Psychosocial Issues

for Children and Adolescents 

in Disasters

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Substance Abuse and Mental Health Services Administration

Center for Mental Health Services
This publication was produced under an Interagency Agreement between the Federal 

Emergency Management Agency and the Center for Mental Health Services, 

Substance Abuse and Mental Health Services Administration. This publication was 

previously published under the title Manual for Child Health Workers in Major Disasters. 

The first edition, printed in 1981, was written by Norman L. Farberow, Ph.D., and 

Norma S. Gordon, Ph.D. The second edition revises and updates the first edition. 

Portland Ridley served as the CMHS publications and editorial coordinator.

Copies are available at no charge from:

SAMHSA’s National Mental Health Information Center

P.O. Box 42557

Washington, D.C. 20015

Toll-free Information Line 1-800-789-2647

TTY 1-866-889-2647

FAX: 240-747-5470

WEBSITE: http://www.mentalhealth.samhsa.gov

All material appearing in this volume, except quoted passages from copyrighted sources, 

is in the public domain and may be reproduced or copied without permission from the 

Administration or the authors. Citation of the source is appreciated.

DHHS Publication No. ADM86-1070R (Revised)

Substance Abuse and Mental Health Services Administration

Reprinted 2005
Psychosocial Issues for Children 

and Adolescents in Disasters

SECOND EDITION

AUTHOR

ANTHONY H. SPEIER, PH.D.

EDITED BY

DIANA NORDBOE, M.ED.

U.S. Department of Health and Human Services

Substance Abuse and Mental Health Services Administration

Center for Mental Health Services
For sale by the Superintendent of Documents, U.S. Government Printing Office

Internet: http://bookstore.gpo.gov Phone: toll free (866) 512-1800; DC area (202) 512-1800

Fax: (202) 512-2250 Mail: Stop SSOP, Washington, DC 20402-0001

ISBN 0-16-075359-7
Table of Contents iii

Table of Contents

Foreword................................................................................... v

Acknowledgments..................................................................... vii

Introduction............................................................................... ix

Chapter 1: The World of Childhood and the Developing Child .... 1

Theories of Child Development.......................................................................... 1

Chapter 2: Reactions of Children to Disasters............................. 9

Normal Reactions to Disaster Induced Stress.................................................... 9

Typical Reactions of Children............................................................................. 12

Chapter 3: Helping the Child and Family .................................... 19

General Steps in the Helping Process ................................................................ 20

The Role of the Family ....................................................................................... 22

Common Feelings and Behaviors....................................................................... 23

Case Examples................................................................................................... 25

Chapter 4: Guidelines for Caregivers, Mental Health and 

Human Service Workers............................................................. 29

Providing Disaster Mental Health Services........................................................ 29

Supervision of Human Service Workers............................................................. 30

Providing Mental Health Training...................................................................... 31

Systems Consultation......................................................................................... 31

Assisting Crisis Counseling Staff to Manage Stress........................................... 32

Conclusion ......................................................................................................... 32

References and Resources.......................................................... 35

Appendix A: Agency Assistance in Disasters.............................. 39

Appendix B: Sources for Additional Information......................... 43

Foreword v

Foreword

This manual is a second edition and is intended to reaffirm and extend the 

concepts expressed in the first edition written by Norman L. Farberow, Ph.D., and 

Norma S. Gordon, Ph.D., and published in 1981 under the title Manual for Child 

Health Workers in Disasters. Since 1981, the nation has experienced many major, 

natural disasters and several devastating, human-caused disasters. In all cases, these 

events deeply affected children. The collective experience of individuals involved in 

disaster work over two decades has repeatedly demonstrated the special vulnerability 

of children to the impact of traumatic events and the importance of providing crisis 

counseling and recovery assistance within the context of their special world. An 

extensive review of the professional literature, materials developed through various 

Federal Emergency Management Agency (FEMA) and Center for Mental Health 

Services (CMHS) funded Crisis Counseling Program grants and contracts, and 

personal communications with numerous crisis counseling and outreach workers 

contribute to the substantive additions to the original volume.

This manual provides information and guidance for individuals concerned with 

the mental health needs of children who experience major disasters. This background, training, and experience will vary and may include health and mental health 

professionals, professional and paraprofessional social service personnel, school and 

daycare personnel, clergy, volunteers, and parents.

Responding to the disaster-related needs of children is unlike any other type of 

work with children. It is distinct because it always involves helping children and 

their support systems cope with the emotional impact of a traumatic event. FEMA 

provided CMHS funding to develop this publication as part of a continuing effort 

to disseminate knowledge gained from previous crisis counseling programs. These 

two Federal agencies serve as conduits of information to others responsible for 

planning and implementing disaster mental health services. 

The information in this manual is intended as a supplement to the Training 

Manual for Mental Health and Human Service Workers in Major Disasters, Second 

Edition (CMHS, 2000), which provides an overview of essential information for 

training disaster mental health workers. It is our hope that the material presented in 

this manual serves as an effective resource in the tool kit for disaster workers.

Seth Hassett, M.S.W. Chief

Emergency Mental Health and Traumatic 

Stress Services

Center for Mental Health Services

Substance Abuse and Mental Health 

Services Administration

Acknowledgments vii

Acknowledgments

The disaster mental health professionals listed below contributed information, 

insights, and thoughtful review to the development of this manual. I incorporated 

many of the suggestions made by my colleagues, which have significantly improved 

the quality of the final product. Deborah J. DeWolfe, Ph.D., Disaster Mental 

Health Psychologist, Robert Benedetto, DPA, LCSW, Disaster Coordinator for 

Ventura County Behavioral Health, Ventura, California; and Bonnie Selzler, 

Ph.D., Project Director for the North Dakota Flood Project, provided substantial 

reviews of earlier drafts of the manual and greatly improved its structure and content 

through their comments. Mr. Daniel Thompson, Disaster Coordinator for the State 

of Texas, Ms. Joan Smyrski, Disaster Coordinator for the State of Maine; Ms. Julie 

Council, Regular Services Grant Coordinator for Projects Cope and Recover in 

Arkansas all contributed case histories from the various projects that were 

incorporated into the case examples in Chapter Three. Finally, I would like to thank 

Ms. Mary Elizabeth Nelson, M.S.W., Chief of the Emergency Services and 

Disaster Relief Branch, Center for Mental Health Services. Her guidance and 

suggestions were essential in bringing this project to fruition. 

Anthony H. Speier, Ph.D.

March 2000

Introduction ix

Introduction

Following a disaster of such magnitude that the President has declared it as 

eligible for Federal assistance, communities are often in chaos and individual 

survivors are undergoing their own feelings of disbelief and shock. It is within this 

context communities must respond to the emotional needs of their residents: adults 

and children. Adults living in the impacted area must balance their roles as survivors, 

responders and caregivers during this time of turmoil. They are often overwhelmed 

with the responsibility and immediate tasks of crisis response and recovery and must 

take time to meet the physical and emotional needs of themselves and family 

members and respond to the needs of the larger community. Consequently, children 

may be left in the care of unfamiliar persons or provided with limited explanations 

of what has actually happened. 

Disaster response workers, who are providing crisis counseling and emotional 

recovery assistance, need to be sensitive to the emotional vulnerability of children. 

The materials discussed herein will give crisis response workers essential information about the impact of disasters on individuals, how the trauma associated 

with such events impacts children, the unique world of children, and the diversity 

of family structures in which children reside. 

A special emphasis is placed on assisting child health workers to understand 

children as uniquely different from adults, and childhood as distinct from adulthood. Child health workers must engage children in the ever changing and 

qualitatively distinct world of emotional and cognitive stages of development in 

which children find themselves. The purpose of the manual is to achieve a better 

understanding of the world of children and the nature of disaster response.

The manual also provides information and guidance for the broader group of 

individuals concerned with the mental health needs of children who experience 

major disasters, and may include the following:

■ Experienced mental health professionals who specialize in working with 

families and their children who experience serious emotional disorders;

■ Experienced mental health professionals who specialize in working with 

families and their children who experience serious emotional disorders;

■ Other health professionals such as physicians, physician assistants, nurses, 

and rehabilitation specialists who are experienced in working with children;

■ Professional and paraprofessional workers who provide crisis and suicide 

intervention services, case managers, and other public health and social 

service personnel who work with children on a regular basis;
x Introduction

■ School and licensed day care center personnel, including teachers, teachers’ aides, guidance counselors, school social workers and psychologists, and 

administrators;

■ Nonprofessional volunteers from the community who have little or no 

training, but who have had personal experience with their own and neighbor’s children; and, 

■ Adults who routinely work with children either as volunteers, or as paid 

service providers or caregivers who have a strong commitment to helping 

children in times of crisis. 
The World of Childhood and the Developing Child 1

CHAPTER 1

The World of Childhood and the Developing Child

Children are one of the most vulnerable groups during and following a 

disaster. A disaster is a strange event that is not easily understood. It is emotionally confusing and frightening and results in children needing significant 

instrumental and emotional support from adults. Children, parents, and whole 

families in need of assistance are found at shelters, recovery centers, and other 

locations. A review of some basic principles and reminders from child developmental theory show how a child’s current stage of development influences 

their behavior and their understanding of traumatic events associated with the 

disaster. Below is a list of basic principles that may be helpful as we, the helpers, 

are rapidly trying to determine the best strategy for providing assistance to children in both the early stages of crisis response and the later stages of emotional 

recovery from the disaster:

■ Be a supportive listener.

