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P-FLASH with Kids: PRACTICAL FRONT LINE
ASSISTANCE & SUPPORT FOR HEALING
P-FLASH with Kids: PRACTICAL FRONT LINE
ASSISTANCE & SUPPORT FOR HEALING
Betty Pfefferbaum, MD, JD1
Carol S. North, MD2
Robin H. Gurwitch, PhD1
Barry Hong, PhD2
University of Oklahoma Health Sciences Center1
Washington University School of Medicine2
INTRODUCING...
YOUR PRESENTERS
INTRODUCING...
YOUR PRESENTERS
PPURPOSEURPOSE
To provide a tool kit for practical,
front line postdisaster mental
health interventions with children
following the 9/11 terrorist attacks
GGOALS OF THE OALS OF THE TTRAININGRAINING
1) Differentiate normative and pathological responses
2) Review disaster responses, assessment, and treatment
3) Provide disaster mental health education and skill-building
PleasePlease introduceintroduce yourself yourself to the groupto the group
What issues do you face?What issues do you face?
IINTRODUCTIONSNTRODUCTIONS
TOPICS Part 1:Part 1: Reactions to disaster Reactions to disaster
Part 2:Part 2: Assessment Assessment
Part 3:Part 3: Intervention Intervention
ReactionsReactions
PPART ART 11
REACTIONS
Posttraumatic stress disorder
Other disorders
Reactions
Factors affecting response
DDISASTERSISASTERS
Overwhelming events
Affect many individuals and entire communities
Result in:
Property damageDisruption of daily lifeHuman suffering, injury, and/or loss of life
Innocent people targeted
Unpredictable
TTERRORISM AS ERRORISM AS UUNIQUE NIQUE TTRAUMA RAUMA
Intentional human design
- to undermine sense of safety and trust in government and social institutions
TIMING: PHASES OF DISASTER
Disaster phases:
Pre-disaster
Acute impact
Early post-disaster
Long-term post-disaster
Normal reactions Most children significantly exposed to a disaster
will manifest some distress, but most do not develop psychiatric illness
Pathological reactions Some children will develop a diagnosable mental
disorder after a disaster
REACTIONS TO DISASTER
DDIAGNOSIS VS. IAGNOSIS VS. DDISTRESSISTRESS
Subdiagnostic distress: Subdiagnostic distress: -- Deserves recognition and interventionDeserves recognition and intervention
(just because it is not PTSD does (just because it is not PTSD does not mean it is not significant)not mean it is not significant)
Psychiatric diagnosis: not just a labelPsychiatric diagnosis: not just a label -- Need for professional evaluation and treatmentNeed for professional evaluation and treatment -- Has implications for prognosisHas implications for prognosis -- Used to select appropriate interventionsUsed to select appropriate interventions
PTSD DOESN'T CAPTURE IT ALL
Comorbidity with PTSD in adolescents Population adolescents: 6% PTSD (lifetime)
- 80% of those with PTSD had another disorder Adolescents in cruise ship sinking: 52% PTSD
- Few or no delayed-onset cases- 1/3 of those with PTSD recovered within 1 year
and another 1/3 recovered by 5-8 years
COMMON NORMAL REACTIONSPTSD FEATURES:
Intrusive re-experience Re-enactment in play
Group B
Group C Emotional constriction
Group D Heightened arousal Increased sensitivity to sounds Increased activity Irritability Concentration problems Sleep disturbance
COMMON NORMAL REACTIONS
Fear and anxietyFear and anxiety Disaster-specific fears
Fear of recurrence
Concerns about safety
Separation anxiety
COMMON NORMAL REACTIONS
Depressive symptoms are common. They may:Pre-date the trauma exposure
Occur in the context of: PTSD and other disorders Intervening stressors Bereavement
INFANTS
Sleeping problems
Feeding problems
Irritability
Failure to meet developmental milestones
PRESCHOOL CHILDREN
Behavioral regression
Separation anxiety, clinging, and dependence
Irritability, temper tantrums, and behavior problems
Sleep disturbance; nightmares
Repetitive play re-enactment
Withdrawal: subdued or even mute
SCHOOL CHILDREN
Excessive questions or discussion about the incident
Irritability
Increased negative behaviors
Somatic complaints
Changes in school performance
ADOLESCENTS Irritability
Isolation and withdrawal
Guilt and self-blame
Anger and hate
Anxiety about the world and their future
Fascination with death and dying
Absenteeism
Risk for substance abuse/alcohol use
Poor impulse control and high-risk behaviors
BEREAVEMENT AND TRAUMATIC GRIEF
Bereavement is a normal process that may be a focus of clinical attention; traumatic grief is complicated
Bereavement may complicate recovery from traumatic events, and traumatic circumstances may complicate the grief process
Bereavement and traumatic grief are distinct from, but share common features with, psychiatric disorders, most notably major depression and PTSD
FACTORS AFFECTING RESPONSE
Disaster characteristics
Exposure
Child factors
Family factors
Community factors
CHARACTERISTICS OF THE DISASTER
Man-made disasters may be more traumatizing than natural disasters because:
they are intentional
their purpose is to create fear, mistrust, and societal disruption
TYPE OF EXPOSURE
Physical presence and witnessing
Proximity
Subjective experience
Interpersonal relationship with those directly exposed
ELEMENTS OF EXPOSURE
Separation
Property damage
Secondary adversities
Traumatic reminders
MEDIA COVERAGE
Exposure to media coverage absent other means of exposure does not meet the PTSD stressor criterion
Research connecting media exposure and PTSD symptoms does not imply causality
Cognitive processing of media coverage depends on the child's developmental level
CHILD FACTORS
Age and development
Gender
Ethnicity
Pre-existing conditions and prior trauma
FAMILY FACTORS Association between child and parent reactions
Risk:Disruption of routine
Parent symptoms
Family stressors
Impaired family functioning
Strained parent-child relationship
Interpersonal awareness
COMMUNITY FACTORS
Pre-disaster characteristics of communities
Post-disaster changesProperty damageCommunity disruptionCompetition for resourcesCommunity response