Draft Storyboard: Psychosocial Impacts of Disasters on Children
July 24, 2013
These are the storyboards for the NCDMPH lesson titled ”Psychosocial Impacts of Disasters on Children.”
This lesson includes a title screen and the following topics:
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Title/Faculty
Disclosures
Objectives
Introduction
Children’s Post-Disaster Reactions
Adjustment Risk Factors
Reactivation of Stressors
Fostering Wellness & Recovery
Professional Self-Care
Summary
References & Resources
Author & Reviewers
Special Thanks
CME/CE Credit
General Lesson Navigation
If users just keep clicking “Next,” they should be able
to progress through the lesson and all 10 topics,
from beginning to end. However, users will also be
able to jump from one topic to another with the lefthand side navigation, in which links to the 10 topics
will be presented on the left side of the screen.
Left Side Navigation Information
The left side navigation should be visible at all times.
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The Topic Titles (links) in the navigation may be shorter versions of the Page Titles,
because of available screen space.
Each Topic in the navigation will be preceded by a line to mark off a new section.
Once the learner clicks into a Topic, the subsections for the topic should be displayed.
The subsections should be displayed as long as the learner remains in a specific topic.
Page 1 of 52
Draft Storyboard: Psychosocial Impacts of Disasters on Children
July 24, 2013
Navigation Branching
Following are the initial screens for each topic of the lesson. (The page numbers shown reference the starting
point of each topic in the storyboard document.)
Title/Faculty = NC_PI_T00_010............................................................................................................ 2
Disclosures = NC_PI_T00_020 ............................................................................................................ 4
Objectives = NC_PI_T00_030 .............................................................................................................. 5
Introduction = NC_PI_T01_010 ............................................................................................................ 6
Children’s Post-Disaster Reactions = NC_PI_T02_010 .......................................................................13
Adjustment Risk Factors = NC_PI_T03_010 .......................................................................................34
Reactivation of Stressors = NC_PI_T04_010 ......................................................................................40
Fostering Wellness & Recovery = NC_PI_T05_010 ............................................................................45
Professional Self-Care = NC_PI_T06_010 ............................................ Error! Bookmark not defined.
Summary = NC_PI_T07_010 ................................................................ Error! Bookmark not defined.
References & Resources = NC_PI_T08_010 ........................................ Error! Bookmark not defined.
Author & Reviewers = NC_PI_T09_010 ................................................ Error! Bookmark not defined.
Special Thanks = NC_PI_T10_010 ....................................................... Error! Bookmark not defined.
CME/CE Credit = NC_PI_T11_010 ....................................................... Error! Bookmark not defined.
Each screen of the lesson will contain the following buttons:
 [Back] Moves learners back one screen (should be inactive on first screen).
 [Next] Moves learners forward one screen (should be inactive on last screen).
 Text Size: [ + ] [ - ] allows learners to change the font size to enhance readability
 [Share/Email] expands to allow learner to choose from Email or Facebook icons (TBD)
 Email option: OnClick open a screen that lets user add their name/email, a title, recipient’s email,
and comment. Comment is autopopulated with link to the specific page.
 Facebook option: OnClick open a screen that lets user share on a Facebook page.
Optional Buttons (appear as indicated in the storyboards):
 [Resource] appears whenever a resource of note is mentioned in the text – this button is present and
shows INACTIVE state when it is not applicable.
Section 508 Considerations
Following are some guidelines that should be followed to ensure improved access for learners using screen
readers or similar assistive devices:
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Each graphic or photo should have an ALT tag associated with it.
Code should be included in each page that directs screen reading devices to “skip” reading the
navigation to a learner using the device.
Page 2 of 52
Draft Storyboard: Psychosocial Impacts of Disasters on Children
Lesson Name: Psychosocial Impacts of
Disasters on Children
Topic Name: Lesson Home
Storyboard: NC_PI_T00_010
Template: [TextGraphic]
July 24, 2013
Screen Title: Title/Faculty
On–Screen Text:
Psychosocial Impacts of Disasters on Children
David J. Schonfeld, MD, FAAP
Footnotes: n/a
Graphic:
Graphic = NC_PI_T00_010
photo (FPO Only)
ALT tag: alt="Photo collage of a stormy sky, young boy holding a candle with tears in his eyes, and evacuation
route sign with stormy sky"
Photo caption: n/a
Photo credit: n/a
Screen Prompt: Click Next to continue.
Programmer Notes / Interactions & Feedback:
This screen contains text and a photo. The photo should be centered on this title screen. The links should open
in the same window.
Page 3 of 52
Draft Storyboard: Psychosocial Impacts of Disasters on Children
Lesson Name: Psychosocial Impacts of Disasters on
Children
Topic Name: Lesson Home
Storyboard: NC_PI_T00_020
Template: [TextGraphic]
July 24, 2013
Screen Title: Disclosures
On–Screen Text:
This continuing education activity is managed and accredited by Professional
Education Service Group. The information presented in this activity represents
the opinion of the author(s) or faculty. Neither PESG, nor any accrediting
organization endorses any commercial products displayed or mentioned in
conjunction with this activity.
Commercial Support was not received for this activity.
Neither the author nor any of the reviewers involved in this educational activity have any relevant financial
relationships with commercial interests to disclose. (A complete listing of the author and reviewers is available
at the end of this activity)
CME Staff Disclosures
Professional Educational Services Group staff have no financial interest or relationships to disclose.
Graphic:
Graphic = NC_PI_T00_020
ALT tag: alt="logo for Professional Education Services Group, A CME Company"
Screen Prompt: Click Next to continue.
Programmer Notes / Interactions & Feedback:
This screen contains text and an inline graphic (logo) -- This logo will likely be smaller than the standard rightsize photo.
Page 4 of 52
Draft Storyboard: Psychosocial Impacts of Disasters on Children
Lesson Name: Psychosocial Impacts of Disasters
on Children
Topic Name: Lesson Home
Storyboard: NC_PI_T00_030
Template: [TextOnly]
July 24, 2013
Screen Title: Objectives
On–Screen Text:
After completing this lesson, you should be able to
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describe common adjustment reactions in children exposed to disasters, including the unique ways that
bereavement and specific risk factors make adjustment more difficult.
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take steps to create a healthcare delivery environment that anticipates and reduces contributions to
child and family distress after a disaster.
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advise parents and other caregivers about supporting children’s recovery after a disaster.
Footnotes:
n/a
Screen Prompt: Click Next to continue.
Programmer Notes / Interactions & Feedback:
This screen contains text.
Page 5 of 52
Draft Storyboard: Psychosocial Impacts of Disasters on Children
Introduction = NC_PI_T01_010
Page 6 of 52
July 24, 2013
Draft Storyboard: Psychosocial Impacts of Disasters on Children
Lesson Name: Psychosocial Impacts of Disasters
on Children
Topic Name: Introduction
Storyboard: NC_PI_T01_010
Template: [TextGraphic]
July 24, 2013
Screen Title: Long-Term Psychological and Social Impacts
On–Screen Text:
When disaster strikes — whether natural or manmade — lives and communities are permanently altered.
Visible damage provides clues to the devastation and loss of life, while news reports progress from grim to
hopeful to stories of recovery. Less frequently reported are the lingering psychological and social impacts of
disasters on a population.
The psychosocial impacts of disasters have potentially long-term consequences for the psychological
functioning, emotional adjustment, and developmental trajectory of children. In fact, an Institute of Medicine
report has shown that children are among those at highest risk of psychological trauma and behavioral
difficulties after a disaster.[1] Adults who care for – and about – children play a vital role in mitigating the
negative effects of these events and promoting children’s ultimate coping and adjustment.
This lesson addresses the common adjustment reactions of children to community-wide disasters and crisis
events, identifies risk factors associated with their adjustment difficulties, and describes strategies to promote
successful coping and resiliency for children. Because it is important for any successful helping strategy, we
also address self-care for healthcare professionals.
Footnotes:
1 Institute of Medicine. Preparing for the Psychological Consequences of Terrorism: A Public Health Strategy.
Washington, DC: National Academics Press; 2003.
Graphic = NC_PI_T01_010
Photo collage of a stormy sky, family at I AM JOPLIN event, and evacuation route sign with stormy sky”
Photo caption: n/a Photo credit: n/a
Screen Prompt: Click Next to continue.
Programmer Notes / Interactions & Feedback:
This screen contains text and a graphic aligned to the right of the text.
Page 7 of 52
Draft Storyboard: Psychosocial Impacts of Disasters on Children
July 24, 2013
[Objectives moved to Home topic]
Lesson Name: Psychosocial Impacts of Disasters
on Children
Topic Name: Introduction
Storyboard: NC_PI_T01_020
Template: [TextOnly]
Screen Title: Competencies
On–Screen Text:
If you are using a competency-based approach for your professional development, or participating in
this lesson as part of a competency-based education or training program, the following information is
provided to assist you in relating this lesson to competency development.
