Introduction to Natural Disasters
Judy Oehler-Stinnett, Ph.D.
1
Why care about natural disasters?
Widespread
destruction
 Affect
everyone
 Tied to mental
health
 Awareness
means
preparedness!

Source: Jeff Piotrouski,
courtesy OK Dept of Health
Judy Oehler-Stinnett, Ph.D.
2
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)
Judy Oehler-Stinnett, Ph.D.
3
Natural Disasters:
School Psychology’s
Role
Judy Oehler-Stinnett, Ph.D.
Team names
U.S. Major Disaster Definition
Federal Emergency Management Agency

Local response
http://www.wtsp.com/video/player.aspx?aid=12620&sid=9618&bw=hi



State declared disaster




Local government first responders
Neighboring & volunteer agencies assist
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
Judy Oehler-Stinnett, Ph.D.
5
Natural Disasters
Hurricanes/Typhoon
Drought/Heat wave
Tornadoes
Non-Tropical Floods
Earthquakes
Thunderstorms/
Severe weather
Wildfires
Landslides/Mudslides
NOAA
Volcanoes
Blizzards/Freezes/
Ice Storms
Lightning strike
Tsunami
Sandstorms
Resulting technical
disaster (Na-tech)
Judy Oehler-Stinnett, Ph.D.
6
Frequent Natural Events Qualifying
as Disasters*
Worldwide







United States
Floods
Hurricanes
Drought/famine
Earthquake
Tornadoes
Heat wave





Hurricanes
Floods
Earthquake
Tornadoes
Drought
(*Tsunami infrequent but
devastating)
Judy Oehler-Stinnett, Ph.D.
7
8
9
Most deadly natural disasters
>100,000
 Tsunami
 Drought
 Tornado/windstorm
 Flood
 Earthquake

>10,000
Volcano
Extreme Temp
Slides
>1000
Wildfire
(CRED)
Judy Oehler-Stinnett, Ph.D.
10
U.S Weather Fatalities 2003
(NOAA)
11
12
13
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)
Judy Oehler-Stinnett, Ph.D.
14

Better
Industrialized Countries
 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 dioxideJudy Oehler-Stinnett,
Ph.D.
impacts climate change
$
Source: *worldbank.org
$worldviewofglobalwarming,
#FEMA; picture FEMA
15
Carbon Dioxide Increases.
16
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)
Judy Oehler-Stinnett, Ph.D.
17

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
 Primary Prevention

NASP
Prevention
Trauma (all types) #1 cause of preventable mental illness
Judy Oehler-Stinnett, Ph.D.
18
Making
Natural Disasters Real:
Pictures and Maps
19
Hurricane
(FEMA)
20
21
Hurricane/Cyclones World Wide
22
Tornado
23
24
http://www.tornadoproject.com/allt
orns/world.htm#top
 Tornadoproject.com
clickable map of
tornado information available
worldwide
 No free map currently available
25
Tsunami
(FEMA)
26
Tsunami potential map
(NOAA)
27
Thunderstorm & Lightning
(NOAA/NWS)
28
Thunderstorm frequency
(Eastern Illinois U)
29
Lightning Frequency Worldwide
(National Lightning Safety Institute)
30
Severe Storms
(FEMA)
31
Hail map
(NWS Blueprint for Safety)
32
Flood
33
Flood Frequency Map
(USGS)
34
Flood Global Map 2004
35
Drought
(FEMA)
36
37
Heat Wave
38
Fire
(FEMA)
39
Wildfire Potential
(USGS)
40
Countries with recent forest fires

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
41
Earthquake
(FEMA)
42
Earthquakes
USGS
43
Earthquake world history
44
Volcano
(FEMA)
45
Volcano Locations in U.S.
(Michigan Tech Volcanoes)
46
Volcano map worldwide
(Michigan Tech
Volcanoes)
47
Landslide
(NASA)
48
Landslide Frequency U.S.
(USGS)
49
Western Europe Landslide
(ESA)
50
Sandstorm
(European Space Agency)
51
Duststorm Map
(European Space Agency)
52
Global warming data
(worldviewofglobalwarming.org)
53
Drought/Flood Prediction from changes in
precipitation
(International Research Institute for Climate Prediction)
54
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/
Judy Oehler-Stinnett, Ph.D.
55
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
Judy Oehler-Stinnett, Ph.D.
56
Geographic locations


