Manuscripts Contributed to Other Journals(Takashi Igarashi et al. Disaster management to reduce mental health risks for children FY2014 Welfareand Labor Sciences Research Grants Community Health Infrastructure Development Research Project“Research on post-disaster mental health support for children.” Published in 2015）

Camping for children and parents in the affected areas

Miyagi Disaster Mental Health Care Center - Naru Fukuchi< Introduction >I have been visiting the affected areas since the Great East Japan Earthquake, and have been paying close
attention to the situation of the affected children and their families while visiting shelters, temporary housing,and schools. Among them, I was worried that ① children had no safe place to play, ② children couldn't
leave their guardians because of the terrifying experience, and ③ many children acted as though nothing had
happened even though they would have had a difficult experience1)2). Under these circumstances, we planned
to take the children to an inland campsite away from the coast and offer a series of programs to restore theirusual peace of mind. The emphasis was on playing in nature and sharing thoughts with other children whohad the same experience. Also, by incorporating psychological education into the program, the goal was toprovide correct knowledge regarding disasters, to understand the mechanism of one's mental health, and tolearn how to avoid being overwhelmed by anxiety.
Thus, the first camp was held in July 2011 for children and their parents in the affected areas3). It was
carried out with the cooperation of members of a study group that had been working in Sendai for many years,
the specialists of related organizations that we often collaborated with, and several volunteer organizations.
Recruitment was limited to areas where doctors could provide follow-up support, in case the children became
ill after the camp. Currently, the camp is operated as a project of the Miyagi Disaster Mental Health Care
Center, where the author is enrolled and is held once a year in cooperation with various local organizations
and professionals. In this paper, I would like to introduce a camp attempt for children and their parents andmake proposals for future psychological education after a disaster.
< Camp Overview >As of January 2015, a total of five camp events have been held (in July and November 2011, and once ayear in October between 2012 and 2014). The survey was conducted for children in elementary schools inSendai City and Natori City. A small number of preschoolers and junior high school students were also present
because their siblings were participating. Besides, a small number of children who I provided guidance to andchildren who visited a hospital due to physical/mental illness participated. We prepared a flyer for the event,visited the above elementary school, and distributed them within the school with the consent of the Board ofEducation. Applicants applied by mail or fax, and the maximum number of participants was about 20. The
required number of staff was arranged so that children could be accommodated one-on-one.
Children were brought to a campsite away from the disaster areas without their parents and were provided- 120 -

with a series of programs including psychological education (Appendix 1). For parents, a separate venue wasset up near the meeting place, and a program was provided that included lectures, relaxation, and individualconsultations by professionals. The contents of psychological education for the first, second, and third timecomprised children drawing using a picture-story show; and in the fourth and fifth times were breathing andmuscle relaxation activities using toys.
1. Drawing using a picture-story show (Appendix 2)Children were taught using a picture-story show so that they could express their feelings more easily
with shapes and colors. We had them draw their feelings using colored pencils and crayons. After
drawing, they showed their drawings to one another, talked about what would make them more fun,and were asked to add more pictures.
2. Breathing and muscle relaxation using toys (Appendix 3)
An attempt was made to connect abdominal breathing and muscle relaxation using inflatable pipes.
By breathing in and blowing little by little, the ball could keep floating on top of the pipe, and bypracticing repeatedly, they could naturally do abdominal breathing.
Before participation, a preliminary survey was conducted by mail to understand the state of damage tothe family and the physical and mental state of the child4). A questionnaire was also given to both, parents andchildren, after the event. Only children were asked to fill out the post-traumatic stress response scale (PTSSC15) before and after the camp. PTSSC-15 consists of a self-completed rating scale consisting of 15 questions
that can evaluate PTSD and depression symptoms5). The post-camp evaluation scale was returned by mailwithin two weeks of the end of the camp.
< Evaluation Results >The total number of participants was 124 (64 boys, 60 girls, an average of 24.8 participants per event),
and the average age was 8.3 years. Of these, 101 (81.4%) were analyzed excluding children who did notprovide all of the required information (Appendix 4). Various events were considered to be painful
experiences, with 27 (27%) saying “our house was destroyed,” 11 (11%) “witnessing an injured person,” 36(36%) “losing a close person,” and 28 (28%) "witnessed the tsunami." In the second session, many children
whose medical treatment I had been in charge of attending, and nine people had "consulted a psychiatrist.” A
total of 36 families participated in the parent program, with the largest number of participants in the first andsecond sessions, and only about 3 to 4 people thereafter.
Appendix 5 shows the changes in mental states before and after the camp. Generally, a PTSSC-15 scoreof 23 or higher is considered a high risk for PTSD or depression, and 54 children (53.5%) were judged to beat high risk before camp. Since no control group was set, the effects could not be compared unequivocally,
but PTSSC-15 values tended to decrease after the intervention in the camps, excluding the 4th camp event.
The average value for all participants was the highest in the second session and then tended to decrease overtime.
- 121 -

