Tsunami Disaster - Psychosocial Care for Children [PDF] - Nimhans

Childhood is a period of growth and development. It has been seen that the developing yearsare critical as these years lay the foundation for development into a well-adjusted adult. At eachstage of development there are certain tasks that the child must get opportunities to master for ahealthy personality development. Relevant and continuous interactions with caregivers, as well astheir environment, enable the children to master these tasks and move on to the next phase ofdevelopment. E H Erikson (1964) highlighted the important role environmental factors play in thenormal development of the child and how lack of opportunities to adequately master the developmentaltasks can lead to dysfunctional behavior.For instance, a child during babyhood must have caregivers who meet the basic needs of thechild. Through this the child develops a sense of security and trust or else the child will not feelsecure and will develop a general feeling of mistrust about people around him/her. As the childgrows up, he/she needs an environment, which can be explored to enable the development of selfesteem,self reliance and doing things on his/her own. When the child starts going to school, he/shemakes friends and interacts with peers and learns from them. All these are possible in an environmentwhen the child has caring caregivers who give quality time to the child, a home where the childfeels secure, has accessibility to school and has playmates in the neighborhood to interact with.A disaster like the tsunami disrupts the process of interaction the child has with his/her environment.It leads to displacement wherein the child loses his familiar environment (home, school,peers, etc). There is a sense of panic and confusion and the caregivers are unable to care for thechild or not around for sometime; and thus the regular life patterns are disrupted. There can beinstances of death of both the parents, or one of the parents or sibling(s) or even a pet, leaving thechild with a sense of loss. The child might find it extremely difficult to cope with loss. Disastershamper the process of healthy emotional and psychological development.Children feel safe and secure if they have consistent and predictable routines in life. Innormal situations, caregivers who are caring and responsive help children to be comfortableand happy. However, in a disaster situation caregivers themselves are affected, and thus areunable to provide care and comfort to children. Hence, disasters disrupt the sense of wellbeing in children by destroying normal predictable and consistent life routines. This causesanxiety, fear and a great sense of insecurity among children. Their worries and fears manifestthrough a large number of reactions like clinging behavior, regressive behaviors likethumb sucking and bed-wetting, refusal to attend school, bodily aches and pains, palpitations,aggression, irritability and sleep disturbances.In order to help the children recover their sense of well being, an attempt to normalize theirdaily life routines and their emotional reactions is essential. Children need to feel safe and secureboth physically and emotionally. It is important that children are given opportunities to expressthemselves in a safe and accepting environment. These efforts will enable the children to overcomethe trauma they have been through and re-establish their sense of well being and good health.2 INFORMATION MANUAL 3: TSUNAMI PSYCHOSOCIAL CARE FOR CHILDREN

This manual attempts to enable caregivers (parents, teachers and other adults such asAnganwadi workers, PRI members, ANMs etc.) to:Ø Understand the impact of the tsunami on children.Ø Understand the emotional reaction that the children would be experiencing as aresult of the trauma.Ø Understand how recovery can be facilitated in children so that they regain their senseof well being.Ø Understand the needs of the children who may require additional care to recoverand come back to normalcy.TOT INFORMATION MANUAL - 1 3

IMPACT OF THE DISASTERON CHILDRENChildren are vulnerable to the negative impacts of a disaster. Due to lack of experienceand maturity, they are unable to fully comprehend what has happened to them. Thereactions of the adults around them, the kind of loss that they have experienced, theamount of exposure to the trauma, the available support system, etc all determine the effect of thedisaster on the children.The tsunami that affected thousands of lives including that of children was unexpected andsudden, leaving children confused, shocked and frightened. In a moment, their whole world wasdisrupted. Some children were orphaned, some lost one parent, some lost their siblings, and somehad to adjust to a displaced life as they lost their homes. Some of the children live in the camps withlittle or no possessions and do not know when they can go back to their places and the adultsaround them are not in a position to provide much solace or comfort as they themselves are victimsof the killer waves. The normal daily routine is disrupted, and often there is no regular school,making it all the more difficult for the children to restore back to normal life.Children in their process of growth are presented with developmental tasks at certain agesthat they must achieve in order to move onto the next stage successfully. They need stability andmeeting of some basic needs to provide them the nurturance to develop into healthy adults. Adisruption of familiar routine and previously secure world leaves children as one of the most vulnerablegroups during and following a disaster.LOSSGiven below are the impacts of the tsunami on the children.F Loss of relationships: This can be with parents/siblings/caregivers like grandparents orother relatives, teachers, friends, neighbors or pet. Loss of relationship can be due to death of aperson, displacement, and absence since the person is away in a hospital or may still be missing.* 6-year-old boy who lost his mother and two siblings, “The sea mother came andtook away my mother, my sister and my brother. I want my mother. I miss my ‘amma’. I don’twant to go to school. I come here every evening beside my old house to see my mother, sisterand brother (he points out to a crow and two mynas) I know that the crow is none but mymother and the two mynas are my sister and my brother”.4 INFORMATION MANUAL 3: TSUNAMI PSYCHOSOCIAL CARE FOR CHILDREN

* 10-year-old boy who lost his neighbor, “My best friend Vanitha’s father savedtwelve people in the tsunami. However, he himself died. He was a very tall and strong man.We all loved him because he used to climb the coconut tree and give us tender coconuts. I amvery scared at night because his spirit comes and pinches me on my cheeks and calls me. I amscared to go out for toilet at night because I can see him standing beside the coconut tree.”* 8-year-old boy who lost his cow, “We had a cow called Laxmi. She was a very goodand gentle cow. She used to give us milk. We used to drink her milk everyday and also sell hermilk. She got washed away. Today we don’t have money to buy our own food and we don’tget fresh milk in the mornings.”* 7-year-old girl who lost her cows, “We had two cows. They were my friends. I usedto play with them everyday. We could not save them. I saw them getting washed away infront of my own eye. I feel sad and miss them very much.”F Loss of possessions like toys, dolls, cycles, clothes, books, etc.* 12-year-old girl who lost her doll, “I had a very beautiful doll. If you made it liedown, it would shut its eyes. I used to like it a lot as the eyes were very beautiful. The doll gotwashed away by the sea. My uncle has bought me a new doll. But I miss my old doll. I am nothappy with my new doll. I wish I could get back my old doll!”F Loss of physical parts or injuries to self or loved ones like a broken leg, etc.F Loss of familiar environment– home, schools, play grounds, trees, religious places,market area etc. Having to move out of their surroundings especially into camps/rented accommodationwith no friends or not going to school is profoundly disturbing to children.* 15-year-old girl whose school was destroyed, ''We had such a nice and big school.We had a big library with so many books. The school has been destroyed by the waves of thesea. I have also lost my mark card. I miss my school. I am worried because I don’t know if Ihave to repeat the same class because I have lost my mark card. What can I do?”DISRUPTION OF DAILY LIFE AND STRESS OF DISPLACED LIVINGThere are great changes in living conditions and daily life activities after a disaster. The routineschildren were comfortable with and the surrounding they knew no longer exist. Relationshipswith parents and significant others might undergo changes as caregivers are themselves affected bythe disaster and become busy and preoccupied in getting their life back in order. The children arethrown in to new surroundings all of a sudden. They are unable to lead the life they were earlier usedto. Their life becomes difficult for the following reasons:TOT INFORMATION MANUAL - 1 5

¨¨¨¨¨¨¨¨Death of loved ones.Separation from loved ones while fleeing.Exposure to frightening sounds and sights while they reached secure places of shelter.Witnessing the destruction of homes, property, or personal possessions.Injury or being faced with physical danger.Witnessing the panic and vulnerability of people trying to escape.Exposure to deaths, injury, pain and massive destruction in the surroundings.Loss of familiar environment.TOT INFORMATION MANUAL - 1 7

UNDERSTANDING EMOTIONAL REACTIONSOF THE CHILDRENIt is important to understand how children who have been affected by the tsunami wouldbe processing the information gathered and what sort of reactions they show as a result.Since, children have limited capacities to process information, their sense of what happenedis often not realistic and they are unable to comprehend the totality of the situation. Oftenadults tend to overlook the necessity to respond to needs/queries of the child and explain things tohim/her, clarify his/her doubts. But the fact remains that children are the worst affected population inany disaster and need extra care and comfort.Children process events around them according to their developmental ages. It is importantto try and understand how children of various age groups feel and react to a disaster situation sothat they can be understood, reached and helped to feel better.An unexpected disruption of a secure environment results in fear, anxiety, sadness and changeof behaviors. Most children simply need time to experience their world as a secure place again andwith their parents as nurturing caregivers. In the tsunami disaster, many of the children lost lovedones and thus it is important to understand how these children view death since this would be a coreissue that children would need to deal with effectively. It is imperative for us to understand howchildren of different age groups feel and react after a disaster so that when we work with them weare able to relate to them in a better and empathetic way.The following information has been adapted from The psychosocial issues for children andfamilies in Disasters CD HSS series, American Academy of Pediatrics and explains to us aboutwhat children think about death at various ages.CHILD’S VIEW OF DEATH AT VARIOUS DEVELOPMENTAL STAGESSmall children view their world from the perspective of stability and availability of dependablecaretakers. If this is disturbed, they feel anxious and restless. They feel helpless and fearful inthe face of a disaster, especially if they are separated from parents. They find it difficult to protectthemselves and may feel very insecure without adult caregivers. They are often unable to expresstheir feelings. They typically look to parents, significant others and older siblings for comfort andstability.Children who have lost one or both parents need more attention. Loss of a relative, playmate,or a pet can be very disturbing.8 INFORMATION MANUAL 3: TSUNAMI PSYCHOSOCIAL CARE FOR CHILDREN

Infants„ No comprehension but sense something has happened„ Recognize that people around him/her are unhappy, sad or worried and hence becomeafraid„ May change eating, sleeping and toilet habitsPre-school„ Death brings confusion and guilt. Views illness and death as a punishment for somewrong doing„ May see death as something that is reversible„ Recognizes people around him/her are unhappy, sad, worried or frightened and in turnbecomes frightenedFamily is centre of his/her world and is confident that the family will take care ofthe needsSchool age children have the ability to understand what the tsunami has done to the peopleand the environment around them. This makes them sad about the family members being killed inthe tsunami and worried about near and dear ones who are injured. School age children have aneed to understand what has happened and the concrete steps that they can take to prepare andprotect themselves from any such happenings in future. Children at this age are very attached toparents, siblings, friends and their pets. Thus a loss of any of the aforementioned people causes agreat amount of distress to children and they find it difficult to cope.Often children are unable to identify the emotions that they are experiencing. To allappearances they may seem to be all right but there might be lot of turmoil and conflicts withinthem that requires to be ventilated. They may want to talk about the details of the event over andover again.5–9 Years„ Often feels responsible for the events and the loss„ Begins to realize that death is final but believes it will never happen to him/her or anyoneknown„ Tends to personify death„ May associate death with a skeleton or have nightmares.„ Unavailability of other family members to help cope is worrying„ May think about it as magical illusion or punishment„ Develops an interest in the causes of death (violence, old age, sickness)„ Has to cope with social reactions like people at school or others aroundTOT INFORMATION MANUAL - 1 9

9–12 Years„ Starts recognizing that death is permanent and common to anyone who is alive„ May deny loss and carry on with his/her life„ Curious and interested in the gory details and asks questions„ Starts an interest in biological factors of death„ Wonders who will care for him/her„ May regress to an earlier stage of developmentMay feel guilty and overcomes this by attempting to be very goodNormally, it’s during adolescence (12-18 years) that one gains maturity, becomesindependent and competent in carrying out his/her daily life activities. They are capable of takingmany responsibilities and making decisions. However, when a disaster results in deaths,adolescents are not sure how to handle their own emotions, and may feel guilty and responsible forthe deaths that occurred.Adolescents„ Have adult notions and view death as inevitable, universal, irreversible„ Try to be independent and will feel dependent when forced to face a loss„ Find it very confusing and may have suicidal feelings„ Will question life itself and want a lot of discussions based on life and death„ Need someone to listen; to talk with„ Think about their own deaths which can be frightening„ May withdraw and deny the loss„ May feel guilt, anger, even some responsibility for death that occurredNot sure how to handle own emotions in public or private, they need adult guidanceThe manner in which every child processes his/her own experiences will be unique andexclusive to himself/herself. The age of the child, the events he/she has been through, the amount ofexposure to the event, the support and care available to him/her for recovery, will all play animportant role in how the child is able to cope and deal with his/her emotional reactions.One must remember that„ These emotional reactions are normal responses to an abnormal experience„ Reactions are common and experienced by everyone„ No one who experiences a disaster is untouched by it„ Reactions manifest differently at different periods of time after the disaster10 INFORMATION MANUAL 3: TSUNAMI PSYCHOSOCIAL CARE FOR CHILDREN

After a horrifying disaster like the tsunami, it is inevitable that children will indulge in antisocialacts such as stealing, substance abuse, and use of foul language. This in no way should be interpretedas reflecting the child’s character. Instead it is more a reaction of the child to the pain andtrauma that he/she has gone through - a response to the event the child has been unable to comprehendand cope with. If one understands this, then one is in a better position to help the child in therecovery process.REACTIONS SEEN IN CHILDREN OF DIFFERENT AGE GROUPSAfter a disaster, children can show physical reactions, emotional reactions and there can bebehavioral changes. These are normal reactions to an abnormal event in their life. Children of differentage groups react differently as they perceive the event differently. The reactions are temporaryfor most children and some support and attention can help them to overcome the trauma and reachtheir normal level of functioning. Given below are the reactions shown by children of different agegroups:Preschool (1–5 years)„ Temper tantrums„ Crying – whimpering or screaming„ Excessive clinging and demanding„ Regressive behavior (thumb sucking, wanting to be carried, bed-wetting)„ Loss of bowel/bladder control„ Fear of darkness„ Fear of being left alone„ Easily frightened and then angry„ Sleep disturbances- gets up crying, unable to sleep alone, nightmares„ Sensitivity to loud noises„ Fears weather- lightening, rain, strong winds„ Moodiness,irritability„ Helplessness and confusion„ Loss of appetite„ Speech difficulties„ Increased aggression, especially in boys*3-year-old Santosh had been a very playful boy earlier. The waves of the tsunamidestroyed his house. Since then he has become very quiet, always clings to his mother andinsists that his mother carry him all the time unlike before. He does not eat properly andTOT INFORMATION MANUAL - 1 11

ecomes scared and starts crying if left alone.* 4-year-old Jairam was a very amiable child. However, since the tsunami, he hasbecome very irritable. For trivial or for no reason, he gets angry and bites his mother. Hismother is confused about the change in the child’s behavior and feels helpless, as she doesnot know how to take care of the child.School Age (6–11 years)„ Physical complaints-headache, stomach aches, giddiness„ Aggressive behavior at home or school„ Bed-wetting.„ Change in appetite.„ Inability to sleep, nightmares.„ Sadness and apathy.„ Disobedience.„ Disruptive behavior„ Understands loss and becomes anxious.„ Withdrawal - does not mix with friends.„ Fear of recurrence, fear of darkness, sleeping alone, separation from parents,fear about weather; water, safety, imaginary fears.„ Difficulty in following routines„ Fights with siblings, parents, friends„ Disinterest or difficulties in school work – disturbs others, worrying, remains tense,in-disciplined, refusal to go to school, poor concentration.„ Feels guilty and responsible for the loss.* 8-year-old Bala lost her father in the tsunami disaster. She was very attached to herfather. Her father used to put her to sleep everyday by telling her bedtime stories. Now Balarefuses to return to her house till her father returns and insists that father should come andtell her bedtime stories. She is currently staying with her relatives.* 8-year-old Kiran was a very lively child. The unexpected tsunami destroyed Kiran’shouse. He and his family members had to run for their life. Following the disaster, Kiranrefuses to leave his parents, especially his mother even for a short while. He always clings tohis mother, does not allow her to carry out household chores and insists that mother alwayssits beside him. Kiran is very fearful to go near the seashore. He does not mix with his friendsand refuses to go out to play with his fellow mates.12 INFORMATION MANUAL 3: TSUNAMI PSYCHOSOCIAL CARE FOR CHILDREN

