Transcript Lecture Psychosocial Issues 3.0 - University of Massachusetts

Pediatric Disaster
©
Life Support (PDLS )
A Course in Caring for
Children During Disaster
Continuing Medical Education
University of Massachusetts Medical School
©
PDLS :
Psychosocial Issues:
Children in Disasters
Disasters have Significant
Psychological Impact on Children
PDLS - Psychosocial Issues
 A “Bio-Psycho-Social” approach to victim
management is best
 Recognizes that effective preparedness and
response requires integration of three realms
Biological
Psychological
Social
PDLS - Psychosocial Issues
- Anatomy and Physiology unique to children
- Focus on vulnerabilities of children, not on
resuscitation
- Discuss relationship to:
Environmental exposure (heat, cold, entrapment)
Decontamination
Susceptibility to Chemicals, Toxins
Behaviors that increase risk
Immature immune systems
Biological
Lack of verbal skills
Lack of self-preservation skills
PSYCHOLOGICAL
- A child's emotional Response to Disaster
- How to anticipate and recognize problems
- How long do these disorders last?
- Integrating these concepts into disaster
preparedness and response plans
SOCIAL
- Kids are irreversibly integrated into our society
• If children are not accounted for, parents will not
comply with officials
- Adapting to the concept that children may be
intentional targets of terrorism
- Role of parents in disaster
- Role of media in disaster, a double edged sword
- Role of schools, where children spend the bulk
of their time away from home
- Children routinely cause increased stress in
emergency providers
Interplay of Medical and Mental
Health Triage
 Separate mental health
triage and treatment
area may be
established
-
Once medically cleared
Separate child from
adult mental health area
Photo Credit: FEMA
Interplay of Medical and Mental
Health Triage
 Primary triage:
Physical health must take first
priority
-
Walking, crying patients that have
good airways are triage category
ambulatory
 Secondary triage:
Identify patients with signs of
acute distress
-
Panic/fear
Confusion
Disorientation
Anger
Withdrawn or apathetic
Photo Credit: FEMA
Infants and severely cognitively
disabled don’t understand disaster
Provide:
 Feeding
 Comfort
 Familiar caretakers
Photo Credit: FEMA
Toddlers, preschoolers and
moderately cognitively disabled
 Concerned about
consequences of disaster
 Reactions often are
behavioral disturbances,
mood changes and anxiety
 Can comprehend absence
of parents but not the
permanence of death
Photo Credit: FEMA
Specific Responses of
Toddlers to Disasters
 Reaction reflects that of parents
 Regressive behaviors
 Decreased appetite
 Vomiting, constipation, diarrhea
 Sleep disorders (insomnia, nightmares)
 Tics, stuttering, muteness
Specific Responses of
Preschoolers to Disasters
 Clinging
 Reenactment via play
 Exaggerated startle
response
 Irritability
 Posttraumatic stress
disorder
Specific Responses of School
Age Children to Disasters (5-12)
 Most marked reaction
 Fear, anxiety
 Increased hostility with siblings
 Somatic complaints
 Sleep disorders
 School problems
School Age Children to Disasters
(continued)
 Social withdrawal
 Reenactment via play
 Apathy
 Posttraumatic stress disorder
 Decreased interest in peers,
hobbies, school
Adolescents (13–19)
 Have full understanding of
disaster’s causes and
consequences
 Tend to retain sense of
omnipotence, boys > girls
 May suffer depression and anxiety
 May be aggressive to self or
others, risk of suicide
 May become sullen and
withdrawn
Photo Credit: FEMA
Specific Responses of
Adolescents to Disasters
 Decreased interest in social
activities, peers, hobbies, school
 Anhedonia (inability to
experience pleasure)
 Decline in responsible behaviors
 Rebellion, behavior problems
 Somatic complaints
 Sleep disorders
QuickTime™ and a
TIFF (Uncompressed) decompressor
are needed to see this picture.
Adolescents Response to
Disasters (continued)
 Eating disorders
 Change in physical activity
 Confusion
 Lack of concentration
 Risk-taking behaviors
QuickTime™ and a
TIFF (Uncompressed) decompressor
are needed to see this picture.
