Whose Woods These Are

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I awoke to my first snow of the season dusting the rooftops, fence posts and trees of Malejovice. The woods called to me and so I donned hiking boots and set out over the fields to the forest. The snow sifted quietly, the mud of the unpaved road sucked at my feet and the utter silence filled my heart.

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Arriving in the forest felt like entering the haunts of Hansel and Gretel.  I stepped past the trickling brook and into the peace of the sheltering pine trees. The pine needles cushioned my steps and the trolling of birds and patter of melting snow the only sounds. i passed a fallen tree, it’s root system an earthy sculpture.  Pine cones and balsam branches decorated the forest floor.  Mossy tree stumps stirred memories of nature walks with my dad when I was very young. He used to point them out to me and tell me that they were fairy castles.

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I stood still and closed my eyes and listened. The first poem that I learned and memorized at age seven welled up from within.
“Whose Woods these are
I think I know.
His house is in the village though.
He will not mind me stopping here
To watch his woods fill up with snow.
My little horse must think it queer
To stop without a farmhouse near.
He gives his harness bells a shake
To ask if there is some mistake.
The only other sounds the sweep
Of easy wind and downy flake.
The woods are lovely dark and deep.
But I have promised to keep
And mikes to go before I sleep
And miles to go before I sleep.”
Robert Frost

Indeed I knew that friends and breakfast awaited. I reluctantly left the silence of the woods and headed back to the warmth of Malejovice over fields glistening in the melting snow.

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Over the River And through the Woods to the Czech Republic I Go

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I greatly anticipated my fourth visit to collaborate with the Klicek Foundation in the Czech Republic. The cold weather brings to mind the song from my childhood of traveling via horse and sleigh through the woods to grandmother’s house. For me, it meant taking a new route flying to Prague via a stop over in Zurich, which provided me with my first glimpse ever of the majestic Swiss Alps. I had no idea they covered such an expanse.

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Our adventures began immediately, as Jiri and Marketa Kralovec included me in some important errands along the way from Prague to their home in the small village of Malejovice.  The Klicek Foundation has secured a plot of land close to the Motol Hospital, on which they will build a new hostel for parents of sick children visiting Prague for specialized medical care. Our assignment for the day was to measure the distance between several trees and a wall, so that an engineer could design the parking lot to meet the requirements of the environmental council.

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And so, armed with measuring tape and a clipboard, we gathered the necessary measurements. We then wound through the city, making stops at two publishing companies and an electronics store, where we gained sustenance in a lovely cafe to tide us over before the hour long trip home to the village.

Molly the dog and the many cats greeted us, and there was hot homemade soup waiting on the stove and a crackling fire in the green ceramic fireplace. Having missed a night’s sleep on the plane, I was happy to fall into bed in the dark country night, and I slept deeply without remembering my dreams until rising early for a full day’s work the next morning.

The first scheduled event was a gathering of three schools that are housed in one building in Prague. There are two secondary schools, one for nursing and one for social work, and a college of nursing. The students came together in a chapel at the school of nursing Jana Paula 11, and we presented a workshop on the value of play and the psychosocial needs of children in hospitals. The room was jam packed with young people, and the more interactive we got, the more engaged they became.

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Following this seminar, I accompanied Jiri and Marketa to a city council meeting where they advocated for permission to build upon the plot. There are many steps to take before they can announce the council’s approval and begin fundraising for their project. A well known actor, David Vavra,  who also happens to be an architect, is designing the building.

Following a challenging meeting, we headed over to the famous Old Town Square, to the medieval building that houses the Skautsky Institute. There we hosted a gathering of hospital play specialists that also included the medical director of a hospital on the northern border, a book publisher, and a British law student studying abroad at the Charles University. We discussed the challenges facing the profession, many of which involved issues of racism regarding the care of Roma families. The thorough marginalization of the Roma leads to trust issues between the families and the staff. The play specialists often feel overwhelmed by the intersectionality of the many societal factors that impact the lives of Roma families.  They feel helpless in the face of such poverty and hopelessness.

