|Year : 2019 | Volume
| Issue : 1 | Page : 103-108
Psychological first aid for children during the Kumamoto earthquake disaster response in Japan
Miyuki Akasaka1, Yuzuru Kawashima2
1 BA, Save the Children, Japan
2 MD, PhD, Clinical Research Institute at the National Disaster Medical Centre, Disaster Medical Assistance Team Secretariat, Disaster Psychiatric Assistance Team Secretariat, Tokyo, Japan
|Date of Web Publication||28-Jun-2019|
Save the Children Japan, 2-8-4-4F Uchikanda, Chiyoda-ku, Tokyo 101-0047
Source of Support: None, Conflict of Interest: None
The following field report is based on lessons learned from the adaptation and utilisation of the Psychological First Aid for Child Practitioners (Save the Children, 2013) materials in Japan. Psychological first aid (PFA) is a set of skills and competencies that help reduce the initial distress of children and caregivers due to accidents, natural disasters, conflicts or other critical incidents. The manual was developed by Save the Children based on Psychological First Aid: A Guide for Field Workers (World Health Organization, War Trauma Foundation and World Vision International, 2011). National capacity-building in PFA was focused in Japan on mental health professionals and emergency responders to enhance mental health and psyschosocial support in times of disaster. In April 2016, during the Kumamoto earthquake, emergency disaster responders in Japan learned PFA and worked at child friendly spaces for children and caregivers.
Keywords: child practitioners, Japan, natural disaster-affected children, psychological first aid
|How to cite this article:|
Akasaka M, Kawashima Y. Psychological first aid for children during the Kumamoto earthquake disaster response in Japan. Intervention 2019;17:103-8
| Introduction|| |
Mental health and psychosocial support in Japan
The Great East Japan Earthquake and Tsunami (GEJET) of 11 March 2011 was the most powerful earthquake recorded in Japan. It triggered a massive tsunami which struck Japan’s north-east coast. There were more than 15,000 deaths, 3000 homes were totally destroyed and 47,000 people became evacuees (Cabinet Office, Government of Japan, 2018a). Lifesaving relief operations were delivered to the affected areas, which included mental health and psychosocial support (MHPSS). The Ministry of Health, Labour and Welfare dispatched 57 mental healthcare professional teams called ‘kokoro-no care teams’ comprised of psychiatrists, nurses, psychologists or psychosocial workers and logisticians to the affected areas (Ministry of Health, Labour and Welfare, 2018). ‘Kokoro’ in Japanese means ‘heart, mind, emotions, thoughts and feelings’, and the term ‘kokoro-no care’ has the same meaning as MHPSS as described in the IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings (Suzuki, Fukasawa, Nakajima, Narisawa, Asano, & Kim, 2015). The term ‘kokoro-no care’ itself is widely known among mental health professionals as well as community members; however, misunderstandings can occur and the IASC guidelines are very helpful in this regard. The IASC guidelines recommend a multi-layered support approach, including provision of basic needs and security, and specialised support. These layers are designed to complement each other to best respond to a diverse variety of needs. The guidelines emphasise the importance of cross-sectoral collaboration and inter-agency coordination in times of emergency (IASC, 2007). These points have been generally understood among Japanese mental health professionals, but have not been widely integrated into practice (Kim, 2011). Different professions have different point of views on MHPSS in emergency settings. For example, healthcare professionals tend to identify and address pathological mental health issues in times of crisis. Community members often think that the ‘kokoro-no care’ approach does not include specialised mental healthcare (Suzuki et al., 2015). In the GEJET response, varied responders who had different backgrounds or expertise were involved in the relief operation, and everyone was in a position to be provided with psychosocial support. However, it is important to note that improperly providing psychosocial support itself can cause harm, as we deal with highly sensitive isues (Inter-Agency Standing Committee, 2007). It was therefore necessary to increase awareness of ‘kokoro-no care’ in order to have a common understanding to reduce the risk of harm. The national level of capacity-building effort was made by the mental health professionals and partners by introducing psychological first aid (PFA). PFA is a popular evidence-informed approach based on international expert consensus. It provides ‘a humane, supportive and practical response to a fellow human being who is suffering and may need support’ (Shultz & Forbes, 2014). The Japan National Information Centre for Disaster Mental Health (NICDMH) and partners translated Psychological First Aid: A Guide for Field Workers (World Health Organization, War Trauma Foundation and World Vision International, 2011) into Japanese and started training in PFA in 2012. In 2014, Save the Children with support from NICDMH introduced Psychological First Aid for Child Practitioners (Save the Children, 2013) and started disseminating the training.
