Natural Disasters: School Psychology`s Role
Download
Report
Transcript Natural Disasters: School Psychology`s Role
Introduction to Natural Disasters
Judy Oehler-Stinnett, Ph.D.
1
Why care about natural disasters?
Widespread
destruction
Affect
everyone
Tied to mental
health
Awareness
means
preparedness!
Source: Jeff Piotrouski,
courtesy OK Dept of Health
Judy Oehler-Stinnett, Ph.D.
2
Disaster Definition
“Disasters can be defined as any event,
human-made or natural, sudden or
progressive, causing widespread
human material or environmental
losses, which exceed the ability of the
affected community to cope using its
own resources” (Asian Disaster Preparedness Center)
(Source: GOVT E-1027/W: Preventive Measures: the Politics of Disaster
http://www.vranet.com/govt1027)
Judy Oehler-Stinnett, Ph.D.
3
Natural Disasters:
School Psychology’s
Role
Judy Oehler-Stinnett, Ph.D.
Team names
U.S. Major Disaster Definition
Federal Emergency Management Agency
Local response
http://www.wtsp.com/video/player.aspx?aid=12620&sid=9618&bw=hi
State declared disaster
Local government first responders
Neighboring & volunteer agencies assist
Local services cannot handle alone
May send National Guard, agency workers
Damage assessment conducted
Federal major declared disaster
Governor commits state funds, requests major disaster
declaration
FEMA evaluates request, makes recommendation
President approves or denies request
Requests submitted: Individual, business, public assistance,
tribe http://www.wtsp.com/video/player.aspx?aid=12620&sid=9618&bw=hi
Judy Oehler-Stinnett, Ph.D.
5
Natural Disasters
Hurricanes/Typhoon
Drought/Heat wave
Tornadoes
Non-Tropical Floods
Earthquakes
Thunderstorms/
Severe weather
Wildfires
Landslides/Mudslides
NOAA
Volcanoes
Blizzards/Freezes/
Ice Storms
Lightning strike
Tsunami
Sandstorms
Resulting technical
disaster (Na-tech)
Judy Oehler-Stinnett, Ph.D.
6
Frequent Natural Events Qualifying
as Disasters*
Worldwide
United States
Floods
Hurricanes
Drought/famine
Earthquake
Tornadoes
Heat wave
Hurricanes
Floods
Earthquake
Tornadoes
Drought
(*Tsunami infrequent but
devastating)
Judy Oehler-Stinnett, Ph.D.
7
8
9
Most deadly natural disasters
>100,000
Tsunami
Drought
Tornado/windstorm
Flood
Earthquake
>10,000
Volcano
Extreme Temp
Slides
>1000
Wildfire
(CRED)
Judy Oehler-Stinnett, Ph.D.
10
U.S Weather Fatalities 2003
(NOAA)
11
12
13
Economic Impact
Property damage and loss
Employment time loss
Tourism loss
Crop, topsoil destruction
Disease in & loss of livestock
Looting
Increase illness and disease costs
Large disaster estimates: millions to billions
Tsunami cost: 4.4 billion
(World Bank)
Judy Oehler-Stinnett, Ph.D.
14
Better
Industrialized Countries
Insurance
coverage*
Warning, death & damage
prevention*
Emergency & medical care*
Economic recovery*
Mental health services
Most affected
High
risk areas
Uninsured, low income#
When disaster not declared#
Contribution
Federal
& global disaster assistance
Emitting most carbon dioxideJudy Oehler-Stinnett,
Ph.D.
impacts climate change
$
Source: *worldbank.org
$worldviewofglobalwarming,
#FEMA; picture FEMA
15
Carbon Dioxide Increases.
16
Impact in Developing Countries
Poor construction increases damage
Setbacks to economic & social
development
Poor to no early warning system
Massive casualties
Development money diverted to
relief
Longer secondary trauma from
displacement, illness, grief,
economic loss
(Text source: Worldbank; Photo source: American Red Cross.com)
Judy Oehler-Stinnett, Ph.D.
17
Mental Health Impact/Needs
Psychological first aid
Normalize majority reactions
Access to recovery services
Treatment of severe reactions
Acute Stress Disorder
Post-traumatic Stress Disorder
Intervention for long-term stress
Secondary trauma
Fear of reoccurrence
Long-term planning
Crisis Intervention
Mitigation/Secondary
Primary Prevention
NASP
Prevention
Trauma (all types) #1 cause of preventable mental illness
Judy Oehler-Stinnett, Ph.D.