* 8-year-old Murthy’s family was affected by the devastating tsunami. They lost theirhouse and fishing boat. He startles whenever there is a slight sound, like that of an aeroplaneflying or the whistle of a pressure cooker. He talks in his sleep. He sleeps holding tightly toone of his parents. He refuses to go out to play with his friends and never goes near theseashore. He is fearful that the tsunami may occur again. He insists that the family shouldshift to the nearby village for safety where his grandmother lives.* 10-year-old Shiva had seen the waves destroying his house. Now on hearing soundsof waves, or a pressure cooker or an aircraft, he becomes very fearful. Sometimes on justhearing the word ‘thanni’ (water), he starts running for safety.* 10-year-old Mukesh was very fond of playing on the seashore along with his friends.He would jump around in the seawater, splash water on his friends. After witnessing thefearful image of the sea, which washed away his house, he is terrified to go near the sea. Hisheart beats fast when he pours water on his body during bath. It reminds him of the destructivetsunami waves, which washed away everything in their way.* 10-year-old Murali was swept away by the sea waves. Fortunately he caught holdof a branch of a tree and hung on there for ten days till he was rescued. He had becomeextremely weak and lost a lot of weight. He refused to talk to anyone and was unable tosleep.* 11-year-old Savitri saw her father being washed away in front of her own eyes.However, even after one month she and her mother refuse to believe that the father is gone.The mother insists on seeing the dead body. The family has not performed the last rituals. Ifanyone tells Savitri that her father is dead, she screams and cries. Savitri has become veryirritable. She does not sleep or eat properly.* 11-year-old Shakuntala’s mother and brother got washed away in the tsunami.The sea waves carried the body of Shakuntala’s mother some three kilometers away.Shankuntala did not go to see her mother’s dead body as the place was far away. Her fatherwent to see the dead body of the mother and the brother. Now Shakuntala feels extremelyguilty that she did not go to see her mother for the last time. She is unable to sleep properlyand keeps thinking about her mother.Adolescence (12–18 years)„ Seek isolation, become less communicative„ Change in appetite and sleep disturbances- sleeplessness or increased sleep„ Feel different or alienated because of their experiences„ Irritability„ Increased risk-taking behavior, irresponsible behaviourTOT INFORMATION MANUAL - 1 13

„ Substance abuse-smoking, drinking and consumption of other drugs„ Avoidance of trauma -related thoughts, feelings and activities„ Aggression-argue, fights, destroy things„ Feelings of hopelessness, feelings of neglect and isolation„ Disobedience, especially towards authority and parents„ Try to get involved in activities to get a sense of control like rescuing and organizing at thecamps„ Angry, frustrated and may feel very helpless„ Depression due to loss„ Guilt for not being able to do enough or for having survived„ Suicidal thoughts„ Inability to concentrate„ Behavioral problems like aggression, lying, stealing„ Dropping out of school or work„ Decreased levels of energy, aches and pains and other physical complaints due to stress„ Low interest in social activities /recreations* 12-year-old Arvind had to run for his life when the tsunami struck his village. Hesaw houses and cattle being washed away. He was in the midst of a chaotic situation withpeople running away, shouting for help. Since then, Arvind has not been able to sleepproperly. At night he gets nightmares of sea waves gushing in, houses being washed awayand people from his neighborhood being swept away. He wakes up in the middle of the nightterrified with the images in his head, and is unable to go back to sleep.* 12- year-old Praveen lost his father and his house in the tsunami. Now he is forcedto stay in a camp. Praveen keeps waking up in the middle of the night haunted by the imagesof the killer waves. He feels upset about losing his father, losing his secured environment. Hewould then wake up his friend, talk about his feelings. Talking it out with his friend relieveshim and then he goes back to sleep.* 12-year-old Savitha was playing near her house when she saw the sea waves rushingtowards her village. To save herself, she climbed on the top of a coconut tree. From thereshe screamed for help. She was rescued by people from her village. Two weeks later whenschools reopened, teachers noticed that she was restless, had difficulty in concentration.Savitha found it difficult to remember what was being taught in the class. Prior to tsunami,Savitha was an attentive and a bright student.* 12-year-old Raman was very attached to his eight-year-old brother. He lost hisbrother in the tsunami. Since then, he has been looking very dull, and hardly talks to anyone.While he is regular with his attendance to school, he does not respond when the teacher asksquestions. When biscuit packets are distributed in the school, he takes them but never eats.14 INFORMATION MANUAL 3: TSUNAMI PSYCHOSOCIAL CARE FOR CHILDREN

He has collected some fifty biscuit packets but has not eaten a single biscuit.* 15-year-old Manjula was swept away by the waves of the sea. She was rescued bypeople from her locality. However, she had already swallowed sand by that time. She vomitedsand four times after being rescued. Subsequently she often coughs, has fever on and offand has become very weak. She hardly has any energy. She has lost weight. She is unable tosleep and eat properly.* 15-year-old Fernandes was away from the village when the tsunami struck hisvillage. On returning, he found his house completely destroyed. Now his parents have built atemporary shelter. But Fernandes refuses to stay there. He is extremely fearful. Earlier heused to attend school, which is little distance away from his village. Now after the tsunami,on his insistence, parents have sent him to the school hostel.* 15-year-old Thomas had a Christmas celebration with his family on 25th December.Next day early morning, Thomas got up and took a bus, as he wanted to meet his friendin the church. While he was in the bus, the tsunami struck. There were damages to his bus buthe managed to escape. On his return home, he found that all his family members had died inthe disaster. His friend whom he was supposed to meet had also died. Thomas found a briefcaselying and did not know who the owner was. He broke open the briefcase and took outsome money. The first thing he did was he went and bought a camera. He took snaps of thedead bodies and the destruction all around. He always carries those photographs along withhim and keeps viewing them every now and then. He says that he wants to see how it happened.He feels guilty that he had left his family members while they had been sleeping. Hesays that life is meaningless to him and he wants to die. He often feels like committingsuicide.* 17-year-old Nagraja lost his father at an early age. His mother was unable to runthe house due to financial constraints. Hence, Nagraja was forced to drop out of school toearn money. He has one brother and one sister who are paralytic patients. He has two sisterswho are of marriageable age. With a lot of difficulty, he had managed to make a house andthe house warming ceremony was only two days prior to the tsunami. The tsunami washedaway Nagraja’s newly constructed house. He used to earn his living by fishing. However,after the tsunami he has become too scared to go out into the sea for fishing. Consequentlyhe has developed feelings of emptiness and helplessness. He feels lost and does not knowwhat to do in life.These case stories reflect how children of different age groups react to a disasterTOT INFORMATION MANUAL - 1 15

HELPING CHILDREN TO RECOVERAs adults in a caregiver’s role (parents, relatives or members of outside agencies,teachers and all those who can help the survivors of tsunami) it is imperative tounderstand how to help children recover. This understanding will help one to workwith children and help them overcome the trauma.Disasters disrupt the life of children in the community in some way or the other. Many childrenwould have lost loved ones whereas others would have lost their homes or their belongings inthe tsunami. Even if there has been no personal loss, seeing others suffering around them or hearingabout loss from others can be extremely disturbing and distressing to children.Literature supports the fact that normalization of life routines is the best way in which the childcan regain a sense of well being and security. As seen in the field, many of the children have lostcaregivers who were sources of support for them. The adults around them are busy trying to gettheir lives back in order and are pre-occupied with their own concerns about housing, livelihood,compensations, uncertain future etc. Some are too upset about losing their own spouse, children,near and dear ones. They often lack awareness about how to respond to the needs of the survivingchildren, and how to address their issues and concerns.Disasters can leave a child with feelings of confusion and insecurity that result in emotionalreactions. At such times children turn to adults in their life whom they are close to and whom theytrust, for support and care. It is very important that one is able to provide security in their life thatwill help them master these reactions in a healthy manner.When children experience a traumatic event, which they are unable to comprehend or copewith, they tend to behave in a manner that is not always pleasant, to the caregivers around. Forinstance, children become disruptive in class, start performing badly in school. At home they mightwet the bed, use bad language, misbehave with visitors or scream and shout at family members. Allthese can actually make those around the child angry and frustrated. At such times, one needs toremember that punishment or getting angry is not the solution. One needs to understand why thechild is behaving in such a way.The child unknowingly resorts to such behavior in order to deal with the pain and sufferingbeing experienced within them. This is their coping mechanism; they are asking and reachingout for help. They want someone to attend to them and help them cope in a moreeffective manner. At such times children need extra love and reassurance. They need to be acceptedalong with the behavior they are exhibiting. Irrespective of what one thinks of his/her behavior,one must accept the child. Rejection or punishment will enhance their pain. Reject the behaviorbut never the child.16 INFORMATION MANUAL 3: TSUNAMI PSYCHOSOCIAL CARE FOR CHILDREN

Remember that these behaviors are a response to the abnormal situation that the childrenhave experienced. It is their method of coping with that event. It is not a reflection of the characterof the child or the fault of the caregiver. Also these are not permanent changes; they can be overcome.If the child is given enough care, time and guidance, he/she can overcome these behaviorsand resume a normal manner of functioning.Keeping this in mind and as a background, this section attempts to take us through a frameworkto provide care and guidance. There are basically three things that one can do:„ Understand the emotional reactions the child is exhibiting. This will enable one tosupport him/her better.When children face any traumatic event, they have both emotional and physical reactions.These reactions and feelings are normal responses and occur in most children who face anevent that overwhelms them. Knowing this will help one understand the child better andbe more caring and comforting towards the child.„ Offer emotional support and security to the child.It is well established that talking about the event and allowing the child to share his/herexperiences and feelings decreases emotional stress. One needs to be available for thechild and create a space where the child can talk openly.„ Help the child to adopt healthy coping strategies.The child will often be confused about what can help them. One needs to facilitate therecovery process .For this, the first task is to normalize their life routines. Help them getinvolved in routine tasks like helping with household work, getting back to school andattending classes regularly, and so on. Also one needs to be available for play or ‘talktime’ where the child may want to talk or play out his/her experiences. Both these will helpthe child regain his/her original level of functioning.The school at times may be a very important source of comfort for the child’s emotionalrecovery. School going children regard the school and their teachers as very important and oftenturn to the schoolteachers for comfort, care and guidance to deal with this difficult phase of theirlife. Schools can help children to get back a sense of well being with teachers playing a verycrucial role in offering support and being a role model for them. During this time, schools may beone source, which can provide the children with a predictable routine and this in turn will developa sense of comfort and security in them.TOT INFORMATION MANUAL - 1 17

DISASTER Can lead to CONFUSION AND INSECURITYHELP THE CHILD TO RECOVER BYUnderstand EmotionalReactions and FacilitateRecoveryUnderstand his/her emotionalreactions by:l Observing changes inbehaviorl Acknowledging, acceptingand validate the changesl Monitoring progress inschoolDecrease the physical andemotional effects by:l Providing listening space tochildren.l Reassuring the childl Modeling healthy copingbehaviorFacilitate recovery by:l Normalizing life routinesl Talkingl Encouraging play and otheractivities.Create SafeClassroomsl Facilitate establishment ofa peer support system inthe class.l Enhance self esteemthrough group workl Set rules and limits forbehavior.l Help them share theirhoughts and feelingsthrough various mediumslike drawing, claymoulding, drama, gamesetc.l Help achieve competenciesthrough non-academic andacademic means.l Don’t punish if the childstarts performing badly, orbecomes disruptive inclass. Try and understandwhy this is happening.Work with Adult Caregiversl Help to normalize liferoutines.l Spend one to one qualitytime with children who needextra help.l Help caregivers understandtheir child’s reactionsl Provide tips on how theycan support their childl Ensure that basic needs ofthe child are metlTHIS WILL LEAD TOMoving from a state of confusion and insecurity towards hope and confidence.l Establishment of caring support systems in schools and homesl Enhancement of positive social and communication skillsWHICH WILL HELPl Adjustment and mastery over emotional distressl Build resilience in children18 INFORMATION MANUAL 3: TSUNAMI PSYCHOSOCIAL CARE FOR CHILDREN

UNDERSTAND EMOTIONAL REACTIONSIt is important that children are not neglected after a disaster like the tsunami. In the earliersection it was seen that even pre-school children are able to sense the feelings and emotions ofadults around them and, this in turn, makes them very vulnerable. So there is a need to keep a watchon the child and observe any changes the child is showing. For instance, a child who was quiet andreserved may become very irritable and aggressive. One needs to accept and acknowledge thischange in the child. The reaction is only to the event, so do not shout at the child for misbehaving butinstead be caring and gentle to him/her. Children spend a lot of time at school. The child’s performancemight undergo a change if he/she is disturbed. A parent should monitor child’s progress atschool. A teacher can recognize signs of distress. A teacher should make sure to inform the parentsabout any changes in the child’s behavior at school.It is important that all children are given time. Even though some may not necessarily showdefinite signs of distress, all children would have been affected to different degrees as a result of thetsunami. For children who are showing signs of distress, it is important to monitor their progress.Ensure that the children are made to understand that it is okay to feel the way they are feeling andthat it is fine for them to share their thoughts and feelings with others. This will help them talk abouttheir concerns and issues. Accept the changes in them and do not make them feel ashamed abouttheir reactions. Do not put stress on children for performance. Allow them time and space torecover slowly. This acceptance from a teacher or an adult is what is required in the recoveryprocess.Remember:ü Be warm and friendly- if the child needs reassurance or comfort, he/she should feelcomfortable to reach out to you.ü Accept the child as he/she is- a lot of the emotional reactions may tend to irritateadults. Remember he/she is disturbed after the event and one should be understandingand give the child all the space for expression.ü Avoid flooding the child with advice- one needs to give the child space and not try toimpose one’s ideas of how to behave or to be. Listen to the child’s view and feelings.ü Respect the child-however young the child may be respect his/her views and emotions.Do not stop the child from expressing him/herself.ü Be there- give both time and attention.TOT INFORMATION MANUAL - 1 19

DECREASE THE PHYSICAL AND EMOTIONAL EFFECTS THROUGH SUPPORTIn helping the child to share his/her experiences and feelings about the whole event, allowhim/her the space and security to feel accepted and be cared for. Once the child feels secure andthere is a comfort situation around, he/she will be able to share thoughts and feelings. It is veryimportant that we listen and try to understand the child’s perspective.Be there when the child wants to talk; do not push the child. The child may not talk at allbut may find it comforting to know that there is somebody who cares.You need to:ü Convince the child it is normal to think about the traumatic event.ü Share some of your feelings and thoughts about the event.ü Use child-friendly language and explanations.ü Tell him/her to come and talk about it anytime.ü Listen and provide answers to questions (even if they are very painful) while beingreassuring all the while.ü In case there are no adequate explanations, tell the child that you too are confused andupset by it.ü A child sometimes takes on responsibility or feelings of guilt for the event, leading tovery destructive and inappropriate behavior. This should be checked and correctedimmediately.ü Be honest, open and clear.ü Do not avoid the topic when the child brings it up.Understand what the child feels about death, and his /her fears about it etc. This willhelp you to communicate with him/her in a meaningful fashion.Talking helpsTalking about the event helps the child accept it and cope with the losses that follow. Talking,especially with older children, will be more useful since it could help to clarify thoughts and removemisconceptions that may be confined within themselves.It is important to give factual information to the child. If not, he/she will ‘fill in’ the details,which very often could be inaccurate. Just being available and reassuring the child, helps restore agreat sense of safety and security.20 INFORMATION MANUAL 3: TSUNAMI PSYCHOSOCIAL CARE FOR CHILDREN

