3.4 Intervention

Hello.

Welcome back to our continuing discussion of disaster.

Last time we talked about the knowledge on resilience and recovery.

This time I'm going to discuss what we've learned about intervention in

the aftermath of disaster.

What helps.

And next time I'll take a look at preparing for disaster.

In this segment, we're going to take a look at lessons from the field,

from experts, what's been learned, and also, what's been

learned from various research studies on what helps in the aftermath of a disaster.

And we'll also discuss briefly some of the cautions and controversies in this area.

In the middle of an unfolding disaster and in the early part of the crisis,

the highest priority is rescuing people and preserving life.

That takes priority over everything.

But after that what comes next?

What helps children do well and recover from a devastating experience like this.

There are three approaches that summarize what's been

learned in the research literature.

One approach is when experts reach a consensus and

they publish an article about.

Their conclusions.

Another approach is called the Delphi method.

This is similar, in that it's based on experts.

But it's a more systematic way of putting the knowledge of experts together.

And I'll talk about an example of that.

And then, the third approach is, to gather up

the recommendations from a lot of different reviews of the literature.

What they glean recommendations from reviewing all of

the findings from research on disaster and we'll take a look at those as well.

An example of the first approach,

where experts discuss what to do in reach a consensus and

then publish it in an article, is this article by Hob Fall and colleagues.

And they came to.

Conclusions they described in terms of five principles of

intervention in the aftermath of disaster.

And these are very straightforward and I, I think there's a great deal

of consensus throughout the entire field that these are wise conclusions.

One is to promote a sense of safety.

The second is to enhance calming in people after disaster.

Another is to promote self efficacy, a sense of confidence in individuals,

families, and the community, that they can and will recover.

Another principle is to support connectedness among people in,

in disasters.

And the final one is to promote a sense of hope and optimism about the future.

Here's an example of a Delphi study.

This was done in, published around 2010 in a special issue of

the Journal of Child Development that was focused on children in war and disaster.

And in this Delphi study,

the investigators surveyed 30 experts from around the world, from

the leading humanitarian agencies that respond to disasters around the globe.

And in this method, first they.

Got their ideas from their agencies about what are the best practices

that you recommend from your experience for helping children after disasters.

And then they did another round where they took all of those answers and

went back to the experts and asked them to rate them.

For how important they were.

And they, I've provided here a list of some of

the examples of the highly rated recommendations that these experts had.

I've one that I think is really important is to first do no harm.

You have to be thoughtful about what you're doing in the aftermath of

a disaster because most of the people both the victims and the.

First responders may well be traumatized in these situations.

And another one is to make sure that you have child experts on hand.

You know, these big disaster response teams that,

there's a recognition that you need to have somebody in the response team

understands the needs of children and how they may react to the disaster.

They also emphasize the importance of preventing separation of families.

And if children do get separated from their parents that you need to get them

back together with their caregivers and families as quickly as possible.

These experts also emphasize the importance of resuming normal

routines especially, for children and school-age children.

Their school activities or

child care whatever their routine daily activities are.

And also to provide safe places to play and

do recreational activities for children and youth.

The third approach is to examine the reviews of

the disaster field and gather up the recommendations from.

Re, reviewers who have surveyed the evidence.

And I've listed some examples here of the kind of conclusions reviewers have reached

about what's important into, in terms of helping children after a disaster.

One of the most important conclusions in the child literature is

to think developmentally about it.

To recognize that.

Children of different ages have different reactions to disaster.

And that our response to help them needs to take that into account.

Children of different ages have different needs after a disaster.

Another conclusion is to prepare for children.

And prepare for children facing a disaster.

And this is can take many different forms.

One of the most basic is to make sure that your

medical response teams have the right equipment for children.

You, you, you know, in a, in a disaster,

you may not be able to get a child into a child ambulance or a child hospital.

You may have to have personnel who have the equipment and

training to help children, no matter where they are.

There's also preparations that are psychological.

We have to have our first responders trained to understand what,

what children do in the middle of a disaster, and what helps them.

And we have to think about who are first responders are.

Many of the reviews suggest that.

Teachers and parents need to be viewed as first responders in

addition to firefighters and police officers and other emergency workers.

Because often, in a disaster, children are at, will be at school or in their homes.

And teachers and parents will, in effect, have to be functioning.

As first responders for the children around them.

Keeping families together is also recommended by these reviews.

That is one of the strongest recommendations across all

three approaches.

And another one like that is restoring normal routines.

All of the methods of figuring out what helps children agree that,

restoring school, family meals and practices, opportunities to play,

these kind of activities give children a sense that life is getting back to normal.

And they are resh,

reassuring, not only to children, but also to ad, adults around them.

Several more examples are provided here of these, recommendations from the,

the research literature.

An important one is to monitor child exposure to trauma,

because not only do children get exposed during an unfolding disaster,

but also through media exposure, children can be traumatized by seeing.

Disaster scenes over and over on television without adequate monitoring.

This is particularly an issue for very young children who don't understand that

they're seeing a rerun of some disaster happening.

And this is very important research has shown that if children watch a lot of

media about disasters that, that, that can have a traumatizing effect on them in and

of itself.

Clearly, it's important to support family resilience in the wake of

disasters because for, for, for parents and other family members to support

the resilience of children, the family has to be supported and functioning well.

