Audio transcript (edited)

MR DOLMAN: Well good afternoon everyone, and welcome to today's webinar, 'Supporting children after natural and human-induced disasters', which is coproduced by CFCA and Emerging Minds. My name's Chris Dolman. I'm the senior workforce development officer here at Emerging Minds, National Workforce Centre for Child Mental Health, and I'm really delighted to be facilitating and joining our presenters today for this webinar.

In today's presentation, we'll be discussing importance of not overlooking, but in fact attending to the needs of children in relation to their experience of natural and human-induced disasters, and how practitioners can help children and families navigate through, you know, the effects of disaster on their lives and those around them; so we're looking forward to really delving in to those things. But before we do, we have some, I guess, housekeeping details to give you.

Of course, one of the core functions of the CFCA information exchange is to share knowledge, and so I'd really like to invite you all to submit questions via the chat box during the webinar. This really adds to the richness of what is discussed today, and we'll respond to these questions at the end of the presentation. Any questions that we don't quite get to will be published or may be published, along with your first name on the CFCA website, and there'll be a response from the panellists as well to those questions. So please let us know if you don't want your questions published or your first name included.

We'd also be really keen to continue the conversation we begin today. In fact, we haven't really begun it today; it's been an ongoing one at Emerging Minds. But to facilitate the continuation of the conversation, we've set up a forum on the CFCA website, where you can discuss ideas and issues raised or put forward other questions as well. We'd really welcome that opportunity. So we'll send you this link at the end of our presentation today. And also at the end of this hour long presentation, we'd like to invite you to complete a short survey. Really appreciate your feedback, and that helps us get better at what we do.

So yes, please also remember this webinar's being recorded and so the audio and transcript and slides, all of that will be available on the CFCA website and CFCA YouTube channel in the coming weeks or so. So yes, I hope that's all clear around some of those housekeeping matters. I'd like to sort of continue on and to the next slide, and offer a acknowledging of country as well. I mean, Emerging Minds and CFCA really wish to acknowledge the traditional custodians of the lands across Australia on which our webinar presenters and our participants are located, and we certainly wish to pay our respects to elders past, present and future, for the memories, the traditions and culture and hopes of indigenous Australia.

It seems as though there's a bit of a delay with the slides changing. I'm sorry about that. We certainly like to recognise the wisdom and knowledge that Aboriginal communities have in responding to natural events on the land and their commitment to caring for the land over a long period of time. But in terms of our learning outcomes today, so you know what's ahead in the next hour, this webinar will be supporting practitioners to prepare children and their families practically and psychologically for a disaster.

We'll be having conversations that support practitioners to interact with children during an event, in a way that may enhance their resilience and recovery; support children and their families immediately after an event, as they re-establish a sense of safety; support children and their families in the ongoing recovery process; understand the importance of self-care during and after a traumatic event. And from today, one of the outcomes will be that you'll be able to identify emotional and behavioural difficulties in children that may indicate that ongoing specialised support is required.

So this webinar is in fact the first of one of six webinars that is being coproduced by CFCA and Emerging Minds for this current 1920 year. So we've got a list of our current webinars coming up now. You'll see some other webinars that we'll be presenting around responding to parents who are addicted to alcohol and other drugs, and how children's needs can be considered through parent sensitive and child aware practice and non-shaming practice. Another webinar around parent/child play, a mental health promotion strategy for all children.

We'll be looking at child-focused supervision practices in the new year, and what does this mean and how it works; as well as working with Aboriginal children and families in mainstream services, and also cultural considerations when working with children and families from cultures other than the practitioner's own. That's a bit about what's ahead in our webinar series. But it would be good to move on and actually introduce our presenters for today.

It's certainly my pleasure to do that, to introduce Nicola Palfrey and Michelle Roberts. Yes, Nicola, I was wondering if you could begin even by saying a few words, a bit about what's kind of captured your interest in this area.

MS PALFREY: Thanks Chris, and hello to everybody this afternoon. Yes, I think what's captured my interest in working in this space over the past couple years, pulling together the community trauma tool kit resources, is just the complexity of the space. I think going into it, I thought I knew a little bit about impacts of trauma and adversity on children and families. And I think particularly often, natural disasters get categorised as a kind of simple disaster, or a simple type of trauma. And I think what's captured my surprise is that's not true. It's incredibly complex, and so understanding the different layers of that has really got me interested to learn more actually.

MR DOLMAN: Great. Yes, well thank you for that. Yes, we're looking forward to you sharing some of your learnings and knowhow from your involvement in this area of work, so thank you for that. Michelle, what about for you? What would you say has captured your interest, and what's kind of sustained you over such a long period of time of involvement in this area, and commitment to this area of practice?

MS ROBERTS: So hello everyone. I have been involved in this area for just over 30 years now, and in that time I've seen enormous blooming of knowledge and understanding and recognition. My interest began when I was a teacher in a school that was impacted by the Ash Wednesday bushfires, and we had very little knowledge back then. And I made it an important part of my understanding and professional development to see if we could do better each there was a disaster or an incident that required support of community and children.

Sustaining me is my passion for it, because I'm seeing it grow and I see more and more people aware and interested, and wonderful practice out there, and I want to see that keep on growing.

MR DOLMAN: Terrific. Yes, to see if we could do better; that's what it was that kind of drew you to this and yes, certainly we're hoping that that's a contribution that today's webinar can make to the practice of many folks out there. So thanks, Michelle, for that as well. So welcome to both of you, and yes, Nic, I'd like to kind of hand it over to you now to kind of continue with the presentation. Thank you.

MS PALFREY: Great. Thank you, Chris. So, yes, if we start by I suppose orienting ourselves to when we're talking about – we have got natural disaster on these slides; we're also talking about some of man-made or events that are perpetrated by humans to one another, when we're talking about the general principals today. But in terms of the timelines, just give ourselves an orientation, we're talking about preparedness, which is obviously any time up to an event. So it could be, not necessarily something right before, because we don't know when events are going to happen.

