2. Judy Oehler-Stinnett, Ph.D.1 Introduction to Natural Disasters

3. Judy Oehler-Stinnett, Ph.D.2 Why care about natural disasters? Widespread destruction Affect everyone Tied to mental health Awareness means preparedness ! Source: Jeff Piotrouski, courtesy OK Dept of Health

4. Judy Oehler-Stinnett, Ph.D.3 Disaster Definition “Disasters can be defined as any event, human-made or natural, sudden or progressive, causing widespread human material or environmental losses, which exceed the ability of the affected community to cope using its own resources” ( Asian Disaster Preparedness Center ) (Source: GOVT E-1027/W: Preventive Measures: the Politics of Disaster http://www.vranet.com/govt1027)

5. Natural Disasters: School Psychology’s Role Judy Oehler-Stinnett, Ph.D. Team names

6. Judy Oehler-Stinnett, Ph.D.5 U.S. Major Disaster Definition Federal Emergency Management Agency Local response http://www.wtsp.com/video/player.aspx?aid=12620&sid=9618&bw=hi  Local government first responders  Neighboring & volunteer agencies assist State declared disaster  Local services cannot handle alone  May send National Guard, agency workers  Damage assessment conducted Federal major declared disaster  Governor commits state funds, requests major disaster declaration  FEMA evaluates request, makes recommendation  President approves or denies request  Requests submitted: Individual, business, public assistance, tribe http://www.wtsp.com/video/player.aspx?aid=12620&sid=9618&bw=hi http://www.wtsp.com/video/player.aspx?aid=12620&sid=9618&bw=hi

7. Judy Oehler-Stinnett, Ph.D.6 Natural Disasters Hurricanes/Typhoon Drought/Heat wave Tornadoes Non-Tropical Floods Earthquakes Thunderstorms/ Severe weather Wildfires Landslides/Mudslides Volcanoes Blizzards/Freezes/ Ice Storms Lightning strike Tsunami Sandstorms Resulting technical disaster (Na-tech) NOAA

8. Judy Oehler-Stinnett, Ph.D.7 Frequent Natural Events Qualifying as Disasters* Worldwide Floods Hurricanes Drought/famine Earthquake Tornadoes Heat wave (*Tsunami infrequent but devastating) United States Hurricanes Floods Earthquake Tornadoes Drought

9. 8

10. 9

11. Judy Oehler-Stinnett, Ph.D.10 Most deadly natural disasters >100,000>10,000 TsunamiVolcano DroughtExtreme Temp Tornado/windstormSlides Flood>1000 EarthquakeWildfire (CRED)

12. 11 U.S Weather Fatalities 2003 (NOAA)

13. 12

14. 13

15. Judy Oehler-Stinnett, Ph.D.14 Economic Impact Property damage and loss Employment time loss Tourism loss Crop, topsoil destruction Disease in & loss of livestock Looting Increase illness and disease costs Large disaster estimates: millions to billions Tsunami cost: 4.4 billion (World Bank)

16. Judy Oehler-Stinnett, Ph.D.15 Industrialized Countries Better  Insurance coverage*  Warning, death & damage prevention*  Emergency & medical care*  Economic recovery*  Mental health services Most affected  High risk areas  Uninsured, low income #  When disaster not declared # Contribution  Federal & global disaster assistance  Emitting most carbon dioxide- impacts climate change $ Source: *worldbank.org $worldviewofglobalwarming, #FEMA; picture FEMA

17. 16 Carbon Dioxide Increases.

18. Judy Oehler-Stinnett, Ph.D.17 Impact in Developing Countries Poor construction increases damage Setbacks to economic & social development Poor to no early warning system Massive casualties Development money diverted to relief Longer secondary trauma from displacement, illness, grief, economic loss (Text source: Worldbank; Photo source: American Red Cross.com)

19. Judy Oehler-Stinnett, Ph.D.18 Mental Health Impact/Needs Psychological first aid  Normalize majority reactions  Access to recovery services Treatment of severe reactions  Acute Stress Disorder  Post-traumatic Stress Disorder Intervention for long-term stress  Secondary trauma  Fear of reoccurrence Long-term planning  Crisis Intervention  Mitigation/Secondary Prevention  Primary Prevention Trauma (all types) #1 cause of preventable mental illness NASP

