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Psychosocial Care & Support for Children
& Adolescentsin Disaster Situations
Dr. Jitendra Nagpal - ‘Expressions India’ Expressions India’ Expressions India’ Expressions India’
Mrs. Divya S Prasad - VIMHANS
Dr. Cherian Varghese - WHO, New Delhi
Dr. Sheema Sen Gupta - UNICEF, New Delhi
TSUNAMI - The killer wave
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Situation Data on TsunamiSituation Data on TsunamiSituation Data on TsunamiSituation Data on Tsunami ---- IndiaIndiaIndiaIndia
K a r n a t a k a
K e r a
l a
M e d i c a l C o l le g eA l l e p p y
S t a t e M e n t a l H e a l th A u t h o r i tyT r i v a n d r u m
M a h a r a s h t r a
N I M H A N SB a n g a l o re
T a m i l N a d u
A n d h r a P r a d e s h
S C A R FC h e n n a i
M e d i c a l C o l le g eG u n t u r
J I P M E RP o n d i c h e r r y
I n d i a n P s y c h i a t r ic S o c i e t yC h e n n a i
T o D e l h i
V I M H A N SD e l h i
N E L L O R E ( 2 0 )
E R N A K U L A M ( 5 )
A L A P P U Z H A ( 3 5 )
K O L L A M ( 1 3 1 )
K A N N I Y A K U M A R I ( 8 2 4 ) T I R U N E L V E L I (4 )
T U T I C O R I N (3 )
R A M A N A T H A -P U R A M ( 6 )
P U D D U K O T T A I (1 5 )
T H A N J A V U R ( 2 6 )
T H I R U V A R U R ( 1 7)
K A R A I K A L ( 4 8 4 )
N A G A P A T T I N A M ( 6 0 51 )
C U D D A L O R E ( 6 12 )
P O N D I C H E R R Y ( 1 0 7 )
V I L L U P U R A M ( 4 7 )
K A N C H I P U R A M ( 1 2 8 )
C H E N N A I ( 2 0 6 )
K R I S H N A ( 2 7 )
W E S T G O D A V A R I ( 8)
E A S T G O D A V A R I ( 3)
T I R U V A L L U R ( 2 9 )
G U N T U R ( 1 2 )
P R A K A S A M ( 3 5 )
Psychosocial Support(Tsunami – India)
Map not to scale
Training/Service DeliveryAll affected DistrictsIndian Psychiatric Society, Chennai
Psychosocial SupportKollam, TrivandrumState Mental Health Authority, Trivandrum
Psychosocial SupportAlleppyMedical College, Alleppy
Child Psychiatry/Capacity BuildingTamil Nadu, NelloreVIMHANS, Delhi
Psychosocial SupportGuntur, Prakasam, KrishnaMedical College, Guntur
Psychosocial in Pondicherry through training of NGOsPondicherryJIPMER, Pondicherry
Training of NGOs and support in Cuddalore, ChennaiTamil Nadu, Cuddalore, ChennaiSCARF, Chennai
Technical Support/Capacity BuildingTamail Nadu, Andhra Pradesh, KeralaNIMHANS, Bangalore
Support ForSupported State/DistrictsInstitution
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“Although difficult to quantify, mental
health and psychosocial problems can be
associated with any type of disaster and
post-disaster setting. The horrors, losses,
uncertainties and other stressors
associated with disasters can place people
at increased risk of various psychiatric and
psychological and social problems”
- Sphere Standards
CHILD RESPONSE TO DISASTERS……
After a disaster, children are most afraid that:
• The event will happen again.
• Someone they know will be injured or killed.
• They will be separated from the family.
• They will be left alone.