Vary within U.S. and world (see maps)
Variance from year to year, but stability in high
incidence areas




Variance contributes to




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)
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)
Judy Oehler-Stinnett, Ph.D.
57
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
58
Judy Oehler-Stinnett, Ph.D.
(NWS, FEMA, Red Cross, worldbank)
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)
Judy Oehler-Stinnett, Ph.D.
59
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
Judy Oehler-Stinnett, Ph.D.
(FEMA)
60
U.S. Cost Increase of
Natural Disasters
(Princeton)
61
Severity/Intensity

Severity ratings in scale numbers



FEMA
Size impacts





FEMA
Number of victims
Amount of land
Ability to predict
Intensity/speed impacts


Most severe are less frequent
People in high frequency areas underestimate
severity
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)
Judy Oehler-Stinnett, Ph.D.
62
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)
Judy Oehler-Stinnett, Ph.D.
63
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)
Judy Oehler-Stinnett, Ph.D.
64
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
Judy Oehler-Stinnett, Ph.D.
65
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)
Judy Oehler-Stinnett, Ph.D.
66
Sensory Input during Event
 Sounds
Wind
Rain,
Ice, Hail
Thunder
Cries for help
Property stress and destruction
Land shifting, cracking
(Red Cross, APA)
Judy Oehler-Stinnett, Ph.D.
67
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)
Judy Oehler-Stinnett, Ph.D.
68
Sensory Input during Event
 Smell
Wind-carried
odors
Water-soaked objects
Contamination
Death
(Red Cross, APA)
Judy Oehler-Stinnett, Ph.D.
69
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)
Judy Oehler-Stinnett, Ph.D.
70
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)
Judy Oehler-Stinnett, Ph.D.
71
Programming for Natural
Disasters

What school personnel need to know
72
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
Judy Oehler-Stinnett, Ph.D.
73
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

Judy Oehler-Stinnett, Ph.D.
74
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.cfm
 Storm
shelter
 Knowledge of specific disasters
 Disaster preparedness kit
 Disaster drills
 Weather radio, heed warnings
Judy Oehler-Stinnett, Ph.D.
75
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)
Judy Oehler-Stinnett, Ph.D.
76
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)
Judy Oehler-Stinnett, Ph.D.
77
Preparedness Programs
FEMA, Red Cross
 Children
 Families
 School
personnel
 Community
Judy Oehler-Stinnett, Ph.D.
78
Preparedness Programs, con’t
see FEMA and Red Cross for excellent resources, links
 Child
 Use
education
available local resources
Television weather personnel
 Science teachers and others

 Utilize

science natural disasters curriculum unit
Often covered in 5th to 7th 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

Judy Oehler-Stinnett, Ph.D.
79
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
FEMA

Mental health preparedness
 Shock
of event
 Coping skills for recovery

For program packages, see:

http://www.femagov/kids/

http://www.redcross.org/disaster/masters/
Judy Oehler-Stinnett, Ph.D.
80

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


Enlist parent organizations
Provide incentives – disaster kits
 Include

cultural, religious sensitivity
Beliefs regarding causation




involvement
divine punishment
miracle
predetermination
Beliefs regarding death


Death to be feared or welcomed
Rituals and symbolic meaning
Judy Oehler-Stinnett, Ph.D.
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
81
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.
Judy Oehler-Stinnett, Ph.D.
82
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
Judy Oehler-Stinnett, Ph.D.
83
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/
84
Judy Oehler-Stinnett,
Ph.D.
FEMA
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
Judy Oehler-Stinnett, Ph.D.
85
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
Judy Oehler-Stinnett, Ph.D.
86
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

