Thomas P. Demaria, Ph.D.

Doctoral Program in Clinical

Psychology

Long Island University - Post

720 Northern Boulevard

Brookville, New York 11548-1300

Tel: 516-299-2053

Fax: tdemaria@liu.edu

Dr. Demaria received his Ph.D. in Clinical/School Psychology from Hofstra University in 1986 and has been a New York State licensed Psychologist since 1987. Dr. Demaria has over twenty years of hospital behavioral healthcare leadership experience including the management of inpatient psychiatric and behavioral medicine consultation services and outpatient mental health and substance abuse programs He is a Fellow of the Trauma Division of the American Psychological Association, Director of the Psychological Services Center of the Doctoral Psychology Program at Long Island University Post and founder of the Graduate Student Trauma Response Team which was awarded the 2012 Innovative Program Award from the National Counsel of Schools of Professional Psychology. Dr. Demaria currently serves on the Professional Advisory Board for the National Center for School Crisis & Bereavement and is involved in web-based training initiatives for the National Coalition to Support Grieving Students. Dr. Demaria has earned numerous awards for leading hundreds of community disaster counseling responses during the past 28 years and is a volunteer for Greater New York and Nassau County Red Cross and the Salvation Army. He is a two time recipient of the prestigious New York State Liberty Award for community service in New York following the World Trade Center terrorist attacks and in the Gulf Coast following Hurricane Katrina. In 2004, Dr. Demaria was presented a Humanitarian Award by the Center for Christian & Jewish studies for his work with Holocaust survivors. In 2005, Dr. Demaria was co-recipient of International Society for Traumatic Stress Studies’ Sarah Haley Award for Clinical Excellence for his clinical work with World Trade Center families and 9/11 First Responders and a Distinguished Mentor Award in 2013 for his mentorships of students in the field of trauma. In 2015, Dr. Demaria coauthored “Child & Disaster” practice guidelines for the American Academy of Pediatrics.

Providing Psychosocial and Grief

Support to Children in the

Aftermath of Disasters and

Crises

INFLUENCES OF ADJUSTMENT REACTIONS OF CHILDREN TO DISASTERS

1) nature of the event and the amount of death, destruction, and disruption

2) degree of personal involvement of children and their families

(3) duration of time before children’s daily environment & overall community, returns to a safe, predictable, and comfortable routine

(4) whether the stressor is a 1-time or chronic event

(5) level of coping ability of the children’s caregivers

(6) children’s preexisting mental health, developmental level, baseline

resiliency and coping skills

(7) nature of the secondary stressors losses that follow the crisis event.

Common Symptoms of Adjustment Reactions in Children after a Disaster

• Sleep problems: difficulty falling or staying asleep, frequent night awakenings or difficulty awakening in the morning, nightmares, or other sleep disruptions.

• Eating problems: loss of appetite or increased eating.

• Sadness or depression: may result in a reluctance to engage in previously enjoyed activities or a withdrawal from peers and adults.

• Anxiety, worries, or fears: children may be concerned about a repetition of the traumatic event (e.g., become afraid during storms after surviving a tornado) or show an increase in unrelated fears (e.g., become more fearful of the dark even if the disaster occurred during daylight). This may present as separation anxiety or school avoidance.

• Difficulties in concentration: the ability to learn and retain new information or to otherwise progress academically.

• Substance abuse: the new onset or exacerbation of alcohol, tobacco, or other substance use

• Risk-taking behavior: increased sexual behavior or other reactive risk-taking can occur, especially among older children and adolescents.

• Somatization: children with adjustment difficulties may present instead with physical symptoms suggesting a physical condition.

• Developmental or social regression: children (and adults) may become less patient or tolerant of change, revert to bedwetting, or become irritable and disruptive.

• Adjustment & Posttraumatic reactions (less than one month)

PTSD & DSM V Exposure Criteria

Exposure to actual or threatened death, serious injury or sexual violence. The exposure must result from

• directly experiences the traumatic event

• witnesses the traumatic event in person

• learns that the traumatic event occurred to a close family member or close friend (with the actual or threatened death being either violent or accidental)

• experiences first-hand repeated or extreme exposure to aversive details of the traumatic event (not through media, pictures, television or movies unless work-related).