20. 19 Making Natural Disasters Real: Pictures and Maps

21. 20 Hurricane (FEMA)

22. 21

23. 22 Hurricane/Cyclones World Wide

24. 23 Tornado

25. 24

26. 25 http://www.tornadoproject.com/allt orns/world.htm#top Tornadoproject.com clickable map of tornado information available worldwide No free map currently available

27. 26 Tsunami (FEMA)

28. 27 Tsunami potential map (NOAA)

29. 28 Thunderstorm & Lightning (NOAA/NWS)

30. 29 Thunderstorm frequency (Eastern Illinois U)

31. 30 Lightning Frequency Worldwide (National Lightning Safety Institute)

32. 31 Severe Storms (FEMA)

33. 32 Hail map (NWS Blueprint for Safety)

34. 33 Flood

35. 34 Flood Frequency Map (USGS )

36. 35 Flood Global Map 2004

37. 36 Drought (FEMA)

38. 37

39. 38 Heat Wave

40. 39 Fire (FEMA)

41. 40 Wildfire Potential (USGS)

42. 41 Countries with recent forest fires Dominican Republic, April 2005 Syria, October 2004 Australia, January 2004 Dominican Republic, April 2005 Syria, October 2004 Australia, January 2004 United States, November 2003 Russian Federation, October 2003 Kazakhstan, October 2003 India, October 2003 Brazil, September 2003 Portugal, September 2003 Canada, September 2003 South Africa, September 2003 Greece, September 2003 Spain, August 2003 Italy, August 2003 Argentina, August 2003 Paraguay, August 2003 Croatia, August 2003 France, August 2003 China, June 2003 Sumatra, Indonesia, June 2003 Mexico, May 2003 Nicaragua, April 2003 Guatemala, March 2003

43. 42 Earthquake (FEMA)

44. 43 Earthquakes USGS

45. 44 Earthquake world history

46. 45 Volcano (FEMA)

47. 46 Volcano Locations in U.S. (Michigan Tech Volcanoes)

48. 47 Volcano map worldwide (Michigan Tech Volcanoes)

49. 48 Landslide (NASA)

50. 49 Landslide Frequency U.S. (USGS)

51. 50 Western Europe Landslide (ESA)

52. 51 Sandstorm (European Space Agency)

53. 52 Duststorm Map (European Space Agency)

54. 53 Global warming data (worldviewofglobalwarming.org)

55. 54 Drought/Flood Prediction from changes in precipitation (International Research Institute for Climate Prediction)

56. Judy Oehler-Stinnett, Ph.D.55 Factors in Natural Disasters  Contribute to the total experience of the event  Note for common & unique reactions in victims  For more info, go to: http://www.fema.gov/ http://www.noaa.gov/ http://www.redcross.org/ http://www.worldviewofglobalwarming.org/

57. Judy Oehler-Stinnett, Ph.D.56 Factors in natural disasters Geographic location Frequency Predictability Suddenness & Warning time Severity/Intensity-size, speed Duration Destruction method Sights, sounds during Injury, damage, deaths Aftermath Preparation methods Prevention methods

58. Judy Oehler-Stinnett, Ph.D.57 Geographic locations  Vary within U.S. and world (see maps) Variance from year to year, but stability in high incidence areas  Hurricanes coastal but vary on where on coast hurricane hits  Tornadoes concentrated in Midwest but vary as to exactly where land  Influenced by airflow (e.g. Jet Stream) Variance contributes to  building in high risk areas  lack of preparation  failure to heed warnings Every area of world at risk for some types of natural disaster (NOAA, NWS, FEMA, Red Cross)

59. Judy Oehler-Stinnett, Ph.D.58 Frequency Varies from year to year Varies across locations Can be seasonal, cyclic Flood most frequent worldwide High frequency areas  Most awareness  Most official preparation  Habituation can lower public response  Repeated disasters lower resilience (NWS, FEMA, Red Cross, worldbank)

60. Judy Oehler-Stinnett, Ph.D.59 Predictability, Suddenness & Warning Time, & Response Predictions  take substantial resources  Vary in accuracy  Have seasonal factors May have seconds to months  Hurricanes longer warning time  Tornadoes may have minutes only  Earthquakes may have no warning Dangerous to underestimate time to impact Preparedness increases rapid response Failure to respond increases severity exposure and likelihood of trauma symptoms (FEMA, NWS, Red Cross)