Judy Oehler-Stinnett, Ph.D.
87
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
Judy Oehler-Stinnett, Ph.D.
88
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
89
When Natural Disasters Occur

Steps for Imminent Disaster and Beyond
90
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
Judy Oehler-Stinnett, Ph.D.
91
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.
Judy Oehler-Stinnett, Ph.D.
92
Bloomsburg, PA High School
Flooding from Hurricane Ivan
Jared Fenstermacher – from Bloomsburg Weater
93
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 onsite, 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

Judy Oehler-Stinnett, Ph.D.
94
School Used as Disaster Center
after California Earthquake
FEMA
95
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 96
Judy Oehler-Stinnett, Ph.D.
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
Judy Oehler-Stinnett, Ph.D.
97
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
)

Judy Oehler-Stinnett, Ph.D.
98
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
Judy Oehler-Stinnett, Ph.D.
99
100
Post-trauma adjustment Factors

Cultural considerations



Rural vs. urban setting






Preexisting mental health issues
Need for additional support services
Preexisting crisis procedures


Use of existing support systems
Availability of services
Persons with disabilities


Concepts of death
Adaptation rituals
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
Judy Oehler-Stinnett, Ph.D.
101
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 102
Judy Oehler-Stinnett, Ph.D.
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

Anger at family or school for not protecting them better
 Alterations


of event
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
Judy Oehler-Stinnett, Ph.D.
103
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.

Judy Oehler-Stinnett, Ph.D.
104
Assessment/Intervention for Acute Stress Disorder &
Post Traumatic Stress Disorder in Natural Disasters

Post-disaster phases
 Emotional


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

numbing
Tsunami orphans: 7,722 lost 2
parents; 32,735 lost 1 parent
Worldbank.org
Traumatic Stress Disorder
Symptoms onset or remain more than
one month post-disaster
Not all symptoms present in children
Judy Oehler-Stinnett, Ph.D.
Amma teaching tsunami survivor
how to swim Amritapuri.org
37% of deaths were children
105
Common Symptoms in Youth who are at
risk for PTSD Following Natural Disaster

Re-experiencing:



Avoidance:




Nightmares about disaster or symbol of it
Trauma play (in young children)
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

Judy Oehler-Stinnett, Ph.D.
106
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)
Judy Oehler-Stinnett, Ph.D.
107
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)
Judy Oehler-Stinnett, Ph.D.
108
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
Judy Oehler-Stinnett, Ph.D.
109
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
Judy Oehler-Stinnett, Ph.D.
110

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)
Judy Oehler-Stinnett, Ph.D.
111
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)
Judy Oehler-Stinnett, Ph.D.
112
Prevalence rates, con’t.: Child self-report






Almost all children in hurricanes show initial symptoms (8695%)
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)
Judy Oehler-Stinnett, Ph.D.
113
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
Judy Oehler-Stinnett, Ph.D.
114
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
Judy Oehler-Stinnett, Ph.D.
115
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)

Judy Oehler-Stinnett, Ph.D.
116
Interventions con’t.
Continue long-term intervention
 Prepare better – see prevention and
mitigation slides!

Judy Oehler-Stinnett, Ph.D.
117
Disaster Mental Health Training

Disaster Mental Health in Natural
Disasters
118
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.
Judy Oehler-Stinnett, Ph.D.
119
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
Judy Oehler-Stinnett, Ph.D.
120
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/
Judy Oehler-Stinnett, Ph.D.
121
Resources from NASP on Natural
Disasters




http://www.nasponline.org/NEAT/crisismain.html
#natural
http://www.nasponline.org/crisisresources/22Lazarus.pdf
http://www.nasponline.org/crisisresources/tsuna
mi.html
http://www.nasponline.org/NEAT/MidwestFloods.
pdf
Judy Oehler-Stinnett, Ph.D.
122
NASP Resources on Natural Disasters









Natural Disasters from NASP's book Best Practices in School Crisis
Prevention and Intervention
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
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/NEAT
for updated crisis information
Judy Oehler-Stinnett, Ph.D.
123