Being family inclusive means appreciating the family as a system. Ask questions about the family.

• How did the family function prior to the disaster? Was there stability in the family prior to the disaster?
• Are there any additional risk factors that may contribute to how the family are currently coping? e.g., life stressors, conflict in family interactions, previous adverse experiences, family mental health conditions, that might impact on their ability to recover?
• Has the family diverted from what they would normally do as a family?
• How are they looking after themselves since the disaster occurred?
• Do the family or family members need access to other supports or referral to other professionals?

Provide psycho-education about the potential immediate, medium and longer term effects on families following a disaster event. Effects may include the following:

Immediate effects

There reactions may occur immediately following the disaster event and continue for a few weeks following the event:

• Parents may be afraid for the safety of their child/ren or each other while away from home or away from each other
• Family members may develop fears that a new crisis will happen to them
• Family members may express anger because of the distress they experienced – such feelings may be directed at one family member, each other or at people who are outside the family
• Family members may lose confidence in themselves and others as the world may no longer feel safe and the uncertainty they feel around their wellbeing may seem difficult to manage
• When they feel insecure, children may express this insecurity through behaviour such as disobedience, bed-wetting, changes in eating and sleeping, or regressing developmentally which means they may temporarily lose the ability to do things they could previously do
• Any family member may display increased emotional instability or behaviour that is out of character
• Communication may be hard because family members do not know what to say to each other or they may not feel like talking.

Medium term effects

Some families cope well in a crisis and in the immediate aftermath, but problems may emerge for the first time weeks and months later. Where problems emerge for the first time months after the disaster, they may not seem obviously related to the disaster event itself. Other families may experience immediate difficulties which persist. Medium term effects might include the following:

• Individuals may experience changes in motivation and concentration, resulting in changes in the ability to engage in routine activities, school and work with consequent challenges for the family unit
• Individuals may lose interest in previously enjoyed leisure, sport and social activities, this may be compounded by reduced access to venues for activities with possible destruction of infrastructure as a result of disaster, again leading to challenges for the family unit
• Individuals may be more irritable or short tempered which can lead to more persistent conflict in relationships and misunderstandings within the family unit
• Children or teenagers can be more dependent, less compliant and engage in attention seeking behaviours – usually indicative of anxiety or fear
• Teenagers may become more rebellious or demonstrate a need of have a greater sense of control over their lives
• Some individuals, even children and adolescents, may be focused on helping a particularly affected member of the family at the expense of their own needs.
• Where the emotional or psychological functioning of parents is impacted, parenting style can change, which in turn can make it hard for children who benefit from consistency, containment, routine and boundaries
• Couples may experience emotional or sexual problems in their relationship, and tension in the couple relationship might mean that parents are less available to their children.
• Everyone may feel exhausted and may want and need support, but are unable to give much in return.
• Interpersonal relationships can become strained – family members’ feelings for each other may change by becoming more detached, less involved with one another or preoccupied with personal problems as each family member tries to cope with their own reactions.
• Teenagers may turn towards peers or other adults outside of the family for emotional support.

Long term effects

Immediate or medium term effects can become habitual. Alternatively, problems may become apparent for the first time, months or years after the disaster event.

• In another crisis or disaster situation, memories of the original disaster event may come back for family members, and if similar feelings are aroused it can be harder to handle the new crisis. This may be particularly relevant in the case of repeated natural disasters over time.
• Some members of the family may experience “anticipatory anxiety” about the possibility of disaster events reoccurring. Consider for example, the anniversary of a disaster event, and the increased anxiety individuals may experience as that anniversary draws closer
• There is often a need to think and talk about the event again when family members grow into new stages of maturity and develop a capacity to understand more about the experience.
• Family members may cope with difficult feelings until the disaster is over and the situation has stabilised and only then begin to show their distress. This is particularly relevant in disaster scenarios, where the rebuilding and recovery phase may be protracted
• Family members may also feel that others don’t understand their particular experience, so may cover up their feelings.
• Sometimes the trauma of a disaster event makes it harder to deal with ordinary or everyday frustrations.

Provide psycho-education about helpful strategies for families:

• Relationships are central and communication is key! Encourage families to keep communicating – talking about what is happening and what family members need from each other is important. Encourage them to make opportunities for this to happen: being able to communicate and genuinely trying to understand each other’s feelings can be very meaningful.
• Share information: Encourage families to share information with children and teenagers, in the form of facts, without unnecessary detail. Children and teenagers understand that something has happened, and it is often easier for them to deal with facts than the unknown.
• Do things together: Families should be encouraged to take time out for just being together and to participate in enjoyable activities.
• Be proactive: It is helpful for families to take all concerns, complaints and questions seriously as family members may be trying to express something they are finding hard to articulate. This helps prevent a build-up of issues.
• Maintain clear family roles: As much as possible, family members should preserve their roles and responsibilities within the family. Children should not take on too much responsibility for too long even if they want to care for a distressed parent. Families should also be encouraged to resist overprotecting impacted individuals. When individuals are impacted by a disaster, they may be able to participate in or complete some of their usual roles or responsibilities, at the level appropriate to their current functioning. It may be helpful to consider this as a negotiated process, which includes an open conversation about when that person is ready, willing and able to resume their usual roles and responsibilities.
• Look back: Sometimes families benefit from reflecting on how each member has changed since the disaster and look for the ways the disaster has influenced everyone both positively and negatively.
• Explore strengths: Families might like to explore and articulate their family strengths.
  Allow expressions of emotions: It is helpful for families to understand that distress may need to be expressed many times before it subsides.
• Connect with other people: Encourage families to avoid isolation by maintaining contact with other families, friends, social groups, work colleagues and neighbours. Social connectedness is a strong predictor of recovery following disaster.
• Share the experience with those you trust. Encourage families to ask for help when they need it – most families have the ability to grow following a disaster and understanding the effects that a disaster can have can support this process.