Reassure the childChildren need a lot of comfort and a feeling of security. Hold the child close if the child iscrying. If the child wakes up at night, be there to comfort him/her. In school the child may be feelingleft out, support him/her during that time. All these will help the child feel cared for. If the childcomes and sits close or clings to you, do not forcibly move him/her away. Allow the child to be nearyou if that brings him/her comfort. Pat the child once in a while and hold him/her close to show youraffection.Model healthy coping behaviorChildren will look up to adults to learn how to cope with these incidents/events. So oneneeds to model a healthy coping behavior in how one is leading one’s life and trying to return tonormalcy.Make sure that as an adult you:§ Follow regular sleep times§ Eat well§ Remain calm and happy§ Take interest in activities at home or outside§ Do not consume any alcohol or other addictive substances§ Exercise regularly§ Spend time in recreational activitiesAn adult’s lifestyle enables the child also to pick up healthy coping strategies. The child willrealize that the adult has normalized his/her life and will be motivated to do the same.FACILITATE RECOVERYSet up life routinesAs an adult one needs to help the child normalize his/her life. Children find it very comfortingto have routines in their lives. If these routines are disturbed, they too get disturbed. The first stepthat one can take to help the child to recover from the trauma is to re-establish life routines. Thiswould mean ensuring that children:§ Have their meals on time§ Go to bed at a particular time at night§ Re-start their schooling if they are of a school going age§ Get involved in helping with household work or sewing activities§ Spend time together as a family§ Spend time playing and having some fun daily§ Have some time to share whatever they might be thinking or feelingTOT INFORMATION MANUAL - 1 21

All these will help get their mind off from the experience they have been through during andafter the tsunami and start looking positively at their future.Play in the life of a childChildren use play to express themselves. Play is an extremely crucial communication tool forchildren. It serves the same purpose as talking is for adults. Selected toys and materials can helpchildren act out feelings and fears as have been experienced. Children not only express themselvesbut also learn a lot of new things while playing. When children play and /or draw, a lot of theirfrustrations, fears, tension, anger and insecurities are expressed. This helps them face the emotionsand decrease the power these emotions have on them.During a drawing session in a camp, a 15-year-old girl drew a village with a school, primaryhealth centers, houses etc. When she was asked about her feelings, she said that she was missingschool badly and that her school was very good. It had a wonderful library. She also expressed herworry that she might not be allowed to take exams as she has lost her mark sheets in the tsunami.This clearly indicates that children use play as medium to express whatever is going on within them.It helps them to bring out their concerns and worries.An overview of how play and other activities help childrenTo gain mastery over eventsPlay helps children express their feelings andemotions. This release helps children feellighter. Repeated expressions also lightenthe power negative emotions have overchildren’s lives and help them move forward.Develop self-esteemOpportunities to present their creations, talkabout themselves, get praised by others fortheir work or behavior, make new friendsetc., help the children feel good.In development of understandingChildren can change their way of thinking,modify their behavior or learn new healthyways of interacting, behaving, or coping byreacting to concepts presented through stories,listening and observing other children.In skill developmentWhile interacting and playing, the childrenlearn to take turns, share things, play by therules, learn to talk in a group, make friends,etc. These skills are developed during theprocess of play.CREATE SAFE CLASSROOMSStarting the normal school routine is the best way to help the children to get a sense that all iswell. The school provides structure, stability, and predictability through routines. Consistent rulesprovide order and give a sense of security to the children. It keeps them meaningfully occupied and22 INFORMATION MANUAL 3: TSUNAMI PSYCHOSOCIAL CARE FOR CHILDREN

they get a sense of self worth as they learn and accomplish academic and non-academic tasks. Itmay often be the only place where the children receive attention and care, as life at home remainsdisrupted.Provide space for sharing thoughts and feelings. Be available and listen to the child so that he/she feels heard and understood. The atmosphere in the school should make children feel wanted,accepted and loved.Through group activities, children can begin to understand that there are many others likethem. This is a great feeling and will help them to feel less alienated. They can learn a lot of positivebehaviors in the group. Group bonding develops. The classroom becomes a source of support forthem and they pick up valuable coping skills from other children and are able to reach out to othersin need.Take time from the curriculum to do specific group work with the class to assist the childrentowards recovery. Activities in the classroom can be directed at helping them to share their concernsand feelings about the event and building up coping skills. Documenting the process of eachactivity and how the child reacted is important as it provides great insight into how the child is feelingand coping. The classroom can then be an environment where the child feels cared for, loved andsecured.You may need to:§ Set ground rules to enable the classroom to be safe space for children§ Give time to the group for sharing personal issues§ Facilitate listening and sharing through various mediums and activities in the class§ Try to find time for one-one interactions where the child can spend time exclusivelywith you§ Give attention to all children§ Praise and acknowledge children for small things that they accomplishRemember the following in a class:ü Some reactions in the child as a result of disaster may prevent him/her from fully participating in academic work. Hence, one needs to be understanding and give time.ü Each child is unique. Some children may recover quickly and some may take longer.Avoid comparisons in class.ü Some children may show immediate reactions others may show it weeks later. Hence,allow space for them.ü Be patient while managing children displaying disruptive and aggressive behavior. Oneneeds to understand why his is happening.ü Take care of yourself so that you do not get strained and stressed out as a result ofhandling the class.TOT INFORMATION MANUAL - 1 23

WORK WITH ADULT CAREGIVERSIt is important that the adults who are taking care of the children at home are able to understandwhy the child maybe demonstrating certain changes in behaviour. They need to be aware thatthese changes are not permanent but are only signs of distress that will get better as time passes by.They need to understand how to handle children at this stage, how to be a source of support tothem. Hence, inform caregivers about the reactions that a child can exhibit after a disaster andprovide them tips as to how to handle such reactions.Remember:ü Help the adult caregivers understand their childrenü Keep communication between the home and school openü Make sure that the basic needs of the child are being metü Make sure that the child has at least one caring adult at home who is there to listen,give attention, love and reassure the childAll these interventions help children to help develop their resilience. Resilience is simply definedas the ability of a person to recover from adverse circumstances and continue his/her lifeprocesses. Basically resilience has three sources and our work with children should help them tobuild the three sources.Firstly, children need to slowly develop trusting relationships with adults who accept them,care for them and love them despite how they behave or feel. They are the people who guide themon how to do the right things, help them reestablish their routines and provide for their basic needs.Secondly, children need to slowly take on little tasks both at school and at home and haveothers compliment and praise them for their achievements. This helps them to develop a sense ofself worth and gives faith in their abilities to do things on their own.Lastly, children need to share their feelings and be supported through their pain andconfusion. In the process, they learn how to identify and manage their emotions, and pick up theappropriate ways to deal with situations from adults. They learn to find solutions to issues that are ofconcern to them. All these help in developing resilience in the child. The table below gives an idea24 INFORMATION MANUAL 3: TSUNAMI PSYCHOSOCIAL CARE FOR CHILDREN

Preschoolers· Follow regular routines for the child· Avoid unnecessary separations· Encourage expression regarding losses(i.e., deaths, pets, toys)· Avoid too much exposure to informationor talking about the event· Encourage expression through playactivities.· Provide verbal reassurance and physicalcomforting· Give frequent attention to the child· Take care of basic needs like food,water etc.· Allow the child to sleep close to youScholars· Give additional attention to the child· Relax rules and expectations from themat home and school· Set gentle but firm limits and rules· Provide structured but undemandingtasks and responsibilities to keep themoccupied· Encourage play, which can help childrenexpress their feelings and emotions· Listen to the child’s repeated retelling ofthe disaster event· Involve the child in preparation of familyemergency kit· Rehearse safety measures as apreparation for future disastersAdolescents· Give additional attention.· Temporarily relax expectations of performance at home and school.· Share your own feelings with them and help them understand that it is okay to feelvulnerable and seek help.· Encourage physical activities.· Rehearse family safety measures as a part of preparation for future disasters.· Encourage social activities.· Hold group discussions towards rehearsing appropriate behavior for future disasters.· Give some undemanding responsibilities.· Encourage participation in community rehabilitation work.Encourage but do not insist upon discussion of fears and insecurities within the family orfriends.TOT INFORMATION MANUAL - 1 25

GUIDANCE NOTES FOR ADULTS ON HOW TO HELP CHILDREN:TeacherslllllllllllllllReassure children that they are safe at school.Provide opportunities for the students to talk about their fears.Share how various people are coping and overcoming this event.Do school projects to reach out to the larger community.Do not stress too much on performance and academic achievement of children immediately after the disaster.Let children and adolescents know that it is normal to feel upset after something badhappens and allow them to cry and express their feelings.Reassure children that the event was not because of their fault.Do not criticize regressive behaviors that children might display.Praise and positively reinforce all good behaviors and initiatives taken by children.Hold sessions to help children build resilience through planned activities.Use play, art and other creative mediums along with discussions to reach out tochildren.Encourage children to develop coping and problem-solving skills to handle anxiety.Meet adult caregivers and guide them on how to support their children.Be honest about what happened and provide the children with accurate informationabout the facts so that they are not confused.Identify children who need extra help to cope and refer them to a specialist.CaregiversllllBe open and available so that child can approach and talk with you if he/she feels like.Use family times like having meals to share how everyone is feeling.Keep the children with you and do not send them away to live elsewhere.Spend extra time with the children. Give them more hugs, attention and care.26 INFORMATION MANUAL 3: TSUNAMI PSYCHOSOCIAL CARE FOR CHILDREN

lllllllllMake sure that the children are eating well, sleeping on time and keeping occupiedduring the day.Do not repeatedly talk or see pictures of the event as these enhance their sense ofinsecurity.Answer their questions correctly stating facts, as inaccurate information will make themfeel confused and anxious.Share your own feelings about the event.Tolerate mood and behavioral changes in the child.Reinforce family, community, religious support and other support systems.Listen to the children and ease their worries. Clarify misunderstandings, which theymay have.Model good coping behavior by following self-care and by avoiding negativebehaviors like arguments, smoking and drinking. Children tend to be easily influencedby what adults around them say and do.If you live in an area that is prone to these types of natural disasters, make a plan withyour child about what to do to be prepared for these events.TOT INFORMATION MANUAL - 1 27

ILLUSTRATIONS FROM THE FIELDIllustration one*15-year-old Usha was taking a bath when the tsunami struck their village. She was nakedand stuck inside the bathroom. Before Usha could do anything, the sea waves gushed inside thebathroom, breaking the walls. She could see water level rising. To save herself, she caught hold ofa pipe in the bathroom and hung on for safety. She was noticed by a man from her locality and wasrescued. He provided her his shirt to cover up herself as she didn’t have any clothes on her. Everyonein the village came to know about this incident. After this, Usha was very disturbed. She wasunable to sleep or eat properly. She was very embarrassed and stopped going out of the house. Shewould hardly talk to others and even if she talked at all, it would be through her mother. She alsostopped going to school.Day 1The first day the CLW made a homevisit, and introduced herself to Usha’s mother. The CLWdid not make any efforts to meet Usha on the first day. The interaction with the CLW and Usha’smother was as follows:CLW: You must be going through a low phase as you have undergone a difficultsituation and lost your house. It must have been difficult for you people to build up thistemporary shetler.Mother: I don’t know why this happened to us. I have never seen such a picture of thesea since my childhood. Our house got washed away. Usha’s father does not go for fishingnowadays. He has started taking more amounts of alcohol since the tsunami. I am finding itdifficult to run the house.CLW: How do you feel now a days?Mother: I feel very tired and upset. I do not feel like doing any work. I don’t get propersleep. I don’t even feel like cooking as Usha refuses to eat. There is no point in cooking.CLW: Why does Usha refuse te eat?Mother: On the day of tsunami, Usha was there in the bathroom when the sea wavesrushed in. She did not have a piece of cloth on her body. One man from our locality saved her.The wholevillage knows about it and she is very embarrassed . She does not go out and does noteat or sleep properly.28 INFORMATION MANUAL 3: TSUNAMI PSYCHOSOCIAL CARE FOR CHILDREN

CLW: How do you feel about the incident?Mother: I am worried about Usha and want her to be alright.CLW: You can talk to her about how she feels, and what her fears are. That might helpher to feel little better. You can assign small household responsibilities so that she does notalways keep thinking about the incident. Do you go out and talk to other women?Mother: No I don’t go out nowadays as I am sad and upset .CLW: Try taking proper care of yourself. Seeing you, Usha might also get inspiration.Atleast during some part of the day, do things which you like.Mother: I will try to.The CLW ended the session at that point instead of trying to persue the topic further for theday. She did not insist the mother to allow her to meet Usha. The cultural issues should be taken intoconsideration while working in the field. In such sensitive issues, it is advisable that a female CLWshould be available for a female child.Day 2The CLW went to Usha’s house. The mother welcomed the CLW and without the CLWsaying anything, the mother took her to Usha’s room. They found Usha sitting quietly, with her facedown. She looked very distressed. The CLW went and sat beside her. Usha started sobbing. TheCLW held her hands. She started sobbing all the more. Usha cried for a long time. The CLW satbeside her, patted her head and just told her that she understood how she must be feeling. Usha didnot speak a word, but after crying she looked more relaxed. The CLW kept pace with her and didnot pressurize Usha into talking. The CLW used non-verbal communication, mostly touch, to buildrapport with Usha. The CLW told Usha before leaving that she would come again the next day.Day 3The CLW went to Usha’s house at the scheduled time. Usha looked upset and sad.However, she asked the CLW to sit. The CLW started the conversation with a very neutral topic.Here is a part of the interaction that the CLW had with Usha.CLW: Which class do you study in?Child: I was in class IX. But nowadays I do not go to school.CLW: You don’t like going to school?Child: I like but… (The child starts sobbing)CLW: Is there anything that is bothering you?TOT INFORMATION MANUAL - 1 29

Child: I did not know what was happening. I was taking a bath. I suddenly saw seawaves gushing in. I caught hold of the pipe on the roof and kept hanging from there. I was soscared. I did not have a piece of cloth on my body! A neighbor came and rescued me. He hasseen me naked. The entire village knows about this. How can I get out of my house? I feel soashamed and upset.CLW: I understand what you must be going through. But I guess you were strongenough to get hold of the pipe and save yourself. Not everyone could have done that. Yourparents must be happy that you are alive.Child: Yes they are. They have never told me anything about it. But I still feel bad about it…CLW: What do you think will make you feel good? Do you feel that staying at home allday will help you?Child: No it is not making me feel good.The CLW found out about Usha’s interests and the things that she was good at. Usha talkedabout her interests with lot of enthusiasm. The CLW reinforced the positive qualities that Usha had.Usha looked much better after being able to ventilate her feelings to the CLW.The CLW met Usha regularly and spent some time with her. Usha gradually started recoveringfrom the trauma. She started following a routine. Her sleeping habits and appetite improved.Usha soon got the motivation to do something constructive. After discussing with Usha, the CLWengaged her in the survey work. In ten days time, Usha started coming out of her house and helpedthe CLW with filling up forms, counting number of houses affected etc. At home as well, she starteddoing certain tasks like helping around with the household chores, etc. After around twenty days,Usha started going to school and she is doing well now.ILLUSTRATION TWO* 9-year-old Manoj lost his home in the tsunami. His father who is a fisherman stoppedgoing for work after the tsunami. Manoj started coming to school late. He looked withdrawn,inattentive and did not concentrate on what was being taught in the class. Initially the class teacherdid not pay much attention to the fact that Manoj was coming late but after a week she realized thatManoj was coming late to school everyday. On asking him the reason, Manoj kept quiet. With thischild, the use of a medium helped the teacher to gain an insight into his problems.The teacher asked Manoj to draw the members of his family. The teacher assured Manojthat it did not matter if the picture was not perfect. The teacher showed Manoj the stick figures asin Picture 14 (page ) and told him that he could represent his family members like that. Manoj drewhimself as a sad person. He drew both his father and mother as angry. On asking him why he wassad in the picture, Manoj started ventilating. He said that their house got destroyed in the tsunami.His father has stopped going for work since then and had started drinking a lot of alcohol recently.30 INFORMATION MANUAL 3: TSUNAMI PSYCHOSOCIAL CARE FOR CHILDREN