18
Making
Natural Disasters Real:
Pictures and Maps
19
Hurricane
(FEMA)
20
21
Hurricane/Cyclones World Wide
22
Tornado
23
24
http://www.tornadoproject.com/allt
orns/world.htm#top
Tornadoproject.com
clickable map of
tornado information available
worldwide
No free map currently available
25
Tsunami
(FEMA)
26
Tsunami potential map
(NOAA)
27
Thunderstorm & Lightning
(NOAA/NWS)
28
Thunderstorm frequency
(Eastern Illinois U)
29
Lightning Frequency Worldwide
(National Lightning Safety Institute)
30
Severe Storms
(FEMA)
31
Hail map
(NWS Blueprint for Safety)
32
Flood
33
Flood Frequency Map
(USGS)
34
Flood Global Map 2004
35
Drought
(FEMA)
36
37
Heat Wave
38
Fire
(FEMA)
39
Wildfire Potential
(USGS)
40
Countries with recent forest fires
Dominican Republic, April 2005
Syria, October 2004
Australia, January 2004
United States, November 2003
Russian Federation, October 2003
Kazakhstan, October 2003
India, October 2003
Brazil, September 2003
Portugal, September 2003
Canada, September 2003
South Africa, September 2003
Greece, September 2003
Spain, August 2003
Italy, August 2003
Argentina, August 2003
Paraguay, August 2003
Croatia, August 2003
France, August 2003
China, June 2003
Sumatra, Indonesia, June 2003
Mexico, May 2003
Nicaragua, April 2003
Guatemala, March 2003
41
Earthquake
(FEMA)
42
Earthquakes
USGS
43
Earthquake world history
44
Volcano
(FEMA)
45
Volcano Locations in U.S.
(Michigan Tech Volcanoes)
46
Volcano map worldwide
(Michigan Tech
Volcanoes)
47
Landslide
(NASA)
48
Landslide Frequency U.S.
(USGS)
49
Western Europe Landslide
(ESA)
50
Sandstorm
(European Space Agency)
51
Duststorm Map
(European Space Agency)
52
Global warming data
(worldviewofglobalwarming.org)
53
Drought/Flood Prediction from changes in
precipitation
(International Research Institute for Climate Prediction)
54
Factors in Natural Disasters
Contribute
to the total experience of the event
Note for common & unique reactions in victims
For more info, go to:
http://www.fema.gov/
http://www.noaa.gov/
http://www.redcross.org/
http://www.worldviewofglobalwarming.org/
Judy Oehler-Stinnett, Ph.D.
55
Factors in natural disasters
Geographic location
Frequency
Predictability
Suddenness & Warning time
Severity/Intensity-size, speed
Duration
Destruction method
Sights, sounds during
Injury, damage, deaths
Aftermath
Preparation methods
Prevention methods
Judy Oehler-Stinnett, Ph.D.
56
Geographic locations
Vary within U.S. and world (see maps)
Variance from year to year, but stability in high
incidence areas
Variance contributes to
Hurricanes coastal but vary on where on coast
hurricane hits
Tornadoes concentrated in Midwest but vary as to
exactly where land
Influenced by airflow (e.g. Jet Stream)
building in high risk areas
lack of preparation
failure to heed warnings
Every area of world at risk for some types of
natural disaster
(NOAA, NWS, FEMA, Red Cross)
Judy Oehler-Stinnett, Ph.D.
57
Frequency
Varies from year to year
Varies across locations
Can be seasonal, cyclic
Flood most frequent
worldwide
High frequency areas
Most
awareness
Most official preparation
Habituation can lower
public response
Repeated disasters lower
resilience
58
Judy Oehler-Stinnett, Ph.D.
(NWS, FEMA, Red Cross, worldbank)
Predictability, Suddenness & Warning Time,
& Response
Predictions
take substantial resources
Vary in accuracy
Have seasonal factors
May have seconds to months
Hurricanes longer warning time
Tornadoes may have minutes only
Earthquakes may have no warning
Dangerous to underestimate time to
impact
Preparedness increases rapid response
Failure to respond increases severity
exposure and likelihood of trauma
symptoms
(FEMA, NWS, Red Cross)
Judy Oehler-Stinnett, Ph.D.
