A guide for health and social service workers: Supporting children’s mental health in the short term following a disaster

These guidelines assist practitioners to help families with children in the short term following a disaster.

Children of all ages can be profoundly affected by natural disasters such as bushfires, floods, cyclones and severe storms. These events can produce trauma, grief, destruction of children’s sense of safety and security, and loss of their home, school or social networks.

When disasters occur, parents need guidance, information and support for their own needs so they can reassure and care for their children as effectively as possible.

To help with this support for families, practitioners themselves need to be professionally prepared to discuss the issue of disasters with their client families. They need to recognise the ways that disasters can affect the psychological health of children and families, particularly immediately after a disaster occurs.

Practitioners are in a unique position to help monitor their clients over time and see how they are doing. Practitioners can play a pivotal role in helping a community recover after a disaster.

It is normal for nearly everyone to experience some form of psychological difficulty after a significant or traumatic event. Reactions following a traumatic event are intense and usually at their worst during the first few weeks after the event when the upheaval and change in life patterns is often overwhelming.
For most people, these feelings fade over time, though they may come and go for a much longer period, and also return when people are reminded of the event.

Some of the psychological difficulties people can experience at this stage include:

• intense emotions that can change rapidly from fear to anger to sadness
• a sense of being overwhelmed and uncertainty about what to do next
• worry, anxiety and fear
• despair or hopelessness
• feeling burdened by responsibility
• anger, sadness and even numbness.

People may also commonly experience:

• intrusive thoughts and memories, such as negative thoughts or images that won’t go away
• nightmares or flashbacks of their experience in the disaster.

These psychological difficulties and feelings can be very disturbing for both adults and children. However, they are part of the natural psychological process of dealing with traumatic experiences and memories. For most people, these psychological and emotional difficulties will reduce and disappear over time.

For some adults and children, however, they may persist for months after the event, or become worse over time. These adults or children may need a referral to a psychologist or mental health social worker to help them further process the trauma.

Children’s reactions after a disaster can differ, depending on:

• age (younger children may be more vulnerable)
• the child’s specific experiences of the disaster, which may have included:
  • death of parents or family members
  • loss of significant others
  • damage or destruction of home, neighbourhood, school or community
  • loss of loved pets and possessions.
• the extent of the ongoing disruptions they experience after the disaster (e.g. not being able to go home, return to school or to usual life-routines, over-exposure to traumatic TV images of the disaster).

Children may have ongoing fears regarding safety, security and separation from parents.

These fears may present as follows:

• young children: regression, clinging, sleep difficulties
• older children: bravado, withdrawal, emotional problems, behavioural problems, sleep difficulties
• adolescents: acting out, caregiving, arousal, depression, drug use, sleep difficulties.

Children may experience grief at the losses that have occurred and show sadness or withdrawn behaviours, seek comfort from other family members, cling to attachment objects, ask questions repetitively.

• Young children: may not understand the finality of death, may feel abandoned.
• Older children: may ‘attach’ to others, seek security, experience guilt.
• Adolescents: may show a range of grieving emotions or denial, anger, guilt, pseudo maturity.

Children may develop trauma syndromes (e.g. post-traumatic stress disorder (PTSD)):

• becoming distressed, with sleep difficulties, irritability, lack of concentration
• displaying a lack of emotion, avoidance, withdrawal
• re-experiencing the disaster, including some repetitive play
• developmental regression.

Children may develop traumatic grief, this is a mixture of trauma and grief and is common in such circumstances.

Children are vulnerable to multiple stressors, Chemtob et al. (2008) have highlighted the particular vulnerabilities of children when there are multiple stressors.

Children may be quiet, good and compliant early after the disaster, until they regain some sense of a secure world, and only later show the effects of trauma (even six months or more afterwards).

Common symptom patterns include:

• increased fearfulness about any threat
• becoming clingy and displaying regressed behaviours
• becoming fearful of separation
• sleep difficulties
• general bodily complaints including stomach pains and headaches
• difficulties concentrating at school
• becoming withdrawn, sad and, in some cases, depressed
• displaying aggression and acting out.

Disasters may affect children’s development through the severity of the children’s experience, their reactions, and the degree to which they are able to be supported adequately.

Parents and or other caregivers are pivotal in the recovery of the child. Working with the parent or other caregivers to provide a safe, secure, supportive environment is essential. If children were separated from parents at the time of the event, then the parents’ reactions, both immediately and subsequently, will be important for the child, as will be how much parents, even in their own distress, can support and respond to the child afterwards.
The broader family and social network are key resources as is the community and school support systems.

Helping children involves also helping parents, or other caregivers close to the child, by:

1. supporting them to deal with their own experiences in the disaster and their own trauma and grief
2. providing them with advice about children’s needs and how to support them. For instance, children need reassurance:
   1. that they are loved
   2. that they will be safe and secure
   3. that they can share, or speak about, any of their feelings
   4. that they can ask questions that will be answered simply and honestly
   5. that they will be comforted and looked after now and in the future.

Helping children involves supporting their resilience by recognising and promoting their:

• positive, hopeful and optimistic responses
• connectedness to others and their social skills
• capacity for recognising and expressing their own feelings
• capacity to focus and problem solve as appropriate to their developmental levels and sense of self.

Experiencing a disaster personally and/or being a practitioner in a community that has recently experienced a disaster can be overwhelming. It is important that you attend to your self-care and that of your family.

Putting in place strategies for self-care is essential for practitioners working in trauma and post-disaster fields.

Some essential tools for this include linking into peer supports, engaging in stress reduction activities and seeking opportunities to reflect on your experiences with your professional colleagues.

This document was reviewed and updated in 2018, it is based on resources originally authored by the Australian Child and Adolescent Trauma, Loss and Grief Network.
Ruth Wraith OAM; MCPP