RF_DM-2_DR-22_SUDHA.pdf
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CHILD HEALTH WORKERS IN DISASTERS
increased levels of clinging behavior. Parents of these children may
need the short-term support of the crisis worker. For example, par
ents would be helped by learning that their children have greater
need for reassurance so that they can anticipate and be tolerant of
the increased demands. The parents would also benefit from a crisis
group with other parents of exceptional children. Special education
teachers can be a source of assistance for the children; inasmuch as
they are persons familiar to the families and children, they can be
very effective in assisting both.
Planning in advance for the needs of children in residential set
tings, such as treatment centers for mentally ill, mentally retarded,
or physically handicapped children, and for day programs for chil
dren, such as childcare centers and schools, should have high prior
ity. These agencies should all have their own plans that include
staff deployment, evacuation to alternate settings, and ways to con
tact and inform families of the well-being and location of their
children.
2. The injured or ill children
Like any children who undergo medical procedures, children
who have been physically injured in a disaster or who have become
ill and have been brought to the hospital or the doctor’s office will
be less traumatized by the injury if the medical procedures that are
about to occur are explained to them. In most up-to-date hospitals
this is part of the hospital routine. Consultants can inquire about
the local hospital and professional associations and involve them in
crisis planning. Every effort should be made to have a member of
the immediate family remain with the child during hospital stays
and to be present when the child receives medical care. This is
reassuring to the family and to the child.
F. Helping Techniques
1. The use of play
Few children are able to sit and talk directly about their diffi
culties or to explore the roots that underlie these difficulties. Most
of them are not able to talk about their problems even at a superficial
level. Involving the children in play is effective in helping them
work through their troubled feelings. Play is one of the natural
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HELPING THE CHILD AND FAMILY
modes of communication, and the fantasies that are verbalized while
playing often provide much information about the psychological
processes that are at the bottom of children’s problems. Children’s
play following disasters will reflect their experiences. Paints, clay,
dolls, and water play allow children outlets for their feelings. They
will build dams out of blocks, for example, and have them collapse,
or they will build towers and pretend the earth is shaking, activities
that obviously mirror an earthquake. Children’s drawings will de
pict on a more or less realistic level the feared hurricane winds or
tornados. Fortunately, children’s play discharges feelings that have
been bottled up.
Children seem to use play therapeutically. It is best when they
are allowed to make their own interpretations; adult interpretations
often dampen this expressive avenue. Any adults who care for chil
dren—teachers, counselors, parents—can encourage children to ex
press their feelings in play. The play experience should be a plea
surable one for both adults and children. Adult helpers should get
down to the children’s level—literally play on the floor with them
when necessary. Secondly, the workers must have the capacity to
project themselves into the children’s situation and to see the world
through the children’s eyes. The workers must also have the ability
to remember their own childhood experiences sufficiently to be able
to appreciate the children’s situation.
Parents sometimes feel guilty about the fact that their children
are having problems and may feel threatened that outsiders are
needed to help. Play therapy involves the parents who can be taught
to understand how the children express their feelings and fears
through play. Under optimal circumstances, parents play with their
children. Following a disaster or other family crisis, parental ener
gies are perforce drawn away from the children. Attracting the fam
ilies back to their ordinary roles with the children is therapeutic to
all concerned.
2. Individual counseling
Individual counseling may simply be a time for children to "have
someone to talk to.” As stated before, most children find "just talking
about feelings” difficult. However, there are times when friendly,
supportive adults are just what children need when their own par
ents are not able to listen to them because they are busy with their
own problems. Following a disaster in which there may be a shortage
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CHILD HEALTH WORKERS IN DISASTERS
of trained mental health workers, friendly, caring people who have
received some crisis training can be helpful to the children. Because
disasters arouse natural fears and anxieties in children, workers’
reassurances and emotional support are important. Individual ther
apy by trained, experienced therapists can be used in severe cases
to help the families and children understand the underlying roots
of the problem.
3. Group sessions
•>
a. Children's groups The group experience for children of latency
age and older is a natural one because of their daily experiences in
classroom settings. Children find it easier to relate to each other
than to adults. They gain a lot from a group in which they can talk
openly and honestly about their feelings after a disaster. Finding
peers who are interested encourages even withdrawn children to
talk about their feelings. A leader can provide emotional support
and needed information to the group. Children frequently distort
the information they receive and are afraid of "feeling foolish” about
asking questions. A peer group encourages them to ask their ques
tions, foolish or not.
Group intervention with children is especially useful for thera
peutic expression, as they are able to express their fears before their
peers once they are reassured that having fears and anxieties is
acceptable and that other children (even the bravest ones) also have
these feelings. Children retell their experiences with great enthu
siasm in group discussions with other children of similar age levels.
