Children's Trauma Network

By Rebecca A. Clay

Among the most poignant casualties of Hurricanes Katrina and Rita were children. Many lost not only their homes, but also cherished pets and toys. Others may have seen severely injured people or even dead bodies. Still others witnessed anxiety and fear in their parents who are usually confident.

To help parents and service providers assist children, the National Child Traumatic Stress Network (NCTSN), funded by SAMHSA's Center for Mental Health Services (CMHS), has made the Network's resources available for use in both immediate crisis responses and long-term recovery settings.

SAMHSA has been deploying its own staff, experts from other Network sites, and volunteer providers from across the Nation to help ensure children's needs are met, said Senior Project Officer Cecilia Rivera-Casale, Ph.D., of the Emergency Mental Health and Traumatic Stress Services Branch at CMHS.

"When you meet these children, there's a glazed look on their faces," said Dr. Rivera-Casale, who visited a shelter in Jackson, MS. "They seemed remote and disconnected—one of the signs of trauma."

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The Network

Across the Nation, NCTSN works to improve the quality, effectiveness, and availability of services for traumatized children and youth. With a national coordinating center co-housed at the University of California Los Angeles and Duke University, the Network also includes more than 50 member sites—ideally suited to help the Gulf Coast evacuees, who have been sent to 48 states plus the District of Columbia and Puerto Rico.

Now the Network is offering more than two dozen tools to help mental health professionals, pediatricians, parents, educators, relief workers, social service personnel, and others help children affected by the hurricanes.

"A lot of mental health personnel who don't normally work in disaster situations have been called upon to work with those affected by Hurricanes Katrina and Rita," said Melissa J. Brymer, Psy.D., who manages NCTSN's terrorism and disaster work. "Our goal is to provide resources to people working with kids to help them understand what we know from the research and from experience in past disasters will make a difference in a child's recovery."

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Experts in the Field

Currently, NCTSN is calling on its members for help.

"Some of our centers have specialized expertise," explained Dr. Brymer, citing centers that specialize in very young children, evacuee situations, and school-based interventions as examples. "We've drawn on that expertise and asked our Network centers to develop materials for use in these disasters."

Available at no charge on the Network's Web site at www.nctsn.org, the hurricane resources are organized by target audience. Several are specifically designed for use by mental health and medical professionals.

One of the most important resources is the Psychological First Aid package for mental health providers. Based on research as well as experience from the field, the materials help providers meet the immediate needs and concerns of children and families, reduce their distress, and start them on the path toward healthy coping. To order a copy, just go to the center's Web site, click on Psychological First Aid, and sign in.

"Psychological First Aid is based on the same principles as physical first aid," explained Alan Steinberg, Ph.D., the center's Associate Director. "In the immediate aftermath of traumatic events, Psychological First Aid can reduce initial distress and foster healthy adaptive functioning."

Other resources specifically designed for mental health and medical professionals include the following:

• Children Needing Extra Help: Guidelines for Mental Health Providers. This one-pager provides an overview of treatment recommendations.

• Healing After Trauma Skills Manual. Originally developed after the Oklahoma City bombing, this evidence-informed intervention manual offers more than 100 pages of information about children who have experienced disasters or other traumas plus tips for helping children share their thoughts and develop positive coping skills. Aimed primarily at children from pre-kindergarten to early middle school, the manual can be used with individual children, small groups, or classrooms.

• Providers' Guide: Helping Children in the Wake of Disaster. Prepared by the Yale Child Study Center's National Center for Children Exposed to Violence, these guidelines help relief workers, parents, and others address children's concerns after a natural disaster. The guidelines alert caregivers to signs of adjustment difficulties, share tips for addressing those problems, and offer suggestions for ways to talk to children about their fears.

Several resources address mental health issues in medical settings. The Pediatric Medical Traumatic Stress Toolkit for Health Care Providers, for example, provides an introduction to traumatic stress in injured or ill children, practical tips and tools, and handouts for parents. Childhood Traumatic Grief Educational Materials for Pediatricians and Pediatric Nurses offers brief fact sheets plus in-depth guidelines for recognizing traumatic grief in children.

Medical Events and Traumatic Stress in Children and Families presents personal, anecdotal, and statistical information about how traumatic medical events can affect children, their parents, and health care providers. The Network's site also offers a link to disaster recovery resources from SAMHSA's Center for Substance Abuse Treatment.

These and other NCTSN resources are being put to good use. Psychological First Aid materials are now in the hands of state disaster coordinators, Red Cross volunteers, school officials, first responders, and others, said Dr. Brymer. Schools are already adapting the materials for use with schoolchildren, and Network members hope to have an official Network adaptation early in 2006.

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Other Aid

NCTSN also offers resources for parents. "Supporting children's caregivers is important," said SAMHSA Senior Advisor on Children Sybil Goldman, M.S.W. "Parents, too, are suffering from trauma." Other resources target educators and relief workers. Some materials are available in Spanish and Vietnamese.

In addition to the printed resources offered by the Network, SAMHSA offers many other publications relevant to children, such as Psychosocial Issues for Children and Families in Disasters: A Guide for the Primary Care Physician. This manual and other materials are available at SAMHSA's special Web page created in response to the hurricanes, "Empowering Recovery," at www.samhsa.gov/Disaster/
professional_disaster.aspx.

The Network has also been participating in trainings for school principals and teachers. Sponsored by the U.S. Department of Education, these trainings explain how school personnel can help children recover from the trauma of the hurricanes and help those who were evacuated adapt to their new schools.

SAMHSA Administrator Charles G. Curie, M.A., A.C.S.W., and Ms. Goldman are involved, sharing information about SAMHSA's role and resources. So far, trainings have taken place in Jackson, MS; Mobile, AL; Houston, TX; Atlanta, GA; and Pensacola, FL.

For more information about the National Child Traumatic Stress Network, visit www.nctsnet.org. Also visit SAMHSA's Web site at www.samhsa.gov.

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