Judy Oehler-Stinnett, Ph.D.1 Introduction to Natural Disasters.
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Transcript of Judy Oehler-Stinnett, Ph.D.1 Introduction to Natural Disasters.
Judy Oehler-Stinnett, Ph.D. 2
Why care about natural disasters? Widespread
destruction Affect
everyone Tied to mental
health Awareness
means preparedness!
Source: Jeff Piotrouski, courtesy OK Dept of Health
Judy Oehler-Stinnett, Ph.D. 3
Disaster Definition
“Disasters can be defined as any event, human-made or natural, sudden or progressive, causing widespread human material or environmental losses, which exceed the ability of the affected community to cope using its own resources” (Asian Disaster Preparedness Center)
(Source: GOVT E-1027/W: Preventive Measures: the Politics of Disaster http://www.vranet.com/govt1027)
Judy Oehler-Stinnett, Ph.D. 5
U.S. Major Disaster DefinitionFederal Emergency Management Agency
Local response http://www.wtsp.com/video/player.aspx?aid=12620&sid=9618&bw=hi Local government first responders Neighboring & volunteer agencies assist
State declared disaster Local services cannot handle alone May send National Guard, agency workers Damage assessment conducted
Federal major declared disaster Governor commits state funds, requests major disaster
declaration FEMA evaluates request, makes recommendation President approves or denies request Requests submitted: Individual, business, public assistance,
tribe http://www.wtsp.com/video/player.aspx?aid=12620&sid=9618&bw=hi
Judy Oehler-Stinnett, Ph.D. 6
Natural DisastersHurricanes/Typhoon
Drought/Heat waveTornadoes
Non-Tropical Floods Earthquakes
Thunderstorms/Severe weatherWildfires
Landslides/Mudslides
Volcanoes
Blizzards/Freezes/Ice Storms
Lightning strikeTsunami Sandstorms
Resulting technical disaster (Na-tech)
NOAA
Judy Oehler-Stinnett, Ph.D. 7
Frequent Natural Events Qualifying as Disasters*
Worldwide Floods Hurricanes Drought/famine Earthquake Tornadoes Heat wave (*Tsunami infrequent but
devastating)
United States Hurricanes Floods Earthquake Tornadoes Drought
Judy Oehler-Stinnett, Ph.D. 10
Most deadly natural disasters
>100,000 >10,000 Tsunami Volcano Drought Extreme Temp Tornado/windstorm Slides Flood >1000 Earthquake Wildfire
(CRED)
Judy Oehler-Stinnett, Ph.D. 14
Economic Impact Property damage and loss Employment time loss Tourism loss Crop, topsoil destruction Disease in & loss of livestock Looting Increase illness and disease costs Large disaster estimates: millions to billions Tsunami cost: 4.4 billion
(World Bank)
Judy Oehler-Stinnett, Ph.D. 15
Industrialized Countries Better
Insurance coverage* Warning, death & damage
prevention* Emergency & medical care* Economic recovery* Mental health services
Most affected High risk areas Uninsured, low income#
When disaster not declared#
Contribution Federal & global disaster assistance Emitting most carbon dioxide-
impacts climate change$Source: *worldbank.org $worldviewofglobalwarming, #FEMA; picture FEMA
Judy Oehler-Stinnett, Ph.D. 17
Impact in Developing Countries Poor construction increases damage Setbacks to economic & social
development Poor to no early warning system Massive casualties Development money diverted to
relief Longer secondary trauma from
displacement, illness, grief, economic loss