■ Be sensitive to the child’s cultural, ethnic, and racial experiences.

■ Respond in a way that is consistent with the child’s level of development.

■ Be aware of the child’s emotional status. Is the child actively afraid or 

withdrawn?

■ Determine if the child is comfortable/secure about his/her current surroundings and those of his or her parents, and other significant persons/pets,

■ Assist the child in normalizing his/her experiences.

■ Seek assistance from a child specialist or mental health professional, if 

necessary. Assistance is needed when the helper does not know what to do 

or think or if he or she is making things worse.

Theories of Child Development

An abundance of popular press is available on the subject of children. 

Topical areas of interest include how to raise, parent, educate, and discipline 

children. It is important, especially when one is in a period of stress and turmoil, 

to step back from the issues at hand and assess the current situation from the 

perspective of life during non-crisis routine times. This is especially true when 

engaging children.

The most important concept to remember is that children are different from 

adults; childhood is different from adulthood. As trained child health workers or 
2 The World of Childhood and the Developing Child

disaster mental health outreach workers who encounter children as survivors of a 

disaster, the preceding statement seems with a moment’s reflection as obvious. In 

fact, the reality is so obvious that it is often overlooked. 

Jean Piaget, renowned for his elegant theory of child development, formulated 

much of his theory from simply observing how his own children responded to 

their environment. Piaget, the scientist-observer, systematically confronted his 

children at different chronological ages with various mental challenges and 

recorded his observations of their responses. Classic examples from his work 

illustrate how children perceive the world differently at various chronological 

ages. 

Piaget (Flavell, 1963) noted young children have difficulty observing objects 

from more than one perspective. For example, a seven-year-old is shown two 

glass containers: one is short, wide, and filled with water; the other is empty, 

tall, and slim in shape. The child is convinced that when the liquid from the 

short container is transferred to the tall one, the volume of the contents actually changes as well. Similarly, when a child of ten or eleven is asked to solve 

a problem that requires abstract reasoning, such as a problem of logical inference (i.e., a>b and b>c; therefore, a>c), the child is often baffled by the solution. 

However, when the same problem is presented with solid objects, it is easily solved. 

Because the objects are concrete and readily visible, he or she easily recognizes 

the relationship. An adolescent, on the other hand, can solve this problem in the 

“abstract” by creating mental images of a, b, and c and then solving the problem 

in his or her head.

Piaget was trained as a biologist and based much of his theory of development on 

the notion that organisms seek homeostasis or a steady state of balance or equilibrium. With respect to humans, he postulated that as we grow we change internally 

and thus, our capacity to engage the environment changes as well. Throughout our 

development we experience states of disequilibrium and seek to return to a state of 

equilibrium. The mechanisms he proposed are two active processes of assimilation 

and accommodation. Simply put, assimilation is the process of interpreting new 

information within the context of our existing cognitive structure, while simultaneously accommodating to the new information or demands of our environment. 

Through the tension of these two ongoing processes we develop our cognitive 

knowledge and capacities. Thus, we develop from an infant who responds primarily 

to sensations to an adult who is capable of complex abstract reasoning. 

All of us can recall conversations with friends who related their frustration 

as parents, complaining that their children are disobedient and refuse to do their 

chores. Is this refusal to behave and do the chores simply because the child is 
The World of Childhood and the Developing Child 3

disobedient? Or is it because the parent is issuing commands in a manner that 

requires the child to translate the “abstract” orders into concrete actions, when 

they have not yet developed the necessary cognitive skills? While a comprehensive discussion of cognitive developmental theories is beyond the scope of the 

subject at hand, it is important to recognize that children think and construct 

their responses to the world in different ways depending on their current level 

or stage of cognitive development. 

In summary, we should be aware when we meet a child that they are operating in the world with a different set of cognitive structures than adults and are 

interpreting information from the environment in a different fashion. In the next 

chapter, there are a number of illustrations of how this actually works.

Cosario (1997) recently reasserted that when trying to understand children, 

we must remember that childhood is not simply an apprenticeship to the “real” 

world of adulthood, but is the current world in which children operate. It is the 

environment in which cognitive, social, and emotional development occur for 

individual children. “Children create and participate in their own unique peer 

cultures by creatively taking or appropriating information from the adult world 

to address their own peer concerns” (p.18). Hartup (1979) suggests that children 

really experience two worlds: the world of adult-child interactions, such as with 

teachers and parents, and the world of peer interactions with children of similar 

age. We must be aware of the simultaneous presence of both these environments 

to understand and relate to children as developing individuals.

The emotional development of children parallels, complements, and interacts 

with their cognitive development. Kagan (1982) has shown in studies of normal 

infant development that when confronted with new and different information 

infants may smile if the information is successfully integrated, and they show fear by 

crying or withdrawing if they cannot make sense of the information. The study of 

emotional development affirms that emotions are central to survival. Through 

emotional expression the infant expresses distress (a soiled diaper or hunger), pleasure 

(being comfortable and having a full stomach), and fear of strangers. As children 

in middle school and high school, we learn to respect the social standard of 

non-aggression toward peers and acquire the skills necessary to problem solve 

conflicts and modulate emotional expression accordingly. By adolescence we are 

well skilled in expressing empathy, pride, shame, guilt, and other emotions. Thus, 

throughout normal development we learn more sophisticated strategies of emotional 

expression.

Closely tied to emotional development is the development of attachment. 

Attachment theory as originally developed by John Bowlby (1982) integrates 
4 The World of Childhood and the Developing Child

psychoanalytic concepts of child development with parts of cognitive psychology, ethnology, and human information processing. He defines attachment 

theory as a way of conceptualizing “... the propensity of human beings to make 

strong affectional bonds to particular others, and of explaining the many forms of 

emotional distress and personality disturbance including anxiety, anger, depression, and emotional detachment to which unwilling separation and loss give rise” 

(Bowlby, 1982, p. 39). Attachment refers to the affectional bond that forms 

between a nurturing figure, usually the mother, and her child in the course of 

time and in response to consistent care. Bowlby states that there is an innate 

tendency within the human baby to seek and maintain proximity to the attachment figure. This behavior has the function of protecting children from the risk 

of harm.

Mary Main (1996) recently reviewed the field of attachment research. In the 

years since Bowlby’s original formulation, the concept of attachment has been 

extended beyond infancy to account for behavior throughout the life span. Main 

has affirmed that the development of the attachment relationship is based on 

social interaction. In the overwhelming majority of instances children become 

securely attached to a nurturing caregiver. Children also become attached to maltreating parents and the resulting attachment bond is expressed as an insecure 

attachment. The quality of the attachment bond is usually established by seven 

to eight months of age and is characterized as secure or insecure. Secure attachment is the result of an infant being able to rely on the caregiver as consistently 

available and nurturing. Infants who have incompetent, uncaring, or inconsistent 

caregivers express insecure attachment behavior. Insecure attachment behaviors 

related to separation and reunion with the caregiver range from ignoring the 

caregiver to excessive and disquieting expressions of distress.

Being securely attached to a nurturing caregiver is further expressed by using 

the caregiver as a “secure base” for exploring one’s immediate environment. For 

example, a small child playing in the park will run and play far away from his 

or her mother as long as he or she is in visual proximity. The child will wander 

farther and farther away only to spontaneously return to his or her mother and 

soon wander off again in spirited play. Just as the child displays organized and 

confident behaviors while in the comforting presence of the caregiver, he or she 

can also appear disorganized and highly anxious or fearful upon separation or 

loss of the caregiver. Brief separations from one’s parents is a common event in 

disasters. 

Upon separation and loss of proximity to the caregiver, the child will express 

fear and anxiety until again secure in the knowledge of the availability of the 

caregiver. As discussed earlier, infants and very young children must be able 
The World of Childhood and the Developing Child 5

physically to see objects to keep them psychologically available. However, with 

time, children can build psychological representations of objects, people, and 

relationships. Recent research suggests that through maintenance of mental 

models of caregivers, children are influenced in their formation of relationships 

with peers and in the development of successful interactions with friends. In 

a similar vein, adolescents are influenced by models of adult caregivers as they 

begin developing long-term relationships with significant others. 

To better understand normal and abnormal child development, much research 

has been conducted comparing the behavior of securely attached and insecurely 

attached children. Carlson and Sroufe (Main, 1996) have reported “...in peer 

and school settings, children who felt secure as infants with their mother exhibit 

greater ego resilience as well as social and exploratory competence than insecure 

infants...Security with fathers also contributes favorably to outcome” (p. 240).

Disasters are events postulated with separation and loss. Irrespective of the 

quality of the child’s attachment to the caregiver as secure or insecure, unexpected 

separation and disruption of one’s secure environment results in fear, anxiety, and 

disorganization of one’s own behavior. Children who have experienced secure 

attachment relationships with a nurturing caregiver are the most resilient in reconciling the disruption and recovering from traumatic events. The disruption and loss 

experienced will most likely be more difficult to resolve for children who have 

experienced insecure attachment relationships.

Cassidy (1996) summarized some basic findings from the study of attachment 

relationships: 

■ Linkages exist between family and peer systems.

■ Children’s daily experiences with parents affect their concept of self and 

relationships with others.

■ Children with more positive relationships with peers express more positive 

behaviors.

■ More positive behaviors result in being better liked by peers. 

In summary, the quality of parents’ caregiving behavior initiates a process 

linked with the quality of peer relationships throughout childhood and early 

adolescence. 

