Introduction to Natural Disasters 1 Why care about

Introduction to Natural Disasters 1

Why care about natural disasters? Widespread destruction n Affect everyone n Tied to mental health n Awareness means preparedness! n Source: Jeff Piotrouski, courtesy OK Dept of Health 2

Disaster Definition “Disasters can be defined as any event, human-made or natural, sudden or progressive, causing widespread human material or environmental losses, which exceed the ability of the affected community to cope using its own resources” (Asian Disaster Preparedness Center) (Source: GOVT E-1027/W: Preventive Measures: the Politics of Disaster http: //www. vranet. com/govt 1027) 3

Natural Disasters: School Psychology’s Role Judy Oehler-Stinnett, Ph. D. Team names Judy Oehler-Stinnett, Ph. D.

U. S. Major Disaster Definition Federal Emergency Management Agency n Local response http: //www. wtsp. com/video/player. aspx? aid=12620&sid=9618&bw=hi Local government first responders ¨ Neighboring & volunteer agencies assist ¨ n State declared disaster Local services cannot handle alone ¨ May send National Guard, agency workers ¨ Damage assessment conducted ¨ n Federal major declared disaster Governor commits state funds, requests major disaster declaration ¨ FEMA evaluates request, makes recommendation ¨ President approves or denies request ¨ Requests submitted: Individual, business, public assistance, tribe http: //www. wtsp. com/video/player. aspx? aid=12620&sid=9618&bw=hi ¨ 5

Natural Disasters Hurricanes/Typhoon Drought/Heat wave Tornadoes Non-Tropical Floods Earthquakes Thunderstorms/ Severe weather Wildfires Landslides/Mudslides NOAA Volcanoes Blizzards/Freezes/ Ice Storms Lightning strike Tsunami Sandstorms Resulting technical disaster (Na-tech) 6

Frequent Natural Events Qualifying as Disasters* Worldwide n n n n Floods Hurricanes Drought/famine Earthquake Tornadoes Heat wave United States n n n Hurricanes Floods Earthquake Tornadoes Drought (*Tsunami infrequent but devastating) 7

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Most deadly natural disasters >100, 000 n Tsunami n Drought n Tornado/windstorm n Flood n Earthquake n >10, 000 Volcano Extreme Temp Slides >1000 Wildfire (CRED) 10

U. S Weather Fatalities 2003 (NOAA) 11

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Economic Impact Property damage and loss n Employment time loss n Tourism loss n Crop, topsoil destruction n Disease in & loss of livestock n Looting n Increase illness and disease costs n Large disaster estimates: millions to billions n Tsunami cost: 4. 4 billion n (World Bank) 14

n Better Industrialized Countries ¨ Insurance coverage* ¨ Warning, death & damage prevention* ¨ Emergency & medical care* ¨ Economic recovery* ¨ Mental health services n Most affected ¨ High risk areas ¨ Uninsured, low income# ¨ When disaster not declared# n Contribution ¨ Federal & global disaster assistance ¨ Emitting most carbon dioxideimpacts climate change$ Source: *worldbank. org 15 $worldviewofglobalwarming, #FEMA; picture FEMA

Carbon Dioxide Increases. 16

Impact in Developing Countries n n n Poor construction increases damage Setbacks to economic & social development Poor to no early warning system Massive casualties Development money diverted to relief Longer secondary trauma from displacement, illness, grief, economic loss (Text source: Worldbank; Photo source: American Red Cross. com) 17

Mental Health Impact/Needs n Psychological first aid ¨ Normalize majority reactions ¨ Access to recovery services n Treatment of severe reactions ¨ Acute Stress Disorder ¨ Post-traumatic Stress Disorder n Intervention for long-term stress ¨ Secondary trauma ¨ Fear of reoccurrence n Long-term planning ¨ Crisis Intervention ¨ Mitigation/Secondary ¨ Primary Prevention n NASP Prevention Trauma (all types) #1 cause of preventable mental illness 18

Making Natural Disasters Real: Pictures and Maps 19

Hurricane (FEMA) 20

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Hurricane/Cyclones World Wide 22

Tornado 23

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http: //www. tornadoproject. com/allt orns/world. htm#top n Tornadoproject. com clickable map of tornado information available worldwide n No free map currently available 25

