Camp project for parents and children affected by the disaster

Camp Project for Children in the Disaster Area
Naru Fukuchi – Director, Doctor
Tomoko Uchida - Nurse
Research and Planning Division, Stem Center, MDMHCC
1. Background and Objective
It has been pointed out that a major disaster that destroys communities across a broad geographical area has
a severe physical and psychological impact on children due to the significant changes in their living
environment. As a result of the Great East Japan Earthquake in 2011, in coastal areas affected by thetsunami, the number of places where children could play freely was greatly reduced. The children werebrought to an inland campground away from the coastal area, where a series of programs were conducted to
get them outdoors, raise their interest in mental health, and reduce their daily psychological burden.
Additionally, by incorporating psychological education into the program, the children were helped tobetter understand their own minds and taught methods to help them deal with anxiety and not beoverwhelmed by it.
As a part of Tohoku Welfare University’s support for disaster-stricken areas, a camp project began inJuly 2011 with the cooperation of professionals and several volunteer organizations working in the region2.
It was started as a project managed by the center beginning with its third session in 2012, and it continues tobe held once a year. This paper is the eighth annual report on this project, and it concerns the camp held inOctober 2017.
12. Method
The eight camp session consisted of two parts—a program designed for elementary school children, the“Camp Project for Parents and Children in Affected Areas” (hereafter referred to as the “day camp project”),
and a “Sub-leader Training Workshop for Teenagers,” (hereafter, “sub-leader workshop”)—for past
participants who were teenagers. Junior high school students who took part in the sub-leader training
workshop also participated as day camp staff.
(1) Day camp project① Target audience
Among the three coastal cities that were affected, we received consent from six elementary schools
and had them distribute information to the children at the schools. Beginning with the third session
since the center inherited this project, we have conducted a survey on whether or not participants
wished to have us send them information on the next session. We sent information about the eventto 40 past participants (excluding junior high school students) who requested it.
② Survey procedure
Explanations were given and agreement was obtained from the board of education of each of thethree municipalities. Next, an explanation was provided to each target elementary school, andapplication guidelines were distributed to children in the elementary schools where consent had
been obtained. The purpose of the project was explained to the families who applied, and theircooperation with the survey was requested. At the time, they were free to cooperate with the survey
if they wished to do so, and we explained that they could withdraw their consent at any time.
③ Survey content
To understand the topics that required attention, we conducted pre- and post- questionnaires withchildren and parents to verify their living situations and the effects of the disaster at the time of theearthquake. To understand their effectiveness and psychological state, children took the Pre- andPost-Traumatic Stress Symptoms for Children 15 items (hereafter referred to as PTSSC-15) , whileparents took the Kessler Psychological Distress Stress 6 (hereafter referred to as K6). The prequestionnaire was conducted two weeks before the start of the parent-child camp, and the postquestionnaire was mailed around two weeks after completion. Only the data of those from whom
research participation consent was obtained were analyzed.
3,4

5④ Implementation

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The camp was held at the Matsushima Outdoor Activity Center on Saturday, October 28, 2017. We
provided a series of programs for children, including psychological education, coping, and yoga forrelaxation. The “alpha rice” and fire-making experiences were introduced as a part of disasterprevention education concerning outdoor food preparation. After lunch was recreation period,
followed by an activity called “study of the mind,” which involved yoga practice centering on abreathing method. Another program was designed to conduct a lecture for parents on parenting andrelaxation through yoga.
⑤ Evaluation methods and feedback
Evaluation of the children’s psychological state was c using the PTSSC-15, which was necessary tosupport the 23 points recommended as a cutoff value. The evaluation of parents’ psychologicalstate was done using K6, which was necessary to support the 13 points for identifying moderatemental disorders. Children’s scores on the PTSSC-15 before and after the camp were compared andanalyzed to determine whether there had been a change in psychological burden, and parents’scores on the K6 before and after the parent-child camp were compared and analyzed to determine
whether there had been a change in psychological burden. The results were explained in individualinterviews to children who had been identified as needing support, and the necessary support wasprovided.
⑥ Ethical considerations
This research was approved by the ethics committee of the Miyagi Disaster Mental Health Care
Center, and care was taken to ensure that the personal information of participants was protected.

(2) Sub-leader training session① Target audience
In cases where children who are now teenagers had participated in one of the past seven campsessions, we contacted families that had requested they be informed if similar camp sessions took
place in the future.
② Survey procedures
The purpose of this project was explained to each family applying for the event, and theircooperation was requested. It was explained that participation was optional and that it was possible
to withdraw consent at any time.
③ Survey contents
The questionnaire survey was conducted in advance with participating junior high and high school
students to verify the effectiveness of the sub-leader training session. The PTSSC-15 was used as ameasure to grasp subjects’ psychological state in advance. The questionnaire was conducted twoweeks prior to the start of the sub-leader training session, and the post-questionnaire was mailed
around two weeks after completion. Only the data of those who gave their consent to participate inthe research were analyzed.
④ Implementation details
The session was held at the Ashinaga Sendai Rainbow House on August 9, 2017. A total of five
hours of morning and afternoon training sessions were offered. In the morning, a certified
facilitator conducted a workshop training session using Lego blocks . In the afternoon, thefacilitator of the international NGO Save the Children Japan gave a lecture, and the senior students
conducted a training session on psychological first aid (PFA) to support the junior students.
6⑤ Evaluation methods and feedback
The evaluation of junior high school students’ psychological state was conducted using thePTSSC-15; it was necessary to implement the 23 points recommended as a cutoff value. Results
were delivered in the form of personal feedback given to the parents of the junior high school
students who were assessed as needing support, with an evaluation according to the criteria and theobservation conducted on the day of the camp. We compared the PTSSC-15 results before and after
the sub-leader workshop and camp project and analyzed whether the teenagers’ psychologicalburden had changed.

