Coping Resources

There is so much great information that will enable us as parents to help them and be better advocates for them in the case of a disaster. This is the area of preparedness that most parents know little or nothing about, yet we will be the first responders. With our children's futures and emotional well being at stake we can't afford to wait until help comes along. It is up to us to educate ourselves, our families, and our communities. Here are some great resources for learning more about how to help your children and yourself cope with the trauma of a disaster. Our goal is to be surviors not victims.

http://www.fema.gov/pdf/library/children.pdf - FEMA Pamphlet

http://www.mentalhealthamerica.net/go/information/get-info/coping-with-disaster/coping-with-the-stress-of-natural-diasters

http://www.nasponline.org/resources/crisis_safety/index.aspx/#natural - National Assoc. of School Psychologists website lots of links for coping

—       Helping Children After a Natural Disaster: Information for Parents and Teachers
—       Responding to Natural Disasters: Helping Children and families – Information for school crisis teams
—       Coping with Crisis – Helping Children with special Needs

http://www.nctsnet.org/trauma-types/natural-disasters - National Child Traumatic Stress Network website - great information regarding how to help kids cope with traumatic situations - info divided into subcategories of floods, earthquakes, epidemics, fires, hurricanes, tornadoes, tsunamis

http://www2.aap.org/disasters/index.cfm - American Academy of Pediatrics website - info for parents to help children cope with natural disasters 

http://www.fema.gov/rebuild/recover/cope_child.shtm

http://www.toolkitsportdevelopment.org/html/resources/7B/7BB3B250-3EB8-44C6-AA8E-CC6592C53550/CopingWithDisaster.pdf
104 pg document covering everything, looks like it's for professionals. But a really great read for great information! This document has specific intervention techniques in the appendixes

http://www.trauma-pages.com/disaster.php
This site contains almost all of the disaster-related links and materials available. Here, you'll find mental health handouts as well as links to external disaster web sites, disaster mental health guides, and other informative materials useful in assisting disaster victims. Very impressive lists

        http://www.trauma-pages.com/h/dissteps.php -Steps you can take to cope successfully in stressful situations
        http://www.trauma-pages.com/h/famcope.php - Family coping strategies
        http://www.trauma-pages.com/h/arcvic.php - Emotional Health Issues for Victims

http://www.aacap.org/cs/root/facts_for_families/facts_for_families – facts for families search each sheet at the bottom of the site

o         Helping children after a disaster
o         Talking to children about terrorism and war
o         Posttraumatic Stress Disorder (PTSD)
o         The Depressed Child
o         Children and Grief

Coping - Special Needs (physical)

Due to the nature of their disablities their fears and concerns are going to be different. It may aggrevate some of their symptoms and increase their risk of preoccupations and unhealthy coping. Knowing how to address their concerns and fears, along with proper planning can help tthem feel safe, secure, and confident in their ability to overcome what has happened.

Be aware of and accepting of their fears - namely that of being alone.

Physical disabilities:  They’re biggest concerns will be safety and mobility, this is where your emergency plan really helps to prepare them, therefore review it often, drills will be of greater importance to them and those who will be helping them. When entering unfamiliar territory they will need a clear and simple explanation and if needed physical descriptions as well so they can feel safe.

Vision: They will miss facial cues and verbal images. Provide lots of details explanations to reinforce what they have heard. Ask questions about what they know, it needs to be a conversation. Mobility and safety will be of greater concern to them after and additional practice and orientation maybe necessary.

Hearing: They will not be able to keep up with the all the talking, provide frequent explanations. Understand that they will be frustrated by an inability to keep up with the communication happening around them, explain new terminology (this is why education is so valuable beforehand). Be concrete and simple, and check for understanding. Visuals maybe needed with explanations.

Total communication: Keep a signer close by. They need to know someone will be there to help them. Darkness and poor lighting are going to impact their ability to communicate, be sure to have a head lamp to keep hands free for communication. Assure them that they will be safe and inform them of each step and where they are or are going.

Coping - Special Needs

A child with special needs can have difficulty coping with daily life, so it may seem impossible for them to cope with the trauma of a disaster. Don't lose hope - you gain experience everyday that will enable you to guide and help your child to cope and recover. Start now to gather the information and knowledge that you'll need to help them when they need it most.