There is a paucity of empirical research on the effectiveness of PFA. However, mental health experts and global humanitarian guidelines recommended PFA as an appropriate support for an individual experiencing acute mental distress following a disaster (Child Protection Working Group, 2012; Morris, Ommeren, Belfer, Saxena, & Saraceno, 2007). In Japan, both training in relation to the PFA Guide for Field Workers and PFA for Child Practitioners were successfully disseminated to various people, including fire fighters, medical responders, local prefecture, city and town officials, school teachers, local organisations and non-governmental organisations, company workers, media people and students from universities and colleges. Two governmental disaster medical response teams, the Disaster Medical Assistance Team and Disaster Psychiatric Assistance Team, started introducing PFA in their official trainings. The Board of Education in Miyagi Prefecture, a prefecture affected the by GEJET in 2011, has also adopted the PFA for Child Practitioners training into their official annual teachers training since 2016.
Psychosocial support for children in emergency settings
Children’s responses to the emergency events may cause caregivers or adults around them to feel confused or nervous, because children display unique reactions. For example, they may exhibit regression to younger behaviours (e.g. bedwetting) or socio-dramatic play with content related to the disaster or some children may appear as if they are not registering a response. Most children affected by disasters experience distress, but do not develop mental illnesses and the distress tends to diminish with time (Pfefferbaum, Newman, Summer, & Nelson, 2014). However, some may face post-disaster mental health problems such as depression, somatic symptoms and posttraumatic stress disorder, and may need additional support resources. In an emergency, different socio-ecological levels, family, peers, school and community, are all important factors to protect and promote children’s mental health and psychosocial wellbeing in disaster settings (Betancourt, Meyers-Ohki, Charrow, & Tol, 2013; Norris, Friedman, & Watson, 2002). A report about children after the GEJET said that there were not many children’s cases referred to the mental health professionals in Miyagi Prefecture. The reason may be related to the fact that caregivers may lack information or knowledge on the children’s reactions to disasters, and as a result, they were not aware of the changes in the children (Miyagi Prefecure Kodomo Sogo Center, 2016). A survey conducted by the Ministry of Education, Culture, Sports, Science and Technology, Japan, on 5075 kindergarten to high schools with 33,700 classroom teachers and 3408 school nurses from the seven GEJET-affected prefectures showed that half of the teachers felt that they did not have enough basic knowledge on children’s mental health. School nurses with more knowledge of mental health than teachers identified more stress reactions, had more mental health referral information and referred more children’s cases to mental health professionals (Ministry of Education, Culture, Sports, Science and Technology Japan, 2013). If caregivers and school teachers understood children’s views on disasters and were aware of the children’s distress, they might have normalised less serious distress in children’s psychological reactions and referred children with severe distress (Norris, Friedman, & Watson, 2002). For these reasons, appropriate trainings should cover all sensitive issues of child development and children’s emotional and behavioural reactions to disasters (Pfefferbaum & North, 2013). This information will be beneficial for adults to better respond to children’s behavioural changes in disasters and provide age-appropriate PFA.
| Background|| |
Psychological first aid for child practitioners training manual
In 2013, Save the Children (SC) developed a PFA for Child Practitioners manual which trained people to support and communicate with children in distress and caregivers in emergency settings. The core actions in PFA aimed to encourage children’s positive coping skills by offering safety and comfort, connecting to social support, providing practical support and link children with serious distress to more professional resources. The PFA for Child Practitioners training manual adopted the PFA principles, ‘look, listen and link’ (World Health Organization, War Trauma Foundation and World Vision International, 2011). The training manual was originally designed to be a two-day programme and potentially complemented a one-day training on stress management for staff. The training programme included information on general child cognitive development, general child stress reactions, practice on child age-appropriate communication techniques, communication with caregivers in distress, PFA action principles and key actions
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[Table 1], [Table 2]