This lesson supports learning related to the following competencies, with regard to psychosocial
impacts of disasters on children:*
Core Competencies and Subcompetencies for Disaster Medicine and Public Health by Walsh et
al.[2]
Subcompetency 1.4 “Describe methods for enhancing personal resilience, including physical
and mental health and well-being, as part of disaster preparation and planning”
Subcompetency 5.2 “Describe risk reduction measures that can be implemented to mitigate
or prevent hazardous exposures in a disaster or public health emergency”
Subcompetency 7.1 “Discuss common physical and mental health consequences for all ages
and populations affected by a disaster or public health emergency”
Core Competency 8.0 “Demonstrate knowledge of public health principles and practices for
the management of all ages and populations affected by disasters and public health
emergencies”
Subcompetency 8.1 “Discuss public health consequences frequently seen in disasters
and public health emergencies”
Subcompetency 8.2 “Identify all ages and populations with functional and access
needs who may be more vulnerable to adverse health effects in a disaster or public
health emergency”
Subcompetency 8.3 “Identify strategies to address functional and access needs to
mitigate adverse health effects of disasters and public health emergencies”
Subcompetency 8.4 “Describe common public health interventions to protect the
health of all ages and populations affected by a disaster or public health emergency”
Subcompetency 11.4 “Discuss the importance of monitoring the mental and physical health
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Draft Storyboard: Psychosocial Impacts of Disasters on Children
July 24, 2013
impacts of disasters and public health emergencies on responders and their families”[2]
* There are many published competency sets within the field of disaster health. For additional
information, see Disaster-related competencies for healthcare providers. Disaster Information
Management Research Center, National Library of Medicine
[http://disaster.nlm.nih.gov/dimrc/professionalcompetencies.html]
Footnotes:
2 Walsh L, Subbarao I, Gebbie K, et al. Core competencies for disaster medicine and public health.
Disaster Med Public Health Prep. 2012;6(1):44-52.
Screen Prompt: Click Next to continue.
Programmer Notes / Interactions & Feedback:
This screen contains text.
Page 9 of 52
Draft Storyboard: Psychosocial Impacts of Disasters on Children
Lesson Name: Psychosocial Impacts of Disasters on
Children
Topic Name: Introduction
Storyboard: NC_PI_T01_030
Template: [ClickGraphic]
July 24, 2013
Screen Title: Addressing a Preparedness Void
On–Screen Text:
Pediatric healthcare providers are increasingly recognizing the benefit of further training in behavioral health,
particularly as it relates to helping children cope with crisis.
Click each photo in turn below to discover the value of pediatric behavioral health training for providers,
whether during disaster response or every day.
[ClickGraphicText1]
Boosting Disaster Preparedness
Surveys show that nearly 3 out of 4 pediatric healthcare providers feel unprepared to respond to a bioterrorist
event and its overall aftermath, including mental health concerns.[3] Most pediatric healthcare providers after
Hurricane Katrina reported wanting more help identifying and meeting the mental health needs of their
patients,[4] and more recent disaster responders have indicated that this need persists unabated.
[ClickGraphicText2]
Increasing Everyday Awareness
Because stress is intrinsic to many major life events, including significant illness and its treatment, pediatric
healthcare providers regularly interact with children and families who are in distress. Through the process
known as somatization [NC_PI_T08_040/#soma], psychological distress may present as symptoms that mimic
physical conditions, exacerbate or complicate physical symptoms, interfere with accurate reporting of medical
concerns, or complicate medical management.[5] Healthcare providers who develop skills to identify emotional
and psychological difficulties and can offer effective adjustment and coping strategies will use these skills every
day—even outside of a major crisis event—to the benefit of their patients and practices.
Footnotes:
3 Hu Y, Adams RE, Boscarino JA, et al. Training needs of pediatricians facing the environmental health and
Page 10 of 52
Draft Storyboard: Psychosocial Impacts of Disasters on Children
July 24, 2013
bioterrorism consequences of September 11th. Mt. Sinai J Med. 2006;73:1156-64.
4 Madrid PA, Grant R, Reilly MJ, et al. Challenges in meeting immediate emotional needs: short-term impact
of a major disaster on children’s mental health: building resiliency in the aftermath of Hurricane Katrina.
Pediatrics. 2006;117:S448-53.
5 Schonfeld D. Providing psychological first aid and identifying mental health needs in the aftermath of a
disaster or community crisis. In: Foltin G, Tunik M, Treiber M, Cooper A. Pediatric Disaster Preparedness: A
Resource for Planning, Management, and Provision of Out-of-Hospital Emergency Care. New York, NY:
Center for Pediatric Emergency Medicine; 2008. Available at: http://cpem.med.nyu.edu/teachingmaterials/pediatric-disaster-preparedness. Accessibility verified January 25, 2013.
Graphic = NC_PI_T01_030a
Graphic = NC_PI_T01_030b
ALT tag: alt="young African American man in scrubs
leaning head on window in exhaustion "
ALT tag: alt="older female physician in lab coat
comforting a crying young girl in her office"
Photo caption: n/a Photo credit: n/a
Photo caption: n/a Photo credit: n/a
Screen Prompt: Click each photo to learn more. Click Next to continue.
Programmer Notes / Interactions & Feedback:
This screen contains introductory text and 2 photos. All images should have an ALT text tag. All footnotes
should be displayed at the bottom of the screen at all times.
When the learner clicks a graphic, associated text (noted as [ClickGraphicText#]) displays under both graphics.
This screen contains a glossary term; link to the full text of the glossary term with an anchor tag so that the
term is displayed at the top when the page loads. Provide a Back button that returns learner to the screen they
were on from the glossary.
Page 11 of 52
Draft Storyboard: Psychosocial Impacts of Disasters on Children
Lesson Name: Psychosocial Impacts of Disasters on
Children
Topic Name: Introduction
Storyboard: NC_PI_T01_040
Template: [MultiChoice]
July 24, 2013
Screen Title: Are You Prepared?
On–Screen Text:
How prepared do you feel to deal with the psychosocial issues that children and their families face immediately
after a disaster or in the long-term? (Check all of the statements that apply to you.)
□
□
□
□
□
□
I am aware of acute stress reactions that pediatric patients may display following a disaster.
I am familiar with typical post-traumatic stress disorder symptoms that children may exhibit.
I am familiar with how a crisis event may re-activate or compound existing stressors for children and
families.
I feel confident about helping parents and children establish supportive communications after a
disaster, including how to address bereavement.
The healthcare environment where I work is sensitive to the needs of younger patients and families in
distress.
I have a plan in place for professional self-care, including a personal disaster plan.
Submit
Feedback:
[CORRECT]
Good for you! You are well on your way to understanding how to best support children who have experienced a
disaster or crisis event. This lesson will help you discover additional means for helping children and their
families. Let’s get started!
[INCORRECT]
There’s definitely room for improvement. This lesson will describe how to best support children who have
experienced a disaster or crisis event. Let’s get started!
Resource: Include Resource button at top of screen, link to NC_PI_T01_040.pdf
Screen Prompt: Check all statements that apply, then click Submit. Click Next to continue.
Programmer Notes / Interactions & Feedback:
This screen contains text statements (in checkboxes) that the learner must check to indicate their agreement
with. OnSubmit feedback is displayed below the Question and their responses.
If 4 or more statements are checked (any 4), show CORRECT feedback. If 3 or less are checked, show the
INCORRECT feedback.
Please code so that users can click next without completing (this is true for any knowledge
checks, since you are not actually tracking completion).
Page 12 of 52
Draft Storyboard: Psychosocial Impacts of Disasters on Children
Children’s Post-Disaster
Reactions = NC_PI_T02_010
Page 13 of 52
July 24, 2013
Draft Storyboard: Psychosocial Impacts of Disasters on Children
July 24, 2013
Lesson Name: Psychosocial Impacts of Disasters on
Children
Topic Name: Children’s Post-Disaster Reactions
Storyboard: NC_PI_T02_010
Template: [TextGraphic]
Screen Title: Common Reactions to Disasters
On–Screen Text:
Acute reactions and individual post-traumatic symptoms are very common among children directly affected by
a crisis event. The following may be seen in children after a disaster:
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Anxiety, worries, and fears
Separation anxiety or avoiding school
Bereavement and grief
Sadness or depression, pessimism or decreased future perspective
Avoiding previously enjoyed activities, withdrawal and decrease in peer social interactions
Difficulties with concentration and academic work
Sleep problems
Irritability
Regression – developmental or social
Substance abuse – onset or increase
Somatization
Whenever possible, practitioners should compare these symptoms to a child’s pre-existing functioning and
behavior and consider family and cultural modes of expressing emotions.
Graphic = NC_PI_T02_010
ALT tag: alt="photo collage of teen boy sitting alone in a park, a pre-teen girl looking confused in a classroom,
and a young girl avoiding eye contact"
Photo caption: n/a Photo credit: n/a (all dreamstime.com)
Screen Prompt: Click Next to continue.
