Guidelines for Intervention Immediately after a Disaster

From Zero to Three Guidelines for Helping Young Children Cope with Trauma

Helping Young Children and Families Cope with Trauma in a New Era

September 11, 2001, ushered in a new era in the United States. Our sense of safety, security, and even complacency is gone, as infants, toddlers, and their families have experienced the untimely, violent death of parents on scale that never before occurred so close to home. The long-term impact on young children of expo-sure to such violence and experience of early loss is still unknown. There is much to learn, as well, about protective factors that contribute to the resilience of children and families. As a consequence of September 11th and its aftermath, our perspectives on how young children and families cope with trauma may need to change.

---

From Preschoolers’ Traumatic Stress Post-9/11: Relational and Developmental Perspectives, Susan Coates, PhD and Daniel Schechter, MD

In: Psychiatric Clinics of North America Disaster Psychiatry: A Closer Look. Edited by Craig Katz, MD and Anand Pandya, MD September 2004, 27, 3, 473-489.

Based both on the research findings and our clinical observations at the Kids Corner of the Family Assistance Center at Pier 94 in the months following September 11th and consonant with those developed by Robert Pynoos and his colleagues as psychological first aid after traumatic events, we devised a set of guidelines for clinicians working with young children and their caregivers in the wake of disasters that are either human induced such as terror attacks or environmental disasters such as earthquakes or floods. These guidelines are useful as a first response to traumatic events. These guidelines are reproduced here with minor revisions.

The following guidelines apply to children.

Listen. Some children spontaneously want to talk about what they or their parents and other family members are going through with a sensitive listener from outside the family. Here acknowledging the reality of trauma and loss is implicit in simply listening.

Clarify. Children who wish to talk can be helped to make sense of their feelings and to find words to name emotions. Finding words promotes containment, the development of symbolic representation and the capacity for self-regulation. Clarification of affects and events helps toward the restoration of a coherent narrative. It is important to follow the child’s lead, to avoid probing exploration, responding only to what the child spontaneously introduced, in order to support containment of overwhelming feelings.

Support attachment bonds. In cases of loss of a parent and for children who are ready to do this one can provide support for the child’s identification with or internalisation of the attachment to the lost family member by actively facilitating the child’s need to remember and talk about their lost loved one.

Facilitate. It is important to facilitate children’s symbolic expression in play and in art projects by being supportively interested and available to observe or join play or to talk with them while they use art and crafts materials.

Support the capacity to imagine repair. Bob Pynoos (40) described key moments in the crisis intervention after the bombing in Oklahoma City when he helped children to imagine reparative possibilities. When a session ends with a child who has re-lived the trauma by telling about it or representing it in play or drawings, this may re-traumatize the child, unless the session ends by helping the child imagine some way of repairing or healing the damage. It is important to help younger children to think about how their family and community will take care of them.

The following guidelines apply to parents:

Contextualize the parents’ reactions, by helping them to understand that they were not going crazy and that their fears, anxieties and flashbacks are expectable reactions to a severely traumatizing event.

Support the child’s surviving attachment relationships by helping parents to understand the child's feelings and by facilitating communication between them. Help parents recognize how much their children understand about the events all around them. Help parents, family members and friends to be more accessible by answering children’s questions directly and honestly without providing more information than children need.

Clarify. Help parents to make sense of their children’s perplexing and disturbing expressions and behavior. For example, help parents understand and make meaning of the feelings being expressed through children’s repetitive dramatic play, traumatized drawings, dreams or nightmares that parents often have difficulty making sense of and find upsetting. Some parents are frightened or became angry with their children for their increased clinginess, tantrums, and aggression. Parents sometimes are afraid that these reactions are signs of lasting damage and future pathology. It can be difficult for parents to see these reactions as expectable responses to a situation of great insecurity. Parents’ anxiety or anger in turn makes the child more frightened of losing them, and so more demanding or aggressive. It is important to help parents answer the questions that children raise both direct and indirect, while protecting children from exposure to adult conversations. In this way, the adult’s reflective function can be re-engaged so that they can begin to understand their child’s experience.

It is also important to encourage families to try to return to ordinary daily life and customary routines as soon as possible.

In highly public traumatic events such as occurred on September 11, 2001 we encourage parents to turn off the TV and not expose children to endless repetitions of images of the traumatic event. Especially for very young children each re-presentation of the event can be experienced as a new and additional attack.