COMMENTARY |
In Times of Crisis, What’s a Pediatrician to Do?
Department of Pediatrics
Yale University School of Medicine
New Haven, CT 06520-8064
Pediatricians have always helped children and their families at times of greatest need. The terrorist attacks that began on September 11 provide an unprecedented challenge—and opportunity—for the pediatric community to continue this tradition.
We must first acknowledge that we have been, and will continue to be, impacted directly—and uniquely—by these events and their aftermath. Although at one level, this is a shared experience, it is fundamentally a very personal one. If we feel overwhelmed or disempowered, we may deny or even fail to see many of the problems. If instead we see, even in the setting of a crisis, opportunities to help children and families, we will actively seek out ways to provide such assistance.
An organized crisis response requires: plans for optimizing physical safety and security, rapid dissemination of accurate and appropriate information, and attention to the psychological and emotional impact of the events and the crisis response. For any one of these components to be addressed effectively, all 3 must be dealt with simultaneously and in a coordinated manner. We must remember that the primary goal of terrorist attacks is to create a sense of terror—-any response to terrorism that fails to address the psychological and emotional impact is thereby fundamentally flawed. The American Academy of Pediatrics is working with national leadership to develop response plans that anticipate the unique medical needs of children in a range of potential crises, and rapidly disseminating information for families and pediatricians through its Web site (www.aap.org) and public media, while maintaining a focus on psychological and emotional issues.
Mental health problems are highly stigmatized in our country, and even in times of national crisis, stigma persists as a formidable barrier to seeking traditional mental health care. We need to help families realize the important question is not whether they or their children need counseling, but whether they might benefit from it. Access to quality mental health services for most children in the United States was sorely lacking before September 11, and will likely continue to be, unless we make fundamental changes to the way we support mental health services.
It is important to develop alternative models for providing trauma-related supportive care. Pediatricians can work with schools and local agencies to facilitate the early identification of adjustment reactions and the provision of supportive services in community sites such as schools. Psychoeducational services can be delivered within schools, other community sites, and pediatric practices (examples of parent education materials can be found at www.nccev.org and www.aap.org). Pediatricians can play a key role in promoting the development of school crisis response plans to prepare for future crisis events.
Within months and even weeks of September 11, many children and adults seemed to become disinterested with the crisis and ongoing war. Much of the apparent disinterest likely comes from a sense that there is little we can do to improve the situation. Children also pick up readily on cues from adults when adults are uncomfortable talking about such difficult topics. Children may interpret the discomfort of adults as a sign that their questions are inappropriate and assume it is best not to pose such questions again. The silence that results is not an indication that children are too young to be aware of or to understand what has occurred, nor that they are ready to end the discussion. Adults may wish to believe that children were not impacted by the recent and ongoing events, but this represents more of a wish than reality.
The evolving crisis will challenge each of us in our personal lives and in our professional roles. Although we cannot predict particular crisis events, we can anticipate that crises will occur and do our best to put into place effective crisis response systems. Pediatricians should derive some comfort from the fact that there is much we can do, individually and collectively, to improve the lives of children and families during these difficult times and to advocate for and participate in the development of an infrastructure to respond more effectively in future crisis situations.
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FOOTNOTES |
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Received for publication Nov 29, 2001; Accepted Dec 3, 2001.
Reprint requests to (D.J.S.) Department of Pediatrics, Yale University School of Medicine, 333 Cedar St, Box 208064, New Haven, CT 06520-8064. Email: david.schonfeld{at}yale.edu
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REFERENCE |
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 TOP REFERENCE |
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- Schonfeld D. School-based crisis intervention services for adolescents: position paper of the Committees on Adolescence and School Health, Connecticut Chapter of the American Academy of Pediatrics.
Pediatrics.1993; 91
:656
–657
[Abstract/Free Full Text]
PEDIATRICS (ISSN 1098-4275). ©2002 by the American Academy of Pediatrics
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