psychosocial care of children post disasters 16.j.nagpal et al. vimhans

8/20/2019 Psychosocial care of children post disasters 16.J.nagpal Et Al. VIMHANS

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Psychosocial Care & Support for Children

& Adolescentsin Disaster Situations

Dr. Jitendra Nagpal - ‘Expressions India’ Expressions India’ Expressions India’ Expressions India’

Mrs. Divya S Prasad - VIMHANS

Dr. Cherian Varghese - WHO, New Delhi

Dr. Sheema Sen Gupta - UNICEF, New Delhi

TSUNAMI - The killer wave


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Situation Data on TsunamiSituation Data on TsunamiSituation Data on TsunamiSituation Data on Tsunami ---- IndiaIndiaIndiaIndia

K a r n a t a k a

K e r a

l a

M e d i c a l C o l le g eA l l e p p y

S t a t e M e n t a l H e a l th A u t h o r i tyT r i v a n d r u m

M a h a r a s h t r a

N I M H A N SB a n g a l o re

T a m i l N a d u

A n d h r a P r a d e s h

S C A R FC h e n n a i

M e d i c a l C o l le g eG u n t u r

J I P M E RP o n d i c h e r r y

I n d i a n P s y c h i a t r ic S o c i e t yC h e n n a i

T o D e l h i

V I M H A N SD e l h i

N E L L O R E ( 2 0 )

E R N A K U L A M ( 5 )

A L A P P U Z H A ( 3 5 )

K O L L A M ( 1 3 1 )

K A N N I Y A K U M A R I ( 8 2 4 ) T I R U N E L V E L I (4 )

T U T I C O R I N (3 )

R A M A N A T H A -P U R A M ( 6 )

P U D D U K O T T A I (1 5 )

T H A N J A V U R ( 2 6 )

T H I R U V A R U R ( 1 7)

K A R A I K A L ( 4 8 4 )

N A G A P A T T I N A M ( 6 0 51 )

C U D D A L O R E ( 6 12 )

P O N D I C H E R R Y ( 1 0 7 )

V I L L U P U R A M ( 4 7 )

K A N C H I P U R A M ( 1 2 8 )

C H E N N A I ( 2 0 6 )

K R I S H N A ( 2 7 )

W E S T G O D A V A R I ( 8)

E A S T G O D A V A R I ( 3)

T I R U V A L L U R ( 2 9 )

G U N T U R ( 1 2 )

P R A K A S A M ( 3 5 )

Psychosocial Support(Tsunami – India)

Map not to scale

Training/Service DeliveryAll affected DistrictsIndian Psychiatric Society, Chennai

Psychosocial SupportKollam, TrivandrumState Mental Health Authority, Trivandrum

Psychosocial SupportAlleppyMedical College, Alleppy

Child Psychiatry/Capacity BuildingTamil Nadu, NelloreVIMHANS, Delhi

Psychosocial SupportGuntur, Prakasam, KrishnaMedical College, Guntur

Psychosocial in Pondicherry through training of NGOsPondicherryJIPMER, Pondicherry

Training of NGOs and support in Cuddalore, ChennaiTamil Nadu, Cuddalore, ChennaiSCARF, Chennai

Technical Support/Capacity BuildingTamail Nadu, Andhra Pradesh, KeralaNIMHANS, Bangalore

Support ForSupported State/DistrictsInstitution


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“Although difficult to quantify, mental

health and psychosocial problems can be

associated with any type of disaster and

post-disaster setting. The horrors, losses,

uncertainties and other stressors

associated with disasters can place people

at increased risk of various psychiatric and

psychological and social problems”

- Sphere Standards

CHILD RESPONSE TO DISASTERS……

After a disaster, children are most afraid that:

• The event will happen again.

• Someone they know will be injured or killed.

• They will be separated from the family.

• They will be left alone.