Sometimes they're scheduled; obviously bushfire preparedness or coming into cyclone season, activities that go on, but it could be anytime. In terms of the immediate, we're talking about the days and up to four weeks following an incident; short term, which is up to four months, and then longer term is four months and ongoing consequences after exposure to a traumatic event or disaster. And the reason we've kind of put those timeframes in place and specified them, is we've linked them to mental health and well-being outcomes and research, rather than necessarily recovery timelines, as in when things rebuilt or when schools are reopened, or other timelines which are not necessarily connected to looking after children's mental health and well-being.

The other timeline that's not on there, which we have also been looking a lot at, is the kind of ongoing exposure to natural disaster, which obviously at the moment is very important and present for people throughout Australia that are suffering under drought conditions. So that just orients us a little bit to the timelines that we're going to talk you through today. But as we get into the content for today, I just want to first of all, in the next slide, talk a little bit about self-care. There's a lot of talk about self-care in the health and social services space, which is what that HSSP stands for. Health and social services practitioners, which a lot of the audience may be today, but there'll also be people that work in other contexts.

But we really felt it was important to address this upfront in this context, particularly around impacts of community trauma events or disaster, that practitioners that are working with children and families are often also impacted by these events. So if there's been a major flooding in a town, practitioners are often back at work shortly thereafter, trying to support the families that they work with, whilst also dealing with their own impacts of the disaster or critical incidents.

So I think it's really important not to just add this on it end as a and by the way, look after yourselves. It really is something that needs to be upfront. And I think one of the things that we found, when we were putting together the research and needs assessment of the community trauma tool kit, was that this isn't often on health and social services radar, in terms of community trauma support, until an incident happens.

And so I think for those of you that are listening, that are program managers or policy involved in that way, it's good to reflect on what does actually your organisation have in place in terms of self-care, but also preparedness around how your organisation will support staff to support families in the occurrence of a disaster or community trauma event. So self‑care's really important in terms of finding a way to look after those that you're working with. There really needs to be a prioritisation of self-care for those practitioners working with families. We just wanted to start with that upfront.

So thinking about disaster preparedness and how we might support children before a natural disaster event. As I said, this could occur at any time. It might be in the months leading up to bushfire season or cyclone season, or it could be done any time. We're always on that timeline of disaster recovery, rather than preparedness, short term, long term recovery. But one of the things that we do know, is that sometimes people are reluctant to talk to children about the likelihood or that a natural disaster might occur or that a critical incident might occur because we don't like to frighten children, and that's understandable.

However what we know, and what the research shows us, actually is that children are obviously aware that these events go on. Often they're more aware that we would like to think they are, and so if we don't seek out these topics with children and speak to them, then often we're increasing rather than decreasing their anxiety because they're worried about these things, and they're not necessarily talking to us about them.

So as a practitioner working with families, how might you encourage parents to prepare early. So if we start to go through some of the key points that you might want to consider when you're talking with families. On the next slide, one of the things that we can do, is to support families to speak to their children about these events, and to engage them in a meaningful way.

So again, there's a lot of good research, actually Australian research that's come out around the value of children being involved in disaster preparedness in their family; so age‑appropriately being given tasks or responsibilities within the family planning around what they might do in the case of a need to evacuate, for example, or to take care of pets, or to keep in contact with each other; what they might want to have to take with them.

Obviously we're not wanting to overburden children, but having them involved and understanding of what the plan is, is actually one of the most effective ways you can keep children feeling supported and calm about the likelihood that something might happen, but if it does happen, that there are plans in place. And this has also been shown to be the case even in areas that have been impacted by disaster, so in Queensland, following the floods in 2010 and 11 and in Victoria, following 2009 fires.

There is research that children that have either been through those events or know their families have been through those events, at the time, when they've been involved in really meaningful, child-centred preparedness activities, that they feel more contained, less anxious, and more like if something like that were to happen again, that they would be able to manage it.

And so if we're talking about how we might support families in disaster planning, I think we can talk about a whole family approach, and the necessity or ideally you want to be doing this in an ongoing way, not just with a one-off conversation that you've gotten about and, you know, did three years ago when the kids were much littler and everyone's forgotten where the plan is, and what was involved and all of the kind of procedures and processes are out the window.

But if we have a look at the next slide, we can talk about revisiting early, getting a whole family involved in it, as I said, but also thinking and introducing the notion that we need to prepare for these events practically, which a lot of people are used to. They're used to the kind of Ready Plan, Red Cross resources about who's going to go where or what documents are you going to take with you, but also, equally important is a psychological preparedness, and that's something that obviously practitioners that work with families are well-placed to discuss with them about how they might introduce these ideas to their children, what they might need to work on.

So for example, in frightening situations, we know everyone's going to be a bit overwhelmed, so what kind of activities or skills might we need to calm ourselves down when we're feeling very frightened. And so that psychological preparedness; getting some skills up our sleeve, you know, what tricks or techniques does your family know about how to calm down. So you might be introducing something like slow breathing techniques, and helping parents to support children to know those activities, which obviously apply in lots of different circumstances, but that they can utilise in their preparedness.

All right, and so there's a lot more detail on preparedness plans and how you can support families to do that on the Emerging Minds website, so we won't go into a lot more detail about that at the moment. But if we move forward and think about the immediate support that children and families might need, and the role that practitioners can play in the event of an emergency.

Again, we know from talking to people who've been through emergency situations, bushfires and floods, particularly those living in small communities or rural and remote communities, everybody knows everybody in those contexts, and they certainly know if you are a psychologist or a social worker or an educator or somebody that the community feels knows about children and how to support them. And so we know that practitioners in the immediate aftermath of an event, are not only trying to look after their own safety and the safety and well-being of those around them, they're actually drawn into lots of conversations and asked to comment on how to provide support to children, in the moments, hours and days after a disaster, in recovery centres, but also in the broader community.

So in response to this, we've developed and kind of built on a very well-known and evidenced based approach to providing support in the immediate aftermath of a disaster, which is psychological first aid, and we've adapted it to look at how you might adapt psychological first aid principles directly in working with children. And so when you think about the demands that can be placed on a practitioner in those circumstances, everybody's going to be experiencing these big feelings; a lot of anger or sadness; frightened children; distressed parents that have been separated.