Tsunami (FEMA) 26

Tsunami potential map (NOAA) 27

Thunderstorm & Lightning (NOAA/NWS) 28

Thunderstorm frequency (Eastern Illinois U) 29

Lightning Frequency Worldwide (National Lightning Safety Institute) 30

Severe Storms (FEMA) 31

Hail map (NWS Blueprint for Safety) 32

Flood 33

Flood Frequency Map (USGS) 34

Flood Global Map 2004 35

Drought (FEMA) 36

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Heat Wave 38

Fire (FEMA) 39

Wildfire Potential (USGS) 40

Countries with recent forest fires n Dominican Republic, April 2005 Syria, October 2004 Australia, January 2004 n United States, November 2003 n Russian Federation, October 2003 n Kazakhstan, October 2003 n India, October 2003 n Brazil, September 2003 n Portugal, September 2003 n Canada, September 2003 n South Africa, September 2003 n Greece, September 2003 n Spain, August 2003 n Italy, August 2003 n Argentina, August 2003 n Paraguay, August 2003 n Croatia, August 2003 n France, August 2003 n China, June 2003 n Sumatra, Indonesia, June 2003 n Mexico, May 2003 n Nicaragua, April 2003 n Guatemala, March 2003 41

Earthquake (FEMA) 42

Earthquakes USGS 43

Earthquake world history 44

Volcano (FEMA) 45

Volcano Locations in U. S. (Michigan Tech Volcanoes) 46

Volcano map worldwide (Michigan Tech Volcanoes) 47

Landslide (NASA) 48

Landslide Frequency U. S. (USGS) 49

Western Europe Landslide (ESA) 50

Sandstorm (European Space Agency) 51

Duststorm Map (European Space Agency) 52

Global warming data (worldviewofglobalwarming. org) 53

Drought/Flood Prediction from changes in precipitation (International Research Institute for Climate Prediction) 54

Factors in Natural Disasters q Contribute to the total experience of the event q Note for common & unique reactions in victims q n n For more info, go to: http: //www. fema. gov/ http: //www. noaa. gov/ http: //www. redcross. org/ http: //www. worldviewofglobalwarming. org/ 55

n n n n Severity/Intensity-size, speed Factors in natural disasters Duration Destruction method Sights, sounds during Injury, damage, deaths Aftermath Preparation methods Prevention methods 56

Geographic locations q n Vary within U. S. and world (see maps) Variance from year to year, but stability in high incidence areas Hurricanes coastal but vary on where on coast hurricane hits ¨ Tornadoes concentrated in Midwest but vary as to exactly where land ¨ Influenced by airflow (e. g. Jet Stream) ¨ n Variance contributes to building in high risk areas ¨ lack of preparation ¨ failure to heed warnings ¨ n Every area of world at risk for some types of natural disaster (NOAA, NWS, FEMA, Red Cross) 57

Frequency Varies from year to year n Varies across locations n Can be seasonal, cyclic n Flood most frequent worldwide n High frequency areas n ¨ Most awareness ¨ Most official preparation ¨ Habituation can lower public response ¨ Repeated disasters lower resilience 58 (NWS, FEMA, Red Cross, worldbank)

¨ Predictability, & Response Earthquakes may have no warning Dangerous to underestimate time to Suddenness & Warning Time, impact n Preparedness increases rapid response n Failure to respond increases severity exposure and likelihood of trauma symptoms n (FEMA, NWS, Red Cross) 59

Predictability, Suddenness and Warning Time, Response con’t. 60

U. S. Cost Increase of Natural Disasters (Princeton) 61

Severity/Intensity n Severity ratings in scale numbers Most severe are less frequent ¨ People in high frequency areas underestimate severity ¨ FEMA n Size impacts Number of victims ¨ Amount of land ¨ Ability to predict ¨ n Intensity/speed impacts Level of damage ¨ Amount of time to prepare ¨ n FEMA Increases in victims’ level of trauma Proximity to center of event ¨ Experiencing injury, property damage ¨ Exposure to death, Fear for life ¨ (FEMA. Red Cross, NWS) 62

¨Earthquakes-seconds n Length of secondary trauma Duration ¨Time to clear debris, rebuild ¨Time to restore safety, order, routine (Red Cross, FEMA) 63