Programmer Notes / Interactions & Feedback: This screen contains text and a photo, centered over the text.
Page 14 of 52
Draft Storyboard: Psychosocial Impacts of Disasters on Children
July 24, 2013
Lesson Name: Psychosocial Impacts of Disasters on
Children
Topic Name: Children’s Post-Disaster Reactions
Storyboard: NC_PI_T02_020
Template: [ClickExpand]
Screen Title: Symptoms of Adjustment Reactions in Children
On–Screen Text:
Let’s take a closer look at children’s symptoms of acute stress after a disaster.[6] Any adult in a child
healthcare or caregiving capacity may observe these reactions, particularly if they have prior knowledge of a
child’s behavior or family situation.
Click each symptom to reveal additional information.
[+ Anxiety, worries, and fears]
Children have limited knowledge and experience and tend to misunderstand and misattribute. Keep in mind
that their fears and worries may be very different from those of adults.
[+ Separation anxiety or school avoidance]
Look for any extreme or prolonged distress when separated from caregivers or avoidance of school.
[+ Bereavement and grief]
This is a special concern if deaths occurred as a result of the disaster, and even more relevant if close family
members or friends of a child died. Children may also experience traumatic reactions if they witnessed a
death.
[+ Sadness or depression]
In addition to sadness or depression, children may develop a sense of pessimism about the future or
decreased perspective on what the future may hold.
[+ Avoidance of previously enjoyed activities]
Ask about or look for withdrawal from activities and decreased social interactions, especially with peers.
[+ Difficulties with concentration and academic work]
Explore (or observe) how children and adolescents are able to attend to their work or focus on an activity,
comparing their performance to pre-disaster levels.
[+ Problems with sleep]
Does the child have difficulty falling or staying asleep, have nightmares or frequent waking, resist sleeping
alone, or have trouble waking in the morning?
[+ Irritability]
Consider observed irritability with surroundings or others or reported reactions by parents or caregivers.
[+ Regression – developmental or social]
Has the child taken a step back in developmental milestones (e.g., bedwetting)? Is he or she regressing
socially – becoming more clingy, less cooperative, more demanding, more self-centered, or less tolerant of
others?
[+ Substance abuse]
Look for the onset of tobacco, alcohol or other substance abuse or an increase in these behaviors.
[+ Somatization]
Page 15 of 52
Draft Storyboard: Psychosocial Impacts of Disasters on Children
July 24, 2013
Children may unconsciously present psychological distress as physical symptoms.
Footnotes:
6 Schonfeld D, Gurwitch R. Children in disasters. In: Elzouki AY, Stapleton FB, Whitley RJ, Oh W, Harfi HA,
Nazer H, eds. Textbook of Clinical Pediatrics, 2nd ed. New York, NY: Springer-Verlag; 2011: 687-698,
modified from Table 489.1.
Resource: Include Resource button at top of screen, link to NC_PI_T02_020.pdf
Screen Prompt: Click Next to continue.
Programmer Notes / Interactions & Feedback:
This screen contains text statements that, onClick, will reveal additional text below each statement. Once
revealed, the text will remain revealed (until the learner leaves and returns to the page). The statements will be
brief and coded as “buttons” so that they are easy to open on a mobile device. Each statement will be
preceded by a + sign.
Page 16 of 52
Draft Storyboard: Psychosocial Impacts of Disasters on Children
July 24, 2013
Lesson Name: Psychosocial Impacts of Disasters on
Children
Topic Name: Children’s Post-Disaster Reactions
Storyboard: NC_PI_T02_030
Template: [TextGraphic]
Screen Title: Post-Traumatic Stress Disorder
On–Screen Text:
Although less common, post-traumatic stress disorder (PTSD)
[NC_PI_T08_030#ptsd] may occur in children who have
survived a disaster.
PTSD is characterized by symptoms of re-experiencing,
avoidance, and increased arousal that persists for at least one
month’s time and results in significant impairment in social,
academic or other areas of functioning.
Graphic = NC_PI_T02_030
ALT tag: alt=" pre-teen boy looking sad and confused"
Photo caption: n/a
Photo credit: n/a
Screen Prompt: Click Next to continue.
Programmer Notes / Interactions & Feedback:
This screen contains text and a photo, right-aligned with the text.
Reminder: All photos should be padded by 5px all around.
Page 17 of 52
Draft Storyboard: Psychosocial Impacts of Disasters on Children
July 24, 2013
Lesson Name: Psychosocial Impacts of Disasters on
Children
Topic Name: Children’s Post-Disaster Reactions
Storyboard: NC_PI_T02_040
Template: [ClickExpand]
Screen Title: PTSD Characteristics in Children
On–Screen Text:
Take a moment to more closely explore the core symptoms of PTSD. Click each symptom for details about
how PTSD may present in children.
[+ Re-experiencing]
Re-experiencing may take various forms:
 Dreams or nightmares (in young children, nightmares may not include content from the event)
 Hallucinations or intrusive images (i.e., flashbacks)
 Intense reactions to cues that remind children of the event
Children may demonstrate re-experiencing through repetitive play involving reenactment.
[+ Avoidance]
Children may avoid activities, places, or people associated with an event or may make efforts to avoid
associated thoughts or feelings. As a result, they may withdraw from previously enjoyed activities or friends
and family.
[+ Increased Arousal]
Children may display sleep problems, difficulty with concentration, increased irritability, or angry outbursts.
They may appear hyper-alert or exhibit an increased startle response.
Footnotes: n/a
Resource: Include Resource button at top of screen, link to NC_PI_T02_040.pdf
Screen Prompt: Click each statement to reveal details. Click Next to continue.
Programmer Notes / Interactions & Feedback:
This screen contains text statements that, onClick, will reveal additional text below each statement. Once
revealed, the text will remain revealed (until the learner leaves and returns to the page). The statements will be
brief and coded as “buttons” so that they are easy to open on a mobile device. Each statement will be
preceded by a + sign.
When the learner clicks a statement, associated text with display under the statement.
Page 18 of 52
Draft Storyboard: Psychosocial Impacts of Disasters on Children
July 24, 2013
Lesson Name: Psychosocial Impacts of Disasters on
Children
Topic Name: Children’s Post-Disaster Reactions
Storyboard: NC_PI_T02_050
Template: [TextGraphic]
Screen Title: PTSD Evaluation of Children
On–Screen Text:
When evaluating children for PTSD, keep the following in mind:

The potential for PTSD is especially strong among
children who perceived during an event that their life
was in jeopardy or who experienced intense fear,
helplessness, or horror.

Individuals with PTSD actively attempt to avoid thinking,
talking about, or even remembering the event, so
symptoms may not become evident to others for months
(or longer) without active screening or outreach.[7]
Footnotes:
7 Schonfeld D, Gurwitch R. Children in disasters. In: Elzouki AY, Stapleton FB, Whitley RJ, Oh W, Harfi HA,
Nazer H, eds. Textbook of Clinical Pediatrics, 2nd ed. New York, NY: Springer-Verlag; 2011: 687-698.
Graphic = NC_PI_T02_050
ALT tag: alt="a girl walking through her elementary school parking lot in Henryville, IN after the town was
devastated by a large tornado in March 2012"
Photo caption: n/a
Photo credit: U.S. Army photo by Sgt. John Crosby/Released
Screen Prompt: Click Next to continue.
Programmer Notes / Interactions & Feedback: This screen contains text and a photo right-aligned with the
text.
Page 19 of 52
Draft Storyboard: Psychosocial Impacts of Disasters on Children
July 24, 2013
Lesson Name: Psychosocial Impacts of Disasters on
Children
Topic Name: Children’s Post-Disaster Reactions
Storyboard: NC_PI_T02_055
Template: [TextOnly]
Screen Title: Guidelines for Immediate Referral
On–Screen Text:
If children display any of the following behaviors immediately after a disaster, providers should consider
promptly administering a more urgent mental health evaluation:






Demonstration of intense fear, anxiety, panic, helplessness or horror or uncontrollable and intense grief
Presence of dissociative symptoms such as detachment [NC_PI_T08_030#detach], derealization
[NC_PI_T08_030#dereal], or depersonalization [NC_PI_T08_030#deperson], which may manifest in
children who appear confused, distant, daydreaming, or aloof
Extreme confusion or inability to concentrate or make even simple decisions
Evidence of extreme cognitive impairment or intrusive thoughts
Marked physical complaints suggesting somatization[NC_PI_T08_030#soma]
Suicidal ideation or intent [8]
Children whose caregivers are having significant difficulty coping are also candidates for referral.