(Text source: Worldbank; Photo source: American Red Cross.com)
Judy Oehler-Stinnett, Ph.D. 18
Mental Health Impact/Needs Psychological first aid
Normalize majority reactions Access to recovery services
Treatment of severe reactions Acute Stress Disorder Post-traumatic Stress Disorder
Intervention for long-term stress Secondary trauma Fear of reoccurrence
Long-term planning Crisis Intervention Mitigation/Secondary Prevention Primary Prevention
Trauma (all types) #1 cause of preventable mental illness
NASP
25
http://www.tornadoproject.com/alltorns/world.htm#top
Tornadoproject.com clickable map of tornado information available worldwide
No free map currently available
41
Countries with recent forest fires Dominican Republic, April 2005 Syria, October 2004Australia, January 2004
United States, November 2003
Russian Federation, October 2003
Kazakhstan, October 2003
India, October 2003
Brazil, September 2003
Portugal, September 2003
Canada, September 2003
South Africa, September 2003
Greece, September 2003
Spain, August 2003
Italy, August 2003
Argentina, August 2003
Paraguay, August 2003
Croatia, August 2003
France, August 2003
China, June 2003
Sumatra, Indonesia, June 2003
Mexico, May 2003
Nicaragua, April 2003
Guatemala, March 2003
54
Drought/Flood Prediction from changes in precipitation (International Research Institute for Climate Prediction)
Judy Oehler-Stinnett, Ph.D. 55
Factors in Natural Disasters
Contribute to the total experience of the event Note for common & unique reactions in victims
For more info, go to: http://www.fema.gov/ http://www.noaa.gov/ http://www.redcross.org/ http://www.worldviewofglobalwarming.org/
Judy Oehler-Stinnett, Ph.D. 56
Factors in natural disasters Geographic location Frequency Predictability Suddenness & Warning time Severity/Intensity-size, speed Duration Destruction method Sights, sounds during Injury, damage, deaths Aftermath Preparation methods Prevention methods
Judy Oehler-Stinnett, Ph.D. 57
Geographic locations Vary within U.S. and world (see maps) Variance from year to year, but stability in high
incidence areas Hurricanes coastal but vary on where on coast
hurricane hits Tornadoes concentrated in Midwest but vary as to
exactly where land Influenced by airflow (e.g. Jet Stream)
Variance contributes to building in high risk areas lack of preparation failure to heed warnings
Every area of world at risk for some types of natural disaster
(NOAA, NWS, FEMA, Red Cross)
Judy Oehler-Stinnett, Ph.D. 58
Frequency Varies from year to year Varies across locations Can be seasonal, cyclic Flood most frequent
worldwide High frequency areas
Most awarenessMost official preparationHabituation can lower
public responseRepeated disasters lower
resilience (NWS, FEMA, Red Cross, worldbank)
Judy Oehler-Stinnett, Ph.D. 59
Predictability, Suddenness & Warning Time, & Response
Predictions take substantial resources Vary in accuracy Have seasonal factors
May have seconds to months Hurricanes longer warning time Tornadoes may have minutes only Earthquakes may have no warning
Dangerous to underestimate time to impact
Preparedness increases rapid response Failure to respond increases severity
exposure and likelihood of trauma symptoms (FEMA, NWS, Red Cross)
Judy Oehler-Stinnett, Ph.D. 60
Predictability, Suddenness and Warning Time, Response con’t.
