The Emotional Impact of Disaster on Children and Families

http://www.nctsn.org/

Unfortunately, there is no clear empirical evidence for the effectiveness of any crisis response intervention. In fact, the frequently used and previously heralded Critical Incident Stress Debriefing or Management (CISD or CISM) strategies have not demonstrated effectiveness, and in some studies they have proved detrimental. It is strongly advised to stop all forms of compulsory debriefing of disaster. While it is possible that an alternative method of early crisis intervention may be helpful for assisting recently traumatized people, there is at this stage no clear evidence based intervention, apart from Psychological First Aid. There is consensus that providing comfort, information, and support, and meeting the immediate practical and emotional needs of affected individuals can help people cope with a highly stressful event. This intervention should be conceptualized as supportive and non interventional but definitely not as a therapy or treatment. This suggestion recognizes that most people do not develop PTSD and other posttraumatic symptoms immediately. Instead, they usually will experience transient stress reactions that will abate with time. The goal of early intervention is to create a supportive (but not intrusive) relationship that will result in the exposed individual being open to follow up, further assessment, and referral to treatment when necessary. Inherent in this early intervention is the recognition that interpretation or directive interventions are not to be provided. After assuring that basic necessities are available and are not a pressing concern, the basic principles of intervention should be followed. These principles should ensure that no harm is being done in the intervention process and hopefully prevent or reduce symptomatology and impairment.

An international expert panel proposes five broad intervention principles for mass trauma: promote a sense of safety, promote calming, promote a sense of self- and collective efficacy, promote connectedness, and promote hope (Hobfoll, 2007).

• Interventions should be grounded in the basic principles of child development, and providers should be experienced in working with children of different ages and levels of development.
• Mental health providers should have collaborative relationships with community providers to ensure access and community support for children and families.
• Children and families should be assessed for risk factors and symptoms, and interventions should be crafted to address the findings. An essential objective is to improve parental attention and family cohesion through assessment, psychoeducation, and treatment, when necessary, to parents and primary caregivers.
• Providers should make concerted efforts to prevent social disruption and displacement.
• Providers should identify, assess, and attempt to ameliorate or remove children and families from the continued threat of danger.
• Providers should have continued contact and monitor children for symptoms or impairment.

It is often helpful to make handouts or flyers about helpful and harmful coping strategies and where to get help if needed. Individuals should be given an array of intervention options that may best meet their needs. The goal is not to maximize emotional processing of horrific events, as in expo-sure therapy, but rather to respond to the acute need that arises in many to share their experience, while at the same time respecting those who do not wish to discuss what happened.