Erik Erickson’s theory of psychosocial development (Santrock and Yussen, 

1987) offers a perspective on a child’s social development. Erickson proposed that 

social development is the result of the interaction between internal biological 
6 The World of Childhood and the Developing Child

forces and external cultural pressures. As such, he proposed eight stages of 

development throughout the life span. The conflicts one experiences at each stage 

can be resolved in either a positive (adaptive) or negative (mal-adaptive) way. 

For Erickson, the development of a psychologically healthy adult required the 

successful resolution of conflict at each developmental stage. He accounted for 

variation of emotional expression and behavior among individuals on their resolution of conflict along a continuum of healthy to unhealthy outcomes. The eight 

stages of psychosocial development coincide loosely with eight life stages. Five of 

these stages occur from infancy through adolescence.

Early infancy is the stage of ‘trust versus mistrust’ in which the infant learns 

to view the world as a place where one can trust others to be supportive and caring, or a place where the infant cannot consistently rely on the support and nurturing of others. Late infancy is the stage of ‘autonomy versus shame and doubt’. 

In this stage autonomy is the ability to control one’s own actions, such as successful toileting. An inability to learn such control may result in feelings of shame 

and doubt. Early childhood is the stage of ‘initiative versus guilt’. The child is 

confronted with the conflict of relationships with parents and unresolved feelings 

of love and hate. Taking the initiative and engaging in positive social activities 

resolves conflict; failure to do so results in unresolved guilt. Middle childhood is 

the stage of ‘industry versus inferiority’. During this stage, the child’s cognitive 

knowledge, physical abilities, and social relationships are expanded. Upon comparison of self with others, the child ultimately measures how he or she compares 

to peers. If the child feels incompetent and inferior, as opposed to competent 

and adequate, his or her interactions with others will differ than if the child feels 

confident in how he or she compares with peers. During the storm and stress 

of adolescent years, the child is confronted with the universally known stage 

of Erickson’s theory ‘identity versus identity confusion’. It is during this period 

that the child resolves the conflict between “who I am and what I want to be” 

and struggles to decide the direction of his or her life. Resolution of the conflict 

associated with identity marks the end of childhood and the emergence of adult 

role-taking in society. The remaining three stages continue to deal in a similar 

vein with issues of role performance and development throughout adulthood.

In summary, normative development throughout childhood is generally 

viewed as an active and complex process. It involves the ongoing maturation of 

the child and how he or she engages people and events, attachment to significant 

adults, social relationships with peers, intellectual and emotional development, 

and the actual world in which he or she lives. Childhood is the culture in which 

individual development occurs. The quality and characteristics of their environment also directly influence the healthy development of children. Is it a setting 

where basic needs are a struggle to meet, where danger and fear of personal 
The World of Childhood and the Developing Child 7

safety are daily concerns? Or is it a world that is predictable in its organization 

and resources? Is it a nurturing place with companionship or one of disregard 

and isolation?

When a natural or human-caused disaster invades the world of the child, 

the impact disrupts the normalcy of the environment and normative functioning. Fortunately, most children enjoy successful and normal childhoods surrounded by adults and peers who can help them adjust to the impact of the 

disaster. Traumatic events can be successfully assimilated into their worlds within 

the context of their own individual development. For those children who are 

experiencing childhood as a negative environment and are actively developing 

maladaptive survival strategies, recovery from traumatic events will be a complex 

and time-consuming process. This can result in sustained and significant alterations in how successfully children are functioning in their world. For example, 

children may experience a drop in academic performance at school and disruptions in their social interactions with friends, siblings, or parents. Children who 

are experiencing such significant disruptions in their routine social and cognitive functioning may be at risk for developing Post Traumatic Stress Disorder 

(PTSD) or another form of emotional disorder.

Reactions of Children to Disasters 9

CHAPTER 2

Reactions of Children to Disasters

Normal Reactions to Disaster Induced Stress

Most parents recognize when their children’s behavior indicates emotional 

distress. During routine, non-crisis times parents are tuned-in to the nuances of 

their children’s behavior. Most mothers can tell immediately if their young son or 

teenage daughter had a bad day at school or a fight with their best friend. A very 

common sign indicating distress is the sudden appearance of a very busy child, 

who just suddenly decides he or she will watch TV with his or her parents, and is 

not even particular about what they are watching. For most parents, this is when 

their antennae go up and somehow they know it is time to give that extra hug 

and just be available. Typically, a few words eventually pass between the parent 

and child. The parent smiles, the child looks relieved, and as quickly as the child 

appeared he or she vanishes back into his or her now somewhat reorganized and 

normal world. Under normal circumstances in the majority of nurturing families, 

they play this scene over and over and without really thinking anything of it. It is 

just a slice of daily life.

Disasters are not normal or routine and therefore, impose a significant abnormality on our daily routines. Everyone is affected. Typical modes of interacting 

with each other are strained. All of us are trying to get a grip on things and as a 

result focus less on supporting each other. It is within this context that children 

experience the aftermath of disasters.

The American Academy of Child and Adolescent Psychiatry (AACAP, 1998) 

suggests that a child’s reaction to a disaster, such as a hurricane, flood, fire, or 

earthquake, depends upon how much destruction is experienced during or after 

the event. The death of family members or friends is the most traumatic, followed 

by loss of the family home, school, special pets, and the extent of damage to the 

community. The degree of impact on children is also influenced by the destruction 

they experience second hand through television and other sources of media reports. 

Generally, most children recover from the frightening experiences associated with a disaster without professional intervention. Most simply need time 

to experience their world as a secure place again and their parents as nurturing 

caregivers who are also again in charge. 
10 Reactions of Children to Disasters

Studies of how children have reacted to catastrophic events are limited. 

However, in the available work done on this topic there emerges a consistent 

pattern of responses and factors that influence the difficulty children may have in 

returning to their pre-disaster state. Yule and Canterbury (1994) reviewed a number 

of studies concerning children exposed to traumatic events. The types of reactions 

experienced by many children reported include feeling irritable, alone, and having 

difficulty talking to their parents. Many experience guilt for not being injured or 

losing their homes. Adolescents are prone to bouts of depression and anxiety, 

while younger children demonstrate regressive behaviors associated with earlier 

developmental stages. Many children who have difficulty reconciling their feelings 

will engage in play involving disaster themes and repetitive drawings of disaster 

events. It has also been demonstrated that children as young as two or three can 

recall events associated with disasters. The child’s level of cognitive development 

will influence their interpretation of the stressful events. Some studies reviewed 

by Yule and Canterbury suggest that the intellectual ability of the child, their sex, 

age, and family factors influence their recovery. Girls experience greater stress reactions 

than boys, bright children recover their pre-disaster functioning in school more 

rapidly, and families who have difficulty sharing their feelings experience greater 

distress. As expected, there also appears to be a direct relationship between the 

degree of exposure to frightening events and the difficulty in emotional adjustment and returning to pre-disaster functioning.

Other researchers have attempted to explain what factors influence children’s 

reactions to traumatic or stressful events. In their review of the emotional effects 

of disaster, Lewis Aptekar and Judith Boore (1990) report that one’s belief as to 

who or what caused the disaster and the degree of destruction are major factors 

influencing children’s reactions. These authors have also identified five additional 

factors that influence recovery from the traumatic event:

■ child’s developmental level 

■ child’s premorbid mental health

■ community’s ability to offer support

■ parents’ presence or absence during the event

■ significant adults’ reaction

A more recent review by Vogel and Vernberg (1993) also suggests the influence of children’s developmental level on their ability to comprehend traumatic 

events, their coping repertoire, and their involvement with other groups of people 

beyond the immediate family. 
Reactions of Children to Disasters 11

In a longitudinal study, Vernberg, LaGreca, Silverman, and Prinstein (1996) 

provided a thoughtful account of how elementary school children responded 

to the disastrous impact of Hurricane Andrew in Dade County, Florida. These 

researchers concluded that many symptoms experienced by these children could 

be understood using an integrated conceptual model first discussed by Green et 

al. (1991). Green et. al. investigated four factors: 

■ exposure to traumatic events during and after the disaster

■ pre-existing child characteristics

■ post-disaster recovery environment (social support)

■ coping skills of the child

The model suggested by Vernberg, et al. (1996) increased the number of factors 

from four to five:

■ exposure to traumatic events during and after the disaster

■ pre-existing demographic characteristics

■ occurrence of major life stressors

■ availability of social support

■ type of coping strategies used to manage disaster-related stress

The primary focus of this study was to ascertain what factors influence the 

lingering symptoms and subsequent identification of children experiencing 

PTSD. The authors conclude that symptoms associated with PTSD could 

represent normal adaptive reactions and that for many children the effects of a 

disaster may still be observed beyond one to two years after the event. In trying 

to determine what made the various symptoms persist in these elementary age 

children, the researchers found the daily hassles of routine life in the weeks and 

months following the incident interacted with the severity of the trauma experienced making it difficult to recover. The strains of ongoing life events (e.g., loss 

of employment by a parent, divorce, or other stressors) also impact the availability of a supportive environment. Other factors identified by the authors were the 

overall loss of essential support from the community and schools given the respective 

impact of the disaster on these social systems. 
12 Reactions of Children to Disasters

Typical Reactions of Children

Fears and Anxieties

Fear is a normal reaction to disaster, frequently expressed through continuing 

anxieties about recurrence of the disaster, injury, death, separation, and loss. 