U.S. advances in prediction & death reduction Decreased some prevention & mitigation
effortsIncreased population in high-risk areas
Urban & coastal crowding Increased number of potential victimsReduced evacuation capabilityIncreased cost to rebuild(FEMA)
Judy Oehler-Stinnett, Ph.D. 62
Severity/Intensity Severity ratings in scale numbers
Most severe are less frequent People in high frequency areas underestimate
severity Size impacts
Number of victims Amount of land Ability to predict
Intensity/speed impacts Level of damage Amount of time to prepare
Increases in victims’ level of trauma Proximity to center of event Experiencing injury, property damage Exposure to death, Fear for life (FEMA. Red Cross, NWS)
FEMA
FEMA
Judy Oehler-Stinnett, Ph.D. 63
Duration Length of actual event
Drought- long periodsSevere weather-hours to days Flood waters recede slowlyTornadoes-minutesEarthquakes-seconds
Length of secondary traumaTime to clear debris, rebuildTime to restore safety, order, routine(Red Cross, FEMA)
Judy Oehler-Stinnett, Ph.D. 64
Damage Method Wind - property & personal damage Water movement
Alone reduced property damage (flood)Animal loss risk high
Wind + water=High risk of death/ damage Fire – Leaves little behind Cold Heat/drought Land Movement – earth, mud, snow, ice(Red Cross, FEMA, NWS)
Judy Oehler-Stinnett, Ph.D. 65
Sensory Input during Event Impacted by type and severity of disaster Influences memory and stimulus triggers for
stress & trauma Areas of input
Sights SoundsBodily sensesSmell(Red Cross, APA)
Click for video http://gprime.net/video.php/soccertornado
Judy Oehler-Stinnett, Ph.D. 66
Sensory Input during Event Sights
Clouds, Funnels, LightningWater moving, risingHeat radiationHail, rain, dust, sand, snow, ice, earth,
etc. blownHuman and animal victims injured or
dead, bloodProperty movement, damage and debris
(Red Cross, APA)
Judy Oehler-Stinnett, Ph.D. 67
Sensory Input during Event Sounds
WindRain, Ice, HailThunderCries for helpProperty stress and destructionLand shifting, cracking
(Red Cross, APA)
Judy Oehler-Stinnett, Ph.D. 68
Sensory Input during Event Bodily senses
Being carried by water, wind or earthEarth shaking or shiftingTemperature and pressure changesOwn injuries (Red Cross, APA)
Judy Oehler-Stinnett, Ph.D. 69
Sensory Input during Event
SmellWind-carried odorsWater-soaked objectsContaminationDeath
(Red Cross, APA)
Judy Oehler-Stinnett, Ph.D. 70
Injury & deaths, Damage Injury & death varies with type of
forceWind damage - impales debrisWater damage- risk of drowningEarthquake – falling debrisLand movement – suffocation risk
Amount of damage largely determined by size and severity of event (Red Cross, FEMA)
Judy Oehler-Stinnett, Ph.D. 71
Aftermath: Recovery vs. Secondary Trauma
Food & water vs. starvation
Health vs. disease Rapid rebuilding vs.
long-term displacement
Economic growth
vs. basic relief (FEMA, Red Cross, worldbank)
Judy Oehler-Stinnett, Ph.D. 73
Long-range preparation-educational Community planning to lessen losses
Building codes Insurance coverage Shelters Warning systems
Preparation for specific disasters in your area Ensure that school plans are adequate Have personal plans in place so that you can assist others
Knowledge & supplies to Children Families School Community
Resources Federal Emergency Management Adm (FEMA) American Red Cross State Agencies Media NASP, APA
Judy Oehler-Stinnett, Ph.D. 74
Programming by Phases of Disaster Prevention/mitigation Long-range preparation Immediate preparation for impact Impact or during disaster Immediate aftermath, acute crisis phase Short-term follow-up & evaluation Long-term follow-up & evaluation Continued planning
Judy Oehler-Stinnett, Ph.D. 75
Prevention/Mitigation Event primarily uncontrollable
Damage and outcome somewhat controllable Location of home, business, school Building structure integrity
National Clearinghouse for Educational Facilities Guidelines for building/retrofitting educational facilities:
http://www.edfacilities.org/rl/disaster.cfm Storm shelter Knowledge of specific disasters Disaster preparedness kit Disaster drills Weather radio, heed warnings