The law student, of Roma heritage, adopted by a British family, is researching the educational inequities and racism that Roma children face in Europe. He hopes to champion their cause as he progresses in his profession. He had connected with me after reading my blog about the children of Chanov — such a small world after all

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Spotlight: Child Life Intern in Community-Based Practice

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This week, I will spotlight a Canadian career changer as a guest blogger.  Kim Zink is  currently completing her child life internship in a community-based practice with mentor, Morgan Livingstone, a CCLS based out of Toronto, Ontario. Kim left her position in the school board to focus and refine her scope of practice to assisting children and families facing challenging life events.   She sensed the need for more psychosocial supports and greater visibility of child life services in the Ottawa region. So, with the support of her husband, two children, and extended family, she is chasing her dream!

 

This internship has been the perfect fit for me.  My mentor has been working in her own practice for many years, so she has a broad network of community resources and wealth of knowledge in many areas including global health, retinoblastoma, and traumatic brain injuries. She also wrote an incredible parent guide for families affected by breast cancer (including metastatic disease).

 

My internship has been full and rich. My first rotation took place at the Shoe4Africa Children’s Hospital and the Sally Test Pediatric Centre in Eldoret, Kenya. Morgan has been developing a self-sustained child life program there for many years. It was invaluable to see the robust program which now includes a number of child life specialists, teachers, playroom monitors and child life assistants. The team endearingly refer to Morgan as  ‘ our mwalimu,’ which means teacher in Swahili. Morgan served as an example of how to be patient-centered and culturally sensitive in global healthcare, no easy task.

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While we were there, I was invited to sit in on an oncology meeting. It was deeply moving and inspiring to hear the doctors speak so highly of the child life staff to the families. The doctors spoke of being a team and that families should refer to child life with any questions about their child’s developmental, social and emotional needs. The child life team has built an advanced practice and a great interdisciplinary approach. Unfortunately, in some areas, the pain medications and ideal supplies are not available, so I had the opportunity to offer distractions through games on a tablet and meteor storm toy to bring the child’s  attention away from the burned areas and bandage changes during procedures. It was a proud moment for me when the doctor told me that the best bandage change a particular boy had ever had and that I was welcome back anytime.

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The hospital sees over 300 children every day, and sadly many of the children are not brought to the hospital until their illness has progressed to the palliative state. So we turned our focus to legacy building and adding quality to end of life.  One simple and inexpensive legacy activity that worked well was making a salt dough handprint for each family.

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During my second rotation, I relocated to Toronto to intern in Morgan’s local private practice. She sees a number of teen patients, which was a demographic I knew I needed more experience with. I discovered it’s key to listen carefully to their interests and then go home and study up on these interests to gain common ground for future conversation and show teens that you listen and care about what they have to say. So now I  know  more about the ins and outs of  making slime and the youtube channel, Simply Nailogical, than I ever thought possible. This research paved the way to building rapport and trust with one teen in particular. Showing interest in her interests was a great connector.

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My future work in child life has also be enhanced by working with my mentor on traumatic brain injury cases. I had the opportunity to see treatment plans, do home visits, sit in on team meetings, and understand the billing process through insurance providers. During a recent conference call, a teen’s mother said, “Things started to finally turn around when Morgan was added to the rehab team and started her sessions. She [the teen] found the tools and started to cope, she really improved with Morgan’s help.”

My latest adventure in my internship included a trip to Washington, DC for the One Retinoblastoma World Conference. I had the privilege of assisting Morgan with the child life programming, which included transformative literacy, medical play, and lots of activities with special eyes. It was great to see one child move from fear to familiarization with the sedation mask. Another child displayed new skills of mastery by using the medical doll to practice cleaning and adjusting an ocular prosthesis. Still another young child spoke openly about having a special eye, as he called it, for the first time. One of the teens overheard and said: “Me too, and I like to take mine out with a suction cup.” There is nothing like these spontaneous conversations to bring about that reassurance of ‘sameness” and soothe constant feelings of being different from everyone else.

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Above all, I will finish my internship with ample understanding of what it means to be an advocate for children. Morgan is a tireless champion for her patients, working to be sure they have everything, from a great relationship with their general physician to the correct supports from their school. She moves mountains to make sure the children and teens in her care have everything they need to be happy, healthy children. We need more child life specialists doing this work in the broader community.