Because children’s fears and anxieties after a disaster often seem strange and 

unconnected to anything specific in their lives, the child’s relationship to the 

disaster may be difficult to determine. In dealing with children’s fears and anxieties, accepting them as very real to the children is generally best. For example, 

children’s fears of returning to the room or school they were in when the disaster 

struck should be accepted at face value, and interventions should begin with talking about those experiences and reactions.

Before the family can help, however, they must understand the children’s needs; 

this also requires an understanding of the needs of the family. As discussed throughout this manual, families have their own unique pre-disaster profile of beliefs, values, 

fears, and anxieties. Frequently, dysfunction in the family is mirrored in the child’s 

malfunctioning. The disaster mental health worker may need to talk with the family 

as a whole to better understand the role the whole family can play in responding 

to its own set of fears and anxieties that may exacerbate the fears expressed by the 

children. Sometimes, the pre-disaster level of dysfunction in the family may be 

so severe that referral for more formal mental health services may be necessary.

A parent’s or adult’s reaction to children makes a great difference in the 

children’s recovery. The intensity and duration of children’s symptoms decrease 

more rapidly when families can show that they understand their feelings. When 

children believe their parents do not understand their fears, they feel ashamed, 

rejected, and unloved. Tolerance of temporary regressive behavior allows children 

to redevelop those coping patterns that had been functioning before the disaster. 

Praise offered for positive behavior produces positive change. Routine rules need 

to be relaxed to allow time for regressive behaviors to run their course and the 

reintegration process to take place.

When children show excessive clinging and unwillingness to let their parents 

out of their sight, they are expressing their fears and anxieties of separation or loss. 

They have experienced the harmful effects of being separated from their parents 

and in their clinging are trying to prevent a possible recurrence. Generally, the 

children’s fears dissolve when the threat of danger has dissipated and they feel 

secure again under the parent’s protection. 
Reactions of Children to Disasters 13

Children are typically most fearful when they do not understand what is 

happening around them. Every effort should be made to keep them accurately 

informed, thereby alleviating their anxieties. Adults frequently fail to realize the 

capacity of children to absorb factual information and do not share what they 

know. Consequently, children receive only partial or erroneous information.

Most important to resolving disaster related fears and anxieties in children is 

the quality of safety and security present in the family. The family should make 

every effort to remain together as much as possible, for a disaster is a time when 

the children need their caregivers around them. In addition, the model adults 

present at this time can be growth enhancing. For example, when parents act 

with strength and calmness, while maintaining control and sharing feelings of 

being afraid, they serve the purpose of letting the children see that acting courageously even in times of stress and fear is possible.

Sleep Disturbances

Sleep disturbances are among the most common problems for children after a 

disaster. Behaviors associated with sleep disturbances are likely to take the form 

of resistance to bedtime, wakefulness, unwillingness to sleep in their own rooms 

or beds, and refusal to sleep by themselves. Children will also express a desire to 

be in a parent’s bed or to sleep with a light on, insist that the parent stay in the 

room until they fall asleep, or may begin to rise at excessively early hours. Such 

behaviors are disruptive to a child’s well-being. They also increase stress for parents, 

who may themselves be experiencing some adult counterpart of their child’s disturbed 

sleep behavior. More persistent bedtime problems such as sleep terrors, nightmares, 

continued wakening at night, and refusal to fall asleep may point to deep-seated 

fears and anxieties that may require professional intervention.

In working with families, exploring the family’s sleep arrangements may be 

helpful. Long-term adjustments in sleeping arrangements, such as allowing children to sleep routinely in the parent’s bed, will inhibit the child’s recovery process. However, temporary changes following a disaster may be in order. For very 

young children, it may be especially reassuring to have close contact with their 

parents during those times when disaster fears are most prominent. After a brief 

period of temporary changes, the parents should move toward the reinstatement 

of pre-disaster bedtime routines. Thus, the family may need to develop either new 

or familiar bedtime routines, such as reinstating a specific time for going to bed. 

The family may find it helpful to plan calming, pre-bedtime activities to reduce 

chaos in the evening. Teenagers may need special consideration for bedtime 

privacy. Developing a quiet recreation in which the whole family participates is 

also helpful.
14 Reactions of Children to Disasters

Besides the above descriptions of fears, anxieties, and sleep disturbances, children’s reactions to a disaster can be expressed in many different forms. Below are 

some more common reactions. (For convenience, the reactions are presented for 

three age groups: preschool or early childhood, latency age, and pre-adolescence 

and adolescence.) 

Preschool, Five Years Old and Younger

Most of the symptoms appearing in this young age group are nonverbal fears and 

anxieties expressed as the result of the disruption of the child’s secure world. These 

symptoms include:

■ crying in various forms, with whimpering, screaming, and explicit cries for 

help

■ becoming immobile, with trembling and frightened expressions

■ running either toward the adult or in aimless motion

■ excessive clinging

Regressive behavior, that is, behavior considered acceptable at an earlier age and that 

the parent had regarded as past may reappear. This includes the following: 

■ thumb sucking

■ bed-wetting

■ loss of bowel/bladder control

■ fear of darkness or animals

■ fear of being left alone or of crowds or strangers

■ inability to dress or eat without assistance

Symptoms indicative of fears and anxieties include:

■ sleep terrors (i.e., child abruptly sits up in bed screaming or crying with 

a frightened expression and autonomic signs of intense anxiety. The child 

is unresponsive to the efforts of others to awaken or comfort him/her. If 

awakened, the child is confused and disoriented for several minutes and 

recounts a vague sense of terror usually without dream content.) 

■ nightmares (i.e., frightening or anxiety producing dreams)

■ inability to sleep without a light on or someone else present

■ inability to sleep through the night
Reactions of Children to Disasters 15

■ marked sensitivity to loud noises

■ weather fears – lightning, rain, high winds

■ irritability

■ confusion

■ sadness, especially over loss of persons or prized possessions

■ speech difficulties

■ eating problems

The symptoms listed above may appear immediately after the disaster or after 

the passage of days or weeks. Most often they are transient and soon disappear. 

Parents can help diminish the above symptoms in their children through understanding the basis for the behaviors and giving extra attention and caring. If the 

symptoms persist for longer than a month, parents should recognize that a more 

serious emotional problem has developed and seek professional mental health 

counseling.

Latency Age, Six Years Old Through 11 Years Old

Fears and anxieties continue to predominate in the reactions of children in 

this age group. 

However, the fears demonstrate an increasing awareness of real danger to self 

and to the children’s significant persons, such as family and loved ones. The reactions also begin to include the fear of damage to their environment. Imaginary 

fears that seem unrelated to the disaster also may appear.

Regressive behaviors may appear in this age group similar to those in the preschool 

group. Problem behaviors include the following:

■ bed-wetting

■ sleep terrors

■ nightmares

■ sleep problems (e.g., interrupted sleep, need for night light, or falling asleep)

■ weather fears

■ irrational fears (e.g., safety of buildings, or fear of lights in the sky)
16 Reactions of Children to Disasters

Additional behavior and emotional problems include:

■ irritability

■ disobedience

■ depression

■ excessive clinging

■ headaches

■ nausea

■ visual or hearing problems

The loss of prized possessions, especially pets, is very difficult for children in this age 

group. As noted in the previous section, the school environment and relationships with 

peers is central to the life of latency age children. School problems begin to appear and 

may take the form of:

■ refusal to go to school

■ behavior problems in school 

■ poor school performance

■ fighting

■ withdrawal of interest

■ inability to concentrate

■ distractability

■ peer problems (e.g., withdrawal from play groups, friends, and previous 

activities or aggressive behaviors and frequent fighting with friends or 

siblings)

Preadolescence and Adolescence, 12 Years Old Through 17 Years Old

Adolescents have great need to appear competent to the world around them, 

especially to their family and friends. Individuals in this age group are struggling 

to achieve independence from the family and are torn between the desire for 

increasing responsibility and the ambivalent wish to maintain the more dependent role of childhood. Frequently, struggles occur with the family, because the 

peer group seems to have become more important than the parental world to the 

adolescent child. In the normal course of events, this struggle between adolescents 

and family plays itself out and depending on the basic relationships between the 

child and his or her parents, they resolve the trials and problems.
Reactions of Children to Disasters 17

The effects of a major disaster on adolescents will vary depending on the extent 

to which it disrupts the functioning of the family and the community. The impact 

of the disaster may stimulate fears related to loss of family, peer relationships, 

school life, and even concern over the intactness of their own bodies. Adolescents 

struggling to achieve their own identity and independence from the family may 

be set back in this personal quest with reactivated fears and anxieties from earlier 

stages of development. The trouble signs to watch for in pre-adolescents and 

adolescents include:

■ withdrawal and isolation

■ physical complaints (e.g., headaches or stomach pain)

■ depression and sadness

■ antisocial behavior (e.g., stealing, aggressive behavior, or acting out)

■ school problems (e.g., disruptive behavior or avoidance)

■ decline in academic performance

■ sleep disturbances (e.g., withdrawal into heavy sleep, sleep terrors, or 

sleeplessness)

■ confusion

■ risk taking behavior

■ alcohol and other drug use

■ avoidance of developmentally appropriate separations (e.g., going to camp 

or college)

Most of the above behaviors are transitory and disappear within a short period. 

When these behaviors persist, they are readily apparent to the family and to teachers 

who should respond quickly. Teenagers, who appear to be withdrawn and isolate 

themselves from family and friends, are experiencing emotional difficulties. They 

may be concealing fears they are afraid to express. Just as many adults do, adolescents often show their emotional distress through physical complaints. 