61. Judy Oehler-Stinnett, Ph.D.60 Predictability, Suddenness and Warning Time, Response con’t. U.S. advances in prediction & death reduction  Decreased some prevention & mitigation efforts  Increased population in high-risk areas Urban & coastal crowding  Increased number of potential victims  Reduced evacuation capability  Increased cost to rebuild (FEMA)

62. 61 U.S. Cost Increase of Natural Disasters (Princeton)

63. Judy Oehler-Stinnett, Ph.D.62 Severity/Intensity Severity ratings in scale numbers  Most severe are less frequent  People in high frequency areas underestimate severity Size impacts  Number of victims  Amount of land  Ability to predict Intensity/speed impacts  Level of damage  Amount of time to prepare Increases in victims’ level of trauma  Proximity to center of event  Experiencing injury, property damage  Exposure to death, Fear for life (FEMA. Red Cross, NWS) FEMA

64. Judy Oehler-Stinnett, Ph.D.63 Duration Length of actual event  Drought- long periods  Severe weather-hours to days  Flood waters recede slowly  Tornadoes-minutes  Earthquakes-seconds Length of secondary trauma  Time to clear debris, rebuild  Time to restore safety, order, routine (Red Cross, FEMA)

65. Judy Oehler-Stinnett, Ph.D.64 Damage Method Wind - property & personal damage Water movement  Alone reduced property damage (flood)  Animal loss risk high Wind + water= High risk of death/ damage Fire – Leaves little behind Cold Heat/drought Land Movement – earth, mud, snow, ice (Red Cross, FEMA, NWS)

66. Judy Oehler-Stinnett, Ph.D.65 Sensory Input during Event Impacted by type and severity of disaster Influences memory and stimulus triggers for stress & trauma Areas of input  Sights  Sounds  Bodily senses  Smell (Red Cross, APA) Click for video http://gprime.net/video.php/soccertornado http://gprime.net/video.php/soccertornado

67. Judy Oehler-Stinnett, Ph.D.66 Sensory Input during Event Sights  Clouds, Funnels, Lightning  Water moving, rising  Heat radiation  Hail, rain, dust, sand, snow, ice, earth, etc. blown  Human and animal victims injured or dead, blood  Property movement, damage and debris (Red Cross, APA)

68. Judy Oehler-Stinnett, Ph.D.67 Sensory Input during Event Sounds  Wind  Rain, Ice, Hail  Thunder  Cries for help  Property stress and destruction  Land shifting, cracking (Red Cross, APA)

69. Judy Oehler-Stinnett, Ph.D.68 Sensory Input during Event Bodily senses  Being carried by water, wind or earth  Earth shaking or shifting  Temperature and pressure changes  Own injuries (Red Cross, APA)

70. Judy Oehler-Stinnett, Ph.D.69 Sensory Input during Event Smell  Wind-carried odors  Water-soaked objects  Contamination  Death (Red Cross, APA)

71. Judy Oehler-Stinnett, Ph.D.70 Injury & deaths, Damage Injury & death varies with type of force  Wind damage - impales debris  Water damage- risk of drowning  Earthquake – falling debris  Land movement – suffocation risk Amount of damage largely determined by size and severity of event (Red Cross, FEMA)

72. Judy Oehler-Stinnett, Ph.D.71 Aftermath: Recovery vs. Secondary Trauma Food & water vs. starvation Health vs. disease Rapid rebuilding vs. long-term displacement Economic growth vs. basic relief (FEMA, Red Cross, worldbank)

73. 72 Programming for Natural Disasters What school personnel need to know

74. Judy Oehler-Stinnett, Ph.D.73 Long-range preparation-educational  Community planning to lessen losses Building codes Insurance coverage Shelters Warning systems  Preparation for specific disasters in your area Ensure that school plans are adequate Have personal plans in place so that you can assist others  Knowledge & supplies to Children Families School Community  Resources Federal Emergency Management Adm (FEMA) American Red Cross State Agencies Media NASP, APA

