After the disaster - coping with tragedy

I love a sunburnt country, A land of sweeping plains,
Of ragged mountain ranges, Of droughts and flooding rains.
I love her far horizons, I love her jewel-sea,
Her beauty and her terror -
The wide brown land for me

My Country - Dorothy Mackellar

Dorothy Mackellar wrote this over 100 years ago and not much has changed – Australia is a country of extremes and emergencies. But what about after the shouting has died down? Rebecca Tucker talks about how parents can reassure fearful children.

An adult voice is a powerful tool and in the wake of one of Australia’s most tragic days, Black Saturday, a collective shout echoed through the nation.

Their sounds of pain as the bushfires killed their loved ones, destroyed their homes, and wiped out their communities tore through our minds and their tears stained our hearts. We couldn’t watch the TV without shedding a tear. And we responded with amazing generosity.

Not as loud, but just as powerful, are the voices of the thousands of children touched by the bushfire tragedies. Adults can often verbalise their pain more easily and, in many ways, can make sense of the nonsensical so much more clearly than a child.

When the worst happened, the Victorian Government’s education department immediately implemented its strategy to make sure the needs of those smallest in our communities could be addressed - both now and into the future.

Speaking a month after the fires, the Department of Education and Early Childhood Development’s senior child health medical adviser, Dr Sharon Goldfeld, said the government already had guidelines and plans for how best to respond to situations of trauma, such as the loss of a parent.

‘This is a different level, but that said, bushfires are part of Australian life and we had things already in place,’ Dr Goldfeld said. ‘We collaborated with the Department of Human Services to come up with a plan for the best way for parents to deal with the tragedy.’

The department now has on its website a link to its specially-developed bushfires resource, which outlines support services and tips for parents, schools and early childhood communities.

The resource goes further and offers a link to donating to schools, as well as providing a blog. Featured on the online resource are several videos, in which staff including Dr Goldfeld point parents towards a ‘parent tip sheet’, explain that counsellors are available at schools in areas affected by the bushfires and provide advice on how to respond individually to a child’s behaviour in the wake of the events.

Dr Goldfeld said the department had, for the purpose of discussion, identified three groups of children affected by the fires:

1. Those living in the areas and who had either lost family or friends.
2. Children who lived in other regional areas and who could identify with the surrounding environment which had burned.
3. The more general childhood population, which could likely experience an emotional response to the images they saw through the media.

An immediate priority, Dr Goldfeld said, was to try to normalise life for children as much as possible. Keep children from disturbing images on TV and in the print media where possible. In instances where homes had been destroyed, she said the most important thing was for children to remain with their parents or family, if possible.

She said it was important to monitor behaviour as time passed. Some children will act out, others internalise their thoughts or grief or may regress developmentally such as toileting or their sleep patterns may change. Some behaviours may not emerge until months after Black Saturday.

School and early childhood services quickly resumed in bushfire affected areas to provide a level of normality for children, and in towns such as Marysville where there was no longer a school, temporary measures were put in place.

For those children not living in the towns where bushfires stormed through, it is still important to be mindful of the affects of the tragedy on young minds. Unfortunately, tragedy is not an uncommon occurrence in the world of children. It strikes in many forms, from the large scale bushfires to less-publicised personal loss of loved ones.

As Dr Goldfeld said, ‘We’d like to think the plans the experts have in place never have to be used, but the reality is tragedy and trauma exist in our communities.’ Black Saturday was about as dark a reminder as we have seen.

Planning for emergencies

In Queensland, the Department of Emergency Services has devoted a special web page for children, taking the stress out of the word emergency through games which teach them how to cope – even if they don’t know they are being taught as such.

The resource is a proactive approach towards helping ensure children are prepared for an emergency. A specially-created character, ‘Ernie Kidna’, takes kids though a quiz on how to prepare, while online games test memory in the fun and educational toolset.

In the United States, a similar page has been developed by the US Fire Administration, under the banner of Sesame Street. The USFA has created an activity book and CD of songs and stories for preschool educators teaching fire safety messages. The site provides links to a Let's Have Fun with Fire Safety: Marty and Jett's Activity Book and the Sesame Street Fire Safety Station Color and Learn sites.

Following the Sesame Street theme, Sesame Workshop, the not-for-profit organisation behind the children’s TV program, has developed a family friendly resource on emergency preparedness in the wake of the country’s own national tragedy, 2005’s Hurricaine Katrina.