The mother remains upset with the father because of this. The parents keep fighting over this issue,and scream and abuse each other at night. Manoj was unable to sleep at night because of this. Onlyin the early hours of the mornings, he is finally able to get some sleep and hence he is unable to getup early. As a result he comes late to school. After listening to Manoj, the teacher could empathizewith the child. The teacher asked Manoj’s father to come and meet him. Manoj’s father came andmet the teacher after two days. The teacher talked to the father about Manoj and informed himabout what the child is going through. In a week’s time, Manoj started coming to school on time.Now he is attentive in the class, plays with other children. On asking him about how everyone in thefamily is, he says that his father is all right now and the parents no longer fight as they were doingearlier.In this case, the use of a medium helped the child to ventilate his emotions and helped theteacher to have a better understanding of the child’s problems. Working with the caregiver wasimportant in this case as the well being of the child was directly related to them.ILLUSTRATION THREE* 16-year-old Chandrika lost one of her very close friends in the tsunami. She had beenfrom a nearby village. Since then Chandrika has been unable to sleep or eat properly. At night shehas nightmares and screams “Water, water, run, run”. She feels tired and fatigued all the time. Shekeeps thinking about her friend all the time. She refuses to go to school. The mother is unable tounderstand why Chandrika has been behaving this way. Often the mother gets angry with her fornot eating properly or not doing any work and scolds her.The CLW made a visit to Chandrika’s place. She looked very disturbed. The CLW askedher how she feels nowadays. Chandrika started talking about her friend whom she lost in thetsunami. She said that Sunanda had been a very good friend and they had been really close. The seahad taken her away and she finds it very difficult to forget her. Chandrika said that she was unableto concentrate on anything and keeps thinking and dreaming about Sunanda all the time. She wasalso unable to sleep properly. The CLW was empathetic towards Chandrika, and held her hands asshe cried. The CLW told Chandrika that it was natural for her to feel bad for her friend who she hadlost and who had been very close to her. The CLW talked to the mother about the reactions that thechild was exhibiting as a result of the trauma so that she was able to get a better understanding ofwhat the child was going through and provide her support. This helped the mother to understandChandrika better. Subsequently, she stopped scolding Chandrika and instead tried to understandher. The CLW asked Chandrika to write about the positive qualities that her friend had and thegood times they spent together. This was to reinforce a happy memory of her friend even after theloss. The CLW has also asked Chandrika to pen down her feelings in a diary. There has been a littleimprovement in Chandrika and her eating habits are normal now.TOT INFORMATION MANUAL - 1 31

What follow up is required:§ Meet the child everyday to help her ventilate her feelings at least for one more week andthen gradually space out the sessions depending on the improvement the child is showing.§ Encourage her to talk about the loss. Ask her to draw best memory pictures of her friend.§ Help her to finish unfinished tasks. For example, if she wanted to tell something to herfriend, ask her to write down in a paper.§ Interact with adult caregivers in her family to reinforce the support and care they havebeen giving the child.§ Encourage the child to pray and see how the prayers work for her in terms of giving herstrength.§ Help her to follow a regular routine. Incase she is able to accomplish small tasks, appreciate the effort and encourage her.§ Encourage the child to go to school, play with peers. If there is a need, make school visitso that the teacher has an understanding as to what the child is going through and can besupportive to the child.ILLUSTRATION FOUR* 7-year-old Mani lost her house in the tsunami. During a session in the camp where shewas staying in, the children were given a drawing activity. Mani kept quiet and refused to drawanything. The use of a medium may not work instantly with some children as in Mani’s case. TheCLW needs to be proactive and innovative to reach out to the child in a different way.In this case, the CLW took the drawing sheet from Mani and drew houses, boats and seawaves. At this Mani became very angry. She picked up a crayon and put a big cross on the paperand said that she had enough and she does not want to hear or do anything about the tsunami. Thishelped the CLW understand that the child was disturbed though she was unable to express herfeelings initially.What follow up is required:§ Encourage the child to talk more about the event. Other mediums can be tried to help thechild ventilate her fears, and her insecurities.§ Work with the caregivers so that they are able to provide support to the child. They mightneed to spend some quality time with the child. May be once in a while they need to hugthe child and pat her.§ Play fun games and games that help in instilling hope.32 INFORMATION MANUAL 3: TSUNAMI PSYCHOSOCIAL CARE FOR CHILDREN

SPECIAL CHILDRENIt is now a well-recognized and accepted fact that children are vulnerable and need attention when they have experienced some traumatic event in their lives. They look to adultsfor support and care and adults need to be available for children in a manner that childrencan relate to them and master the negative effects that the event would have had on their lives. Allchildren need help to recover. However, there are some groups of children who require specialattention, and even greater care and support to overcome the trauma. This chapter will look atsome of these groups of children.ORPHANED CHILDREN§ The child needs to be with relatives who can look after him/her. If needed, foster care canbe mobilized for the child. Integration with the new family members is very important forthe child. There can be adjustment issues with cousins or the relatives. Incase the situationdemands it; the CLW has to intervene for mutual acceptance of the child by the relativesand the relatives by the child.§ The child needs to find space to share the pain about the loss of parents with the peoplearound him/her. The CLW needs to build up the social support system for the child.§ Encourage the child to remember the death anniversaries, talk about the good times he/she had with his/her parents and so on.§ He/she should be encouraged to talk about the loss but at the same time the child shouldbe helped so that he can learn to relate to new people in his/her life.§ The child needs to be helped so that he can relate to the new environment and accept theloss of familiar environment.§ Listening and being available is very important.§ There can be changes in roles that the child had been playing. Earlier the child had a safeand secure environment. However the loss of the parents threatens his/her whole world.He/she might have to fulfill the role of a parent for his/her younger sibling. He/she mighthave to perform the role of a bread winner. The child might be stressed out. A CLWworker will need to work with the child to help to relieve his/her stress.§ There can be school dropouts. A CLW worker needs to work with these children andinform the relatives about the available provisions like Rajiv Gandhi Foundation for thechild’s education.§ Help the child to normalize by encouraging him/her to follow a routine, going to school,mix with peers and to step out to play.TOT INFORMATION MANUAL - 1 33

* 5-year-old boy Krishna is a 5-year-old boy. He lost his father about a year ago due tosome illness. He has a younger brother who is two and half years old and an elder brother who iseighteen years old. Prior to the tsunami, Krishna had been staying with his mother and youngerbrother. The elder brother who is very irresponsible was hardly there with the family. Krishna’smother used to sell fish to run the family. On the day of the disaster, Krishna and his brother hadbeen playing with two other children from their locality while their mother had gone to the seashoreto collect fish. The two children were saved by the neighbours when the waves struck the village.However Krishna’s mother was swept away by the sea. For five days Krishna’s mother was missing.On the sixth day, her body was found and Krishna was informed about his mother’s death.Currently, Krishna and his brother stay in a house where seven other families are staying after thedisaster. Krishna has become very restless since the disaster. He would always run around, pull andpush others, snatch things from peers. The workers in the Balwadi find it difficult to manage him. Heis also over familiar with strangers and keeps trying to attract their attention. If anyone asks himabout his mother, he bluntly retorts that she is dead. Krishna’s two and a half year old brother hasdisturbed sleep and someone has to hold him close so that he gets sleep.When the CLW visited the place where Krishna was staying, he was found running around ina jolly mood. He was quite friendly with the CLW. The CLW gave him a paper and a pencil todraw. Though restless, he took 4-5 pages and made some scratches on them, one after the other.On asking him what he had drawn, he said that the first picture was that of the tsunami and theconsecutive four drawings he made were that of boats. Then CLW made the face of a woman andshowed it to Krishna. He remained quiet for some time and then remarked that the picture lookedlike that of his mother.* 8-year-old boy Vijayan lost both his parents in the tsunami. Vijayan was put in an Orphanage.However, after few days Vijayan returned to the village from the orphanage and started livingon his own. He would at times stay with his uncle and aunt, or at a neighbor’s place. He would eatfood given by the people from the locality. At times he would not eat at all. After leaving the orphanage,he attended school for two days. He stopped going to school after that. Due to his continuousabsence, the teacher visited his place. At that time Vijayan was not at home. On hearing that theteacher had come to meet him, he went to school. He told the teacher that he did not want to liveanymore, and that he had left the orphanage as he had not been given proper food and had oftenbeen scolded badly. Vijayan now comes to the school. However, he sits alone most of the time.When he mixes with other children in his group, he tends to disturb them. While playing cricket, heinsists that he will only bat. He comes to school, collects the food packets provided in the schooland often walks out of the class. Vijayan does not have any permanent caregiver now.* 15-year-old girl Kavita lost both her parents in the tsunami. She now lives with heruncle’s family. She remains upset most of the time. When the CLW visited her, she was quiet andrefused to talk. She looked distressed and helpless. The CLW drew the picture of a lady andshowed it to her. This acted as a stimulus. Kavita started weeping and then she disclosed that she34 INFORMATION MANUAL 3: TSUNAMI PSYCHOSOCIAL CARE FOR CHILDREN

had lost her mother in the tsunami, and she misses her and that she is upset about losing her parents.After ventilating her feelings, she looked much relaxed.CHILDREN WHO HAVE BECOME SINGLE PARENT§ The child might find it difficult to cope with the loss of a parent. The surviving parent mightfind it difficult to address the emotional needs of the child as he/she will himself/herself beupset with the loss of the spouse. The CLW can help the child express his/her feelings.Encourage the child to talk about the good times that he/she shared with his/her parentwhen he/she was alive.§ The CLW might need to work with the surviving parent so that the parent is empoweredto take care of the child.§ The CLW needs to help the child to adapt to a new family structure.§ Help the child to normalize by encouraging him/her to follow a routine, going to school,mix with peers and to step out to play.* 16-year-old boy Selvam and his father had been to the sea for fishing on the day when thetsunami struck their village. On their return, they found that everything had been destroyed near theseashore. Selvam found that his house was washed away. He found his younger brother and sisterin a camp. After one day, the dead body of Selvam’s mother was found. Selvam’s father has startedtaking increased amounts of alcohol. The father does not do any work. Selvam has to take theentire responsibility of looking after his younger siblings, cooking, getting compensations etc. He isvery distressed. He says that he is aware of what death is but he is only worried about the twosiblings who are still too young. He feels a lot for his father but is unable to help him. He says thatearlier he was a very easygoing person but since the tsunami, life has changed for him. He feelsconfused at times and wonders how he will be able to fulfill so many responsibilities.CHILDREN WHOSE PARENTS HAVE REMARRIED§ Children who have a new parent to adjust with, will find this change threatening. Hence,they need to be reassured.§ Some time and space has to be given for natural bonding.§ It is important to ensure that the child has some quality time with the parent alone so thathe/she does not reject the new parent.§ Ensure that the basic needs of the child are being met.§ Be available to talk and discuss their fears and apprehensions when they need.§ The CLW might have to intervene incase the child is being neglected.TOT INFORMATION MANUAL - 1 35

* 11-year-old girl Lilly lost her mother in the tsunami. Lilly has another younger sister whois five years old. Lilly had been regular in her attendance to school even after the tsunami, howevershe suddenly stopped going to school. The teacher made a home visit and found that Lilly’s fatherhad remarried few days earlier. As the teacher had made a home visit, Lilly started attending schoolagain. However, she does not talk to anybody in the class, is very inattentive. She does not look atthe black board while the teacher is teaching and keeps staring out of the window.CHILDREN WHO HAVE BEEN DISABLED OR INJURED§ The child may require regular medical check ups so as to enable him/her get a level ofindependence.§ The child has to be provided space to discuss the difficulty of breaking/losing a limb, orgetting bruises. He/she may need to discuss his/her anger, frustrations and depressionregarding the same.§ Listening, being available and empathizing with the child is very important.§ Help the child normalize his/her life.CHILDREN WHO HAVE BEEN ABUSED§ After a disaster, the situation can be very chaotic. People are forced to take shelter incamps where there is lack of privacy. Children, especially girls, are vulnerable to sexualabuse. Besides sexual abuse, there can be emotional, verbal and physical abuse also.§ Abused children need special attention. They may refuse to talk about their distress. Incaseof sexual abuse, they may have guilt feelings and consider themselves responsible forwhatever that happened. What adds to the stress is the fact that, as in most cases, theabuser was a known person. Because of social sanction, parents often discourage theabused child to talk about the issue making it all the more difficult for the child to cope.The child needs to be given a space to ventilate his/her feelings. The CLW should not bejudgmental but should accept the child.§ Incase there is chance of further abuse, it is necessary to shift the child out to a safer place.§ Help the child to talk about neutral things like what he/she likes, focus on the positivequalities that he or she has and help him/her work through the trauma.§ Help him/her normalize his/ her life by making him/her follow a regular routine.* 15-year-old girl Savitha lost her home in the tsunami and hence came along with herparents to stay in the camp. In the camp, during night Savitha was sexually abused by a boy elder toher from36 INFORMATION MANUAL 3: TSUNAMI PSYCHOSOCIAL CARE FOR CHILDREN

her locality. She was unable to tell it to anyone and remained quiet. She was distressed. Shecould not sleep and she was unable to eat properly. After three days, she told the CLW about theincident. She said that she was more affected by this event rather than the tsunami. She felt betterafter ventilating her pent-up feelings in front of the CLW.CHILDREN WHO ARE CHALLENGED§ Mentally or physically challenged children would have also experienced anxiety and shockduring the tsunami.§ Reassurance and extending a feeling of security are important in such cases.§ Efforts to be made to normalize their life routines.§ Referral to specialist may be required for some.In some instances a child may require the help of a specialist and each caregiver needs to beaware and alert to the need for such help.Referral is required if:F No sign of any reduction in the reactions.F Increase in severity.F It is distressing to the family/the child.F Interferes with the daily routine of the child.F Interferes with interaction with others like friends and relatives.F Interrupts work or school.As an adult caregiver, one need to take the child to a specialist, follow up on the advice givenboth at school and home. Discuss the progress periodically with the specialists. The table givenbelow describes some of the symptoms that may require referral.BEHAVIOR FOR WHICH REFERRAL MAY BE REQUIREDConduct problems§ Disobeys people§ Violent towards peers§ Steals or liesHyperactive§ Unable to sit still even for a short time§ Daydreams and has difficulty in concentrating§ Engages in impulsive behavior and activities thatare dangerous like climbing and running on thestreets§ Becomes over-excited in large groups§ Low tolerance for frustration§ Learning difficulties§ Destroys thingsTOT INFORMATION MANUAL - 1 37