－ 130－Camp project for parents and children affected by the disaster⑥ Ethical considerations
This research was approved by the ethics committee of the Miyagi Disaster Mental Health Care
Center, and care was taken to ensure that the personal information of participants was protected.

Table 1 Overview of day camp project and sub-leader training sessions

3. Results(1) Camp project① Attributes of target participantsParticipating children included 15 people (4 boys and 11 girls), with an average age of 10 years.
Their experience during the earthquake was as follows. One person was born after the earthquakeand did not suffer any direct harm as a result of it. The program for parents was cancelled because
there were no applicants.

② Changes in children’s psychological state
Of the 15 children who participated in the study, 12 were analyzed except for 3 who were not able
to complete or who disagreed with the pre-post evaluation scales. Fig. 1 shows PTSSC-15 scoresfor these 12 participants before and after the camp. Before the camp, two children exceeded the 23point cutoff value for the PTSSC-15, while afterwards, two exceeded it. The average score for thePTSSC-15 was 16.4 (12.3 SD) before the camp and 10.3 (10.4 SD) after the camp. A statisticallysignificant difference was observed as a result of verifying pre- and post-camp scores with acorresponding t-test (t (11) = 2.51, Δ = .029, p < 0.05).

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Fig. 1. Changes in children’s pre- and post-camp PTSSC-15 scores(1) Changes in parents’ psychological state
Of the 15 children who participated in the study, the results for 10 were analyzed, except for thefive children who had not yet completed or who disagreed with the pre-post evaluation scale. Fig. 2
shows K6 scores before and after the camp for this group of 10. For parents whose scores exceeded
13 points, the cutoff value for the K6 was not available before or after the camp. The average valueof the K6 was 2.1 (2.5 SD) before the camp, and 1.8 (1.7 SD) afterwards. No statisticallysignificant difference was observed as a result of verification of pre- and post-camp scores with acorresponding t-test (t (9) = (1), Δ = .66, p < 0.05).

Fig. 2. Changes in parents’ pre- and post-camp K6 scores(2) Subleader training① Target audience
Five participants had registered, but only two showed up on the day of the event (three cancelled).
The two participants were a ninth-grade boy and an eighth-grade boy, who had participated in thecamp together several times in the past.
② Changes in participants’ psychological state
We conducted an evaluation of the two participants. One participant’s parent did not give consent
for utilizing his information in the study, so his data were excluded from the analysis. The other’sscore on the PTSSC-15 was 29 before the sub-leader training and 14 after the training.

4. Discussion
The first camp session was held in July 2011, and the center has continued the session since that time. A
total of eight sessions have been conducted to date.
Although the number of participants in the study has declined over the years, there were still many
children who faced traumatic experiences during the earthquake, such as the loss of family members andsightings of the tsunami. Regarding the changes in families’ situation, such as having to rebuild their homes－ 132－

Camp project for parents and children affected by the disaster
inland or to move to reconstructed homes, there were many new participants who wanted to expand thescope of the study to cities that had not been included in the 2010 study.
This time, because we had repeat participation from the same cities and towns as before, it was suggested
that, in the future, we adjust the area of recruitment to reflect the process of recovery in new regions.
In the camp project, approximately one-third of the children exceeded the cutoff value in the pre-camp
PTSSC-15, which suggests that among those wishing to participate, there were children present who still
had some symptoms. Brief evaluation interviews were conducted with children and parents before and after
the camp, but not to the extent that they could be considered clinical treatment. An improvement in PTSSC15 scores from before and after the camp project was confirmed, but 1) the population studied wasextremely small, 2) no control group was established, and 3) there exists the possibility of temporary or
natural recovery, so it cannot be said that this method is superior to other interventions. No K6 scores
exceeded the cutoff value before or after the camp project, and the number below the reference point was
8less than 5% compared to the general population . No improvement in K6 scores was observed in pre- andpost-camp scores. Therefore, the psychological health of the parents of participating children wasconsidered to be unchanged. The bias in studying families with a history of participation cannot bedisregarded; homes where children have been confidently entrusted in the wake of this event have a certain
psychological flexibility, and there is a good chance that their life is becoming more stable.
It is necessary to research the kinds of support that can be offered to families who are not able toparticipate in such a project, including methods other than a camp. The sub-leader workshop was a new
initiative beginning with the eighth camp session. We asked junior high school students who were past camp
participants to participate as camp staff once they participated in preliminary training sessions. Junior highschool students become busy with schoolwork and extracurricular activities, so there were not many whowanted to participate. As the students who participated put it after the camp, however, “This was designed
for us as subleaders to enable children to enjoy themselves safely,” and “I feel that teamwork is alwaysnecessary.” We are planning to continue connecting with camp participants and providing sub-leader
training as part of a system to nurture those who support the community.
References
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