MENTAL HEALTH MOMENT
MENTAL HEALTH MOMENT
July 21, 2000
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"I have moments of real terror when I think we may be
losing this generation." - Eleanor Roosevelt (May, 1934 -
referring to the "Lost Generation" of American Youth).
The plight of youth, Mrs. Roosevelt felt, was the fault
of society; "a civilization which does not provide
young people with a way to earn a living is pretty
poor," she said. "We have got to [make] these young
people...feel that they are necessary," she said. And,
she said, they should be given "certain things for
which youth craves - the chance for self-sacrifice for
an ideal."
Some things change very little.
* * * * *
The National Institute of Mental Health has
announced a program for the integration of basic
behavioral science and public health expertise in
collaborative research on mental health and disorders.
For most grant mechanisms, applications are accepted
on a rolling basis with receipt dates of June 1, Oct. 1,
and Feb. 1. Contact:
Web Site: http://www.grants.nih.gov/grants/guide/pa-files/PA-00-073.html
* * * * *
China Cultural Tour Information
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PROVIDING HELP FOR CHILDREN AND FAMILIES FOLLOWING DISASTERS
Part I
General Steps In The Helping Process
A basic principle in working with problems of children
in disasters is that they are essentially normal
children who have experienced great stress. Most of the
problems which appear are likely, therefore, to be
directly related to the disaster and transitory in nature.
The process recommended for helping children and families
often starts with "crisis intervention", which can be
provided by trained and supervised paraprofessionals
and volunteers. The primary goal in crisis intervention
is to identify, respond to, and relieve the stresses
developed as a result of the crisis (disaster) and then
to re-establish normal functioning as quickly as
possible. Sometimes the reaction is mild. Other times
it is severe. Also, the workers must be trained to
recognize when the condition is mild and can be handled
by the families (with guidance) and when it is severe
and needs professional help.
The general steps in the helping process include:
1. Establishing Rapport
a. Letting the children know you are interested in
them and want to help them.
b. Checking with the children to make sure that
they understand what you are saying and that
you understand them.
c. Having genuine respect and regard for the children
and their families.
d. Communicating trust and promising only what you
can do.
e. Communicating acceptance of the children and their
families.
f. Communicating to the children and their families
that you are an informed authority.
2. Identifying, Defining And Focusing On The Problem
Like adults, children going through a crisis may seem
confused and chaotic in their thinking. It is helpful
to the children and families to identify a specific
problem and to define it and focus on it first. If
possible, the problem should be quickly resolved so
that the children and families quickly experience a
sense of success and control. Evaluating the seriousness
of the problem should determine the families' capacity
for dealing with it.
3. Understanding Feelings
Empathy is the ability to see and feel as others do.
Being empathetic with children requires patience, for
children frequently are unable to express their fears
and the adults need to appreciate the kind and intensity
of the children's feelings. For example, adults may
be required to listen to a child's account of a
disaster many times while the child "works through"
the disaster by talking it out.
4. Listening Carefully
Frequently, the children's experiences of adults listening
to them are unsatisfactory. In working with children,
effort should be made to respond to them and to comment
frequently. Interrupting the children should be avoided
for it tends to happen often and the children may be
particularly sensitive to being interrupted by adults.
5. Communicating Clearly
Itr is important to communicate in language the children
understand. The presence of the family is useful in
interviews with the children for the families will be
more familiar with them and their behavior. In addition,
families will be able to learn how to communicate with
the children better after observing the interviewer.
Simple language should be used in speaking with the
children so that they are not excluded from the helping
process.
ROLE OF THE FAMILY
A basic principle in working with a child with an emotional
problem is that it is a family problem, not just the
child's problem, that is presented. The family should be
considered the unit to be counseled. Every member should
be involved with the process. In addition, one should
take advantage of the assistance provided by the concern,
interest, and availability of various members of the
family. Sometimes adult memebers of the family may be
experiencing emotional distress but hesitate to seek
help. The family is frequently more able to seek help on
the children's behalf than on that of its adult members.
The family may, in fact, use the children's problems as
a way of also asking for help for others in the family.
This request should be respected not confronted. By having
the family involved, others in the family can also be
helped. Denial that problems exist may still occur,
however, in some cultural and disadvantaged areas.
When the family's equilibrium is upset by stress, it may
be pushed off balance temporarily, and the family shows
signs of not being able to fulfill its usual functions.