Damage Method n Wind - property & personal damage Water movement ¨Alone reduced property damage (flood) ¨Animal loss risk high n Wind + water=High risk of death/ damage n Fire – Leaves little behind n Cold n Heat/drought n Land Movement – earth, mud, snow, ice n (Red Cross, FEMA, NWS) 64

Sensory Input during Event Impacted by type and severity of disaster n Influences memory and stimulus triggers for stress & trauma n Areas of input n ¨ Sights ¨ Sounds ¨ Bodily senses ¨ Smell (Red Cross, APA) n Click for video http: //gprime. net/video. php/soccertornado 65

Sensory Input during Event n Sights ¨Clouds, Funnels, Lightning ¨Water moving, rising ¨Heat radiation ¨Hail, rain, dust, sand, snow, ice, earth, etc. blown ¨Human and animal victims injured or dead, blood ¨Property movement, damage and debris (Red Cross, APA) 66

Sensory Input during Event n Sounds ¨Wind ¨Rain, Ice, Hail ¨Thunder ¨Cries for help ¨Property stress and destruction ¨Land shifting, cracking (Red Cross, APA) 67

Sensory Input during Event n Bodily senses ¨Being carried by water, wind or earth ¨Earth shaking or shifting ¨Temperature and pressure changes ¨Own injuries (Red Cross, APA) 68

Sensory Input during Event n Smell ¨Wind-carried odors ¨Water-soaked objects ¨Contamination ¨Death (Red Cross, APA) 69

n Amount of damage largely Injury & deaths, Damage determined by size and severity of event (Red Cross, FEMA) 70

n Rapid rebuilding vs. long-term vs. Aftermath: Recovery displacement Secondary Trauma n Economic growth vs. basic relief (FEMA, Red Cross, worldbank) 71

Programming for Natural Disasters n What school personnel need to know 72

Long-range preparation-educational ¨ ¨ Community planning to lessen losses n Building codes n Insurance coverage n Shelters n Warning systems Preparation for specific disasters in your area n n ¨ ¨ Ensure that school plans are adequate Have personal plans in place so that you can assist others Knowledge & supplies to n Children n Families n School n Community Resources n Federal Emergency Management Adm (FEMA) n American Red Cross n State Agencies n Media n NASP, APA 73

Programming by Phases of Disaster Prevention/mitigation n Long-range preparation n Immediate preparation for impact n Impact or during disaster n Immediate aftermath, acute crisis phase n Short-term follow-up & evaluation n Long-term follow-up & evaluation n Continued planning n 74

Prevention/Mitigation n Event primarily uncontrollable n Damage and outcome somewhat controllable ¨ Location of home, business, school ¨ Building structure integrity n National Clearinghouse for Educational Facilities Guidelines for building/retrofitting educational facilities: http: //www. edfacilities. org/rl/disaster. cfm ¨ Storm shelter ¨ Knowledge of specific disasters ¨ Disaster preparedness kit ¨ Disaster drills ¨ Weather radio, heed warnings 75

Institute high-level planning and funding Prevention/Mitigation Methods n Tie funding and insurance to mitigation n Reduce carbon dioxide emissions n ¨ Reduced energy needs ¨ alternate energy sources (Red Cross, FEMA, worldbank; pictures earthfuture) 76

n Evacuation plan Preparedness Methods n Disaster Communication plan n Shelters n Security plans (FEMA, Red Cross) 77

Preparedness Programs FEMA, Red Cross n Children n Families n School personnel n Community 78

Preparedness Programs, con’t see FEMA and Red Cross for excellent resources, links n Child ¨ Use education available local resources Television weather personnel n Science teachers and others n ¨ Utilize n science natural disasters curriculum unit Often covered in 5 th to 7 th grade ¨ Integrate with language & other units ¨ Include mental health components ¨ Make it Active Don’t just TELL kids what they SHOULD do n get donations to prepare kits n 79

