Jane Nursey: Unfortunately, we know historically that children have been a fairly neglected group, in terms – when it comes to disaster planning and development of resources and support for them following disaster. It is changing and we have seen an increase over the last 10 years in a focus on supporting children and adolescents recovery following disasters.
We still need to learn more though, both about the sort of longer term impacts of disasters on children, as well as what is it that is going to best enable their recovery? Today what we are hoping to do is really present what we know and what the research is telling us and have discussion about the practicalities around that. Children make up roughly half of the global population effected by natural disasters, so that figure of not really seeing a lot of support for them is no excuse, really. We know that children and young people are vulnerable to develop PTSD and other mental health disorders after disaster. They are not immune to those impacts and the prevalence rates are just as high in children, in fact younger children are much more vulnerable to developing PTSD than adults.
We know that children have different needs following disaster. They are dependent on their care givers and if the care givers are overwhelmed and struggling to cope, then the children are likely to be doing that as well, particularly young children who are heavily dependent on their care givers to provide support. They obviously don’t have the skills that adults have, in terms of expressing how they are feeling, identifying their needs and the emotions that they are feeling and they need support to do that. They also have less well developed skills in managing their emotions and regulating their emotions. They will often have – and we know that there is limited access to child and youth focused resources in the post disaster environment.
There are a whole range of impacts on children and adolescents, just as we know the impacts on adults is going to vary, every individual is different, that is the same in children as well. There are some commonalities that we know. The sort of responses we see in children will depend a bit on their age and stage of development, so obviously children of a much – in the early preschool years are going to express their distress in a very different way to an older adolescent. We need to be really aware of what are the likely developmental appropriate responses in children. Most children are going to be resilient and particularly with the support of family, friends and their community, they are going to get through the difficulties and come out unscathed, but there will be a significant minority that may have difficulty adjusting over a longer period of time, who might demonstrate changes in their behaviour, sleeping and eating and who might even go on to develop a mental health disorder.
We know that generally we might expect to see up to 20-25% of people develop a mental health disorder but under the – in the context of cumulative exposure which is what we’re seeing in Australia now with
multiple disasters happening on the back of each other and in the context of pandemics, that prevalence rate can increase significantly. Important to understand that each child is going to have their own unique journey following a disaster and so is each member of a family. Everyone in the family might have a very different experience and a very different reaction.
Important to be aware of that and to look out for specific childs’ needs and reactions. Generally speaking, we know that children are going to have some short-term distress and they might be feeling very confused and upset at what as happened, not able to make sense of it, be fearful that it’s not going to stop or that it’s going to happen again and, therefore, be quite reactive to reminders of it. We know that following bushfires, the smell of burning off can be a trigger for kids, or rain following a hurricane or something can also be a bit of a trigger.
Young children tend to need to talk about what’s happened a lot and they might even act it out in their play a lot. We can see changes in behaviour, kids can become quite restless, they might become more aggressive and irritable. They might withdraw into themselves and not want to play as much, or not engage with others. We can see differences across the age range and while we commonly will see sleep problems and nightmares across all age groups, including adults, we will also likely see some level of irritability and increased aggression across age groups as well. We know that there’s an increase – our research tells us there is a significant increase in domestic violence following disasters and that has been true in the recent disasters as well. It can be that hypervigilance and reactivity that is increased across age ranges and problems with concentration are also very common, increased feelings of feeling unwell, tummy aches, headaches, those sorts of things. With children, certainly some separation anxiety and school refusal but also just separation anxiety from parents can be a really common one.
Sadness is universal but can be expressed in different ways. In young children, it might be that they are crying a lot more, little things set them off and it is hard to settle them down. There might be lots of tantrums thrown. As I said, there can be that repetitive re-enactment. You might see a regression in skills, so young children who have just begun to walk or talk or be toilet-trained, you might find a regression back in those skills and it is going to have to give them time to redevelop them. There can be new fears that develop and these might not necessarily be related to the trauma or the disaster they have been through, but generally being more fearful of other people, of new situations and those sorts of things.
For older adolescents, it carries with them a new awareness of their own mortality and the mortality of others. So a questioning about that and perhaps a fear of that as well. For some adolescents they might become much more responsible and feel like they need to be looking out for everyone in the family and doing everything right and not getting into trouble and really taking on an adult level of responsibility that isn’t appropriate to their age and development. Other kids might just find it very difficult to adapt and get a bit out of control. They might be staying out late at night, they might be engaging in high risk behaviours like drinking and increased promiscuity or substance use. They might be more likely to engage in conflict with parents and with siblings and with friends as well. They might withdraw more from families and friends and spend a lot of time in their room on their own not wanting to talk, not wanting to engage with others. They might also have real trouble keeping up with academic requirements, so concentrations lowered and their motivation is lowered and those sorts of things. We know from our recent research that there – generally we see a lower level of happiness and wellbeing in children and adolescence who are in disaster-impacted areas and there is often a lower engagement in school connectedness, school and connectedness with others.
