disaster and trauma during childhood: the role of clinicians
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Disaster and Trauma During Childhood: The Role of Clinicians. Stephen J. Cozza, M.D. Professor of Psychiatry Uniformed Services University. Child Traumatic Exposures. Physical and Sexual Abuse Domestic and Community Violence Medical Trauma Natural Disasters Terrorism. War - PowerPoint PPT PresentationTRANSCRIPT
Disaster and Trauma Disaster and Trauma During Childhood:During Childhood:The Role of CliniciansThe Role of Clinicians
Stephen J. Cozza, M.D.Professor of PsychiatryUniformed Services University
Child Traumatic ExposuresChild Traumatic Exposures
• Physical and Sexual Abuse
• Domestic and Community Violence
• Medical Trauma• Natural Disasters• Terrorism
• War– Child Soldiering– Displacement/Refugee
Status– Parental Combat
Exposure
• Torture or Kidnapping• Traumatic Grief
Individual Trauma vs. Community DisasterIndividual Trauma vs. Community Disaster
Community Effects of TraumaCommunity Effects of Trauma
• Destruction of infrastructure
• Possible disruption of emergency services
• Permanent effect on community
• Death of loved ones
• Loss of jobs
Community Effects of TraumaCommunity Effects of Trauma
• Parental distraction/preoccupation/
unavailability
• Disruption in schedule and routines
• Separation of families
• Induction of fear and erosion of safety
• Opportunism that
undermines safety
What happens next?What happens next?
Fear of parental death
Separation anxiety
Health facility exposure
Change in parent/family
Change in home/community
CHILD
STRESS LEVEL
T I M E (months)0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
fear of loss of parent
separation from non-injured parent
hospital visits
change in parenting ability
move fromcommunity
Trauma is a Process, Not an EventTrauma is a Process, Not an EventCascade of Events Post Parental InjuryCascade of Events Post Parental Injury
Stages of DisasterStages of DisasterPredisasterPredisaster
IMP
AC
TIM
PA
CT
Rescue and ResponseRescue and Response RecoveryRecovery
T I M E
TreatingTreating
RespondingResponding
PreparingPreparing
TertiaryTertiarySecondarySecondary
PrimaryPrimaryPreventionPrevention
PreparednessPreparednesspredisaster requirementpredisaster requirement
educationeducation
emergency planningemergency planning
drilling for different scenariosdrilling for different scenarios
community relationship buildingcommunity relationship building
“before the fact intervention”“before the fact intervention”
http://www.ready.gov/
http://www.fema.gov/kids/
Disaster Mental Health TrainingDisaster Mental Health Training
http://www.redcross.org/services/disaster/
ResponseResponsePsychological First AidPsychological First Aid
crisis counselingcrisis counseling
psychoeducationpsychoeducation
triagetriage
screeningscreening
risk communicationrisk communication
a non-treatment intervention
calm reassurance
basic information about trauma response
provide comfort and support
establish and ensure safety
connection with community resources
Principles of Psychological First AidPrinciples of Psychological First Aid
Recovery and Social EnvironmentRecovery and Social Environment•Child is contained within layers of support
•Transactional interplay between layers
•Interaction may be mutually constructive or detrimental
•Family is the closest social support
•Encourage recovery by supporting role functioning
National CommunityNational Community
Local Community Local Community
Parents and FamilyParents and Family
IndividualIndividualChildChild
Disaster Recovery and ChildrenDisaster Recovery and Children
• Most dependent are most vulnerable in the process
• Disruption of family equilibrium• Distraction of responsible
parties– many contingencies to address– manage anxiety and personal
stress– potential impairment of role functioning
Disaster Recovery and ChildrenDisaster Recovery and Children
• Disruption of relationships, interpersonal strife, loss of attachments
• Reduction of parental efficacyparental efficacy – influence of parental distress or psychopathology
• Target parental and community efficacyparental and community efficacy as it pertains to child recovery
Developmental ConsiderationsDevelopmental Considerations• Children are subject to many of the
same effects of trauma as adults
• BUT they express their distress differently
• Behavioral manifestations may be misunderstood
• Limited communication skills
• Younger children may harbor cognitive distortions about meaning of trauma
TreatmentTreatment
Understanding riskUnderstanding risk
Diagnostic considerationsDiagnostic considerations
Evidence informed treatmentsEvidence informed treatments
Traumatic GriefTraumatic Grief
Time of trauma
time
fun
ctio
nin
g subject 1
subject 2
subject 3
subject 4
Resilience Variability in Trauma Response
functional illness
Resilience vs. PsychopathologyResilience vs. Psychopathology
• Most disaster victims recover without the development of psychopathology or the need for treatment
• PTSD is not the only psychiatric condition that may result– depression– risk behaviors– substance use disorders
• Variable rates of child PTSD have been reported in the literature after traumatic event (5-75%)
Resilience vs. PsychopathologyResilience vs. Psychopathology
• Difficulty in PTSD diagnosis due to differences in child presentation
• Risk Factors include:– prior history of trauma– preexisting emotional or behavioral problems– severity of stressor and proximity of exposure– psychopathology in the parent– immature familial coping patterns– characteristics of post-disaster environment and
available support
Treatment StrategiesTreatment Strategies
• Psychoeducation
• Parent guidance
• Family intervention
• Supportive services
• Trauma Focused CBT
• Traumatic Grief Treatments
• Pharmacotherapy
Unique Role of Child CliniciansUnique Role of Child Clinicians• Community ConsultantsCommunity Consultants – maintain
ongoing relationships to schools and other agencies that routinely engage children
• Child Development ExpertChild Development Expert – understand the developmental considerations unique to children at all levels of development
• Child AdvocateChild Advocate – highlights the special needs of children when others may not be aware
Unique Role of Child CliniciansUnique Role of Child Clinicians
• ClinicianClinician – treats clinical disorders in children, understanding the importance of interaction with parents and families
• EducatorEducator – communicates information to decision makers and community leaders
• System SpecialistSystem Specialist – effectively coordinates services between different agencies
Available ResourcesAvailable Resources