playground. Some of the signs are fighting and crying in school for no apparent reason, increased motor activity, withdrawal, inattentiveness, marked drop in school performance, school phobia, rapid mood changes, incessant talking about the disaster, and marked sensitivity to weather changes. Puppetry and psychodrama conducted by a counselor or teacher in the classroom or in special groups are helpful in re-enacting the disaster. They may be followed by discussions and reports by the children of their own experiences in the event. Field trips to disaster sites may be arranged, and group meetings with students and parents may be held. Coloring books, word puzzles, connect-the-dot pictures, and arithmetic problems about the disaster build self-confidence. Class projects may be developed in which all the information about the disaster or a previous similar one is collected and made into a book with color drawings. Craft models or replications (such as dams, earthquake geology, volcanoes, rivers, etc.) may be built. Puppets may be made and used to re-enact the disaster.

Children can be encouraged to construct their own games as a way of mastering the feelings associated with the disaster. For example, children play tornado games in which they set up the rules by themselves. In one game, each child is designated as an object, such as a tree, house, car, etc., and one child is the tornado making a noise like a siren and running. The other children begin to run and knock each other over. The "tornado" leaves, and all the children get up and return to their normal activities. Another example has children building a dam in a gutter or ditch and filling it with water. One child then breaks the dam and allows the water to escape harmlessly down the street or into the ditch.

School rap groups are also particularly helpful. Administrative information meetings, teachers' in-service meetings, and parent-teacher meetings can be used for public education. Newsletters and the school newspaper are useful in distributing information among the students. Chat rooms and web-sites on the internet can also be helpful.

Public involvement can be integrated through use of widespread associations, such as Camp Fire Girls, Cub Scouts, Brownies, 4-H, etc.

Loss, Death and Mourning It is not unusual for a disaster, particularly a major disaster in which there has been loss of life, to trigger children's questions about death and dying. The fear of the loss of mother or father underlies many of the questions and symptoms a child may develop, such as sleeplessness, night terrors, clinging behavior and others. Often, when loss has occurred, the children's problems are overlooked. No one assists them in handling their reactions to the loss. When a mother or father dies, most children are fearful of what will happen to them if the remaining parent dies as well. Being told that adults will look after them is very reassuring. The children should be encouraged to voice their questions. The adults should be as honest as they can be with their answers. For example, questions about what happens to a person after death can be answered with the statement that the wisest men and women through the ages have tried to answer this question. However, there is no sure answer. Explanations dealing with heaven and hell, or afterlife, or the flat statement that after death there is nothing are confusing to a child.

It is not uncommon for children to make believe that the deceased parent is still alive. They may call the remaining parent or family a liar and deny their parent's death. Some children may go back and forth between believing and not believing that the parent has died and may ask such questions as "When is Daddy coming home from being dead?" or "I know Mommy's dead, but when is she going to make my supper?" Young children may not realize that there is no return from death - not even for a moment.

Although many of the same issues that adults struggle with in coming to terms with death are also found in children's struggles. Magical thinking is more prevalent in childhood. Most children, when they are very young, believe that wishing for, or thinking about, something can make it happen. Children who have had angry thoughts or death wishes toward the parent (as most children have at one time or another) need to be reassured that these thoughts did not cause something to happen. Children may believe that fighting with a sibling can cause a parent's death and that ceasing to fight will prevent the other parent from dying. They need reassurance that the parent's or family member's death was not their fault, that it was caused by an accident or illness. It is comforting to be told that there are some things they cannot control, such as parents getting sick or having an accident or dying. These can be contrasted with things they can control, such as the games they play, whether or not they play fairly, whether or not they do their chores and homework.

Both the child and family may suffer loss of pets, property, valuables, and treasured sentimental objects. Such losses may have as much impact on them as the loss of a loved one. A mourning process can be anticipated. When family treasures or sentimental objects are still available, they can be helpful to the mourners. They often provide something tangible as a security object. Families in disaster frequently turn to the ruins to retrieve what seem like valueless objects. This is understandable because mourning pertains to the loss of home and objects as well as to loss of loved ones.