And in terms of how you might work with that, without obviously going in, it's not going to be the time or place for, you know, engaging in therapy, but trying to offer on-the-spot support and guidance in terms of how to keep calm, how to meet children's needs in the moment. We feel that psychological first aid is a really helpful framework that health and social services practitioners, but also obviously lots of emergency management personnel are trained, and the volunteers are trained in this response, can be really helpful.

So if we think about why you would want to do this, during an event and in the immediate aftermath, we'll cover through just the impact on the next slide of having the right support at the right time. So we do know that if children are responded to sensitively and appropriately during an incident and the immediate aftermath, there are significant positive knock-on effects. And so the importance of having some capacity or feeling like you know what to do and when to do it, and to be able to translate that over to parents or other volunteers or people that are interacting with children, can be really beneficial for kids' long term recovery.

So if we have a look at psychological first aid for children; we've developed a snappy little infographic to just try and cover the main principles of what that might look like in the immediate aftermath of an incident. So each of these keys points is not rocket science; it would make sense to any of us who interact with children, whether or not we're practitioners or not, in terms of what you might do. We think of it really, in response to some of the feedback we'd had from people about how they interact with children following disasters or being uncertain about the right thing to do, this is really a common sense approach that we feel gives some endorsement or backup for people who feel like, I think this is what I should do, and so this is a way of legitimising probably common good sense that all of us would think is the right thing to do.

So if we just run through them very quickly there again; pretty straightforward concepts. In terms of if you were to interact with a child or young person in the immediate aftermath of a disaster, the first priority is obviously ensure their safety. So take them away, reduce them from threat or harm, in terms of exposure to danger, but also exposure to talk or distressing events, recounting of death tolls or explicit details. So trying to take the child away from the sights and sounds and smells and other stimuli, as much as possible, that will cause them additional distress.

Also within that, is a recognition of keeping them out of the way of the media. Media are often keen to get the story and also sometimes perhaps not operating in a way that we would think is in the best interests of children. That might not be talking directly to children, but talking to their parents while their children are in earshot, and asking their parents to recount what would be very traumatic events for children to hear. So protecting them in terms of safety, again, not just physical, but psychological safety.

Number two; keeping calm. Obviously that can be very difficult to do in an emergency situation, but as much as possible, providing a calm and reassuring environment. Obviously you can't promise that everything's going to be okay, if that's not the case, but trying to give children some sense of calmness and security in the way you speak to them, in the way you reassure them what's being done; that you will get them to wherever they need to be as soon as possible, and just modelling that containing, I think, which is really what is needed in this time as much as possible.

Point three; connecting with others. Obviously if you're with a child that is separated from their parents or caregivers, then you would stay with them for as long as possible, as long as feasible, until you can connect them with someone that they have a relationship with, so if not their direct family, maybe another adult that's known to them, a coach, a teacher; those sorts of things. So that connecting in, and if that's not possible physically, to think about how you might be able connect them via technology if phone lines are up and so forth. But that recognition; just keeping children in the loop, as you do what you're doing and when you know what you know about when they can be reunited with people or things, if there's things around; teddies or other items that they can be drawn together with, to help them feel a bit of a sense of connection.

Encourage self-efficacy. A very common concept for anybody working with children and families. It's just a strength based approach; talking to children around what they're doing well; what a good job they're doing at keeping calm. We don't want to be dismissing them and telling them that they, you know, don't cry now or be brave and keep quiet, or don't distress other people. We want to acknowledge and validate their feelings, but also encourage them, 'You're doing a great job of doing big, deep breaths at the moment'. You know, 'Can you show me how to do it? How deep can you go? Any other ideas of what we could do to keep ourselves feeling calm at the moment', and just really assuring children and giving them some experience, and some distraction really, around what going on.

Having hope. So again, not being unrealistic in the circumstances, but speaking with children about what we think might happen, what will happen next, but also what they can expect. So, 'Things are very frightening at the moment, but things will calm down in a little while, we'll find a nicer place for you to sit or we'll get you something to eat'. I suppose just having some kind of notion that children need to be informed about what's going on, but also that the adults are in control and that they will be moving them towards a much more pleasant situation as soon as they can.

So that's a quick run through of psychological first aid for children, in terms of how we might think about that as a framework, and obviously this can apply in emergency centres, but it also can occur after any frightening incidents, so in schools or in interpersonal incidents that happen within families. Those kind of notions of safety, calmness, connections, self-efficacy and hope are pretty good framing philosophies, I suppose, for working with children and families, more generally.

So that's just an introduction to some of the concepts and resources we've developed around supporting in the preparation and immediate aftermath of natural disasters or other events. I'm going to hand over to Michelle, who can talk a bit more about the shorter and longer term recovery for children and how to support them in those contexts.

MS ROBERTS: Thanks, Nicola. I have to go back and just talk or focus a little bit on that notion of hope, because it always brings to mind some of the work that I did in the 2009 Victoria fires, where so many children that I spoke with, spoke about the fact that people had lost hope for them, and that they thought they were damaged good, and therefore they didn't feel that they had a progression in their life from that point. So although we see psychological first aid as a first step, universal intervention, it's something as you said, needs to be carried through and underpin a lot of the work that we do.

So in supporting in the short term and the longer term, remembering we're talking four months and after, we probably need to think about the fact that it takes a long time for families and the members of families and community to find their equilibrium and what the new normal is, after a disaster. We know that every child will react differently to the traumatic event, and it's not always clear what reactions they're going to display and how it might affect them or impact them in the longer term.

So after a natural disaster, the child's life is really in relation to all the relationships they have, and how they make meaning of the event is within the framing of those relationships, a lot of the time. It's really important I think, as practitioners, that we do our best to support the important people in the child's life, as well as the child, and when we look at ages and stages, you know, in the very early ages, of course we're going to be looking to give the parents and carers the tools to support and help their child through the experience.

So if we move into the next slide, and we're looking at those age-specific supports. There's a bit of a lag on our slides; I'm sorry. The reactions vary depending on the nature of the event. They also vary on the child's subjective experience of that event, their proximity and the exposure they have to distressing sights, sounds and smells; and the sense of life-threat to themselves and others. When we talk about the objective reality of the event and the subjective perception, we can come to an understanding of where the child sits within that experience; and it's the beginning of our ability to triage and understand from the child's perspective what their experience has been and what the likely outcomes might be for them, in relation to that.

