Lecture Psychosocial Issues 3.0 - University of Massachusetts
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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Withdrawn or apathetic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