Footnotes:
8 Schonfeld D. Providing psychological first aid and identifying mental health needs in the aftermath of a
disaster or community crisis. In: Foltin G, Tunik M, Treiber M, Cooper A. Pediatric Disaster Preparedness: A
Resource for Planning, Management, and Provision of Out-of-Hospital Emergency Care. New York, NY:
Center for Pediatric Emergency Medicine; 2008. Available at: http://cpem.med.nyu.edu/teachingmaterials/pediatric-disaster-preparedness. Accessibility verified January 25, 2013.
Screen Prompt: Click Next to continue.
Programmer Notes / Interactions & Feedback:
This screen contains text and links to glossary terms.
Page 20 of 52
Draft Storyboard: Psychosocial Impacts of Disasters on Children
July 24, 2013
Lesson Name: Psychosocial Impacts of Disasters on
Children
Topic Name: Children’s Post-Disaster Reactions
Storyboard: NC_PI_T02_060
Template: [TextGraphic]
Screen Title: Considerations
On–Screen Text:
Man-Made vs. Natural Disasters
Children’s reactions to and recovery from a disaster event may vary
depending on if the disaster was caused randomly by nature or
intentionally by man.
Because the major aim of terrorism is to instill a state of intense fear
or anxiety in victims — rather than to physically harm — the
predominant effects are psychological and emotional. Most people of
age during the September 11 attacks can tell you where they were at
the time, what they were doing, and how it changed their lives.
Man-made disasters, especially when there is such intent to cause
harm, therefore result in more psychological distress than do natural
disasters, and may have longer-term effects.
As we’ll see below, disasters also tend to compound any existing stress already present in the community or
family.
Graphic = NC_PI_T02_060
ALT tag: alt="a young African-American boy sitting alone at the 9/11 Pentagon Memorial"
Photo caption: n/a
Photo credit: DoD photo by Glenn Fawcett/Released
Screen Prompt: Click Next to continue.
Programmer Notes / Interactions & Feedback: This screen contains text and a photo right-aligned with the
text.
Page 21 of 52
Draft Storyboard: Psychosocial Impacts of Disasters on Children
July 24, 2013
Lesson Name: Psychosocial Impacts of Disasters on
Children
Topic Name: Children’s Post-Disaster Reactions
Storyboard: NC_PI_T02_070
Template: [TextGraphic]
Screen Title: Considerations
On–Screen Text:
Overestimating Children’s Resilience
Parents and other adults tend to significantly underestimate children’s adjustment difficulties after a disaster, for
several reasons:

Professionals may miss changes or signs of
distress that are more apparent to family members
and teachers or child care providers familiar with
the child’s personality and characteristic style of
interacting and behavior.

Symptoms (e.g., nightmares) may occur only
outside the context of a healthcare encounter.

Children old enough to verbalize symptoms and
worries may withhold complaints and concerns to
avoid appearing “abnormal” or further burdening
adults struggling to cope.
Although a return to school and home routines as soon as
practical is recommended and can be therapeutic, expectations should be modified until children have
adjusted; a quick return to previous level of functioning should not be expected.
Graphic = NC_PI_T02_070
ALT tag: alt="a typical child’s crayon drawing of sunny skies and a happy family"
Photo caption: n/a
Photo credit: n/a
Screen Prompt: Click Next to continue.
Programmer Notes / Interactions & Feedback: This screen contains text and a photo right-aligned with the
text.
Page 22 of 52
Draft Storyboard: Psychosocial Impacts of Disasters on Children
July 24, 2013
Lesson Name: Psychosocial Impacts of Disasters on
Children
Topic Name: Children’s Post-Disaster Reactions
Storyboard: NC_PI_T02_080
Template: [TextGraphic]
Screen Title: Considerations
On–Screen Text:
Pre-Existing Stressors & Secondary Losses
Take a moment to review the post-disaster adjustment reactions
[NC_PI_T02_020.pdf] that children and adults may experience. In
evaluating actual reactions, consider that many are not posttraumatic and may not result directly from the disaster event.
A major disaster often worsens pre-existing problems and
initiates a cascade of secondary losses and stressors, any of
which may be the primary source of difficulty for children or
families.
Graphic = NC_PI_T02_080
ALT tag: alt="evacuation route sign on a stormy highway"
Photo caption: n/a
Photo credit: n/a
Resource: Include Resource button at top of screen, link to NC_PI_T02_020.pdf
Screen Prompt: Click Next to continue.
Programmer Notes / Interactions & Feedback: This screen contains text and a photo right-aligned with the
text.
Page 23 of 52
Draft Storyboard: Psychosocial Impacts of Disasters on Children
July 24, 2013
Lesson Name: Psychosocial Impacts of Disasters on
Children
Topic Name: Children’s Post-Disaster Reactions
Storyboard: NC_PI_T02_090
Template: [TextOnly]
Screen Title: Considerations
On–Screen Text:
Disasters Compound Existing Problems
Disasters may cause economic and other hardships for the community in many ways, including




loss of jobs or income for parents.
loss of homes and need for families to relocate, resulting in changes in schools or peer groups for
children.
depression, substance use, or discord among parents.
loss of neighborhood supports to mitigate the stress.
After Hurricane Katrina, marital stress, domestic violence, and parental mental health problems were found to
increase in the Gulf Coast Region.[9, 10] Any of these types of stressors may be the primary cause of
children’s current distress.
Footnotes:
9 Larrance R, Anastario M, Lawry L. Health status among internally displaced persons in Louisiana and
Mississippi travel trailer parks. Ann Emerg Med. 2007;49:590-601.
10 Norris FH, Friedman MJ, Watson PJ. 60,000 disaster victims speak. Part II: summary and implications of
the disaster mental health research. Psychiatry. 2005;65:240-60.
Screen Prompt: Click Next to continue.
Programmer Notes / Interactions & Feedback: This screen contains text.
Page 24 of 52
Draft Storyboard: Psychosocial Impacts of Disasters on Children
July 24, 2013
Lesson Name: Psychosocial Impacts of Disasters on
Children
Topic Name: Children’s Post-Disaster Reactions
Storyboard: NC_PI_T02_095
Template: [MultiChoice]
Screen Title: Considerations
On–Screen Text:
Knowledge Check
Pause for a moment to reflect on what you’ve learned so far. Which of the following should you consider when
evaluating children’s post-disaster reactions? (Select all that apply.)
□
□
□
□
□
Adults may be overestimating children’s resilience. [CORRECT]
If children perceived during an event that their life was in jeopardy or experienced intense fear,
helplessness, or horror. [CORRECT]
Whether the disaster was man-made or a result of natural forces. [CORRECT]
Pre-existing stressors may be an issue. [CORRECT]
Children may present psychological distress as physical symptoms. [CORRECT]
Submit
Feedback:
[CORRECT]
You’re right! Each of these should be a consideration when evaluating children’s post-disaster reactions.
[INCORRECT]
Actually, each of these should be a consideration when evaluating children’s post-disaster reactions.
Screen Prompt: Select all statements that apply, then click Submit. Click Next to continue.
Programmer Notes / Interactions & Feedback:
This screen contains text statements (in checkboxes) that the learner must check to indicate their agreement
with. OnSubmit feedback is displayed below the Question and their responses.
Page 25 of 52
Draft Storyboard: Psychosocial Impacts of Disasters on Children
July 24, 2013
Lesson Name: Psychosocial Impacts of Disasters on
Children
Topic Name: Children’s Post-Disaster Reactions
Storyboard: NC_PI_T02_100
Template: [ClickGraphic]
Screen Title: Assessment
On–Screen Text:
Extending the Focus
Comprehensive assessment of children’s post-disaster reactions requires a shift in focus, from solely assessing
how children reacted on the day of an event to determining how they are adjusting to what followed.
Click each photo for guidelines about how to adjust your assessments.
[ClickGraphicText1]
Extend Assessments to Determine Current Coping
Go beyond asking how children are adjusting to the initial event and evaluate how well they’re currently coping.
Reported sleep problems or anxiety may be due to worries about financial problems and parental stress,
resulting from parent job loss after a disaster, and may not result from nightmares or anxiety related to the
disaster itself.
[ClickGraphicText2]
Anticipate Long-Term Recovery
As long as these secondary losses and stressors persist within the community, adjustment difficulties for
children should be anticipated to continue. Home, school, and community environments and supports for
children may not return to being fully functional for many years, explaining in part the often lengthy process for
community recovery seen after major disasters.
Graphics = NC_PI_T02_100a
ALT tag: alt="destroyed overturned truck on front
lawn of tornado damaged home"
Photo caption: n/a Photo credit: n/a
Graphics = NC_PI_T02_100b
ALT tag: alt="angry young boy with parents arguing in
background"
Photo caption: n/a Photo credit: n/a
Screen Prompt: Click each photo to learn more. Click Next to continue.
Programmer Notes / Interactions & Feedback:
This screen contains text and 2 photos. When the learner clicks a graphic, associated text (noted as
[ClickGraphicText#]) displays under both graphics.