75. Judy Oehler-Stinnett, Ph.D.74 Programming by Phases of Disaster Prevention/mitigation Long-range preparation Immediate preparation for impact Impact or during disaster Immediate aftermath, acute crisis phase Short-term follow-up & evaluation Long-term follow-up & evaluation Continued planning

76. Judy Oehler-Stinnett, Ph.D.75 Prevention/Mitigation Event primarily uncontrollable Damage and outcome somewhat controllable  Location of home, business, school  Building structure integrity National Clearinghouse for Educational Facilities Guidelines for building/retrofitting educational facilities: http://www.edfacilities.org/rl/disaster.cfmhttp://www.edfacilities.org/rl/disaster.cfm  Storm shelter  Knowledge of specific disasters  Disaster preparedness kit  Disaster drills  Weather radio, heed warnings

77. Judy Oehler-Stinnett, Ph.D.76 Prevention/Mitigation Methods High-risk areas  Avoid living in  Avoid expensive building in Build or retrofit to withstand disaster Institute high-level planning and funding Tie funding and insurance to mitigation Reduce carbon dioxide emissions  Reduced energy needs  alternate energy sources (Red Cross, FEMA, worldbank; pictures earthfuture)

78. Judy Oehler-Stinnett, Ph.D.77 Disaster Preparedness Methods Awareness & knowledge of potential disasters Emergency survival supplies Materials to protect property Evacuation plan Communication plan Shelters Security plans (FEMA, Red Cross)

79. Judy Oehler-Stinnett, Ph.D.78 Preparedness Programs FEMA, Red Cross Children Families School personnel Community

80. Judy Oehler-Stinnett, Ph.D.79 Preparedness Programs, con’t see FEMA and Red Cross for excellent resources, links Child education  Use available local resources Television weather personnel Science teachers and others  Utilize science natural disasters curriculum unit Often covered in 5 th to 7 th grade  Integrate with language & other units  Include mental health components  Make it Active Don’t just TELL kids what they SHOULD do get donations to prepare kits

81. Judy Oehler-Stinnett, Ph.D.80 Child Education, con’t. What natural disasters occur most frequently in area Disaster preparedness  Supplies  Where to go during disaster  How to contact adults and loved ones  Resources for volunteering Mental health preparedness  Shock of event  Coping skills for recovery For program packages, see: http://www.femagov/kids/ http://www.redcross.org/disaster/masters/ http://www.redcross.org/disaster/masters/ FEMA

82. Judy Oehler-Stinnett, Ph.D.81 Preparedness Programs, con’t Family education  Trained children often more concerned  Adults responsible for safety Children lose faith in adults’ ability to protect them after disaster occurs (Lazarus, 1995) Worse with loss of loved one or high death threat  Increase involvement Enlist parent organizations Provide incentives – disaster kits  Include cultural, religious sensitivity Beliefs regarding causation  divine punishment  miracle  predetermination Beliefs regarding death  Death to be feared or welcomed  Rituals and symbolic meaning Evans (2002) found that children who were in a storm shelter were much less afraid of the tornado NASP resources: http://www.nasponline.org/ culturalcompetence/cc_cris isresources.pdf

83. Judy Oehler-Stinnett, Ph.D.82 Family education, con’t. Include mental health issues:  Awareness of family/child premorbid functioning Chronic stressors Past or recent traumas Trait anxiety, agitation  Degree of exposure relationship to trauma symptoms  Behavioral symptoms Not always observable Must ask children how they are feeling and listen to them. (Evans, 2002)  Importance of social support Emotional support Informational support Tangible support (Norris et al., 2001)  Include coping tools to facilitate post-traumatic growth Use of adaptive coping rather than avoidance (Moss, Cronkite, Billings, & Finny) What did we learn? How can we prepare better? Restore trust in safety.