Take note now of how they react to stress. Also note those things that usually help to relieve their stress.

Take note of triggers – words, images, sounds, etc – that signal danger or disrupt their feelings security and safety.

Take note of their cues – their personal warning signals in response to triggers. (Ticks, facial expressions, withdrawal, quietness, irritability, fear or avoidance)

Write all of these things done, include them in your information binder and with teachers and other care givers. Parents and teachers need to work together to compile this list and remedies as either could be the one there at the time of disaster. IEP meetings or reviews are a great time to go over this. What has worked in the past will have the best chance of working then. Not only can this information help you in any emergency but it can help on a daily basis.

for more information visit http://www.nasponline.org/resources/crisis_safety/specpop_general.aspx

What to do

—       Provide assurance, support and attention IMMEDIATELY. Missing a cue can cause things to escalate quickly.

—       If they lose control remove the child to a safe location, help them to calm down, and then discuss fears or situation as best as possible.

—      
—       Prepare them for any and all changes rather than reacting to them - explain upcoming changes, where your going, what they will expect. If its going to be loud allow them to put on head phones, bright sunglasses, etc.

—       Discuss events in a familiar setting with familiar people.

—       Provide choices to give them a sense of control.

—       It may be necessary to protect or isolate them to minimize distractions and sources of agitation.

—       Keep constant supervision.

—       Deal with inappropriate behavior quickly, calmly and consistently – helps to reinforce the constants and that they can depend on their support network.

—       Steps and explanations will need to be more concrete and consequences more immediate.

—       Now is the time to work on self-regulation skills and strategies. But still remember a disaster means these skills will still be demonstrated at less proficiency then previously demonstrated due to highly unusual and stressful situation.

For Specific disabilities

Autism: Be sure to have a way to communicate before and after a disaster. Changes in schedules and environment are going to cause great emotional and behavioral upset. Try to maintain as much of it as possible even in a new environment. Bring items from their usual environment to help them cope. Use social stories to help them understand what has and is happening, and allow them to create a storybook to help increase their understanding. They may repeat phrases that could further isolate them ("I'm going to die").  Do those things that you would do for other children of the same age or cognitive age as well as what helps them cope normally.

Cognitive limitations: It may be difficult to know what they understand due to their communication skills and they may react like a younger child despite higher levels of understanding. They will react to the disaster more on the observations and reaction of others. Discussions need to be specific, concrete and basic; you may need to use pictures to explain. This will apply to disasters that have occurred far away as well as those close to them. Offer reassurance.

Learning disabilities: It varies greatly based upon the disability and its degree. Typically they are very literal so explain everything carefully. Be watchful of misinterpretations and correct quickly. Accurate information is of great importance. Use of pictures may be needed to explain clearly. They also struggle with time and space concepts and may get confused about the order of events and the whereabouts – a map may be helpful. These kids may need further support now and after a disaster with self regulation and social skills. They will have more difficulties with tolerating others reactions, anger, and communication.

Behavior: They will be at an increased risk of severe trauma problems. Their symptoms will be exaggerated. Suicidal history will put them at higher risk and will require professionally help quickly. Current behavior problems will become more extreme. Maintain schedules and routines. Be as consistent and predictable as possible.

Coping - Pregnancy and Post Partum

If your pregnant your preparing for 2 emergencies - delivary and a disaster. Each by themselves is a very stressful life altering event. Having them back to back could be overwhelming. Pregnancy and Post-pardum will put you at greater risk for severe trauma due to hormone issues, and the fact that you have a little person completely dependent upon you for survival. Since your risk is higher you and your spouse need to be extra vigilant in a disaster in how you cope with the disaster and how you take care of yourself.

There are ways to prepare yourself pyschologically to handle both with less stress and greater confidence. If this is your first pregnancy take infant parenting classes or read a few books, and seek a mentor. Having a baby is a daunting task for any first time parent lacking confidence in caring for a new born, which will only be magnified in a disaster. Prepare now for the changes that are to come to your lifestyle and duties. Offer to watch someone else's baby for a day, or help them so you can learn and get a feel for the schedule and demands. I doubt your offer will be refused.