RISK FACTORS REQUIRING REFERRAL

(1) dissociative symptoms, such as detachment, derealization, or depersonalization, which may present in children as appearing confused, distant, daydreaming, or aloof (such dissociation at the time of exposure has been found to be the most significant predictor of later PTSD)

(2) extreme confusion or inability to concentrate or make even simple decisions

(3) evidence of extreme cognitive impairment or intrusive thoughts

(4) intense fear, anxiety, panic, helplessness, or horror

(5) depression at the time of the event

(6) uncontrollable and intense grief

(7) suicidal ideation or intent

(8) marked physical complaints resulting from somatization

Creating a Safe Haven

• Minimize the likelihood of contributing additional stress to children.

• Practical steps can be taken to minimize children’s exposure to frightening images and sounds that may compound their distress or serve as triggers or reminders of a disaster.

• Doors/curtains in the setting should be closed to reduce exposure to others who are in distress.

• Televisions and Radios can be turned off if they are broadcasting coverage of the crisis event.

• Staff members are encouraged to remember that children can often overhear and understand their conversations.

• Parents and family members should remain with children to the extent possible throughout the support process, provided that they are able to cope with their own discomfort or distress.

• Parents may be guided in supporting their children, such as by using coping strategies they have found effective in the past (e.g., distraction or attention refocusing techniques, like a calming touch or use of gentle humor).

• Parents should be allowed to temporarily if they are feeling overwhelmed, but should notify the child before leaving that they will be in an adjacent area

Psychological First Aid

• Providing timely and accurate information to promote an understanding that will facilitate adjustment

• Offering appropriate (but not false) reassurance that corrects misconceptions and misperceptions that might otherwise unnecessarily increase the appraisal of risk

• Supplying information about likely reactions and practical strategies to facilitate coping with distress, Helping people identify supports in their family and useful resources in their community.

http://www.nctsn.org/content/psychological-first-aid-schoolspfa

http://www.ptsd.va.gov/professional/manuals/psych-first-aid.asp

Listen-Protect-Connect

http://www.ready.gov/sites/default/files/documents/files/PFA_SchoolCrisis.pdf

http://www.ready.gov/sites/default/files/documents/files/PFA_Parents.pdf

Listen

Witness / Validate the Story

Information gathering / history• Mental illness, trauma, loss

& risk factors• Medical & medications• Medically Unexplained

Physical Symptoms

Concerns / Worries• Family members• Ongoing Threat• Traumatic exposure / loss

Needs Assessment• Clarify• Help Develop Action Plan /

Problem Solving

Protect

• Safety Needs

• Practical Needs

• Re-establish Routines &

Structure

• Physical Comfort

• Support Acute Grief Reaction

• Help with Stabilization

• Special Attention to Vulnerable

Connect

• Facilitate Social Support Development

• Engage Youth in Peer Activities

• Reunite Families

• Outreach to Community & Faith Based Systems

• Referral to Long-Term Support Services

• Access to Information

Model

• Model Supportive Behavior

• Model Emotional Regulation

• Practice Self-Care

Teach

• Simple Relaxation Techniques

• Stress Reactions

• Trauma Processing

• Grief & Loss

• Developmental Concerns

• Parenting & Family Coping

• Helpful vs. Problematic Coping Responses

• Symptom Management –

Sleep, Anger, Frustration, Shame/Guilt …

PROMOTING EFFECTIVE COPING STRATEGIES

• Help children understand and begin to accept the disaster; to identify,

• Express, validate, and cope with their feelings and reactions

• Reestablish a sense of safety through routines

• Encourage a variety of developmentally appropriate coping strategies (e.g. Problem Solving vs. Emotionally Focused, Approach vs. Avoidance, Peer vs. Individual, Distraction vs. Expression,)

• Modeling Adult Emotional Regulation & Positive Attitude

• Empowerment of child or adolescent (e.g. provide role, way to experience & contribute)

• Modify Expectations for children’s classroom performance and behavior

Sample Manualized Interventions

• HATS – Helping after Trauma Skills

http://www.nctsnet.org/nctsn_assets/pdfs/edu_materials

/HATS2ndEdition.pdf

• SSET - Support for Students Exposed to Trauma

http://www.rand.org/pubs/technical_reports/TR675.ht

ml

New Resources for Providing Support

for the Grieving Student

12/05/2015

Missouri Coordinated School Health Coalition

Keynote Address

Death is common in the lives of children

• About 5% will face the death of a parent by age 16

• Almost all children experience the death of an important person in their lives by the time they finish high school

• It’s likely you work with grieving children every day, even if you don’t see any children who appear to be grieving

Loss is common in the lives of children

• Relationships /

Attachments

• Objects

• Residence / home

• Pets

• Status / acceptance

• Safety

• Security

• Meaning

• Identity

• Health

• Family Financial

• Divorce & Discord

• Ambiguous Loss

• School Transitions

• Developmental

Transitions

Can school psychologists handle the large volume of grief & loss

experienced by the school community?

