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Children Coping with Terrorism and Disasters: Diagnosis & Treatment
10 CEUs Children Coping with Terrorism and Disasters: Diagnosis & Treatment

Section 14
Trauma Interventions for Disaster Survivors

CEU Question 14 | CEU Test | Table of Contents | Terrorism CEU Courses
Psychologist CEs, Social Worker CEUs, Counselor CEUs, MFT CEUs

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On the last track, we discussed a study conducted in 1994 that investigated the impact of a bushfire disaster in New South Wales, Australia.  The study also evaluated postdisaster screening methods for the children affected by the bushfire.

On this track, we will continue to discuss a study conducted in 1994 that investigated the impact of a bushfire disaster in New South Wales, Australia.  We will specifically discuss postdisaster coping materials evaluated by the researchers.

2 Interventions to Children Identified as Strongly Affected

Researchers offered two interventions to children identified as strongly affected during the assessments we discussed on Track 13.  High school children were offered a group therapy program.  All of the elementary school children, including the young students between the ages of 5 and 8, were offered a guided therapy manual called "The Bushfire and Me: A Story of What Happened to me and my family,"  by Storm, McDermott, and Finlayson.  Similar therapy principles applied to the development of each resource, including the need to be developmentally appropriate and to be sympathetic to the major communication style of children.

Intervention #1 - Guided Therapy Manual
The workbook used with the elementary school children included pictures, drawings, cartoons, activities, and much free space.  This meant that the workbooks were consistent with established therapeutic communication strategies such as Winnicott’s Squiggle Game and the use of drawings and play with traumatized children.  It is important to point out that both the guided workbook and adolescent group programs were not meant to replace mental health professional.  In fact, it was recommended that each child’s workbooks be evaluated by a mental health professional at the end of every complete chapter. 

Additionally, the programs were not seen as a panacea.  Parents, teachers, and other caregiving professionals were encouraged to identify children with either unremitting symptoms or persistent impairments, so that these children could be referred to more intensive individualized treatments. 

The workbook consisted of three sections.  The first and final sections were aimed at parents and caregivers, and included factual information about the bushfires, as well as psychoeducational information summarizing the range of typical emotional responses exhibited by children following a traumatic event.  Guidelines were also given regarding why some children may require a psychological intervention, while others might not. 

The middle section of the book was for children, and began by introducing a cast of anthropomorphic cartoon characters, such as a possum named "Firefighting Pos."  These characterized personified groups of people children likely came in contact with during the bushfires, and asked questions, made suggestions, described possible activities, and introduced factual information.  The structure of the workbook was a chronological progression from the predisaster period of normality, to predisaster apprehension, the actual disaster, the postdisaster aftermath, and transition points following the disaster.  These transition point included returning to school and anniversary reactions.

Manual Contents
-- Chapter one of the workbook focused on biographical details of the child, and training children in how to use the workbook. 
-- Chapter two was entitled "Before the bushfires," which aimed to remind children that their lives did not begin after the traumatic event. 
-- Chapter three, "The Fire Came" and Chapter four, "After the Bushfires,"  promoted intense reexperiencing of the traumatic events. 
-- Chapter 5, "People who helped," emphasized the positive aspects of volunteer and professional involvement in combating the fires and assisting with recovery. 
-- Chapter six, entitled "Back to School,"  encouraged children to share feelings and stories with friends, teachers, and others, and discouraged feelings of lonliness or being singled out. 
-- Chapter 7, "Several months later," focused primarily on community and ecological recovery following the bushfires. 
-- Finally, chaper 8, entitled ‘one year later,’ dealt with the possibility of anniversary reactions and mastery in the form of active preparation for the next summer bushfire season.

Intervention #2 - Six 2-Hour Group Sessions
The adolescent group program was comprised of six two-hour sessions with groups of six to eight students and two therapists.  The introductory session consisted of meeting participants and leaders and sharing expectations. Following sessions included elements of trauma reexposure and testimony, as well as psychoeducation. 

This psychoeducation included normalizing emotional and behavioral changes since the bushfire, as well as coping skills acquisition.  Skills acquisition included relaxation techniques, identifying and challenging unhelpful schemata and cognitions that had arisen as a result of the disaster, and gaining mastery by problem solving and prepare for future bushfire seasons.

Both parents and children reported being pleased with both interventions, although parents expressed a desire for a more simplified workbook for the very young elementary school children.  Unfortunately for the researchers, funding was not available for a detailed follow-up study of children’s psychopathology, so the follow-up was limited to a detailed client satisfaction survey for parents, children and parents together, and children separately.   

A large percentage of parents found the information in the workbooks useful, and agreed they would recommend the workbook to other families in similar situations.  54% of parents indicated that the workbook made it easier for them to discuss the traumatic events of the bushfires with their children.   90% of children felt that the workbook helped them to talk about the disaster.  Children also frequently reported that a parent would help them with exercises in the workbook, which was a positive experience. 

Aspects of the workbook that the elementary school children most liked were the coloring tasks, often of fire-related pictures, the dialogue from the cartoon characters, and certificates they could remove and send to firefighters or other caring people to thank them for their help.  children also described positive responses to the bushfire stories, empty pages on which the child could add his or her own work, and information boxes.

Think of a child you are currently evaluating for post traumatic stress following a disaster.  Would an exercise similar to the workbook described on this track be helpful in his or her recovery process?

On this track, we continued our discussion of a study conducted in 1994 that investigated the impact of a bushfire disaster in New South Wales, Australia.  We specifically discussed postdisaster coping materials evaluated by the researchers.

Peer-Reviewed Journal Article References:
Hamblen, J. L., Norris, F. H., Symon, K. A., & Bow, T. E. (2017). Cognitive behavioral therapy for postdisaster distress: A promising transdiagnostic approach to treating disaster survivors. Psychological Trauma: Theory, Research, Practice, and Policy, 9(Suppl 1), 130–136.

Hoover, S. A., Sapere, H., Lang, J. M., Nadeem, E., Dean, K. L., & Vona, P. (2018). Statewide implementation of an evidence-based trauma intervention in schools. School Psychology Quarterly, 33(1), 44–53. 

Marshall, A. D., Roettger, M. E., Mattern, A. C., Feinberg, M. E., & Jones, D. E. (2018). Trauma exposure and aggression toward partners and children: Contextual influences of fear and anger. Journal of Family Psychology, 32(6), 710–721.

Murray, K. J., Sullivan, K. M., Lent, M. C., Chaplo, S. D., & Tunno, A. M. (2019). Promoting trauma-informed parenting of children in out-of-home care: An effectiveness study of the resource parent curriculum. Psychological Services, 16(1), 162–169.

Jordan, B., Perryman, K., & Anderson, L. (2013). A case for child-centered play therapy with natural disaster and catastrophic event survivors. International Journal of Play Therapy, 22(4), 219–230. 

Online Continuing Education QUESTION 14
With what two established therapeutic communication strategies were the "The Bushfire and Me: A Story of What Happened to me and my family" workbooks consistent? To select and enter your answer go to CEU Test.

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