So the information that we're going to discuss further on from this point on, is to help you, the practitioners, in your practice, and to talk a little bit about how you can prepare yourselves, both professionally and emotionally, and how you can provide parents and children with the tools they need to move forward from this experience.

We're looking now at the slide where we're looking at babies and younger children, and in my time of working in this area, right back at Ash Wednesday, it was considered that children this young would be totally unaffected; that they would be unaware that something catastrophic and challenging had occurred, and that they were too young to know, and therefore we didn't have to do any work there. And I'm pleased to say our knowledge in this area has grown exponentially, and we know that even the tiniest baby and pre-term children, and children who haven't even been born yet, can have adverse impacts from disaster.

Again, I'll use the 2009 Victorian bushfires, because I did a lot of work then. This year, tenth anniversary, is the first year in one school that all their prep-age children have been fully toilet trained, and they noticed a big drop-off after the fire in a lot of those developmental gains, that had been taken pretty much for granted previously. Parents are still identifying that their children are challenged in their language development; that they're reluctant to separate. So from the very, very tiny babies and toddlers of course, can experience fear.

Their brains and bodies are developing, and being suffused with cortisol and adrenaline and all those other hormones, can change their physiology and have long term implications. So they're not too young to be affected, but we do know that good support and nurturing can give them an opportunity to grow through that and to not have long lasting issues related to the disaster. So returning to a sense of safety with care and nurturing is fundamental to helping babies, children and children of older ages as well, in coping with what the event has been.

I think the challenge, as a practitioner, is that we're dealing with a changing dynamic in the child themselves, and development can be difficult in lots of ways, but when we're working therapeutically in this circumstance, it's often hard to know whether the behaviours are characteristic of normal development changes or whether they're linked to the disaster, and their behaviours may be adaptive, and it's hard to know what's indicative of reactive stress and what's trauma related symptomology.

And so reaffirming your own knowledge of normal developmental trajectory and expectations, and then looking at the behaviours and talking with the parents, is a really important part of being able to gauge whether or not we're getting into some sort of tricky territory and some concerning behaviours. And we need to keep in mind, of course, that development's asynchronous, so that we'll have some children from nought to 24, as this slide shows, 24 months, who have fantastic language skills and are probably at about four years of age, but they're still struggling with their toilet training. So that asynchronous development can make it difficult to know what's related to the event and what's the nature of that child. So trying to find a baseline of understanding of how that child had been travelling prior to their exposure to the event, and the impact on the family, is a really good starting point.

There are two really amazing authors in this field; they've been around a very long time. One's name is Lenore Terr, and she wrote a book called, 'Too Scared To Cry'; and another one is Judith Herman, who wrote, 'Trauma and Recovery'. And in their books, they talk about the fact that reactions to the same incident may alter with the developmental progression of the child and circumstances of their exposure, so that a child who may seem to be coping and relatively unaffected by the experience, may as they can more skills such as language and meaning making and a moral standpoint, reassess their exposure and their experience and bring to light different aspects of it, and it can be ongoing. It's something that we need to be checking in with as we go along.

So when we're looking at the behaviours that we're trying to identify whether they're within normal expected behaviours, or whether they're ones that we should be concerned about, crying, searching, being easily triggered into startle responses, being clingy. Significant changes of behaviours are the sorts of things that we would be looking for. The things that we can recommend and that we can do ourselves in supporting these children is, as you can see on your slide, consistent and predicable routines; and that's one that I always feel a need to explain, because in schools, in particular, and that's for the older kids, obviously, we're very quick to try and get kids back into school for routine. But if the teachers and those in the schools aren't coping themselves, then that isn't necessarily the best first step. So routine, predictability, understanding what the expectations are, are really important to getting some sort of rhythm and pattern back into the life.

Monitoring symptoms, using watchful waiting and remembering to put that trauma informed lens that we spoke about, into your watchful waiting, so that you can decide whether or not this is indicative of concern, is a really important part. Reflective listening and listening with your eyes and ears, is also very valuable. Children of this age often communicate in non-verbal ways, and so we need to be looking for signs in their play, in their behaviour, in their distress and their happiness, to interpret what the impacts might be.

Being an advocate is one of the really important things that I see we can do, as practitioners and as teachers, in this area. Adults aren't always able to interpret behaviour in children as being linked to their disaster experience, and in fact some research indicates that teachers and adults are really wary to link behavioural changes to disasters. I think it's quite confronting to think that this little person has been impacted by the experience, and it's not surprising if you, yourself, have been part of that overwhelming experience, that it's going to be tough to acknowledge the impact on children, and so avoidance is quite a common characteristic that we see as a consequence.

Other strategies are providing clear expectations, boundaries; being positive in your communication. Nicola spoke previously about self-efficacy, and part of efficacy is the ability to make choice. Sometimes when they're this tiny, guided choice, but to right from the beginning, use a strength base in your relationships.

Nicola also mentioned about some of those grounding and relaxation strategies that we can teach, even the very young children; and you might be aware of some of the really lovely Sesame Street apps that help really young children understand about calming, self-soothing and breathing. So creating those opportunities and skills is another really important way to support children.

If we move on to looking at children in the two to four and five to 12 year range. Although our strategies can be similar in some areas and some of those core premises hold across the age ranges, there are some things that I'll want to pull out as we go through here. So evidence about big developmental differences here have informed our knowledge around the strategies that can be employed, will make some assumptions around the core premises that we already understand and have spoken about, but I think that it's important to think about as children become more verbal, as they're able to look at what's going on and to understand that there's been a situation and there's been life threat, then we're likely to see more significant reactions and distress.

Once again, you're monitoring those symptoms over time. You're using curious questioning; you're looking at it from the child's perspective; you're maintaining you're knowledge in this area, and we're likely in these ages to see dysregulated behaviour; tantrums that can push people's buttons and get responses that cloud our ability, I think, to see that this is a related behaviour to the experience that they've had. For those older children, there's greater potential for harm if they've witnessed threat to their loved ones, they've heard and seen distressing sounds, and they've felt a sense of life threat for themselves.

