Learning From The Past and Planning For The Future
MENTAL HEALTH MOMENT January 25, 2002 "Nothing in life just happens. You have to have the stamina to meet the obstacles and overcome them." - Golda Meir LINKS AND SHORT TOPICS
LINKS AND SHORT TOPICS
HELPING AMERICA COPE
Dr. Annette La Greca presents two new web-sites designed to help children cope with traumatic stress. Please visit "Helping Children Cope" and "Keeping Children Safe".
Now Available: "Helping America Cope: A guide to help parents and children cope with the aftermath of the September 11th terrorist attacks." Written by Dr. Annette M. La Greca (University of Miami) in collaboration with Scott W. Sevin, and Elaine L. Sevin (7-Dippity, Inc.) is a workbook that provides parents and children with specific activities and coping strategies to deal with the recent disaster. The book can be used with children ages 6 to 12.
AGRICULTURAL RECOVERY IN KOSOVO
Agriculture in Kosovo was already suffering from a decade of insecurity, restrictive policies and economic stagnation when full-scale conflict erupted in 1999. Farmers were badly hit - their buildings were razed, cattle were slaughtered or stolen, agricultural machinery was cannibalized, burned or stolen, crops rotted where they stood and fields were left fallow.
Now, two years later, and partly thanks to a Norwegian Red Cross (NRC) agricultural rehabilitation programme, the patchwork quilt of Kosovo fields looks much healthier, the colours are brighter, the uncultivated gaps fewer. More at: http://www.ifrc.org/docs/news/01/121001/
CHILD AND FAMILY DEVELOPMENT IN THE 21st CENTURY
The need to enhance the development of children and youth, to strengthen families, and to build caring, safe and healthy communities are among the greatest challenges of our time, said Penn State President Graham B. Spanier during a speech at Florida State University yesterday (Jan. 14). "Institutions of higher education have an obligation to marshal our resources to address the many unmet needs of children and families," said Spanier. "As public universities, one of our missions is--and has always been--to harness our wealth of expertise to solve society's most pressing problems." Spanier, a family sociologist, demographer, and marriage and family therapist, was named Florida State University's 2002 Tyner Eminent Scholar in Family and Child Sciences. For the entire speech, visit http://www.psu.edu/ur/2002/14jan02spanierspeech.html
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Solomon, Bravo, Rubio-Stipec, and Canino (1993) hypothesized that family roles (marital and parental status) would moderate effects of disaster exposure on the mental health of victims. Their study included residents of St. Louis who were exposed to floods and dioxin and Puerto Rican residents exposed to floods and mudslides. Worst outcomes in St. Louis were found for single and married parents who were exposed to disaster. Their symptoms significantly exceeded those of non-exposed, non-victim single parents. Puerto Rican victims without families were reported as having higher levels of alcohol abuse symptoms than any other subgroup. The authors found that perceived emotional support was an important moderator of disaster effect on psychiatric distress in Puerto Rico and generally overrode the effect of family role. In a related study, Solomon and Canino (1990) looked at the appropriateness of DSM-III-R criteria for PTSD. They examined whether 1) the psychiatric sequelae resulting from exposure to extraordinary traumatic events (stressor criterion A) differed from the sequellae resulting from exposure to more common yet stressful life experiences, and 2) PTSD sequellae (criteria B&D)accurately described the responses of victims even of extreme events fitting the DSM-III-R definition of stressor. They used data from 452 St. Louis victims exposed to floods and/or unsafe dioxin levels and 912 Puerto Rico victims of mudslides/flooding. Some common stressful events (e.g. moving, money problems) were found to relate more closely to PTSD symptoms than did extraordinary events. They found that exposure to disaster strongly related to symptoms of re-experiencing (criterion B). Reports of symptoms related to avoidance (criterion C) were uncommon. In a study of acute stress reaction in family members, Ma, Lu, Liu, A-Er-Ken, et al (1995) worked with family members of the victims from a fire disaster in Kelamayi, Xinjiang Province, China which took place on December 8, 1994. Participants included 9 male and 72 female adults (aged 18-61). Those who visited the mental health clinic within one week of the event were identified with acute stress reaction according to the International Classification of Diseases-10 (ICD-10). Participants who visited the clinic within 3-5 weeks of the event were diagnosed with acute stress reaction according to family members' description. Subjects clinical manifestations (e.g. extreme sadness, agitating activity, stuporous state, and loss of consciousness), treatment (supporting or sub-hibernation therapy and the use of benzodiazapines), remission (within 48 hours - 2 weeks), frequency of diagnoses, correlation of stress from the event, and severity of acute stress reaction were the focus of their concerns. Some cultural/ethnic groups place more value and receive more support from an extended family and/or community structure than others (Doherty, 1987). It is incumbent on the visiting counselor to have an understanding of the roles of these groups in order to provide more adequate and appropriate interventions for families and family members within the context of their own cultures.