Workers need to know that mourning has a purpose and that crying by both a child and an adult is helpful. A child needs to be aware that thoughts about the dead person are likely to come to mind over and over. Forgetting takes time and overt mourning helps the integrate the loss more quickly. The family that expresses concern and annoyance at a child who asks the same questions about death over and over again needs to understand that this is the child's way of adapting to the loss.

Suicidal Ideation Threats or attempts to injure or kill oneself in latency-age children and younger are rare. However, they are not uncommon among adolescents. Any indication of suicidal feelings must be taken seriously. The most frequent motivation is loss of close family, a sweetheart, and of significant objects such as pets, instruments, or a car. Even loss of the opportunity to participate in team sports for the year may bring on serious depression.

Feelings of helplessness, hopelessness, and worthlessness are strong indicators of suicide potential, expressed verbally or nonverbally through behavioral signs - withdrawal, asocial behavior, loss of interest, apathy, and agitation; physical symptoms - sleep and appetite disturbance; and cognitive process changes - loss of alternatives, poor judgment, and reasoning ability. Evidence of caring and concern are the most immediate, effective elements of help which can be provided by all workers. Generally, however, any person with suicidal ideation should be referred to professional help.

Confusion A trouble sign that requires immediate attention, confusion implies a deep-seated disturbance which also probably requires referral to a mental health professional. Confusion generally refers to a disorientation in which the young person has lost the ability to sort out incoming stimuli, whether sensory or cognitive. As a result he/she is overwhelmed by a profusion of feelings and thoughts. Associations with familiar objects may be distorted or disappear, regressive behavior may reappear, and feelings displayed may be inappropriate for the occasion. In extreme cases, immobilization or uncontrolled movement may occur. The mental health professional can begin the process of helping to reorient the children by talking to them calmly, by providing them with specific information, and by being caring and understanding.

Antisocial Behavior Behavior problems - group delinquency, vandalism, stealing, and aggressiveness - have been reported in some communities following a disaster. These behaviors may be a reaction of an adolescent with low self-esteem to community disruption. A major problem for the adolescents is the boredom and isolation from peers which comes from disruption of their usual activities in school and on the playground. One way to counteract this is to involve adolescents and their peers, under adult direction, in clean-up activities which may be therapeutic to the teenagers and beneficial to the community. The adolescents also serve as an excellent resource for helping elderly people and babysitting for families.

It should be remembered, however, that young people of this age have difficulty expressing their fears and anxieties, lest they seem less competent to their peers and themselves. The use of peer rap groups, in which teens can talk about their disaster experiences and ventilate feelings, is helpful in relieving buried anxieties. A "natural" setting for these rap groups, such as school, work or task sites, or wherever teenagers congregate, is desirable. Training teenagers to lead their own rap groups should be considered. Boy Scout and Girl Scout leaders and teachers are natural leaders/trainers.

CHILDREN WITH SPECIAL NEEDS

Two groups of children with special needs are briefly discussed below: those with prior developmental or physical problems; and those who have been injured or become ill as a result of the disaster. Both require more intensive attention in a disaster than normal or less seriously affected children.

The Exceptional Children Exceptional children are defined as those who have developmental disabilities or physical limitations, such as blindness, hearing impairment, orthopedic handicaps, mental retardation, cerebral palsy, etc. Exceptional children have special needs that require consideration when a disaster occurs. Disasters and their periods of disruption bring additional burdens upon the parents of exceptional children. These parents have problems just in coping with their children's needs on a day-to-day basis. The emotional needs of exceptional children are very likely to be exacerbated by a disaster of any magnitude.