We know that after a disaster or when we know there's an impending disaster coming, children are often sent to relatives or separated out from parents. The disaster itself can bring about separation, and lead to children fearing for those that they love and care about, and often they're imagining of what's happening is more difficult than the reality of being part of the experience for some. And I certainly had children that I worked with you have spoken about they would have rather been there and been able to help and be with their family to feel safer, than to be worried about losing their whole family and their animals in that circumstance.

Psychological distress manifests in many ways, and I think we tend to, as adults, pick up on acting out behaviours more than we do those internalising behaviours, and so I'd like to remind you to look for both when you're doing you're watchful and careful monitoring of children after their exposure to disasters or critical incidents. It can be difficult to interpret the behaviour across the lifespan, as I've already said, but I think that we tend to inadvertently not pick up on the kids who are quiet in the corner, who are overly altruistic, who are so caring that they put their own needs last; and of course our attention is drawn to the child who's angry and acting out. There's a real risk of misdiagnoses in this area and unfortunately these kids are often labelled as having attention deficit ADHD, oppositional defiance disorder; a whole range of things, where that trauma lens isn't being brought to bear as it needs to be.

If we move further along, and we think about our preschool age children. Sometimes they develop false interpretation of what's gone on and assumptions, and at this age, we can see that sometimes they feel that their own thoughts and actions have caused the disaster, and they generalise that to other events. Their developmental understanding of time is not quite there yet, and it's really important that we help them to understand that the threat is over, because they make feel that they're still at risk and don't feel safe; and so the ability for that child to actually make sense, is really impeded by their developmental understanding of time; and as practitioners, it's really helpful to work towards them getting a narrative for themselves around what's happened; what the start was, what the middle; and what the end is; and then to start thinking with them about what sense they make of the experience that they've had and then to give them the supports that they need to make their next steps in their development and their understanding of it.

With the five to 12 year old children, we also see that notion of superhero and they wish that they could have done something a little bit magical; they wish they could have done more, and it's where we start to see the conversations lead to 'If only I had, I could have done this; I should have done this'. And so we're coming back to listening to the narrative, starting with the child, challenging some of those false assumptions, using a strength base and reassuring them, validating and normalising when we can.

The next slide – just to give you some tips around when you're talking with children. My experience has been that adults are really anxious about talking with children about these tough things; and what we do know is that having conversations with them is really important. Nicola spoke about disaster preparedness, and there's some really lovely research around on child-centred disaster resilience education.

We know that even small children can take a role in helping prepare, as Nicola identified, and then the importance that we place on having conversations, validating, normalising; starting from the child's starting point, as we mentioned; being able to model our own coping strategies; being able to support parents in regulating their own behaviours, distress responses; setting up culture of understanding and problem solving are all really useful ways to begin to talk which children about the impending disaster what actions can be taken to keep as safe as we can be during the disaster, and then to talk about what has happened and how we're going to engage in things that are going to help us, help our family and help our community.

What we do see, is that children who can be actively involved in family recovery and community recovery, tend to recover better themselves and more quickly. And we come back to that notion of self-efficacy and collective efficacy, time and time again, as a really positive coping strategy. Depending on the age of the child, we're going to be able to use different modalities to talking with them and giving them opportunity to express what they need to say about their experience.

So drawing and play – there's some amazing apps, as I mentioned before, that you can use; and there's a lot of really good post-disaster workbooks around. Red Cross has them; Annette La Greca from Florida has developed some really good ones that give you an opportunity to partner with the child informing their understanding and their narrative of the experience. This can be used to give you insights into what's been most challenging for them; and eventually, when I'm working with children, I always ask them about what was the worst moment for you; and it's often not what I would assume as an adult, but something purely from their subjective experience of that situation; and then that allows me to start targeting what we need to be working with and how we can assist them.

So we're using positive coping strengths, we're shoring up the adults and carers around them; we're teaching them self‑regulation strategies and making sure that the important people in their support network are aware of all of those strategies as well. If though, you're still feeling that these things aren't making the difference that they need, then seeking additional help is really important.

If we can move to the next slide, please. Then you can see that you should be seeking that additional help when we're looking at these really pervasive, dysfunctional, disabling symptoms occurring over a month or more; that they're in multiple contexts, and that the family, the child and those around them haven't got the resources that are making sufficient difference in helping that child manage all that they're experiencing and feeling in their responses to this experience.

I think that working with schools is really important; making sure that there's partnerships with the adults in children's lives; setting up that network and social connectedness that we know is so beneficial, are really fundamental to doing some of that very difficult work with kids after disasters. So I encourage you to look at the environment and the social ecology around the child, as well as the child themselves, when you're doing this work.

So seeking help is when the child's displaying behaviours that disrupt others, that it's across lots of different contents. They may show regressive behaviours, they may seem stuck. Their level of distress is such that it really interferes in every aspect of their life. Sometimes, as an anomaly, the child seems to be coping quite well, but the family's really struggling, and that would be another time where I'd suggest that you provide additional referral and support for families. And two Australian practitioners, Vanessa Cobham and Brett McDermott have put a lot of effort into disaster, PPP, the parenting program, where you can work with the parents to shore up their skills to then be supporting the children in their recovery.

So I think that's a lot of content in a short period of time, but throughout my discussion, I've woven into the narrative about making sure you engage the adults in the lives of the children, as well as the children. And as you're working with children who are, you know, ten and 12 and onwards, you would be working increasingly with the child and then informing the family, but with those younger children, it very much is a very clear partnership along the way.

The way in which we would suggest supporting parents to support their children, which I think you will see in the next slide; we're talking about helping to organise the emotional environment. We know that after a disaster, the physical environment is really disorganised; it can still be unpredictable. Parents may be physical present but emotionally absent. There's a lot to be involved in, in the recovery process. And if you think Maslow's hierarchy of needs; you know, getting shelter organised, getting meals organised, dealing with insurance company; all take time and energy from parents when they perhaps best need to be grounded as well, in working with their children and supporting their children.