Judy Oehler-Stinnett, Ph.D. 76
Prevention/Mitigation Methods High-risk areas
Avoid living in Avoid expensive building in
Build or retrofit to withstand disaster
Institute high-level planning and funding
Tie funding and insurance to mitigation
Reduce carbon dioxide emissions Reduced energy needs alternate energy sources
(Red Cross, FEMA, worldbank; pictures earthfuture)
Judy Oehler-Stinnett, Ph.D. 77
Disaster Preparedness Methods Awareness & knowledge of
potential disasters Emergency survival supplies Materials to protect property Evacuation plan Communication plan Shelters Security plans (FEMA, Red Cross)
Judy Oehler-Stinnett, Ph.D. 78
Preparedness Programs FEMA, Red Cross
Children Families School personnel Community
Judy Oehler-Stinnett, Ph.D. 79
Preparedness Programs, con’tsee FEMA and Red Cross for excellent resources, links
Child educationUse available local resources
Television weather personnel Science teachers and others
Utilize science natural disasters curriculum unit Often covered in 5th to 7th grade
Integrate with language & other units Include mental health componentsMake it Active
Don’t just TELL kids what they SHOULD do get donations to prepare kits
Judy Oehler-Stinnett, Ph.D. 80
Child Education, con’t. What natural disasters occur
most frequently in area Disaster preparedness
Supplies Where to go during disaster How to contact adults and loved ones Resources for volunteering
Mental health preparedness Shock of event Coping skills for recovery
For program packages, see: http://www.femagov/kids/ http://www.redcross.org/disaster/masters/
FEMA
Judy Oehler-Stinnett, Ph.D. 81
Preparedness Programs, con’t Family education Trained children often more concerned Adults responsible for safety
Children lose faith in adults’ ability to protect them after disaster occurs (Lazarus, 1995)
Worse with loss of loved one or high death threat
Increase involvement Enlist parent organizations Provide incentives – disaster kits
Include cultural, religious sensitivity Beliefs regarding causation
divine punishment miracle predetermination
Beliefs regarding death Death to be feared or welcomed Rituals and symbolic meaning
Evans (2002) found that children who were in a storm shelter were much less afraid of the tornado
NASP resources:http://
www.nasponline.org/culturalcompetence/
cc_crisisresources.pdf
Judy Oehler-Stinnett, Ph.D. 82
Family education, con’t. Include mental health issues:
Awareness of family/child premorbid functioning Chronic stressors Past or recent traumas Trait anxiety, agitation
Degree of exposure relationship to trauma symptoms Behavioral symptoms
Not always observable Must ask children how they are feeling and listen to them. (Evans, 2002)
Importance of social support Emotional support Informational support Tangible support (Norris et al., 2001)
Include coping tools to facilitate post-traumatic growth Use of adaptive coping rather than avoidance (Moss, Cronkite, Billings, & Finny)
What did we learn? How can we prepare better? Restore trust in safety.
Judy Oehler-Stinnett, Ph.D. 83
Family preparedness, con’t. Knowledge of natural disasters in area Family crisis, safety & evacuation plan Emergency supply kit, weather radio Way to communicate, use of social support network Place to gather Listen and heed warnings: Remaining when unsafe
related to trauma symptoms Override family members discounting concerns Do not “chase” storm – leave that to professionals Use care following disaster – make sure children avoid
debris, power lines, fire, etc.American Academy of PediatricsAAP - Family Readiness Kit: Preparing to Handle Disasters
http://www.aap.org/family/frk/frkit.htm
Red Crosshttp://www.seattleredcross.org/disaster/familyplan/index.HTM
Judy Oehler-Stinnett, Ph.D. 84
Don’t forget the Animals Most shelters do not allow
pets Children become very
concerned about their pets Livestock are also a
consideration Plan ahead for animal safety
Failure to evacuate & reentering disaster scene related to pets (Heath, 1997)
