Clinic Pioneered Post-Disaster Counseling

The day after Sunday’s Aeromexico disaster, three counselors from the Los Angeles County Mental Health Department were dispatched to suburban Cerritos. They were there to help ease the grief of families touched by the tragedy.

Among those the counselors spoke with were children. Twenty years ago, the youngsters might have been overlooked.

Emergency counselors first focused their attention on how children react to catastrophe after the 1971 Sylmar earthquake. Much of what is known today about children and disaster comes from work done by the San Fernando Valley Child Guidance Clinic in that quake’s aftermath.

“Before that, people didn’t even know that children reacted strongly to disasters,” said Dr. Stephen J. Howard, director of development and training at the Northridge clinic. Of all potential disasters, the threat of earthquake carries the greatest anxiety because people feel so helpless, Howard said.

“For children it may be a Freudian influence,” Howard said. “We talk about ‘Mother Earth,’ and I think there’s a reason for that. The earth gives life to everything on the planet. To think that the firm ground, to which they are so accustomed, can actually shake and move, it’s a very disturbing idea. Nothing is permanent. Nothing we can be sure of . . . even the earth that we’re walking on. That’s a rude awakening.”

There are ways to prepare a child for the eventuality of a major quake, however, and established techniques for dealing with the emotional aftershocks that Howard and his colleagues have perfected since the jarring Sylmar quake.

Results of the clinic’s research were published in a booklet titled “Coping With Children’s Reactions to Earthquakes and Other Disasters” that is a best seller at the national Office of Emergency Preparedness in Washington, D. C.

The booklet has been translated into Spanish and Vietnamese and is distributed throughout the world. Its crisis intervention procedures have become routine for the Red Cross and other public-health agencies.

Howard had never experienced an earthquake when he immigrated from his native Poland to California in 1950. He gave little thought to the first quake he weathered here in 1956 but, after the Sylmar shake-up, he became involved on a personal level. His Studio City house was not in the epicenter and sustained only minor damage.

“But it shook like a freight train,” recalled his wife, Bebe. “We all ended up in the hall, trying to get to my daughter’s room. Afterward, I remember, I made hot cocoa. We wanted something sweet and hot. We were in shock.”

Their daughter, Jackie, who was 9 at the time, was very upset.

Children Found to Be Frightened

“I called Mrs. Norma Gordon, one of the psychologists who worked at the clinic who had a son a year older,” Howard said. “We compared notes on and decided if our two children were scared, other children might be, too.”

There followed an announcement by the clinic that it would assist any children or families who had reacted with anxiety to the quake.

“We were not prepared for the 350 families who showed up,” he said, “but every one of us took a group of people.”

A heavy storm followed the Sylmar quake, and many of the children reacted to thunder for the first time. Some even became frightened of the sound of trucks on the freeway. Most of the disturbed children were grammar-school age and the clinic counseled them with their families in groups of about 25 or 30.

“One of the first things we did was encourage parents to admit they were afraid, too,” Howard said. “What they were communicating to their children was, ‘We’re not afraid and you are.’ The children believed something was wrong with them.

“Our people dealt with the commonality of the experience. Everybody was afraid. It’s not unusual to be afraid. And, secondly, we got them to talk about it. Parents thought that talking would only increase the anxiety. It may at the time it’s being discussed, but once the discussion is over, the children are less frightened of it and better prepared for the next earthquake.”

Clinic counselors also used desensitization, alternating rattling sounds comparable to those of an earthquake with relaxation techniques.

Howard reported that often a single group session served to quell fears and the majority of patients felt confident to return to a normal routine within two weeks. Most longstanding behavior problems--nightmares, troubled sleeping, generalized anxiety--had dropped to 50% at the end of one year, he says.

The study “was very important because most authorities before that felt children recovered very quickly, . . . after a few weeks,” he said. “But our research showed it took much longer.”

About 1% of the children needed extensive counseling of up to six months. These youths were not reacting just to the quake, he suggests, but suffering from deeper problems that the trauma of the quake brought to the surface.

Howard’s most disturbed patient, an adolescent girl who had been an excellent student and class president, refused to return to school and remained in treatment for nearly a year. Yet she, too, ultimately recovered.

The work of the San Fernando group during the Sylmar quake was followed by the three major television networks, Time and Newsweek magazines and the Wall Street Journal. Shortly thereafter, Howard was invited to Washington by the Defense Department for a conference on preparation for nuclear war.

“The head of the Defense Department felt all Americans were so stout-hearted they wouldn’t react to anything like this. That they were too brave. But clinic experience showed this was not the case.”

Immediately after the earthquake, Howard offered assistance at a Red Cross evacuation shelter, only to be told there was no problem because “everyone was quiet and nobody was making any trouble.”

“We decided to send two people to check on what was going on. And it did look like everything was fine because everyone was sitting there in a stupor saying nothing. The children were not playing, hanging on to the parent. Everyone was quiet.

“Then we started talking to the kids about their experiences and within half an hour everybody in the shelter had clustered around our group. The Red Cross didn’t like it because the children started yelling and throwing things and running around and nothing was quiet anymore.

“The Red Cross had been doing a marvelous job providing for the physical needs of people--shelter, food and clothing--but they didn’t have anything to do with the emotional needs.”

Red Cross officials credit Howard with helping them implement techniques of crisis intervention. The agency published a booklet, in conjunction with the San Fernando clinic, titled, “Children Coping with Disaster.” The Office of Emergency Preparedness followed suit, using clinic material not only for earthquakes but also to follow up on floods, hurricanes and tornadoes.

Classic Text on Subject

Howard and Gordon, who currently coordinates earthquake preparedness for the mental health department, then collaborated to write the clinic’s classic text on the subject, which has been reprinted not only by the Red Cross and government disaster agencies, but also by police and fire departments throughout America.

In preparing a child for an earthquake, Howard suggests that parents explain what to expect--perhaps bouncing a very young child on a bed--and why earthquakes happen. And they should stress that, if separated, they will do everything possible to rejoin their child.

One way to implement this is to work out a mutually agreed upon route from school, so if children are sent home, the parent will know where to look for them.

Assuring children that “Mommy and Daddy will be all right,” so that they will not worry, is not recommended.

“You cannot lie to a child. They will see through it,” Howard said.

If parents are with their children during a quake, it is vitally important to stay with them.

“Do not run out of the house with the children, then leave them outside and return for valuables. Because you’ve left the house you’ve indicated there is some danger in being there,” he said. “When you go back into the house, the child is afraid of separation.

“I think the fear of being alone for young children is even greater than the fear of being injured.”

It is not unusual for children to want to stay very close to their parents for several days after a quake, and Howard recommends indulging them.

“If a child wants to sleep on a mattress in your bedroom, it’s fine. Say to the child after three days, ‘Do you think you are ready to go back to your own room?’ and most children will do so.”

Many youngsters who were alone in their rooms during the Sylmar quake had trouble going back to them, but psychologists discovered that, if the furniture in the room was rearranged, fears lessened considerably.

Howard is generally pleased with the progress that has been made in dealing with emotional stress caused by disasters, and he says he has reason to believe that, with proper handling, children can survive them without long-lasting scars.

His own daughter--now an adult--weathered recent tremors like the seasoned veteran she should be.

“She’s out of bed and ready to leave the house, but she’s not panicking,” he said.