Children’s reactions are affected by• Their age

• Nature of loss they have experienced

• Disruption of daily activities


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Anger and irritabilityClinging behaviour

Loss of appetiteFeeling guiltySleep disturbance

Thoughts of revengeLoss of appetite

SleeplessnessProblems in school,

inability to concentrate

Fearful

Drinking and smokingRegressive behaviourCrying

Low concentrationWorryingIrritability

Feeling sadNot relating with friendsRegressive behaviour

Being aloof NightmaresHelplessness

Feeling helplessnessFearfulNightmares

AggressionBody painStubborn

Denying the eventFeeling sadGetting angry

Adolescents(13 years & above)School Going Children(6-12 years)Young Children(0-5 years)

USUAL RESPONSES TO DISASTERS

THE OUTREACH MODEL

DTERT(Directorate of Teacher Education

Research & Training

NYK(Nehru Yuva Kendra

Orientation ProgrammeDIET Principals, NYK Dist. Coordinators

District Level Training(DIET faculties and Block Level

Resource Teachers)

Community Level Training(DIET faculties and Block Level

Resource Teachers)

Beneficiaries(Children in School)

Beneficiaries(Children – Out of School)

Community Level Training(Teachers)

Community Level Training(Youth Club members)


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Rationale for School Teachers as

Resource

• Teachers are cognizant of a child’s temperament andbehaviour patterns.

• Teachers know the ‘culture’ within each class

• Teachers are experts in providing children withknowledge, more so than psychologists andpsychiatrists

• Teachers are familiar with a variety of expressivemeans beyond rote teaching methods.

• Teachers are well-known to and trusted by thechildren & families.

KEY OBJECTIVES

• To accept the reality of the loss

• To work through the pain of grief

• To adjust to an environment in which

the dead person is missing

• To emotionally relocate the deceased

person and move on in life


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Training of Resource People• Understanding the effect of disaster on children &

adolescents.

• The Helping Process

• Flag signs: identification and referral for mentalhealth services.

• Conducting classroom activities

•

Enhancing effective communication with focus onlistening skills

• Record keeping


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PRE SCHOOL AND PRIMARY

SCHOOL ACTIVITIES

Let’s Talk

Let’s Draw

Let’s Write

Let’s Create


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Activities for Adolescents

• Group discussions, brainstorming &

ventilation. Focus areas:

- Learning to deal with loss and sadness

- Developing group cohesion by sharing hopes &

fears

- Learning to cope with anger

- Education about high risk behaviours (alcohol &substance abuse).


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Recommendations

INTEGRATING DISASTER PREPAREDNESS ININTEGRATING DISASTER PREPAREDNESS ININTEGRATING DISASTER PREPAREDNESS ININTEGRATING DISASTER PREPAREDNESS IN

SCHOOL MENTAL HEALTHSCHOOL MENTAL HEALTHSCHOOL MENTAL HEALTHSCHOOL MENTAL HEALTH

LEVEL OF INTERVENTIONWHO IS INVOLVED

Entire school

community

All students

and teachers

Counselors / teachers

peer mentors

Counselors /

school doctor

other experts

Integrated in

school

curriculum

Part of general

health curriculum

Students needing

additional help

Professional

management

Mental well being

I

Mental health knowledge,

attitudes and behaviours

II

Psychosocial problemsIII

Severe

problems /

disorders

IV


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BENEFICIARY

Children

Adolescents

Teachers

Principals

Parents

PROCESS EVALUATION

– Pre and posttrainingassessment tomonitor changes inknowledge &

helping skills

REGIONAL / STATE/

SCHOOLS

Orientation

programmes

Constitution of

training teams,teachers and peereducators.

Conducting ToTs

NATIONAL LEVEL

Inter-sectoral linkages

Capacity building

Advocacy with key stakeholders

Customize training packages.

IMPLEMENTING

PARTNERS

Schools

Professional

bodies

NGO’s

MONITORING OF THE PROGRAMME

1. Field visits by Regional Resource Persons

2. 3 monthly progress report of specific programme conducted.

3. Effectiveness at the time of disaster

TECHNICAL

Task Force

• Central• Peripheral

Professional

Teams (Regional

and State Level)

ACTION PLANACTION PLANACTION PLANACTION PLAN

Review

Tsunami’s will keep coming. It is the way of nature.

We have to accept them. And keep learning to be prepared and deal with them

Stories of Survival (Documentary) HistoryChannel.com – 20 Jan 2005


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psychosocial care of children post disasters 16.j.nagpal et al. vimhans

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