Concerning the picture-story show, younger children could not understand the intention and tended toimitate "Koro-chan" which was used when teaching the activity. Besides, since the lung capacity of children
depends on age, the ball may not have floated during the inflatable pipe activity unless the young child blew
hard. In the future, in the picture-story show, it would be necessary to have age-appropriate content of teaching
and change the type of toy (windmill, soap bubbles, paper balloon, etc.) used in the breathing method activity
accordingly.
The greatest harvest gain from the camp was thought to be the unity of the region and the sense of security
gained from it. The organizations that cooperated were volunteer groups, various sports clubs in the area, boy
scouts, and student volunteers. The children connected to various human resources in the area and sometimes
consulted with the staff who helped them when they were upset. Of these children, those who required
specialized treatment were sometimes temporarily treated at the clinic of which I was in charge. Besides,
several children participated repeatedly, allowing them to meet each other once a year, and were seen to playa role as leaders who were informed of the flow of the program. The staff who repeatedly participated saw thegrowth and development of the children at each camp and discovered the value of supporting them in thecommunity. In this way, it can be said that it has functioned as a place to connect local children, parents, andvarious professionals.
Over time, it seemed that the participating children became less conscious of the disaster. Parents weresimilar and tended to refrain from participating in programs that emphasized stress management after a disaster.
For the parent program, lectures were given by specialists up to the third time, but the program was modified
to focus on relaxation, taking into account the changing needs of parents. In the future, it will be necessary tocarefully monitor the situation in the region and provide a timely and flexible program.
< References >1） Naru Fukuchi, Mizue Hayashi: Present state of children's heart in the stricken areas. Children's Mentaland Nerve Volume 51 Issue 2. 126-132 (2011) [in Japanese]2） Naru Fukuchi: Mental reactions to disasters and their response. Pediatric Internal Medicine Vol. 45. No.
8. 1438-1441(2013) [in Japanese]
3)

Naru Fukuchi, Asako Murai: Practice of disaster-stricken area support for children. Hospital /Community Psychiatry Vol.55 Nol. 56-58(2012) [in Japanese]

Takashi Igarashi (Research Representative): Research on post-disaster mental support for children. FY
2013 Summary / Shared Research Report (2014) [in Japanese]5) Yoshiki Tominaga, Satori Takashi, Takamitsu Yoshida, et al: Development and validation of the stressresponse scale for children after the disaster (PTSSC15) -For children in nursing homes and victims ofbullying-. Clinical Developmental Psychology Research 8, 29-36(2002) [in Japanese]4)- 122 -.

Appendix 1

Program of the Third Event

Children’s Program
8:30 - 9:30

10:00 - 11:00

11:00 - 12:00

Transportation by bus Introductions, recreation, singing while traveling.
Orientation

Discussing promises and the flow of the day.

IcebreakerWe prepared name cards for each child in advance, and they exchanged them and greeted
each other.

Groupwork
Pitching tents

Divide into groups, decide the goal of the day, and present them.

CookingThe ingredients were prepared in advance and the potatoes were cooked.

12:00 - 13:00 Lunch
Recreation
13:00 - 15:00
Relaxation
15:00 - 16:00

Children played and moved a lot.
Children laid down and were taught simple breathing techniques.

Psychological education

Teaching using picture-story shows, drawing, and presenting in groups.

Groupwork

A reflection meeting by each group and presenting ideas.

16:00 - 17:00 Transportation by bus

Parents’ Program
9:00 - 9:30 Mini Lecture
9:30 - 10:00 Self-Massage
10:00 – 11:00 Relaxation
11:00 - 12:00 One-on-one Consultations

An expert physician gave a lecture on "Children's mental reactions after a disaster."
Simple facial massage that can be done at home.
Get a hand massage
One-on-one consultations for interested individuals.

