Course Pediatric Disaster Behavioral Health (PDBH) Toolkit

Introduction

What is Disaster Behavioral Health?

Disaster behavioral health (DBH) is defined as how organizations prepare for and manage mental and behavioral health impacts related to large-scale emergencies and disasters, across all systems of care and response. Using individual and community-level approaches, DBH coordinates and plans for the necessary resources to effectively respond and recover at-scale from a disaster. 

Disaster behavioral health (DBH) is defined as how organizations prepare for and manage mental and behavioral health impacts related to large-scale emergencies and disasters, across all systems of care and response. Using individual and community-level approaches, DBH coordinates and plans for the necessary resources to effectively respond and recover at-scale from a disaster. 

These features, in addition to key concepts outlined later in this toolkit (see Key Principles & Assumptions), demand a different approach to provision of disaster behavioral health services than that of day-to-day behavioral health services and systems. 

What does this framework address and who is it for?

This framework primarily focuses on children’s hospitals and the role they serve in meeting pediatric disaster behavioral health needs during and after disasters, but children’s hospitals do not respond alone. Children’s hospitals may provide specialized pediatric services, expertise, and leadership, but adequately meeting these significant needs requires collaboration and coordination with numerous organizations and partners, including schools, outpatient treatment clinics, emergency managers and planners, first responders, Hospital/Incident Management Teams, governmental children’s behavioral health program directors, children’s cabinets, public health agencies, shelters, community and adult-focused hospitals, and clinicians providing physical and behavioral health care. 

Note: This toolkit does not address suicide prevention, day-to-day pediatric behavioral health care in emergency departments, or broad pediatric disaster readiness. Instead, readers looking for those resources are recommended to review materials such as the Critical Crossroads – Pediatric Behavioral Health Care in the Emergency Department Toolkit by HRSA, the Zero Suicide resource center, in addition to the ED STOP Suicide Quality Improvement Collaborative and the Checklist of Essential Pediatric Considerations for Every Hospital’s Disaster Policies by EMSC. 

Role of a Framework

Within emergency management, a framework outlines key principles, goals, roles and responsibilities, core processes, and an organizing structure for preparedness, response, and recovery. This framework organizes these components into an operational model with four essential functions for pediatric disaster behavioral health (PDBH): Situational Awareness, Care, Education & Technical Assistance, and Coordination. These functions may be structured within an organization (such as a children’s hospital) and/or at community levels (such as interagency groups). 

 

Critically, this framework and all recommendations of this toolkit should be adapted to the organization implementing it as well as the needs of the local community. It should not be viewed as prescriptive but instead as a potential organizing approach for PDBH. 

Why Care About Pediatric DBH?

1. Long and Variable Lags: Children face serious and lasting behavioral health impacts after disasters, which may be more prevalent and last longer than physical impacts.
   • Children are among the highest risk for sustained post-disaster distress. 
   • Families with children represent a large segment of disaster affected populations. Pediatric behavioral health needs are both acute and long term, with lasting effects on sensitive periods of neurodevelopment and sometimes into adulthood ¹.

2. Lost In Planning: Pediatric DBH is frequently absent from disaster plans.
   • Children’s needs can be overlooked unless they are physically injured or hospitalized. While responders and clinicians acknowledge the emotional and behavioral consequences of disasters on children, these are rarely adequately integrated into emergency management plans, trainings, or exercises. 
3. Pediatric-Driven Recovery: Pediatric behavioral health needs can drive or hinder community recovery.

   • Children’s distress may cause a ripple effect, impacting parents and caregivers, providers, and first responders. This ripple effect can also impact health care facilities, schools, and other systems  causing a surge in demands and other significant disruptions (e.g., prolonged emergency department boarding, increased absenteeism in schools).

   • For communities to recover fully, children’s behavioral health must be prioritized and integrated in preparedness, response, and recovery. Supporting their behavioral health is not optional; it is essential to the recovery and resilience of families and communities.