Camp Project for Parents and Children in Disaster-Affected Areas

Camp Project for Parents and Children in
Disaster-Affected Areas
Miyagi Disaster Mental Health Care Center
Stem Center, Planning and Research Division
Physician – Naru Fukuchi
Nurse – Tomoko Uchida
Certified Psychologist – Shusaku Chiba

1. Background and Objectives
In recent years, natural disasters such as earthquakes and floods have occurred frequently in Japan, andthe mental health support system for affected residents is gradually being expanded. Children are one ofthe vulnerable groups that are at risk of slipping through the gaps in support systems in situations where
physical rebuilding is a priority. The Great East Japan Earthquake in 2011 damaged Miyagi prefecture's
coastal areas over a wide area, significantly reducing the space for children to play freely. Various studies
have been reported on the significant changes in residents' living environment due to the earthquake andthe tremendous impact on the minds and bodies of children 1) 2).
Against this background, we conducted a camp project for parents and children in the disaster area toprovide a space where children can play with peace of mind and share their thoughts with other children
who have been through similar experiences. By incorporating psychological education into the programand providing correct knowledge about disasters, we aimed to help children understand the mechanisms of
their minds and taught them how to deal with anxiety.
This camp project was first held in July 2011 by Tohoku Fukushi University as part of its support forthe disaster area, with the cooperation of local professionals and multiple volunteer groups 3). It has been
operated as a yearly project under the umbrella of this Center since 2012. This project's progress has beenposted as an activity report in the bulletin of this Center 4) -7). This paper is a helpful report on the tenthiteration of the day camp, held in October 2019.
2. Methods
As was done in FY 2018, the camp session consisted of two parts—a program designed for elementary
school children, the “Parent-Child Survivors Camp Project” (“day camp project”), and a “Sub-leader Training Workshop for Teenagers”—for past participants who were teenagers.
(1) Camp Project (Table 1)① Targets
In the three coastal cities affected, we received consent from six elementary schools and distributed information to the schools' children. Since the Center inherited this project, we have surveyed
whether or not participants wished to have us send them information on the next session. We sent
information about the event to 60 school-aged children of past participants who had requested it.
② Survey procedure
Explanations were given, and an agreement was obtained from the board of education in eachof the three municipalities. Next, an explanation was provided to each target elementary school,
and application guidelines were distributed to children in the elementary schools where consent
had been obtained. The project's purpose was explained to the families who applied, and their cooperation with the survey was requested. At the time, we explained that they were free to cooperatewith the study if they wished to do so, and could withdraw their consent at any time.
③ Survey content--108 -

Camp Project for Parents and Children in Disaster-Affected Areas
To understand the topics that required attention, we conducted pre- and post- questionnaires
with children and parents to verify their living situations and the effects of the disaster at the timeof the earthquake. To understand their effectiveness and psychological states, children took the Preand Post-Traumatic Stress Symptoms for Children 15 items (PTSSC-15) 8) 9), while parents took
the Kessler Psychological Distress Stress 6 (K6) 10). The pre-questionnaire was conducted two
weeks before the start of the parent-child camp, and the post-questionnaire was mailed around two
weeks after completion. Only the data of those from whom research participation consent was obtained were analyzed.
④ Implementation
The camp was held at the Matsushima Outdoor Activity Center on Saturday, October 15, 2019.
We included instruction on fire-starting as part of our disaster-preparedness education during ouroutdoor cooking activities. After lunch, we held a recreation period titled “Study of the Heart andMind,” where we provided a program that included a picture-show story incorporating simple psychological education (Document 1) and a breathing method using a blow-up pipe.
⑤ Evaluation methods and feedback
Evaluation of the children’s psychological state was done using the PTSSC-15—the recommended cutoff score of 23 was used as a benchmark for flagging children needing support. Scores
before and after the camp were compared to analyze its effect on the children’s mental state. The
K6 scale was used to evaluate parents’ and guardians’ psychological state. A score of 13 or greater,
widely considered indicative of moderate mental illness, was used as a benchmark for flagging
individuals requiring support. Scores before and after the camp were compared to analyze its effecton parents’ and guardians’ mental state. Children flagged as needing support were given an individual interview where their results were explained to them, and any necessary support was provided.
⑥ Ethical considerations
This study was approved by the Miyagi Disaster Mental Health Care Center Ethics Committee
and was carried out with the necessary safeguards for personal information.
(2) Sub-leader training workshop① Target audience
We contacted the families of children that had participated in at least one of our past eight camps,
were currently middle-schoolers, and had indicated that they would like to receive further information in the event of future camps.
② Survey procedures
The purpose of this project was explained to each family applying for the event, and their cooperation was requested. It was explained that participation was optional and that it was possible
to withdraw consent at any time.
③ Survey content
The questionnaire survey was conducted in advance with participating junior high and highschool students to verify the sub-leader training session's effectiveness. The PTSSC-15 was used
as a measure to grasp the subjects’ psychological state in advance. The questionnaire was conducted
two weeks before 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 in
the research was analyzed.
④ Implementation
The session was held at the Ashinaga Sendai Rainbow House on Wednesday, August 8, 2018.
A total of five hours of morning and afternoon training sessions were offered. In the morning, weplanned group work, including icebreaker activities. In the afternoon, the international NGO Save--109 -