Most exceptional children live in their own homes and receive assistance from community agencies. The agencies, part of the network of human services in the community, may need to be alerted to the special needs of the children in home settings. Exceptional children find it more difficult to function when their usual home environment is damaged or if they are moved to strange surroundings. Helping such children to understand what has occurred requires heightened sensitivity. Generally, it would be desirable to have professionals who normally are in contact with the children assist in providing help. The professionals are able to locate and identify the children in the community and determine what special services they need, such as schooling or medical care. Exceptional children depend to a greater extent than other children on the consistency and predictability of their environment and the people around them. Familiarity with their surroundings is particularly important to mentally retarded children, who tend to become confused and agitated by traumatic events. One reaction is increased levels of clinging behavior. Parents of these children may need the short-term support of the crisis worker. For example, parents would be helped by learning that their children have greater need for reassurance so that they can anticipate and be tolerant of the increased demands. The parents would also benefit from a crisis group with other parents of exceptional children. Special education teachers can be a source of assistance for the children. In as much as they are persons familiar to the families and children, they can be very effective in assisting both.

Planning in advance for the needs of children in residential settings, such as treatment centers for mentally ill, mentally retarded, or physically handicapped children, and for day programs for children, such as childcare centers and schools, should have high priority. These agencies should all have their own plans that include staff deployment, evacuation to alternate settings, and ways to contact and inform families of the well-being and location of their children.

The Injured or Ill Children Like any children who undergo medical procedures, children who have been physically injured in a disaster or who have become ill and have been brought to the hospital or the doctor's office will be less traumatized by the injury if the medical procedures that are about to occur are explained to them. In most up-to-date hospitals this is part of the hospital routine. Consultants can inquire about the local hospital and professional associations and involve them in crisis planning. Every effort should be made to have a member of the immediate family remain with the child during hospital stays and to be present when the child receives medical care. This is reassuring to the family and to the child. <

Parents should encourage children to return to school. They should talk with their teachers about any problems that are evident either at home or in school. Parent-teacher meetings and programs can assist in integrating school and family efforts at reassurance and can encourage the child to understand his/her feelings and to cope with loss and the need to get on with life.

It is important to be aware that each child may react differently, even within the same family. Each child may need a different type of help to cope with his/her feelings about and reactions to the disaster.

 

Adolescents

At this age the motor skills of young people are often equal to those of adults. However, it is important for adolescents not to exceed their abilities and to realize that other aspects of their personalities are not as advanced as their physical development. The mental maturity of adolescents has no direct relation to their physical growth. Adults should not allow themselves to be influenced by appearances and expect an adolescent to have an adult mentality.

Adolescents have a great need to appear competent to those around them. They struggle to gain independence from their families and are divided between a desire for increased responsibilities and a wish to return to the dependent role of childhood. Beyond the family and the school, peer groups have a favored place in their concerns and provide them with various means for validating themselves.

A disaster can have many repercussions on adolescents, depending on its impact on family, friends, and the environment. They show physical, emotional, cognitive and behavioral reactions similar to those of adults.

Studies have shown that the difficulties experienced by adolescents after a disaster are boredom and loneliness resulting from isolation from peers due to disturbance of their activities and re-housing of their families.

Finally, following a disaster, an adolescent may suddenly have to assume an adult role and cope with the need to become the head of the family and provide financial and emotional support to the other members of the family. The adolescent's way of envisioning his/her responsibilities depends on a variety of factors, including cultural background, age, religious views, education, personal equilibrium, and conception of life.

 

PROVIDING HELP FOR CHILDREN AND FAMILIES FOLLOWING DISASTERS

General Steps In The Helping Process A basic principle in working with problems of children in disasters is that they are essentially normal children who have experienced great stress. Most of the problems which appear are likely, therefore, to be directly related to the disaster and transitory in nature.

The process recommended for helping children and families often starts with "crisis intervention", which can be provided by trained and supervised paraprofessionals and volunteers. The primary goal in crisis intervention is to identify, respond to, and relieve the stresses developed as a result of the crisis (disaster) and then to re-establish normal functioning as quickly as possible. Sometimes the reaction is mild. Other times it is severe. Also, the workers must be trained to recognize when the condition is mild and can be handled by the families (with guidance) and when it is severe and needs professional help.

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