Child Education, con’t. n n What natural disasters occur most frequently in area Disaster preparedness ¨ Supplies ¨ Where to go during disaster ¨ How to contact adults and loved ones FEMA ¨ Resources for volunteering n Mental health preparedness ¨ Shock of event ¨ Coping skills for recovery n For program packages, see: n http: //www. femagov/kids/ n http: //www. redcross. org/disaster/masters/ 80

n Family education Preparedness Programs, con’t ¨ Trained children often more concerned ¨ Adults responsible for safety n n Children lose faith in adults’ ability to protect them after disaster occurs (Lazarus, 1995) Worse with loss of loved one or high death threat ¨ Increase n n Enlist parent organizations Provide incentives – disaster kits ¨ Include n cultural, religious sensitivity Beliefs regarding causation ¨ ¨ ¨ n involvement divine punishment miracle predetermination Beliefs regarding death ¨ ¨ Death to be feared or welcomed Rituals and symbolic meaning Evans (2002) found that children who were in a storm shelter were much less afraid of the tornado NASP resources: http: //www. nasponline. org/ culturalcompetence/cc_cris isresources. pdf 81

Family education, con’t. n Include mental health issues: ¨ Awareness of family/child premorbid functioning n n n Chronic stressors Past or recent traumas Trait anxiety, agitation ¨ Degree of exposure relationship to trauma symptoms ¨ Behavioral symptoms n Not always observable n Must ask children how they are feeling and listen to them. (Evans, 2002) ¨ Importance of social support n Emotional support n Informational support n Tangible support (Norris et al. , 2001) ¨ Include coping tools to facilitate post-traumatic growth n Use of adaptive coping rather than avoidance (Moss, Cronkite, Billings, & Finny) n What did we learn? n How can we prepare better? Restore trust in safety. 82

Family preparedness, con’t. Knowledge of natural disasters in area n Family crisis, safety & evacuation plan n Emergency supply kit, weather radio n Way to communicate, use of social support network n Place to gather n Listen and heed warnings: Remaining when unsafe related to trauma symptoms n Override family members discounting concerns n Do not “chase” storm – leave that to professionals n Use care following disaster – make sure children avoid debris, power lines, fire, etc. American Academy of Pediatrics n AAP - Family Readiness Kit: Preparing to Handle Disasters http: //www. aap. org/family/frkit. htm Red Cross http: //www. seattleredcross. org/disaster/familyplan/index. HTM 83

Don’t forget the Animals n n Most shelters do not allow pets Children become very concerned about their pets Livestock are also a consideration Plan ahead for animal safety ¨ Failure to evacuate & reentering disaster scene related to pets (Heath, 1997) ¨ Loss of or injury to animal related to trauma symptoms See Humane Society of the U. S. for animal tips: http: //www. hsus. org/hsus_field/hsus_disaster_center/ 84 FEMA

School Disaster Plan n Identity potential disasters in your area Involve school board, parent groups, administration Use recommended resources: FEMA handout – multi-hazard plan for all phases of disaster: http: //www. fema. gov/fima/rmsp 424. shtm Red Cross Emergency Guide for Business and Industry: http: //www. redcross. org/services/disaster/0, 1082, 0_606_, 00. html#fema 85

Preparedness Programs, con’t. n FEMA School personnel education ¨ Review crisis plan for natural disasters n Include parents, students n Drill procedures for taking cover and evacuating n Ensure evacuation route avoids hazards n Include plan for persons with handicapping conditions ¨ Build shelters, retrofit buildings ¨ “Walk through” to remove, secure hazards n Chemicals n Heavy objects n Windows, glass ¨ Educate on need to protect, respond n Take seriously n Keep first aid kit, flashlights, broom, communication, and weather radio in all classrooms ¨ Plan for use of school buildings as community shelter 86

Preparedness Programs, con’t. n FEMA School personnel education, con’t. ¨ Include mental health issues Prevent stress on children due to school lack of preparedness or follow-up n Know effects of disaster on emotions, academics & social interaction n Reduce parent anxiety by communicating on evacuation, lock-down procedures during natural disaster n Not safe to try to pick up child during disaster ¨ Official means for getting school information ¨ n Address trauma-related symptoms of school personnel who must comfort children Personnel likely have also suffered loss ¨ Secondary trauma of care-givers ¨ 87

Community Preparedness n Coordinate school and community plans ¨ Identify leaders and liaisons in emergency management ¨ Prepare for use of buildings as shelter ¨ Use community resources to facilitate family training in community ¨ Plan for Rapid response team deployment ¨ Plan for dealing with media n Agency or residential facility ¨ be knowledgeable of the disaster plan ¨ Become member of crisis team n Have community-wide disaster drills 88

Media converge on a disaster location when all the people want is to be helped or to be left alone… Photo copyright Mitchell Prothero World Picture News 89