Pregnant women will have an increased risk of depression. It is even more important for you to take care of yourself. Exercise, eating healthy, and rest are even more important. Be sure to have a support network close by, as post partum is a difficult time in and of itself. These normal symptoms will most likely be commanded by the trauma of the disaster. Familiarize yourself with normal postpartum symptoms – both emotional and physical. It is of greater importance to talk about how your feeling before and after the baby is born. Find out if there is a family history of post-partum depression, as that will put you at greater risk. Post-partum depression can happen anytime withing the first year, sometimes two. If there is a disaster within that time, your risk will increase.

Symptoms

—       A sense of disappointment in the birth or yourself
—       A sense of disappointment in the baby
—       A feeling of anticlimax
—       A feeling of unimportance
—       Frustration with lack of control
—       Overwhelmed and overworked
—       Exhaustion
—       Feelings of inadequacy
—       Doubt ability to nurture your child (especially with breastfeeding difficulties)
—       Mourning old self
—       Self-esteem and self-image issues
—       Anxiety and panic attacks
—       Relationship adjustments
 
What to do
—       Drop the guilt, you’re doing fine there are no experts
—       SLEEP
—       Accept help and ask for it
—       Use feeding times as rest times
—       Eat heathly - avoid sugar, caffeine
—       Cry as much as you like - but if you can't stop getting some help
—       Laugh as much as possible (although it may hurt the first few weeks)
—       Relaxation techniques
—       Do something for yourself - anything by yourself
—       Do something as a couple - dating is very important
—       Take care of yourself (hygiene and beauty)
—       Get out of the house if possible (fresh air, sunshine, and vit D)
—       Have a mentor mother or find other new moms
—       Exercise - with doctor approval first
—       Communicate - talk with friends and family, don't keep it in thinking you'll be judged on how your feeling. You be surprised by how many have felt the same way.
—       Talk to your doctor/midwife
—       Don’t be afraid to get help if needed                             
—       Do what you can to help in relief efforts but be careful in what you do. Try focusing on giving comfort and emotional support to others rather than the usual clean up and heavy lifting

Coping - Women

Its only natural that women will handle a disaster differently than men will, after all we rarely handle anything the same way. However our natural disposition and role puts us at greater risk for difficulty in dealing with trauma and the effects of a disaster. But these things can also be our greatest strengths in over coming the trauma and finding a full recovery.

Some things to consider:

• Widowed women will have increased needs both emotional and temporally as their normal schedules, routines, and lifestyles change drastically.
• Women usually have a better social support network than men. Keep friends and family close, they will help you emotionally and physically to recover.
• Remember that trauma makes the basic jobs that you were able to accomplish easily before much more stressful and difficult. Accept that you can’t handle what you were able to before hand, and gradually move toward your old routine. Be gentle with yourself and take care of yourself as well as you do your family. Practice cutting yourself some slack. Being your own worst critic is a habit that will not help you in a disaster.
• Be sure to have something that you find relaxing and enjoyable in your 72 hour kit. Be sure to take the time to relax. As mothers we often get wrapped up in caring for everyone else and forget that if we burn out than we are unable to care for anyone. Practice taking the time to relax now, so you actually know how then.
• As women we are the nutures and leaders of our family, and may very well be left home to man the fort. There is also an increased likelyhood that we could be the lone caregiver if our husbands are unable to get home due to road disruptions. Add this eventualaty to your family emergency plan.

Grief Avoidance

Avoidance of grief can be unhealthy and lead to more severe problems. Be careful of signs of abnormal bereavement and get help if present. This includes yourself.

Symptoms
Extended period of depression with lack of interest in daily activities and events
Inability to sleep, prolonged fear of being alone, loss of appetite
Acting younger for extended period of time
Excessively imitating the deceased
Repeated statements of wanting to join the dead person
Withdrawal from family and friends
Sharp decline in school performance or refusal to attend

Coping with Grief

This cycle is fairly universal. Children may manifest them differently than an adult, look beyond the behavior to the underlying emotions.

Normal cycle of grief

1. disbelief and denial
2. numbness may occur and allow a slow realization and processing
3. realization brings distress and feelings of missing them
4. anger
5. anxiety about living without them
6. mourning
7. gradual heal

This cycle can last for long periods and may come and go. Remember this is normal. Trauma can make this process more difficult – due to own injury’s, survivor guilt, personal trauma, loss of social support and familiar community. Memories may trigger the disaster as well as the deceased.