Page 26 of 52
Draft Storyboard: Psychosocial Impacts of Disasters on Children
July 24, 2013
Lesson Name: Psychosocial Impacts of Disasters on
Children
Topic Name: Children’s Post-Disaster Reactions
Storyboard: NC_PI_T02_110
Template: [TextGraphic]
Screen Title: Assessment
On–Screen Text:
In the Field
Consider this report from the field experience of healthcare
practitioners:
Pediatricians in a community on the United States’ Gulf Coast
noted that, many months after Hurricane Katrina, they had
learned to modify the format of their typical visit. In addition to
the usual components of the visit (e.g., chief complaint,
history, review of symptoms, physical exam, etc.) they had
added the “Katrina History.” They reported that this was the
part of the visit that had the most “pathology,” took the longest
time to cover adequately, and, unfortunately, was the least
compensated by most health insurance.
Graphic = NC_PI_T02_110
ALT tag: alt="Louisiana Gulf Coast residents gathering outside the Houston Astrodome after Hurricane Katrina
evacuation"
Photo caption: n/a Photo credit: n/a
Screen Prompt: Click Next to continue.
Programmer Notes / Interactions & Feedback: This screen contains text and a photo right-aligned with the
text.
Page 27 of 52
Draft Storyboard: Psychosocial Impacts of Disasters on Children
July 24, 2013
Lesson Name: Psychosocial Impacts of Disasters on
Children
Topic Name: Children’s Post-Disaster Reactions
Storyboard: NC_PI_T02_130
Template: [TextGraphic]
Screen Title: Assessment
On–Screen Text:
Online Resource
Feelings Need Check Ups Too. Addressing the Mental Health
Needs of Children in Response to September 11th and Other
Catastrophic Events: An Educational Resource for Pediatricians
is a training tool for pediatric healthcare providers that includes
video vignettes of children and families related to bereavement,
anxiety, depression and post-traumatic stress disorder, as well
as a tool-kit with screening instruments and background
information.[11]
The materials, including the video vignettes, can be accessed
at no charge through the American Academy of Pediatrics’
website.
Access symptom-specific vignettes … [http://www.aap.org/enus/advocacy-and-policy/aap-health-initiatives/Medical-Homefor-Children-and-Adolescents-Exposed-toViolence/Pages/Vignettes.aspx]
Access the toolkit… [http://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/Children-andDisasters/Pages/Feelings-Need-Checkups-Too-CD-Page-4.aspx] (requires Flash Player)
Footnotes:
11 Laraque D, Jensen P, Schonfeld D. Feelings Need Check Ups Too. Addressing the Mental Health Needs
of Children in Response to September 11th and Other Catastrophic Events: An Educational Resource for
Pediatricians. American Academy of Pediatrics; September 2004. [interactive CD-ROM]
Resource:
Include Resource button and link to the vignette page in a new window (most accessible to learners):
http://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/Medical-Home-for-Children-andAdolescents-Exposed-to-Violence/Pages/Vignettes.aspx
Graphic = NC_PI_T02_130
ALT tag: alt="capture of American Academy of Pediatrics Website “Feelings Need Checkups Too" web-based
tool”
Photo caption: n/a Photo credit: n/a
Screen Prompt: Click Next to continue.
Programmer Notes / Interactions & Feedback: This screen contains text and a photo right-aligned with the
text.
Page 28 of 52
Draft Storyboard: Psychosocial Impacts of Disasters on Children
July 24, 2013
Lesson Name: Psychosocial Impacts of Disasters on
Children
Topic Name: Children’s Post-Disaster Reactions
Storyboard: NC_PI_T02_140
Template: [TextGraphic]
Screen Title: When Bereavement is Involved
On–Screen Text:
When children have experienced the deaths of family members or
friends as a result of a disaster, bereavement may be a predominant
concern.
Children may experience post-traumatic grief when bereavement is
further complicated by posttraumatic reactions, such as after
witnessing the violent death of a loved one. However, bereavement
resulting from disaster is not typically that different from bereavement
experienced at most other times. In any context, children struggle with
understanding the loss and its implications and adjusting to a life
devoid of the person who died.[12]
Footnotes:
12 Schonfeld D, Quackenbush M. The Grieving Student: A Teacher's Guide. Baltimore, MD: Brookes
Publishing; 2010.
Graphic = NC_PI_T02_140
ALT tag: alt="young Asian boy holding a candle, tears on his face”
Photo caption: n/a Photo credit: n/a
Screen Prompt: Click Next to continue.
Programmer Notes / Interactions & Feedback: This screen contains text and a photo right-aligned with the
text.
Page 29 of 52
Draft Storyboard: Psychosocial Impacts of Disasters on Children
July 24, 2013
Lesson Name: Psychosocial Impacts of Disasters on
Children
Topic Name: Children’s Post-Disaster Reactions
Storyboard: NC_PI_T02_150
Template: [TextGraphic]
Screen Title: Bereavement
On–Screen Text:
The Importance of Guidance
Adults are often reluctant to talk with children (or even other
adults) who are grieving their loss, fearing they will cause
further distress by raising the topic or “saying the wrong thing.”
In fact, children are upset about the death itself, rather than
the questions or comments. It is not in their best interest to be
left alone to adjust.
Click Play to watch this video clip of comments from children
and parents about their experiences after a parent’s death and
consider how healthcare providers and schools can be better
prepared to offer support.
[Play > ] [[http://www.youtube.com/watch?v=BBHm_L2Fb9k&feature=youtu.be ]
Graphic = NC_PI_T02_150
ALT tag: alt="screen capture from video showing a pre-teen girl talking to the interviewer”
Photo caption: n/a Photo credit: n/a
Play button = Play.png
ALT tag: alt="play”
TITLE tag: title=”watch the video to hear from children who have experienced loss”
Screen Prompt: Click Play to watch the video in a new window. Click Next to continue.
Programmer Notes / Interactions & Feedback:
This screen contains text and a Play button linked to a youtube video. OnClick, open a new full-sized window
showing the link; the learner will need to click Play in the new window to start the video.
Page 30 of 52
Draft Storyboard: Psychosocial Impacts of Disasters on Children
July 24, 2013
Lesson Name: Psychosocial Impacts of Disasters on
Children
Topic Name: Children’s Post-Disaster Reactions
Storyboard: NC_PI_T02_160
Template: [TextOnly]
Screen Title: Bereavement
On–Screen Text:
A Perspective on Grief
How well do you understand how grief may affect a child, particularly if the child lost someone to disaster or
through violence? Take a few minutes to review bereavement resources related to Doug — a young boy who
lost his father in the September 11th terrorist attacks — on the American Academy of Pediatrics website.



Doug’s Case Summary [http://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/MedicalHome-for-Children-and-Adolescents-Exposed-to-Violence/Pages/Bereavement-Case-Summary.aspx]
Bereavement Fact Sheet [http://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/MedicalHome-for-Children-and-Adolescents-Exposed-to-Violence/Pages/Bereavement.aspx]
Explore Doug’s Case in the Feelings Toolkit [http://www.aap.org/en-us/advocacy-and-policy/aaphealth-initiatives/Children-and-Disasters/Pages/Feelings-Need-Checkups-Too-CD-Page-4.aspx] (Note:
Choose “Doug” from the waiting room; requires Flash Player.)
Footnotes:
n/a
Screen Prompt: Click Next to continue.
Programmer Notes / Interactions & Feedback: This screen contains text. All links should be designated to
open in new windows.
Page 31 of 52
Draft Storyboard: Psychosocial Impacts of Disasters on Children
July 24, 2013
Lesson Name: Psychosocial Impacts of Disasters on
Children
Topic Name: Children’s Post-Disaster Reactions
Storyboard: NC_PI_T02_170
Template: [TextGraphic]
Screen Title: Bereavement
On–Screen Text:
Resources for Grieving & Death Notification
We’ve heard how healthcare practitioners and adults working
with children can support grieving children and families by
listening and offering support. Take a few minutes to review the
following two resources that offer practical tips and guidelines.
After a Loved One Dies—How Children Grieve and How
Parents and Other Adults Can Support Them
[http://www.achildingriefcom]
This booklet for parents and other caring adults provides
information on explaining death to young children,
strategies to help them with personal loss, guidance on
funeral attendance, and advice about supporting children
as they adjust to significant loss. The booklet may be
downloaded in English or Spanish; hard copies can be
requested at no charge.
Practical Guidelines Regarding Death Notification
[http://archive.ahrq.gov/research/pedprep/pedchap8.htm#Death]
Practitioners should consider how to best approach notifying children regarding the death of a family
member or friend. This list of guidelines offers an excellent overview. Additional guidelines for those tasked
with death notification in the context of a disaster may be found elsewhere.[13,14]
Footnotes:
13 Foltin GL, Schonfeld DJ, Shannon, MW, eds. Pediatric Terrorism and Disaster Preparedness: A Resource
for Pediatricians. AHRQ Publication No. 06-0056-EF. Rockville, MD: Agency for Healthcare Research and
Quality; October 2006.
