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Care of Children Exposed to the Traumatic Effects of Disaster

by Jon A. Shaw, , M.D., Zelde Espinel, , M.D., M.A., M.P.H., and James M. Shultz , M.S., Ph.D. Washington, DC, American Psychiatric Publishing, 2012, 243 pp., $54.00.

Reviewed by Rupinder Legha, M.D.; Daniel Savin, M.D.
Am J Psychiatry 2013;170:933-934. doi:10.1176/appi.ajp.2013.13030318
View Author and Article Information

The authors report no financial relationships with commercial interests.

Aurora, Colo.
Dr. Legha is affiliated with the Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colo.
Dr. Savin is an Associate Professor in the Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colo.

Accepted March , 2013.

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Recent tragedies, such as the Newton, Connecticut, school shooting and Hurricane Sandy, have charged us with the difficult task of helping children deal with random, senseless, and tragic events. As psychiatrists, we face the challenge of supporting young people through these traumas; and as members of our local communities, we assume the responsibility of educating parents and teachers about how to do the same. We (the authors of this review) have personally faced these challenges and responsibilities as members of the community affected by the Aurora theater shooting in July 2012.

This timely book, written by experts with extensive clinical and public health experience in disaster recovery, offers helpful and understandable frameworks for preventing and managing the traumatic effects of disasters on our children. It begins with basic explanations about different types of disasters (natural versus human-made), associated stressors, and common emotional and behavioral responses seen in children and parents. The life cycle of disasters is broken down into “preimpact,” “impact,” and “postimpact” phases. A disaster ecology model demonstrates how the quality and severity of the disaster, individual risk and resilience factors, family factors, community factors, and societal factors affect outcomes from exposure to traumatic events. These simple yet comprehensive frameworks provide readers with a foundation for understanding how to intervene on behalf of children and parents when disaster strikes.

The authors emphasize that children, both because they are dependent on others and because they are still in the process of development, are especially vulnerable to the effects of disasters. If parents are physically and emotionally available to help, childhood resilience is promoted. This important yet concise emphasis, again, provides readers with a way to support children and parents during disasters and other traumatic events. When discussing postdisaster psychopathology, the authors do not limit their discussion to posttraumatic stress disorder. They instead suggest that children present in multiple, complex ways, which we appreciated. Chapter 6, devoted to traumatic bereavement, nicely summarizes childhood understandings of death and expressions of grief at different ages. Simple and straightforward recommendations in this and other chapters (for example, recommending that children read Charlotte’s Web to learn about death as a natural phenomenon) make this book appealing to caregivers and teachers, as well as to mental health providers, including trainees. Latter chapters addressing child and family assessments and interventions provide practical rating scales and interview questions. Brief reviews of diverse clinical interventions (including psychological first aid, psychoeducational approaches, and pharmacology) give readers readily available tools that can be used in the immediate, short-, and long-term at the individual, family, school, community, and federal levels.

While disasters are damaging to all communities, they can be even more devastating to more vulnerable ones. We, therefore, appreciated how the authors dedicated an entire chapter to children who face unique challenges, such as children of minorities and children in foster care. A poignant example is given of thousands of foster children who were tragically displaced and separated from adult caregivers and other foster care children in the aftermath of Hurricane Katrina. When resettled in other states, many lost their eligibility for welfare and Medicaid benefits. In fact, the book's various references to Hurricane Katrina highlight how children and families from communities afflicted by poverty, inadequate infrastructure, and racism can be disproportionately affected by disaster. These references to Hurricane Katrina were, therefore, critical and valuable. The book appropriately recommends predisaster and postdisaster planning that identifies how children with unique obstacles can be evacuated, receive medical care, and be reunited with their families, friends, school, and other support networks during and after a disaster. However, we would have liked more consideration of the challenges vulnerable populations in resource-limited settings face in creating and implementing pre- and postdisaster plans. We also noticed that there was no reference to school-based gun violence, a topic of great importance in light of recent events in the United States.

This book nicely accomplishes its goal by providing simple, practical frameworks for mental health care workers and public health experts. Teachers and parents will find certain chapters helpful. The mental health clinician already familiar with how traumatic events affect children and families may be especially interested in learning about the big picture of how a disaster can affect an entire society. The public health expert familiar with disaster interventions on a larger scale may be interested in learning about the emotional effects on individual children and families. Because this book is a fairly “quick read,” psychiatric trainees at all levels can read it as a first step to understanding how disasters affect our youths. In our uncertain world, we highly recommend this book to a wide audience interested in learning the basics of preparing for disaster and working toward recovery when it strikes.

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