to struggle with school work, became increasingly withdrawn from friends, and non-responsive at school. As the school year was nearing the end, his teacher became concerned he would not advance to the fourth grade. Consultation with the school guidance counselor and the crisis counseling outreach workers revealed that many children displaced from the same trailer park as Roger were still feeling anxious and tense and doing poorly in school. In some cases, the pressures of the long disruption had affected the relationships of the parents, and separations and divorces were occurring within the families of his peers.

   The crisis counselors became more involved with Roger's class, assisting with field trips and performing skits about floods and the lengthy time it takes to return families to pre-disaster status. The counselors also began encouraging the families in the trailer park to get together with their neighborhood friends over potluck suppers to talk about common issues and plans to get things "back to normal." The school helped Roger's parents find a retired teacher to tutor Roger with his school work, so that he would be ready to advance to the fourth grade.

7. Anniversary Reactions of Children and Families
   A crisis counseling team assisting the community to recover worked with schools and the local unmet needs committee to arrange a number of commemorative events to assist survivors during the anniversary of the disastrous floods. Some families were still waiting for financial assistance, while others were rebuilding their homes. Since many families had returned to their daily routines, there was some degree of community impatience with those still struggling with the impact of the flood. During the commemorative week of the anniversary, many children expressed lingering fears and a remaining sense of loss. The anniversary events focused on individual and community healing, celebrating their survival, and the accomplishments of the last year. At several schools, outreach workers visited the younger children and distributed coloring books depicting the recovery and return to daily routines experienced by Andy and Allie, two young alligator characters who had lived through the storms. Through human interest stories revealing the ongoing needs of survivors, additional resources were donated to assist in their recovery.