Helping the Child and Family 19

CHAPTER 3

Helping the Child and Family

This section of the manual focuses on helping children and their families deal 

with the emotional aftermath of a disaster. Major disaster events irrespective of 

their origin impact all persons who experience the event. Evidence from numerous disasters clearly demonstrates that persons who are impacted by the event either 

directly or indirectly will experience a range of feelings and emotions regarding 

the effect of the disaster and its consequences. 

While everyone interprets life events within the context of their experiences, 

children interpret their personal experiences within the limited context of their 

current stage of psychological development. As mentioned in the previous sections, the world of the child is defined by his or her stage of intellectual and emotional development, experiences with siblings and parents and extended family 

including grandparents, uncles, aunts, and cousins, the child’s history and culture, 

and his or her school, peers, neighborhood, and community within which he or 

she lives. It is within the structure of these relationships that a child must cope 

with the impact of the disaster event. 

Understanding the definition(s) of family for a child is essential to understanding the complexity of their emotional reaction to the disaster. Family in its 

most common definition is a group of persons consisting of parents and their 

children. However, in its broadest interpretation it can be defined as any class or 

group of related things. Thus given the appropriate context, a child’s family can 

be as broad as their neighborhood, community, or school, or as narrow as their 

relationship to their parents. Considering the various definitions of family when 

trying to assess the depth of impact of a disaster on children is important and 

necessary to determine appropriate crisis counseling and disaster mental health 

recovery strategies.

Below are examples of some potential relationships that comprise the notion 

of family for children:

■ children to natural parent, direct caregiver, or guardian

■ children to brothers and sisters, living in the same and other households

■ children to grandparents (maternal and fraternal)

■ children to uncle, aunts, and cousins, within and distant from the impact 

area
20 Helping the Child and Family

■ children to significant non-related adults

■ children to the world of their school (teachers, staff, and students)

■ children to school friends and neighborhood friends — from their inner 

circle of very close confidants to casual acquaintances

■ children to community of worship (church, synagogue)

■ children to persons in the communities of reference, (e.g., local neighborhood, village, town, city, county) 

General Steps in the Helping Process

A basic principle of working with children in disasters is that they are essentially normal children who have experienced great stress. Most of the problems 

that appear are likely therefore to be directly related to the disaster and transitory 

in nature.

The process recommended for helping children and families often starts with 

“crisis intervention,” which trained and supervised paraprofessionals and volunteers can provide. The primary goal in crisis intervention is to identify, respond 

to, and relieve the stresses resulting from the crisis (disaster) and to reestablish 

normal functioning as quickly as possible. Sometimes the reaction is mild, but 

other times it is severe. Also, the workers must be trained to recognize when 

the condition is mild and can be handled by the families (with guidance), when 

referral to a helper, such as a school counselor is warranted, and when it is severe 

and requires intervention by a mental health professional.

The general steps in the helping process are:

1. Establishing rapport

■ Let the children know you are interested in them and want to help.

■ Check with the children to make sure that they understand what you are 

saying and that you understand them.

■ Display genuine respect and regard for the children and their families.

■ Communicate trust and promise only what you can do.

■ Convey acceptance of the children and their families.

■ Communicate to the children and their families that you are an informed 

authority.
Helping the Child and Family 21

2. Identifying, defining, and focusing on the problem

■ Identify and prioritize specific problems with the children, parents, and 

family.

■ Select a specific problem, define its characteristics, and focus on solving it 

first.

■ Achieve a quick resolution to the problem so that the members of the 

family experience a sense of success and control.

■ Evaluate the seriousness of each of the identified problems and the capacity of the family to deal with them.

3. Understanding feelings

■ Demonstrate your ability to see and feel as others do.

■ Display patience in trying to understand children’s feelings, for children 

are frequently unable to express their fears.

■ Respond to the children’s stories frequently by commenting on the events 

and affirming their feelings. 

■ Express a nurturing positive regard for the children, to convey an appreciation for the kind and intensity of their feelings.

4. Listening carefully

■ Understand the disaster concerns from the point of view of the children.

■ Listen to the children’s account of the disaster many times, in order to 

help children “work through” their feelings associated with the disaster.

■ Refrain from interrupting the children as they tell their stories.

■ Affirm children’s feelings by giving them time to express themselves.

5. Communicating clearly 

■ Communicate in a language children understand.

■ Talk with children in groups or with siblings or other family members.

■ Seek the presence of family members to interpret code words used by the 

children.

■ Communicate with children in their dominant language.
22 Helping the Child and Family

The Role of the Family

As discussed earlier, many factors can influence the child’s psychological definition of family. However, for purposes of the current discussion, the child’s family is defined in terms of significant persons providing caregiving and support, 

who are also members of the child’s nuclear and extended family structure. Since 

children live in family systems, both the experience of the disaster and recovery 

from its aftermath are most often mutually experienced. Consequently, children 

will share common aspects of the disaster event experience. The retelling of these 

experiences between the adults and children in the family can normalize the 

overwhelming rush of feelings associated with the disaster. For many families, 

the role of the outreach worker is simply to give them permission to share their 

feelings with each other and to communicate that having disaster related feelings 

is normal and sharing these feelings with each other is appropriate and healthy. 

A function of the crisis counseling program is to convey information to parents 

about the common reactions of families to trauma and loss following a disaster. 

Often parents deny the need for this type of information for themselves, but 

will gladly participate in programs or gatherings where this type of information 

is provided for helping support their children. Typically parents will recognize 

stress reactions and accompanying behavioral changes in their children, before 

they recognize them in themselves. The disaster mental health worker helps all 

members of the family unit by sensitizing parents to the signs of stress in their 

children and suggesting strategies for helping their children. 

Outreach workers can remind parents of these simple facts:

■ Parents should acknowledge the parts of the disaster that were frightening 

to them and other adults.

■ Parents should not falsely minimize the danger as it will not end a child’s 

concerns.

■ The child’s age affects how he or she will respond to the disaster. (A six-yearold may express his or her concerns by refusing to attend school, while an 

adolescent may express his or her concerns by arguing more with parents.)

■ The way the child sees and understands his or her parent’s response is very 

important.

■ Parents should admit their concerns and also stress their abilities to cope 

with the situation.

Often the role of the family is simply to learn to work together to solve problems and actively recognize the needs and feelings of both the children and the 
Helping the Child and Family 23

adults. The identification of concrete issues that are problematic for the family 

unit, as well as for individuals within the family, is often the first step in the emotional recovery of the family. This is followed by crafting solutions to problems, 

resolving problems by implementing solutions, and celebrating the successes of 

positively resolving problems. Through this process, family members begin to 

reestablish mastery over their environment and bring back into equilibrium the 

role of each of the family members. By routinely repeating this process throughout the various stages of recovery, the family members will become closer as a 

unit and individually more autonomous, thus helping all members of the family 

reestablish their identity and proceed with their normal developmental roles.

In working with families of diverse backgrounds, outreach workers must be 

sensitive to language differences and cultural needs. Children are often thrust into 

the role of interpreter if their parents and relatives are not fluent in English. This 

responsibility may require skills beyond the child’s current stage of development 

and be too stressful for the child. The outreach worker can relieve the child of this 

responsibility by seeking out adult interpreters for the family. 

Common Feelings and Behaviors

Children and adults express signs and symptoms to stressful events along four 

dimensions: cognitive, emotional, physical, and behavioral. Common reactions 

expressed by children along each of these dimensions include the following:

Cognitive

■ trouble concentrating

■ preoccupation with the event

■ recurring dreams or nightmares 

■ questioning spiritual beliefs

■ inability to process the significance of the event

Emotional

■ depression or sadness

■ irritability, anger, resentfulness

■ despair, hopelessness, feelings of guilt

■ phobias, health concerns

■ anxiety or fearfulness
24 Helping the Child and Family

Behavioral

■ isolation from others

■ increased conflicts with family 

■ sleep problems

■ avoiding reminders

■ crying easily

■ change in appetite

■ social withdrawal

■ talking repeatedly about the event

■ refusal to go to school

■ arguments with family and friends

■ repetitive play

Physical

■ exacerbation of medical problems

■ headaches

■ fatigue

■ physical complaints with no physical cause
Helping the Child and Family 25

Case Examples

Below are examples of the situations that confront children in the aftermath 

of a disaster event. These examples are from ice storms in Maine, tornadoes in 

Texas and Arkansas, and floods in Louisiana and Texas.

1. SEPARATION ANXIETY

 Katy, an eight-year-old girl, and her father were returning home from the 

video store one Saturday afternoon when a tornado struck. Katy and her father 

hunched down in the car, when suddenly the windows blew out and a tree fell 

across the hood. They crawled out of their demolished car shaken but miraculously unhurt. Katy’s mom and two older brothers, who were in the home when 

the tornado struck, survived with only bumps, bruises, and one broken arm, but 

their two-story home was a pile of rubble.

The next few weeks after the tornado were difficult for Katy. She did not 

want to go to school and had difficulty sleeping at night. She had dreams about 

the tornado and feared leaving her mom, dad, and brothers. The teachers at 

school were supportive and understanding of Katy’s needs. The first few weeks 

after the tornado Katy felt anxious and worried about her parents. School 

personnel allowed Katy to call and “check-in” with her parents at recess so she 

was assured that they were okay. Katy’s family also held a family meeting and 

discussed what they should do to be safe at home, school, or work in the event 

of another disaster. After a few weeks, Katy could sleep in her own room again 

and go to school without much anxiety.