And similarly, we need to support.

The work of teachers in schools,

because they play an important role in the lives of children following disasters.

And the final one I wanted to mention here is that,

many have recommended that older children and youth

be given important roles in the recovery after disaster because it can be very.

Assuring to them, and give children and youth a sense of control and

contribution to have a role to play in helping the community recover.

And this could range from helping family members or taking care of young children

to planning for important school events, that are happening after a disaster.

Based on evidence like the evidence I've just been discussing, an, a,

a very interesting method of intervention has been

developed by the National Child Traumatic Stress Network.

This is a, an important operation of a center.

Based in the Los Angeles area and

a network of researchers who have developed and done a lot

of research on how to respond to trauma of many different kinds, including disaster.

And they've developed an intervention they call psychological first aid.

It's designed to be a safe.

Evidence based intervention.

And they have put together a field guide to this method so, for training.

And you can download that field guide and read all about Psychological First Aid.

It's a very good manual and it comes, as you can see, in different languages.

And psychological first aid is focused on being practical and supportive.

It does not re, require some training but not extensive training.

And it really is oriented to being respectful, helpful, and non-intrusive.

There are other interventions that require significantly more training and expertise.

One that's been widely used in the trauma field and works also

in disaster children exposed to disaster especially if they're having persisting.

Trauma symptoms is called trauma-focused cognitive behavioral therapy, or TFCBT.

And there's a very good website, again,

we'll point you to online, where you can learn about this methodology.

And you can even.

Try out some of the early stages of training on line.

But this requires more extensive training than psychological first aid.

Another example of an intervention that requires specialized training is KidNET.

NET stands for Narrative exposure therapy.

This type of therapy which is.

Gradual exposure to a narrative or

telling your story about what has happened has been found to be helpful not only for

trauma survivors in a disaster but

also for trauma survivors in war and other situations.

For example, child soldiers, which we'll be.

Talking about in the next module of this class.

In KidNET often the therapist works with a,

a traumatized young person or adult in different situations,

and they use symbolic timelines where they use a rope to illustrate your life.

And then you have a set of flowers and stones, small stones and large stones and

you mark out your life on this rope starting at the beginning of your life, or

anywhere else and then without really saying what the events are,

you put flowers for good events and stones for

difficult or traumatic events along your timeline.

And you kind of lay out your life.

And then, gradually, over time, could range from four to ten sessions usually,

you talk about the various flowers and stones in your life.

With a lot of emotional support from the therapist.

And this combines the, a, an autobiographical narrative.

With the support of a therapeutic relationship.

And it helps the person deal with the anxiety and stressful arousal

that often traumatic memories have and there's a kind of desensitization process.

This has been, demonstrated to work in a randomized control trial,

among a group of children who were traumatized in Sri Lanka,

with a combination of traumatic experiences in the wake of that tsunami.

We've al, already talked about this investigator, Catani.

In terms of looking at evidence on a disaster effects on children.

And this was a very interesting study that was done showing that

this method was effective with these children.

One more I wanted to mention that also was implemented in Sri Lanka is

called ERASE-Stress Sri Lanka.

In this intervention,.

Which stands for enhancing resiliency among students experiencing stress.

The investigators use a train the trainer model so the teacher in a group classroom

delivers the intervention but an expert trainer trains the teacher on what to do.

And this is a group intervention with 12 sessions.

And it involves education about stress and

coping strategies for stress and how to calm yourself and that sort of thing.

And they have a variety of group activities that in this case were

based on a deep knowledge of the culture.

In this region as well, and

that was found to be effective with, young people who'd survived trauma in Sri Lanka.

One other thing I wanted to mention about, what interveners

would have to pay attention to in, in a disaster, team, is secondary trauma.

A lot of the times, those who are helping.

The first responders or others who are intervening to support families and

children after disasters can be traumatized by the helping role.

It is very difficult and traumatic in many situations of disaster,

to be helping children and families who are so devastated, injured.

Who've lost lots of people that, the destruction itself, experiencing it,

can be very devastating.

So it's also important in disaster response to pay attention to

the trauma symptoms and supporting the needs

of the first responders who are trying to help the people who have been directly.

Victimized by the trauma and disaster itself.

I also wanted to mention some, that there's some controversy in this area

about what to do after disaster, because if you abide by that first principle,

first do no harm, you have to keep in mind the possibility that.

Even though you may have good intentions, some of, some of the interventions that,

that people might go in and try could be harmful.

And there's a strong perspective out there in the field that it's important to give,

to support the efforts of the local families and community to.

Respond to disaster and allow natural healing and supportive systems to work.

Sometimes if we go in and try to do too much,

we can interfere with some of the natural recovery processes.

One of the investigators who's very supportive of this view of letting,

giving people a chance to recover and respond is George Benano.

And you'll find references to his work on the course reference list, and

it's just important to keep in mind that sometimes we try to do good, but

we can be harmful and there isn't that much research yet

on what works the best, so it's wise to be thoughtful and cautious about.

What we do in, in the aftermath of a disaster.

In the next segment we're going to talk about preparing for a disaster.

So, tune in for the next part.

Resilience in Children Exposed to Trauma, Disaster and War: Global Perspectives

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