84. Judy Oehler-Stinnett, Ph.D.83 Family preparedness, con’t. Knowledge of natural disasters in area Family crisis, safety & evacuation plan Emergency supply kit, weather radio Way to communicate, use of social support network Place to gather Listen and heed warnings: Remaining when unsafe related to trauma symptoms Override family members discounting concerns Do not “chase” storm – leave that to professionals Use care following disaster – make sure children avoid debris, power lines, fire, etc. American Academy of Pediatrics AAP - Family Readiness Kit: Preparing to Handle Disasters http://www.aap.org/family/frk/frkit.htm Red Cross http://www.seattleredcross.org/disaster/familyplan/index.HTM

85. Judy Oehler-Stinnett, Ph.D.84 Don’t forget the Animals Most shelters do not allow pets Children become very concerned about their pets Livestock are also a consideration Plan ahead for animal safety  Failure to evacuate & reentering disaster scene related to pets (Heath, 1997)  Loss of or injury to animal related to trauma symptoms See Humane Society of the U.S. for animal tips: http://www.hsus.org/hsus_field/hsus_disaster_center/ FEMA

86. Judy Oehler-Stinnett, Ph.D.85 School Disaster Plan Identity potential disasters in your area Involve school board, parent groups, administration Use recommended resources: FEMA handout – multi-hazard plan for all phases of disaster: http://www.fema.gov/fima/rmsp424.shtm Red Cross Emergency Guide for Business and Industry: http://www.redcross.org/services/disaster/0,1082,0_606_,00.html#fema

87. Judy Oehler-Stinnett, Ph.D.86 Preparedness Programs, con’t. FEMA School personnel education  Review crisis plan for natural disasters Include parents, students Drill procedures for taking cover and evacuating Ensure evacuation route avoids hazards Include plan for persons with handicapping conditions  Build shelters, retrofit buildings  “Walk through” to remove, secure hazards Chemicals Heavy objects Windows, glass  Educate on need to protect, respond Take seriously Keep first aid kit, flashlights, broom, communication, and weather radio in all classrooms  Plan for use of school buildings as community shelter

88. Judy Oehler-Stinnett, Ph.D.87 Preparedness Programs, con’t. FEMA School personnel education, con’t.  Include mental health issues Prevent stress on children due to school lack of preparedness or follow-up Know effects of disaster on emotions, academics & social interaction Reduce parent anxiety by communicating on evacuation, lock-down procedures during natural disaster  Not safe to try to pick up child during disaster  Official means for getting school information Address trauma-related symptoms of school personnel who must comfort children  Personnel likely have also suffered loss  Secondary trauma of care-givers

89. Judy Oehler-Stinnett, Ph.D.88 Community Preparedness Coordinate school and community plans  Identify leaders and liaisons in emergency management  Prepare for use of buildings as shelter  Use community resources to facilitate family training in community  Plan for Rapid response team deployment  Plan for dealing with media Agency or residential facility  be knowledgeable of the disaster plan  Become member of crisis team Have community-wide disaster drills

90. 89 Media converge on a disaster location when all the people want is to be helped or to be left alone… Photo copyright Mitchell Prothero World Picture News

91. 90 When Natural Disasters Occur Steps for Imminent Disaster and Beyond

92. Judy Oehler-Stinnett, Ph.D.91 Immediate preparation for Impact Follow natural disaster procedures in agency/school Keep communication open-limit use of cell phones if children have them Help children and caretakers remain calm Stay alert to changing conditions and take protective steps Keep weather radios on NEVER IGNORE SIRENS

93. Judy Oehler-Stinnett, Ph.D.92 Impact If natural disaster occurs while children are at school, school will become a trauma stimulus Remain calm and help others to do so Model positive coping self-talk Remember that care-givers as well as children will be affected Take care of your own needs as well If event happens while children are away from school, school will be used to help normalize adjustment.

94. 93 Bloomsburg, PA High School Flooding from Hurricane Ivan Jared Fenstermacher – from Bloomsburg Weater

95. Judy Oehler-Stinnett, Ph.D.94 Acute crisis phase Continue to implement school crisis plan Assist in controlling media access Assist in communications between home and school Work with any emergency team that is on- site, have credentials available Help with triage in determining who needs immediate assistance Assess property damage and hazards Assist with activities if school is an emergency shelter

96. 95 School Used as Disaster Center after California Earthquake FEMA

97. Judy Oehler-Stinnett, Ph.D.96 Short-term follow-up Once acute crisis team has left, continue to meet immediate needs through school crisis team Practical assistance most critical at this phase  Survival: Food, water, shelter  Finding loved ones and pets  Access to disaster services Guidance programs for majority of children  Normalization of responses  Coping skills  Reduce school requirements to make time for intervention Screen for children needing mental health services  Victims who were not in desperate need immediately may start showing trauma symptoms – later onset of PTSD  Kids do not need to show full-blown PTSD to need help  Parents often underestimate impact of trauma on kids

