September 11, 2001
on children in NYC

The following statistics about the September 11, 2001 tragedy in New York City alone point out the negative impact it has had on children and how they have been affected:

• 53% of NYC families know someone who died on 9/11 or in the Bell Harbor crash. 11% of city families lost a family member in one of these events. 93% of NYC children saw the WTC attacks live or on videotape.
• In a NYC Board of Education survey of 8,266 NYC public school students in grades four through twelve, there was a broad range of mental health problems at a higher than expected rate. 26.5% of the students had at least one of the assessed mental health problems such as agoraphobia (3 times greater than expected). 10.5% had symptoms consistent with PTSD (5 ½ times greater than expected)
• Many children have developed serious problems including anxiety attacks, depression, Post-Traumatic Stress Syndrome, increased alcohol and drug use, suicidal tendencies, even fear of riding in the subways because of the threats of terrorism.
• Unemployment has skyrocketed. Nearly 90,000 jobs were lost as a result of the destruction of the WTC. It is predicted that it will take several years before 50,000 of those lost jobs will be recovered. Despite charitable and government assistance, many families who lost loved ones have seen their income drop an average of 40%. This has had a major impact on how children are cared for as well as on their health and nutritional status.
• Many families are not able to afford basic household needs like food, rent and essential health care. Even middle class families are at risk of losing their homes, which fills them with anxiety. That fear and apprehension has also been passed on to their children.
• It is projected that between 250,000 to 400,000 people were emotionally damaged and will need mental health services over the next two years.
• A major problem is that very few health workers and clinicians have been trained to treat trauma – especially with children.
• Most children do not have good support systems or places to heal from their fears, disappointments, their loss of confidence and grief.

Unfortunately, trauma or distress brought on by disasters often surfaces much later. For some children, the impact might not become evident until months or even years later. If it is not dealt with, the outcome can be extremely serious.

 

TRAUMA & ITS IMPACT

SOME DEFINITIONS

DISASTER: A sudden event bringing great damage, loss or destruction and in which a broad cross-section of the population is exposed, objectively, to the same traumatic experience.

TRAUMA: An event that may involve threats to life or bodily integrity or a close encounter with violence and death. Feelings of intense fear, helplessness, loss of control and threat of annihilation can be the psychological result of trauma.

CRISIS: A period of acute difficulty following an emotionally significant event.

WHAT IS A TRAUMATIC EVENT?

“Psychological trauma is an affliction of the powerless. At the moment of trauma, the victim is rendered helpless by overwhelming force. When the force is that of nature, we speak of disasters. When the force is that of other human beings, we speak of atrocities. Traumatic events overwhelm the ordinary systems of care that give people a sense of control, connection and meaning.” 

- Judith Herman, M.D.

THINGS WE KNOW
ABOUT EMOTIONAL TRAUMA

• Results from actual or threatened death, serious injury, sexual or other physical assault
• Results in shock and overwhelming emotions
• Causes intense fear, horror or hopelessness

TRAUMA AND ACTION

• Trauma challenges feelings of safety and basic life assumptions
• Relative sense of safety and predictability are preconditions for effective planning and personal action
• Traumatized people seem to lose the capacity for action; they have difficulty turning inward top utilize emotions as guides for action
• Internal world becomes danger zone; spend energies on NOT thinking and planning

DIFFERENCES BETWEEN TRAUMATIC EVENTS & STRESSFUL EVENTS

• Traumatic events:
• More extreme both psychologically and biologically
• Effects can continue after events have passed
• Effects of stress can be alleviated when stressor is removed

TRAUMATIC EVENTS IMPACT FAMILIES & COMMUNITIES

• Significant employment loss
• Significant family disruption/relocation
• Interface with large bureaucracies
• Significant disruption of support system
• Changes in school configurations
• Disruption to community infrastructure
• Significant influx of outsiders into community

EFFECTS OF TRAUMA VARY BY:

• Age, developmental stage, prior condition, degree of personal impact, prior trauma, ethnicity, political beliefs, cultural group
• Severity of the disaster, proximity, amount of advance warning, level of community preparedness, degree of supportiveness in the environment

LONG TERM TRAUMATIC
STRESS REACTION

• Not all long term trauma reactions are Post Traumatic Stress Disorder
• Many people may continue to re-experience stressful reactions over long period of time
• Such reactions usually in response to “trigger events”
• Intensity and frequency usually decrease over time

POST-TRAUMATIC STRESS DISORDER

• Distressing event persistently re-experienced
• Persistent, deliberate avoidance of stimuli associated with event
• Persistent reactions of increased arousal
• When there is an OVERWHELMING presence of symptoms over time and things do not get better, then need to refer to mental health help

ENGAGEMENT TECHNIQUES
FOLLOWING TRAUMA

TRAUMA RESPONSE COUNSELING

• Short term focus
• Assessment of person’s strengths, adaptation ability and coping skills
• Seeks to restore pre-disaster functioning
• Accepts content from person at face value
• Validates appropriateness of reactions (fear, sleeplessness); normalizes experience
• Provides links to individuals or agencies that may provide assistance

COMMUNITY TRAUMA RESPONDERS COUNSELING MODEL

• Engage/attend
• Listen
• Listen between the words for the feeling behind what is being said
• Understand that the same word can mean different things to people
• Ask questions to make sure you understand the person
• Acknowledge what the person says by repeating key words or phrases
• Listen for the tone of one’s voice, how it is being said
• When someone is talking, listen, don’t rehearse what to say back
• Don’t interrupt, except when necessary
• Adapt manner of speaking & listening to communicate more effectively
• Be careful not to interpret behavior only based on meanings from own culture
• Use open body language & appropriate eye contact
• Some Helpful Phrases that Are Nonjudgmental and Help Engage
• “I hear you saying . . .” 
• “Tell me more about that.” Type your question here, and then click Search.
• “Sounds like talking about that is hard for you – is it?”
• “Sounds like you are angry about that – is that accurate?”
• You sound lonely (sad, frustrated) . . .”
• Ask
• Observe
• Identify Appropriate Coping Strategies (don’t watch TV, talk with friends, play, relaxation techniques, etc.)
• Assess, Refer & Close

SOME STRESS REDUCTION TECHNIQUES

• Relaxing sighs and noisy sighs
• Deep breathing
• Shoulder relaxation, stretching, yoga
• Visualizations
• Power words – “peace”
• “Instant grounding’ mechanisms: touching hot or cold, carrying something
• Journaling, painting, candles, music, aromatherapy
• Exercise & good nutrition