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close this bookMental Health Services in Disasters: Manual for Humanitarian Workers (PAHO; 2000; 92 pages) [ES]
View the documentPreface
View the documentObjectives
View the documentIntroduction
open this folder and view contentsChapter 1: Historical Overview and Mental Health Role
open this folder and view contentsChapter 2: Basic Mental Health Content
open this folder and view contentsChapter 3: Developmental Stages of Survivor Behavior
open this folder and view contentsChapter 4: Post-disaster Intervention Programs
close this folderChapter 5: Populations with Special Needs
View the documentChildren
View the documentElderly Populations
View the documentPersons with Mental Illness
View the documentPersons with HIV/AIDS infection
View the documentPersons With Substance Abuse Problems
View the documentPost-disaster workers
View the documentMental Health Services in Disasters: Manual for Humanitarian Workers


A disaster produces a variety of reactions in children that are specific for each child and depend on a group of variables. The type, extent, and proximity of the impact on a child within a family living in a geographical area has to be understood both from a child psychology and a disaster response perspective.

The following concepts are useful in understanding a child's reactions to a disaster:


• Stage of development;
• Gender, ethnicity, and economic status;
• Usual coping style;
• Intensity of the impact;
• Availability and appropriate "fit" between child's needs and support systems;
• Extent of dislocation;
• Availability of relief and community post-disaster assistance.

Based on these concepts, the post-disaster mental health intervention program can be organized along two major lines of activity. The first is direct face-to-face intervention through outreach or through contact with families housed in emergency shelters during the acute stage of the emergency. The second line of activity begins as the families relocate to temporary or permanent housing, which may mean a complete change of neighborhood or human support networks. This is accompanied by changing phases of crisis resolution that will necessitate different therapeutic procedures.

The objective of post-disaster mental health intervention is to restore the child to his/her developmental level of functioning by helping the child handle the stressful situation. The worker also assists family members in reorganizing their world so they can extend adequate parenting support to the child.

Collaboration with child welfare agencies can offer broad-based opportunities to help children that have been traumatized by a disaster. School personnel are important collaborators to help children resolve the post-disaster crisis.


The following key issues are critical in helping a child deal with a disaster:


• Children's reactions will vary according to their stage of cognitive, affective, and sociobehavioral development.

• The reactive phenomena observed after a catastrophic event represent of bio-psychosocial systems reactions and early efforts to cope with the disorganization of these systems.

• Family and societal behavior toward a child are powerful influences that can enhance or impede the trauma resolution process. The child's reliance on the family for cognitive guidance and socioemotional support is influenced by the child's stage of psychosexual development and preexistent psychopathology.

• A mourning process accompanies all catastrophic psychic trauma due to loss of body configuration, interpersonal bonds, worldview and familiarity, expectations and trust.

• Reactive depression as a clinical syndrome needs to be differentiated from the expression of psychic trauma and an effective/ineffective mourning outcome.

Current intervention practices for children include the following three elements:

1. An opportunity for exposure to a disaster's frightening elements in a nonthreatening atmosphere.


Activities such as drawing pictures, sharing stories, and playing disaster games let children "relive" and deal with the disaster.

2. Development of coping skills for issues that remains difficult.


Adjustment to new surroundings helps children cope with the loss of their house.

3. Access to supportive social relationships.


Parenting support helps children adjust when a disaster has affected a parent's ability to cope.

Key Variables Influencing Post-disaster Reactions among Children


• Speed of onset
• Duration of the trauma
• Potential for recurrence
• Degree of life threat
• Degree of exposure to death, dying, and destruction
• Proportion of the family affected
• Role of caregiver in the trauma
• Degree of displacement in home continuity
• Separation from nuclear family
• Rekindling of childhood anxieties
• Communicated anxiety between parents and children
• Cultural expectations


A post-disaster assistance model for children who may need further assistance should include a diagnostic and treatment service for children and families who identify themselves as needing help and/or are referred for psychological assistance. The model should also provide special consultation services for social agencies that work in the post-disaster program, with direct links between the psychological teams and the agencies. In this way, special problem cases can be referred for discussion and problem-solving to assist the social agencies in obtaining resources for the family and the child.

Objectives of Post-disaster Counseling for Children

• To help the child develop an internal sense of perspective so that he/she will be able to organize the environment.

• To assist the recuperative process of sharing painful emotions provoked by the stressor events in order to help the child put events into perspective.