According to the site, the US Children's Health Fund estimated that about 65 per cent of families did not have a known emergency plan. With that in mind, Sesame Workshop created its Let's Get Ready! Planning Together for Emergencies with the Department of Homeland Security's Ready Kids initiative and in conjunction with the US Ad Council's ongoing plans. The project included a Sesame Street DVD, a magazine for parents and caregivers, and a children's activity book, all based on expert research and recommendations.

Regular contributor Dr John Irvine discussed ways to help children after any traumatic event on 9AM with David and Kim (Channel 10)

For young preschool children, the reaction of those trusted adults around them is the biggest factor in how the child will react. Children have little perspective of life and may be unable to interpret its meaning other than through the reaction of others.

After an accident, emergency or a disaster, the best thing parents can do for their child’s welfare is to put their child into the care of a calm trusted adult. Then they can attend to the immediate situation.
For primary school aged children, the reaction of the caregiver is also important, but be aware that kids from age 6 need their brain settled too, not just their body and soul.

Be ready to answer questions, take them through what they remember and do some of the initial debrief you would do for older children and adults.

Debriefing is about as important as CPR in the emergency repertoire. It should be provided by a professional trauma specialist or psychologist to every person who has experienced trauma as soon as practicable after the disaster, so that the mind and emotions can come to terms with the incident.

It has several phases starting at the cognitive or thinking levels, linking in the emotional or feeling aspects and then reintegrating these together for the mind to make sense of it all.

1. Introductory Phase - the counsellor explains the purpose of the debrief which is to help their mind come to terms with the trauma and confusion it has suffered.
2. Fact Phase – the debriefer asks those traumatised to recall and relay just the facts about what they saw, smelt, felt and heard so it's as real as possible.
3. Thought Phase – trauma victims are then asked to say what thoughts went through their mind personally as they came out of shock or off ‘automatic pilot’. This aims to personalise the experience beyond just simply a collection of facts.
4. Reaction Phase – this is the emotional level of the process where participants are encouraged to go beyond thoughts to feelings – how they felt at the time and how they feel about it now. In this phase the trauma victims are asked to describe the worst part of the incident and it is at this point that past unresolved feelings from previous events may occur.
5. Symptom Phase – in this phase the victims are asked about any unusual experiences or symptoms they felt at the time or since. This is an important phase as it gives an indication as to what future intervention or help may be required.
6. Teaching Phase – this is the opportunity to reposition any such stress reactions or symptoms by providing information about normal stress reactions experienced by people following the type of trauma they're now dealing with. This can be very reassuring for victims to know they're not going ‘mad’ and to understand why they have reacted as they have. Often the debriefer will talk about the stages in the grieving process and together decide on what friends or family they might call on to help in this healing process.
7. Re-Entry Phase – this brings it all back to the mind or thinking level where the debriefer summarises what went on, again mentions how normal it is to have stress reactions, answers questions and talks about what follow up there will by phone or visits or whatever.

Problems on the mind can escalate to dangerous levels unless handled by expert psychologists. Let's face it, whatever the problem, they know how to ‘couch’ it.

Post Disaster Phase

Some kids are more resilient than others and some wear more psychological aftermath. Generally be guided by what you see of their recovery.

Symptoms of stress

Research shows that parents have difficulties identifying a child under stress and it’s not until the stress is quite serious – extreme violence, suicidal talk, self-harm – that they acknowledged its presence. Here's a checklist for identifying stress in kids before it gets too serious. There may be cause for concern if your child presents with more than seven of these factors, or if one or two are quite extreme:

• Sleeping late (even on weekends) or insomnia
• Avoiding school
• Fighting with both siblings and friends
• Displaying hostility to teachers and other adults
• Irritability and sensitivity to people and environment
• Complaints of physical illness
• Onset of bedwetting or soiling
• Nightmares
• Increase in clumsiness and accidents
• Trembling, nervous tics (twitches)
• Teeth grinding
• Prolonged loss of appetite
• Stuttering
• Repeated movements – rocking, head-banging

If you have the feeling that many of these symptoms resemble those children with defiant, aggressive and hostile behaviour ('naughty kids') rather than 'stressed kids' than in a sense you’d be right – because many of the kids suffering stress are misdiagnosed as ‘naughty’. Far too often, parents, teachers and health professionals treat the symptoms of the stressed child by targeting the disruptive behaviour, rather than treating the cause.

Adapted from the full text of Dr John’s segment, Feb 11, 2009

Resources 

Victorian Bushfire Resource

Let's Get Ready - Seasame Workshop

Queensland Government Kid's Page

USFA Kid's

This article was first published in Australian Family Magazine, May 2009. Updated July 2009.