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PS: Navigating independent and Canadian internship possibilities has its challenges. I highly recommend the Facebook group for ‘Child Life for Canadian Students’ and http://www.cacll.org/

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How to talk to kids about the Las Vegas mass shooting

 

I have no words, so today I reach to Katie Kindelan for hers. The following is reprinted from ABC News  website

By KATIE KINDELAN

Oct 2, 2017, 2:09 PM ET

 

When Vickie Nieto digested the news this morning that at least 58 people died in a mass shooting in Las Vegas, the first thing she thought about was what she would tell her two daughters, ages 10 and 14.

“My 10 year-old heard about it on the TV before school,” Nieto, of Land O’ Lakes, Florida, told ABC News. “I didn’t want to tell her about it because I didn’t want to scare her.”

Nieto said her fifth grade daughter is “already scared about school shootings because they have to practice for them at school.”

But this morning, many people like Nieto woke up to the news of a mass shooting at the Route 91 Harvest Music Festival in Las Vegas, where a gunman opened fire on a music festival crowd, starting just after 10 p.m. local time Sunday. At least 58 people were killed and 515 were injured.

In the wake of the shooting, the Las Vegas Police Department said authorities responded to a hotel room on the 32nd floor of the Mandalay Bay hotel, where police said the suspected gunman, 64-year-old Stephen Paddock, was dead. Police said they believe Paddock, of Mesquite, Nevada, killed himself prior to police entry.

Many parents and caregivers were faced with conversations about the mass shooting even before children left for school.

‘Parents should let their kids know that, ‘I’m here to answer any questions you may have, any worries you have we can discuss,”

For others, the conversation about the tragedy could begin when kids return from school, after they may have heard about the shooting from classmates or teachers.

“It’s important for parents to start the conversation,” said Robin Gurwitch, a psychologist at Duke University in Durham, North Carolina. “As much as we would like to wrap our arms around our children and try to keep anything bad from getting through, it’s unrealistic that we have that ability.”

Gurwitch, also a member of the National Child Traumatic Stress Network, said that the conversation parents have with children should be age-appropriate.

For children old enough to understand what happened, parents should focus on letting them know that they are not in specific danger.

“Help them understand that there was a shooting in Las Vegas and many families were out listening to music when somebody, for unknown reasons, started shooting people,” Gurwitch said. “And tell them that because the police responded so quickly [the suspected gunman] is no longer a threat.”

Dr. Lee Beers, a pediatrician at Children’s National Health System in Washington, D.C., said a tragedy does not have to be a trauma for children if it is “buffered by good, strong and caring relationships, by the adults around the child.”

She also recommends different responses for different ages, and individualizing the approach for each child.

Preschool age: This is a time when parents have a high level of control over what their children see and hear so it does not need to be brought up unless a child hears about it first. In that case, Beers recommends making sure the child knows you are there to answer any questions.

Elementary school age: This is an age when parents should preemptively help their child know about the tragedy and share basic details and leave the door open for them to ask questions, according to Beers.

Middle and high school age: Beers advises having a more detailed conversation with children. Start by asking questions like, “Have you heard about this?” and “What do you think about this?” to find out what they know and what may be bothering them.

In the Las Vegas shooting, videos taken by onlookers and shared on social media gave a glimpse of the chaos during and after the shooting.

“So hard to raise a child in this country these days,” posted one mom on Facebook. “There doesn’t appear to be anywhere that’s safe.”

Gurwitch said the visual aspect of the shooting should give parents even more of a reason to speak with their children openly and candidly, according to their ages.

“Parents should let their kids know that, ‘I’m here to answer any questions you may have, any worries you have we can discuss,’” she said. “Check in at the end of the day to see what their friends were talking about at school and what they saw on social media so they have an idea of where they’re starting from and how to continue the conversation.”

Seeing frightening images repeatedly can be traumatic for children, so talking about the images and limiting exposure to them can be important.