Somatisation§ Complains of aches and pains§ Difficulties in bodily functions like breathing,increased heart beat, giddiness§ Wants to go to the doctor, but doctor finds nomedical problems§ Complaints interfere with daily activities likeschool, studies and so on§ Gets attention from others due to thesecomplaintsSeverely depressed§ Feels sad all the time§ Cries a lot§ Refuses to play§ Has no interest in games§ Body posture is limp and eyes lack lustre§ Does not eat well and gets thinner§ Tired all day and wants to keep lying down orbe by himself§ Unable to sleep at night.§ Talks of ending his /her life.§ Feels helpless, worthless and hopeless.Post-traumatic stress disorder§ Re-experiences the tsunami through nightmares,thinking about it in the day, having flashbacks§ Avoids anything that will remind him of thetsunami§ Increased state of alertness, nervousness,startled response, poor concentration, disturbedsleep§ Distant from friends and family and does not enjoy activitiesSubstance abuse§ Admits to taking alcohol or drugs or gutkha(tobacco leaves)§ Smells of these substances§ Moves between extreme restlessness tolethargy§ Unable to sleep§ Slurred speech and inability to communicateclearly§ Declined performance in school or other workthey used to do.§ Overspending or claims to misplace money.§ Indiscriminate sexual behavior.Timely referral is important to prevent illness from setting in. It is important that in the care ofchildren, all the caregivers contribute to the process of helping the child recover fully. The diagrambelow depicts the simple things that each person can do for the child.38 INFORMATION MANUAL 3: TSUNAMI PSYCHOSOCIAL CARE FOR CHILDREN

Role of Different CaregiversSCHOOL TEACHERSPARENTS/RELATIVESBe available, listen and talk to themHug and hold them closeHelp to re-establish life routinesHelp in meeting their basic needsEnsure that they have playtimeInvolve them in small household workKeep a watch on their behaviourMonitor their schoolworkSeek support of people, school or otheragenciesEnhance self esteem through group workDo not ridicule the child for regressive behavioursHelp the child to talk about the issueGive extra attention to new children in yourclass; make them comfortableMonitor the academic progressKeep interacting with the familyEnhance the self-esteem of the childAppreciate and accept the childDo not scold or punish the child if he/she isunable to concentrate or perform.CHILDTOT INFORMATION MANUAL - 1 39

This chapter looks at how we can create an environment for children where they feelsafe and comfortable. It can be a space where children can slowly learn to feel goodabout themselves and their lives. The activities carried out can provide the children ameans to share their concerns. Through play and group work, children can pick up skills and builda support system that will give them a sense of security and well being.This chapter will help one to make choices about which activity to use for work with children.It will help one to understand which medium will work best with which age group. Moreover,it will assist one in making a better choice while selecting an activity to use for a specific purpose inmind. The relevant worksheets to be used are included in the manual and reference has been madethrough page numbers. The section also contains a list of items that would be required to make aplay kit for working with children.UTILITY OF PLAY AND GROUP WORK WITH CHILDRENPlay is the natural language of the child. They engage in play very comfortably and are familiarwith it. Children use play to express themselves through various activities –art, stories, modelingetc. For some children, it maybe the tool they use to convey emotions that they are either unwillingto share or do not have the sufficient ability to express verbally. As they engage in play, their negativeexperiences and emotions like frustrations, fears, tension, anger and insecurities associated withthe event are brought out and the intensity of those emotions lessens through repeated expressions.This enables the child to look beyond the issues and move forward in life.¨CONDUCTING ACTIVITIES WITHCHILDRENGiven below are the four ways in which play and group work help children:Children gain mastery over issues and get a sense of powerIn a caring and safe environment, children learn how to express their emotions and how tocontrol disruptive behaviors and feelings. They are able to create, protect and destroy during playwithout harming anyone and this gives them a sense of control, which they may not have in real life.The negative emotions associated with painful events are brought out and the intensity of thoseemotions lessens through repeated expression. In this way the children can overcome the negativeemotions and are able to move forward in life.The following page has a list of activities that can be used to help children overcome theeffects of the disaster. Details about the activities can be found at the end of the manual along withthe relevant worksheets and material required to facilitate these activities.40 INFORMATION MANUAL 3: TSUNAMI PSYCHOSOCIAL CARE FOR CHILDREN

ACTIVITIES THAT CAN BE USED TO HELP CHILDRENTO GAIN MASTERY OVER THE EVENTS.No.ActivityCan be used to1. Facial expressions Get an idea about how the child is feeling that day ormaybe about an issue2. Feelings factory Help the child understand that it is okay to share thefeeling when he/she is upset or confused3. Deal with your anger When the child is feeling angry about something4. Before and after outlines Help the child understand that some things and time willhelp him/her feel better and also provides a place forthem to talk about what is bothering them5. Body mapping Help the child understand that both good and badfeelings come up and we can deal with them6. Which mood Understand how the child is feeling and what helps him/her to feel better7. What are you scared of ? Understand that all of us feel scared and how we candeal with those fears8. Candle talk Talk about the loss of a loved person and how we needto live beyond that loss9. Group creation Create a feeling of belonging, and sharing among thegroup about how they all feel10. The ‘Bhaloo’ inside Understand that at times we act badly because we storea feeling inside and need to talk about that hurt or fearor anger11. How are you today? Talk about their present feelings and deal with that12. Best Memory picture Understand that memories will always remain and helpthem to share their loss and griefTOT INFORMATION MANUAL - 1 41

¨ Children develop self-esteem and self-confidenceBeing involved in activities like drawing or clay modeling help children tremendously. Theyare able to create visual expressions of their feelings and emotions and hence find it easier toexpress themselves through this medium. Appreciation for their work or behavior enables them tofeel good about themselves. The process of creation is healing in itself and when they getrecognition from others, they feel happy. During play and group work, they make new friends.Acceptance in the group helps them realize their self worth. Through these small achievements, thechild learns to identify positive qualities in himself/herself, which enhances his/her self-esteem.The activities given below will help the children discover the positive things about their livesand themselves, and all of these would add to their feeling of security and feeling good. Includingthese activities periodically in working with children can be of immense help.ACTIVITIES THAT CAN BE USED TO HELP CHILDRENFEEL GOOD ABOUT THEMSELVESS.No.ActivityCan be used to1. Whom can I trust? Help children rediscover their support systems also, youcan get an insight into whether they have caring adults intheir lives2. Sentence completion The child will get a focus on him/herself and a chance tospeak about it. It can also be used for sharing deeperfeelings3. Getting to know you Getting the child to be comfortable to talk and be in agroup4. My family drawing Understand how the child perceives his/her familymembers5. People who love me Child feels good about the warmth or love received. Incase a child does not have someone, he/she can writeabout the need to facilitate the love network6. Feel-good worksheets Helps the child to discover the qualities that he/she hasand makes him/her feel good for himself/herself.7. Help in there Help the child discover many things to help him/her tofeel better8. Safety hand Help the child understand that there are people who willhelp him/her out42 INFORMATION MANUAL 3: TSUNAMI PSYCHOSOCIAL CARE FOR CHILDREN

¨ Children develop understandingChildren have an opportunity to learn in a group without feeling threatened by their ownpersonal fears. Children learn by listening to experiences of other children on how they copedindividually in a particular situation. They also watch how other children behave in a group, andmodify their own behavior accordingly. All these help them to enhance their own understanding ofsituations and issues and help them adopt more healthy ways of behaving and coping. Throughgroup work they learn how to reach out to others who require support as well as seek for helpwhen they require. Peer relationships are sources of support for children as they reduce feelings ofisolation.ACTIVITIES THAT CAN BE USED TO HELP CHILDRENDEVELOP UNDERSTANDINGS.No.ActivityCan be used to1. Question bag or box Answer their queries and concerns2. Misinterpretations How something can be hurtful because of howwe look at it3. When I felt hurt What helps them cope with situations4. Opposing emotions How to move from negative to positive emotions5. Happy memories We need to move on in life6. Story sessions Cover various issues in a non-threatening manner7. What would you do Help them to reflect upon various possible solutions8. Lifelines Discover the kinds of ups and downs they have beenthrough; what they remember about their lives most9. Learning new things Help to develop new healthy behaviour without beingpreachy10. My time Help them to make more constructive use of their timeTOT INFORMATION MANUAL - 1 43

¨Children develop positive skillsPlay and group work leads to development of skills in children (i.e. - problem solving skills,communication skills, decision-making and social skills). While interacting and playing with others,children learn simple things like waiting for their turn to speak, listening to others, appreciating thework done by others, sharing things, playing by rules, talking in a group, making friends, etc. Theyare able to use the forum to practice positive skills and replace undesirable behaviors like hitting,fighting, yelling or being too passive. Certain activities bring children together to find appropriatesolutions to issues that they alone, cannot deal with. It helps them develop a sense of competence asa group and also enhances the solidarity within the group. Learning to think, plan, and find solutionslead to development of confidence.Some skills that can be developed through these activities are:Ø Speaking skillsØ Listening skillsØ ConcentratingØ Waiting for turnsØ Appreciating othersØ Being positiveØ Developing understanding and being sensitive to othersØ Creative skillsØ Finding solutionsØ Co-operationØ Competition to some extentØ Learning to have funØ Sharing thingsThus we must ensure that the activities we conduct with children, contribute in some mannerto the development of resiliency, where they gain skills and confidence to handle future crises in theirlives. For this, the following four basic steps should be kept in mind as shown below:44 INFORMATION MANUAL 3: TSUNAMI PSYCHOSOCIAL CARE FOR CHILDREN

Step oneForm a trusting relationship with children§ Go down to their level, sit with them, talk intheir language or play with them.§ Request them and join in what they are doing.§ Show an interest by asking about their friends,schoolwork etc.§ Be a friend; empathize with the children so thatthey begin to trust you.Step twoCreate a safe, secure and comforting environmentfor conducting activities§ Do not reprimand even if the child misbehaves.§ Do not criticize, humiliate or punish the child.§ Give lots of praises.§ Celebrate good work or achievements.§ Have fun and encourage laughterStep threeUnderstand the child and be available§ Listen carefully to what the child is saying.§ Look at the drawings and other expressive workof children to understand how they are feeling.§ Respond to questions with accurate information.§ Always answer queries even if they are beingrepeated.§ Watch out for non-verbal indications to see howthe child is feelingChoose the correct mediumResiliencycharacteristicsthat aredeveloped Sense of self worth. Social, problem solvingand communication skills. Positive and effectivecoping skills. Confidence and a feelingof competence. Network of support. Positive outlook and hopefor the future.Step fourAddress concerns, help the child to workthrough problems, help the child feel empoweredand competent through small achievementsand recognition of their positive qualities§ Address their concerns through activities§ Highlight the child’s effective coping skills orpositive qualities§ Help children to develop a sense of self-worthTOT INFORMATION MANUAL - 1 45

SOME TIPS FOR FACILITATING ACTIVITIES WITH CHILDRENvvvvvvvvSet up some rules, which the children should adhere to. Make it a group responsibility thateveryone will follow:Ø Listen when someone is speaking.Ø Sit in a circle so that nobody fights or troubles others.Ø Talk only for yourself.Ø Do not tell tales about other children.Ø If we do not follow rules, other children can choose to keep us out of the circle.Make sure that as a facilitator you choose to have children of similar ages in one group so thatit is easier for you to work with them.Make sure you remember what you did in the last session with the children because you mayneed to raise certain issues from the last session.Choose only a number of children that you can handle at one time – a maximum of eightchildren.Keep aside a one-to-one session time for children who need some extra help, like a childwho is constantly breaking down every time something about the tsunami comes up.Do not have more than two to three hours at a stretch with any group.Have at least two activities per session.Always have a good ending for your sessions.KNOW WHICH MEDIUM SUITS WHICH AGE GROUPMedium 2–5 years 6–10 years 11–14 years 15–18 yearsStories 1 1 2 3Talking 3 2 1 1Play 1 1 2 3Games 2 1 1 2Painting 1 1 2 246 INFORMATION MANUAL 3: TSUNAMI PSYCHOSOCIAL CARE FOR CHILDREN

Drawing 2 1 1 1Puppets 1 1 2 2Clay 2 1 1 1Activities/ worksheets 3 1 1 2Drama 3 2 1 1Writing 3 3 2 1Physical games 3 1 1 2Adapted from Geldard et al: 1 indicates it will work very well 2 that it is okay and 3 that it is the leastsuited medium.All the mediums mentioned above can engage the children meaningfully and help them toexpress their thoughts and feelings. One needs to support and provide comfort to the child throughwhat one says, a pat, holding his/her hand or even a hug if he/she is too upset. (Be careful about theage and gender of the child when you do so as it may go against the local cultural norms).These sort of activities can be done for general events (like - how people go through difficulttimes and are able to work through it), tsunami specific experiences (like the water coming into thevillage and how their community was destroyed) or it could be related to personal experiences(like– loss of friends or loved ones, missing their pet whom they lost in the tsunami, concerns abouttheir schools, exams etc.). Even if the children become emotional and start crying one need notworry. Remember that such expressions:ü Relieve tension, fear, and anxiety.ü May give children a sense of understanding or control over their lives or the eventsin their lives.ü Help children to convey their needs to others.PLAYSand – It is a very effective medium for children. They are very familiar with this medium.They can create and destroy whatever they want to without harming anyone.Games- Some games will get the children to interact with each other and pick up social skillsand start bonding. They will be able to learn the right kind of behavior and control their emotions asthey play. They will learn positive interaction and communication skills without too much pressure.Physical games are good to build up team spirit, instill bonding and release energy in a constructivemanner. Games are effective ways of keeping children occupied.TOT INFORMATION MANUAL - 1 47

Toys- These could be provided to children who have lost all their toys in the tsunami or whohave been affected by the tsunami. Children can spend some time playing and enjoying themselves.Set a time when you would bring toys and stick to that routine. Let the child know that he/she canplay with the toys for sometime and after that he/she must give it back as it needs to be used byother children too. This is useful as some children may develop an attachment and then it may bedifficult to take it back from them.Ensure that the toys that are provided are local familiar toys that the children are used to. Thetoy bag could include things like fish, boats, kitchen sets, animals, dolls, household materials, vehicles,etc. The toys should be such that they can help a child to create a picture of his/her world andhelp to ventilate his/her feelings.TALKING AS A MEDIUMWhile talking, ask very few questions. If you need to ask a question, stick to open endedquestions like ‘which’, ‘what’, ‘how’ and ‘when’. Keep in mind how the child is viewing the worldaccording to his or her age and then discuss issues. Express and share your own feeling about thetsunami and how it made you feel. This will help the children open up and be comfortable aboutexpressing their own experiences. Give the children your full attention and address their fear andworries as best as you can. Be honest and say you do not have solutions to everything if you getstuck. Do not advice the child but listen to what they are saying.Set a time on a daily basis which you could use to share thoughts, questions, feelings andbasically talk about the tsunami. Call it the “the talk time”. Place a box and label it “Talk box” orwhatever name the children decide. The idea is to help children drop in notes or questions, whichcould generate a discussion in the next day’s talk time. Concentrate on coping skills and the processof recovery in your discussions. Give lots of praise and support for the way in which they arecoping. When children are sharing their opinions, do not insist that everyone has to speak but letthose who want to do so come forth. Do not pressurize those who do not want to talk.Use the following sentences to encourage a child who has shared something with you.§ I am glad you chose to speak with me.§ I want to know how you are feeling.§ I am always available when you want to come and share anything with me.§ I am sorry you are going through a difficult time.§ I respect your ability to cope so well.48 INFORMATION MANUAL 3: TSUNAMI PSYCHOSOCIAL CARE FOR CHILDREN