Camp Project for Parents and Children in Disaster-Affected Areas
the Children Japan facilitator gave a lecture. The senior students conducted a training session on
psychological first aid (PFA) to support the junior students.
⑤ Evaluation methods and feedback
The evaluation of junior high school students’ psychological state was conducted using the
PTSSC-15; the recommended cutoff value of 23 points was used to designate individuals in a“needs-support” state. Results were delivered in the form of personal feedback given to the juniorhigh school students' parents who were assessed as needing support, with an evaluation according
to the criteria and the observation conducted on the camp's day. We compared the PTSSC-15 results
before and after the sub-leader workshop and camp project and analyzed whether the teenagers’
psychological burden had changed.
⑥ Ethical considerations
This study was approved by the Miyagi Disaster Mental Health Care Center Ethics Committee
and was carried out with the necessary safeguards for personal information.
Table 1: Overview of day camp project and sub-leader training workshop“Parent-Child Survivors Camp Project” (daySub-leader training workshop for teenagers
camp project)(subleader training workshop)
Targets
Among families of children that had partici• Current elementary school chilpated in at least one of our past eight camps anddren and their parents whose famhad indicated that they would like to receive
ilies have participated in any offurther information in the event of future
the past nine sessions and asked tocamps, any children that were currently midreceive information about futuredle-schoolers
events• Elementary school students ofseven schools in three disaster-affected coastal municipalities fromwhich we obtained prior consent
Survey• Pre-event questionnaire• Pre-event questionnaire
content• PTSSC-15• PTSSC-15• Post-event questionnaire• Post-event questionnaire• Group work (“Today’s goals,”• Group work (icebreaker, “What is a subProetc.)
leader?” “Finding your strengths.”gram• Fire-starting experience and cook• “Let’s think about what we can do.”ing
• Senior students conducted a training session on psychological first aid (PFA) to sup• Psychological education througha picture-show story
port the junior students• Breathing techniques using a
blow-up pipe
3. Results(1) Camp project① Target attributes
A total of 27 children participated, but after excluding those children for whom participationin this study was not obtained and those that did not fill out the questionnaires, 19 children wereselected as analysis targets. Thus, 19 targets were analyzed (9 boys, 10 girls), with a mean age of
8.2 years (SD – 1.36). Their disaster experiences have been summarized below. Six of these children were born after the disaster and did not directly undergo any traumatic experiences.
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Camp Project for Parents and Children in Disaster-Affected Areas
Table 2: Attributes of participating children
Number of children (%)
Participants
boys
girls
Mean age
Born after the disaster
Damage to their home (destroyed)
Dangerous experience
Saw wounded individuals
Lost something important
Had a loved one die in the disaster
Witnessed the tsunami

199108.2 years
6 (31.2%)
1 (5.3%)0 (0%)
1 (5.3%)2 (10.5%)
2 (10.5%)
1 (5.3%)② Changes in children’s psychological state
Figure 1 shows PTSSC-15 scores for the 19 analyzed children before and after the camp. Before
the camp, seven children exceeded the 23-point cutoff value for the PTSSC-15, while afterward,
six exceeded it. THE mean PTSSC-15 score for participants was 18.6 (SD – 14.7) before the campand 16.6 (SD = 14.4) afterwards. No statistically significant difference was observed as a resultof verifying pre- and post-camp scores with the corresponding t-test (t (18) = 2.10, p = .50,
p > 0.05).