When Natural Disasters Occur n Steps for Imminent Disaster and Beyond 90

Follow natural disaster procedures in agency/school preparation for Impact Immediate n Keep communication open-limit use of cell phones if children have them n Help children and caretakers remain calm n Stay alert to changing conditions and take protective steps n Keep weather radios on n NEVER IGNORE SIRENS n 91

Impact n n n If natural disaster occurs while children are at school, school will become a trauma stimulus Remain calm and help others to do so Model positive coping self-talk Remember that care-givers as well as children will be affected Take care of your own needs as well If event happens while children are away from school, school will be used to help normalize adjustment. 92

Bloomsburg, PA High School Flooding from Hurricane Ivan Jared Fenstermacher – from Bloomsburg Weater 93

Acute crisis phase Continue to implement school crisis plan n Assist in controlling media access n Assist in communications between home and school n Work with any emergency team that is onsite, have credentials available n Help with triage in determining who needs immediate assistance n Assess property damage and hazards n Assist with activities if school is an emergency shelter n 94

School Used as Disaster Center after California Earthquake FEMA 95

Short-term follow-up n n Once acute crisis team has left, continue to meet immediate needs through school crisis team Practical assistance most critical at this phase ¨ Survival: Food, water, shelter ¨ Finding loved ones and pets ¨ Access to disaster services n Guidance programs for majority of children ¨ Normalization of responses ¨ Coping skills ¨ Reduce school requirements n to make time for intervention Screen for children needing mental health services ¨ Victims who were not in desperate need immediately may start showing trauma symptoms – later onset of PTSD ¨ Kids do not need to show full-blown PTSD to need help ¨ Parents often underestimate impact of trauma on kids 96

Short-term coping n Social support system available ¨ Family ¨ Friends ¨ Community/church ¨ School n Positive role models for coping ¨ Those around child take steps to cope, make positive coping statements ¨ Support for discussing event, feelings ¨ Discussions are not anxiety-filled or provoking, but don’t negate severity of event ¨ Volunteer opportunities 97

Short to long-term follow-up Coping with funerals, sometimes multiple n Delays and cost in rebuilding n Lack of resources, services, extended secondary trauma n Low social support and high modeled social anxiety (Evans, 2002 ) n 98

Long-term follow-up n n n n Significant evidence that children experience long -term effects of natural disasters (Evans, 2002) Support groups for most kids Trauma treatment for those most affected Disaster preparation Anniversary dates Find ways to minimize trauma cues, change thoughts surrounding seeing cues Cognitive-behavioral therapy most successful 99

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Post-trauma adjustment Factors n Cultural considerations ¨ ¨ n Rural vs. urban setting ¨ ¨ n n Preexisting mental health issues Need for additional support services Preexisting crisis procedures ¨ ¨ n Use of existing support systems Availability of services Persons with disabilities ¨ ¨ n Concepts of death Adaptation rituals Communicating with media & limiting access to trauma victims Determining who is eligible to provide services and triage Children’s re-exposure through television and other media Availability of mental health services 101

Post-Trauma Adjustment Factors n n n Closeness to impact: Sights, sounds Severity of event: most severe damage Injury to self Witnessing injury to others Witnessing death of other people, pets Place during event damaged or destroyed Home, school or other location damaged or destroyed Injury of significant others: family, friends Death of significant other Fear of being severely injured or killed Inability to contact, locate loved ones Feelings of safety (e. g. , in storm shelter with family) can mitigate trauma symptoms to some extent 102

Post-trauma adjustment Factors n What happens in the mind of a child? ¨ Causation beliefs - mistaken connection between their behavior and event Survivor guilt – their survival cost someone else n Omen formation – thinking they could have prevented event (March, 2003) n ¨ Understanding n Anger at family or school for not protecting them better ¨ Alterations n n of event in existing schema due to event No longer feel safe, optimism bias of childhood shattered Foreshortened future beliefs ¨ See Pynood et al. , 1997 for model of PTSD 103

Post Trauma Adjustment Factors: Developmental Considerations There are many developmental lists out there, not all are based on research. n Preschool, child and adolescent symptoms vary, yet within each age group, different children will react differently. n Children likely have different reactions than adults and adults may notice or understand child’s concerns either because the adults are not upset or they are too upset themselves. n 104