14 Schonfeld D. Providing support for families experiencing the death of a child. In: Kreitler S, Ben-Arush MW,
Martin A, eds. Pediatric Psycho-oncology: Psychosocial Aspects and Clinical Interventions, 2nd ed. West
Sussex, UK: John Wiley & Sons, Ltd.; 2012: 223-230.
Graphic = NC_PI_T02_170
ALT tag: alt="preteen boy looking sad and confused”
Photo caption: n/a Photo credit: n/a
Screen Prompt: Click Next to continue.
Programmer Notes / Interactions & Feedback: This screen contains text and a photo right-aligned with the
text.
Page 32 of 52
Draft Storyboard: Psychosocial Impacts of Disasters on Children
July 24, 2013
Lesson Name: Psychosocial Impacts of Disasters on
Children
Topic Name: Children’s Post-Disaster Reactions
Storyboard: NC_PI_T02_175
Template: [SingleChoice]
Screen Title: Bereavement
On–Screen Text:
Knowledge Check
True or False? Adults should avoid asking questions or commenting when a child has lost a loved one; it’s
better to leave them alone and let them try to get back to normal.
o
o
True
False [CORRECT]
Submit
Feedback:
[CORRECT]
Yes, this statement is false. Adults are often reluctant to talk with children (or even other adults) who are
grieving their loss, fearing they will cause further distress by raising the topic or “saying the wrong thing.” In
fact, children are upset about the death itself, rather than the questions or comments. It is not in their best
interest to be left alone to adjust.
[INCORRECT]
No, this statement is false. Adults are often reluctant to talk with children (or even other adults) who are
grieving their loss, fearing they will cause further distress by raising the topic or “saying the wrong thing.” In
fact, children are upset about the death itself, rather than the questions or comments. It is not in their best
interest to be left alone to adjust.
Screen Prompt: Select your answer, then click Submit. Click Next to continue.
Programmer Notes / Interactions & Feedback:
This screen contains a true/false statement that the learner must respond to. OnSubmit feedback is displayed
below the Question and their response.
Page 33 of 52
Draft Storyboard: Psychosocial Impacts of Disasters on Children
Adjustment Risk Factors =
NC_PI_T03_010
Page 34 of 52
July 24, 2013
Draft Storyboard: Psychosocial Impacts of Disasters on Children
July 24, 2013
Lesson Name: Psychosocial Impacts of Disasters on
Children
Topic Name: Adjustment Risk Factors
Storyboard: NC_PI_T03_010
Template: [TextGraphic]
Screen Title: Interrelated Factors Affect Risk
On–Screen Text:
The impact of a disaster on individual children depends on a number of interrelated factors, including
 the nature of the disaster itself (e.g., man-made versus natural, extent of damage and death caused).
 what children or those closest to them experienced or saw.
 the level of exposure to graphic media or online coverage.
 the extent and nature of secondary losses and stressors.
 if there was associated physical injury.
 the emotional impact experienced by children and their family and disruption to children’s extended
support system.
 children’s pre-existing skills in coping with distress.
 the ability of adults in the family and community to provide support and promote adjustment and
recovery. [15]
Footnotes:
15 Schonfeld D, Gurwitch R. Children in disasters. In: Elzouki AY, Stapleton FB, Whitley RJ, Oh W, Harfi HA,
Nazer H, eds. Textbook of Clinical Pediatrics, 2nd ed. New York, NY: Springer-Verlag; 2011: 687-698.
Graphic = NC_PI_T03_010
ALT tag: alt="photo collage of Hurricane Sandy aftermath, young sad girl against a graffiti covered wall, and a
line of adults waiting with gas cans"
Photo caption: n/a Photo credit: n/a
Screen Prompt: Click Next to continue.
Programmer Notes / Interactions & Feedback: This screen contains text and a photo, centered over the text.
Page 35 of 52
Draft Storyboard: Psychosocial Impacts of Disasters on Children
Lesson Name: Psychosocial Impacts of Disasters on
Children
Topic Name: Adjustment Risk Factors
Storyboard: NC_PI_T03_020
Template: [TextOnly]
July 24, 2013
Screen Title: Factors Associated with Increased Risk
On–Screen Text:
These particular factors are associated with an increased risk of adjustment problems after a disaster:[16]









Injury of the child, or death or injury of those close to the child
Child’s perception (at the time of the event) that his or her life was in jeopardy
Extent of exposure to horrific scenes (including indirectly through the media)
Separation of a child from parents or other important caregivers as result of event
Loss of property or belongings; disruption in daily routine or environment
Prior psychopathology, significant losses, or traumatic events
Parental difficulty in coping
Lack of supportive family communication style
Lack of community resources and support
The presence of one or more of these risk factors indicates the need for closer monitoring for adjustment
difficulties and/or the provision of supportive services.
Footnotes:
16 Schonfeld D, Gurwitch R. Children in disasters. In: Elzouki AY, Stapleton FB, Whitley RJ, Oh W, Harfi HA,
Nazer H, eds. Textbook of Clinical Pediatrics, 2nd ed. New York, NY: Springer-Verlag; 2011: 687-698.
Adapted from Table 489.2.
Resource: display Resource button and link to NC_PI_T03_020.pdf
Screen Prompt: Click Next to continue.
Programmer Notes / Interactions & Feedback: This screen contains text and displays the active Resource
button
Page 36 of 52
Draft Storyboard: Psychosocial Impacts of Disasters on Children
Lesson Name: Psychosocial Impacts of Disasters on
Children
Topic Name: Adjustment Risk Factors
Storyboard: NC_PI_T03_030
Template: [ClickGraphic]
July 24, 2013
Screen Title: Make Family Reunification a Priority
On–Screen Text:
Because separation from parents or other important caregivers is associated with increased difficulty adjusting
to a disaster, efforts to reunite children separated from families by the event should be a high priority. The
NCDMPH online lesson “Tracking and Reunification of Children in Disasters: A Lesson and Reference for
Health Professionals” [http://ncdmph.usuhs.edu/Learn/PedsTR/TRCD_0a.htm] focuses on achieving family
reunification as a first step in disaster recovery.
Click each photo for general guidance to minimize the effects of family separation.
[ClickGraphicText1]
Give Children Consistent Alternative Support
In those situations where children require medical treatment before reunification is possible, assign individual
volunteers who can provide consistent and ongoing support to individual children until reunification is achieved.
[ClickGraphicText2]
Guide Parents in Recovery Roles
When parents, guardians or other family members are available, guide them to serve an active and appropriate
role in the evaluation and treatment process, so they can help reduce children’s distress.
Resource: link Resource button to http://ncdmph.usuhs.edu/Learn/PedsTR/TRCD_0a.htm; the links should
open in a New Window
Graphics = NC_PI_T03_030a
ALT tag: alt=" nurse with young patient "
Photo caption: n/a Photo credit: n/a
Graphics = NC_PI_T03_030b
ALT tag: alt=" dad hugging young son, wearing a
backpack"
Photo caption: n/a Photo credit: n/a
Screen Prompt: Click each photo to learn more. Click Next to continue.
Programmer Notes / Interactions & Feedback:
This screen contains text and 2 photos. When the learner clicks a graphic, associated text (noted as
[ClickGraphicText#]) displays under both graphics.
Page 37 of 52
Draft Storyboard: Psychosocial Impacts of Disasters on Children
Lesson Name: Psychosocial Impacts of Disasters on
Children
Topic Name: Adjustment Risk Factors
Storyboard: NC_PI_T03_040
Template: [TextGraphic]
July 24, 2013
Screen Title: Perform Mental Health Triage
On–Screen Text:
Immediate disaster response requires that pediatric healthcare
providers assess both the physical and mental health of young
patients. To identify children most likely to benefit from mental
health referral, providers should conduct a secondary mental
health triage as soon as possible after initial medical stabilization
and evaluation.
The identified risk factors for increased adjustment difficulties
[NC_PI_T03_020.pdf] can be an important part of this evaluation
for children of all ages.
Resource: display Resource button and link to NC_PI_T03_020.pdf in a new window.
Graphic = NC_PI_T03_040
ALT tag: alt="close up teenaged girl, looking worried"
Photo caption: n/a Photo credit: n/a
Screen Prompt: Click Next to continue.
Programmer Notes / Interactions & Feedback:
This screen contains text and a photo, right-aligned with the text + display active Resource button and link to
NC_PI_T03_020.pdf
Page 38 of 52
Draft Storyboard: Psychosocial Impacts of Disasters on Children
Lesson Name: Psychosocial Impacts of Disasters on
Children
Topic Name: Adjustment Risk Factors
Storyboard: NC_PI_T03_060
Template: [MultiChoice]
July 24, 2013
Screen Title: Adjustment Risk Factors
On–Screen Text:
Knowledge Check
Which of the following may indicate an increased risk of adjustment problems for children after a disaster?