59
Predictability, Suddenness and
Warning Time, Response con’t.
U.S. advances in prediction & death
reduction
Decreased
some prevention & mitigation
efforts
Increased population in high-risk areas
Urban
& coastal crowding
Increased
number of potential victims
Reduced evacuation capability
Increased cost to rebuild
Judy Oehler-Stinnett, Ph.D.
(FEMA)
60
U.S. Cost Increase of
Natural Disasters
(Princeton)
61
Severity/Intensity
Severity ratings in scale numbers
FEMA
Size impacts
FEMA
Number of victims
Amount of land
Ability to predict
Intensity/speed impacts
Most severe are less frequent
People in high frequency areas underestimate
severity
Level of damage
Amount of time to prepare
Increases in victims’ level of trauma
Proximity to center of event
Experiencing injury, property damage
Exposure to death, Fear for life (FEMA. Red Cross, NWS)
Judy Oehler-Stinnett, Ph.D.
62
Duration
Length
of actual event
Drought-
long periods
Severe weather-hours to days
Flood waters recede slowly
Tornadoes-minutes
Earthquakes-seconds
Length
of secondary trauma
Time
to clear debris, rebuild
Time to restore safety, order, routine
(Red Cross, FEMA)
Judy Oehler-Stinnett, Ph.D.
63
Damage Method
Wind - property & personal damage
Water movement
Alone reduced property damage (flood)
Animal loss risk high
Wind + water=High risk of death/ damage
Fire – Leaves little behind
Cold
Heat/drought
Land Movement – earth, mud, snow, ice
(Red Cross, FEMA, NWS)
Judy Oehler-Stinnett, Ph.D.
64
Sensory Input during Event
Impacted by type and severity of disaster
Influences memory and stimulus triggers for
stress & trauma
Areas of input
Sights
Sounds
Bodily
senses
Smell
(Red Cross, APA)
Click for video
http://gprime.net/video.php/soccertornado
Judy Oehler-Stinnett, Ph.D.
65
Sensory Input during Event
Sights
Clouds,
Funnels, Lightning
Water moving, rising
Heat radiation
Hail, rain, dust, sand, snow, ice, earth,
etc. blown
Human and animal victims injured or
dead, blood
Property movement, damage and debris
(Red Cross, APA)
Judy Oehler-Stinnett, Ph.D.
66
Sensory Input during Event
Sounds
Wind
Rain,
Ice, Hail
Thunder
Cries for help
Property stress and destruction
Land shifting, cracking
(Red Cross, APA)
Judy Oehler-Stinnett, Ph.D.
67
Sensory Input during Event
Bodily
senses
Being
carried by water, wind or earth
Earth shaking or shifting
Temperature and pressure changes
Own injuries
(Red Cross, APA)
Judy Oehler-Stinnett, Ph.D.
68
Sensory Input during Event
Smell
Wind-carried
odors
Water-soaked objects
Contamination
Death
(Red Cross, APA)
Judy Oehler-Stinnett, Ph.D.
69
Injury & deaths, Damage
Injury
& death varies with type of
force
Wind
damage - impales debris
Water damage- risk of drowning
Earthquake – falling debris
Land movement – suffocation risk
Amount
of damage largely
determined by size and severity of
event
(Red Cross, FEMA)
Judy Oehler-Stinnett, Ph.D.
70
Aftermath: Recovery vs.
Secondary Trauma
Food
& water vs.
starvation
Health vs. disease
Rapid rebuilding vs.
long-term
displacement
Economic growth
vs. basic relief
(FEMA, Red Cross, worldbank)
Judy Oehler-Stinnett, Ph.D.
71
Programming for Natural
Disasters
What school personnel need to know
72
Long-range preparation-educational
Community planning to lessen losses
Building codes
Insurance coverage
Shelters
Warning systems
Preparation for specific disasters in your area
Ensure that school plans are adequate
Have personal plans in place so that you can assist others
Knowledge & supplies to
Children
Families
School
Community
Resources
Federal Emergency Management Adm (FEMA)
American Red Cross
State Agencies
Media
NASP, APA
Judy Oehler-Stinnett, Ph.D.