2. ACTING OUT

Tommy, an eleven-year-old fifth grader, had been receiving mental health 

treatment for disruptive behavior and defiance in the classroom prior to the 

tornado. He was responding well to treatment and receiving positive reports 

from his teacher. Tommy, who had never experienced any kind of disaster, was 

at a friend’s house when the tornado struck and several trees came smashing through the windows. Tommy was not hurt physically by the tornado, but 

both his teachers and parents reported an increase in his disruptive and defiant 

behavior even though he continued in treatment. Upon review of Tommy’s 

situation with the school and an interview with his parents, it became clear that 

no one had offered Tommy any opportunity to deal with his disaster related 
26 Helping the Child and Family

experience and with the subsequent stress he was trying to manage due to 

fears associated with the occurrence of another tornado. A series of visits by 

the disaster outreach workers to Tommy’s home and school helped Tommy 

normalize his experience and feel more open about discussing his fears. Both 

his parents and teacher reported a lessening of Tommy’s disruptive and defiant 

behavior.

3. ANXIETY

Jill, a six-year-old, was at home with her mother and father on the afternoon 

when the tornado struck. The family escaped with no injuries. Jill started having 

problems within the next few days, scared that another tornado would strike. 

Jill would frequently question her parents about the weather and often became 

tearful.

Jill’s mother called the 1-800 tornado coping line and asked for advice. The 

crisis counselor suggested that Jill’s parents explain tornadoes to her, discuss 

the warning signs for a tornado in their community, and develop and practice 

its own family safety plan. The crisis counselor sent the family some informational 

materials about tornadoes. The crisis counselor called Jill’s parents several days 

later to see how they were doing. Jill’s parents reported that her fears had lessened by learning about tornadoes and knowing how to protect herself. 

4. DISRUPTIVE BEHAVIOR AT SCHOOL

Following a major ice storm, Jason, age eight, was displaced from his home 

to a Red Cross shelter for eleven days waiting for power to be restored to his 

home. Greg, age eleven, was displaced from his family for thirteen days and 

spent this time with relatives in a very crowded house. Both children exhibited 

disruptive behaviors upon returning to school. Jason was constantly talking and 

appeared very anxious. Greg was inattentive in class and presented an angry 

and defiant manner. The outreach crisis counselor spoke with the teacher and 

offered to come to the weekly health class to talk about the ice storm and to 

tie the conversation with the classroom material about the five senses. The crisis 

worker first encouraged the children to share their personal experiences with 

the storm (i.e., What did you see? What did you smell? What did you hear? 

What did you feel?). This was a creative way of discussing the effects of the 

storm, providing assurance and information, and for the students to hear from 
Helping the Child and Family 27

their peers that they shared many of the same feelings. Within a few days both 

Jason and Greg settled back into their daily routines.

5. ADOLESCENT AGGRESSION

Patrick, a sixteen-year-old, became verbally aggressive and threatened other 

youths after only one night in a large urban shelter following a major flood. 

Patrick had a history of petty crimes, homelessness, and drug use, and was 

well known to the local police. Given Patrick’s history and current behavior, the 

shelter manager and local police seriously considered removing him to a juvenile 

detention center. His mother met with the crisis counselor, the shelter manager, 

and a law enforcement official to work out an alternative plan. They asked 

Patrick to assist the National Guard in their duties distributing water and other 

food supplies. He readily agreed, helped the community, and with this more 

structured level of adult guidance was able to maintain good behavioral control 

and remain at the shelter.

6. REACTIONS THREE TO SIX MONTHS POST-DISASTER

Several months following the floods, many children remained in temporary 

living situations. Roger, an eight-year-old third grader, continued to struggle 

with school work, became increasingly withdrawn from friends, and non-responsive at school. As the school year was nearing the end, his teacher became 

concerned he would not advance to the fourth grade. Consultation with the 

school guidance counselor and the crisis counseling outreach workers revealed 

that many children displaced from the same trailer park as Roger were still feeling anxious and tense and doing poorly in school. In some cases, the pressures 

of the long disruption had affected the relationships of the parents, and separations and divorces were occurring within the families of his peers. 

The crisis counselors became more involved with Roger’s class, assisting with 

field trips and performing skits about floods and the lengthy time it takes to 

return families to pre-disaster status. The counselors also began encouraging 

the families in the trailer park to get together with their neighborhood friends 

over potluck suppers to talk about common issues and plans to get things 

“back to normal.” The school helped Roger’s parents find a retired teacher to 

tutor Roger with his school work, so that he would be ready to advance to the 

fourth grade.
28 Helping the Child and Family

7. ANNIVERSARY REACTIONS OF CHILDREN AND FAMILIES

A crisis counseling team assisting the community to recover worked with 

schools and the local unmet needs committee to arrange a number of commemorative events to assist survivors during the anniversary of the disastrous 

floods. Some families were still waiting for financial assistance, while others 

were rebuilding their homes. Since many families had returned to their daily 

routines, there was some degree of community impatience with those still 

struggling with the impact of the flood. During the commemorative week of 

the anniversary, many children expressed lingering fears and a remaining sense 

of loss. The anniversary events focused on individual and community healing, 

celebrating their survival, and the accomplishments of the last year. At several 

schools, outreach workers visited the younger children and distributed coloring 

books depicting the recovery and return to daily routines experienced by Andy 

and Allie, two young alligator characters who had lived through the storms. 

Through human interest stories revealing the ongoing needs of survivors, additional resources were donated to assist in their recovery.
Guidelines for Caregivers, Mental Health and Human Service Workers 29

CHAPTER 4

Guidelines for Caregivers, Mental Health and 

Human Service Workers

Disaster work almost always requires training, supervision, and consultation 

of human service workers, many of whom have little or no training in disaster 

issues. This section is directed to the various roles professionals, parents and caretakers of children may be called upon to serve during and following a disaster 

event. Side by side, professionals and paraprofessionals alike can work together 

to utilize basic skills in responding to the special needs of children who have 

experienced a disaster.

Providing Disaster Mental Health Services

The hallmark of a disaster mental health operation is to assist persons in dealing with their emotional response and recovery following the trauma of a major 

disaster event. The intended outcome is to return persons affected by the disaster 

to their pre-disaster level of coping. Since most disaster survivors do not perceive 

themselves as ill or in need of mental health services, crisis counseling programs 

emphasize outreach to communities, neighborhoods, churches, schools, and 

existing social networks to help persons who typically would not seek assistance 

from mental health service agencies. Hundreds of crisis counseling programs 

across the nation have repeatedly demonstrated that paraprofessionals indigenous to the affected community perform most effectively in the role of providing 

basic crisis counseling services. In these programs, it has been demonstrated that 

special services and programs for children have been developed within schools, 

extended school programs, communities, youth organizations, and summer recreational programs. 

Children may have an extensive support system, but usually do not have the 

life experiences or coping skills that would assist them in responding to the 

dramatic changes in their lives caused by disaster. Knowing what kind of 

assistance is available in the community, through government, religious and 

private agencies, is critical in responding to the needs of children and families 

in disasters. Most services will be found in local government and private 

agencies. Professionals, paraprofessionals and caretakers such as teachers need 

to learn as much as practicable about the community resources specifically 

offering services to children. Examples are family services agenices, child 

guidance agencies, child care centers and after school programs.
30 Guidelines for Caregivers, Mental Health and Human Service Workers

However, due to the unpredictable nature of outreach work and the potential 

for engaging persons who may significantly benefit from professionally delivered 

mental health services, it is crucial that outreach workers are provided with sufficient levels of supervision from trained mental health professionals.

Supervision of Human Service Workers

The FEMA/CMHS Crisis Counseling Assistance and Training Program 

(commonly referred to as the Crisis Counseling Program) that follows a 

Presidentially declared disaster employs intervention models that mobilize a 

broad spectrum of persons with a great diversity of experience and training. 

Crisis Counseling Programs emphasize outreach to communities, neighborhoods, schools, and other networks to help persons who typically would not seek 

assistance from mental health service agencies. Hundreds of Crisis Counseling 

Programs across the nation have repeatedly demonstrated that paraprofessionals indigenous to the affected community perform most effectively in the role of 

outreach workers. Outreach workers must have certain communication skills and 

other attributes necessary for successfully conducting their roles, which are discussed in other CMHS publications. However, due to the unpredictable nature 

of outreach work and the potential for engaging persons who may significantly 

benefit from professional mental health services, it is crucial that outreach workers are provided with sufficient levels of supervision from trained mental health 

professionals. Below are examples of the broad range of supervisory roles mental 

health professionals provide:

■ Supervision Through Didactic Training — Increasing the knowledge base 

of workers through brief in-service sessions explaining the basics of human 

behavior and development, assessing survivor needs, and providing tips on 

engagement.

■ Group Supervision — Team building through weekly review of current 

events and activities of the outreach workers. This includes discussing 

recent interactions with disaster survivors, problem-solving unique situations, and stimulating innovative thinking among outreach team members.

■ Individual Supervision — Supporting each individual team member 

with strategies for managing administrative workload, emotional/professional commitment, personalization of outreach experiences, development 

of dependency relationships, and issues of transference and counter 

transference. 
Guidelines for Caregivers, Mental Health and Human Service Workers 31

Providing Mental Health Training

Crisis Counseling Programs often engage mental health professionals to provide 

specific information about working with special populations. After a disaster, 

persons in a community who would have little reason to meet each other now 

find they share a bond through the common challenge of post-disaster recovery. 

