National Association of Perinatal Social Workers
CEU Module #1
Lisa Baker, Ph.D., L.C.S.W.
Department of Social Work
University of Alabama at Birmingham
LRBaker@uab.edu
Objectives
 What is a disaster?
 Effects on families
 Disasters and children
 Preparedness Recommendations
 Preparing families with infants
What is a Disaster?
 An event that exceeds the capabilities of the response –
need exceeds resources
 Loss of life, property and livelihood
 Alters lives of individuals, families and communities
 Creates hazardous conditions that exceed ability to
endure and succeed
Types of disasters
 Natural
 Tornados
 Hurricanes
 Earthquakes
 Floods
 Tsunamis
 Landslides
 Wildfires
 Volcanic explosions
 Pandemic Flu
 Man-made
 Bombings
 Arson
 Mass shootings
 Terrorism
 Nuclear emergencies
 Chemical emergencies
 Mass food & water
contamination
All-hazards Approach
 All-hazards
 Collection of man-made & natural events that have the
capacity to cause multiple casualties
 All-hazards Preparedness
 Comprehensive preparedness required to manage the
casualties resulting from all possible hazards
Potential impacts of disaster
Immediate needs
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Communication/information
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Water, food, shelter
Access to resources
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Transportation
Electricity/power/gas
Health Care
 Acute issues/ injuries
 Exacerbation of chronic
illness
Long term needs
 Rebuilding/relocating
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Infrastructure
Financial/economic
Psychosocial
Health, well-being,
complicated loss issues
Mental health
Time frame of impact can range from hours/days to months/years
Psychosocial aspects
 Mental Health Needs
 PTSD, Depression, Anxiety
 Substance abuse
 Special concern about vulnerable populations
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Elderly
Low income
Chronic health care and mental health needs
Children
C-MIST (Kailes & Enders)
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Communication, Medical, Independence, Supervision, Transportation
 Displaced persons after Katrina
 Decrease in household income
 Increase in mental health problems
 Transportation issues

Including school and children’s health care
Children in disasters
 Children
 Major determinants affecting susceptibility
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Degree of exposure to event
Parental response to event
Pre-existing Mental health illnesses
Age
Separation from parents
 Mitigating factors
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Early support & intervention
Return to normalcy, especially school
 Key issues include
 School readiness
 Reunification
Perinatal Health
 Evidence that disasters impact maternal mental health
and some perinatal health outcomes
 Low birth weight
 Preterm delivery
 Maternal depression
 Anxiety
 Post traumatic stress
Children & Disasters
 Special challenges
 Dependent