ARTWORKAt the start, let the child know that the drawing or artwork is for them and will not be judgedby you. This helps children who are not good at art also join in freely. Once the children havefinished their task, invite them to talk one by one about the picture that they have drawn. Allow themto talk about what they have drawn and do not pass any good or bad comment. Do not bejudgmental. Seek clarifications if you do not understand something.The child’s painting may something that still concerns them (flooded home, significantindividuals in his/her life, stressful place or events). This brief insight into the child’s world may be asign of a specific area where some help may be needed. Artwork can be done repeatedly usingdifferent mediums and themes to explore the child’s world. Various materials like paint, crayons,chalk and blackboard, sketch pens or the whole hand painting or finger paints can be used.CLAY WORKThe main advantage of using clay as a medium is that children can express their feelings veryeffectively through clay. Things can be made and destroyed and remade again. Children can give anidea about the things that they have lost and the process of creating it is greater than the actual endproduct. During their creation process, they are able to think about the loss and later during asharing round they can talk about it and bring out their feelings. Some children may not even talk butthe process of making that model would have released some of their emotions.USE OF STORYTELLING/DRAMA/PUPPETRYThere is a two-fold benefit of storytelling. The adult can use a story to pass on a message toa child and a child can be encouraged to tell a story to get an insight into his/her world. The storycould be fictional or something from his/her own life.Use some issues that come up during these sessions as matter to develop a story that teachesthe child something positive. For instance, the story can be that of a child who coped with a scarysituation effectively. As a child listens to the story, he/she will be able to relate that to his/her own life.Provide the basic ingredients of the story-characters, location, event, and then give fewminutes to think about what the people will do in such a situation. Ask the child to tell a story basedon the given characters, location and the situation. Use questions to get a better understanding incase there are some gaps. You can also do this as a group activity. Storytelling is an effectivemedium to talk about frightening issues without upsetting the child. For small children, it is moreinteresting than talking. Also children derive a lot of fun.Storytelling can also be done using mediums like dolls, toy animals or puppets to expressfeelings. Children find it easier to ventilate when some medium is used. Once the problem isexpressed it becomes much easier to address. It can be done with one child or can be done with agroup of children. Generate discussions and follow it up.TOT INFORMATION MANUAL - 1 49

Children can also get together and put up a play and bring out issues concerning them. It ishealing to put up a production that demonstrates positive stories and this instills hope and confidencein the children watching it. Use real life aspects rather than fiction as a story line in the drama.Acting and getting appreciation makes a child feel good about himself/herself.Guidelines for small group activitiesü Set aside some time for group work on a periodic basis. Initially it can be once in twodays and gradually it can be spaced to twice a week and then later on once a week.ü Meet regularly.ü Set some ground rules with the help of the children (e.g. talk one at a time, listen whensomeone is talking, do not put down anyone, no negative comments about anyone, do notmake fun about anyone, do not tease if someone cries.)ü Keep notes about what happened in the last session so that you have some continuity andyou may need to raise certain issues from the last session.ü Observe children and their reactions and note them down to see how they are changingovertime as you do different activities.ü Always end the session with a fun game to help children feel good when they leave.ü If you are doing activities in a class choose mediums, as mediums are very effective withchildren. While choosing a medium pay attention to the age of the children.ü For children who require more attention, conduct sessions in smaller groups.ü Keep time aside for one-one session for children who need some extra help, who want totalk separately.ü Keep a box where children can come and put their names and then you can decide tomeet them.ü If you are doing activities in camps or elsewhere then choose only a number of childrenthat you can handle at one time- a maximum of eight members.ü Choose to have children of similar ages in one group so that it is easier for you to workwith them.ü Help children develop relevant skills.50 INFORMATION MANUAL 3: TSUNAMI PSYCHOSOCIAL CARE FOR CHILDREN

Helping children to cope with lossü It is important to let the child know that it is normal to think about the traumatic event, feelupset and angry about it.ü Allow the child to express his/her feelings about the loss. Do not stop him/her from cryingor ventilating his/her feelings. Share your own pain with him/her so that he/she feels that itis okay to show their emotions.ü Do not try and avoid talking about the event in the belief that it will make a child sad.Children want to talk about what has happened, they have many queries related to theevent and they feel better if there is someone to talk to them.ü Children are different from adults. If a child is found actively playing, it does notnecessarily mean that the child all right from within. The child often does not know how toexpress/verbalize his/her pain or difficulties.ü You need to be honest and confess that you do not have answers to all their queries.In case you are finding it difficult to deal with your own situation, do not hesitate to admitthat.ü Allow the children to participate in family rituals if they want to.ü Make sure some caregiver is around to take care of the child during this period when thechild is trying to cope with his/her loss.ü Do not say things that are not true. For example if a person is dead, do not say that theperson has gone on a long trip or god has called him/her. This creates confusion in thechild and makes him/her anxious and the child anticipates about the return of the person orthinks why god did not take him/her.ü Help to remove misconceptions that the children may be having. For example they maybe thinking that they are bad and thus this happened to them or they may be thinking thatthey could have done something to prevent it from happening and hence they may haveguilt feelings.ü You may have to repeat the information over and over again many a time especially foryounger children.ü Allow the child to engage in activities to remember the loved person who has died or ismissing. He/she may like to write about that person or write letters to that person, draw apicture of them etc. This will help him/her to say a proper good bye to the person who hasgone and accept the reality.TOT INFORMATION MANUAL - 1 51

Activity key indicating the purpose and suitability for various age groupsName of the activityPurposeAgegroupIndividual/GroupactivityPagenumberFacial expressionsVentilation5 +Both69Feelings factoryVentilation/Understanding5 +Group70Deal with your angerVentilation5 +Both71Before after outlinesVentilation5 +Both72Body mappingVentilation5 +Both73Which moodVentilation/Understanding8 +Both74What are you scared of?Ventilation8 +Both75Candle talkVentilation/Understanding8 +Both75Group creationVentilation8 +Group76Bhaloo insideVentilation/Understanding5-10Group77How are you today?Ventilation5 +Both77Best memory pictureVentilation8 +Individual78Whom can I trust?Self esteem5 +Both79Getting to know youSelf esteem8 +Group8052 INFORMATION MANUAL 3: TSUNAMI PSYCHOSOCIAL CARE FOR CHILDREN

Name of the activityPurposeAgegroupIndividual/GroupactivityPagenumberFamily drawingSelf esteem/Ventilation5 +Both81Feel good worksheetsSelf esteem5 +Both82Safety handsSelf esteem6 +Both83Question box/bagUnderstanding5 +Group84Opposing emotionsUnderstanding8 +Group85Happy memoriesUnderstanding/Ventilation8 +Group85Story sessionsUnderstanding5 +Both86What would you do?Understanding8 +Group87Life linesLearning new thingsUnderstanding/VentilationUnderstanding/Ventilation/ Selfesteem10 +5 +BothBoth8889My timeUnderstanding8 +Both90MirrorFun/Self esteem8 +Group90Name tagsFun/ Self esteem5 +Both90Paper cuttingFun5 +Both90Blind carFun/Understanding8 +Group91TOT INFORMATION MANUAL - 1 53

Name of the activityPurposeAgegroupIndividual/GroupactivityPagenumberArm linkFun5 +Group69Dream person or objectUnderstanding/Ventilation8 +Both70Pass the maskFun5 +Group71Zoom and brakeFun5 +Group72Electric squeezeFun5 +Group73Pass the smileFun5+Group74Mime an actFun8 +Group75PlacesFun8 +Group75Describe your handsFun/Self esteem8 +Both76Being something elseFun/Ventilation8 +Both77Water and iceFun5 +Group77Frozen lionFun5 +Group78Fruit basketFun5 +Group79Animals callingFun6 +Group80Snake catcherFun8 +Group81Storytelling, change theendingFun/Ventilation8 +Group8254 INFORMATION MANUAL 3: TSUNAMI PSYCHOSOCIAL CARE FOR CHILDREN

Name of the activityPurposeAgegroupIndividual/GroupactivityPagenumberStorytelling, give an endingFun/Ventilation8 +Group83Friend circleFun/Self-esteem5 +Group84Support netUnderstanding5 +Group85Draw in pairsFun5 +Group85Forward moving boatFun5 +Group86Act of KindnessUnderstanding5 +Both86Say nice thingsUnderstanding/Fun5 +Group86TOT INFORMATION MANUAL - 1 55

ACTIVITIESDETAILS OF THE ACTIVITIES FOR GAINING MASTERYFACIAL EXPRESSIONSMaterialAimProcessPre-drawn faces depicting various emotions given in pictures 1–9Ø An understanding into what the child feels about a certain event, issue or individual in his/her lifeØ Discover what helps the child cope.· Lay out the pre-drawn faces on the floor. Tell them they are going to play a game.I am going to ask you a question and you have to pick up the face that representshow you feel.· Some questions help children talk about the tsunami and how their life has changed as aresult of that. It can provide an insight into how they are feeling. Ask the child a questionwhich could be:How do you feel now?When you think about school, how do you feel?Would you like to go back to your earlier home?How do you feel at night?How are you feeling today?How did you feel during the recent tsunami?What do you feel about your family, your friends?What makes you sad/upset/angry/scared?What could be done to change this feeling?What do you do when you are feeling this way?What do you do when you feel this way?What helps you feel better?Is it okay to have a bad day once in a while?56 INFORMATION MANUAL 3: TSUNAMI PSYCHOSOCIAL CARE FOR CHILDREN

· The child has to respond to the question by picking up the face that best suits his/heranswer. For example if the child feels scared at night then he will choose the face givenrelating to fear in the picture.· Then have a round of sharing as to why each child chose that particular expression.· If someone gets stuck or does not wish to share, be ready with your own choice andshare this with them so that they feel comfortable to share their own expressions.· Tell them that all of us feel angry, sad, and happy, and if he/she talks with some adult aboutsuch feelings they will feel better.Outcome¨ You will get an idea about how the child feels about things or people in his/her life.¨ You will get an idea about how he/she copes with those feelings.¨ The child will be able to share his/her thoughts and feelings in a non-threatening mannerFEELINGS FACTORYMaterialThe factory of feelings chart as given in picture 11.AimØ To introduce the idea to the children that both good and bad feelings are part of us.Ø It is okay to have these feelings.Ø These bad feelings will go away.Ø There are ways to get those bad feelings out of us.Process· Tell the child/group you are going to tell them a story.· Use the pre-drawn chart to tell the story.A factory inside us produces good and bad feelings like anger, sadness, happinessand so on. Most of the time happy feelings are produced inside so we feel happy andsmileSometimes the factory does not work well and more bad feelings are produced; thenwe feel sad or angryWhen we cry, talk about such feelings or write them down; that makes us feel better.TOT INFORMATION MANUAL - 1 57

· Now ask them to share when he/she has recently faced some problems and bad feelingshave been overproduced· After this sharing, ask them what they do when they feel bad.· Tell them that crying and talking about such feelings would help them feel better.· Give an example of your own if there is hesitation from the group members.· Introduce to them how they can cope better by sharing with others. You can also sharehow you coped with similar situations or you can take an example of a child who hascoped in an effective manner. Put up the ideas on board.- Talk to others about how you feel.- Do something to solve the problem.- Relax yourself.- Have some fun.- Seek help to solve problem.Outcome¨ You will get an insight into what upsets the child and how he/she copes with those emotions.¨ Child models healthy coping behavior.DEAL WITH YOUR ANGERMaterialClay, drawing material, sponge bricks, hit-me doll, edible beans and a box.AimØ Help the child identify what makes him/her angry.Ø Express his/her anger as a symbolic representation of the cause of anger.Ø Ventilate his/her feelings and slowly experience calmness.Ø Cope with his/her negative emotions.58 INFORMATION MANUAL 3: TSUNAMI PSYCHOSOCIAL CARE FOR CHILDREN

Process· They first need to draw or create, using a medium, what they are angry or upset with.· There are various options for creating this image. The medium you may like to use can be:A clay model of the personDrawing of the person or situationA soft dollA hit-me dollA box into which beans/stones can be thrown· The second step would be to ventilate his/her feelings:The clay model could be destroyed.The drawing could be scribbled over or torn.The soft doll could be hit with sponge bricks or shouted at.The hit-me doll could be beaten repeatedly.The beans or stones could be thrown into the box.· These acts would help the child get rid of the negative feelings and anger within him/her· As an example to get the child/group started, you must demonstrate how you are angrywith a person and then get the children to start thinking.· Close the session saying that if he/she wants to talk about it you will listen. If the child isnot comfortable sharing it, respect his/her wish.Outcome¨ The child will accept some of the negative emotions that he/she has.¨ There is great deal of release/ventilation of the anger and negative emotions.BEFORE AND AFTER OUTLINESMaterialCopies of the body outline given in picture 10.Crayons representing different emotions like red for anger, black for sadness, yellow forhappiness, green for pain and illness, light blue for peace and calmnessTOT INFORMATION MANUAL - 1 59

AimØ Help the child connect with his/her emotions, and to see how he/she experiences it in thebody.Process· Give out the copies of the body picture.· Ask the children to think of themselves and then colour the body parts where they felt painimmediately after the event· Have a ready-made demonstration model representing yourself and include negativeemotions in your model. This could help the children feel free to share their ownnegative emotions.· Then have them colour another body outline to show how they feel now after so muchtime has passed after the eventOutcome¨ The child will be aware of his/her emotion.¨ The child will ventilate how he/she is feeling.¨ You will get an understanding about how the child is experiencing emotions in the body.¨ This works very well with children who are very specific in their anger or sadness.BODY MAPPINGMaterialNewspaper, marker pens/crayons, feeling words on small cards or coloured circles representingdifferent emotions.AimØ A child can be helped to connect with his/her emotions.Process· Ask a child to lie down on a newspaper and draw an outline.· Then present a list of happy and sad feelings to the child.· Ask the child to choose one.· Ask where he/she feels it and place the emotion cards in the body outline.· While this is being done, ask the child why these feelings develop.60 INFORMATION MANUAL 3: TSUNAMI PSYCHOSOCIAL CARE FOR CHILDREN

· Have a discussion on how he/she deals with those feelings.Outcome¨ You will get an understanding into how the child feels and whether he/she has some support system to look after him/her when he/she feels sad or angry.¨ It may bring up issues that could be addressed later on to help the child develop anunderstanding on how to deal with different emotions.WHICH MOOD?MaterialAimProcessOutcomeCards with various emotionsØ To understand what emotions are influencing the children at the present moment.· Lay out all the cards on the ground· Ask each child to pick up at least two cards, which reflect a change in how he/she isfeeling (anger to calm, sadness to happiness, hate to love, frightened to security, listless toenergetic, trapped to feeling free, lonely to being popular, patience to impatience).· Make sure you demonstrate using one example for yourself.· Explore the following areas:Which mood is dominating their life at present?Does it affect their relationships or how they feel about themselves?How do they cope with bad moods and feelings?What helps them to change from one mood to another?¨ They will share what makes them angry or scared, sad or happy.¨ Some children will get an understanding as to how to make one feel better by listening toothers.¨ This could be repeated at regular intervals to see how children are progressing and whattheir current status is.TOT INFORMATION MANUAL - 1 61

WHAT ARE YOU SCARED OF?MaterialSome examples that you might like to talk about like being scared (fear of mice, being followed,burglary, talking on the stage, exams, loud noises, darkness, sea waves).AimØ Talk about what is scary for children.Process· Ask children to think of one thing that they are really scared of, then let them talk aboutwhy they are scared and where would they run away in case the thing comes or they seethe thing.· Later, let them share what would help them to cope.· It will help children to hear about fears of other children, as they will understand that it isnormal to have fears. The children would be able to develop an understanding into howone can cope and overcome these fears.Outcome¨ The child will be able to share his/her feelings of being scared.¨ This would help them to cope with their fears.CANDLE TALKMaterialTwo candlesAimØ To help children, who have lost a family member or a near and dear one address their lossProcess· Light up both candles.· Bring both candles together and say these lines:Just like this candle we have people who come together. When we share our lives webecome brighter and there is a lot of happiness.Even when one candle goes away (take one candle off and blow it out), a part of itgoes on burning within the other candle.62 INFORMATION MANUAL 3: TSUNAMI PSYCHOSOCIAL CARE FOR CHILDREN