Time and informed interventions help in re-establishing
the family and its developmental role.
COMMON FEELINGS AND BEHAVIORS
Below are described some of the more common reactions
of children in disasters and suggested possible responses:
1. Fears And Anxieties
Fear is a normal reaction to disaster, frequently expressed
through continuing anxieties about recurrence of the
disaster, injury, death, separation and loss. Because
children's fears and anxieties after a disaster often
seem strange and unconnected to anything specific in their
lives, their relationship to the disaster may be difficult
to determine. In dealing with children's fears and
anxieties, it is generally best to accept them as being
very real to the children. For example, children's fears
of returning to the room or school they were in when the
disaster struck should be accepted at face value. Treatment
efforts should begin with talking about those experiences
and reactions.
Before the family can help, however, the children's
needs must be understood. This requires an understanding
of the family's needs. Families have their own shared
beliefs, values, fears and anxieties. Frequently, the
children's malfunctioning is a mirror of something wrong
in the family. Dissuading them of their fears will not
prove effective if their families have the same fears
and continue to reinforce them. A family interview
should be conducted in which the interviewer can
observe the relationship of the children and their
families, conceptualize the dynamics of the child-family
interactions, and involve the family in a self-help system.
The parents' or adults' reactions to the children make
a great difference in their recovery. The intensity and
duration of the children's symptoms decrease more rapidly
when the families are able to indicate that they
understand their feelings. When the children feel that
their parents do not understand their fears, they feel
ashamed, rejected, and unloved. Tolerance of temporary
regressive behavior allows the children to re-develop
anew those coping patterns which had been functioning
before. Praise offered for positive behavior produces
positive change. Routine rules need to be relaxed to
allow time for regressive behaviors to run their course
and the re-integration process to take place.
When the children show excessive clinging and unwillingness
to let their parents out of their sight, they are
actually expressing and handling their fears and anxieties
of separation or loss most appropriately. They have
detected the harmful effects of being separated from
their parents and, in their clinging, are trying to
prevent a possible recurrence. Generally, the children's
fears dissolve when the threat of danger has dissipated
and they feel secure once more under the parents'
protection.
Children are most fearful when they do not understand
what is happening around them. Every effort should be
made to keep them accurately informed, thereby alleviating
their anxieties. Adults, frequently failing to realize
the capacity of children to absorb factual information,
do not share what they know, and children receive only
partial or erroneous information. Children are developing
storehouses of all kinds of information and respond to
scientific facts and figures, new language, technical
terms, and predictions. Following the 1971 earthquake,
the children in Los Angeles were observed to become
instant experts. The language used by them in a daycare
setting was enriched by technical terms, such as Richter
Scale, aftershock, temblor, etc. The children learned
these new words from the media and incorporated them
readily, using them in play and in talking with each
other.
The family should make an effort to remain together as
much as possible, for a disaster is a time when the
children need their significant adults around them. In
addition, the model the adults present at this time can
be growth enhancing. For example, when the parents act
with strength and calmness, maintaining control at the
same time they share feelings of being afraid, they
serve the purpose of letting the children see that it
is possible to act courageously even in times of stress
and fear.
2. Sleep Disturbances
Sleep disturbances are among the most common problems
for children following a disaster. Their behavior is
likely to take the form of resistance to bedtime,
wakefulness, unwillingness to sleep in their own rooms
or beds, refusal to sleep by themselves, desire to be
in a parent's bed or to sleep with a light, insistence
that the parent stay in the room until they fall asleep,
and excessively early rising. Such behaviors are
disruptive to a child's well-being. They also increase
stress for the parents, who may themselves be experiencing
some adult counterpart of their child's disturbed sleep
behavior. More persistent bedtime problems, such as night
terrors, nightmares, continued awakening at night, and
refusal to fall asleep may point to deep-seated fears
and anxieties which may require professional intervention.
It is helpful to explore the family's sleep arrangements.
The family may need to develop a familiar bedtime routine,
such as reinstating a specific time for going to bed.
They may find it helpful to plan calming, pre-bedtime
activities to reduce chaos in the evening. Teenagers
may need to have special consideration for bedtime
privacy. Developing a quiet recreation in which the
total family participates is also helpful.
Other bedtime problems of the children, such as refusing
to go to their rooms or to sleep by themselves, frequent
awakening at night, or nightmares can be met by greater
understanding and flexibility on the part of the parents.