School Psychologist

Parent & Family Loss

School Staff Loss

Peer Group Loss

Community Loss

Student Loss

Personal Loss

Loss

Death

TraumaStrong

Emotions

Stress

Child Grief & Loss Experience

Grief Support Focus?

• Screen ---- Intervene

• Palliative ---- Preventative

• Teach ---- Treat

• Adjustment Distress ---- Traumatic Stress

• Single Loss ---- Cumulative Loss

• Traumatic Exposure ---- Grief

• Child ---- School Community

• Short-term ---- Long Term

Attachment

Emotional Regulation

Competency

Reptilian Brain• eat, sleep, wake, cry, breathe,• feel temperature, hunger, wetness & pain• rid the body of toxins • hypothalamus & brain stem control energy levels in body, heart & lungs, endocrine & immune systems

Mammalian Brain• Limbic system• emotions, monitor danger, survival, pleasure• jumps to conclusions based on similarities & perception • fight, flight, freeze

Front Lobe• Planning & anticipation• Sense of time & context• inhibition of inappropriate emotions• empathic understanding

Consensus on the efficacy of bereavement

interventions?

Currier, J. M., Holland, J. M., & Neimeyer, R. A. (2007). The effectiveness of

bereavement interventions with children: A meta-analytic review of

controlled outcome research. Journal Of Clinical Child And Adolescent

Psychology, 36(2), 253-259

• A quantitative review of existing controlled outcome literature (n = 13)

yielded a conclusion akin to earlier reviews of grief therapy with adults,

namely that the child grief interventions do not appear to generate the

positive outcomes of other professional psychotherapeutic interventions.

• Effect size of .13 contrasts with the large positive outcomes (i.e., overall

effect size . 7 –. 9) typically shown in reviews of general psychotherapy

with children

Rosner, R., Kruse, J., & Hagl, M. (2010). A meta-analysis

of interventions for bereaved children and adolescents.

Death Studies, 34(2), 99-136.

• 2 meta-analyses were based on a total of 27

controlled & uncontrolled treatment studies

published before June 2006. Results yielded

small to moderate effect sizes. 00.35 and 0.490.

• Interventions for symptomatic or impaired

participants tended to show larger effect sizes

than interventions for bereaved children &

adolescents without symptoms.

Grief Support Ownership

Family School ?

Are school staff competent and comfortable with

providing support to a grieving child?

Is there time for grief support training during the school

year?

Where will school districts find the resources to provide

the training?

Will the different specialists working in the schools be

able to collaborate?

What are the accepted practice guidelines for grief

support?

Expert Consensus - One Voice.

www.grievingstudents.org

Launched - January 2015

Coalition

Information

Additional

Resources

Organizational

Links

Coalition

Information

Additional

Resources

Additional

Resources

Training Slides with Instructor Notes

Modules Placed into Six Sections

• Each module contains 2 - 4 sections (21 total)

• Instruction provided on 10 – 15 minute video

segments in each section by grief expert with

power point slides to note important points

• Videos of school staff from around the USA

used to illustrate teaching points accompanied

• Downloadable handout that summarizes major

points available

www.achildingrief.com

Schonfeld, D., and M. Quackenbush. After a Loved One Dies—How Children Grieve and How Parents and Other Adults Can Support Them. New York, NY: New York Life Foundation, 2009.

Support Services & Additional Resources

www.schoolcrisiscenter.org

info@grievingstudents.org

toll-free # 877-53-NCSCB (877-536-2722)

*** Resource for information, training materials, consultation and technical assistance – provided at no charge to schools.

NCSCB Resources

• Guidelines for responding to the death of a student or school staff

• Guidelines for schools responding to death by suicide • Sample letter templates

Staff notificationFor death of various causesFor suspected suicideFor confirmed suicide

Parent notificationFor death of various causesFor suicide

Student notificationFor death of various causesFor suicide

Long Island University Post

Psychological Services Centerhttp://www.liu.edu/CWPost/Academics/Schools/CLAS/Dept/Psycho

logy/PsyD2/PSCTrauma Team

https://sites.google.com/site/traumateamliu/