(Select all that apply.)
□
□
□
□
□
□
A. The child’s parents are having great difficulty coping after a disaster. [CORRECT]
B. Children were separated from their parents or other caregivers during an event. [CORRECT]
C. A child is exposed to horrific scenes after the event, on TV and social media. [CORRECT]
D. This is the first time a child has experienced an overwhelming traumatic event.
E. If a child was injured or someone close to them was injured or killed. [CORRECT]
F. A family must move away from their community support system into temporary housing.
[CORRECT]
Submit
Feedback:
[CORRECT]
That’s right. All of the statements except D are indicators of an increased risk of adjustment problems for
children after a disaster.
[INCORRECT]
Actually, all of the statements except D are indicators of an increased risk of adjustment problems for children
after a disaster.
Screen Prompt: Select all statements that apply, then click Submit. Click Next to continue.
Programmer Notes / Interactions & Feedback:
This screen contains text statements (in checkboxes) that the learner must check to indicate their agreement
with. OnSubmit feedback is displayed below the Question and their responses.
Page 39 of 52
Draft Storyboard: Psychosocial Impacts of Disasters on Children
Reactivation of Stressors =
NC_PI_T04_010
Page 40 of 52
July 24, 2013
Draft Storyboard: Psychosocial Impacts of Disasters on Children
Lesson Name: Psychosocial Impacts of Disasters on
Children
Topic Name: Reactivation of Stressors
Storyboard: NC_PI_T04_010
Template: [TextGraphic]
July 24, 2013
Screen Title: Reactivation of Pre-Existing or Past Stressors
On–Screen Text:
Disasters often uncover prior or concurrent psychopathology or adjustment difficulties caused by stressors that
individuals have not fully resolved.


These pre-existing stressors may become the primary focus for children or adults.
Reactivation of pre-existing stressors may occur even if prior and current events do not seem to be
related.
Footnotes:
n/a
Graphic = NC_PI_T04_010
ALT tag: alt="photo collage of September 11th memorial beams, young boy with his head down, and memorial
field of American flags"
Photo caption: n/a Photo credit: n/a
Screen Prompt: Click Next to continue.
Programmer Notes / Interactions & Feedback: This screen contains text and a photo, centered over the text.
Page 41 of 52
Draft Storyboard: Psychosocial Impacts of Disasters on Children
July 24, 2013
Lesson Name: Psychosocial Impacts of Disasters on
Children
Topic Name: Reactivation of Stressors
Storyboard: NC_PI_T04_020
Template: [TextGraphic]
Screen Title: Reactivation of Existing Stressors
On–Screen Text:
In the Field
Consider this report from the field, in which pre-existing stressors
played a role:
Students on a field trip were inadvertently exposed to Nbutyl mercaptan (an odorant with a skunk-like odor used
in natural gas) when a student opened a personal
protective device on a bus. Students who did not require
medical treatment underwent controlled decontamination
at a local children’s hospital in a very supportive context.
They were greeted by a nurse and child life specialist
who explained the decontamination process, and they
showered one at a time and changed into donated, new
clothing. Children then waited with child life specialists
and watched movies, played games, and had cookies
and punch until being promptly reunited with their
caregivers.
Despite nearly ideal conditions for decontamination, two adolescents experienced panic attacks for
several weeks after the incident and could not return to school. The school attributed the panic attacks
to trauma from the decontamination event and wondered what could have been done differently.
Professionals advised looking into the personal lives of the two children. One student was a new
transfer to the school, and the reason for the transfer was the recent murder of a parent. Further
inquiry with the other student identified previously undisclosed assault by a family member as the
cause of her distress.
Footnotes:
n/a
Graphic = NC_PI_T04_020
ALT tag: alt="neighborhood damage surrounded by emergency tape"
Photo caption: n/a Photo credit: n/a
Screen Prompt: Click Next to continue.
Programmer Notes / Interactions & Feedback: This screen contains text and a photo, right-aligned with text.
Page 42 of 52
Draft Storyboard: Psychosocial Impacts of Disasters on Children
July 24, 2013
Lesson Name: Psychosocial Impacts of Disasters on
Children
Topic Name: Reactivation of Stressors
Storyboard: NC_PI_T04_030
Template: [TextOnly]
Screen Title: Unrelated Events & Experiences
On–Screen Text:
When working with children, families, and professional staff that have been affected by a disaster, it is
important to anticipate that unrelated events and experiences may be the cause for what appear to be
reactions to the disaster itself. As the following story illustrates, such reactions may be experienced by
professionals as well.
In the Field
A primary school student is accidentally shot when another child discovers a loaded gun and
discharges it during play. During a meeting to train teaching staff about how to support grieving
children, one teacher begins to cry, resulting in the need to pause the training session. When asked
about her reaction, the teacher disclosed for the first time to her colleagues that she had miscarried –
over 10 years before.
Footnotes:
n/a
Screen Prompt: Click Next to continue.
Programmer Notes / Interactions & Feedback: This screen contains text.
Page 43 of 52
Draft Storyboard: Psychosocial Impacts of Disasters on Children
July 24, 2013
Lesson Name: Psychosocial Impacts of Disasters on
Children
Topic Name: Reactivation of Stressors
Storyboard: NC_PI_T04_040
Template: [TextGraphic]
Screen Title: Future Triggers
On–Screen Text:
Future events and references that remind children of losses or
disturbing images, sensations, and emotions associated with a
disaster event may trigger grief or trauma symptoms.
Click Play to hear children in this video explain how everyday
occurrences of studying in school and interacting with friends can
trigger thoughts and strong feelings associated with their loss.
[Play > ] [[http://www.youtube.com/watch?v=taJi4I4Yuw&feature=youtu.be]
Graphic = NC_PI_T04_040
ALT tag: alt="screen capture from video showing a young boy talking to the interviewer”
Photo caption: n/a Photo credit: n/a
Play button = Play.png
ALT tag: alt="play”
TITLE tag: title=”watch the video to hear from a child who has experienced loss”
Screen Prompt: Click Play to watch the video in a new window. Click Next to continue.
Programmer Notes / Interactions & Feedback:
This screen contains text and a Play button linked to a youtube video. OnClick, open a new window showing
the link; the learner will need to click Play in the new window to start the video.
Page 44 of 52
Draft Storyboard: Psychosocial Impacts of Disasters on Children
Fostering Wellness &
Recovery = NC_PI_T05_010
Page 45 of 52
July 24, 2013
Draft Storyboard: Psychosocial Impacts of Disasters on Children
July 24, 2013
Lesson Name: Psychosocial Impacts of Disasters on
Children
Topic Name: Fostering Wellness & Recovery
Storyboard: NC_PI_T05_010
Template: [TextGraphic]
Screen Title:
Community Wellness & Recovery
On–Screen Text:
Healthcare providers and other professionals that work with children and families are well positioned to lead the
way toward recovery for children and their families in the wake of a disaster or crisis event. By creating
supportive environments, coordinating services, providing information about resources, and fostering skills,
adults in positions of trust can provide a strong foundation for rebuilding community health. Basic steps for
fostering recovery include:





Creating a safe, child-friendly healthcare environment
Providing basic psychological first aid and supportive services
Facilitating supportive parent-child communications
Identifying short- and long-term interventions
Planning useful school-based crisis response
Continue on for details about these interventions or navigate to the areas that reflect your potential
contributions to community healing.
Footnotes:
n/a
Graphic = NC_PI_T05_010
ALT tag: alt="photo collage of healthcare provider and female patient, flag memorial, and a smiling young boy
with his dad"
Photo caption: n/a Photo credit: n/a
Screen Prompt: Click Next to continue.
Programmer Notes / Interactions & Feedback: This screen contains text and a photo, centered over the text.
Page 46 of 52
Draft Storyboard: Psychosocial Impacts of Disasters on Children
July 24, 2013
Lesson Name: Psychosocial Impacts of Disasters on
Children
Topic Name: Fostering Wellness & Recovery
Storyboard: NC_PI_T05_020
Template: [ClickExpand]
Screen Title: A Child-Friendly Healthcare Environment
On–Screen Text:
Pediatric healthcare providers can work to ensure that sites delivering medical care after a disaster are adapted
to minimize conditions that may increase post-traumatic distress for children and families.
Click each of the steps below to discover recommendations for creating safe, child-friendly environments.
[+ Reduce exposure to frightening images and sounds]



Close doors/curtains to reduce exposure to others who are injured or in pain.
Turn off televisions in waiting and exam rooms after a disaster.
Be aware that children can overhear conversations with staff and take action to shield them from too much
information.
[+ Minimize painful or invasive procedures or treatments]
Provide appropriate analgesia and sedation as needed.
[+ Facilitate connections with loved ones]
Encourage parents or other family members to remain with children throughout the evaluation and treatment
process to the extent possible.