Just like the candle if people go away nothing and no one can take memories andgood feelings we have about them away from us.We have to go on shining and burning bright.· This is symbolic for an older child who may not have fully accepted the loss of a lovedone. The message is not to forget but to continue with life in spite of the loss.Outcome¨ Allows the child to ventilate about the loss.¨ Emphasizes the need to accept the loss by the child.GROUP CREATIONMaterialAimProcessOutcomeA big sheet of plain paper, colours and drawing materialØ An activity-based group work to discover how children feel about certain issues.· You might have to stick four sheets together so that many children can use the same sheetat a time.· Put one feeling right in the middle of the sheet and draw a boundary around that word – itcould be fear, anger, happiness, sadness, illness.· Ask the group to think about that word and draw whatever comes to their mind aroundthe word, wherever they like.¨ Through this group activity, you will have a collective idea about how thefeeling about that issue.children are¨ It is more action-based rather than talking and hence will work better with younger childrenTHE ‘BHALOO’ INSIDEMaterialTwo pictures of teddy bear faces as shown in picture 12.TOT INFORMATION MANUAL - 1 63

AimØ To help children understand that all of us have negative emotions once in a while.Process· Build a story about a good-natured bear, who at times is very angry and feels bad withinhimself.· As he tries to talk he starts shouting, screaming.· When people go near him he hurts them.· Say that he is like this because he is sad and upset.· Then ask the children:Do you too feel like this sometimes?Why or when do you feel like this bear?What or who makes you feel this way?Outcome¨ The child will understand what makes him/her angry or sad.¨ The child will learn that he/she is not alone who has feelings of anger or sadness.HOW ARE YOU TODAY?MaterialPre-drawn faces expressing various emotions as given in pictures 1–9AimØ To have a quick look at how the child is feeling on that day.Process· Put out all the faces on the floor in different parts of the room.· Ask each child to go and stand next to the face, which depicts how he/she is feeling thatday.· A quick discussion on why they are feeling that way should wrap up the session.Outcome¨ This could be used daily to know how the children are and it could be a monitoring tool toidentify a child who may always be feeling very angry or someone who feels sad everyday.¨ These issues could then be addressed through activities.64 INFORMATION MANUAL 3: TSUNAMI PSYCHOSOCIAL CARE FOR CHILDREN

BEST MEMORY PICTUREMaterialDrawing material –chart papers, pencils erasers and crayons.AimØ To help the child talk about the person he/she has lost.Process· Ask the child which is the best memory he/she has of the person or object that he/she haslost.· Talk about how you could create the memory pictorially and then ask the child to draw it.· Discuss using the following guidelines:Why is this, the best memory?What else does it make you think of?· Reinforce that even when there is a loss, we have happy memories and we can think of allthe good things about the person or object we have lost.Outcome¨ Allows the child to talk about the loss¨ Reinforces a happy memory even when there is loss.DETAILS OF THE ACTIVITIES FOR SELF-ESTEEMWHOM CAN I TRUST?MaterialConcentric circles drawn on large sheets of paper as given in picture 13AimØ To find out some unmet needs of the child and to discover support system.Process· Give children the sheets and take one for yourself.· Tell them: We are going to do some activity together.TOT INFORMATION MANUAL - 1 65

· Ask each one of them to draw a figure of himself/herself right in the middle of theinnermost circle.· Tell them that in the first circle around the figure they have to write the names of the peoplethey feel they are very close to – it could be his/her mother, father, sibling, friend, relative,teacher or pet. These are the people with whom they can talk anytime and about anything.· Then in the next circle they should write names of the people they are close to but not soclose -people with whom they talk sometimes.· In the outermost circle they should write names of the people they are not close andhardly talk. For younger children just have people they are close to or not close to so thatit is easier.· Once they finish doing the exercise, have a round of sharing.· Do not ask any questions about why they have chosen to put people in a particular circle;just let them share.· Keep these observations in mind. This will help you to explore more in future.Outcome¨ The child through this activity knows that adults around him/her can understand and he/she can seek support incase of need.¨ You as an adult can understand the support circle the child has and can reinforce thesupport system or help the child build a supportive circle if he/she does not have one.¨ You can repeat the exercise to see how the circles have been revised as time goes by.GETTING TO KNOW YOUMaterialCards having incomplete sentences for instance – I like…, My mother… (or any relevantfamily relations), This is what happened…, It seems difficult…, In school…,I cry… I fear… I donot like… I am happy when… I am sad when….., I feel angry, I am upset with…….., I wish………AimØ To get the children to talk about themselves.Process· The group is divided into pairs66 INFORMATION MANUAL 3: TSUNAMI PSYCHOSOCIAL CARE FOR CHILDREN

· Each child gets a chance to think and complete the sentence and share it with his/herpartner.· Each child then presents what his/her partner shared to the larger group.Outcome¨ This exercise helps the child in ventilating his/her feelings.¨ It encourages each child to talk in the larger group.¨ Children start feeling comfortable within the group as a result of sharing.¨ As an adult you can understand a child better through this activity.MY FAMILY DRAWINGMaterialAimProcessSeparate cards for drawing, pencils, and erasers.Ø To get an idea about the child’s family and how he/she feels about his/her familymembers.· Start the session with each child introducing himself/herself.· Request each one of them to draw on the cards all their family members as you cannotvisit their respective families.· It is likely that they will state that they find it difficult or that they do not know how todraw their family members. You could suggest that they draw simple stick figuresdepicting three emotions as shown in picture 14.· Ask the child to explain as to why that particular family member feels angry or sad sothat when the child tries to explain, his/her feelings are ventilated and he/she feelscomfortable.· As the children share their views about family members, note down the key points on thesame sheet so that you have a record of what they have shared and can have abetter understanding about them.TOT INFORMATION MANUAL - 1 67

Outcome¨ It’s a great way to start off the process of rapport building. It gives an understandingabout whom the child is close to.¨ It can be useful in assessing whom to contact in the family when support is required.FEEL-GOOD WORKSHEETSMaterialAny worksheet given in pictures 15–22AimTo give a visual activity to help the child identify and work on the qualities he/shepossesses and to make him/her feel good and positive about himself/herself.Process· Choose the theme you would like to work with.· Think about what sort of points you would like to highlight to the group and keep those inmind before starting the session.· Give out the worksheet· Include a discussion before or after the worksheet is filled.· Make the activity a fun by allowing the child to colour and talk about his/her work:* On the worksheet with a tree (picture 15), get the children to write some good traits ondifferent branches. Ask them to use blue colour for the branches which show the traitsthat they have. Ask them to use red colour for the branches that depicts traits that theywould like to develop.* On the worksheet with a clown (picture 16), get the children to write nice things aboutthemselves in the balloons and colour them. You could also ask them to list on theballoons the good deeds they have done for others and which made them feel goodabout themselves. More options could be chosen for this worksheet.* In the worksheet with the roads (picture 17) leading to the top of the hill, write a goalin the flag at the top of the hill like good classroom behavior. Get the children to writedifferent goals and add your own inputs. Then get the children to fill up the milestoneswith traits needed to reach the goal. Other options could be the road to doing well in68 INFORMATION MANUAL 3: TSUNAMI PSYCHOSOCIAL CARE FOR CHILDREN

studies or being good friends or happiness at home or happiness within or overcomingmy fears etc. It can be anything that the children need to work on.* The worksheet with a heart surrounded by small circles (picture 18) can be used toask the children to write in the circles what others do to make them feel loved.* In the worksheet with the bulb (picture 19) the children can be asked to write in thebulb one or two good qualities that they possess. These could be – kindness, being agood friend, obedience, helpful at home and so on.* Picture 20 has a stick figure in the middle and four boxes around. Get the children towrite nice things about themselves in these boxes. This will help them to lovethemselves.* In the worksheet with a star (picture 21) get the children to colour and decorate it andgive it to themselves for something good that they have done or for a good quality thatthey possess.* In picture 22, each square represents different kind of emotion like that of anger,happiness, sadness and worry. Ask the child to write in each of the boxes what makeshim/her feel that particular emotion.SAFETY HANDMaterialAimProcessOutcomeChart papers, pencils and erasers.Ø To get the children to identify people with whom they can talk to and feel better.· Ask children to draw an outline of their hands.· Ask them to think of at least five people at home or at school whom they can talk to andapproach for help. They should write the names on the drawing.¨ It instills a feeling of security and makes the child feel good and secured.TOT INFORMATION MANUAL - 1 69

DETAILS OF ACTIVITIES FOR DEVELOPING UNDERSTANDINGQUESTION BOX/BAGMaterialTake a polythene bag or a cardboard box and with the help of children decorate it so thatit looks attractive to them.AimØ To address the worries and concerns of children that may be bothering them.Process· Tell the children we are going to set up a worry box or bag.· Explain that often many questions and thoughts come up in our mind and we do not knowwhom to ask. So this is one way that we can look at some of those questions, thoughts orfeelings.· Let them know that the bag or box is for any thought, feeling or emotion that is botheringthem.· You can offer two options:- Tell them not to put down their name if they do not want to.- If anyone wants a one-to-one interaction about an issue then he/she can markthe slip and meet you separately.· Set a time- maybe a week or ten days, when you will be emptying the box and discuss theissues.· This can be done in the school/home or with a small group of children in the locality.· Maintain confidentiality. Give space and time for one to one interaction if there is a need.· You must remember to answer in a way that is age appropriate and try to remove themisconceptions, fears and apprehensions of the child. If you do not have answers, behonest and admit that you do not know .Also talk about various options to the child andsay that there are various ways of solving a problem and different people have differentviews, ideas and ways of solving a problem.Outcome¨ A good way to address a lot of issues that could be causing a lot of fear and worries to thechildren.¨ It can also help children to fill in the gaps in the information and remove theirmisconceptions.70 INFORMATION MANUAL 3: TSUNAMI PSYCHOSOCIAL CARE FOR CHILDREN

¨ Provides a platform for the children to share their feelings and concerns.¨ Children feel secure.OPPOSING EMOTIONSAimØ To make children think about how they have felt being in absolutely opposite emotions.ProcessAsk children to think of any two opposing emotions and compare how they have felt eachtime. For instance, ask them to think of a time when they have been really kind and compare it withone incident when they have been really mean, angry or rude. Ask them how they felt at both times.You could use the following pairs:- Love & jealousy.- Happiness & sadness.- Being silly & serious.- Like & dislike.- Courage & fear.- Self-sacrifice & selfishness.Outcome¨ A good way to address absolutely opposite emotions.¨ Child develops a better understanding of his/her emotions.Happy memoriesMaterialChart papers, pencils, erasers, and crayons.AimØ To help children understand that there is a need to move ahead in life after a loss or atraumatic event.Process· Ask the group to think about something or someone that they were fond of but have lost.· Once everyone has had time to think, ask them one by one to talk about what happenedon that particular day of loss.TOT INFORMATION MANUAL - 1 71

· Ask them to say goodbye to that object or person by drawing some happy memories ofthat object or person.· Tell them that the happy memories of the person or the object that they drew will alwaysbe with them, but life has to go on.OutcomeDevelops an understanding of how to move on after a loss or some traumatic eventSTORY SESSIONSMaterialHere one can use thematic pictures as given in pictures 23–33. You can use animal figures asgiven in the kit. You can also use family figures provided in the kit.AimØ To make the children to talk or think about an issue which concerns them.Process· Either invite the child to choose any picture and tell a story or you could start yourself andthen they can reciprocate.· Keep your story short and simple with emphasis on key points.· Ask them to reflect upon what happened to the character in the story and then ask themto tell you whether anyone of them have faced similar situations.Themes that should be touched here are:* Nightmares (Picture-31)* Loneliness (Picture-24)* Loss of loved one (Picture-25)* Disinterest in life (Picture-30)* Sadness (Picture-32)* Fear (Picture-26)* Happiness (Picture-27)* Coping with changes like shifting of schools or homes (Picture-23)* Making friends (Picture-29)* Being or feeling different (Picture-30)72 INFORMATION MANUAL 3: TSUNAMI PSYCHOSOCIAL CARE FOR CHILDREN

Outcome¨ Provides an understanding about the issues concerning the child.¨ Helps in ventilation.WHAT WOULD YOU DO?MaterialCards with various situations. For example:F You are a 5-year-old child and you are lost in the market place. What do you feel?F You had to leave your hometown suddenly without saying goodbye to your friends. Howwould you feel?F You are to become captain of your cricket team, but fall and break your leg. What wouldyou do?F You wanted to do the lead role in the play, but someone else got it. How would you feel?F A person tells a lie about you and gets you into trouble in school. How do you feel?AimØ To enable children to understand that it is normal to have various kinds of emotions.Process· Ask them to think whether they have ever felt like the five-year old child who has got lostin the market place? Explain that like tsunami, there are other situations in life that elicitsimilar feelings like feeling sad, fearful or angry.· Reinforce that in earlier situations they have been able to cope and come out of it and soeven now they will be able to overcome these feelings.· Have a set of feeling cards per child. Each set should have cards depicting happiness,sadness, fear and anger.· Give one set of cards to each child.· Ask the child to pick the card that represents the feelings that were topmost during therecent tsunami.· Talk about how they are feeling now.· This gives the child an opportunity to own and mark out the feeling and see how they havemoved on since the event.TOT INFORMATION MANUAL - 1 73

Outcome¨ Enables the child to understand that it is normal to have various emotions.¨ Enables the child to evaluate how his feelings about the traumatic event have changedover time.LIFELINESMaterialChart papers, pencils, and erasers.AimØ To make the child understand that we experience both positive and negative events in ourlife and that life experience adds on and we move ahead in life.Process· Ask children to mark out on a sheet their ages from birth till date as shown in picture 36.· Ask them to add to each year any special event or memories that they can recollect. Theycan add on special people too. For example like the year their sister was born. Some maynot clearly remember year-wise, but it is okay. This is just a rough chart to help them putthings down.· They may include times when they have had a loss like their grandmother’s death· Talk about how they felt both during the negative events and the positive events.· Reinforce the fact that just as we have moved from one event to another event in our lives,so we will also be able to move beyond the tsunami, no matter how difficult it may seemnow.Outcome¨ Helps the child understand that all of us experience both negative and positive life events.¨ Encourages a child to move ahead inspite of having experienced a trauma.LEARNING NEW THINGSMaterialCopies of the flowers given in pictures 34–35AimØ Help children learn and think about different issues.74 INFORMATION MANUAL 3: TSUNAMI PSYCHOSOCIAL CARE FOR CHILDREN

Process· Pick up one issue say ‘Caring for others’.· Give them small cards with various statements, some speaking of the right things andsome the wrong ones· Ask the children to write which ones would go to the happy flower and which ones wouldgo to the sad flower. The happy flower indicates the right things that we should do and thesad flower indicates the wrong things. We should avoid doing the wrong things.· Ask each child to say one good thing that he/she already has and one bad quality that he/she would like to change. This would help them understand their strengths and weaknesses and they can learn without you having to advise or teach them directly. Forinstance a flower exercise on ‘Playing with friends’ would include statements like:* Enjoys playing with others* Does not share toys with other children* Waits for his turn to speak* Takes turns to play* Breaks other people’s items* Gets angry when does not win* Wants to be first while playing* Fights with others* Gives everyone a chance* Does not disturb others· Other themes to work upon are: Patience, friendship, love and care, good eating habits,classroom behavior, etc.Outcome¨ Helps the children to learn and think about different issues.¨ Children are able to understand desirable and undesirable behaviors.MY TIMEMaterial2 pictures of a clockTOT INFORMATION MANUAL - 1 75

