5. Specific Interventions

5.1. Interventions for Emotional Disorders in Children Exposed to A Situation of ­Disaster

If you are part of a disaster response it is important to have some awareness of the risks of being traumatized yourself or overly activated, especially if you are and have had minimal training. You need to recognize when you are yourself getting overwhelmed when your own resources are limited by the disaster or you have suffered losses of your own.

Adolescents may react with withdrawal, apathy, behavioral changes, substance abuse and risk-taking behaviors, but also feelings of guilt, hopelessness, helplessness and sadness.

Children with adverse reactions to stress and behavioral symptoms for more than 1 month are at higher risk of developing emotional or behavioural in the future.

The issue of early psychological or therapeutic interventions in the first months after a disaster is controversial. Two of the most well known psychological crisis interventions are critical incident stress debriefing and early grief counseling. Masten and Narayanan have stated “While these interventions were widely practiced, they appear not to have positive impacts and may even have negative effects.”

In order to prevent doing inadvertently harm and to maximize the use of promotive factors, the current guidance is to use nonintrusive supportive techniques that are summarized under the name Psychological First Aid. See Box 3

BOX 3. Psychological first aid (PFA)

Psychological first aid (PFA) is recommended for children, youth and adults in distress. It is meant to elicit feelings of safety, connection and selfhelp in people recently exposed to serious crisis events to promote recovery. The major principles of PFA are: look, listen and link. It can be done by anyone who is in the position to help by:

  • Providing non-intrusive practical care and support
  • Assessing needs and concerns
  • Helping people to address basic needs (for example, food and water, information)
  • Listening to people, but not pressuring them to talk
  • Comforting people and helping them to feel calm
  • Helping people connect to information, services and social supports
  • Protecting people from further harm

PFA workshops of half to one day are helpful for all staff in direct contact with highly distressed populations (for example; health workers, child protection workers, teachers, volunteers, rescue workers, police officers, and people involved in food distribution and shelter).

Most children present first to primary care clinicians or to non-mental health professionals. Primary care clinicians play an important role in educating families about prevention and support strategies, providing early intervention, screening for emotional disturbance, providing less intensive interventions, and referring for mental health and community-based treatment (Box 4). Pediatricians have the capacity to provide appropriate anticipatory guidance and manage emotional conditions early on when these conditions may be ameliorated. Prompt measures to minimize fear and anxiety in children exposed to a traumatic event are essential. These measures should give children the certainty that adults are in control and responding appropriately, and that previous family and community routines are returning. It is necessary to evaluate the child’s context; especially the state of the parents, siblings, and disruption of basic needs. Parents may need their own help and pediatricians should be able to at least give some firstline advice.

BOX 4. Pediatrician’s role

  • Anticipatory guidance
  • Manage early disturbance
  • Screen for disorders 
  • Provide less intensive intervention
  • Refer for mental health and community based treatment

The best way to reduce the emotional impact of disaster is to try to keep the family together and the parents functioning well.

Following a disaster, the primary mental health goals in the initial 1 to 2 months are to restore stability, improve social networks, decrease hyperarousal, and help natural recovery seeking. Anticipatory guidance for post-trauma emotional symptoms includes explaining that many symptoms are a normal response, and suggesting ways to help the child and family adapt to the stressor and return to previous functioning. This guidance can be given to individual families, to educators, and to the media. In general, these universal recommendations include the following:

  • Return to normal routines
  • Be patient and supportive and give children time to adapt to his/her distress
  • Continue to set normal and appropriate limits on the child’s behavior
  • Allow children to talk about his/her worries and feelings if the child wants but never pressure the child to talk
  • Encourage the child to spend time with friends
  • Encourage children to return to his/her previous developmental tasks
  • Parents are encouraged to deal with their own feelings and get support and treatment if indicated

More in-depth individual counseling and anticipatory guidance should be developmentally based (Box 5).

BOX 5. How can we help children?

Recommendations for promoting adjustment to stressful and traumatic events

A. Understand emotional reactions

  • Pay attention to behaviors at home and at school or daycare
  • Acknowledge and accept behavior as normal adaptations to stress

B. Reduce the emotional impact

  • Provide support, comfort, and time for play and discussion
  • Model healthy coping behavior
  • Have parents seek help if needed

C. Facilitate recovery

  • Normalize routines as soon as possible 
  • Listen to children and validate their feelings
  • Encourage activities that help them express their feelings: different type of games, art related activities, etc.

Adolescents need a space to talk about the events, with freedom to ask all the questions they have.