Loss of or injury to animal related to trauma symptoms
See Humane Society of the U.S. for animal tips:http://www.hsus.org/hsus_field/hsus_disaster_center/FEMA
Judy Oehler-Stinnett, Ph.D. 85
School Disaster Plan Identity potential disasters in
your area Involve school board, parent
groups, administration Use recommended resources:
FEMA handout – multi-hazard plan for all phases of disaster:http://www.fema.gov/fima/rmsp424.shtm
Red Cross Emergency Guide for Business and Industry:http://www.redcross.org/services/disaster/0,1082,0_606_,00.html#fema
Judy Oehler-Stinnett, Ph.D. 86
Preparedness Programs, con’t. FEMA School personnel education
Review crisis plan for natural disasters Include parents, students Drill procedures for taking cover and evacuating Ensure evacuation route avoids hazards Include plan for persons with handicapping conditions
Build shelters, retrofit buildings “Walk through” to remove, secure hazards
Chemicals Heavy objects Windows, glass
Educate on need to protect, respond Take seriously Keep first aid kit, flashlights, broom, communication, and weather
radio in all classrooms Plan for use of school buildings as community shelter
Judy Oehler-Stinnett, Ph.D. 87
Preparedness Programs, con’t. FEMA
School personnel education, con’t. Include mental health issues
Prevent stress on children due to school lack of preparedness or follow-up
Know effects of disaster on emotions, academics & social interaction
Reduce parent anxiety by communicating on evacuation, lock-down procedures during natural disaster
Not safe to try to pick up child during disaster Official means for getting school information
Address trauma-related symptoms of school personnel who must comfort children
Personnel likely have also suffered loss Secondary trauma of care-givers
Judy Oehler-Stinnett, Ph.D. 88
Community Preparedness Coordinate school and community plans
Identify leaders and liaisons in emergency management
Prepare for use of buildings as shelterUse community resources to facilitate family training
in communityPlan for Rapid response team deploymentPlan for dealing with media
Agency or residential facilitybe knowledgeable of the disaster planBecome member of crisis team
Have community-wide disaster drills
89
Media converge on a disaster location when all the people want is to be helped or to be left alone…
Photo copyright Mitchell ProtheroWorld Picture News
Judy Oehler-Stinnett, Ph.D. 91
Immediate preparation for Impact Follow natural disaster procedures in
agency/school Keep communication open-limit use of cell
phones if children have them Help children and caretakers remain calm Stay alert to changing conditions and take
protective steps Keep weather radios on NEVER IGNORE SIRENS
Judy Oehler-Stinnett, Ph.D. 92
Impact If natural disaster occurs while children are at
school, school will become a trauma stimulus Remain calm and help others to do so Model positive coping self-talk Remember that care-givers as well as children
will be affected Take care of your own needs as well If event happens while children are away from
school, school will be used to help normalize adjustment.
93
Bloomsburg, PA High SchoolFlooding from Hurricane Ivan
Jared Fenstermacher – from Bloomsburg Weater
Judy Oehler-Stinnett, Ph.D. 94
Acute crisis phase Continue to implement school crisis plan Assist in controlling media access Assist in communications between home
and school Work with any emergency team that is on-
site, have credentials available Help with triage in determining who needs
immediate assistance Assess property damage and hazards Assist with activities if school is an
emergency shelter
Judy Oehler-Stinnett, Ph.D. 96
Short-term follow-up Once acute crisis team has left, continue to meet
immediate needs through school crisis team Practical assistance most critical at this phase
Survival: Food, water, shelter Finding loved ones and pets Access to disaster services
Guidance programs for majority of children Normalization of responses Coping skills Reduce school requirements to make time for intervention
