Addressing Disaster Mental Health Needs of Children: Practical Guidance for Pediatric Emergency Health Care Providers

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Emergency health care providers are often the first to respond to the needs of children after a disaster. Although there has been an increase in research related to the impact of disasters, including terrorist events, on children's mental health, physicians continue to cite a need for additional information and training on the topic. This article provides an overview of recent literature on disasters and mental health, covering children's stress reactions, mental health problems that may arise, and risk factors that affect these reactions. Practical guidance for pediatric emergency health care providers is emphasized, including psychological first aid, recommendations for screening questions to facilitate mental health triage, and an overview of effective mental health interventions. It concludes with a discussion of the impact of providing care in the aftermath of a disaster on the health care professional.

Section snippets

Practical Assistance

In the aftermath of a disaster, pediatric emergency health care providers will need to be able to provide psychological first aid to children and their families, conduct a brief assessment for the presence of adjustment problems and risk factors for difficulties with adjustment, and provide rapid and effective triage for mental health concerns. Preparedness efforts should also focus on identifying systems of care that are suited to hospital settings for the screening and management of emotional

Psychological First Aid

The American Red Cross defines psychological first aid (PFA) as “the practice of recognizing and responding to people who need help because they are feeling stress, resulting from the disaster situations within which they find themselves”.34 Psychological first aid is practical assistance that includes offering emotional support, providing information and education, encouraging the practice of positive coping, and recognizing when more help is needed and helping individuals to get this extra

Children's Immediate and Short-Term Reactions to Disaster

How children react in the setting of a disaster depends on a number of factors, including the nature and extent of their direct involvement, their preexisting vulnerabilities and coping skills, and their age and developmental/cognitive level.3, 4, 33 Some common reactions that hospital staff may observe in children in the immediate and short-term aftermath of a disaster8, 12, 22 include the following:

  • Fears. After a disaster, children may develop fears related to the particular event (eg, after

Mental Health Triage

As soon as possible after initial medical stabilization and evaluation, assessment for adjustment reactions should be initiated. Without active screening, many children with mental health problems are not likely to be identified.39 This secondary triage will help clarify whether the symptoms observed are likely to represent an underlying physical condition, permit initial brief intervention and support for distress already evident, and identify children most likely to benefit from referral for

Mental Health Interventions

There are evidence-based interventions for children with PTSD and trauma-related disorders after any type of trauma, including disasters. Trauma-focused Cognitive Behavioral Therapy has been strongly recommended as the treatment for children experiencing PTSD and adaptations to this treatment have recently been made to incorporate traumatic grief.41 Children who experience the death of a family member or friend may benefit from bereavement counseling or support. Health care professionals will

Impact of Disaster on Professional Staff

When a disaster strikes a community, it is important to remember that providers along with their patients often have significant losses.3 Health care providers may need to respond to a dramatic surge in the number and level of acuity of patients at the same time they may be worried about the well-being of their family or friends and feel torn by these competing obligations. It is therefore helpful for professionals to have in place family disaster preparedness plans, so that alternative

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