Course The Emotional Impact of Disaster on Children and Families

Introduction

In addition to their profound effects on the life and infrastructure of communities, disasters produce a massive collective stress exceeding the ability of the affected population to cope with the physical, emotional, and financial burdens. Disaster episodes affect millions of people and exert a collective social suffering that requires a monumental effort by individuals, communities, societies, and the world community to overcome.

Classically, relief efforts focus on the physical consequences of disasters by providing immediate medical attention and addressing health and ­environmental services (water supply, sewage disposal, and shelter). Only in recent years have the short and long-term consequences on mental health and psychosocial well being of individuals, families and communities been taken into consideration. By definition, coping with a disaster challenges individual and community adaptive capacity.

Children and adolescents are emotionally vulnerable to their experiences during a disaster. However, a child’s reaction to a disaster varies widely ­depending on circumstances such as: (1) the extent of exposure to the event, (2) the amount of support during the disaster and its aftermath, and (3) the amount of personal loss and social disruption. In addition, the child’s response and adaptation are influenced by the child’s developmental stage, degree of dependency on adults, unique individual characteristics, and the child’s previous experiences. In most cases the child’s emotional response after a disaster represents “expected” adaptive behaviors. However, this “expected” adaptive behavior can become a significant mental health problem that will chronically impair a child’s social and emotional development when it is too intense or persistent. Therefore, identifica­tion of intense and problematic responses needs to be followed by adequate support and treatment, according to the emotional needs and developmental stage of each child and taking the social supportive networks in consideration.

Interventions to promote emotional wellbeing and to protect children against adverse outcomes should be informed by a resilience perspective and can often consist of strengthening supportive factors in social ecology of the child. Paramount is to restore safety and routine in the life of the child, and promote a sense of agency and self-efficacy. Such interventions can consist of educating adults who provide care (parents, teachers, pediatricians, and other professional staff) about how to help a distressed child, and how to differentiate between normal and abnormal adaptive reactions. Knowing when to intervene is important, because adverse experiences during childhood are associated with a higher risk of later emotional and behavioral disorders. On the other hand, well intended interventions at the wrong time can disturb the natural healing and recovery and make things worse.

Interventions need to be situated in a multilayered response system that works on various levels, such as individual support for those who need it, as well as strengthening family and community support mechanisms. Many useful interventions can and should be done by non–specialists since the availability of pediatric mental health professionals is often limited, especially in low and middle income countries, Even high income countries may lack specialists in rural areas, and disasters may disrupt access or overwhelm resources even where the supply is nominally adequate. Training pediatricians, nurses, other professional staff and school based staff has the potential to greatly enhance the effective management, early intervention, and support for children and families affected by a disaster, so that the majority of impacted children will adjust and recover functioning.

This module provides information on the emotional consequences of exposure to massive incidents among children and adolescents. This module describes the cri­teria for the identification of more serious mental health disorders, and pro­poses strategies for the referral and management of children at different developmental stages.