Screen for children needing mental health services Victims who were not in desperate need immediately may
start showing trauma symptoms – later onset of PTSD Kids do not need to show full-blown PTSD to need help Parents often underestimate impact of trauma on kids
Judy Oehler-Stinnett, Ph.D. 97
Short-term coping Social support system available
Family Friends Community/church School
Positive role models for coping Those around child take steps to cope, make positive
coping statements Support for discussing event, feelings Discussions are not anxiety-filled or provoking, but
don’t negate severity of event Volunteer opportunities
Judy Oehler-Stinnett, Ph.D. 98
Short to long-term follow-up Coping with funerals, sometimes multiple Delays and cost in rebuilding Lack of resources, services, extended
secondary trauma Low social support and high modeled social
anxiety (Evans, 2002 )
Judy Oehler-Stinnett, Ph.D. 99
Long-term follow-up Significant evidence that children experience
long-term effects of natural disasters (Evans, 2002)
Support groups for most kids Trauma treatment for those most affected Disaster preparation Anniversary dates Find ways to minimize trauma cues, change
thoughts surrounding seeing cues Cognitive-behavioral therapy most successful
Judy Oehler-Stinnett, Ph.D. 101
Post-trauma adjustment Factors Cultural considerations
Concepts of death Adaptation rituals
Rural vs. urban setting Use of existing support systems Availability of services
Persons with disabilities Preexisting mental health issues Need for additional support services
Preexisting crisis procedures Communicating with media & limiting access to trauma victims Determining who is eligible to provide services and triage
Children’s re-exposure through television and other media
Availability of mental health services
Judy Oehler-Stinnett, Ph.D. 102
Post-Trauma Adjustment Factors Closeness to impact: Sights, sounds Severity of event: most severe damage Injury to self Witnessing injury to others Witnessing death of other people, pets Place during event damaged or destroyed Home, school or other location damaged or
destroyed Injury of significant others: family, friends Death of significant other Fear of being severely injured or killed Inability to contact, locate loved ones Feelings of safety (e.g., in storm shelter with family)
can mitigate trauma symptoms to some extent
Judy Oehler-Stinnett, Ph.D. 103
Post-trauma adjustment Factors What happens in the mind of a child?
Causation beliefs - mistaken connection between their behavior and event
Survivor guilt – their survival cost someone else Omen formation – thinking they could have prevented event
(March, 2003)
Understanding of event Anger at family or school for not protecting them better
Alterations in existing schema due to event No longer feel safe, optimism bias of childhood shattered Foreshortened future beliefs
See Pynood et al., 1997 for model of PTSD
Judy Oehler-Stinnett, Ph.D. 104
Post Trauma Adjustment Factors: Developmental Considerations
There are many developmental lists out there, not all are based on research.
Preschool, child and adolescent symptoms vary, yet within each age group, different children will react differently.
Children likely have different reactions than adults and adults may not notice or understand child’s concerns either because the adults are not upset or they are too upset themselves.
Judy Oehler-Stinnett, Ph.D. 105
Assessment/Intervention for Acute Stress Disorder & Post Traumatic Stress Disorder in Natural Disasters
Post-disaster phases Emotional numbing
Gets you through acute phase of trauma Shouldn’t mistake for children being “fine”
Coping vs. Acute Stress Disorder Most victims have a support system and
take positive action to get through crisis Excessive stress reaction during first
month following disaster ASD
Post Traumatic Stress Disorder Symptoms onset or remain more than
one month post-disaster Not all symptoms present in children
Tsunami orphans: 7,722 lost 2 parents; 32,735 lost 1 parent
Worldbank.org
Amma teaching tsunami survivor how to swim Amritapuri.org
