Evidence in Action

A quarterly research brief from the Center on Trauma and Children

Volume 1, Issue 1 
January 2013 

The Center on Trauma and Children (CTAC) is dedicated to the enhancement of the health and well-being of children and their families through research, service and dissemination of information about child abuse and trauma.

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Pandemic planning must address the psychosocial effects of pandemic disease and social distancing measures, particularly quarantine and isolation, to promote compliance and cooperation and minimize negative effects on children and families.
Pediatric Pandemic Planning & Response: A Social Behavioral Evaluation

Disasters, including pandemic events, can be traumatic for children, families and communities. As public health scientists project a major health related disaster within the next century, officials
prepare to implement disease containment strategies that while necessary may be unpleasant and uncomfortable. As Robert K. Merton (1936) warned, such rapid social action responses may result in unintended consequences of significance. Pandemic disaster is ripe for such unintended consequences, particularly for children.

 

The UK Behavioral Health Disaster Response Project (UKBHDRP), under the auspices of the Center on Trauma and Children, examined the responses of children, families, and professionals to the H1N1 pandemic of 2009-2010 and the 2003 SARS outbreak, and found evidence for Merton's assertions: Pandemic response activities may cause negative sequelae for children that can inhibit public health compliance, prolong disaster conditions and impair future psychosocial growth and development.

 

Methods: Using a mixed-methods approach, this international study explored the psychological, social and physical responses of 2608 children, parents, behavioral health and health care professionals and public health responders and policymakers to pandemic events and public health responses to pandemic in eight target sites throughout North America. Sites were identified using a "follow the virus" method based on pandemic pediatric mortality and morbidity rates. Surveys, focus groups and interviews allowed researchers to

identify the nature of the responses and significant variables. Content analysis of required State Plans and national, international and local pandemic response strategies informed the project on the understanding of, recognition of, attention to and preparation for these non-medical responses. Findings from surveys, interviews, focus groups and content analysis were synthesized into a set of evidence-based best practice strategies. These recommendations were field tested with national and international experts to determine the efficacy and validity of the guidelines, placing strong emphasis on the translational utility. A final set of Evidence-Informed Guidelines for Child-Focused Pandemic Planning and Response and a web-based training developed to reflect the findings and recommendations for use by public health, health care and behavioral health professionals resulted.

 

Findings: Pandemic health disasters create a number of negative psychosocial outcomes for children, families and the community: anxiety, confusion, depression, difficulties with child care or elder care, frustration at the pace of evolving knowledge and changing recommendations, contradictory messages, media hysteria, avoidance and stigmatization of the infected or exposed (including health care providers), mistrust of government and stress from changes in access to material resources, to name a few. These pandemic responses are similar to the psychological effects on children and families experiencing natural disasters. Findings from the UKBHDRP indicate that the experience of disease containment may be traumatic for children and families: post traumatic stress disorder criteria was met in 30% of isolated or quarantined children and 25% of isolated or quarantined parents in the study. Findings also indicate that few, if any, behavioral health supports were available to children and families who were required to quarantine or isolate. Few professionals recognized the need for such interventions, or know how best to provide them.  

  

Evidence in Action:

Pediatric Pandemic Behavioral Health Guidelines

 

Traumatic stress reactions, if untreated, can create severe and profound negative consequences, especially in children who may experience interruptions in normal psychological, emotional, social and physical development as a result. Parent anxiety, confusion and mistrust of messages may have serious implications for cooperation with public health recommendations during pandemic disasters, including social distancing and inoculation.

  

It is imperative that public health preparedness planning contain response strategies that efficiently and effectively address the psychological impact of pandemic and other health disasters on children and families. Such strategies include:

  • Local, state and federal infrastructure development to provide child-focused, interdisciplinary attention to behavioral health responses, including traumatic stress reactions, during public health disasters. The use of a Pediatric Boundary Spanner is proposed to improve the effectiveness of immediate response strategies by engendering maximum compliance and cooperation, facilitating communication between child-serving systems of care, mitigating unintended consequences, cataloging best practices, and being sensitive to the psychosocial as well as the medical needs of children and families.
     
  • Creation and adoption of a Pediatric-Focused Behavioral Health Module as part of state, local and federal pandemic plans. These modules should be available for advanced and just-in-time training for public health, health care and behavioral health professionals to promote child, family and community psychological well-being and enhance cooperation and compliance with disease containment strategies.  
     
  • Multimedia risk messages must be child-focused, parent-focused, and developmentally and culturally appropriate to promote cooperation with public health recommendations and provide critical information on psychosocial effects. Risk communication should promote strategies to include special populations and pediatric health providers as messages are crafted, disseminated and interpreted. 
     
  • Pediatric healthcare response should include brief screening tools for anxiety to identify those at risk of developing traumatic stress responses. Screening of children and parents experiencing quarantine or isolation should be routine and could be integrated into the electronic healthcare records system. A range of follow-up services and interventions following evidence informed protocols should be available in the community and known to providers in advance, including alternative service delivery approaches

    (i.e. telemedicine).

  • Professional Organization Standards for behavioral health professionals and pediatric mental health providers are needed to allow professional organizations to provide their membership with professional guidance on triage, screening, intervention, prevention and other issues related to child-focused pandemic planning and response. Such standards will improve the level of knowledge and skill, enhance public health response strategies, ensure consistent approaches across disciplines, and improve outcomes for children and families.  
     
  • Resiliency in children, parents and communities (and subsequent advancement of public health containment measures) will be promoted through the availability of comprehensive psychosocial supports before, during and after the pandemic event. Such measures include consistent and appropriate information and risk messaging, routine behavioral health screening and evidence-informed intervention, basic structural support and material provision, and psychosocial support to pandemic responders in meeting their personal and professional responsibilities.  

Conclusion: Traumatic stress responses to disasters can be serious and the impact of pandemic on children, families and communities warrants attention to minimize negative proximate and distal effects. Pandemic planning seeks successful and rapid disease containment, and strategies to secure such containment must consider the needs and unique circumstances of affected individuals.   Families who are anxious, depressed, experiencing traumatic stress reactions, confused, feeling mistreated or undervalued, and receiving a barrage of mixed messages, are not likely to be willing or able to   comply with public health recommendations no matter how necessary. Pandemic planning must address the potential psychosocial effects of pandemic disease and social distancing measures on children and families in order to ensure cooperation and compliance and mitigate any latent enduring negative effects on children.

Suggested citation: Sprang, G. & Silman, M. (2013). Pediatric pandemic planning and response: A social behavioral evaluation. Evidence in Action, 1(1).


Ginny Sprang, PhD, is the Executive Director of the Center on Trauma and Children and a professor at the University of Kentucky. Miriam Silman, MSW, is a Research Associate at the Center on Trauma and Children and Adjunct Faculty in the University of Kentucky College of Social Work.  

 

Funding for this project was provided by the Department of Homeland Security through the National Institute for Hometown Security. Resources and more information about the Behavioral Health Disaster Response Project are available at: http://www.uky.edu/CTAC/BHDRP