[+ Encourage children to use coping strategies]
If children are familiar to you, suggest strategies they have found effective in the past, or suggest additional
strategies (e.g., distraction, guided imagery).
[+ Provide explanations in positive terms, underscoring what you are doing to keep them safe
or healthy]
Avoid emphasizing potential risks and reframe information in a positive light. For example, state “We are going
to put this belt around your waist so you stay safely in the stretcher while we bring you to the hospital,” rather
than “This belt will make sure you don’t go flying out of the ambulance if we have to stop quickly.”
Footnotes: n/a
Screen Prompt: Click each statement to reveal details. Click Next to continue.
Programmer Notes / Interactions & Feedback:
This screen contains text statements that, onClick, will reveal additional text below each statement. Once
revealed, the text will remain revealed (until the learner leaves and returns to the page).
Page 47 of 52
Draft Storyboard: Psychosocial Impacts of Disasters on Children
July 24, 2013
Lesson Name: Psychosocial Impacts of Disasters on
Children
Topic Name: Fostering Wellness & Recovery
Storyboard: NC_PI_T05_030
Template: [TextOnly]
Screen Title:
Psychological First Aid & Basic Supportive Services
On–Screen Text:
In the immediate aftermath of a disaster, all individuals who are affected (whether or not they appear to have
adjustment difficulties) should be provided psychological first aid (PFA)[ NC_PI_T08_030#pfa] and offered
basic supportive services.
The goals of PFA are to



promote effective coping strategies and accelerate the natural healing process by providing timely and
accurate information, appropriate (but not false) reassurance and psychoeducation, including guidance
regarding likely reactions to the event and strategies to promote adjustment.
help people identify supports in their family and community.
offer compassionate support.[17]
Pediatric healthcare providers and all those who support children (e.g., educators, youth leaders, spiritual
leaders) should aim to develop PFA skills and offer such support after a disaster.
Footnotes:
17 American Red Cross. Foundations of Disaster Mental Health. Washington, DC: American Red Cross;
2006.
Screen Prompt: Click Next to continue.
Programmer Notes / Interactions & Feedback: This screen contains text and a link to the glossary.
Page 48 of 52
Draft Storyboard: Psychosocial Impacts of Disasters on Children
July 24, 2013
Lesson Name: Psychosocial Impacts of Disasters on
Children
Topic Name: Fostering Wellness & Recovery
Storyboard: NC_PI_T05_040
Template: [TextGraphic]
Screen Title:
Supportive Parent-Child Communications
On–Screen Text:
By fostering parent-child communications during disaster recovery,
practitioners help establish a vital source of long-term support for
children and help families move toward a brighter future. Effective
communications can be achieved by following a few basic
guidelines:






Seek first to inform.
Start the conversation.
Encourage open dialogue.
Monitor media coverage.
Model healthy coping skills.
Reassure and encourage action.
Let’s take a closer look at each of these recommendations.
Footnotes:
n/a
Graphic = NC_PI_T05_040
ALT tag: alt="happy Latino family of four in front of their home"
Photo caption: n/a Photo credit: n/a
Screen Prompt: Click Next to continue.
Programmer Notes / Interactions & Feedback: This screen contains text and a photo, right-aligned with the
text.
Page 49 of 52
Draft Storyboard: Psychosocial Impacts of Disasters on Children
July 24, 2013
Lesson Name: Psychosocial Impacts of Disasters on
Children
Topic Name: Fostering Wellness & Recovery
Storyboard: NC_PI_T05_050
Template: [TextGraphic]
Screen Title:
Supportive Parent-Child Communications
On–Screen Text:
Seek First to Inform
It’s best to inform children as soon as information is known about a
disaster, rather than attempting to hide or shield them from the
reality. Even very young children readily pick up on the distress of
trusted adults and will overhear or otherwise learn information
about events.
A brief recording by one parent of conversations with his 2 year-old
daughter after the 9/11 terrorist attack on the World Trade Center
illustrates that even very young children are aware of such events.
Furthermore, with assistance, they can come to their own
understanding (at least at a basic level).
[Play > ]
[View Transcript ]
Footnotes: n/a
Audio = NC_PI_T05_050
Mp3 format
Graphic = NC_PI_T05_050
ALT tag: alt="young Indian girl looking scared"
Photo caption: n/a Photo credit: n/a
Play button = Play.png
ALT tag: alt="play”
TITLE tag: title=”listen to the audio recording of a
young child’s perspective after the 9/11 terrorist
attacks”
“View Transcript” button = view_transcript.png
Alt tag: alt="view transcript”
Title tag: title=”read the transcript of a discussion
between and young child and parent after the 9/11
terrorist attacks”
Screen Prompt: Click Next to continue.
Programmer Notes / Interactions & Feedback: This screen contains text and a photo, right-aligned with the
text. Place a Play > button below the text that opens an audio player and play the provided MP3 file from this
page. Original audio link = [http://soundcloud.com/michaelsradio/talking-2-sophia]
OnClick of View Transcript button, branch to NC_PI_T05_055 to display a page showing the audio transcript.
The Next button for this screen advances to NC_PI_T05_060; learner only sees the transcript if they
clicked View Transcript.
Page 50 of 52
Draft Storyboard: Psychosocial Impacts of Disasters on Children
July 24, 2013
Lesson Name: Psychosocial Impacts of Disasters on
Children
Topic Name: Fostering Wellness & Recovery
Storyboard: NC_PI_T05_055
Template: [TextGraphic]
Screen Title:
Supportive Parent-Child Communications
On–Screen Text:
Audio Transcript
Sophia: [Inaudible]
[Music begins to play]
Sophia: sings to music [inaudible]
Father (narration): I was talking to Sophia my two year old
daughter. We talk a lot, she and I. One day not too long ago
I woke up to the sound of crying; not Sophia’s but her
mother’s.
“A plane crashed.”
“They crash all the time,” I said sleepily.
“Into a building- the World Trade Center, New York.”
We decided to make it a normal day; Sophia would go to our friend’s house for the day as usual. I
would go to work and pick her up at the end of the day.
When I came to pick her up, our friend was watching TV, so was my daughter; watching the plane
go into the building again, and again, and again. Our friend said that Sophia was building block
towers earlier and knocking them down again, and again, and again.
Sophia: Crash!
Father (narration): What would I tell her about what happened? Well, the next night my wife and I
talked about this. She had told Sophia that it was an accident; that they didn’t mean to fly the airplane
into the towers, but, I don’t want to lie to my daughter. Even those little parental white lies: “there’s no
more ice cream,” “if you eat your spinach you can jump higher, right away,” “monsters aren’t real.” I
decided to see how much of the situation she had absorbed from TV, from our little talks, from her
parents anxiety. I asked her what happened on September 11 in New York.
Sophia: The airplane, it crashed! It went in the building and then the smoke came. Then I saw it.
Then it crashed!
Father (narration): It seems that she had taken in a lot, had thought about it. She asked me more
questions and I tried to relate September 11 to other things that were in her life, to help her and me
to understand why.
Sophia: The airplane flew in the building. What if somebody was angry so decided to hurt all the
Page 51 of 52
Draft Storyboard: Psychosocial Impacts of Disasters on Children
July 24, 2013
people.
Father: All which people?
Sophia: All the New York people.
Father (narration): in the beginning she called them ‘the New York people,’ but after a while they
became ‘the die people.’ Were the like plants? Do they dry up? Were they broken like the raccoon
that’s lying out in the street?
Sophia: What happens when you die?
Father (narration): A tough question for the best of them. I told her I didn’t know. What I did know
was that here in San Francisco the terrorist attack seemed blessedly far away and I just couldn’t
imagine New York and what it must be like these days; the physical and mental scars still fresh. I
asked Sophia if the story made her sad.
Sophia: No. I wasn’t in there. I wasn’t in..I wasn’t in New York. I wasn’t in the building that crashed.
Our building is okay.
Father: Yeah?
Sophia: Yeah.
Father (narration): Was I reading a nervous assurance in her voice? Or was she trying like many of
us to tell herself a story to make the world a safer place, at least in her mind?
Sophia: I don’t like the story of New York.
Father: Is it sad?
Sophia: Yeah.
Father (narration): I don’t like the story of New York either, but, its one I’m afraid I may have to tell
again, and again, and again, as I talk to Sophia.
[Music begins to play]
Sophia: sings to music [inaudible]
Footnotes:
n/a
Graphic = NC_PI_T05_050
ALT tag: alt="young girl looking scared"
Photo caption: n/a Photo credit: n/a REUSE photo here from NC_PI_T05_050
Screen Prompt: Click Next to continue.
Programmer Notes / Interactions & Feedback: This screen contains text and a photo, right-aligned with the
text.
This screen displays only if the learner clicks the View Transcript button on NC_PI_T05_050. The Back button
returns to screen NC_PI_T05_050 and the Next button advances to NC_PI_T05_060.
Page 52 of 52