Parents themselves are adversely impacted and emotionally vulnerable at this time. They may be experiencing their own anxiety, depression, fear and guilt. I frequently hear parents talk about their guilt, about choices and why they were there at that point in time and what the consequence might be for their family and their children. I also see parents often reluctant to go back to being a clear decisive parent, and their parenting style becomes one of either being quite laissez-faire, or to the other extreme, of being so anxious about making sure that everything's right, that they become quite punitive and tough. They lose their idea of where they want to sit as a parent, and it takes a while to feel comfortable again in re‑establishing themselves in their relationship with their child, putting in boundaries, being able to give the child a sense of what the family expectations are, and so I know that a lot of parents will say that, 'My child's been through the most horrific thing and I'm not sure now if it's reasonable to expect that they go to bed at 9 o'clock and to make a big deal about it'.

My experience has been that children feel much more safe and comfortable when they know what the boundary is and what the expectation is, and this is helpful in their recovery as well. It's a way of letting children know what predictability there is, what the routines, what the expectations are, and that the world is an understandable place again. So the key strategy for supporting children after a disaster event is to make sure that parents are shored up in their parenting, they're shored up in their well-being, they understand their child's needs, and that the child's needs are understood from the child framework as well as their exposure to whatever the incident or the disaster has been.

So I think that we're almost up to the questions, and some further conversation from the other panel members.

MR DOLMAN: Great. Thank you very much, Michelle, and also Nicola, for those really rich sharings of your knowledge in relation to supporting children's experience following and before natural and man-made disasters. You've certainly generated a number of questions from our participants. So thank you to all of those that have submitted questions. Those we don't get to in the time remaining, we'll respond to via the CFCA website.

Just briefly to mention, there's been a couple of requests for the restating of authors and app names. We'll be including that in the online resources that go with this webinar. But Michelle and Nicola, there's a question for both of you. Michelle, perhaps we could start with you in terms of a response. And I know you both have an interest in the self‑efficacy or agency of children, and there was a question about supporting and explaining to children how it might be possible for them to support other children; to support their friends through these difficult situations. Do you have any kind of ideas or, you know, from your work in this area, you know, what can be kind of said to children about that, or even the appropriateness of that? Do you have kind of reflections on that, both of you?

MS ROBERTS: That's a really good question, and I know that when I've been a school psychologist and worked with a set school community, when we've had a disaster impact on our school community, we've actually spoken quite explicitly to friendship groups and the leadership group within the student body about how to listen, how to be active in your listening, how to support friends, what to do if you feel concerned for a friend, who to go to. What do you say to that person if you're finding what they're telling you too distressing and how to bring in more supports around supporting that individual.

So I think particularly for those, you know, ten year old to 16 year old children, we often see them turn to peers, and so I think we need to be mindful of that and to shore up the peer group to be supportive of the others. I think also that in the before and during stages of the disaster or the critical incident, the research that's been done by Briony Towers here in Victoria, she's actually found that children ten to 12 are really effective at taking on board and understanding response to threat and disaster-related threats, and then can communicate and educate their peers and adults in their community about that. And so there's been some really great work done around teaching Grade 5 and 6 children to do CPR and what steps they need to take to call an ambulance; what information they have to give and so on.

So I think it's hard for us as adults to actually put ourselves into thinking we can give kids these skills and in fact it's quite protective for them to have this knowledge, and then they can share it amongst their peers, so that we're giving them more agency and more efficacy.

MR DOLMAN: And it sounds like they respond well to these invitations adults extend to them, to be part of the support of their friends and others as well.

MR ROBERTS: Very much so. Yes.

MR DOLMAN: Right. Yes, terrific. Yes. Actually, I guess, it links a bit – of course, sorry; Nicola, was there something else you wanted to sort of add to that or?

MS PALFREY: No, I think Michelle's covered it. We'll take another question.

MR DOLMAN: Yes, sure. There's another question around the theme of efficacy, children's efficacy, how it can sometimes become hidden from adults in these kind of tough times, and these times of natural disasters, and I guess maybe even hidden from children themselves, I suppose. You know, they may not realise what they're doing or what they've done to get through. Like, yes, are there sort of – yes, some questions, how can this be made kind of more apparent or how can adults be more aware of this in working with children. The questions' for both of you.

MS PALFREY: I can have a go at that if you like. I think it's a really good question, and I think it links in with what Michelle was talking about, which is actually the adults in the children's lives, whether they be practitioners or practitioners supporting family members to do is, is to actually talk to the children about their experience, and what went on, and how they've made sense of it, and what they did, and then you open up the opportunity for reflection and acknowledgment of what the children did that, you know, wow, that they actually managed to you know, get through that situation or that they actually did a great job of grabbing their pet and reassuring them; or you noticed that even though that it's been really difficult, that they're doing a great job of coping without any of their belongings around them.

So I think it's our role as adults, as we interact with children, is to help them make sense of their narrative and feedback to them exactly what we see as their capacity that they've exhibited in that time, because they are likely to be focussing on, as we all do, what they didn't do or what they thought they should have done, or what they could have done, if they were in these circumstances. So I think taking the opportunity to hear the narrative, make sense of it, and also you know, reframe as we talk about, that you know, perhaps at a different angle and perspective that they may not have seen, because they be very focused on what they didn't do or should have done.

MR DOLMAN: Makes me think whether when parents kind of get to witness those conversations, or when that efficacy, children's efficacy becomes apparent to parents, whether that can make a bit of a difference to them too, in terms of how they're responding to the ongoing effects of the disaster perhaps.

MS PALFREY: I think you're right, and I think those parallel conversations – I think we tend to pendulum swing from not telling kids everything or then over-sharing, versus trying to have that balance around talking with kids about what the experience was, how we experienced it, that we found it very overwhelming or frightening or we still have some bad dreams about it. So sharing our experiences, not to burden our kids, but to kind of work with them in terms of how we're managing it, to chat about it and to also share strategies about what we might find that helps or do they have ideas about what we might be able to do to get through this period together.

MS ROBERTS: I think that's a really vital point, Nicola, that sharing of what's working and what strategies you're using as an adult to cope, and to move forward, is valuable. I think that we sometimes forget how cued in children are to incongruence, where you know, they're seeing one thing and hearing another thing. And one of the things that I always encourage parents in this space, is to be honest and truthful with their children, but to be age-appropriate and to titrate their information, because you can always add more information if the child's managing and listening and coping with what you're talking about, but you can't take it back if it's overwhelming and it frightens them. So again, it's that power of observation and monitoring of the effects along the way.