CULTURAL ROLE OF FAMILIES FOLLOWING DISASTERS Children
In an article about psychosocial intervention in disaster management in the Philippines, Ladrido and Perlas (1996) identify 3 phases of intervention: impact, inventory, and reconstruction/rehabilitation. In this framework, psychosocial processing (PSP) is aimed at helping victims re-establish equilibrium and harmony following a disaster and at regaining personal control. They identified six types of PSP activities: critical incident stress debriefing; multiple group; action-related; activity-based (for special groups such as children and adolescents); team-building; and community organization for crisis management. Ladrido and Perlas contend that delivery of psychosocial intervention to disaster victims in general, and children in particular, has a beneficial filtering effect that can significantly reduce the number of those suffering from incapacitating symptoms. Children exposed to disasters are at risk for a number of mental health related problems. The type and severity depend on the nature and extent of disaster trauma, the influence of family and community, the resilience or vulnerability of the child, and symptom onset and duration (Aptekar& Boore, 1990). Levels of functioning and cross-cultural differences also play an important part. Schreiber (1999) described a firestorm which struck Laguna Beach, CA on October 30, 1993 in which 400 homes were lost. He described a FEMA supported program which provided services for affected children and parents over a 17 month period. The results he reported found that levels of PTSD and comorbid depression were significantly higher in children whose homes were destroyed. Current dissatisfactions with living arrangements and perceptions of greater difficulty in school were seen as being strong correlates of distress. He discussed factors related to sustained vulnerability, post disaster stresses, adversities and traumatic reminders. The findings presented were suggested as confirming the need for extended mental health services beyond the initial event as the risk from disaster exposure continued to accrue over time. It is well established that children and adolescents can manifest adult-like PTSD after experiencing a life-threatening stressor (Yule, 1994). Delamater and Applegate (1999) examined post-traumatic stress disorder (PTSD), behavioral adjustment, and developmental outcomes in preschool children exposed to Hurricane Andrew in 1992. Their study measured mothers' self-reports of their child's symptoms of PTSD. They concluded that many young children can be expected to exhibit PTSD symptoms and other behavioral disruptions for at least 18 months following exposure to a natural disaster. Their study demonstrated that preschool age children exposed to the stress of a major hurricane are more likely to exhibit symptoms of PTSD than a comparison group who are less exposed. Children with PTSD at 12 months were reported as being more likely to be developmentally delayed at 18 months and those with PTSD at 18 months were also likely to be delayed. They suggest the children are at risk for failure to achieve normal development in cognitive, social and emotional skills and conclude that children with PTSD are at risk for developmental delays. This study is one of the first to examine the effects of PTSD on the general development of young children and presents information that will require further study in this important area. In the light of recent school incidents in the United States, it is of importance to find ways to develop approaches for dealing with some of the psychological, social and educational aspects of the critical challenges faced during severe crises. Stein (1997) offers a blueprint for the school psychology profession to take a leadership role in these areas. Some of the challenges he identifies include preparing communities to cope effectively with crises at the individual, school, community, and national levels; preparing children and adults to deal with potential and actual disasters; intervening on the spot during crises; and treating the psychological problems that may manifest in the aftermath. Using experiences of the past 20 years in Israel, including the relatively recent traumatic events such as the assassination of prime minister Yitzhak Rabin, Stein presents a model in which he describes different stages of reaction. In his model he places emphasis on the role of the schools and of school psychologists in developing and implementing prevention programs which emphasize the fostering of inner strengths and resources in children