“Repeated exposure to viewings really does increase the stress and trauma in your emotions, in the way that you respond to it,” Beers said. “It’s very tempting to watch the coverage 24-7 so I think really self-limiting that is really important because that repeated exposure escalates the emotions and escalates the feelings.”

Nieto said she recognizes how upsetting the images on TV and social media can be.

“It’s terrifying for me and I’m an adult,” she said. “It’s very terrifying for kids to see it.”

“Acknowledge that there may be a little bit of extra help that is needed …

Nieto said she “always has conversations” with her daughters about tragedies like today’s, but is struggling for what to say in the wake of yet another shooting.

“This is very upsetting for them to have to hear about this again, because it happens all the time now,” she said.

Older children in particular may have concerns because the Las Vegas concert shooting happened so soon after the May 22 bombing at an Ariana Grande concert in Manchester, England, killed 22 and left more than 100 injured.

“Parents who are up front with their kids about these kinds of things, their kids tend to do better than parents who try to hide these things,” she said. “Talk about safety issues and what we do to keep our families safe, what we do to keep each other safe and what communities do to keep us safe.”

Both Gurwitch and Beers advised parents find ways they and their children can help those affected by the shooting, like first responders.

“Little children can draw pictures and older children or teens can write letters,” Gurwitch said. “Sending these to Las Vegas Police, EMS, Fire and/or local responders to thank them for what they do every day can help children feel that they have taken a positive action and the boost to responders is priceless.”

Nieto described one reaction she had to the shooting as being scared to “go anywhere” out in public.

“It terrifies me to even go to the store, especially with my children,” she said. “Because you never know who has a gun these days.”

Gurwitch shared language parents like Nieto can use to reassure both themselves and their children that it is safe to continue life as normal, while being alert to safety issues.

She recommends parents say something like: “I also know that there are a lot of people that this is their job to keep us safe, so I’m going to continue to do the things that we like.”

If parents and caregivers notice children are overly worried or having trouble focusing at school or at home, Gurwitch said to not delay in reaching out for help, and to have patience.

“Acknowledge that there may be a little bit of extra help that is needed with homework, care and attention around bedtime, and that’s true for younger children as well as teenagers,” she said. “If you don’t know what to do or what to say, there are people you can turn to ask what you can do for your child.”

Gurwitch and Beers recommend as resources for parents, the American Psychological Association, the American Academy of Pediatrics, school counselors, family physicians and local mental health counselors.

Child Life in Private Practice: Supporting Parents and Children through Medical Encounters

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Studies show that children who are prepared for medical procedures recover faster with less emotional stress. Even routine procedures such as vaccinations can cause children undue stress and lead to treatment noncompliance and avoidance of medical care. Children require developmentally appropriate information about what they will see, feel, hear, taste and smell that will prepare them without overwhelming them. Through hands on demonstration and guided play, I can prepare you and your child for medical encounters, and coach you both in coping strategies. Calm, informed parents are the best support for their children when facing routine and unexpected medical visits and hospitalizations.

I am pleased to announce the expansion of my private practice as a Child Life Coach on the upper east side in Manhattan. Child life specialists are trained in child development, education, anatomy, health care systems, family systems, ethnocultural issues, advocacy, and bereavement. In and out of hospitals, we help children and families prepare for and adjust to medical encounters by providing education, medical play, support,  coaching and advocacy.

Here are several of the services I offer to parents & schools:

  • Coaching and Support for Parents in::
    • how to prepare their cildren for medical events, from routine wellness appointments to surgery or long term treatment.

    • how to support siblings when a child is ill

    • how to support children through a parent’s serious illness.

    • Child centered play skills to caregivers who wish to connect more with children in this digital age.

    • In home preparation for elective medical, diagnostic, and surgical procedures.

    • Workshops: Please see my listing on Cottage Class Parents As Heroes: Supporting Children Through Medical Encounters
  • Professional Development: Training and Support for Teachers
    • How to support your class (school) when a student faces illness and loss

    • Child-centered play techniques

    • Emotionally responsive teaching

    • State mandated child abuse detection and reporting

  • Video Conference Consultation and Support
    • If traveling is an issue, I am available through video chat to support parents at a distance

More information about my practice can be found on my website at  debvilas.com, and please take the time to like my FaceBook page at Pediaplay

I greatly appreciate any referrals to parents and caregivers who need this kind of support. I can be reached at debvilasconsult@gmail.com

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All the best,

Deb

Deborah Vilas, MS, CCLS, LMSW

Follow me on Twitter:  @DeborahVilas at Twitter

CLC Video with Deb Vilas Appearance: That’s Child Life!