Assessment/Intervention for Acute Stress Disorder & Post Traumatic Stress Disorder in Natural Disasters n Post-disaster phases ¨ Emotional numbing n Tsunami orphans: 7, 722 lost 2 Gets you through acute phase of trauma parents; 32, 735 lost 1 parent n Shouldn’t mistake for children being “fine” ¨ Coping n n vs. Acute Stress Disorder Most victims have a support system and take positive action to get through crisis Excessive stress reaction during first month following disaster ASD ¨ Post n Worldbank. org Traumatic Stress Disorder Symptoms onset or remain more than one month post-disaster Amma teaching tsunami survivor how to swim Amritapuri. org 37% of deaths were children 105

Common Symptoms in Youth who are at risk for PTSD Following Natural Disaster n Re-experiencing: Nightmares about disaster or symbol of it ¨ Trauma play (in young children) ¨ n Avoidance: Avoidance of place reminders ¨ Avoidance of people reminders ¨ Avoid discussion of trauma ¨ n Hypervigilance/arousal: On look out for cues of reoccurrence (e. g. , react strongly to clouds in sky following tornado) ¨ Excessive startle reaction (Carrion, Weems, Ray, & Reiss, 2002) DSM-IV-TR ¨ 106

Common Symptoms in Youth who are at risk for PTSD Following Natural Disaster q Anxiety/worry ¨ Concern about safety ¨ Don’t want to leave parents n Somatic complaints ¨ Stomachaches ¨ Headaches n Agitation/ anger ¨ Anger at not being protected ¨ Agitation related to hypervigilance (Chorpita, Albana & Barlow, 1998) 107

n Social interaction Common Symptoms in Youth who are at difficulties risk for PTSD Following Natural Disaster ¨ Family ¨ Teachers ¨ Peers n School difficulties ¨ School work ¨ Concentration, memory (Caffo & Belaise, 2003; Weinstein, Staffelbach, & Biaggio, 2000) 108

Screening n n n If you work where a natural disaster has occurred at any time that the children you work with could have been exposed to it, then you need to screen for effects of the disaster! Under these conditions, any child referred should be screened to see if symptoms are related to the natural disaster that impacted them. (Ford et al. , 2000) Broad-band scales do not measure PTSD per se, but scales such as the BASC-SRP are related to PTSD scales (Cook-Cottone, 2004; Evans, 2002) General anxiety scales may also capture some symptoms 109

Screening, con’t. n If a natural disaster occurs while you are providing services, then you need to screen/assess for children affected ¨ Immediately following ¨ 1 month to 1 year following ¨ 2 year follow-up ¨ Long-term follow-up 110

PTSD Scales Validated for Use with Children in Natural Disasters n Children’s PTSD Inventory (Saigh, et al. , 2000; Saigh, Yasik, n Impact of Events Scale (Horowitz, Wilner & Alvarez, 1979; Yule, Oberfield, Halamandaris, & Mc. Hugh, 2002) Bruggencate, & Joseph, 1994); The Child Post-Traumatic Stress Disorder Reaction Index (CPTSD-RI, see Frederick, Pynoos, & Nader, 1992); n The Child PTSD Symptom Scale (CPSS; Foa, Johnson, n Feeny & Treadwell, 2001); When Bad Things Happen (WBTH; Fletcher, 1996) n The Kauai Recovery Index, patterned on the n CPTSD-RI (Hamada, Kameoka, Yanagida, & Chemtob, 2003). n The OSU PTSD Inventory – Child (Evans, 2002; Evans & Oehler-Stinnett, submitted) 111

Prevalence of PTSD in Children Following Natural Disasters Using PTSD Inventories n n Youth more impacted by disaster than adults & Violence victims more impacted than those in natural disaster (Norris, Friedman, & Watson, 2002) (see Freyd, 2002 re: betrayal trauma theory) Children in developing countries more impacted than those in developed countries (Evans, 2002; Bulut, 2003) Some evidence that girls and minorities more affected, but results not consistent (Vernberg, La. Greca, Silverman, & Prinstein, 1996) 112

