Developmental and Behavioral Issues While Sheltering CSHCN

Leslie Johnson, CCLS Jamie Moreau, CCLS Elisa Oros, CCLS

Objectives

• Consider the special needs of the individual child while providing comprehensive developmentally appropriate care • Gain basic understanding of how children with developmental disabilities react to disaster • Learn general strategies to promote positive coping in children with developmental disabilities

Identifying a child with special needs

• A special needs child presents with a condition that affects their cognitive, physical, or psychological development.

– A child’s abilities or disabilities may not be readily apparent – There is broad spectrum of functioning within children with special needs – A child’s condition can affect one or more of these categories which results in their individual ability to function

Identifying a child with special needs…

• With caregiver present TAKE ADVANTAGE!!!

Questions you should ask: – What are your child’s medical needs?

– What is your child’s daily routine? (comfort items, school attendance) – What toys/activities does your child enjoy?

– What specifically agitates your child (noise, separation, lack of routine, fatigue, taking meds)? • Absence of caregiver Assessment begins by observing the child’s responses to their environment It is imperative to provide a child friendly environment – – – – Soft voice, low tone Eye level Personal space Play opportunities

Cognitive Child Development Chart Psychological Motor/Play 0-12 Months 12-36 Months 3-5 Years

     Recognizes mother Reaches for familiar people or toys Learns through routines and rewards Recognizes name Imitates familiar words  WIDE RANGE OF LANGUAGE SKILLS AT THIS AGE.

 Understands some abstract concepts  Knows shapes  Understands family relations  Uses sentence length of 4 to 5 words   Speaks of imaginary conditions “I hope” Understands basic concept of right and wrong – punishment centered      Attachment to mother/caretaker Totally dependent Begins to develop a sense of self Stretches arms to be picked up Likes to look at self in mirror  Rapid language growth  Understands a lot more than what they can say  Gives first name  Holds up fingers to tell age   Combines nouns and verbs “mommy go” Refers to self as “me” rather than by name  Egocentric  Seeks adult approval  Social development increases  Points to things they want  Joins in play with other children  Separation anxiety common  Neck muscles develop  Laughs/ coos  Rolls over  Stands with sup-port  Creeps/crawls; walks with help  Pulls self to standing position  Feeds self cracker      Runs, throws, kicks, jumps Holds crayon with thumb and fingers Uses one hand consistently in most activities Uses spoon with little spilling Gets drink from fountain or faucet in dependently   Opens door by turning handle Washes and dries hands with assistance  Can cooperate  Experiences and copes with feelings (sad, jealous, embarrassed)  Plays and interacts with other children  Symbolic representation of self begins (can now use a doll or picture to represent self)  Swings/climbs  Walks on tiptoes; balances on one foot  Pastes and glues appropriately  Buttons and unbuttons large buttons  Washes hands independently  Uses toilet independently

6-9 Years 10-15 Years 16-21 Years Cognitive Child Development Chart Psychological Motor/Play

 Thinks using symbols  Recognizes differences  Makes comparisons  Can take another’s perspective  Identifies penny, nickel, dime   Knows common opposites like “big/little” Asks questions for information  Distinguishes left from right  Separates fantasy from reality  Improved sequencing of events  Early close peer relationships  Presence of well-developed defenses  Develops identity outside family (school, friends)  Plays competitive games  Engages in cooperative play  Egocentrism crumbles – suddenly question how others think of them.

       Increasing small muscle motor skills Cuts foods with a knife Laces shoes Dresses self completely Ties bow Brushes independently Crosses streets safely  Can engage in inductive and deductive logic  Understands hypothetical situations  Conflicts with parents increase  Increased focus on identity  Focus on peer relationships  Can be rebellious/moody  Romantic feelings  Struggle with sense of identity  Feels awkward or strange about his or her body  Worries about being normal  Greater body competence (e.g., physical coordination)  Manual dexterity  Growth patterns vary  Uses formal logic debates and can change sides of debate  Understands probabilities  Uses more flexible abstract thinking  Examination of inner experiences  Conflict with parents begins to decrease  Interest in relationships  Solidifies personal identity  Becomes goal directed  Can be rebellious  Increased concern for others  Increased concern for future  Places more importance on his or her role in life  Heightened physical power, strength, and coordination

CSHCN’s response to disaster

Factor’s affecting CSHCN in a disaster: • Age, ability, past experiences • Length of exposure to trauma • Misconceptions about event • Separation from caregiver • Change in environment • Change in routine • Perceived stress in others • Uncertainties • Loss of control • Need for expression • Anxiety inducing images/sounds • Worries about reoccurrence of disaster • Fear of safety

CSHCN’s response to disaster

Possible reactions of CSHCN in a disaster: • Agitation, moodiness • Aggression, feelings of hate, retaliation • Uncooperative behavior • Risk-taking behaviors • Sleep/eating disturbances, nightmares • Withdrawal or hyperactivity • Exaggerated startle response • Repetitive behaviors • Nervous tics • Impaired abilities to socialize with peers, play, or verbalize clearly • Increased somatic complaints • Recreating and discussing event

Meeting the psychosocial needs of CSHCN in a sheltering environment

Play is the work of children – it will provide opportunity for expression and control, normalization of environment, and comfort during a stressful event. It is imperative!

Meeting the psychosocial needs of CSHCN in a sheltering environment

General Goals: • Support caregivers • Create a routine – Play (individual/group, directed/nondirected), meals, snacks, rest, medical care, family-time • Provide comfort items • Provide opportunities for verbal expression – Non-directed one-on-one attention • Provide expressive play opportunities – Art, music, dance, writing, etc.

• Provide therapeutic approaches for stress management – Deep breathing, guided imagery, relaxation • Provide choices and control when possible

Meeting the psychosocial needs of CSHCN in a sheltering environment

General Goals: • Limit exposure to disaster-related material • Look for specific cues that may indicate concern • Validate the child’s feelings and address appropriately • Expect misconceptions – provide accurate and appropriate information, repeat, check understanding • Address concerns about safety • Allow more time than expected for additional support and nurturing • Involve caregiver in all aspects

Meeting the medical CSHCN in a sheltering environment needs of

General Goals: • Provide necessary medical care using developmentally appropriate interventions • Involve the caregiver whenever possible • Limit number of caretakers • Only give the child choices that truly exist – Example: “Do you want to watch me, or look at mom?” • Preparation – Be honest – Use terms and wording the child will understand – Allow child to manipulate safe medical equipment • Distraction – Choose developmentally appropriate activities • Regrouping – Allow the child time and incentives to return to their baseline

Meeting the needs of the caregiver of CSHCN in a sheltering environment

General goals: • Provide safe environment for caregiver and family • Understand the special needs of the caregiver’s child • Provide emotional support for stressed caregiver • Encourage and provide for self-preserving behaviors of caregiver – Healthy eating habits – Rest – Opportunity for breaks • Assistance with planning and preparing for life post shelter