Groups function well when the leaders are democratic and care
about children. If adults run the groups in an authoritarian manner,
the groups will not "work,” and the children will not feel free to talk
about their feelings. When groups of children talk about disaster,
or draw pictures about them, they are helped to dispel their fears
about such happenings.
The following is one example of a group technique: Form a group
with a maximum of 12 children. Introduce the purpose as a chance
for everyone to learn about the experiences of others in the disaster.
(1) Ask all the children what happened to them and their fam
ilies in the disaster.
(2) As the stories appear, ask the children to tell about their
own fears (perhaps even act them out in dramatic, play).
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HELPING THE CHILD AND FAMILY
(3)
(4)
(5)
(6)
In the course of the discussion, provide factual information
on the disaster (what happened, why).
Ask members of the group to take turns being helpers. The
children are paired and then take turns, first asking for help
with a problem and then acting as helpers with the others’
problem.
Assign two children as co-leaders to help control restlessness
and distractibility among the children.
Provide the children with paper, plastic materials, clay, or
paints, and ask them to depict the disaster. The less verbal
children find this helpful.
b. Parents' groups Working with parents in a group is an ex
cellent means of helping them understand their children’s behavior
and providing them with specific advice on how they can deal with
problems. In the group, parents have the opportunity to share their
concerns with other parents who may be having similar concerns.
Advice from other parents is frequently more acceptable than advice
from “experts.”
A parent group is useful when it is also educational. Parents often
want to be informed on techniques for handling specific problems,
such as fears and anxieties, sleep problems, school difficulties, and
behavior problems.
Often the parents in groups express their own fears. Helping the
parents understand their own fears makes them more effective with
their children. The groups and group leaders are most supportive
to the parents when they reinforce strengths present in the families
and help them see how they have been able to deal efficiently with
problems in the past. If additional help is needed from other re
sources in the community, the group leaders should have the infor
mation available.
4. Telephone crisis service
A telephone crisis line offering help with problems of children in
disasters is effective in reaching the community. Families find it is
an acceptable way to ask for help, and it is an efficient way to reach
large numbers of families. The crisis line can be publicized on radio
and TV as available "to help parents deal with their children’s fears
and anxieties.” The media are usually pleased to announce the
availability of the crisis line as a public service. The telephone line
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CHILD HEALTH WORKERS IN DISASTERS
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self-expression, either
either by
by talking
talking or writing, slips of the
tongue, staggering gait.
• Feelings and mood
.
Feelings include depression, irritability, anxiety, easily triggered
and excessive rage, guilt, ready overexcitement.
2. Management
The first step is to be aware of, to be alert for, and to recognize
the symptoms when they begin to appear. The earlier they are rec
ognized the better. All personnel need to be instructed about the
early symptoms so that they may recognize burnout not only in
themselves but also in their fellow workers. Any such observations
should be reported to supervisors who should then talk to the in
dividuals and try to get them to recognize the symptoms in
themselves.
The supervisors should first attempt to persuade the helpers to
take time off, but, if necessary, they should order it. Guilt over
leaving the activity can be relieved by receiving official permission
to stop and by being shown how the they are no longer helping
because of the loss of their effectiveness. They can be reassured that
they will be welcomed on their return, that their duties will be
covered while they are absent, and that they will have improved
greatly as a result of their short interruption in service.
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THE MENTAL HEALTH PROFESSIONAL
The consultants may do so and share techniques and supportive
behavior with the consultees. Another example is an evacuation
shelter where the Red Cross is assisting distressed families and
children. The consultants can lead a demonstration group in a joint
activity, with the Red Cross workers as co-leaders.
C. Burnout
One of the primary responsibilities of the consultants is to alert
the workers to the possibility of burnout, both in themselves and
in their colleagues. Burnout is a condition frequently experienced
by workers involved in disaster relief and related activities, occuring
often among those working with children and families. Burnout is
the normal result of increased demands and overwork after a dis
aster occurs. It appears as physical and emotional exhaustion, unre
lieved feelings of fatigue, and marked irritability, and it decreases
the individual’s desire to work effectively.
Overwork and overcommitment are primarily responsible for the
occurrence of burnout. After a disaster, workers make extreme de
mands on themselves as they try to help the victims. Even after this
emergency phase has passed and they return to their regular jobs,
many workers continue their disaster relief work, exhausting them
selves in the process. Burnout may thus appear early or well into
the postdisaster period.
1. Symptoms
Symptoms appear in at least four areas. Some people may develop
just a few; others may develop many.
• Thinking
Thinking ability slows, confusion appears, and the workers cannot
seem to make their usual good judgments and decisions, cannot
set priorities, nor evaluate their own functioning objectively.
• Body symptoms
Symptoms include physical exhaustion and fatigue, sleep difhculties (inability to fall asleep and/or to sleep through the night);
stomach and digestion problems, such as loss of appetite or com
pulsive eating; loss of energy; tremors; many minor physical
complaints.
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