1. 1 THE AFTERMATH OF HURRICANE IVAN: HELPING CHILDREN COPE FRANK J. ZENERE, Ed.S FLORIDA CRISIS RESPONSE TEAM

2. 2 WHAT HAPPENS Crisis and trauma throw people so far out of their range of balance that it is difficult to quickly restore equilibrium Crisis reactions may be precipitated by either “acute or chronic” stress Acute stress caused by sudden, arbitrary and often random event Chronic stress occurs repeatedly over time with each recurrence further challenging a person’s adaptive resources

3. 3 THE CRISIS RESPONSE: THE SHORT-TERM CRISIS REACTION The normal human response to trauma follows a similar pattern called the crisis reaction; It occurs across gender, ethnicity, age and culture

4. 4 THE PHYSICAL RESPONSE The physical response to trauma is based on the human’s more primitive instincts; It includes: Physical shock, disorientation and numbness Frozen Fright “Fight-or Flight” response Adrenaline and hormone increase Body may relieve itself of excess materials Physical senses heightened (sight, sound, feeling, taste, smell) Heart and respiratory rates increase Vascular dilation and muscle engorgement

5. 5 THE PHYSICAL RESPONSE cont. Exhaustion Physical arousal associated with the “fight or flight” syndrome cannot be prolonged indefinitely and results in physical exhaustion Caregiver Reaction Production of chemical “oxytocin”, primarily in women, may produce “Tend and Befriend” reaction as effort to protect children or loved ones

6. 6 THE EMOTIONAL REACTION Our emotional reactions are heightened by our physical response Stage 1: Shock, disbelief and denial Stage 2: Cataclysm of emotions including anger/rage, fear/terror, sorrow/grief, confusion/frustration, self blame/guilt Stage 3: Reconstruction of equilibrium – the emotional roller coaster that seeks balance

7. 7 TRAUMA AND LOSS Trauma is accompanied by a multitude of losses Loss of control over one’s life Loss of faith in one’s religious/spiritual belief system Loss of trust in other people Loss of worldview – of fairness and justice

8. 8 TRAUMA AND LOSS cont. Trauma is accompanied by a multitude of losses Loss of significant persons Loss of meaningful and sentimental property Loss of a sense of immortality and invulnerability Loss of future and expected rights of passage Trauma losses result in bereavement and the need for integration

9. 9 TRAUMA AND REGRESSION Trauma is often associated with regression to an earlier stage of development – mentally and physically Individuals may do things that later seem childish Examples include loose humor, diminished impulse control, free floating irritation, assuming a fetal position, referring to authority figures such as parents, law enforcement or administrators as “mommy or daddy”

10. 10 TRAUMA AND REGRESSION cont. Individuals may feel childish; Examples include: Feeling small Wanting someone to take care of them Feeling weak Feeling as if things are out of control as if one were a child again Using language that is highly simplified Withdrawing and seeking nurture

11. 11 TRAUMA REACTIONS: PRESCHOOL-AGE CHILDREN Play hurricane games Fear of storm Withdrawal Anxiety General behavioral problems Thumb sucking Bedwetting

12. 12 TRAUMA REACTIONS: PRESCHOOL-AGE CHILDREN Clinging to parents Sleep disturbances Fear of dark Regressive behavior Loss of appetite

13. 13 TRAUMA REACTIONS: ELEMENTARY-AGE CHILDREN Extreme withdrawal Disruptive behavior Difficulty paying attention Outburst of anger Stomach aches Headaches Depression

14. 14 TRAUMA REACTIONS: ELEMENTARY-AGE CHILDREN Anxiety Emotional numbing Fears Of dark Of being left alone Of being separated from family That something bad will happen to family That they caused some part of the disaster

15. 15 TRAUMA REACTIONS: ELEMENTARY-AGE CHILDREN Irritability Aggressiveness Nightmares School avoidance

16. 16 TRAUMA REACTIONS: MIDDLE AND HIGH SCHOOL-AGE CHILDREN Sleeping and eating disturbances Agitation Irritability Delinquency Physical complaints Poor concentration Depression

17. 17 LONG-TERM CRISIS REACTIONS Not all victims of trauma/crisis suffer significantly from long-term stress reactions Many victims may continue to be reminded or re- experience some degree of crisis reactions over a longer period of time These crisis reactions are often associated with “trigger or kindling events”, environmental cues, that remind the person of the trauma. These cues can bring back the intense emotion and physical reactions of the original trauma

18. 18 LONG-TERM CRISIS REACTIONS cont. Trigger Events vary with different victims/survivors but may include: Sensing (seeing, hearing, touching, smelling, tasting) something similar to what one was acutely aware of in the original incident Anniversaries of the event Proximity of holidays or significant “life events” to the trauma/crisis

19. 19 LONG-TERM CRISIS REACTIONS cont. SUMMARY: Survivors of trauma/crisis may experience stress reactions for years. Long-Term Stress Reactions are natural responses to terrible events. Unresolved stress reactions may result in several forms of post traumatic behavior.