How to help

—       Let them choose to attend the funeral. Don’t force them either way. Choices are important. This choice applies to whether to view the body as well. Use discretion as it can be graphic, however take into consideration that it can be very healing. Those who see the body despite injuries have rarely regret it.

—       Encourage them to memorialize the deceased in a special way- scrapbooks, prayers, stories, candle lighting, etc.

—       Let them express their grief in their own way. They may appear unaffected. Preschoolers will have difficulty understanding. Ages 5 and up will grieve more like an adult. They will express their grief in their play as well.

—       Despite your personal grief it is important to be there for them – your absence will make things worse. Remember you need each other.

—       Loved ones should spend as much time as possible with the child – allowing free expression.

—       Don’t force them to talk about their feelings. Let them know that you’re there, you love them and will listen when they are ready.

—       Be honest and only offer details they can understand (medical descriptions are too much).

—       Allow them to express their fears concerning death and validate them.

—       Listen and offer simple expressions of sorrow and grief.

—       Maintain schedules and routines.

—       Be patient – their grief will repeat itself, as will your own. Be more conscious of reminders like birthdays, anniversaries, death dates, etc. as symptoms of grief or trauma will be more likely to resurface. Be sure you’re more available at those times and maybe create a special tradition to help cope, and morn on those occasions.

Resources for help include the Dougy Center for Grieving Children and Families and there are numerous other similar organization exist around the country they can be found online at www.dougy.org (503)775-5683 (in the Portland/Vancouver Area). There are numerous institutions nation wide modeled after this organization.

Loss of a Loved One

Children see death differently. Once again, now is the time to talk about death with your child. This is a personal subject that has many views and religious significance. By talking about your families beliefs on the subject you can help lay a foundation for better understanding when it occurs. Remember that it is still a difficult concept for young children to grasp. Preschoolers typically see death as temporary and elementary school children often understand the concept but may believe that it won’t happen to them or any one they know. Children don’t just grieve the person, but the changes to the environment and family or friends.  Imagine a table, if you take away a leg the entire table is affected and unstable. This is how it is for children. It affects their entire world.

The Natural Reactions to the death of a loved one can be:

—       A belief that they may come back to life again
—       Immediate grief
—       Denial, shock, and confusion
—       Sadness
—       Anger – sometimes directed toward surviving members
—       Irritability
—       Inability to sleep
—       Nightmares
—       Loss of appetite
—       Physical complaints - headaches, stomache aches
—       Loss of concentration
—       Guilt – younger children may feel that they caused it and blame themselves
—       Depression
—       Regression
—       Excessively boisterous play (can be a manifestation of anger)
—       Withdrawal from friends
—       Repeated imitation of the deceased, or a desire to join them
—       Inventing games about dying

http://www.mentalhealthamerica.net/go/helping-children-cope-with-loss-resulting-from-war-or-terrorism

Relocation

Relocation forces people to deal with the consequences of the disaster constantly. Included with the loss of possessions is a loss of privacy, independence, and familiarity, and increased uncertainty. These transfer to children. Family roles and schedule are disrupted - 2 important signals of stability and safety for children.

There are several factors that impact a child's emotional well being when it comes to relocation.

1)      How parents and other family members react
2)      The duration
3)      Their natural coping style and emotional reactivity
4)      How well they can stay in touch with family, friends ,and familiar activities

There are things we can do to help them to adjust:

—       Provide opportunities for them to see family and friends - if the move is to far for a visit, use Skyp, phone calls, and letters.
—       Bring special personal items to where you are staying
—       Daily routines – you may not be able to return to a fully functioning schedule but include what you can, especially those that include the entire family.
—       Provide opportunities for them to share their feelings, concerns, and fears - be present and loving, don't just assume a counselor will do it for you.
—       Be sensitive to the disruption and responsive to their increased needs
—       Remember each child’s different and their responses will vary even within a family

Secondary Trauma

The primary source of emotional trauma is, of course the disaster itself. But the sources of tramatization do not end when the disaster is over (in a literal sense) and when the victims have been rescued. After the disaster comes the “second disaster” – the effects of the disaster – dealing with the after math and recovery from the disaster.