In terms of our approach to supporting children, the adopted approach in most countries now and certainly in Australia is what we call a stepped care approach. This is an approach that is designed to appropriately match the level of care to the needs of the individual presenting. We don’t expect everyone to need psychological support or interventions, we do, in the early days, expect that most people are going to need some advice and some support just to help them get over that initial distress and identify their needs and get those needs met. There will be a percentage of people, as I said, who go on to have difficulty adapting and might show ongoing distress and level two interventions are targeted at those people, to help build up their skills to manage that distress, develop some emotional regulation skills, remind them about their capacity to solve problems and get through adverse times. Then, level three interventions are designed for those people who do go on to developmental health disorders like depression, anxiety, substance abuse
These interventions particularly at level one and two, but to some extent at level three, you could argue as well, are really based on principles of – five core principles of recovery, if you like. An example of a
level one intervention is psychological first aid and we can thank our Patricia Watson for being one of the key players in developing these five what we have learnt over the years from disaster impacts on people and
The five principles are these. One is, it is important to, as early as possible, establish a sense of safety. Disasters and trauma really destabilise our environment and destabilise our sense of self and our connectedness to others and it makes us feel really unsafe. It is really important to, as quickly as possible, remove people from unsafe situations, but also provide some security and rebuilding connections and those sorts of things as early as possible to help build that sense of safety.
It is important for them to develop a sense of self and community efficacy and another thing that – sorry, I am going the wrong way – I will go across to calming. It is also really important in those early days, in terms of improving why a sense of safety is to help them calm down, give them skills that are going to help them manage their emotions, calm them down, provide a sense of security and safety. The longer their adrenaline remains high, they’re feeling that distress, the higher the risks they are going to be at developing some longer term problems.
Developing the connectedness, getting them linked into resources that will help them and other people and also reconnecting with family members and friends and community members who they might have been separated from during the disaster, or because the environment is so damaged, they are unable to engage with regular activities – helping them to get reconnected is really important and probably the biggest, single most influential predictor of recovery is that connectedness with others.
Instilling a sense of hope is really important. Helping them understand that this is really difficult but this is a temporary situation, that you will recover over time and remind them that things will and can be different and that they’ve got the resources to help manage that recovery.
Then building a sense of self efficacy and community efficacy. It goes along with that. The idea that they have got the skills to manage their own recovery. They can utilise and rely on other supports that are out there as well to help them implement those, but they are the instrument really for their own recovery is really important. That is something really important that we want children and adolescents to understand and to help engage them in that process.
When it comes to supporting young people, we know from experience that when children and young people are given opportunity to engage with resources and support systems around them, they thrive,
that they really get stuck into doing that, they get a lot of rewards from it, they – it builds their self-esteem, their self of self-efficacy and it builds their own sense of security because they are actively engaged in that
There is a number of concurrent factors that have been shown to influence post disaster resilience and outcomes for children and young people. They include individual factors like age, gender, ethnic minority, status, temperament. We know older children can engage very well, younger children are going to need some more support to do that. We know that there are some groups that are particularly vulnerable to disasters and might find it more difficult or their recovery is slower. Particularly, adolescents with gender, who identify with different gender identity, kids with disabilities or living with disabilities, kids living in dysfunctional families with low levels of support are going to be much more vulnerable to a slower recovery and perhaps higher risk of developing a mental health disorder.
Then there is a range of disaster-related factors that will also predict recovery, so things like what went on for them at the time of the disaster, what was the degree of exposure, what did they see? Did people around them – have they lost loved ones? Have they lost possessions? Have they lost housing, pets? Did they lose their school? That degree of loss and the degree of exposure of them seeing horrifying things is going to increase their risk.
Then when it comes to planning, we need to be really careful that we’re sort of understanding where that particular child is coming from.
What is their age and what risk does that provide? What are the extra resources you might need around that? Are they in a particularly high risk vulnerable group? What’s their family support like? How much do they – support do they need? What was the degree of exposure they had? All of that needs to go into the planning of recovery.
That might look something like this, really helping the child to think about what are the different groups that they can engage with to help promote their recovery? This is something that we will go on to talk about in the panel but it really needs a coordination across multiple groups. The young person is at the centre of a system and it really takes engagement of the whole system to help their recovery. School, the community, health, family, their peers and so forth.