and teachers and making provision for the professionals helping the community in times of crisis. He also suggests future development of the school psychology profession into a broader community service. Saylor (1993) provides a valuable resource for disaster planners, crisis interventionists, clinicians, and researchers in a book dealing with the prevention and treatment of children's mental health problems following disasters. Along with other colleagues, Saylor discusses basic theory, assessment and intervention techniques and provides a critical survey of relevant literature. Children's perceptions of disasters and crises are largely determined by the reactions of their parents. Depending on their ages, experiences, cultural teachings, beliefs, etc. they tend to have a number of common physical, emotional, cognitive and behavioral reactions. Younger children may experience different levels of contagious, objective and/or profound anxiety. Older children (adolescents), due to the disaster or crisis, may suddenly have to assume the role as head of the family. How they see these responsibilities depends to a large extent on such factors as cultural background, age, religious views, education, personal equilibrium and how they view life in general. In summary, children may appear more resilient in their response and recovery from disaster. However, the research and literature suggest they are at risk for PTSD, depression and anxiety disorders as well as possible developmental delays as a result. Children will follow the leads of their parents, cultural/ethnic groups and belief systems. Interventions should involve, wherever possible, collaboration with a "culture-broker" or practitioner from the affected cultural group. **************************************************************************************************************REFERENCES Aptekar, L. & Boore, J. A. (1990). The emotional effects of disaster on children: A review of the literature. International Journal of Mental Health, 19: 77-90. Delamater, A. & Applegate, E.B. (1999). Child development and Post-traumatic Stress Disorder after hurricane exposure. TRAUMATOLOGYe http://www.fsu.edu/~trauma/a3v5i3.html Vol. 5, Issue 3, Art. 3, Retrieved May 1999. Doherty, G.W. (1987). Extended Families. https://www.angelfire.com/biz/odochartaigh/xfam.html Retrieved May 20, 1999. Ladrido-Ignacio, L. & Perlas, A.P. (1996). From victims to survivors: Psychosocial intervention in disaster management in the Philippines. International Journal of Mental Health, 24: 3-51. Ma, H.; Lu, Q.; Liu, P.; A-Er-Ken; et al. (1995). Acute stress reactions of fire-disaster victims' family members: A clinical analysis. Chinese Mental Health Journal, 9: 107-109. Saylor, C. F. (Ed) (1993). Children and disasters. New York, NY, USA: Plenum Press. xxii, 237 pp. Schreiber, M.D. (February 1999). School-based disaster mental health services in the Laguna Beach firestorm. Paper presented at the 1999 Rocky Mountain Region Disaster Mental Health Conference, Laramie, WY Feb 11-14, 1999. Solomon, S.D.; Bravo, M.; Rubio-Stipec, M.; & Canino, G.J. (1993). The effect of family role on response to disaster. Journal of Traumatic Stress, 6: 255-269. Solomon, S.D. & Canino, G.J. (1990). Appropriateness of DSM-III-R criteria for posttraumatic stress disorder. Comprehensive Psychiatry, 31: 227-237. Stein, B. (1997). Community reactions to disaster: An emerging role for the school psychologist. School Psychology International, 18: 99-118. Yule, William (1994). Posttraumatic stress disorder. Ollendick, Thomas H. (Ed); In King, Neville J. (Ed); et-al. International handbook of phobic and anxiety disorders in children and adolescents. Issues in clinical child psychology. (pp. 223-240). New York, NY, USA: Plenum Press. xiii, 496 pp. To search for books on disasters and disaster mental health topics, children and disasters and purchase them online, go to the following url: https://www.angelfire.com/biz/odochartaigh/searchbooks.html ***************************************************************************************************** ***************************************************************************************************** Contact your local Mental Health Center or check the yellow pages for counselors, psychologists, therapists, and other Mental health Professionals in your area for further information. ****************************************************************************************************** George W. Doherty O'Dochartaigh Associates Box 786 Laramie, WY 82073-0786 MENTAL HEALTH MOMENT Online: https://www.angelfire.com/biz3/news