73
Programming by Phases of Disaster
Prevention/mitigation
Long-range preparation
Immediate preparation for impact
Impact or during disaster
Immediate aftermath, acute crisis phase
Short-term follow-up & evaluation
Long-term follow-up & evaluation
Continued planning
Judy Oehler-Stinnett, Ph.D.
74
Prevention/Mitigation
Event primarily uncontrollable
Damage and outcome somewhat controllable
Location
of home, business, school
Building structure integrity
National Clearinghouse for Educational Facilities Guidelines
for building/retrofitting educational facilities:
http://www.edfacilities.org/rl/disaster.cfm
Storm
shelter
Knowledge of specific disasters
Disaster preparedness kit
Disaster drills
Weather radio, heed warnings
Judy Oehler-Stinnett, Ph.D.
75
Prevention/Mitigation Methods
High-risk areas
Avoid
living in
Avoid expensive building in
Build or retrofit to withstand
disaster
Institute high-level planning
and funding
Tie funding and insurance to
mitigation
Reduce carbon dioxide
emissions
Reduced
energy needs
alternate energy sources
(Red Cross, FEMA, worldbank; pictures earthfuture)
Judy Oehler-Stinnett, Ph.D.
76
Disaster Preparedness Methods
Awareness
& knowledge of
potential disasters
Emergency survival supplies
Materials to protect property
Evacuation plan
Communication plan
Shelters
Security plans
(FEMA, Red Cross)
Judy Oehler-Stinnett, Ph.D.
77
Preparedness Programs
FEMA, Red Cross
Children
Families
School
personnel
Community
Judy Oehler-Stinnett, Ph.D.
78
Preparedness Programs, con’t
see FEMA and Red Cross for excellent resources, links
Child
Use
education
available local resources
Television weather personnel
Science teachers and others
Utilize
science natural disasters curriculum unit
Often covered in 5th to 7th grade
Integrate
with language & other units
Include mental health components
Make it Active
Don’t just TELL kids what they SHOULD do
get donations to prepare kits
Judy Oehler-Stinnett, Ph.D.
79
Child Education, con’t.
What natural disasters occur
most frequently in area
Disaster preparedness
Supplies
Where
to go during disaster
How to contact adults and loved ones
Resources for volunteering
FEMA
Mental health preparedness
Shock
of event
Coping skills for recovery
For program packages, see:
http://www.femagov/kids/
http://www.redcross.org/disaster/masters/
Judy Oehler-Stinnett, Ph.D.
80
Preparedness Programs, con’t
Family education
Trained
children often more concerned
Adults responsible for safety
Children lose faith in adults’ ability to protect them
after disaster occurs (Lazarus, 1995)
Worse with loss of loved one or high death threat
Increase
Enlist parent organizations
Provide incentives – disaster kits
Include
cultural, religious sensitivity
Beliefs regarding causation
involvement
divine punishment
miracle
predetermination
Beliefs regarding death
Death to be feared or welcomed
Rituals and symbolic meaning
Judy Oehler-Stinnett, Ph.D.
Evans (2002) found that
children who were in a
storm shelter were much
less afraid of the tornado
NASP resources:
http://www.nasponline.org/
culturalcompetence/cc_cris
isresources.pdf
81
Family education, con’t.
Include mental health issues:
Awareness of family/child premorbid functioning
Chronic stressors
Past or recent traumas
Trait anxiety, agitation
Degree of exposure relationship to trauma symptoms
Behavioral symptoms
Not always observable
Must ask children how they are feeling and listen to them. (Evans, 2002)
Importance of social support
Emotional support
Informational support
Tangible support (Norris et al., 2001)
Include coping tools to facilitate post-traumatic growth
Use of adaptive coping rather than avoidance (Moss, Cronkite, Billings, & Finny)
What did we learn?
How can we prepare better? Restore trust in safety.
Judy Oehler-Stinnett, Ph.D.
82
Family preparedness, con’t.
Knowledge of natural disasters in area
Family crisis, safety & evacuation plan
Emergency supply kit, weather radio
Way to communicate, use of social support network
Place to gather
Listen and heed warnings: Remaining when unsafe
related to trauma symptoms
Override family members discounting concerns
Do not “chase” storm – leave that to professionals
Use care following disaster – make sure children avoid
debris, power lines, fire, etc.
