CHP Blog

November 16th, 2013

How Do We Help the Helpers?

By Elissa J. Brown, Ph.D. & Alana Moses, M.A.

Most traumatic events, including violence exposure, motor vehicle collisions, and medical illness, affect individuals and their families. Helpers, including physicians, mental health providers, and law enforcement are outsiders—they meet the family after the trauma and often can leave the trauma “at the office” when they return to their homes at the end of the day.

In contrast, large-scale traumas, such as natural disasters and war, have a community-level impact. The emotional reactions to the trauma seem universal and unavoidable because they are experienced by all who live and work in the affected area—including those who will be expected to help the trauma survivors recover.

Shared trauma is defined as a traumatic event that is experienced by both clients and their helping professionals. There have been a number of traumatic events over the past 15 years in which this “shared” experience was the norm. According to the United Nations Office for Disaster Risk Reduction (UNISDR), from 2000-2012, 2.9 billion people were affected by natural disasters, 1.2 million people were killed by natural disasters, and damages from natural disasters amounted to $1.7 trillion. In many of these situations, therapists were both trauma survivors and helpers. They lived and worked in the vicinity of the trauma and faced the economic, practical, and psychological challenges that emerged.

What impact does shared trauma have on mental health providers? How does that influence the effectiveness of their therapy? What do these providers need to recalibrate and provide trauma-informed interventions? In short…we don’t know.

In spite of the large numbers of providers who have experienced shared trauma, we know little about their responses and needed interventions. Research suggests that therapists with their own trauma histories and those with higher trauma caseloads may be especially susceptible to adverse reactions, such as secondary traumatic stress (PTSD due to their clients’ trauma exposure). In turn, providers with high levels of secondary traumatic stress have higher scores on job burnout, turnover intention, poorer psychological well-being, and lower scores on job satisfaction and occupational commitment.

What do we need to do to learn how to help the helpers?

Helping professionals constantly are called upon in communities after natural disasters to address the mental health needs of children and adults who have been traumatized. Community-wide trauma, such as natural disasters, are becoming increasingly more frequent and debilitating to communities. Significant amount of money is being invested in the training of current providers in evidence-based, trauma-informed mental health services. If we don’t figure out how to protect and sustain these providers, job turnover will result in additional psychological and economic crises following community trauma.

We are suggesting a call to action for research on shared trauma. Studies using a prospective longitudinal design could provide information on the short- and long-term responses of providers, and factors that are associated with higher levels of secondary traumatic stress. Reliable and valid measures of both client and provider exposure will ensure an understanding of the similarities and differences in experience and responses. Intervention studies are needed to examine strategies that might prevent and treat secondary traumatic stress. We ask those in charge of disaster preparedness, funding, and children’s health and welfare to step up and demand knowledge and guidance for our communities.

November 14th, 2013

Breaking it Down: Simple Steps to PREVENT Child Sexual Abuse

by Lois Beekman Oliveira & Elissa J. Brown

Child sexual abuse is a serious public health problem in the United States, affecting as many as 1 in 10 children. Research shows that there are ways adults can prevent sexual abuse, but these studies are rarely accessed by those who need it the most, parents and other caregivers who take care of children. Even when the information is available, caregivers’ discomfort with the topic of child sexual abuse might stop them from trying the recommended steps. As a result, we at Child HELP Partnership have translated this research to simple steps all adults can take to PREVENT child sexual abuse. In PREVENT, we outline steps to both protect children and overcome any understandable discomfort.

PREVENT:

Policy investigation

Know the policies your child’s school has in place for hiring staff.
Do they conduct background checks on all employees at the school?

Risk assessment

You can reduce potential risks, especially in today’s cyber-driven society, by making sure your child’s computer, TV, and other electronic devices are available only in rooms where you can observe your child’s technology
Check your child’s use of these devices at irregular times and look for contact with unknown others/adults

Eliminate opportunity

You can eliminate the opportunity for predators in your community by advocating this issue be a top priority at your child’s school.
The more informed a community is, the less likely this will occur.