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Camp Project for Parents and Children in Disaster-Affected Areas③ Changes in parents’ psychological state
The pre- and post-camp scale values of the parents of the 19 children that participated wereanalyzed. Figure 2 depicts the pre- and post-camp K6 scores of these 19 individuals. Before thecamp, 0 parents exceeded the 19-point cutoff value for the K6 scale, while afterwards, 1 exceeded
it. The average value of the K6 was 4.0 (SD = 3.1) before the camp and 3.3 (SD = 3.6) afterwards.
No statistically significant difference was observed as a result of verification of pre- and postcamp scores with a corresponding t-test (t (18) = 2.10, p = .25, p > 0.10).

(2) Subleader training workshop① Targets
Two children applied to participate (one 10th grade boy and one 9th grade girl). Both hadparticipated in the camp project multiple times before and had also taken part in the 2018 subleader
training workshop.
② Changes in participants’ psychological state
We evaluated both participants using their pre- and post-camp PTSSC-15 scores. The boy wentfrom 23 points (pre-camp) to 19 points (post-camp), whereas the girl went from 0 points (precamp) to 8 points (post-camp). Both were evaluated. Because we did not have enough subjects
for this metric, we did not test these values for significance.
4. Discussion
The first camp session was held in July 2011 by Tohoku Fukushi University, and the center has continued these sessions since FY 2012. A total of 10 sessions have been conducted to date. Because the children
who were directly impacted by the disaster have now grown older, and because children born after thedisaster have started to participate, we decided to conclude this project this year, making the tenth iteration
the final one. Over the past nine iterations, the number of participants had decreased with each passing year,
but we received many applications this year. We believe that a lack of scheduling overlap with school andregional/community events is part of the reason we received so many applications.
The number of children who exceeded the cutoff value of PTSSC-15 is 7 (37%) before the camp and 6(32%) after the camp, indicates those living with a psychological burden. A brief evaluation interview was
conducted with children and parents before and after the camp, and it was confirmed that none of them--112 -

Camp Project for Parents and Children in Disaster-Affected Areas
required treatment. Since these children had less direct trauma due to the earthquake, it was considered that
non-earthquake stress or indirect stress related to the earthquake might have affected them. Changes in themean value of PTSSC-15 were examined before and after the camp project, but no statistically significant
improvement was observed, and no effect of the camp intervention was identified.
No parent exceeded the K6 cutoff value before the camp, but one did after the camp. A brief evaluationinterview was conducted with this one person before and after the camp, and it was confirmed that treatment
was not required. The percentage of at-risk individuals measured by the K6 score was below the reference
point of 5% for the general population 12). The change in the mean value of K6 scores was checked before
and after the camp; no statistically significant improvement was observed, and no effect of the camp intervention was identified. Therefore, we believe that the parents of the participating children were able tomaintain their psychological health. However, the participating families' bias cannot be ignored. The families that participated were those who had the peace of mind and psychological stability to leave their children for such an event. Therefore, we believe it is necessary to consider methods other than this camp
project to refer families that cannot easily participate in this project to supporters.
The sub-leader workshop is a new initiative that began with the seventh session in 2017. We reached
out to junior and senior high school students who had participated in the camp in the past, conducted training
to provide preliminary knowledge in advance, and asked them to participate as staff members. The numberof participants was small in all three instances. It became clear that junior and senior high school students
are usually busy with their studies and club activities and find it challenging to participate. We provided ashortened version of “Psychological First Aid for Children, PFA,” a guideline for psychological support,
and devised ways to use it concerning the camp. Attempts to provide PFA for junior and senior high school
students have been rarely reported in the past. We believe that this may serve as a model for training humanresources to support the community.
5. Conclusion
This project has been ongoing since the disaster in 2011 to help children cope with stress and reduce theburden on parents. Many children participated repeatedly, and we were often surprised by their growthwhen we met them each year. It seems that our staff’s role was effective in monitoring the children's development in the area. Additionally, we received management support from entities outside this center,strengthening our local network.
References
1) Fujiwara T, Yagi J, Homma H, Mashiko H, Nagao K, Okuyama M. Clinically significant behavior
problems among young children two years after the Great East Japan Earthquake. PLoS One. 2014
Oct 21: 9 (10): e109342.
2) Fujiwara T, Yagi J, Homma H, Mashiko H, Nagao K, Okuyama M. Suicide risk among young children
after the Great East Japan Earthquake: A follow-up study. Psychiatry Research. 2017 Jul: 253: 318324.
3) Naru Fukuchi, Asako Murai: Practice of disaster area support for children, Hospital and Community
Psychiatry 55 (1), 56-58, 2012.
4) Reira Onuma. Report on camp project for parents and children in the disaster area: Effects and issues
seen from the questionnaire results. Miyagi Mental Health and Welfare Association Miyagi Mental
Care Center 2015 Bulletin No. 4, 141-145, 2016.
5) Tomoko Uchida. A survey report on a camping project for parents and children in the disaster area.
Miyagi Mental Health and Welfare Association Miyagi Mental Care Center 2016 Bulletin No. 5, 107114, 2017.
6) Naru Fukuchi, Tomoko Uchida. Camping business for parents and children in the disaster area. Miyagi
Mental Health and Welfare Association Miyagi Mental Care Center 2017 Bulletin No. 6, 116-120,
2018.