98. Judy Oehler-Stinnett, Ph.D.97 Short-term coping Social support system available  Family  Friends  Community/church  School Positive role models for coping  Those around child take steps to cope, make positive coping statements  Support for discussing event, feelings  Discussions are not anxiety-filled or provoking, but don’t negate severity of event  Volunteer opportunities

99. Judy Oehler-Stinnett, Ph.D.98 Short to long-term follow-up Coping with funerals, sometimes multiple Delays and cost in rebuilding Lack of resources, services, extended secondary trauma Low social support and high modeled social anxiety (Evans, 2002 )

100. Judy Oehler-Stinnett, Ph.D.99 Long-term follow-up Significant evidence that children experience long-term effects of natural disasters (Evans, 2002) Support groups for most kids Trauma treatment for those most affected Disaster preparation Anniversary dates Find ways to minimize trauma cues, change thoughts surrounding seeing cues Cognitive-behavioral therapy most successful

101. 100

102. Judy Oehler-Stinnett, Ph.D.101 Post-trauma adjustment Factors Cultural considerations  Concepts of death  Adaptation rituals Rural vs. urban setting  Use of existing support systems  Availability of services Persons with disabilities  Preexisting mental health issues  Need for additional support services Preexisting crisis procedures  Communicating with media & limiting access to trauma victims  Determining who is eligible to provide services and triage Children’s re-exposure through television and other media Availability of mental health services

103. Judy Oehler-Stinnett, Ph.D.102 Post-Trauma Adjustment Factors Closeness to impact: Sights, sounds Severity of event: most severe damage Injury to self Witnessing injury to others Witnessing death of other people, pets Place during event damaged or destroyed Home, school or other location damaged or destroyed Injury of significant others: family, friends Death of significant other Fear of being severely injured or killed Inability to contact, locate loved ones Feelings of safety (e.g., in storm shelter with family) can mitigate trauma symptoms to some extent

104. Judy Oehler-Stinnett, Ph.D.103 Post-trauma adjustment Factors What happens in the mind of a child?  Causation beliefs - mistaken connection between their behavior and event Survivor guilt – their survival cost someone else Omen formation – thinking they could have prevented event (March, 2003)  Understanding of event Anger at family or school for not protecting them better  Alterations in existing schema due to event No longer feel safe, optimism bias of childhood shattered Foreshortened future beliefs  See Pynood et al., 1997 for model of PTSD

105. Judy Oehler-Stinnett, Ph.D.104 Post Trauma Adjustment Factors: Developmental Considerations There are many developmental lists out there, not all are based on research. Preschool, child and adolescent symptoms vary, yet within each age group, different children will react differently. Children likely have different reactions than adults and adults may not notice or understand child’s concerns either because the adults are not upset or they are too upset themselves.

106. Judy Oehler-Stinnett, Ph.D.105 Assessment/Intervention for Acute Stress Disorder & Post Traumatic Stress Disorder in Natural Disasters Post-disaster phases  Emotional numbing Gets you through acute phase of trauma Shouldn’t mistake for children being “fine”  Coping vs. Acute Stress Disorder Most victims have a support system and take positive action to get through crisis Excessive stress reaction during first month following disaster ASD  Post Traumatic Stress Disorder Symptoms onset or remain more than one month post-disaster Not all symptoms present in children Tsunami orphans: 7,722 lost 2 parents; 32,735 lost 1 parent Worldbank.org Amma teaching tsunami survivor how to swim Amritapuri.org 37% of deaths were children

107. Judy Oehler-Stinnett, Ph.D.106 Common Symptoms in Youth who are at risk for PTSD Following Natural Disaster Re-experiencing:  Nightmares about disaster or symbol of it  Trauma play (in young children) Avoidance:  Avoidance of place reminders  Avoidance of people reminders  Avoid discussion of trauma Hypervigilance/arousal:  On look out for cues of reoccurrence (e.g., react strongly to clouds in sky following tornado)  Excessive startle reaction (Carrion, Weems, Ray, & Reiss, 2002) DSM-IV-TR