American Academy of Pediatrics
AAP - Family Readiness Kit: Preparing to Handle Disasters
http://www.aap.org/family/frk/frkit.htm
Red Cross
http://www.seattleredcross.org/disaster/familyplan/index.HTM
Judy Oehler-Stinnett, Ph.D.
83
Don’t forget the Animals
Most shelters do not allow
pets
Children become very
concerned about their pets
Livestock are also a
consideration
Plan ahead for animal safety
Failure
to evacuate &
reentering disaster scene
related to pets (Heath, 1997)
Loss of or injury to animal
related to trauma symptoms
See Humane Society of the U.S. for animal tips:
http://www.hsus.org/hsus_field/hsus_disaster_center/
84
Judy Oehler-Stinnett,
Ph.D.
FEMA
School Disaster Plan
Identity potential disasters in
your area
Involve school board, parent
groups, administration
Use recommended resources:
FEMA handout – multi-hazard plan for all phases of
disaster:
http://www.fema.gov/fima/rmsp424.shtm
Red Cross Emergency Guide for Business and Industry:
http://www.redcross.org/services/disaster/0,1082,0_606_,00.html#fema
Judy Oehler-Stinnett, Ph.D.
85
Preparedness Programs, con’t.
FEMA
School personnel education
Review crisis plan for natural disasters
Include parents, students
Drill procedures for taking cover and evacuating
Ensure evacuation route avoids hazards
Include plan for persons with handicapping conditions
Build shelters, retrofit buildings
“Walk through” to remove, secure hazards
Chemicals
Heavy objects
Windows, glass
Educate on need to protect, respond
Take seriously
Keep first aid kit, flashlights, broom, communication, and weather
radio in all classrooms
Plan for use of school buildings as community shelter
Judy Oehler-Stinnett, Ph.D.
86
Preparedness Programs, con’t.
FEMA
School personnel education, con’t.
Include
mental health issues
Prevent stress on children due to school lack
of preparedness or follow-up
Know effects of disaster on emotions, academics & social
interaction
Reduce parent anxiety by communicating on evacuation,
lock-down procedures during natural disaster
Not safe to try to pick up child during disaster
Official means for getting school information
Address trauma-related symptoms of school personnel
who must comfort children
Personnel likely have also suffered loss
Secondary trauma of care-givers
Judy Oehler-Stinnett, Ph.D.
87
Community Preparedness
Coordinate school and community plans
Identify
leaders and liaisons in emergency
management
Prepare for use of buildings as shelter
Use community resources to facilitate family training
in community
Plan for Rapid response team deployment
Plan for dealing with media
Agency or residential facility
be
knowledgeable of the disaster plan
Become member of crisis team
Have community-wide disaster drills
Judy Oehler-Stinnett, Ph.D.
88
Media converge on a disaster
location when all the people want is
to be helped or to be left alone…
Photo copyright Mitchell Prothero
World Picture News
89
When Natural Disasters Occur
Steps for Imminent Disaster and Beyond
90
Immediate preparation for Impact
Follow natural disaster procedures in
agency/school
Keep communication open-limit use of cell
phones if children have them
Help children and caretakers remain calm
Stay alert to changing conditions and take
protective steps
Keep weather radios on
NEVER IGNORE SIRENS
Judy Oehler-Stinnett, Ph.D.
91
Impact
If natural disaster occurs while children are at
school, school will become a trauma stimulus
Remain calm and help others to do so
Model positive coping self-talk
Remember that care-givers as well as children
will be affected
Take care of your own needs as well
If event happens while children are away from
school, school will be used to help normalize
adjustment.
Judy Oehler-Stinnett, Ph.D.
92
Bloomsburg, PA High School
Flooding from Hurricane Ivan
Jared Fenstermacher – from Bloomsburg Weater
93
Acute crisis phase
Continue to implement school crisis plan
Assist in controlling media access
Assist in communications between home
and school
Work with any emergency team that is onsite, have credentials available
Help with triage in determining who needs
immediate assistance
Assess property damage and hazards
Assist with activities if school is an
emergency shelter
Judy Oehler-Stinnett, Ph.D.