20. 20 LONG-TERM STRESS REACTIONS Persistent symptoms of increased physical arousal (not present in pre-crisis state) such as: Difficulty falling or staying asleep Irritability or outbursts of anger Difficulty with concentration Hyper-vigilance & heightened startle response Physiologic reactivity at exposure (anxiety, fear, panic attack) that symbolizes incident

21. 21 RECOVERY FROM TRAUMA Many people live through trauma and are able to reconstruct their lives without additional help 20/60/20 Rule: About 20% of those experiencing trauma will adapt and return to normal function within a short period of time; About 60% will experience some type of stress reaction that will, for a period of time, impair function; About 20% will suffer extensive impairment in one or more of their life functions

22. 22 RECOVERY FROM TRAUMA cont. Recovery from immediate trauma is often affected by the following factors: The severity of the incident and level of crisis reaction The ability to understand what happened The person’s pre-crisis stability The nature and breadth of one’s support system Access to help The degree to which one’s experience is validated by culture and others

23. 23 RECOVERY FROM TRAUMA cont. Recovery issues for survivors include: The victim gaining some meaningful perception of control over the event Working out an understanding of the incident and, as needed, a redefinition of worldview and values Re-establishing a sense of future and personal goals Re-establishing a sense of meaning, integration of the event into a personal narrative

24. 24 HELPING CHILDREN AFTER DISASTER: RECOMMENDATIONS Meet and greet students Remain calm and reassuring Acknowledge and normalize feelings/reactions Encourage expression about disaster-related events Promote positive coping and problem-solving skills Emphasize children’s resiliency

25. 25 HELPING CHILDREN AFTER DISASTER: RECOMMENDATIONS Establish/reinforce routines and expectations Provide opportunities for children to share their concerns Involve children in activities that allow them to make choices and resume a sense of control over their environment. Incorporate information about the disaster into related subject areas, as appropriate.

26. 26 HELPING CHILDREN AFTER DISASTER: RECOMMENDATIONS Listen to and observe children’s behavior. Be sensitive to the disruption that relocation may cause. Consider the developmental level and unique experiences of each child. Involve students in recovery-related activities/projects. Identify children at risk and make a referral to the appropriate school or community-based resource.

27. 27 STUDENTS WHO ARE AT HIGH RISK Had a high level of exposure Felt like they might die during the disaster Were physically injured Witnessed a grotesque destruction Suffered significant loss Are grieving for victims Relocated following the disaster Had preexisting anxiety disorders or mental health problems

28. 28 STUDENTS WHO ARE AT HIGH RISK Had inadequate parental support Are separated from their family Used inadequate coping mechanisms Experienced previous trauma

29. 29 POST-DISASTER ACTIVITIES: CLASSROOM DISCUSSION Where were you during the hurricane? Who was with you during the hurricane? What do you remember about the hurricane? What was the worst part of your hurricane experience? How did you feel before, during, and after the hurricane?

30. 30 POST-DISASTER ACTIVITIES: CLASSROOM DISCUSSION Do you know anyone who was injured during or after the hurricane? What did you learn from this experience? What would you do differently if another hurricane was to strike? What can you do to help others affected by the hurricane? How will this hurricane change you, your family, and your community?

31. 31 HELPING CHILDREN AFTER DISASTER: RESPONSES TO QUESTIONS How do I respond to students when they ask, “Why did this happen?” How can I help students with their lessons? How do I assist students in understanding why some families experienced losses while others did not? How do I help students deal with anxieties about the future?

32. 32 HELPING CHILDREN AFTER DISASTER: SUGGESTIONS FOR PARENTS Listen to your child’s concerns, anxieties and fears – validate their feelings. Offer realistic reassurances of safety and comfort. Provide structure and routine in the home environment. Encourage involvement in family and community recovery efforts.

33. 33 HELPING CHILDREN AFTER DISASTER: SUGGESTIONS FOR PARENTS Be aware of abrupt changes in your child’s behavior; make appropriate professional contacts. Provide factual information and talk in hopeful terms regarding the future. Be prepared to tolerate regressive and acting out behaviors during the early post disaster phase.

34. 34 AFTER FRANCES: TAKING CARE OF ME Be with other people. Express your feelings/reactions. Seek information and advice. Reassure yourself. Maintain healthy lifestyle/routines. Seek professional help.