Outreach workers, volunteers, unmet needs committee members, emergency 

operations personnel, clergy, housing specialists, and others may be confronted 

with situations and persons with special needs with whom they have little or no 

experience. Children with serious emotional or behavioral disorders and their 

families are an example of a special population that disaster recovery personnel 

may encounter in shelters, disaster recovery centers, and other sites. Brief training 

sessions for operations staff by mental health professionals can alleviate much 

apprehension of personnel and equip them with information and strategies that 

will result in successful outcomes for all involved parties. Mental health professionals may be called upon to provide ongoing training on specific topics to crisis 

counseling staff. Examples include the following: specialized information topics 

about case finding techniques of in-home intervention, working with children 

with developmental disabilities, issues related to family interventions, child abuse, 

and recognizing maladaptive patterns of alcohol and drug use.

Systems Consultation

Mental health professionals also play a significant role as consultants to Crisis 

Counseling Programs. A common role of consultants is to provide orientation and 

ongoing project development training to the crisis counseling staff. In the context 

of children and their recovery, the main purpose of the consultant is to sensitize 

project staff to the mental health needs of children and families in their recovery 

from the disaster and to assist project staff to integrate their services through 

interagency collaboration with other child-serving agencies. Many communities 

throughout the country have developed Child and Adolescent Services System 

Programs (CASSP). These children oriented systems of care are designed for at-risk 

children with serious emotional disorders. In a time of a disaster, these agencies 

may represent significant resources to crisis counseling recovery programs. Often 

the child mental health professionals in a community play an important role in 

this network. They can provide consultation on how interagency collaboration is 

done in a specific community, as well as which combined community and agency 

resources may be available to disaster survivors. Consultants can also assist staff 

with issues of organizational boundaries, working with school administrators, 

referral criteria for various community services, and role clarification.
32 Guidelines for Caregivers, Mental Health and Human Service Workers

Assisting Crisis Counseling Staff to Manage Stress

Responding to the needs of children and families who are coping with the 

aftermath of a major disaster is physically demanding and emotionally charged 

work. This is true even for the seasoned mental health professional who is accustomed 

to the fast paced, often chaotic environment of mental health crisis intervention 

work. A distinguishing characteristic of disaster mental health work is that often 

the worker identifies on a personal level with survivors and cannot find a quick 

method for establishing psychological distance with the persons seeking assistance. 

Additionally, the disaster mental health worker may also be a survivor of the disaster 

and must deal with issues concerning his or her own recovery and that of family 

members.

Acknowledging the high stress load of this work and implementing an array 

of stress reducing strategies is an important role for mental health professionals. 

Examples of typical stress management activities linked to Crisis Counseling 

Programs are: routine defusing and debriefing sessions during all phases of recovery operations, identifying a stress management counselor outside the project’s 

administrative chain of command, offering ongoing stress management training 

sessions, providing auto-relaxation techniques, and assisting staff to recognize the 

signs and symptoms of burnout in survivors and staff.

Burnout is the normal result of increased demands and overwork after a 

disaster and may appear as persistent physical and emotional exhaustion, unrelieved feelings of fatigue, marked irritability, and a decrease in the individual’s 

desire and ability to work effectively. With respect to staff working with children 

and families, burnout is often the result of overwork and over commitment. 

Burnout among project staff may be very harmful not only to the worker, but 

also to the disaster survivors who are seeking assistance. Project staff may become 

irritable with survivors and make promises they cannot possibly keep. CMHS 

strongly recommends that staff responsible for implementing disaster mental 

health services seek consultation on the development of a comprehensive stress 

management program as an integral part of their disaster recovery operations. 

Conclusion

Most parents are capable of assisting their children in overcoming fears and 

anxiety related to a disaster event. However, when the situation seems beyond 

their reach, assistance can easily be provided through pediatricians, family physicians, or mental health and school counselors. Understanding and helpful intervention can reduce a child’s fears and prevent more serious problems from developing. The manner in which adults, caregivers and mental health professionals 
Guidelines for Caregivers, Mental Health and Human Service Workers 33

help children to resolve their emotional turmoil at uncertain times may have a 

lasting effect on the child. Knowing the type of assistance that is available in a 

community is necessary in responding to the needs of children after a disaster. 

References and Resources 35

REFERENCES AND RESOURCES

References

Aguilera, D. M., & Planchon, L. A. (1995). The american psychological 

association-california psychological association disaster response project: 

Lessons learned from the past, guidelines for the future. Professional 

Psychology: Research and Practice, 26 (6), 550-557.

American Academy of Child and Adolescent Psychiatry. (1998). Facts for 

families: Helping children after a disaster [Fact Sheet No. 36]. Washington, DC: 

Author. http://www.aacap.org/web/aacap/facts/factsFam/disaster.htm

American Psychiatric Association. (1994). Diagnostic and statistical manual of 

mental disorders (4th ed.). Washington, DC: Author.

American Red Cross. (1997). Emotional health issues for victims. Arlington, VA: 

Author. http://www.redcross.org/disaster/safety

Apetekar, L., & Boore, J. A. (1990). The emotional effects of disaster on children: 

A review of the literature. International Journal of Mental Health, 19 (2), 

77-90.

Bowlby, J. (1982). Attachment and loss (Vol. 1). London: The Hogarth Press.

Carlson, E. A., & Sroufe, L. A. (1995). Contribution of attachment theory to 

developmental psychology. In Cicchetti & D. Cohen (Eds.), Developmental 

psychopathology: Vol 1. Theory and methods (pp. 581-617). New York: Wiley.

Cassidy, J. (1996). Attachment and representations of peer relationships. 

Developmental Psychology, 32 (5), 892-904.

DeWolfe, D. J. (2000). Training manual for disaster mental health workers (2nd

Ed.). Rockville, MD: Center for Mental Health Services.

Cosario, W. A. (1997). The sociology of childhood. Thousand Oaks, CA: Pine Forge 

Press.

Echterling, L. G. (1988). An ark of prevention: Preventing school absenteeism 

after a flood. Journal of Primary Prevention, 8 (4).
36 References and Resources

Flavell, J. (1963). The developmental psychology of Jean Piaget. New York: D.Van 

Nostrand.

 Flynn, B. W., & Nelson, M. E. (1998). Understanding the needs of children 

following large-scale disasters and the role of government. Child and 

Adolescent Psychiatric Clinics of North America, 7 (1), 211-227.

Green, B. L., Korol, M., Grace, M. C., Vary, M. G., Leonard, A. C., Gleser, 

G. C., & Smitson-Cohen, S. (1991). Children and disaster: Gender and 

parental effects on PTSD symptoms. Journal of the American Academy of Child 

Psychiatry, 25, 346-356.

Hartup, W. W. (1979). The social worlds of childhood. American Psychologist, 34 

(10), 944-950.

Kagan, J. (1982). Psychological research on the human infant: An evaluative 

summary. New York: W.T. Grant Foundation.

LaGreca, A. M. (1996). Symptoms of posttraumatic stress in children after 

hurricane Andrew: A prospective study. Journal of Consulting and Clinical 

Psychology, 64 (4), 712-723.

LaGreca, A. M., Vernberg, E. M., Silverman, W. K., Vogel, A. L., & Prinstein, 

M. J. (1994). Helping children prepare for and cope with natural disaster: A 

manual for professionals working with elementary school children. Coral Gables, 

FL: The BellSouth Foundation & the University of Miami.

Lystad, M. (1985). Special programs for children. Children Today, 14 (1), (13-17).

Main, M. (1996). Introduction to the special section on attachment and 

psychopathology: Overview of the field of attachment. Journal of Consulting 

and Clinical Psychology, 64 (2), 237-243.

Mitchell, J. T., & Everly, G. S., Jr. (1993). Critical incident stress debriefing 

(CISD): An operations manual for the prevention of traumatic stress among 

emergency services and disaster workers. Ellicott City, MD: Chevron.

O’Hara, D. (1994). Critical incident stress debriefing: Bereavement support 

in schools: Developing a role for an LEA educational psychology service. 

Educational Psychology in Practice, 10, (27-34).
References and Resources 37

Pynoos, R. S., Steinberg, A. M., & Goenjian, A. (1996). Traumatic stress in 

childhood and adolescence. In B. A. van der Kolk, A. C. Mc Farlane, & L. 

Weisaeth (Eds.) Traumatic stress: The effects of overwhelming experience on 

mind, body, and society. New York: The Guilford Press.

Santrock, J. W., & Yussen, S. R. (1987). Child development, an introduction (3rd

ed.). Dubuque, IA: Wm. C. Brown.

Saylor, C. F. (1988). Children and Disasters. New York, NY: Plenum Press.

Speir, A. H. (1999). Disaster response and recovery: A handbook for mental health 

professionals (Draft Rev. Ed.). Rockville, MD: Center for Mental Health 

Services.

 University of Illinois at Urbana-Champaign. (1998). Children, stress, and 

natural disasters: School activities for children. Urbana-Champaign, IL: 

Author http://www.ag.uiuc.edu/~disaster/teacher/teacher.html

Yule, W., & Canterbury, R. (1994). The treatment of post traumatic stress 

disorder in children and adolescents. International Review of Psychiatry, 6,

(141-151).

Vernberg, E. M., LaGreca, A. M., Silverman, W. K., & Prinstein, M. J. (1996). 

Prediction of postraumatic stress symptoms in children after hurricane 

Andrew. Journal of Abnormal Psychology, 105 (2), (237-248).

