Meeting the Psychosocial Needs of Child Survivors

An estimated 14% of children in the United States experience a natural disaster during childhood. One study suggests that children today will live to see three times as many natural disasters as their grandparents. These statistics do not account for other non-natural mass fatality catastrophes. Children are especially vulnerable to physical and psychological harm due to their ongoing development and dependency on others for survival. Without proper support and resources, these traumatic events can have lasting psychological impacts on children.

Mental health issues are common following natural and manmade disasters, with acute stress response rates especially high in the first few months following an event. Children are no exception. Five years after Hurricane Katrina, an estimated one-third of exposed children were diagnosed with a mental health issue such as post-traumatic stress disorder. The rates of child depression following natural disasters more generally are estimated up to 44%. Early intervention and preventing re-traumatization are essential as repeated exposure to disasters or other traumatic events significantly increases the risk of long-term mental health issues. Untreated, these experiences can lead to more pervasive adverse developmental impacts, leading to decreased school performance, profound behavioral impacts, and other functional issues, thereby impacting more than children as a collective, but also emerging generations of adults.

Understanding a Child’s Response

Unlike adults, children’s ability to express themselves and use coping skills is greatly dependent on their developmental stage. Notably, young children may struggle to articulate their needs following a crisis. This struggle prompts the need to recognize symptoms or behaviors that indicate distress post-disaster. The way children express distress can vary across cultures. Some children, for example, may not display observable symptoms, in part, to avoid increasing stress on those around them. Others may react in more commonly documented ways, such as engaging in regressive behaviors (e.g., fear of the dark, clinginess to caregivers, or social withdrawal) or complaints of physiological issues such as nightmares, digestive issues, and headaches. While these reactions vary over time and by age, they all indicate a need for additional support.

Children are resilient, but the idea that children simply bounce back overlooks the context needed to understand when that is possible and the mechanisms needed to ensure that they can. Much of the U.S. disaster system relies on caregivers to be a source of support and routine deemed necessary for children’s resilience. However, it is not realistic to assume that all caregivers can provide a predictable, safe, and consistently comforting routine following a disaster. For that reason, psychosocial support can aid in the resilience process for children.

Psychosocial Support

Psychosocial refers to the relationship between individuals’ emotional well-being and their broader social environment. Psychosocial support (PSS) aids children in healing through their processing of experiences, restoration of a sense of safety and autonomy, and further promotion of well-being and healthy long-term development. Often combined into the phrase “mental health and psychosocial support,” this is a multi-sector approach to children’s health and protection. PSS recognizes that existing support networks (such as family and community touchstones) may be disrupted during a crisis. Children may assume different family roles, and disrupted school routines may alter their access to regular meals and social contact. Even once the basic needs of a child are met (food, water, shelter, safety), a child’s resilience in the face of disaster is largely dependent on their access to reliable and nurturing relationships. The way a child’s caregiver responds to an emergency influences the whole family unit’s ability to recover. Therefore, PSS recognizes the need for safe, culturally competent emergency responses that enable communities to care for their own while providing access to additional services and support when indicated.

PSS interventions are often conducted in a tiered approach. These tiers move from basic supports, like familiarizing parents with signs of child distress, to more specialized counseling and treatments as indicated. The vast majority of PSS services provided during domestic disasters are on the “basic” tier, such as psychological first aid. Psychological first aid reduces initial distress and increases coping and functioning by offering compassion during crisis and by connecting survivors to resources. While a great starting place for all active in the disaster space, cuts to federally funded grant programs may increase reliance on state and local emergency managers to fill this need. Therefore, it is worth identifying what else emergency managers can do to provide PSS to children in disasters.

Preparedness: The Role of the Emergency Manager

Write plans with children in mind. When reviewing emergency documentation, take the first step and type Ctrl + F “child.” Greater awareness can set the course to integrate children’s needs more broadly into emergency plans. Consider supporting the implementation of child-focused annexes to better integrate PSS needs into all phases of the disaster life cycle. As with any plan, basic survival needs are the foundation.

• Update sheltering plans. Emergency shelters provide an opportunity for PSS engagement through family reunification, implementation of child-friendly spaces, culturally relevant activities away from news and media exposure, and opportunities to familiarize children and their caregivers with available resources. When designed with children’s needs in mind, shelters can support children’s overall well-being.
• Align all plans with internationally supported child protection guidelines. Enhance child protection measures in all phases of relief to prevent further harm and keep recovery on track, for example, vetting all volunteers and personnel prior to engaging with children and establishing reporting and feedback systems for accountability.
• Ensure plans include accessibility of services to all. Children with disabilities and access or functional needs may need additional supports. This category includes a wide variety of children, such as those in foster care, those with acute medical needs, and those in rural communities that may lack transportation to access typical services.
• Ensure that communication plans facilitate information sharing across sectors to identify gaps before and after a disaster. With consistent communication and rapport across partners, the opportunities and willingness to provide PSS interventions may increase.

Engage community partners. Understand the broader mental health and psychosocial support systems that are in place in the community and who funds these partners (e.g., school-based grant programs). Consider partnering with mental health and youth task forces when possible. These groups often harbor invaluable community-specific knowledge and community connections that increase the accessibility, acceptability, and sustainability of PSS services during disasters. These task forces may also keep rosters of paraprofessionals who can build PSS capacity across sectors and source culturally competent non-specialist staff to assist with PSS services.

• Source existing community members to help establish support services after external disaster response personnel leave. Paraprofessionals are especially valuable in rural communities and general “health professional shortage areas.”
• Get familiar with private resources versus those available federally, such as the Crisis Counseling Assistance and Training Program. Understand what referral pathways exist and how they can be connected to avoid duplication of effort. Funding for service delivery and programs may be available through Social Service or Community Services Block Grants. A federal disaster declaration may come with increased funding and expansion of these services.
• Encourage child preparedness beyond “go kits.” Many American households lack sufficient resources on a day-to-day basis, which makes purchasing and maintaining multiple days of supplies unrealistic. Shift the focus away from solely building a kit and consider partnering with local schools using free resources that can enhance preparedness, increase a sense of autonomy, and empower children to act in a crisis.

Take children into account when creating emergency training and exercises. As an estimated 21.7% of the American population, children are on the scene of many disasters.

• Conduct exercises that focus on children as potential victims. Keep in mind that children should not be involved in high-intensity exercises or drills due to a lack of consent and an inherent risk of trauma. Exercises that involve children (as opposed to child-size mannequins or hypothetical scenarios) should demonstrate direct benefit to the children and not just adult professionals. All exercises involving children should avoid deception.
• Increase training opportunities for PSS interventions and consider requesting technical assistance for grant writing to increase access to training and programming funds. For those interested in a broader overview of children’s needs, the Federal Emergency Management Agency has independent study courses such as IS-366: Planning for the Needs of Children in Disasters; IS-368: Including People with Disabilities and Others With Access and Functional Needs in Disaster Operations; and IS-36.A: Preparedness for Child Care Providers.

Children remain a critical source of hope in unsteady times. Beyond symbolism, children’s mental health may act as an indicator of a community’s disaster recovery progress. This is yet another reason to acknowledge their invaluable role in resilient communities. But children cannot do it alone. Emergencies undermine the existing mechanisms that protect them at their most vulnerable. While merely a starting point, the PSS preparedness actions outlined here offer those in emergency management a unique opportunity to support them.

For further child disaster resources, see—
https://rcrctoolbox.org/
https://www.nctsn.org/what-is-child-trauma/trauma-types/disasters
https://npdcoalition.org/resources/mental-health/#