The 2 biggest secondary traumas are relocation and death of a loved one. Moving and death have a huge impact on children in the best of circumstances. After a disaster it could be the straw that breaks teh camels back. These force a person to confront the effects of the disaster for extended periods of time - or simply forever. They commplicate the healing process by increasing the stress and risks for severe trauma. They aren't things that can be easily avoided. But there is much we can do to less their effects and help not just in dealing with these things but with the disaster as a whole.

Severe Trauma

There are 3 main types of severe emotional trauma that can have a debilitating effect, especially on children, that we need to be watchful for and get immediate professional help for them. I've included a link to more information for each area.

PTSD
http://www.aacap.org/cs/root/facts_for_families/facts_for_families – facts for families search: PTSD
PTSD – Post Traumatic Stress Disorder – is a set of symptoms that can result from experiencing, witnessing, or participating in an overwhelmingly traumatic event.
Symptoms
—       Regular trauma symptoms
—       Persistent fears (particularly separation from parents)
       Repeated episodes of re-experiencing the trauma in play or nightmares (which may or may not include the disaster)
—       Anticipating the disaster will happen again
—       Emotional numbness
—       Sleep disturbances
—       Jumpiness and startling
—       Behavior problems at home or school
—       Preoccupation with the disaster
—       Avoid reminders of the disaster
—       Increased arousal symptoms (inability to concentrate and startle reactions)
—       May increase risk of suicide and depression
—       Develop emotional or physical symptoms that remind them of the event
—       Sudden and extreme emotional reactions
        Worry about dying young
—       Repetitive play in which themes or aspects of the trauma may occur.
A minority of victims are at risk of developing PTSD, and it often surfaces months or years after the event.
Continue to emphasis feelings of safety and get help. Women usually have a higher rate of PTSD.

Generalized anxiety disorder
http://www.mentalhealthamerica.net/go/information/get-info/coping-with-disaster/helping-children-handle-disaster-related-anxiety
Persistent and excessive anxiety and worry (not just in relation to disaster and its consequences)- for children these concerns may be school competency, punctuality, overzealous approval seeking, perfectionist tendencies, conforming
— Difficult to control worry- it interferes with functioning
— Anxiety and worry associated with symptoms
Symptoms
—·        Restlessness
·        Feeling on edge
·        Easily fatigued
·        Difficulty concentrating or mind goes blank
·        Irritability
·        Muscle tension
·        Difficulty sleeping or staying asleep
·        Usually have depression symptoms as well
·        Can include physical symptoms
o       Cold clammy hands, dry mouth, nausea
o       Panic attacks (heart racing, difficulty breathing, intense fear and Panic)

Depression
http://www.aacap.org/cs/root/facts_for_families/facts_for_families – facts for families search: The Depressed Child
Symptoms
—       Frequent sadness, tearfulness, crying
—       Decreased interest in activities or inability to enjoy previous favorites
—       Hopelessness
—       Persistent boredom, low-energy
—       Isolation, poor communication
—       Low self esteem and guilt
—       Extreme sensitivity to rejection and failure
—       Increased irritability, anger, hostility
—       Difficulty with relationships
—       Frequent physical complaints
—       Frequent school absences or poor performance
—       Poor concentration and memory
—       Major eating and sleep changes
—       Self-destructive behavior or thoughts or expressions of suicide
—       Talk or efforts to run away
—       Often occurs with PTSD
Symptoms may vary between home and school. She may not always be sad.

For these three areas of severe trauma, continue to do what you were doing before. Those coping strategies are helping and will continue to help. I would also recommend healthy eating, exercise, and service. They have added important if these are a concern as they are natural remedies (not eliminators).

Vulnerability to Coping Difficulties

There are factors that could make your child or you more vulnerable to psychological difficulties in coping.