37% of deaths were children
Judy Oehler-Stinnett, Ph.D. 106
Common Symptoms in Youth who are at risk for PTSD Following Natural Disaster
Re-experiencing: Nightmares about disaster or symbol of it Trauma play (in young children)
Avoidance: Avoidance of place reminders Avoidance of people reminders Avoid discussion of trauma
Hypervigilance/arousal: On look out for cues of reoccurrence (e.g.,
react strongly to clouds in sky following tornado)
Excessive startle reaction (Carrion, Weems, Ray, & Reiss, 2002)DSM-IV-TR
Judy Oehler-Stinnett, Ph.D. 107
Common Symptoms in Youth who are at risk for PTSD Following Natural Disaster
Anxiety/worryConcern about safetyDon’t want to leave parents
Somatic complaintsStomachachesHeadaches
Agitation/ angerAnger at not being protectedAgitation related to hypervigilance (Chorpita, Albana & Barlow, 1998)
Judy Oehler-Stinnett, Ph.D. 108
Common Symptoms in Youth who are at risk for PTSD Following Natural Disaster
Social interaction
difficultiesFamilyTeachersPeers
School difficultiesSchool workConcentration,
memory(Caffo & Belaise, 2003; Weinstein,
Staffelbach, & Biaggio, 2000)
Judy Oehler-Stinnett, Ph.D. 109
Screening If you work where a natural disaster has occurred
at any time that the children you work with could have been exposed to it, then you need to screen for effects of the disaster! Under these conditions, any child referred should be screened to see if symptoms are related to the natural disaster that impacted them. (Ford et al., 2000)
Broad-band scales do not measure PTSD per se, but scales such as the BASC-SRP are related to PTSD scales (Cook-Cottone, 2004; Evans, 2002)
General anxiety scales may also capture some symptoms
Judy Oehler-Stinnett, Ph.D. 110
Screening, con’t. If a natural disaster occurs while you are
providing services, then you need to screen/assess for children affected Immediately following1 month to 1 year following2 year follow-upLong-term follow-up
Judy Oehler-Stinnett, Ph.D. 111
PTSD Scales Validated for Use with Children in Natural Disasters
Children’s PTSD Inventory (Saigh, et al., 2000; Saigh, Yasik, Oberfield, Halamandaris, & McHugh, 2002)
Impact of Events Scale (Horowitz, Wilner & Alvarez, 1979; Yule,
Bruggencate, & Joseph, 1994); The Child Post-Traumatic Stress Disorder
Reaction Index (CPTSD-RI, see Frederick, Pynoos, & Nader, 1992); The Child PTSD Symptom Scale (CPSS; Foa, Johnson,
Feeny & Treadwell, 2001);
When Bad Things Happen (WBTH; Fletcher, 1996)
The Kauai Recovery Index, patterned on the CPTSD-RI (Hamada, Kameoka, Yanagida, & Chemtob, 2003).
The OSU PTSD Inventory – Child (Evans, 2002; Evans & Oehler-Stinnett, submitted)
Judy Oehler-Stinnett, Ph.D. 112
Prevalence of PTSD in Children Following Natural Disasters Using PTSD Inventories
Youth more impacted by disaster than adults & Violence victims more impacted than those in
natural disaster (Norris, Friedman, & Watson, 2002) (see Freyd, 2002 re: betrayal trauma theory)
Children in developing countries more impacted than those in developed countries (Evans, 2002; Bulut, 2003)
Some evidence that girls and minorities more affected, but results not consistent (Vernberg, LaGreca, Silverman, & Prinstein, 1996)
Judy Oehler-Stinnett, Ph.D. 113
Prevalence rates, con’t.: Child self-report Almost all children in hurricanes show initial symptoms (86-
95%) At 10-month to 1 year follow-up, rates are lower, but
majority of children still showing some symptoms Much lower percentage show severe or pervasive
symptoms (18-30%) using DSM-IV criteria Must look at specific symptoms, not just overall score Using standard deviation units on factor scoring, tornado
victims show fewer severe symptoms (10-15%), moderate symptoms higher (47-65%)
Earthquake victims worldwide much higher rate than U.S. children
(e.g., Anthony, Lonigan, & Hecht, 1999; Evans & Oehler-Stinnett, submitted; Hamada, Kameoka, Yanagida & Chemtob, 2003; Lonigan, Shannon, Taylor, Finch & Sallee, 1994; Vernberg, LaGreca,
Silverman, and Prinstein, 1996)
Judy Oehler-Stinnett, Ph.D. 114
Prevalence rates, con’t.