- 123 -Appendix 2Teaching How to Draw With a Picture-Story Show

(original draft: Fukuchi, drawing: Akiko Miyake)A boy and characters of various shapes and colors are lined up.

The character is as plain as possible and colorless. Just a circle withlines for hands and legs.
Facilitator: “My name is ‘Koro.’ I change shapes and colors depending
on my mood.”
A scene where Koro is inside the boy’s body.
Facilitator: “I’m inside of Taro.”

A scene where Koro has his head stroked gently.
Facilitator: “When you’re nice to me…”

Appears all round, bright blue, and with a gentle expression.
Facilitator: “I become this shape and color. What happens to you in thesesituations?”

A scene that is being shaken violently to recall an earthquake.
Facilitator: “When I’m surprised…”

Appears with a distorted shape, with red and dark colors and a confusedexpression.
Facilitator: “I become this shape and color. What happens to you in thesesituations?”
Taro appears again. A scene where he is relaxing his body.
Facilitator: “When Taro relaxes, Koro becomes a gentle color and shape.
Let’s draw the Koro inside each of us.”- 124 -Appendix 3

Breathing and Muscle Relaxation Teaching Method(After engaging in physical activity by playing outside, move indoors. Implement after wiping sweat andrehydrating)
Facilitator: “Now we’re going to relax and quieten our minds. From now on, we will look into our hearts.
Today we’re going to learn about breathing in and out and putting in and releasing force. Please pair up
with one child and one adult. Everyone please take a yoga mat and sit on the floor.”
Facilitator: “Today we did a lot of fun things. How is everyone feeling?”
 Children: “It’s fun” “I’m tired” “I want to go home”
Facilitator: “So how is everyone’s body feeling?”
 Children: “I sweated” “My heart is beating fast” “I’m out of breath” “I bumped into something
so it hurts”
Facilitator: “Our bodies react when we do something fun or are
excited, mad, or if we remember something bad.”Facilitator: “I’m going to pass some toys. Let’s try to play withthese first.” (Passes the inflatable pipes to each person)
 Children: “What is this?” “I’ve seen this before”“candy stores have these”< Teaching Breathing Methods >Facilitator: “To make the ball float, you have to take a deep
breath and slowly blow out. Let’s try to practice this. When you
breathe in, fill your stomach and slowly breathe out. This iscalled belly breathing.” (Get in a pair with a staff member andpractice belly breathing.)
Facilitator: “Now imagine the ball floating. Without the pipe,
close your eyes, imagine this while you lay down on the yoga
mat. Let’s turn down the lights and try this quietly.”< Teaching Muscle Relaxation >Facilitator: “Next we will be using our bodies a little. The key is
to put in force and release it. While laying down, put both yourhands in a fist and slowly put in more force. Put force into yourshoulders… Then release all of that force and relax. Let’s repeat
this again.”< Combining Breathing Methods and Muscle Relaxation >Facilitator: “Now we will breathe in and out 3 times and put inand release force 3 times.”
Facilitator: “How does your body feel?” Children: “I’m sleepy now” “I’m hungry” “I want togo to the bathroom”
Facilitator: “Your feelings and your bodies are connected. Try
to do these exercises when you are excited, when you remember
something bad, or when you are angry or anxious.
- 125 -

.

Appendix 4

Characteristics of ParticipantsFirst TimeJuly 2011

Second Time
October 2011

Third Time
October 2012

Fourth Time
October 2013

Fifth Time
October 2014

Total

191278.8

10150
518.3

Lost something important
Saw the tsunami

1322005221666149126966048779750181077650269654
27
24
11136
40
28

Have had a painful experiencein the past
Have been to a psychiatrist

444
9

1532

30

15
20

Number of Participants
Boys
Girls
Average age
PTSSC-15 scores before camp:
23 or moreHouses completely destroyed
Almost died
Got injured
Saw someone who got injured
Someone close passed away

Appendix 5

21
1110
8.1

2212108.3

181088.321
516
8.3

Changes in PTSSC-15 Averages Before and After the CampFirst
SecondThird
FourthFourthFifth
Fifth

Pre-Intervention

Post-Intervention- 126 -