Children’s reactions are affected by• Their age
• Nature of loss they have experienced
• Disruption of daily activities
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Anger and irritabilityClinging behaviour
Loss of appetiteFeeling guiltySleep disturbance
Thoughts of revengeLoss of appetite
SleeplessnessProblems in school,
inability to concentrate
Fearful
Drinking and smokingRegressive behaviourCrying
Low concentrationWorryingIrritability
Feeling sadNot relating with friendsRegressive behaviour
Being aloof NightmaresHelplessness
Feeling helplessnessFearfulNightmares
AggressionBody painStubborn
Denying the eventFeeling sadGetting angry
Adolescents(13 years & above)School Going Children(6-12 years)Young Children(0-5 years)
USUAL RESPONSES TO DISASTERS
THE OUTREACH MODEL
DTERT(Directorate of Teacher Education
Research & Training
NYK(Nehru Yuva Kendra
Orientation ProgrammeDIET Principals, NYK Dist. Coordinators
District Level Training(DIET faculties and Block Level
Resource Teachers)
Community Level Training(DIET faculties and Block Level
Resource Teachers)
Beneficiaries(Children in School)
Beneficiaries(Children – Out of School)
Community Level Training(Teachers)
Community Level Training(Youth Club members)
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Rationale for School Teachers as
Resource
• Teachers are cognizant of a child’s temperament andbehaviour patterns.
• Teachers know the ‘culture’ within each class
• Teachers are experts in providing children withknowledge, more so than psychologists andpsychiatrists
• Teachers are familiar with a variety of expressivemeans beyond rote teaching methods.
• Teachers are well-known to and trusted by thechildren & families.
KEY OBJECTIVES
• To accept the reality of the loss
• To work through the pain of grief
• To adjust to an environment in which
the dead person is missing
• To emotionally relocate the deceased
person and move on in life
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Training of Resource People• Understanding the effect of disaster on children &
adolescents.
• The Helping Process
• Flag signs: identification and referral for mentalhealth services.
• Conducting classroom activities
•
Enhancing effective communication with focus onlistening skills
• Record keeping
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PRE SCHOOL AND PRIMARY
SCHOOL ACTIVITIES
Let’s Talk
Let’s Draw
Let’s Write
Let’s Create
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Activities for Adolescents
• Group discussions, brainstorming &
ventilation. Focus areas:
- Learning to deal with loss and sadness
- Developing group cohesion by sharing hopes &
fears
- Learning to cope with anger
- Education about high risk behaviours (alcohol &substance abuse).
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Recommendations
INTEGRATING DISASTER PREPAREDNESS ININTEGRATING DISASTER PREPAREDNESS ININTEGRATING DISASTER PREPAREDNESS ININTEGRATING DISASTER PREPAREDNESS IN
SCHOOL MENTAL HEALTHSCHOOL MENTAL HEALTHSCHOOL MENTAL HEALTHSCHOOL MENTAL HEALTH
LEVEL OF INTERVENTIONWHO IS INVOLVED
Entire school
community
All students
and teachers
Counselors / teachers
peer mentors
Counselors /
school doctor
other experts
Integrated in
school
curriculum
Part of general
health curriculum
Students needing
additional help
Professional
management
Mental well being
I
Mental health knowledge,
attitudes and behaviours
II
Psychosocial problemsIII
Severe
problems /
disorders
IV
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BENEFICIARY
Children
Adolescents
Teachers
Principals
Parents
PROCESS EVALUATION
– Pre and posttrainingassessment tomonitor changes inknowledge &
helping skills
REGIONAL / STATE/
SCHOOLS
Orientation
programmes
Constitution of
training teams,teachers and peereducators.
Conducting ToTs
NATIONAL LEVEL
Inter-sectoral linkages
Capacity building
Advocacy with key stakeholders
Customize training packages.
IMPLEMENTING
PARTNERS
Schools
Professional
bodies
NGO’s
MONITORING OF THE PROGRAMME
1. Field visits by Regional Resource Persons
2. 3 monthly progress report of specific programme conducted.
3. Effectiveness at the time of disaster
TECHNICAL
Task Force
• Central• Peripheral
Professional
Teams (Regional
and State Level)
ACTION PLANACTION PLANACTION PLANACTION PLAN
Review
Tsunami’s will keep coming. It is the way of nature.
We have to accept them. And keep learning to be prepared and deal with them
Stories of Survival (Documentary) HistoryChannel.com – 20 Jan 2005
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