Journal of Child and Adolescent Psychiatric Nursing: Richness of collaboration for children's response to disaster

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1 FindArticles > Journal of Child and Adolescent Psychiatric Nursing > Jan-Mar 2003 > Article > Print friendly Richness of collaboration for children's response to disaster Raphel, Sally As the first anniversary of September 11, 2001, passed, there was an opportunity to meet with experts from around the country to share what has been learned about children's responses to disaster situations. The one-day Intensive Training Institute, Developing Effective School-Based Responses to Crisis/Disaster/Trauma, was held in Philadelphia in fall 2002 as a preconference to the national School-Based Mental Health meeting convened by the Center for School Mental Health Assistance at the University of Maryland. This author served as the nursing representative to the planning and implementation committees. Disaster is no longer a novel term limited to natural events, such as hurricanes, fires, and floods. We now are keenly aware of planned human acts that create loss of life and have ripple effects and consequences. When I wrote this article, there was an emergency notice of Code Blue-school lockdown-for all schools in the Maryland county adjacent to the nation's capital because of five random sniper murders within 24 hours. Ordinary people doing ordinary things become victims. Officials believed unusual responses were required, and the superintendent of schools invoked emergency procedures and canceled all activities. In subsequent days, the victim list grew to include a middle-school youth on his way to school. It is apparent that preparation and crisis training for those working with and touching the lives of youth are necessary. The institute participants represented the health professions (nursing, medicine, psychology, social work and health counselors), educators and administrators, state and national government agencies. There were plenary and workshop presentations about the findings related to mental health components of the Oklahoma City bombing, Columbine High School shootings, and World Trade Center attacks. The topics covered lessons learned from research and experiences of clinicians. A keynote speaker reminded us that in a disaster there are direct victims, family members, (1 of 5) [7/9/2008 8:02:28 PM]

The one-day Intensive Training Institute, Developing Effective School-Based Responses to Crisis/Disaster/Trauma, was held in Philadelphia in fall 2002 as a preconference to the national School-Based

2 first responders, and indirect victims (all the rest of us). Studies of Oklahoma public schools showed a high rate of students in middle school had a "known" effect: 50% knew a direct victim, 66% heard or felt the explosion, and most experienced the 4 days of nonstop media coverage. A sample of students 100 miles away 2 years later, who had not been in the city during the explosion, experienced post-traumatic stress disorder (PTSD) related to indirect interpersonal experience, print, or other media exposure. Media coverage of disasters is always intense. The effect was presenting novel events, informing, educating, and rallying support for dealing with perpetrators. Pictures or print media were found to be the most powerful stimulant because the children could study the material for any length of time. There is a contagious quality of reaction to disaster. As with the infectious disease process, it spreads. There are parent or family individual responses absorbed by the child, feelings and intensity of peer response, and media presentation. Children may engage in overreporting or fabricating exposure to maintain a sense of belonging. There have been few studies of aftereffects on teachers and school personnel to date. Fewer than 5% of school personnel in Oklahoma sought help. The lessons learned in Oklahoma City were (a) information is vital, (b) information must be developmentally appropriate, (c) youngsters with direct involvement must be connected with family member(s) immediately, and (d) updated information briefings are necessary. Most helpful is the focus on recovery, letting children take part in anniversary events and other decision making, and listening to the questions of children. Dr. Scott Poland shared lessons learned from direct response to 10 separate school shootings, the most widely known being Columbine High School. School safety first requires commitment from students themselves, then faculty, parents, and the community. There is no profile on youth shooters but there are common threads: Each talked to someone about what they were planning, each was bullied, and each expressed suicidal ideation ("suicide by cop"). According to Scott, children are conditioned not to tell on others, which blocks prevention interventions. The origins of youths' violent behaviors are well documented. Dr. Poland contends that teaching secondary students warning signs and actions will help, along with establishing methods to demonstrate that "someone cares that I show up at school today." The example was shared that at one elementary school, volunteers from a local (2 of 5) [7/9/2008 8:02:28 PM]

3 church took turns so that each day every child who went through the metal detectors first got a hug and greeting from a caring adult. Dr. Mary Courtney of the New York University School of Medicine gave a clinician's view of New York City 9/11 at ground zero and the efforts to assist school children in the immediate area and the entire region as the ripple effects were experienced. The struggles of the first 24 hours were monumental, from setting up organizational communication systems and personnel to triaging the 1,000 phone calls for immediate help. Since the tragic event, we know that those below age 11 are three times more likely to have PTSD (estimated 75,126 needed help), that symptoms tend to persist and worsen over time, and that parents generally underestimate both the intensity and duration of a child's reactions. Courtney's studies show children's feelings were different at each ripple ring (ground zero, high-risk area, remainder of New York). Because of the total numbers (11,000 public schools) and limited mental health resources, only 34% of the children either sought or received help. At month 1, schools imposed normalcy-children were very quiet. At month 2, health and mental health agencies merged efforts and support for principles to set goals. In month 3, the decision makers experienced ambiguity about whether to return to original ground zero school sites. In month 4, psychoeducation programs began for parents and children. By month 5, there was full-time postvention. Month 7 saw double the number of referrals, with a suicide rate that doubled in one school district. Clinical and administrative challenges were discussed throughout the day. The most significant clinical strategies were community education about crisis management, outreach to all categories of those affected, support groups at each level of the ripple effect, and individual interventions with affected youth. Connecting children with others, clarifying misinformation or personal distortions, and consistency in adult messages are critical. The institute participants were encouraged not to rush in to take over communities, but to offer assistance in activating services already organized and asking communities and local leaders what help they needed. Most helpful is professional clinicians' willingness to place their names on a list for future availability. Communities want to regain control, know whom they can trust ahead of time, and need to do many things all at once. The advice is to offer necessary help before mental health components are in place. (3 of 5) [7/9/2008 8:02:28 PM]

region as the ripple effects were experienced.

4 Lessons Learned It is important to have a clear sense of the ripple effect on children who were not directly affected by the loss of a family member. Pay attention to the signs of acute anxiety disorders and changes in children's ways of coping. Assist in developing or disseminating information about existing resources for children, parents, families, teachers, and administrators to answer questions, satisfy curiosities, and eliminate fears as children attempt to incorporate what the event means to them personally. It was evident in the review of Philadelphia's follow-up program to 9/11 that planning, communication, and organizational sharing of resources were key. City officials and educators worked rapidly to incorporate safety, health promotion, and mental health crisis services for teachers, children, and families. Within 24 hours, using a train-the-trainer model, immediate skills training was provided so that schools were able to reopen within 48 hours of 9/11. Mental health clinicians were used for auxiliary services with individuals, small group meetings, and referral for follow-up with severe or enduring reactions to the disaster and uncertainty. What next? We have no crystal ball, and this writer believes that is a good thing in most instances. However, nurses, as experts in prevention, can get involved by seeking opportunities to establish links with education and service agencies for disaster preparedness. As an example, there are never enough mental health nurse volunteers for the local Red Cross needs. Watch for the next annual meeting of the Center for School-Based Mental Health Assistance in Portland, OR, October 23-25,2003 ( Sally Raphel, MS, APRN, CS-P, FAAN University of Maryland School of Nursing (4 of 5) [7/9/2008 8:02:28 PM]

Assist in developing or disseminating information about existing resources for children, parents, families, teachers, and administrators to answer questions, satisfy curiosities, and eliminate fears

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Supporting Children s Mental Health Needs in the Aftermath of a Disaster: Pediatric Pearls

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