94
School Used as Disaster Center
after California Earthquake
FEMA
95
Short-term follow-up
Once acute crisis team has left, continue to meet
immediate needs through school crisis team
Practical assistance most critical at this phase
Survival: Food, water, shelter
Finding loved ones and pets
Access to disaster services
Guidance programs for majority of children
Normalization of responses
Coping skills
Reduce school requirements
to make time for intervention
Screen for children needing mental health services
Victims
who were not in desperate need immediately may
start showing trauma symptoms – later onset of PTSD
Kids do not need to show full-blown PTSD to need help
Parents often underestimate
impact of trauma on kids 96
Judy Oehler-Stinnett, Ph.D.
Short-term coping
Social support system available
Family
Friends
Community/church
School
Positive role models for coping
Those
around child take steps to cope, make positive
coping statements
Support for discussing event, feelings
Discussions are not anxiety-filled or provoking, but
don’t negate severity of event
Volunteer opportunities
Judy Oehler-Stinnett, Ph.D.
97
Short to long-term follow-up
Coping with funerals, sometimes multiple
Delays and cost in rebuilding
Lack of resources, services, extended
secondary trauma
Low social support and high modeled social
anxiety (Evans, 2002
)
Judy Oehler-Stinnett, Ph.D.
98
Long-term follow-up
Significant evidence that children experience
long-term effects of natural disasters (Evans,
2002)
Support groups for most kids
Trauma treatment for those most affected
Disaster preparation
Anniversary dates
Find ways to minimize trauma cues, change
thoughts surrounding seeing cues
Cognitive-behavioral therapy most successful
Judy Oehler-Stinnett, Ph.D.
99
100
Post-trauma adjustment Factors
Cultural considerations
Rural vs. urban setting
Preexisting mental health issues
Need for additional support services
Preexisting crisis procedures
Use of existing support systems
Availability of services
Persons with disabilities
Concepts of death
Adaptation rituals
Communicating with media & limiting access to trauma victims
Determining who is eligible to provide services and triage
Children’s re-exposure through television and other
media
Availability of mental health services
Judy Oehler-Stinnett, Ph.D.
101
Post-Trauma Adjustment Factors
Closeness to impact: Sights, sounds
Severity of event: most severe damage
Injury to self
Witnessing injury to others
Witnessing death of other people, pets
Place during event damaged or destroyed
Home, school or other location damaged or
destroyed
Injury of significant others: family, friends
Death of significant other
Fear of being severely injured or killed
Inability to contact, locate loved ones
Feelings of safety (e.g., in storm shelter with family)
can mitigate trauma symptoms to some extent 102
Judy Oehler-Stinnett, Ph.D.
Post-trauma adjustment Factors
What happens in the mind of a child?
Causation
beliefs - mistaken connection between
their behavior and event
Survivor guilt – their survival cost someone else
Omen formation – thinking they could have prevented event
(March, 2003)
Understanding
Anger at family or school for not protecting them better
Alterations
of event
in existing schema due to event
No longer feel safe, optimism bias of childhood shattered
Foreshortened future beliefs
See
Pynood et al., 1997 for model of PTSD
Judy Oehler-Stinnett, Ph.D.
103
Post Trauma Adjustment Factors:
Developmental Considerations
There are many developmental lists out
there, not all are based on research.
Preschool, child and adolescent symptoms
vary, yet within each age group, different
children will react differently.
Children likely have different reactions than
adults and adults may not notice or
understand child’s concerns either because
the adults are not upset or they are too
upset themselves.
Judy Oehler-Stinnett, Ph.D.
104
Assessment/Intervention for Acute Stress Disorder &
Post Traumatic Stress Disorder in Natural Disasters
Post-disaster phases
Emotional
Gets you through acute phase of trauma
Shouldn’t mistake for children being “fine”
Coping
vs. Acute Stress Disorder
Most victims have a support system and
take positive action to get through crisis
Excessive stress reaction during first
month following disaster ASD
Post
numbing
Tsunami orphans: 7,722 lost 2
parents; 32,735 lost 1 parent
Worldbank.org
Traumatic Stress Disorder
Symptoms onset or remain more than
one month post-disaster
Not all symptoms present in children
Judy Oehler-Stinnett, Ph.D.
Amma teaching tsunami survivor
how to swim Amritapuri.org
37% of deaths were children
105
Common Symptoms in Youth who are at
risk for PTSD Following Natural Disaster
Re-experiencing:
Avoidance:
Nightmares about disaster or symbol of it
Trauma play (in young children)
Avoidance of place reminders
Avoidance of people reminders
Avoid discussion of trauma
Hypervigilance/arousal:
On look out for cues of reoccurrence (e.g.,
react strongly to clouds in sky following
tornado)
Excessive startle reaction
(Carrion, Weems, Ray, & Reiss, 2002)
DSM-IV-TR
Judy Oehler-Stinnett, Ph.D.