Physically and emotionally
 Non-communicative
 Increased anxiety
 More vulnerable to exposures
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Especially biological, chemical and radiological/nuclear
agents
 Unable to provide information in a crisis
 Often separated from caregiver
Special health concerns of women
and infants
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Disruption in clean water supply for drinking and bathing
Inadequate access to safe food
Exposure to environmental toxins
Crowded shelter conditions
Disruptions of public health and clinical care
infrastructure
 Increase in psychosocial stressors
Callaghan, et. Al. (2007). Health concerns of women and infants in times of natural
disasters: Lessons learned from Hurricane Katrina. Maternal Child Health Journal, 11
Children with Healthcare Needs
 20% of households
 May include
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Home Ventilator or other electrical device
Wheelchairs/equipment
Chronic daily meds
 Parents not always able to provide correct information
 47% of caregivers bringing child to specialty care clinic were unable
to provide correct diagnosis (in non-crisis situation)
 29% were unable to provide correct medication list
 Carracio et. Al (1998)
Children with Special Healthcare Needs
 Present a challenge to EMS, non-
children’s hospitals
 Can place undue burden on
medical needs shelters
 Med refill – most common
request in shelters
 Loss of power in home
 Basic supplies
Current level of preparedness
 Campaigns primarily mass media – education based
 3 Steps
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Be informed
Have a plan
Have a kit
 Less than 1/3 public has basic emergency plan
 Nat’l Ctr. Of Disaster Preparedness at Columbia Univ.
 Majority of Americans are unprepared for a major disaster
 Citizen Preparedness Survey Database Report (Dept. Homeland
Security, 2007)
 Growing research base on level of preparedness
Reasons why people are not
prepared
 Lack of resources
 Incomplete knowledge about what to do
 Competing priorities
 Especially with complicated care
 Impediments
 Barriers
 Lack of Transportation
 Caring for Pets
 Life
 How do the spare flashlight batteries end up in the Game
boy?
Steps to Personal Preparedness
(Red Cross, FEMA, AAP)
Most common recommendations
Get informed
Make a Plan
Assemble a Kit
Maintain the Plan
3-day rule
Get Informed
1.
Community Hazards
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2.
Community disaster plans
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3.
Hurricanes
Tornados
wildfires
Response plans
evacuation plans
shelters
Community warning systems
Make a Plan
 Meet with family members
 Choose “out-of-town” contact
 Designate a meeting place
 Complete a Family Communication Plan
 Plan escape routes
 Plan for those with special needs
 Emergency Information Form for Children with Special
Needs
 Plan for pets
 Prepare for different disasters
Especially critical when dealing with children
Assemble a Kit
 General Kit
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Water & food
First aid supplies
Medications
Radio
Small tools
Clothing
Personal items
Copies of ID and important
papers
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Insurance, passports, driver’s
license
 Money
 Store in large. waterproof
container
 Children
 Age-related supplies
 Diapers, wipes, bottles, powdered
formula
 Activities
 Coloring books, crayons
 Extra “transition” objects
 Blankets
 Stuffed animals
 Copies of Guardianship related
documents
 Current photos of children
 Emergency Information Form
for Children with Special Health
Care Needs
6 Key Elements for Every Disaster Plan
1.
2.
3.
4.
5.
6.
Designated shelters for pregnant women & families
Basic supplies & equipment for pregnancy women and infants
A plan to provide prenatal and well baby care
A plan to provide for access to safe environments for delivery
A plan to keep families together or reconnect families with
infants
Specialized educational materials
March of Dimes
Preparedness considerations for evacuated
pregnant women and infants
 Ascertain pregnancy status as part of intake
 Make pregnancy tests available
 Consider contraceptive needs
 Promote continuation of breastfeeding (more on this later!)
 Recognize effects of exposures and provide information
 Determine feasibility of establishing a pregnancy registry to track
outcomes
 Equip DMAT and other response teams with capacity for managing
pregnant and lactating women and their infants
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Callaghan, et. Al. (2007). Health concerns of women and infants in times of natural disasters: Lessons
learned from Hurricane Katrina. Maternal Child Health Journal, 11
Infant Feeding
post disaster
 Breastfeeding
advantages
 Milk is nutritionally perfect
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(even in cases of maternal
malnourishment)
Readily available
Protective against infectious
diseases and respiratory
illnesses
Always correct temp – can
prevent hypothermia
Hormone release in mother
provides stress relief – calming
for mother and infant
 Formula
Disadvantages
• May not be available
• May require brand switch
• Errors in prep may occur
• Water may be contaminated
• Limited or no method of
sterilization for bottles &
nipples
• Limited electricity to cold store
opened formula
American Academy of Pediatrics
Ways to support breastfeeding
mothers
 Keep families together
 Provide supportive environment
 Assure mothers that human milk provides adequate
nutrition in absence of safe complementary foods
 Encourage re-initiation of breastfeeding if previously
stopped
 Recommend ready-to-feed formula if breastfeeding
not possible
Pregnant women and families with infants
Before a Disaster
 Complete general preparedness guidelines
 In addition:
 Let healthcare provider know where you will be
 List all prescriptions and prenatal vitamins

Take extras when available
 Get copy of prenatal records
 Give other providers contact numbers
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Any special services or programs
During a Disaster
 Bring any prescriptions when evacuating
 Keep copy of prenatal records with you
 Get out and walk every 1-2 hours if driving
 Wear comfortable shoes
 Pack snacks
 Pack maternity clothes
 Use car seats and helmets for infants and young
children
If evacuated
 Keep informed
 Try to eat throughout the day
 Do not eat spoiled or questionable food
 Listen to and follow public announcements
 Drink bottled water or treated water
 Recognize symptoms of labor
 Take measures to reduce stress as much as possible
Post-disaster
 Potential dangers
 Flood water in streets and buildings
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Could be contaminated
Avoid contact/ wash after contact
 Toxic exposures
 Contact health provider if concerned
 Returning home
 Bacteria and mold
 Hard physical work
 Electrical shocks
 General safety issues
Care Providers
 Provide support for mothers and families
 Protect, Promote and Support
 Protect families
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Create safe zones where families can stay together
 Promote breastfeeding
 Support breastfeeding and alternative feeding
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Provide lactation consultants
Private spaces
 Provide multi-lingual materials
Take home message
 Preparedness saves lives
 Special considerations for pregnant women and
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newborns
Research base is growing
Promote family-centered care during mass critical care
incidents
Medical setting is great for preparedness activities
Have the discussion 
Recent Recommendations for Perinatal Populations:
Pregnant Women and Infants
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American Academy of Pediatrics
March of Dimes
Academy of Breastfeeding Medicine
American College of Nurse-Midwives
Centers for Disease Control
American Red Cross
 Be Prepared!!