• To help the child reach out to both family members and the emergency teams and use available resources to develop a sense of comfort, security, and affection.

The model should also include a program of regular group discussions with professionals who work with children. The aim of these programs is to help the professionals deal with their current problems and increase their therapeutic, supportive, and healing skills. Because assisting children who are orphaned or separated from their parents following a disaster is such a new component of social welfare systems, professionals need regular help and support in their dealings with the children and in their contacts with relatives.

The following are the components of a model counseling program for traumatized children:

Relationship-building and information-gathering regarding the trauma: The mental health worker describes the purpose and process for assisting children who have been traumatized and then proceeds to gather details about the trauma from family and child.

Assessment of the child and family: The mental health worker gathers information regarding the family structure, the child's experience in the disaster, previous traumatic experiences, addiction patterns, and the presence of consequences or symptoms of post-traumatic stress reactions.

Trauma interview: The mental health worker facilitates the child's telling of the traumatic experience through drawings or through role-playing that encourages attention to specific, details including sights, sounds, smells, and accountability for the event.

Identification of post-disaster issues: The mental health worker identifies issues that need to be addressed with the child, such as difficulty coping with nightmares, physiologic reactivity, or impulse control. Issues are also identified for the family, including management of their own and their child's post-trauma consequences and parenting and communication skills.

Crisis intervention methods: Short-term play therapy, activity therapy, family therapy, or group therapy is provided, based on the age of the child and the needs of the family post-disaster. Consultations are held with other service providers, including the school system, social services, and foster parents.

Relapse prevention: The mental health worker helps the child develop skills for coping with post-trauma consequences and situations. The return of some disaster-related problems is expected and viewed as normal. The family is encouraged to return to counseling if necessary.

Variables Assisting in the Recovery of Families

• Developing structures and networks
• Establishing reliable schedules
• Choosing activities that enhance self-esteem
• Continued strengthening of social contacts
• Becoming involved in group activities
• Attending to material/personal needs
• Encouraging relationships and attachments
• Identifying risk factors
• Learning about children's reactions at home and in school
• Using all available help and resources

Direct and Indirect Impacts of a Catastrophic Event on a Child

Body trauma

Sensory changes

• pain

• visual

• autonomic arousal

• auditory

• increased tension

• olfactory

• loss of function


Emotional expressions

Cognitive changes

• fear

• language

• distress

• communication

• anxiety


Traumatic reactions

Disorganization of social system

• parents

• school

• siblings

• religious

• friends

• parents' employment

• extended family

• housing


Preschool Child

Somatic systems
• Muscular immobilization, hyperactivity
• Temper tantrums, slow movements, not goal-directed
• Disorganization of acquired body functions
• Autonomic nervous system signs, vomiting, crying
• Sleeping/eating disturbances, pale skin, hyperventilation
• Wide pupil stare, startle reactions

Affective system
• Constricted/flat affect
• Detachment
• Rage/aggressive responses
• Fear/worry
• Anxious/suspicious

Cognitive system
• Recurrent memories, thoughts, fantasies of event
• Disturbed dream content
• Decrease of acquired performance, language
• Visual-spatial, concentration
• Distorted description of visual phenomena

Social behavior system
• Avoidance, dependence, passive/ intense, energetic/impulsive
• Partial loss of toilet training
• Increased autoerotic activity
• Abrupt, destructive play

School Age Child

Somatic systems
• Energy level affected
• Movements slow, low-intensity, or rapid, frenetic, impulsive
• Autonomic disorganization; appetite/sleep/ elimination

Affective system
• Lability of affect; anxious, sad, giggly, "nervous"
• Cautious; afraid to take chances or return to familiar places
• Increased fear of competition, of losing, of getting lost
• Increased dependency/decreased independence feelings
• Increased susceptibility of emotional reactions to sensory reminders of the traumatic event
• Initial process of mourning and reactions to loss

Cognitive system
• Constriction and hypervigilant alertness
• Intellectual functions affected; dull, obtuse
• Obsessive rumination and increased distractibility affecting memory loss
• Decreased associations leading to spontaneous reminder of event characteristics
• Increased fantasizing about how they could have changed events, controlled outcome of the incident
• Appearance of learning problems

Social behavior system
• Obsessive-compulsive expressive play, talk, curiosity about event and its consequences
• Inconsistent, capricious reactions to parents
• Argumentative and disobedient
• Poor impulse control
• Difficulty returning to routines
• Some loss of habits, customs, skills

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