108. Judy Oehler-Stinnett, Ph.D.107 Common Symptoms in Youth who are at risk for PTSD Following Natural Disaster  Anxiety/worry  Concern about safety  Don’t want to leave parents Somatic complaints  Stomachaches  Headaches Agitation/ anger  Anger at not being protected  Agitation related to hypervigilance (Chorpita, Albana & Barlow, 1998)

109. Judy Oehler-Stinnett, Ph.D.108 Common Symptoms in Youth who are at risk for PTSD Following Natural Disaster Social interaction difficulties  Family  Teachers  Peers School difficulties  School work  Concentration, memory (Caffo & Belaise, 2003; Weinstein, Staffelbach, & Biaggio, 2000)

110. Judy Oehler-Stinnett, Ph.D.109 Screening If you work where a natural disaster has occurred at any time that the children you work with could have been exposed to it, then you need to screen for effects of the disaster! Under these conditions, any child referred should be screened to see if symptoms are related to the natural disaster that impacted them. (Ford et al., 2000) Broad-band scales do not measure PTSD per se, but scales such as the BASC-SRP are related to PTSD scales (Cook-Cottone, 2004; Evans, 2002) General anxiety scales may also capture some symptoms

111. Judy Oehler-Stinnett, Ph.D.110 Screening, con’t. If a natural disaster occurs while you are providing services, then you need to screen/assess for children affected  Immediately following  1 month to 1 year following  2 year follow-up  Long-term follow-up

112. Judy Oehler-Stinnett, Ph.D.111 PTSD Scales Validated for Use with Children in Natural Disasters Children’s PTSD Inventory ( Saigh, et al., 2000; Saigh, Yasik, Oberfield, Halamandaris, & McHugh, 2002) Impact of Events Scale (Horowitz, Wilner & Alvarez, 1979; Yule, Bruggencate, & Joseph, 1994); The Child Post-Traumatic Stress Disorder Reaction Index (CPTSD-RI, see Frederick, Pynoos, & Nader, 1992); The Child PTSD Symptom Scale (CPSS; Foa, Johnson, Feeny & Treadwell, 2001); When Bad Things Happen (WBTH; Fletcher, 1996) The Kauai Recovery Index, patterned on the CPTSD-RI ( Hamada, Kameoka, Yanagida, & Chemtob, 2003). The OSU PTSD Inventory – Child (Evans, 2002; Evans & Oehler-Stinnett, submitted)

113. Judy Oehler-Stinnett, Ph.D.112 Prevalence of PTSD in Children Following Natural Disasters Using PTSD Inventories Youth more impacted by disaster than adults & Violence victims more impacted than those in natural disaster (Norris, Friedman, & Watson, 2002) (see Freyd, 2002 re: betrayal trauma theory) Children in developing countries more impacted than those in developed countries (Evans, 2002; Bulut, 2003) Some evidence that girls and minorities more affected, but results not consistent (Vernberg, LaGreca, Silverman, & Prinstein, 1996)

114. Judy Oehler-Stinnett, Ph.D.113 Prevalence rates, con’t.: Child self-report Almost all children in hurricanes show initial symptoms (86- 95%) At 10-month to 1 year follow-up, rates are lower, but majority of children still showing some symptoms Much lower percentage show severe or pervasive symptoms (18-30%) using DSM-IV criteria Must look at specific symptoms, not just overall score Using standard deviation units on factor scoring, tornado victims show fewer severe symptoms (10-15%), moderate symptoms higher (47-65%) Earthquake victims worldwide much higher rate than U.S. children (e.g., Anthony, Lonigan, & Hecht, 1999; Evans & Oehler-Stinnett, submitted; Hamada, Kameoka, Yanagida & Chemtob, 2003; Lonigan, Shannon, Taylor, Finch & Sallee, 1994; Vernberg, LaGreca, Silverman, and Prinstein, 1996)

115. Judy Oehler-Stinnett, Ph.D.114 Prevalence rates, con’t. Problems with DSM – IV – TR diagnosis  Not completely substantiated by factor analysis studies  No Likert rating or anchors, or norms  Children not likely to evidence most symptoms unless very severely affected  Use of rating scales recommended