Prevalence rates, con’t. : Child self-report n n n Almost all children in hurricanes show initial symptoms (8695%) At 10 -month to 1 year follow-up, rates are lower, but majority of children still showing some symptoms Much lower percentage show severe or pervasive symptoms (18 -30%) using DSM-IV criteria Must look at specific symptoms, not just overall score Using standard deviation units on factor scoring, tornado victims show fewer severe symptoms (10 -15%), moderate symptoms higher (47 -65%) Earthquake victims worldwide much higher rate than U. S. children (e. g. , Anthony, Lonigan, & Hecht, 1999; Evans & Oehler-Stinnett, submitted; Hamada, Kameoka, Yanagida & Chemtob, 2003; Lonigan, Shannon, Taylor, Finch & Sallee, 1994; Vernberg, La. Greca, Silverman, and Prinstein, 1996) 113

Prevalence rates, con’t. n Problems with DSM – IV – TR diagnosis ¨ Not completely substantiated by factor analysis studies ¨ No Likert rating or anchors, or norms ¨ Children not likely to evidence most symptoms unless very severely affected ¨ Use of rating scales recommended 114

Serious Concerns in Adolescents n Increased risk of ¨ Alcohol and substance abuse ¨ Depression ¨ Suicide n Influence on culture ¨ TSUNAMI SUICIDE By the Unseen Copyright 03 -04 These feelings in my head Of things that can't be said Because I'm grasping for the words To make you understand And I wanna destroy myself Don't wanna destroy myself I wanna destroy myself Hurricanes of love and pain Tsunami tides of suicide Like a cobra poised to strike Like a criminal in the night Depression sleeping in Like a ship without a light But life is just a game And we all end up the same So let the storms come Cause the clouds will bring the rain 115

Interventions for Children with PTSD in Natural Disasters Cognitive-Behavioral Therapy (Foa, Treadwell, & March, 2004) n Exposure, relaxation, massage less evidence n Psychoeducation, coping (Teicher, et al. , 2002) n Medication (Bryant & Friedman, 2001) n 116

Interventions con’t. Continue long-term intervention n Prepare better – see prevention and mitigation slides! n 117

Disaster Mental Health Training n Disaster Mental Health in Natural Disasters 118

Long-range planning-Mental Health n Who trains disaster mental health workers? ¨ NOVA – National Organization for Victims’ Assistance has liaison with National Association of School Psychologists for NEAT (National Emergency Assistance Team) ¨ Red Cross – Has liaison with American Psychological Association’s Disaster Response Network (DRN) for DMH. n Who is eligible to provide disaster mental-health services? ¨ Must be licensed to provide DMH services to any location, according to Red Cross, for protection of public. ¨ Certified school psychologists are often involved in crisis services in their schools, but need appropriate training. 119

American Psychological Association Disaster Response Network in conjunction with the American Red Cross n n n http: //www. apa. org/practice/drnindex. html Licensed psychologists can be trained through the DRN program Must obtain liability insurance Series of disaster trainings, including mass trauma and disaster-specific training In need of child specialists Contact APA or your local Red Cross 120

NASP National Emergency Assistance Team (NEAT) n NASP helps in disasters through the National Emergency Assistance Team ¨ Trained NASP personnel are on call for emergencies ¨ Should you be a crisis responder? http: //www. nasponline. org/NEAT/neat_crisis. html q There additional helpful materials available on line through NASP: http: //www. nasponline. org/NEAT/ 121

Resources from NASP on Natural Disasters n n http: //www. nasponline. org/NEAT/crisismain. html #natural http: //www. nasponline. org/crisisresources/22 Lazarus. pdf http: //www. nasponline. org/crisisresources/tsuna mi. html http: //www. nasponline. org/NEAT/Midwest. Floods. pdf 122

NASP Resources on Natural Disasters n n n n n Natural Disasters from NASP's book Best Practices in School Crisis Prevention and Intervention Helping Children in the Event of a Tsunami: Information for Parents and Teachers Effects of the Indian Ocean Tsunami: Helping Children Cope Helping Children After a Wildfire: Tips for Parents and Teachers Responding to Wildfires: Helping Children and Families Responding to Natural Disasters - Helping Children and Families: Information for School Crisis Teams Helping Children After a Natural Disaster: Information for Parents and Teachers Winds of Terror: Children's Response to Hurricane and Tornado Disasters - from the NASP publication Crisis Prevention and Response: A Collection of NASP Resources (pp. 231 -239). Natural Disasters, Crisis Intervention, and School Psychology: Melding Human Needs and Professional Roles See http: //www. nasponline. org/NEAT for updated crisis information 123