·        Exposure to actual event (threat to safety or thoughts they would die in a disaster)

·        Personal injury or loss (loved ones and belongings)

·        Level of parental support (maternal preoccupation with the trauma or separation from parent[s])

·        Dislocation or relocation (home destroyed or temporary housing or shelters)

·        Level of physical destruction (more physcial damage = more emotional damage)

·        Pre-existing risks (depression, anxiety, previous trauma)

·        Man-made disasters over natural (man-made will have a greater vulnerablitiy due to their diliberate nature)

·        Mothers of young children up to 10 years - and I would include pregnancy in this.

Those with foster children or children who have been adopted are going to need to be extra vigilant and supportive. They will be at higher risk from repeated trauma, separation from family, and possible psychological issues due to unresolved previous trauma or circumstances. As beware of increased fear and distrust toward you due to previous dealings with own family. Lastly be careful for family members looking for them. Reassure them that their child is fine and looked after and safe, but that they will not be released until the proper authority declares it. Returning back to their families in this situation puts them at higher risk because previous family habits will be compounded with the high stress and trauma of the circumstances. If you know children that may not be in foster care but you are aware of some difficulties at home, be watchful as well, due to a likely increase in domestic violence at these times.

Family Coping Strategies

After a disaster family dynamics will change. Death, disabilities, separations, marital conflicts, increased divorce rates, conflicts between parents and children, and dependency on outside help are  all factors. How each member deals with the trauma will affect the other family members. There is a great deal that we can do to help each other cope with the trauma and to help prevent the increased conflicts and difficulties that can result from a disaster.

—       Take care of ourselves – we are the parents and we are the key to their recovery and survival.

—       Review emergency preparedness plans and kits, make adjustments and replace the items that were used (along with your food storage). Continue drills. Let the kids help in all planning and preparation.

—       Hugs and cuddles - Physical contact is important as it provides extra assurance of safety and security. Extra comfort and contact is necessary especially before bedtimes. That cuddle time is a tangible sign that they are safe and not alone.

—       Minimize exposure to media, if they are exposed be present to explain and discuss images and facts.

—       Use social support systems – friends, family, churches, community organizations, other resources

—       Continue to involve them with specific tasks in helping the family and community to recover. Allow them to help choose where and what they do.

—       Do something positive as a family – help others, volunteer, write letters, or visit others. Service is one of the best medicines (be sure you choose safe and age appropriate tasks)

—       Laugh and take time to do something together as a family – replace fear with good memories

—       Strengthen peer relationships and support- this is important for everyone in the family. Talking with friends and family will help everyone sort through emotions and problems that accompany disaster. Friends and family help to establish a feeling of safety and normalcy. Isolation only increases emotional distress and anxiety.

—       Return to school – the classroom should include discussions about the disaster an opportunities to express their feelings about it and gradually move back to regular schedule. Encourage your school to have teacher's trained before a disaster in coping techniques. They are usually the ones asked to help with coping after a disaster by disaster personal, if they have that training before hand, than they can focus on the students faster.

—       Maintain daily schedules and routines - they are reassured through structure and familiarity. Continue celebrating birthdays and holidays, gatherings, and sports have extra meaning during stressful times. Someone at a presentation mentioned adding an emergency birthday kit to your 72 hour kit or food storage. Have a cake mix and small gift. And if there's no birthdays... well everyone loves cake!

—       Use rituals  - there was a family that released a balloon for every item lost in a house fire. You could create a family memorial, or decide a tradition to do on the date of the disaster.

—       Work with teachers, sitters, and day care providers. Parents need to be aware of classroom discussions and teachers need to be aware of children’s fears or concerns

—       Be tolerant of irritability and short tempers

—       Stay in touch with family and friends outside the area and within

—       Accept help in the spirit in which it is offered

—       Prayer is a great coping skill!

—       Let them be kids

—       Watch for physical symptoms of stress

—       Set priorities and problem solve as a family, take it one step at a time. Even an ordinary work load under this kind of stress can be unbearable. Create a checklist of to do’s and allow a sense of accomplishment for each one.

Priorities should be

1)      basic needs: food, water, clothing, shelter

2)      physical safety and security

3)      safety and integrity of their family

4)      long term needs (jobs, homes, community)

These will help restore emotional balance and health. Here there is no separation between emotional and physical needs meet one, meet both.

—       Relief of symptoms – (great distress) relaxation techniques, desensitization, restoring previous treatments for those with previous mental issues. Using or creating community rituals.