Problems with DSM – IV – TR diagnosisNot completely substantiated by factor
analysis studiesNo Likert rating or anchors, or normsChildren not likely to evidence most
symptoms unless very severely affectedUse of rating scales recommended
Judy Oehler-Stinnett, Ph.D. 115
Serious Concerns in Adolescents
Increased risk of Alcohol and
substance abuse Depression Suicide
Influence on culture TSUNAMI SUICIDE By the Unseen Copyright 03-04
These feelings in my headOf things that can't be saidBecause I'm grasping for the wordsTo make you understandAnd I wanna destroy myselfDon't wanna destroy myselfI wanna destroy myselfHurricanes of love and painTsunami tides of suicideLike a cobra poised to strikeLike a criminal in the nightDepression sleeping inLike a ship without a lightBut life is just a gameAnd we all end up the sameSo let the storms comeCause the clouds will bring the rain
Judy Oehler-Stinnett, Ph.D. 116
Interventions for Children with PTSD in Natural Disasters
Cognitive-Behavioral Therapy (Foa, Treadwell, & March, 2004)
Exposure, relaxation, massage less evidence
Psychoeducation, coping (Teicher, et al., 2002)
Medication (Bryant & Friedman, 2001)
Judy Oehler-Stinnett, Ph.D. 117
Interventions con’t.
Continue long-term intervention Prepare better – see prevention and
mitigation slides!
Judy Oehler-Stinnett, Ph.D. 119
Long-range planning-Mental Health Who trains disaster mental health workers?
NOVA – National Organization for Victims’ Assistance has liaison with National Association of School Psychologists for NEAT (National Emergency Assistance Team)
Red Cross – Has liaison with American Psychological Association’s Disaster Response Network (DRN) for DMH.
Who is eligible to provide disaster mental-health services? Must be licensed to provide DMH services to any location,
according to Red Cross, for protection of public. Certified school psychologists are often involved in crisis
services in their schools, but need appropriate training.
Judy Oehler-Stinnett, Ph.D. 120
American Psychological Association Disaster Response Network
in conjunction with the American Red Cross
http://www.apa.org/practice/drnindex.html Licensed psychologists can be trained through
the DRN program Must obtain liability insurance Series of disaster trainings, including mass
trauma and disaster-specific training In need of child specialists Contact APA or your local Red Cross
Judy Oehler-Stinnett, Ph.D. 121
NASP National Emergency Assistance Team (NEAT)
NASP helps in disasters through the National Emergency Assistance Team Trained NASP personnel are on call for emergencies Should you be a crisis responder?
http://www.nasponline.org/NEAT/neat_crisis.html
There are additional helpful materials available on line through NASP:http://www.nasponline.org/NEAT/
Judy Oehler-Stinnett, Ph.D. 122
Resources from NASP on Natural Disasters
http://www.nasponline.org/NEAT/crisismain.html#natural
http://www.nasponline.org/crisisresources/22-Lazarus.pdf
http://www.nasponline.org/crisisresources/tsunami.html
http://www.nasponline.org/NEAT/MidwestFloods.pdf
Judy Oehler-Stinnett, Ph.D. 123
NASP Resources on Natural Disasters Natural Disasters from NASP's book Best Practices in School Crisis
Prevention and Intervention Helping Children in the Event of a Tsunami: Information for Parents
and Teachers Effects of the Indian Ocean Tsunami: Helping Children Cope Helping Children After a Wildfire: Tips for Parents and Teachers Responding to Wildfires: Helping Children and Families Responding to Natural Disasters - Helping Children and Families: Info
rmation for School Crisis Teams
Helping Children After a Natural Disaster: Information for Parents and Teachers
Winds of Terror: Children's Response to Hurricane and Tornado Disasters - from the NASP publication Crisis Prevention and Response: A Collection of NASP Resources (pp. 231-239).
Natural Disasters, Crisis Intervention, and School Psychology: Melding Human Needs and Professional Roles
See http://www.nasponline.org/NEATfor updated crisis information