1. Children in Disaster Mental Health Curriculum

2. Curriculum Materials Build resilience in children and families Understand the risk factors Comprehend the effects of terrorism on children Know the normal signs of stress in children developmentally

3. Providing Coping Skills “What matters apparently, is not how individuals actually cope but rather how they perceive their capacities to cope and control outcomes.” Psychiatry Interpersonal and Biological Processes, “ 60,000 Disaster victims Speak: Part II. Summary and Implications of Disaster Mental Health Research” Fran H. Norris, PhD, Matthew J. Friedman, MD, PhD, and Patricia J. Watson, PhD, Vol. 65, #3, Fall 2002, p. 238-239.

4. BUILDING RESILIENCE Resilience: “the ability to adapt well to adversity, trauma, tragedy, threats, or even significant sources of stress.”

5. Teaching Children & Teens to Adapt Well 1.Connections 2.Helping Others 3.Daily Routine 4.Take a break 5.Self-care APA Help Center: Get the Facts: Psychology in Daily Life, A Guide for Parents and Teachers.

6. Teaching Children & Teens to Adapt Well, continued 6.Goal reaching 7.A positive self- view 8.A hopeful outlook 9.Self-discovery 10.Change is inevitable APA Help Center: Get the Facts: Psychology in Daily Life, A Guide for Parents and Teachers, 12-11-2003.

7. The Effects KNOW THE ODDS! Did the disaster affect the child directly? How close was the child to the disaster scene? How are the child’s parents or other caregivers coping?

8. The Effects What gender is the child? Does the child have pre- existing risk factors? If the whole family was affected, are they accepting help?

9. Special Considerations Evacuation Child/parent reunification Shelter in place Isolation or quarantine Decontamination Dispensation site: –Vaccination /treatment

10. Developmentally Appropriate Outreach Children are not little adults. Delayed reactions Routine Referrals

11. UNDERREPORTING Parents and teachers underreport children’s internal experiences after a trauma. Encourage parents/ teachers to provide support by reflecting on the –Experience –Reminders –Reactions

12. The Media Encourage families and schools to protect children/teens from contact with the media Discuss with parents the impact that repeated images of the event have on children.

13. Responses to Disaster Behavioral Emotional Cognitive Physiological Remember that the reactions that you see within each of these categories are normal and temporary in the aftermath of a disaster.

14. Toddlers and Preschoolers Reaction reflects parents Regresses developmentally Changes in eating or sleeping patterns Fears Clingy behaviors/ separation anxiety Exaggerated startle response

15. Ages five to eleven Withdrawal Separation anxieties Needs more attention Decline in school performance Difficulty concentrating Somatic complaints – stomach aches Heightened aggression/ temper outbursts

16. Ages twelve to fourteen Sleep Disturbances -& other physical complaints Appetite disturbance Competes for attention Deserts responsibilities Withdraws- loss of interest Resists authority Turns to friends Experiments with alcohol/drugs

17. Confusion/poor concentration Feel guilt and helplessness Minimize reactions More risk-taking behavior Separation anxieties Overwhelmed by emotions, but unable to discuss with family.

18. Helping Children with Special Needs 3 –Visual –Hearing –Physical Limitations –Severe Emotional Disturbance –Behavior disorders

19. Helping Children with Special Needs 2 –Autism –Cognitive Limitations –Learning Disabilities

20. Helping Children with Special Needs 1 Triggers –Special words –Images –Sounds Cues –Physical warning signs National Association of School Psychologists: www.nasponline.org/NEAT/specpop_general.html

21. Helping Families with Injured Children Higher Risk for emotional problems Emotional Support Negotiating the system

22. Unattended Children Definition Higher emotional risks later Safety Anxiety Abandonment

23. Reassurance Terrorism Events Kinds of events: –Terrorism Chemical Biological Radiological Incendiary Nuclear (CBRIN) Terrorism is an unusual event Regain sense of safety Desensitization

24. Cultural Sensitivity Disability Language Ethnicity Norms and Values

25. Help for the Caregivers

26. When Do We Become Concerned? Continuing problems Signs to watch for Stress or traumatic stress? Mental Health Diagnosis

27. Warnings Signs – Longer Range –Refusal to return to school –Clinging behavior –Persistent fears –Sleep disturbances –Loss of concentration –Irritability American Academy of Child & Adolescent Psychiatry, “Helping Children After A Disaster,”, January 26, 2004. www.aacap.org/publications/factsfam/disaster.htm www.aacap.org/publications/factsfam/disaster.htm

28. Warnings Signs – Longer Range –Behavior problems –Physical complaints –Withdrawal from family & friends –Listlessness American Academy of Child & Adolescent Psychiatry, “Helping Children After A Disaster,”, January 26, 2004. www.aacap.org/publications/factsfam/disaster.htm www.aacap.org/publications/factsfam/disaster.htm

29. Supportive Activities Group discussions Puppet plays Constructive writing Community involvement

30. Preparing Children for “Special” Events Information –Age-dependent –Accurate –Appropriate –Timely Involvement –Age-dependent –Promotes healing –Respect child’s wishes –Culturally appropriate

31. Preparing Children for “Special” Events Hospitalization of family members Appropriate visitation Keep child involved in hospitalized family member’s life.

32. Reporting Requirements Report to your supervisor if you suspect: –Child Neglect –Child Abuse –Domestic Violence –Substance Abuse

33. Impact of Disaster Positive actions with families can: Reduce child abuse and neglect Reduce domestic violence Promote understanding in differences in recovery time for people Help families make positive changes in their living circumstances Increase recovery Help families understand that their reactions are normal.

34. Contact Information Jenny Wiley Assistant Coordinator, Disaster Readiness Department of Mental Health 1706 E. Elm Jefferson City, MO 65102 573-751-4730 Email: jenny.wiley@dmh.mo.gov