MR DOLMAN: Yes. Thanks. We also wonder about – and this links to another question around – actually, yes, how children in their contribution to planning, you know, or to preparedness. I guess there's the effect of not only having children feel supported but, you know, from your work and research, what effect this can have on parents as well, to have children actually contributing and offering their novel, perhaps, ideas to this preparedness and planning as well.

MS PALFREY: Yes, I think – we're probably going to run out of time, so we will put it in the resources, but people interested in that point, as Michelle pointed out, Briony Towers' research on this, and the importance of doing it well. So preparedness done in a kind of tokenistic way with children is not going to give us the result we want, but child-centred, where they're actually driving it, interested in it, being able to set the agendas and ask the questions they want and then share that knowledge in a very empowered way, is – yes, there's really good evidence for why you do it properly. But yes, we will – there's some great research written up about that and demonstration of child‑centred practice, so we can point people to those resources.

MR DOLMAN: Terrific. Yes, we are running short of time. There's been other questions in relation to, you know, future research going forward and in relation to a number of things, including ongoing – you know, the climate crisis and the effects of that on children and families and whether these ideas can be responded – can be used to respond to that. But we might leave those for the forum and the online responses afterwards.

So thank you, Michelle. Thank you, Nicola, for your presentations, your contributions to our understandings today. And thanks everyone for tuning in to this webinar. We would also again just like to mention the Emerging Minds National Work Force Centre for Child Mental Health, Community Trauma Toolkit, that Nicola mentioned at the start of the hour. We'll be providing some links to that, as well as other resources that you might well find helpful in your practice in supporting children through these difficult circumstances. So thank you, everyone, and look forward to your joining us next time. Thank you.

WEBINAR CONCLUDED

IMPORTANT INFORMATION - PLEASE READ

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The Commonwealth of Australia, represented by the Australian Institute of Family Studies (AIFS), is not responsible for, and makes no representations in relation to, the accuracy of this transcript. AIFS does not accept any liability to any person for the content (or the use of such content) included in the transcript. The transcript may include or summarise views, standards or recommendations of third parties. The inclusion of such material is not an endorsement by AIFS of that material; nor does it indicate a commitment by AIFS to any particular course of action.

Slide outline

1. Supporting children after natural and human-induced disasters

Chris Dolman, Nicola Palfrey and Michelle Roberts 
CFCA Webinar 7 August 2019

2. Housekeeping

• Send through your questions via the chat box at any time during the webinar.
• Let us know if you don’t want your question published on the online forum following the presentation.
• All our webinars are recorded.
• The slides are available in the handout section of Gotowebinar.
• The audio and transcript will be posted on our website and YouTube channel in the coming week.

3. Supporting children after natural and human-induced disasters

4. Learning Outcomes

This webinar will support practitioners to:

• prepare children and their families practically and psychologically for a disaster
• interact with children during an event in a way that may enhance their resilience and recovery
• support children and their families immediately after an event as they
• re-establish a sense of safety
• support children and their families in the ongoing recovery process
• understand the importance of self-care during and after a traumatic event
• identify emotional and behavioural difficulties in children that may indicate that ongoing, specialised support is required.

5. Acknowledgements

Emerging Minds and CFCA wishes to acknowledge the Traditional Custodians of the lands across Australia upon which our webinar presenters and participants are located.

We wish to pay respect to the Elders past, present and future for the memories, the traditions, the culture and hopes of Indigenous Australia.

6. Webinar series

2019/20 Emerging Minds series: Focus on infant and child mental health.

Future webinars:

• Responding to parents who are addicted to alcohol and other drugs. How can children’s needs be considered through parent sensitive and non-shaming practice?
• Parent-child play: A mental health promotion strategy for all children
• Child-focused supervision. What does this mean and how does it work?
• Working with Aboriginal children and families in mainstream services
• Cultural considerations when working with children and families

7. Presenters

• Nicola Palfrey, Psychologist & Researcher, Emerging Minds, ANU
• Michelle Roberts, Psychologist
• Chris Dolman, Senior Workforce Development Officer, Emerging Minds

8. Timelines of a natural disaster

An infographic of the timelines of a natural disaster:

• Preparedness = getting ready for disaster
• During and immediate aftermath
• Short-term recovery
• Long-term recovery

9. Tips for HSSP self-care

Monitor your own reactions, emotions and needs

Seek help in trauma-related distress

Find your support system

Maintain a healthy lifestyle

Engage in stress reduction activities

Use positive coping strategies

• Breathing techniques, muscle relaxation, imagery
• Challenge unhelpful thoughts that cause distress
• Use helpful (but realistic!) thoughts and coping statements
• Look for self-help resources (e.g. websites, books)

Seek opportunities to reflect on your experiences with your professional colleagues.

Make time for yourself, family and friends

• Actively schedule, rather than wait for opportunities

10. Disaster preparedness: Supporting children before a natural disaster event

11. Encouraging parents to prepare early

• One of the most effective ways for parents and carers to minimise their children’s stress and anxiety in a natural disaster event is to remain calm and cope well themselves.
• Engaging parents and carers about the importance of being prepared for disasters can increase their emotional and practical ability to manage disasters and traumatic events.
• In turn, this increases their confidence and ability to support their children during and after a natural disaster.
• HSSPs can help reduce stress by talking to each family member about what they need to do in a disaster, in the light of what they know about their particular strengths, needs and vulnerabilities.

12. Supporting families in disaster planning

• Adopt a ‘whole of family’ approach to disaster preparedness planning 
  Talking to children about a disaster helps them to feel safer and more secure in the knowledge they have a family plan, are prepared and able to manage the threat. This provides sense of control to the child (and all family members).
• Prepare early and revisit plans on a regular basis 
  Preparation can occur anytime prior to a disaster. Plan early and review the plan regularly.
• Prepare parents and children both practically and psychologically.