The child may be allowed to sleep in the parents' bedroom
on a mattress or in a crib, or may be moved into another
child's room. A time limit on how long the change will
continue should be agreed upon by both parents and
child, and it should be adhered to firmly. Some
children are satisfied if the parents spend a little
extra time in the bedroom with them. If they come out
of bad at night, they should be returned to it gently,
with the reassurance of a nearby adult presence. Having
a night light or leaving the door ajar are both helpful.
Getting angry, punishing, spanking, or shouting at the
child rarely helps and more frequently makes the situation
worse. Sometimes, it becomes clear that it is actually
the parent who is fearful of leaving the child alone.
Parents from middle-class families have been educated to
believe that allowing their child to sleep in the
parents' room has long-lasting deleterious effects on
the child. Families accustomed to overcrowded and
shared sleeping space have less trouble in allowing
children to be close to them. Closeness between parents
and children at bedtime reduces the children's and adults'
fears.
Provideing families with information on how to handle
bedtime fears can best be done in the family setting or
with groups of families meeting together. The families
feel reassured upon learning that what they are
experiencing is a normal, natural response, and that
time and comfort are great healers. Learning that the
sleep disturbance behavior is a problem shared with
other families is reassuring.
3. School Avoidance And School Phobias
It is important for children and teenagers to attend
school since, for the most part, the school is the center
of life with peers. The school becomes the major source
of activity, guidance, direction, and structure for the
child. When a child avoids school, it may generally be
assumed that a serious problem exists. One of the reasons
for not going to school may be fear of leaving the family
and being separated from loved ones. The fear may actually
ba a reflection of the family's insecurity about the
child's absence from the home. Some high achieving
children may be afraid of failing and, once they have
missed some time at school, may have concern about
returning. The low performers may find that the chaos of
disaster makes it even more difficult for them to
concentrate. School authorities should be flexible in
the ways they encourage children to attend school.
Programs designed for schools vary. Some projects involve
teachers and school counselors, while others provide
trained workers who have direct contact with the children
and the teachers. In some instances, management within
the school setting is advantageous. Troubled children
can be identified by their behavior in both the classroom
and on the playground. Some of the signs are fighting and
crying in school for no apparent reason,increased motor
activity, withdrawal, inattentiveness, marked drop in
school performance, school phobia, rapid mood changes,
incessant talking about the disaster, and marked
sensitivity to weather changes. Puppetry and psychodrama
conducted by a counselor or teacher in the classroom or
in special groups are helpful in re-enacting the disaster.
They may be followed by discussions and reports by the
children of their own experiences in the event. Field
trips to disaster sites may be arranged, and group meetings
with students and parents may be held. Coloring books,
word puzzles, connect-the-dot pictures, and arithmetic
problems about the disaster build self-confidence. Class
projects may be developed in which all the information
about the disaster or a previous similar one is collected
and made into a book with color drawings. Craft models
or replications (such as dams, earthquake geology,
volcanos, rivers, etc.) may be built. Puppets may be made
and used to re-enact the disaster.
Children can be encouraged to construct their own games
as a way of mastering the feelings associated with the
disaster. For example, children play tornado games in
which they set up the rules by themselves. In one game,
each child is designated as an object, such as a tree,
house, car, etc., and one child is the tornado making
a noise like a siren and running. The other children
begin to run and knock each other over. The "tornado"
leaves, and all the children get up and return to their
normal activities. Another example has children building
a dam in a gutter or ditch and filling it with water.
One child then breaks the dam and allows the water to
escape harmlessly down the street or into the ditch.
School rap groups are also particularly helpful.
Administrative information meetings, teachers' in-service
meetings, and parent-teacher meetings can be used for
public education. Newsletters and the school newspaper
are useful in distributing information among the students.
Chat rooms and web-sites on the internet can also be
helpful.
Public involvement can be integrated through use of
widespread associations, such as Camp Fire Girls, Cub
Scouts, Brownies, 4-H, etc.
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For books, self-help books, etc. on this topic, go to
the following URL and use the SEARCH engine to look
for books on the topic. Use descriptors such as children
and disasters, children and trauma, disasters and families,
etc.
https://www.angelfire.com/biz/odochartaigh/searchbooks.html
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Contact your local Mental Health Center or
check the yellow pages for counselors, psychologists,
therapists, and other Mental health Professionals in
your area for further information.
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