106
Common Symptoms in Youth who are at
risk for PTSD Following Natural Disaster
Anxiety/worry
Concern
about safety
Don’t want to leave parents
Somatic complaints
Stomachaches
Headaches
Agitation/ anger
Anger
at not being protected
Agitation related to hypervigilance
(Chorpita, Albana & Barlow, 1998)
Judy Oehler-Stinnett, Ph.D.
107
Common Symptoms in Youth who are at
risk for PTSD Following Natural Disaster
Social interaction
difficulties
Family
Teachers
Peers
School difficulties
School work
Concentration,
memory
(Caffo & Belaise, 2003; Weinstein,
Staffelbach, & Biaggio, 2000)
Judy Oehler-Stinnett, Ph.D.
108
Screening
If you work where a natural disaster has occurred
at any time that the children you work with could
have been exposed to it, then you need to screen
for effects of the disaster! Under these
conditions, any child referred should be screened
to see if symptoms are related to the natural
disaster that impacted them. (Ford et al., 2000)
Broad-band scales do not measure PTSD per se,
but scales such as the BASC-SRP are related to
PTSD scales (Cook-Cottone, 2004; Evans, 2002)
General anxiety scales may also capture some
symptoms
Judy Oehler-Stinnett, Ph.D.
109
Screening, con’t.
If a natural disaster occurs while you are
providing services, then you need to
screen/assess for children affected
Immediately
following
1 month to 1 year following
2 year follow-up
Long-term follow-up
Judy Oehler-Stinnett, Ph.D.
110
PTSD Scales Validated for Use with
Children in Natural Disasters
Children’s PTSD Inventory (Saigh, et al., 2000; Saigh, Yasik,
Oberfield, Halamandaris, & McHugh, 2002)
Impact of Events Scale (Horowitz, Wilner & Alvarez, 1979; Yule,
Bruggencate, & Joseph, 1994);
The Child Post-Traumatic Stress Disorder
Reaction Index (CPTSD-RI, see Frederick, Pynoos, & Nader, 1992);
The Child PTSD Symptom Scale (CPSS; Foa, Johnson,
Feeny & Treadwell, 2001);
When Bad Things Happen (WBTH; Fletcher, 1996)
The Kauai Recovery Index, patterned on the
CPTSD-RI (Hamada, Kameoka, Yanagida, & Chemtob, 2003).
The OSU PTSD Inventory – Child (Evans, 2002; Evans &
Oehler-Stinnett, submitted)
Judy Oehler-Stinnett, Ph.D.
111
Prevalence of PTSD in Children Following
Natural Disasters Using PTSD Inventories
Youth more impacted by disaster than adults &
Violence victims more impacted than those in
natural disaster (Norris, Friedman, & Watson, 2002)
(see Freyd, 2002 re: betrayal trauma theory)
Children in developing countries more impacted than
those in developed countries (Evans, 2002; Bulut,
2003)
Some evidence that girls and minorities more
affected, but results not consistent (Vernberg,
LaGreca, Silverman, & Prinstein, 1996)
Judy Oehler-Stinnett, Ph.D.
112
Prevalence rates, con’t.: Child self-report
Almost all children in hurricanes show initial symptoms (8695%)
At 10-month to 1 year follow-up, rates are lower, but
majority of children still showing some symptoms
Much lower percentage show severe or pervasive
symptoms (18-30%) using DSM-IV criteria
Must look at specific symptoms, not just overall score
Using standard deviation units on factor scoring, tornado
victims show fewer severe symptoms (10-15%), moderate
symptoms higher (47-65%)
Earthquake victims worldwide much higher rate than U.S.
children
(e.g., Anthony, Lonigan, & Hecht, 1999; Evans & Oehler-Stinnett, submitted; Hamada, Kameoka, Yanagida
& Chemtob, 2003; Lonigan, Shannon, Taylor, Finch & Sallee, 1994; Vernberg, LaGreca, Silverman,
and Prinstein, 1996)
Judy Oehler-Stinnett, Ph.D.