13. Supporting children during and immediately after a natural disaster event

14. Introduction

• In the aftermath of a natural disaster, reactions will be at their most intense and children (and adults) will have different ways of dealing with the ‘big’ feelings they experience.
• Children will need the adults in their lives to help them when memories of the disaster, or ‘big’ feelings like sadness or anger, come up for them.
• Parents, however, may also be struggling with their own grief and loss and need external support to assist them in providing stability and routine for their children.
• HSSPs will be a critical resource for parents, families and children, providing support, guidance, reassurance and advice in the days, weeks, months and (in some cases) years after the crisis.

15. During and immediate aftermath

• The chances of children having ongoing difficulties are significantly reduced if they receive support, comfort and reassurance from the adults around them at the earliest possible stage post-disaster.
• Simply by remaining calm, acting in a controlled manner and displaying good coping skills, HSSPs will minimise stress and anxiety for any children they encounter and greatly assist them to feel safe and secure in the aftermath of a natural disaster.
• In addition, the application of some simple strategies, known as Psychological First Aid (PFA) can be key to reducing children’s distress and assisting them to regain a sense of emotional and physical safety following a natural disaster event.

16. Psychological First Aid for Children

Infographic showing the five concepts of Psychological First Aid for Children:

1. Ensure safety - Remove the child from, or reduce exposure to the threat of harm.
2. Keep calm - Provide a clam environment, away from stressful situations or exposure to sights, sounds and smells of the trauma event.
3. Connect with others - Keep families together and keep children with their parents or other close relatives whenever possible.
4. Encourage self–efficacy - Help families to identify their own strengths and abilities to cope.
5. Have hope - Reassure the child that their feelings are normal, but assure them that things will be ok

17. Supporting short and long-term disaster recovery

18. Age specific supports for assisting recovery

Children’s reactions after a disaster will vary depending on several factors such as the child’s age, development, temperament, their specific experience of the disaster and the significance of their losses, as well as their previous history of trauma and disruption.

The following information will assist HSSPs to inform their own practice – and provide parents and other significant caregivers (e.g. extended families, teachers, child care professionals) with age-appropriate advice and strategies to support resilience, coping and recovery in children after a natural disaster event.

19. Babies and younger children (0-24 months)

• Babies and toddlers can experience fear, but as their brains and bodies are still developing, they may not be able to make sense of what is happening.
• They will communicate their experience and feelings through their behaviours (e.g. crying or being clingy, withdrawn, angry or anxious) as well as verbal and/or non-verbal means (e.g. facial expressions, eye movements, drawings, play).
• After a natural disaster event, most babies and younger children who are well supported by nurturing and caring adults and predictable routines will overcome their distress and return to being themselves within weeks or months.

20. Strategies for babies and younger children

• Provide a consistent and predictable routine.
• Limit exposure to the media.
• Listen with your eyes and ears
  • Active listening, reflective listening and observational skills are all key.
• Monitor verbal expressions.
• Monitor non-verbal signals.
• Set expectations.
• Emphasise strengths.
• Be positive in communications and actions.
• Provide choice.
• Use relaxation techniques.
• Create safe ‘relaxation’ spaces.

21. Strategies for children 2–4 years and 5–12 years

• Monitor symptoms over time.
• Remain vigilant and curious about changes in behaviour or family circumstances.
• Familiarise yourself with ways to arrange help for the child.
• Maintain routines.
• Set clear and firm limits/expectations of behaviour.
• Explore origins of ‘acting out’ behaviour.
• Provide choice to assist in children regaining ‘control’.

22. Strategies for children 2–4 years and 5–12 years (cont.)

• Anticipate difficult times and plan ahead
  • Be aware, plan where possible and arrange support.
• Focus on strengths and positives
  • Reinforce positive coping strategies.
• Help children to build an extended support system.
• Talk about the event. But how?

23. Tips for talking to children about a natural disaster

• Place rules around disaster talk and amend the rules over time.
• Contain conversations that encourage fear
  • Focus on the threat being over; now is the time for recovery and rebuilding.
• Arrange extra support where necessary.
• Maintain professional role when sharing experiences.
• Model calmness.
• Focus on strengths, positive coping strategies and positive outcomes.
• Find alternative ways of ‘talking’ (e.g. drawing, play).
• For older children, conversation can include complex issues, such as relationships.

24. When should I seek additional help?

• Symptoms persist for longer than one month or worsen over time.
• Child shows a significant decline in performance.
• Problems interfere with daily functioning or cause significant distress.
• Child displays specific (ongoing or worsening) problems regulating emotions (e.g. difficulty controlling crying, anger).
• Child shows significant and lasting changes in social functioning.

25. When should I seek additional help? (cont.)

• Child regularly displays behaviours that disrupt others.
• Difficulties prevent the child from engaging in age-appropriate tasks.
• Child returns to behaviours typical of a younger child.
• Behaviour exists in multiple areas.
• Ongoing stressors outside of school.
• Child/family are experiencing significant distress or concern.

26. Supporting parents to support children

• A post-disaster environment may be disorganised and unpredictable. Parents may be unable to provide basic needs such as food and shelter.
• Parents are at increased risk of experiencing adverse psychological outcomes (anxiety, depression) and may develop ineffective parenting behaviours following a natural disaster.
• These changes in parenting style and the environment may have a negative impact on the parent-child relationship, further exacerbate behavioural and emotional difficulties or contribute to a child’s belief that the world is a dangerous and unsafe place.

One of they key strategies for supporting children after a natural disaster event is to therefore ensure that parents are looking after their own personal wellbeing and seeking help and support for themselves as needed.

27. Supporting parents to support children (cont.)

• It is important for HSSPs to check-in with parents to:
  • assess how they are coping and encourage them to put strategies in place to look after their own needs and personal wellbeing
  • provide them with advice, information and guidance regarding the needs of their children and how best to support and reassure them
  • encourage the ongoing modelling of positive behaviours and coping strategies.
• Reassure parents that by looking after themselves they will be in the best position to support and proactively assist their children in their recovery.
• Introduce parents to self-care plans and pleasant events schedules.

28. Questions and discussion

29. Continue the conversation

Do you have any further questions?

Please submit questions or comments on the online forum following today’s webinar.