Stress response in children
 “Fight or flight”
 Adrenaline/epinephrine mediated
 Arousal state
 Increased startle, response, agitation
 Increased heart rate, respiratory rate, blood
pressure
Alternate stress response
 “Freeze and hide”
 Vagal nerve stimulus
 Opposite of “fight or flight”
 Blunted reactions, affect, responses
 Lowered heart rate, respiratory rate, blood
pressure
 Syncope may result
Short term reactions
 Disbelief
 Denial
 Anxiety
 Grief
 Altruism
 Relief
Short-term reactions
 Grief, loss, anger, guilt
 Coping strategies
- Regression – loss of developmental milestones
- Clinging and increased dependency
- Helpfulness – more useful in older children
- Acting out – competing for attention
Second Stage: Immediate PostEvent Period
Time
 A few days to several weeks after disaster
Reaction
 Clinging, appetite changes, regressive
symptoms, somatic complaints, sleep
disturbances, apathy, depression, anger, and
hostile delinquent acts
Aggressive/Defiant Behavior
 Toddlers and preschoolers may exhibit hostile
behaviors such as hitting and biting.
 School age children may get involved in peer
fights.
 Adolescence may become delinquent or
rebellious.
Aggressive/Defiant Behavior
(continued)
Recommendations
 For the younger child, limit setting may be
of help.
 With adolescents, involving them in the
rebuilding of the community or helping with
younger children or elderly may aid
recovery.
Repetitious Behavior
 Most commonly seen in toddlers and
preschoolers after disaster.
 These children will reenact crucial details of
the disaster.
 Other repetitive behaviors are recurrent
nightmares and frequent flashbacks.
 The Healthcare worker should allow the child
or preschooler to reenact the events as these
are therapeutic and can help in recovery.
Somatic Symptoms
 These include headaches, abdominal pain,
and chest pain and are commonly observed
in children and adolescents.
 Reassurance by the healthcare worker can
be of help after evaluation.
 Counseling and mental health intervention
may be necessary for the victims as well as
the Healthcare workers.
Delayed Post-event Period (months)
 Depression
-
More likely to manifest sleep,
somatic and behavioral symptoms
than adults
Family and personal history of
depression increase risk
Exacerbated by re-exposure to venue of
or media
Delayed Post-event Period
 Post-Traumatic Stress Disorder (PTSD)
-
An anxiety disorder with psychological and physical symptoms including:
Intrusive thoughts, memories and nightmares
Exacerbation by anniversaries and reminders of the event
Aggression, anger and fear
Apathy, numbness
QuickTime™ and a
decompressor
are needed to see this picture.
Delayed Post-event Period
Children have special
susceptibility to certain
risk factors
- Witnessing terror in parents
and loved ones
- Repeated exposure to
media of the disaster
Little data about
Photo Credit: FEMA
preventing and treating
PTSD in children
People with Special Healthcare
Needs (PSHCN)
Cognitive and/or Emotional Disabilities
 Reaction to disaster similar to typical
children with important differences
 May be and feel particularly
vulnerable due to technology
dependence and impaired mobility
-
Cognitively impaired children may
respond similarly to chronologically
younger children
Emotionally disabled children are at
increased risk for acute and chronic
negative disaster responses
Photo Credit: FEMA
Caring for Disaster Mental Health
Adapted mental health first aid:
Strategy for identifying children in
need of help
 Introduce yourself in a
developmentally
appropriate way
 Explain that you are trying to help
 Remain non-threatening but be
honest
and direct
-
Preserve credibility
Avoid unrealistic promises or false
statements
Photo Credit: FEMA
Caring for Disaster Mental Health
 Listen for anxiety, fear about
location of care-takers and
immediate needs
-
Acknowledge the child’s
emotions
Give reassurance and
information
 If available, guide child to
mental health triage/treatment
facility
 Encourage self-help strategies
-
Guided imagery
Exercise
Preservation of routine
Caring For Disaster Mental Health
 Play
 Home
 Drawings
 Nightmares
Guided play/imagery to take
control of scenario and make a
happy ending.
Caring For Disaster Mental Health
Treatment/Recommendations
 Parents, teachers, and Healthcare workers should create and maintain
a predictable schedule for children.
 Night lights, stuffed animals, and reassurance are helpful.
 Compassion is helpful but punishment is not.
 Consultation with psychiatrist or psychiatric social worker may be a
benefit.
Responding to children’s needs
 Parents should know age appropriate
responses
 Monitor and limit media exposure to disaster
coverage
 Early counseling may reduce long term
negative effects
Responding to children’s needs
 Rehearsal of plan reduces anxiety and gives
a sense of control
- Rehearsal of plan with a live drill that has children
acting out roles
Step #1 exercise – school bus accident
Step #2 exercise – school evacuation
Normal Recovery
 Talking with others
 Coping mechanisms
- Learning healthy mechanisms
 Counseling