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Camp Project for Parents and Children in Disaster-Affected Areas
7) Naru Fukuchi, Tomoko Uchida, Yoshiko Sugiyama, Hiroyuki Kimura. Camping business for parents
and children in the disaster area. Miyagi Mental Health and Welfare Association Miyagi Mental Care
Center 2018 Bulletin No. 7, 110-116, 2019.
8) Yoshiki T. Preparation and validity of children’s post-disaster stress response scale (PTSSC-15) for
children and bullying victims in an orphanage. Journal of Clinical Psychology 8: 29-36, 2002.
9) Usami M, Iwadare Y, Watanabe K et al. Prosocial behaviors during school activities among childsurvivors after the 2011 Earthquake and Tsunami in Japan: A retrospective observational study. PLoS
One. 2014 Nov 21; 9 (11): e113709.
10) Kessler RC, Andrews G, Colpe LJ et al. Short screening scales to monitor population prevalences andtrends in non-specific psychological distress. Psychol Med. 2002 Aug; 32 (6): 959-76.
11) Save the Children Japan: Emergency Child Mental Health Care “Psychological first aid for children.”(http://www.savech ildren.or.jp/lp/kumamotopfa/, 2020.4.16)
12) Kawakami N, Takano A. A method for investigating the psychological effects of trauma in the general
population. Scientific Research Grant for Integrated Research Project on Disability Countermeasures,
Disability Policy Integrated Research Project (Mental Disorders); Research on Improving Intervention
Outcomes for Mental Disabilities in Disasters. Ministry of Health, Labor and Welfare. 2014 Summary
and research report (Yoshiharu Kin). 93-118, 2015.

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Camp Project for Parents and Children in Disaster-Affected Areas
Document 1: Psychological education via a picture-show story
We’re going to start our “Studying the Heart andMind” exercise now.
Put out your yoga mats and wait for everyone
else to get ready.

Studying the Heartand Mind

There are different feelings inside each of us.

Sometimes, bad things
happen. They canmake you feel...

Which feelings do you have?
I hatethis!

Fun!
I lovethis!

Sad

I don'tcare...

Sad and blue

Or red and angry

Let's try to fix those bad
feelings!
When do you have bad
feelings?

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Camp Project for Parents and Children in Disaster-Affected Areas

Is to breathe!
The trick for that...

Let's try "deep breathing."
We're going to learn how to
do a special kind of breathing
today. It's called "deepbreathing."

When you breathe in,stick out your tummy!

When you breathe out,
suck your tummy in!

Let's put our hands on yourtummy and make sure we're"deep breathing" correctly!

Next, we're goingto "deep breathe"using a tool.

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Camp Project for Parents and Children in Disaster-Affected Areas

Let's try using our blowup pipes!

When you breathein, stick out yourtummy! When you
breathe out, suck
your tummy in!

Now, we're going to try"deep breathing" without
any tools, while lying down,with the lights off, and with
our eyes closed.

Did you get it?

Close your eyes and take"deep breaths."

Breathe in for 3 seconds.
Breathe out for 5 seconds.

Let's try that 3
times.

What you just learned is called"abdominal breathing."

How do you feel now?

If you learn how to do iton your own, you can get
rid of bad feelings whenever you want!

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