Self-efficacy and hope are important principles to follow as they promote a strengths based approach – acknowledge the efforts of the family.

The aftermath of disaster is a time when safety and stability are important. Most parents will work to support their children and provide their families with a sense of calm, whilst managing their own emotional wellbeing. However, when the wellbeing of parents is compromised, it is difficult for them to be available to others. Parents have a central role in their children’s adjustment after exposure to a disaster so it is important for them to manage stress so it does not get in the way of family recovery. Parents can set a good example by managing their own stress through:

• Healthy lifestyle choices, such as eating healthy foods, exercising regularly, getting enough sleep and avoiding drugs and alcohol.
• Nurturing themselves by spending time each day doing something that will help with relaxation such as deep breathing, meditation or a relaxing activity.
• Reaching out and spending time with loved ones.

For some families, reactions following disaster may fluctuate, while for others, issues may emerge over time. Where families experience negative mental health impacts, most will recover in the days and months following disaster without psychological interventions, but the recovery phase may be prolonged and may continue to exert influence over time. Ongoing observation allows the health practitioner to assess the family functioning, as well as the well-being of individuals within the family unit, and to refer on to general practitioners and specialist mental health practitioners if necessary.

• Are there any additional risk factors that might be impacting how children or young people have responded to the disaster event? This might include experience of previous adverse events or a history of mental health difficulties.
• Is there a risk of self-harm? Is the child at risk?
• Does the child have access to social supports?
• Did the child experience the death of family members and friends or suffer the loss of possessions? This might increase the risk of the development of frank mental health difficulties in the aftermath of disaster
• Is the child having difficulties that last for longer than 6 weeks after the disaster occurred?
• Is distress extreme or interfering with their ability to participate in day to day activities?

Provide psycho-education about the effects on children following a disaster event. The vast majority of children and young people involved in a disaster recover with the care and support of family, friends and community as well as by drawing on personal strengths.

Some children cope well in a crisis and in the immediate aftermath. However, cognitive, behavioural, physiological and emotional changes may occur some weeks or months after the event which do not appear to be obviously related to the disaster event. Sometimes problems become apparent for the first time, months or years after the event.

Children’s reactions after disaster vary and may include:

• Sleep difficulties such as nightmares, reluctance to go to bed or to get out of bed.
• Changes in eating and toileting habits
• Regression in terms of developmental stage, meaning loss of previously acquired skill or ability
• Increased irritability, uncooperative or non-compliant behaviour, restlessness or over activity
• Exaggeration of small injuries or complaints in order to obtain comfort
• Increased difficulties in relationships with siblings and peers
• Over-concern for others, which may involve reluctance to express their own needs in order to protect parents, caregivers or other adults
• Decreased ability to cope with changes or ordinary, everyday problems that would have previously been managed
• Apparent “over reactions” to small things, which may represent an expression of their distress about the disaster, and may not be well understood by the child themselves or parents
• Difficulties concentrating and decreased school performance
• Preoccupation with the disaster – wanting to talk about it and play it out
• Clinging more to family or familiar things and needing objects for security

The aftermath of disaster is a time when safety and stability are important. Most parents will work to support their children and provide their families with a sense of calm, whilst managing their own emotional wellbeing. However, when the wellbeing of parents is compromised, it is difficult for them to be available to others. Parents have a central role in their children’s adjustment after exposure to a disaster so it is important for them to manage stress so it does not get in the way of family recovery. Parents can set a good example by managing their own stress through:

• Encourage parents or care-givers to be emotionally available to their children – although this can be hard to do when they have been through the same disaster event, and have a lot to cope with it themselves. Where parents are experiencing their own mental health difficulties as a result of the disaster, receiving professional support can help them stay calm and in control, and thereby in a better position to help their children feel safe and cared for.
• Encourage parents to be a role model to their children by undertaking self-care activities. This can include encouraging them to get enough rest, reaching out to family and friends for support, or engage in community-based activities.
• Encourage parents to prioritise family time and to participate in shared activities and experiences with their children.
• Encourage parents to be good listeners. This brief listening exercise may be helpful:

Listening Exercise

• Parent: is there something you would like to talk to me about?
• Young person/child: talks about worry (uninterrupted)
• Parent: “What I hear you saying is…” (Reflect back what young person/child said after listening to what was said not – resisting urge to interpret or make assumptions)
• Parent: “I can understand that” (validate)
• Parent: “that must make you feel…” (Empathise by suggesting 3 feelings e.g., Sad, lonely, scared that you feel most accurately reflect the child or young person’s feelings)

This exercise can be repeated by parent asking: “is there more?”

For some children and young people, reactions following disaster may fluctuate, while for others, issues may emerge over time. Where mental health impacts are experienced, most will recover in the days and months following disaster without psychological interventions, but the recovery phase may be prolonged and may continue to exert influence over time. Ongoing observation allows the health practitioner to assess the well-being of children and young people, and to refer on to general practitioners and specialist mental health practitioners if necessary.

• Bonanno GA, Brewin CR, Kaniasty K, Greca AML. Weighing the Costs of Disaster: Consequences, Risk and Resilience in Individuals, Families and Communities. Psychological Science in the Public Interest 2010:11 (1) 1-49.
• Wraith, R & Australian Red Cross (2010) Helping children and young people cope with crisis: information for parents and caregivers. At: redcross.org.au/files/helping_children_and_ young_people_cope.pdf.
• Caruana, C (2010) Family functioning in the aftermath of natural disaster: picking up the pieces, Family Matters 84 – May 2010