116. Judy Oehler-Stinnett, Ph.D.115 Serious Concerns in Adolescents Increased risk of  Alcohol and substance abuse  Depression  Suicide Influence on culture  TSUNAMI SUICIDE By the Unseen Copyright 03-04 These feelings in my head Of things that can't be said Because I'm grasping for the words To make you understand And I wanna destroy myself Don't wanna destroy myself I wanna destroy myself Hurricanes of love and pain Tsunami tides of suicide Like a cobra poised to strike Like a criminal in the night Depression sleeping in Like a ship without a light But life is just a game And we all end up the same So let the storms come Cause the clouds will bring the rain

117. Judy Oehler-Stinnett, Ph.D.116 Interventions for Children with PTSD in Natural Disasters Cognitive-Behavioral Therapy (Foa, Treadwell, & March, 2004) Exposure, relaxation, massage less evidence Psychoeducation, coping (Teicher, et al., 2002) Medication (Bryant & Friedman, 2001)

118. Judy Oehler-Stinnett, Ph.D.117 Interventions con’t. Continue long-term intervention Prepare better – see prevention and mitigation slides!

119. 118 Disaster Mental Health Training Disaster Mental Health in Natural Disasters

120. Judy Oehler-Stinnett, Ph.D.119 Long-range planning-Mental Health Who trains disaster mental health workers?  NOVA – National Organization for Victims’ Assistance has liaison with National Association of School Psychologists for NEAT (National Emergency Assistance Team)  Red Cross – Has liaison with American Psychological Association’s Disaster Response Network (DRN) for DMH. Who is eligible to provide disaster mental-health services?  Must be licensed to provide DMH services to any location, according to Red Cross, for protection of public.  Certified school psychologists are often involved in crisis services in their schools, but need appropriate training.

121. Judy Oehler-Stinnett, Ph.D.120 American Psychological Association Disaster Response Network in conjunction with the American Red Cross http://www.apa.org/practice/drnindex.html Licensed psychologists can be trained through the DRN program Must obtain liability insurance Series of disaster trainings, including mass trauma and disaster-specific training In need of child specialists Contact APA or your local Red Cross

122. Judy Oehler-Stinnett, Ph.D.121 NASP National Emergency Assistance Team (NEAT) NASP helps in disasters through the National Emergency Assistance Team  Trained NASP personnel are on call for emergencies  Should you be a crisis responder? http://www.nasponline.org/NEAT/neat_crisis.html  There are additional helpful materials available on line through NASP: http://www.nasponline.org/NEAT/

123. Judy Oehler-Stinnett, Ph.D.122 Resources from NASP on Natural Disasters http://www.nasponline.org/NEAT/crisismain.html #natural http://www.nasponline.org/NEAT/crisismain.html #natural http://www.nasponline.org/crisisresources/22- Lazarus.pdf http://www.nasponline.org/crisisresources/22- Lazarus.pdf http://www.nasponline.org/crisisresources/tsuna mi.html http://www.nasponline.org/crisisresources/tsuna mi.html http://www.nasponline.org/NEAT/MidwestFloods.pdf http://www.nasponline.org/NEAT/MidwestFloods.pdf

124. Judy Oehler-Stinnett, Ph.D.123 NASP Resources on Natural Disasters Natural Disasters from NASP's book Best Practices in School Crisis Prevention and Intervention Natural Disasters Helping Children in the Event of a Tsunami: Information for Parents and Teachers Effects of the Indian Ocean Tsunami: Helping Children Cope Helping Children After a Wildfire: Tips for Parents and Teachers Responding to Wildfires: Helping Children and Families Responding to Natural Disasters - Helping Children and Families: Information for School Crisis Teams Responding to Natural Disasters - Helping Children and Families: Information for School Crisis Teams Helping Children After a Natural Disaster: Information for Parents and Teachers Helping Children After a Natural Disaster: Information for Parents and Teachers Winds of Terror: Children's Response to Hurricane and Tornado Disasters - from the NASP publication Crisis Prevention and Response: A Collection of NASP Resources (pp. 231-239). Natural Disasters, Crisis Intervention, and School Psychology: Melding Human Needs and Professional Roles See http://www.nasponline.org/NEAThttp://www.nasponline.org/NEAT for updated crisis information