113
Prevalence rates, con’t.
Problems with DSM – IV – TR diagnosis
Not
completely substantiated by factor
analysis studies
No Likert rating or anchors, or norms
Children not likely to evidence most
symptoms unless very severely affected
Use of rating scales recommended
Judy Oehler-Stinnett, Ph.D.
114
Serious
Concerns in
Adolescents
Increased risk of
Alcohol
and
substance abuse
Depression
Suicide
Influence on culture
TSUNAMI
SUICIDE
By the Unseen
Copyright 03-04
These feelings in my head
Of things that can't be said
Because I'm grasping for the words
To make you understand
And I wanna destroy myself
Don't wanna destroy myself
I wanna destroy myself
Hurricanes of love and pain
Tsunami tides of suicide
Like a cobra poised to strike
Like a criminal in the night
Depression sleeping in
Like a ship without a light
But life is just a game
And we all end up the same
So let the storms come
Cause the clouds will bring the rain
Judy Oehler-Stinnett, Ph.D.
115
Interventions for Children with
PTSD in Natural Disasters
Cognitive-Behavioral Therapy (Foa,
Treadwell, & March, 2004)
Exposure, relaxation, massage less
evidence
Psychoeducation, coping (Teicher, et al.,
2002)
Medication (Bryant & Friedman, 2001)
Judy Oehler-Stinnett, Ph.D.
116
Interventions con’t.
Continue long-term intervention
Prepare better – see prevention and
mitigation slides!
Judy Oehler-Stinnett, Ph.D.
117
Disaster Mental Health Training
Disaster Mental Health in Natural
Disasters
118
Long-range planning-Mental Health
Who trains disaster mental health workers?
NOVA –
National Organization for Victims’ Assistance has
liaison with National Association of School Psychologists
for NEAT (National Emergency Assistance Team)
Red Cross – Has liaison with American Psychological
Association’s Disaster Response Network (DRN) for
DMH.
Who is eligible to provide disaster mental-health
services?
Must
be licensed to provide DMH services to any location,
according to Red Cross, for protection of public.
Certified school psychologists are often involved in crisis
services in their schools, but need appropriate training.
Judy Oehler-Stinnett, Ph.D.
119
American Psychological Association
Disaster Response Network
in conjunction with the
American Red Cross
http://www.apa.org/practice/drnindex.html
Licensed psychologists can be trained through
the DRN program
Must obtain liability insurance
Series of disaster trainings, including mass
trauma and disaster-specific training
In need of child specialists
Contact APA or your local Red Cross
Judy Oehler-Stinnett, Ph.D.
120
NASP National Emergency
Assistance Team (NEAT)
NASP helps in disasters through the National
Emergency Assistance Team
Trained
NASP personnel are on call for emergencies
Should you be a crisis responder?
http://www.nasponline.org/NEAT/neat_crisis.html
There are additional helpful materials available
on line through NASP:
http://www.nasponline.org/NEAT/
Judy Oehler-Stinnett, Ph.D.
121
Resources from NASP on Natural
Disasters
http://www.nasponline.org/NEAT/crisismain.html
#natural
http://www.nasponline.org/crisisresources/22Lazarus.pdf
http://www.nasponline.org/crisisresources/tsuna
mi.html
http://www.nasponline.org/NEAT/MidwestFloods.
pdf
Judy Oehler-Stinnett, Ph.D.
122
NASP Resources on Natural Disasters
Natural Disasters from NASP's book Best Practices in School Crisis
Prevention and Intervention
Helping Children in the Event of a Tsunami: Information for Parents
and Teachers
Effects of the Indian Ocean Tsunami: Helping Children Cope
Helping Children After a Wildfire: Tips for Parents and Teachers
Responding to Wildfires: Helping Children and Families
Responding to Natural Disasters - Helping Children and Families:
Information for School Crisis Teams
Helping Children After a Natural Disaster: Information for Parents and
Teachers
Winds of Terror: Children's Response to Hurricane and Tornado
Disasters - from the NASP publication Crisis Prevention and
Response: A Collection of NASP Resources (pp. 231-239).
Natural Disasters, Crisis Intervention, and School Psychology: Melding
Human Needs and Professional Roles
See http://www.nasponline.org/NEAT
for updated crisis information
Judy Oehler-Stinnett, Ph.D.
123