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1、K-FLASH,P-FLASH with Kids: PRACTICAL FRONT LINE ASSISTANCE & SUPPORT FOR HEALING,Betty Pfefferbaum, MD, JD1 Carol S. North, MD2 Robin H. Gurwitch, PhD1 Barry Hong, PhD2,University of Oklahoma Health Sciences Center1 Washington University School of Medicine2,INTRODUCING. YOUR PRESENTERS,PURPOSE,To pr
2、ovide a tool kit for practical, front line postdisaster mental health interventions with children following the 9/11 terrorist attacks,GOALS OF THE TRAINING,1) Differentiate normative and pathological responses 2) Review disaster responses, assessment, and treatment 3) Provide disaster mental health
3、 education and skill-building,Please introduce yourself to the group What issues do you face?,INTRODUCTIONS,TOPICS,Part 1: Reactions to disaster Part 2: Assessment Part 3: Intervention,Reactions,PART 1,REACTIONS, Posttraumatic stress disorder Other disorders Reactions Factors affecting response,DISA
4、STERS, Overwhelming events Affect many individuals and entire communities Result in:,Property damage Disruption of daily life Human suffering, injury, and/or loss of life,TERRORISM AS UNIQUE TRAUMA, Innocent people targeted Unpredictable, Intentional human design - to undermine sense of safety and t
5、rust in government and social institutions,TIMING: PHASES OF DISASTER,Disaster phases: Pre-disaster Acute impact Early post-disaster Long-term post-disaster,REACTIONS TO DISASTER,Normal reactions Most children significantly exposed to a disaster will manifest some distress, but most do not develop p
6、sychiatric illness,Pathological reactions Some children will develop a diagnosable mental disorder after a disaster,DIAGNOSIS VS. DISTRESS,PTSD DOESNT CAPTURE IT ALL,Comorbidity with PTSD in adolescents Population adolescents: 6% PTSD (lifetime) - 80% of those with PTSD had another disorder, Adolesc
7、ents in cruise ship sinking: 52% PTSD,- Few or no delayed-onset cases - 1/3 of those with PTSD recovered within 1 year and another 1/3 recovered by 5-8 years,COMMON NORMAL REACTIONS,PTSD FEATURES:,COMMON NORMAL REACTIONS,Fear and anxiety Disaster-specific fears Fear of recurrence Concerns about safe
8、ty Separation anxiety,COMMON NORMAL REACTIONS,Depressive symptoms are common. They may: Pre-date the trauma exposure Occur in the context of: PTSD and other disorders Intervening stressors Bereavement,INFANTS, Sleeping problems Feeding problems Irritability Failure to meet developmental milestones,P
9、RESCHOOL CHILDREN, Behavioral regression Separation anxiety, clinging, and dependence Irritability, temper tantrums, and behavior problems Sleep disturbance; nightmares Repetitive play re-enactment Withdrawal: subdued or even mute,SCHOOL CHILDREN, Excessive questions or discussion about the incident
10、 Irritability Increased negative behaviors Somatic complaints Changes in school performance,ADOLESCENTS, Irritability Isolation and withdrawal Guilt and self-blame Anger and hate Anxiety about the world and their future Fascination with death and dying Absenteeism Risk for substance abuse/alcohol us
11、e Poor impulse control and high-risk behaviors,BEREAVEMENT AND TRAUMATIC GRIEF, Bereavement is a normal process that may be a focus of clinical attention; traumatic grief is complicated Bereavement may complicate recovery from traumatic events, and traumatic circumstances may complicate the grief pr
12、ocess Bereavement and traumatic grief are distinct from, but share common features with, psychiatric disorders, most notably major depression and PTSD,FACTORS AFFECTING RESPONSE, Disaster characteristics Exposure Child factors Family factors Community factors,CHARACTERISTICS OF THE DISASTER,Man-made
13、 disasters may be more traumatizing than natural disasters because: they are intentional their purpose is to create fear, mistrust, and societal disruption,TYPE OF EXPOSURE, Physical presence and witnessing Proximity Subjective experience Interpersonal relationship with those directly exposed,ELEMEN
14、TS OF EXPOSURE, Separation Property damage Secondary adversities Traumatic reminders,MEDIA COVERAGE, Exposure to media coverage absent other means of exposure does not meet the PTSD stressor criterion Research connecting media exposure and PTSD symptoms does not imply causality Cognitive processing
15、of media coverage depends on the childs developmental level,CHILD FACTORS, Age and development Gender Ethnicity Pre-existing conditions and prior trauma,FAMILY FACTORS, Association between child and parent reactions Risk: Disruption of routine Parent symptoms Family stressors Impaired family functioning Strained parent-child relationship Interpersonal awareness,COMMUNITY FACTORS, Pre-disaster characteristics of communities Post-disaster changes Property damage Community disruption Competition for resources Community response,