 Vogel, J., & Vernberg, E. M. (1993). Children’s psychological response to 

disaster. Journal of Clinical Child Psychology, 22, (470-484).

Literature for Children

Preschool Children:

Carrick, D. Drip, drop. Picture book studio. 1989. ISBN# 0887081215.

Stallone, L. The Flood That Came to Grandma’s House. Upshur, 1992. ISBN# 

0912975024.

Children in Grades K–3:

Walton, W. Weather or Not: Riddles for Rain and Shine. Lemer Publications, 1990. 

ISBN# 0822523299.
38 References and Resources

Children in Grades 4–6:

Berry, J. About disasters. Children’s Press, 1990. ISBN# 0516029592.

Stolz, M. Storm in the Night. Harper and Row, 1988. ISBN# 0060259124.

Children in Middle/Junior School:

Arnold, C. Coping with Natural Disasters. Walker and Co., 1988. ISBN # 

0802767168.

Ruckman, I. Night of the Twisters. Crowell, 1984. ISBN# 069044089.

Adolescents in High School:

Wignell, E. Escape by Deluge. Holiday House, 1989. ISBN# 0823408027.

Billings, H. Great Disasters. Steck-Vaughn, 1990. ISBN# 081144175x.

Additional Examples of Children’s Books About Disasters

Greenburg, K. Hurricanes & Tornadoes (When Disaster Strikes). Twenty First 

Century Books, (9-12), 1995. ISBN # 0805030956.

Mark, B. S., Layton, A., and Chesworth, M. I’ll Know What to Do: A Kid’s Guide 

to Natural Disasters. Magination. (Ages 9-12). 1997. ISBN # 0945354762.

Newton, D. E. Earthquakes (first book). Franklin Watts, Inc, Pages 4-8, 1993. 

ISBN # 0531156648.
Appendix A – Agency Assistance in Disasters 39

APPENDIX A

Agency Assistance in Disasters

Services for Children and Families

When a disaster strikes a community, it temporarily disrupts the infrastructure 

of community services on which many children and families rely. It is essential for 

disaster mental health workers to become familiar with the remaining available postdisaster resources. Most communities have developed resource guides describing 

the available community services in their area. Seeking out information from 

community resource guides is always a good place to find what pre-disaster assistance was available for children and their families. Health and social services are 

provided through municipal, county (parish), non-profit, and private agencies in 

most communities. Direct services are usually not provided by the state government; however, in some areas of the country state government is directly involved 

in the delivery of services.

Assisting persons to cope with the aftermath of a major disaster requires access 

to traditional mental health services and to basic social and physical health services. 

The role of disaster mental health workers is to be aware of resources that can be 

useful to families and children as they go through the recovery process. Below is 

a partial listing of the types of organizations that are actively involved with children and families. These organizations are potential sources of information about 

existing and new resources that may be developed following a disaster:

■ Area church /religious organizations

■ Community mental health centers

■ Case management agencies

■ Child Adolescent Services System Program (CASSP) local teams

■ Children’s hospitals

■ Family service agencies

■ Foster care providers

■ Home health agencies

■ Local/county public health agencies

■ Local professional associations for mental health professionals

■ Local funding organizations such as the United Way and non-profit 

foundations
40 Appendix A – Agency Assistance in Disasters

■ School counselors

■ Social service (welfare) and child protection agencies

■ Support groups for child-related disorders such as attention deficit disorder or support groups for various learning disabilities

Human Services Programs

Below is a listing of current programs administered through the Federal 

Emergency Management Agency (FEMA) and other related federal agencies. These programs are authorized under the Robert T. Stafford Emergency 

Assistance and Disaster Relief Act or other federal legislation.

Cora Brown Fund

These funds are used to assist survivors of Presidentially-declared major disasters 

for disaster-related needs that have not or will not be met by governmental agencies 

or other organizations which have programs to address such needs. Disaster 

survivors do not apply directly for these funds. The FEMA Regional Director, 

with assistance from other governmental agencies and disaster volunteer agencies, 

identifies potential recipients. This fund may not be used in a way that is inconsistent 

with other Federally mandated disaster assistance programs. A verification of the 

facts of each case must be conducted by the FEMA Regional Director, who then 

prepares a memorandum of recommendation and decision to the Deputy Associate 

Director, Response and Recovery Directorate.

Crisis Counseling Assistance and Training Program

This program is designed to provide supplemental funding to states for short-term 

crisis counseling services to people affected by Presidentially-declared disasters. 

There are two separate portions of the Crisis Counseling Program which can 

be funded: immediate services for up to sixty days of assistance following the 

disaster declaration date and regular services for an additional nine months. The 

program is available to State Mental Health Authorities through the State Office 

of Emergency Services and is administered by FEMA with technical assistance 

and collaboration from the Center for Mental Health Services.

Disaster Housing Assistance Program

The Disaster Housing Assistance Program makes temporary housing and funds 

available to individuals whose home is uninhabitable because of a disaster. 
Appendix A – Agency Assistance in Disasters 41

Disaster Legal Services

Through an agreement with the Young Lawyers Division of the American Bar 

Association, free legal advice is available for low-income individuals regarding 

cases that will not produce a fee (i.e., those cases where attorneys are paid part of 

the settlement which is awarded by the court). Cases that may generate a fee are 

turned over to the local lawyer referral service.

Disaster Unemployment Assistance (DUA)

Unemployment benefits may be available through the State unemployment 

office and are supported by the U.S. Department of Labor. The benefit period 

begins with the week (as defined by State law) following the disaster incident 

or date thereafter that the individual becomes unemployed and can extend for 

up to 26 weeks. The DUA benefit amount may not exceed the maximum weekly 

amount authorized under the unemployment compensation law of the State in 

which the disaster occurred. Individual eligibility is dependent on other available 

unemployment benefits to the victim/survivor. Individuals should contact a local 

office of the agency that administers the UI program in their State. It should 

be listed in the State government section of the telephone directory under such 

titles as Unemployment Insurance, Unemployment Compensation, Employment 

Security, or Employment Service.

Individual Family Grant Program (IFG)

The purpose of the IFG is to provide funds for the necessary expenses and 

serious needs of disaster survivors. IFG funds are for expenses that are not met 

through other means of federal or private assistance (e.g., Small Business 

Administration loan or private insurance). The maximum grant amount is 

adjusted annually in accordance with changes in the Consumer Price Index 

(CPI). IFG eligible categories include: real and personal property, medical, dental, 

funeral, and transportation. Ineligible costs are: improvements or additions to real 

or personal property, recreational property, cosmetic repair, business expenses, and 

debts incurred before the disaster. Home inspections are normally conducted before 

a check is issued. The IFG program is administered by the state.

Stress Management Program

This program is intended to ameliorate, to the extent practicable, the stresses 

experienced by its disaster workers as a result of the demands of working directly 

in a disaster operation. The Center for Mental Health Services works in collaboration with FEMA on the implementation of this program.
42 Appendix A – Agency Assistance in Disasters

Department of Veterans Affairs (VA)

The VA provides death benefits, pensions, insurance settlements, and adjustments 

to home mortgages for veterans.

Internal Revenue Service (IRS)

The IRS can allow certain casualty losses to be deducted on Federal Income 

Tax returns for the year of the loss or through an immediate amendment to the 

previous year’s return.

U.S. Small Business Administration Disaster Loans (SBA)

Most, but not all, federal assistance is in the form of low interest loans to cover 

expenses not covered by the state or local programs, or private insurance. Loans 

are available to individuals, businesses, and farmers for repair, rehabilitation, or 

replacement of damaged and real personal property and some production losses 

not fully covered by insurance.

Social Security Administration (SSA)

The SSA provides no special benefits during a disaster, however SSA staff are 

provided to the Federal Coordinating Officer and Disaster Recovery Centers to 

process SSA benefit services such as: processing survivor claims, obtaining eligibility evidence for claims processing, resolving problems with lost or destroyed 

Social Security checks, and redevelopment of lost/destroyed pending claims.
Appendix B – Sources for Additional Information 43

APPENDIX B

Sources for Additional Information

Administration for Children and Families, the Department of 

Health and Human Services

http://www.acf.dhhs.gov/

American Academy of Child & Adolescent Psychiatry

http://www.aacap.org/web/aacap/

American Association of Psychiatric Services for Children 

http://www.cwla.org/mentalh/mentalhealth.html

Child, Adolescent and Family Branch, the Center for Mental Health 

Services

http://www.mentalhealth.org/cmhs/ChildrensCampaign/index.htm

Connect for Kids

http://www.connectforkids.org/index.htm

Federation of Families for Children’s Mental Health

http://www.ffcmh.org/

Georgetown University Child Development Center

http://www.dml.georgetown.edu/depts/pediatrics/gucdc/

Kids Count

http://www.aecf.org/aeckids.htm

National Association for the Mentally Ill

http://www.nami.org/

National Mental Health Association

http://www.nmha.org/children/index.cfm

Parent Advocacy Coalition for Educational Rights (PACER)

http://www.pacer.org/

Parents Place

http://www.parentsplace.com/

Research and Training Center on Family Support and Children’s 

Mental Health

http://www.rtc.pdx.edu/
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Substance Abuse and Mental Health Services Administration

Center for Mental Health Services

Rockville, Maryland 20857

Official Business

Penalty for Private Use $300

DHHS Publication No. ADM 86-1070R

Substance Abuse and Mental Health Services Administration

Reprinted 2005