Psychological First Aid for Children 2 Dealing with Traumatic Responses in Children

Schedule 2 Schedule PFA 2 Training 9.00 – 9.20 1. Introduction Welcome   Welcome 9.20 – 9.30 2. Responding to children 2.1 Check-in exercise 9.30 – 10.55 2.2 Role-play on children’s reactions (85 min. total) Preparation for role-play (15 min.) Group work (20 min.) Role-play presentations (50 min.) 10.55 – 11.00 Q & A 2.3 Comments and questions from session 2 (5 min.) 11.00 – 11.20 Refreshment break 11.20- 11.30 3. Responding to parents and caregivers 3.1 Check-in exercise (10 min.) 11.30 – 12.55 3.2 Role-play on how to talk to parents (70 min total)   Preparation for role-play (15 min.) 12.55 – 13.00 3.3 Comments and questions from session 3 (5 min.) 13.00 – 14.00 Lunch Break 14.00 – 14.30 4. When to worry 4.1 Group work (20 min.) 4.2 Referral mechanisms (5 min.) 4.3 Comments and questions from session 4 (5 min.) 14.30-14.45 5. Wrap up (15 minutes) PFA II – Dealing with traumatic responses in children January 2017

Children’s reactions Withdrawal/depression Anxiety Flashbacks Sleep disturbances Anger/aggressive behavior PFA II – Dealing with traumatic responses in children January 2017

1. Withdrawal/depression A depressed child is sad, lacks energy and desire. Sleep disturbances and difficulties in concentrating are common as well. When depressed, it is hard to imagine that things will improve, and feelings of worthlessness, hopelessness and social withdrawal are often associated with depression and suicide. Sometimes, depression is accompanied with suicidal thoughts. PFA II – Dealing with traumatic responses in children January 2017

2. Anxiety Physical reactions include headache, nausea, dizziness, diarrhea, numbness, shortness of breath, rapid heartbeat, feeling faint, sweaty or shaky hands and feet. Emotional reactions include feelings of anger, fear, helplessness, disappointment and excessive worrying. Behavioral reactions can involve lack of eye contact (if culturally appropriate) and low voice volume. PFA II – Dealing with traumatic responses in children January 2017

3. Flashbacks Flashbacks are intrusive thoughts provoked by images, smells, sounds, tastes and situations reminding the child of a stressful or traumatic situation. Flashbacks sometimes feel like the traumatic experience is happening all over again here and now. For some, a flashback even feels like a threat to life, and it might trigger anxiety (see section on anxiety). A flashback may be temporary and the child may be able to maintain some connection with the present moment. However, some might also lose all awareness of what is going on around him/her and be taken completely back to the traumatic event, and the child might scream and act out. PFA II – Dealing with traumatic responses in children January 2017

4. Sleep disturbances The child has problems going to sleep, staying asleep or may experience bad dreams. PFA II – Dealing with traumatic responses in children January 2017

5. Anger/aggressive behavior Children with aggressive behaviour may be argumentative and verbally aggressive. Children may also have difficulty controlling their temper and are easily upset and annoyed by others. They are often defiant and may appear angry and resentful. PFA II – Dealing with traumatic responses in children January 2017

Children’s reactions which may cause concern to parents and caregivers Sleep problems Lack of appetite Crying when parents or caregivers leave Excessive crying Risk-taking behaviour Withdrawal and lack of interest in playing Fear of everything PFA II – Dealing with traumatic responses in children January 2017

When to worry and consider a referral If the child is at risk of harm to himself/herself and/or others. If the child expresses suicidal thoughts If the child shows extreme, persistent withdrawal i.e. no emotional response, and the child’s expression seem flat with no negative or positive expressions. If the child is persistently whining/whimpering, uncontrolled crying over time (different from a grieving, liberating sob) If the child is dissociating i.e. if the child is detached from surroundings and fails to engage emotionally like the child used to do. If the child is experiencing hallucinations i.e. the child is hearing voices that are not real (auditory hallucinations) or seeing things/people that are not real (visual hallucinations) in ways that do not seem playful or joking If the child is experiencing persistent anxiety attacks If the child is showing signs of mental disability (such as permanent difficulties understanding language and social interaction) PFA II – Dealing with traumatic responses in children January 2017