AimProcessOutcomeØ To help children understand the proper use of time.· For Clock One, write about things you have done today that have been good use ofyour time.· For Clock Two, write about things you have done today that have been waste of yourtime.· Finish with a discussion on good healthy living, which includes time for prayers, play,study, family time, etc. Ask children to include these in their clock.¨ Enables the children to make proper use of their time.¨ This exercise can be used to monitor how the child is spending his/her time.ACTIVITIES FOR POSITIVE ENDINGS TO SESSIONSOften when you have discussions with children about loss or what scares them, fearis a crucial element in this situation. So before they leave a session they should feelcomfortable and happy. All sessions should end on a happy note through light games orfun drawing or some free clay work. The following activities can be used for positiveendings.MIRROR GAMEDivide the group into pairs. One person becomes the leader and the other is the mirror. Theyget two minutes wherein the leader makes movements as he/she likes and the mirror has to copy themovements. After two minutes they change roles that is the leader becomes the mirror and themirror becomes the leader and repeat the process.MAKE NAME TAGSEach child in the group is given a cutout of some shape and he/she spends time writing his/hername on his/her tag and decorating it beautifully. Then the child presents the tag to himself/herself.The group goes around looking at each other’s tags and they can only appreciate, not make fun ofany tag.76 INFORMATION MANUAL 3: TSUNAMI PSYCHOSOCIAL CARE FOR CHILDREN

PAPER CUTTINGAsk children to cut bits of coloured paper and stick it on a plain sheet of paper as they want.The colours need to be really bright and the process is fun.BLIND CARThe group is divided into pairs. In each pair, one person takes the role of being a car and theother the driver. The car has to close his or her eyes and the driver stands behind and guides the caracross the area.Instructions to move around are as follows when the driver:Presses the right shoulder = car turns right.Presses the left shoulder = car turns left.Presses both the shoulders = car stops.Pushes a little with both hands = car starts.After two minutes roles are reversed i.e., the car becomes the driver and vice-versa.ARM LINKThe facilitator calls out a number and the children quickly have to link up their arms accordingto that number. The children who cannot find a place are eliminated. For example, the facilitatorcalls out the number ‘3’, children have to quickly link up their arms and form groups of three. Thosewho are left out are eliminated.DREAM PERSON/OBJECTChildren have to think and talk about their dream person or object. Say, for instance, theyhave chosen siblings, then they can talk about how they play together, talk to each other, fight, howthe elder brother protects him/her, etcPASS THE MASKThe group sits in a circle. One person starts by making a face at the person sitting right besidehim/her. That person imitates the face that has been made and shows it to the child sitting next tohim/her. This continues till all the children get a chance to make faces.TOT INFORMATION MANUAL - 1 77

ZOOM AND BRAKEThe group sits in a circle. One person starts by looking at the partner next to him and says,‘zoom’. The person then turns to the next person and says ‘zoom’. This has to be done in onedirection till someone says, ‘brake’ and then the direction gets reversed. This has to be done veryfast to have lots of fun.ELECTRIC SQUEEZEAll the children sit in a circle and then hold hands. One person starts the ‘electric squeeze’ byslightly pressing the palm of the person sitting next to him /her. This continues in clockwise direction.Each person leaves the room after getting the squeeze, which signifies friendship and belongingness.PASS THE SMILEAll the children sit in a circle. The facilitator looks into the eyes of the child sitting next to him/her and passes on a big smile. The child has to turn his/her head and look into the next person’s eyesand pass on the big smile. This continues till the smile comes back to the facilitator. The session forthe day ends with a smile.MIME AN ACTThe group is divided into two teams. Each team calls a member of the other team and giveshim/her an action to mime, which, if guessed correctly by the teammates, wins their team a point.PLACESOn a board put up words like garden, bedroom, kitchen, hall, bathroom, playground, classroom,gate, etc. Children have to select one or two words from these and write or talk about eventsrelated to such places. Ask the child:Why did he/she choose that particular place?Does he/she feel more comfortable in that place?What sorts of memories are associated with such places?These are some of the aspects that can be talked about.DESCRIBE YOUR HANDSEach child can spend time thinking about his/her hands and then describe what sort of handsthey have (overall type of skin, lines on it and major marks, injuries). They can discuss how hands78 INFORMATION MANUAL 3: TSUNAMI PSYCHOSOCIAL CARE FOR CHILDREN

feel when they are idle, the kind of things hands do, what they think or feel about their hands, whatthey would like to tell their hands. This can be repeated on another day for some other body partslike face, legs, head, eyes etc. or the whole body itself.BEING SOMETHING ELSETake an insect or an animal from the play kit and then ask the child to talk about a day in thatanimal’s life. Ask him/her why he/she chose that animal and what he/she likes and dislikes about it.Then ask him/her which animal he/she would like to be and why.WATER AND ICEThere is one child who is the den. The other children have to try to run away from the den. Ifthe den touches any child, the child freezes till someone else comes and touches the child and defreezeshim/her.FROZEN LIONEverybody has to stand still like a statue, except for the one who is the lion. He/she movesaround and if he/she finds someone shaking, that person becomes the lion.FRUIT BASKETThe group members are divided into 3 smaller groups representing three types of fruits bydrawing circles - 1 being apple, 2 being banana and 3 being orange. When the facilitator calls outorange, all the oranges exchange places; when he says apple, all the apples rush to exchange theirplaces. Similarly when the facilitator calls out banana, all the bananas exchange their places. Butwhen he/she says ‘fruit basket’ all the fruits rush around and change places. This is a fun game withphysical activity and children enjoy this game a lot.ANIMALS CALLINGThe Children are divided into four groups of dogs, cats, goats and pigs by calling out 1 to 4.All the children are asked to close their eyes and make the sound of that particular animal and thenform their own groups.SNAKE CATCHERChildren stand behind each other to make a long snake. One child is a catcher and he/shetries to catch the tail of the snake and the snake has to move fast to escape. If it is caught, then thehead of the snake becomes the catcher, and the catcher becomes the tail.TOT INFORMATION MANUAL - 1 79

CONTINUOUS STORY TELLINGMake children stand or sit in a circle. A child is asked to a tell story and he/she is stopped inthe middle of a sentence. The next participant continues the story, and so on, until the story ends.CHANGE THE ENDINGTell the children a story with a sad or unproductive ending. Now ask the children to sit ingroups and re-do the story with a positive and happy ending.GIVE THE ENDINGTell the children a story and do not provide the endLet children write their own endings and share their work with the groupFRIENDSHIP CIRCLESit in a circle and then take one person’s name and say five nice things about that person.Continue this till all children are covered.SUPPORT NETSAsk each child to make a drawing of his/her face and stick it on a big chart paper. Let allchildren stick the drawing of his/her face on the chart paper. This is the network of people thechildren in this group can rely on.DRAW IN PAIRSDivide the group into pairs. Give each pair a sheet of paper and a drawing matter.Ask the pair to draw a picture together without talking at all. Firstly, one person will draw anobject then pass the paper to the other who has to add something to the picture.FORWARD MOVING BOATPut up a picture of a boat and then ask the group to write on this boat all the things that arepositive in their life so that the boat can move forward after this event.ACT OF KINDNESSAsk the children to perform acts of kindness/good work during the week. At the end of theweek they have to share with the group the things that they did during the week.80 INFORMATION MANUAL 3: TSUNAMI PSYCHOSOCIAL CARE FOR CHILDREN

SAY NICE THINGSAsk the children to sit in a circle. Put names of all the children in a bag. As the bag is passeddraw out one name from the bag and then the child has to compliment the person.MATERIAL REQUIRED FOR A PLAY KITDifferent things need to be included in a play kit. You can add more, but the basic ones aregiven below:Family of dogs: To use for building up stories to play out family scenes symbolicallyA baby doll with a milk bottle: Play out caring relationshipsA box of miniature plastic animals: Ventilation and for developing an understandingA set of skittles or a hit-me doll: Take out their anger in an effective mannerA few cars: Play out real life scenesPlasticine or moulding clay: Creative work and expressions for ventilationPicture cards for story telling: Developing an understandingToy guns: ExpressionsDrawing material (Poster paints and brushes, paper, crayons, pencils, sharpeners,erasers): Expressions and creative work for ventilationGlue, scissors, coloured paper: Creative workKitchen utensils: Play out real life situationsDoctor set: Expressions and to play out caring relationships.Small plastic/paper boats, toy fishes: Expressions and ventilationTOT INFORMATION MANUAL - 1 81

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REFERENCES§ American Red Cross (2001). Helping young children cope with trauma, ARC 1303.From www.prepare.org/children/childrencope.htm§ Axline V M (1969), Play Therapy. Ballantine Books, New York§ Carrell, S. (2000). Group exercises for Adolescents: A manual for Therapists. SagePublications, Inc. New Delhi, India§ Children’s Resources Center. Disasters: Helping Children Cope. Fromwww.seattlechildrens.org/child_health_safety/pdf/flyers/ce395.pdf§ Cooperative Extension services. Michigan State University (1986). Children and death: Aguide for caring adults. From www.msue.msu.edu/msue/iac/disasterresp/FamilyIssues/E-1944.pdf§ Crisis Counseling Guide: Age related reactions of children to disasters (2001). Fromwww.omh.state.ny.us/omhweb/crisis/crisiscounseling3.html§ Dave, A.S. , Jadav, B.B., Sekar, K., Bhadra, S., Rajshekhar, G.P., Kumar, K.V.K., Murthy,R.S. (2003). Information Manual 3, Psychosocial Care for Children. Action Aid India§ DeBord, K. (1993). Disaster Recovery: Children’s Needs. From www.ces.ncsu.edu/depts/fcs/human/disint.html§ Disaster response: Facts for Families (2005). American Academy of Child and AdolescentPsychiatry. From www.aacap.org/publications/DisasterResponse/index.htm§ Ehrenreich, J.H. (2001). Coping with Disasters: A Guide Book to Psychosocial InterventionCenter for Psychology and Society, State University of New York. U.S.§ Erikson E H (1964), Childhood and society (2nd ed). New York. Norton§ Gardner R A (1993), Storytelling in Psychotherapy with Children. Jason Aronson§ Geldard K, Geldard D (1997), Counselling children. London Sage Publications§ Gershaw, D.A Children in Disasters. From www3.azwestern.edu/psy/dgershaw/lol/ChildDisaster.html§ Goldman, L. (2000). Life and Loss: A guide to help grieving children 2 nd Ed. AcceleratedDevelopment Inc. Philadelphia. U.S.§ Greca A.M.L. et al (2001). Helping children cope with disasters. University of Miami.§ Grotberg, H.E., (1995). A Guide to Promoting Resilience in Children: Strengthening theHuman Spirit. Bernard Van Leer Foundation, The Netherlands. From http://resilnet.uiuc.edu/library/grotb95b.html§ How to help a grieving child. From www.fernside.org/grownups/how.html§ Howley, R., Mangan,, M., Oplawski, K., Vogel, J. (1997). Building character and Communityin the classroom. Creative Teaching Press Inc. Cypress.§ Hurlock E B (1980), Developmental Psychology, A Lifespan Approach 5th ed. TataMcGraw Hill, New Delhi. IndiaTOT INFORMATION MANUAL - 1 101

§ Koger, D. (2001). Helping Children and Their Families Cope with Disasters; real wordsto help children cope with tragedy From www.msue.msu.edu/msue/cyf/disaster/realwords.html§ Landreth G L (ed) (1982), Play therapy: Dynamics of the process of counseling withchildren. USA: Charles C Thomas Publisher§ Linares, LO. (2004). Children’s resilience in the face of trauma, Vol 8 No 3. Child StudyCenter. From www.aboutourkids.org/aboutour/letter/janfeb04.pdf§ Moseley J (1996), Quality Circle Time in the primary classroom, L D A, U.K.§ National Association of School Psychologists. Children and Responding to NationalDisaster: Information for Teachers. From www.nasponline.org/NEAT/terror_eds.html§ National Institute of Mental Health (2001). Helping Children and Adolescents Cope withViolence and Disasters. From http://www.nimh.nih.gov/publicat/violence.cfm§ National Mental Health Information Center. Emergency Mental Health and TraumaticStress: Tips for Talking About Disasters. From www.mentalhealth.samhsa.gov/cmhs/EmergencyServices/after.asp§ Parthasarathy R, Bharat S, Kumar K V K, Sekar K, Girimaji S, Murthy R S (2001),Information Manual 3, Psychosocial Care for Children, A Manual for Teachers. ActionAid India§ Raphael, E., Newman, L. (2000). Disaster Mental Health Response Handbook. Centrefor Mental Health, NSW Health, Sydney, Australia§ Refugees Studies Centre, University of Oxford and UNICEF: Working with Children inUnstable Situations - A guiding manual for psycho-social interventions (Draft), 2002.§ Resources for Educators. From www.fernside.org/resource/educat.html§ Sanders, J.M. and Flynn, B.W (1994). Psychosocial Issues for Children and Families inDisasters: a guide for the primary care physician. American Academy of Pediatrics, ElkGrove Village, Il 60009-0927.§ Smith S C (ed) (1995), Interventions with Bereaved Children. Jessica Kingsley Publishers.U.K.§ Speier A H (2000), Psychosocial Issues for Children and Adolescents in Disasters, USDepartment of Health and Human Services§ Worden J.W. (1991). Talking to children about death. From www.hospicenet.org/html/talking.html§ Zubenk WN (ed) (2002), Children and Disasters: A Practical Guide to Healing andRecovery. Oxford University Press 2002. UKThe case stories have been taken from the field experiences of the Community Level Workers.102 INFORMATION MANUAL 3: TSUNAMI PSYCHOSOCIAL CARE FOR CHILDREN

WHAT WE KNOW...§ Intense emotional reactions in the face of these events are expected and normal.§ There is a trajectory of responses over time most often starting early and subsiding withinweeks and months. But for some people, the onset of responses may be delayed.In others, the reactions may become long-term leading to considerable disability.§ Responses will be highly individual in nature, often quite intense and sometimes conflictual.The vast majority of reactions are in the normal range and the intensity will diminish for mostpeople over time without the need for professional help. Support from family and friendsis critical . For some, however, the degree of exposure may lead to more serious andprolonged reactions.§ The range of feelings experienced may be quite broad. People may describe intensefeelings of sadness followed by anger. Others may eperience fearfulness and hypervigilanceto the environment among numerous other reactions.§ There may be temporary disruptions in normal coping mechanisms for many peopleand some may go on to develop problems with sleep, nightmares, concentration, intrusivethoughts and a preoccupation with reliving the events. These reactions are generally shortlived but if they persist, professional consultation should be sought.WHO, October 2001.TOT INFORMATION MANUAL - 1 103

WHAT CAN BE DONE ?§ Create opportunities for people to talk and share experiences in supportive groups.This is often done best in familiar surroundings such as religious places, schools orcommunity centers.§ Provide accurate and practical information especially concerning the larger recovery efforts.Special attention to the needs of relief applicants is necessary as relating to the rules andregulations of the relief organizations during the crisis can be overwhelming.§ Give particular consideration to the needs of special groups such as children, those whohave been most intensely exposed or had an history of previous events (exposure to trauma),rescue workers and people with pre existing mental health conditions.§ Children and adolescents will need the support of their caregivers. This support shouldreflect accurate concerns, and diminish any words or actions that would increase the child oradolescent’s anxiety. Caregivers should offer reassurance as to their presence andavailability during this time. Exposure to television, movies or printed matter that offers toographic depictions of the destruction or victims should be limited.§ A percentage of people, as high as 30%, who experience the most direct exposure to theevents may go on to develop more serious mental health concerns and should be referred forservices if they develop persistent issues.§ Overwhelming feelings are to be expected and can stress individuals, communitities andnations. There are many actions that canbe taken at the level of governments, internationalNGOs and local groups to appropriately and effectively support victims of such acatastrophe.WHO, October 2001.104 INFORMATION MANUAL 3: TSUNAMI PSYCHOSOCIAL CARE FOR CHILDREN