Validate yourself

If you have unsettled feelings or something just doesn’t seem right, follow your instincts
Go to your child’s school and demand answers to the questions or concerns you have

Encourage your child

Make sure your child knows that he/she can always come to you if they ever feel uncomfortable with anyone
Encourage them to take control of their own bodies by giving them the choice to decide who they want to give hugs/kisses to. Oftentimes children are simply told to give a relative or family friend a hug or kiss even if they are not comfortable doing so.

No child alone

Remember that a child should never be alone in a room with an adult
Make sure you can always observe what is going on in a room that your child is in at school whether it is through windows or the classroom door kept ajar.

Talk to your child

Challenge your own discomfort about having a conversation about private parts and sexual abuse with your child, knowing that this will open up a dialogue with your child

This will show your child that you are the source of accurate information and they will feel more comfortable talking to you about these topics

If you want to learn more about protecting children from abuse and injury, please consider attending a Keeping Every Youth Safe training.

November 3rd, 2013

Parenting in 2013: To Talk or Not to Talk? Why and How to Have Difficult Conversations.

Elissa Brown, Ph.D., Professor of Psychology and Executive Director of the Child HELP Partnership, St. John’s University

The end of 2012 brought two traumatic events to the northeastern U.S., both of which devastated the children and adults who were directly impacted. The power of trauma is that it also impacts those of us who were not directly impacted. At the Child HELP Partnership, a specialized center for child trauma, we were called upon by mental health professionals, educators, clergy, and media to offer advice after Hurricane Sandy and the shootings at Sandy Hook Elementary School. Among the questions that arose again and again were: “Should we tell our children? If so, how?”

As much as we want to protect our children from knowing about tragedy, we need to consider the consequences of not telling them, and we need to think about the reasons why we wouldn’t. What role does our discomfort play in avoiding these conversations?

Below are my reasoning and suggestions for having these conversations. I have tried to consider my experiences with children and research on children’s development. My goal is to empower you to open the lines of communication and deliver accurate, age-appropriate information to your children.

Why Tell Your Children:

Because, depending on their age, they are likely to find out—remember that your children probably have friends with older siblings who know…and talk about it.
You want to be the source of information for your children—not another child, not the media, not even other adults (who may not realize the sensitivity of little ears).
Knowledge is power – you don’t want your children wondering what the other kids are whispering about in the corner.
You do not want your children to think you are uncomfortable talking about upsetting topics (even if you are)—this can stop them from coming to you down the road when they need help.

How to Prepare:

Make a plan with all of the caregivers of your children—have a united front.
Think about what you want your children to learn—consider that you may have different take home points for different children.
Consider each child’s personality and sensitivities, including how they have reacted to upsetting information in the past.
Try to anticipate questions and prepare your answers. Some of the tougher questions that children may ask include: Can this happen to me? Why did that happe
Role play the interaction with your spouse, another family member, or friend—someone who has a sense of how your children will respond.
Turn off the media coverage.

An Outline of the Conversation:

Start by asking your children what they know about the trauma. For example: “There seems to be a lot of buzz at the school lately. What is it about?” You will learn what about the situation is prominent for your children and whether they are misinformed.
Tell them what happened. Your goal is to balance honesty with conveying a sense of safety. Use short phrases (e.g., “20 children were badly hurt in a school in Connecticut”) and observe your children’s responses.
Encourage questions. If the question is factual (e.g., “Did they die?”), answer it (i.e., “Yes”). Answer only the question that is asked – children tend to ask questions that they can handle the answers to. If the question is conceptual (e.g., “Why would someone do this?”), ask your children what they think. Their answer will provide guidance to you about next steps—follow their lead. It is okay to say that you need time to think about and/or research an answer to their question.
Not all parents will decide to tell. Remind your children that every parent gets to decide what they tell their children—it is not your children’s job to tell others.
That said, we all need social support after a trauma. Identify some friends with like-minded parents with whom your children can discuss the event. Eavesdrop to ensure that none of the children are becoming agitated during the discussion.
End the conversation by telling your children that it is natural for them to have more thoughts and/or questions over time. Encourage them to revisit the topic with you.
Inform your children’s caregivers about the conversation.
Connect with schools, other local resources, and national experts as needed.