Child Life & Art Therapy in Disaster Shelters: The Humanity Factor

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During these recent days of hurricanes, tornados, fires and violence, it is hard to know in which direction to turn – what to focus on – where to put our energies. Fred Rogers taught us all to “look for the helpers”, and I always find that calming and inspiring, so I have decided to republish a piece that I cowrote with Tara Lynch Horan after we coordinated services at a shelter in NYC following Hurricane Sandy in 2012. It gives a taste of what child life specialists and art therapists can do to ease the suffering of children in times of upheaval.

In addition, tapping into our ability to BE the helpers can also assist us in making sense of tragedy. In this vain, I attended a training this past weekend given by  Children’s Disaster Services  in coordination with the Child Life Disaster Relief organization. It was empowering, and I highly recommend the training to anyone who wishes to volunteer to provide safe play opportunities for children following disasters. You can do this locally or be deployed to other states in the USA. And if you can’t lend a hand, donations to organizations like these can still make a difference and impact quality of life for children.

Here is the article reprinted from Vilas, D. & Lynch Horan, T. (2013). Trees, Houses and Sidewalk Cities: Child Life and Creative Arts Interventions at a Post-Sandy Shelter.  New York Association for Play Therapy Newsletter, January 2013, 16 (2).

“A phone call from a Naval Commander stationed at a shelter in  NYC sparked the —-  Shelter Creative Arts Therapy / Child Life Initiative Mission. Commander Moira McGuire headed up a mental health team at the shelter serving many families. As a behavioral health nurse, she saw the need for therapeutic activities for the approximately 50 children facing displacement and uncertainty. In response to her outreach, a consortium of Creative Arts Therapists and Child Life Specialists quickly assembled. Our goal was to provide therapeutic creative arts opportunities to children and families post Hurricane Sandy. We hoped to facilitate psychosocial coping and adjustment to the stress and potential trauma of the Hurricane experience and to the stressors of the shelter environment. The first team of volunteers that responded within 24 hours numbered 14 and included 11 child life specialists who were colleagues, alumni or current students from the Bank Street College of Education, along with two art therapists and one dance and movement therapist.

We would like to share some of the techniques that we employed successfully during the two weeks that the shelter was in operation. Leyla Akca, an art therapist, brought paper shopping bags in on that first day. She led children in an activity that explored the “stuff “we carry with us daily, and the invisible stuff we carry on the inside no matter where we are. It was a powerful metaphor, and the children took to it eagerly, decorating their bags with many open-ended materials. Leyla had previously participated in disaster relief in Turkey following earthquakes there. She had a lot of wisdom to share with us all, and her activity gave us focus and purpose.

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Maryanne Verzosa, a child life specialist from St. Lukes Roosevelt Hospital, supplied found objects from nature, which included sticks and twigs. As she gathered children in a circle sitting on the floor of the shelter, the children spontaneously created three-dimensional houses out of the materials. One child presented his stick house to his uncle, saying, “This is for you because you lost your house.” Commander McGuire had asked us to bring sidewalk chalk with us, as the children had access to an outdoor patio. Her instincts were perfect. A six year-old boy spent all afternoon creating a chalk city of roads, “for the children”, and buildings. We provided the child with miniature buildings and figures for his chalk city, and the play continued and drew other children into its circle.

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One of the final activities took place during the last day when families were moving out of the shelter, many of them to hotels. Tara Lynch Horan, a child life specialist, worked with several art therapists on a community project of building a mural tree and decorating it with leaves representing what families leaned on during Sandy‟s aftermath. The art therapists worked with the children creating the tree, while Tara went from cot to cot, engaging parents in depicting their resiliency factors on precut leaves made from construction paper.

The collaboration of Child Life and Creative Arts Therapists brought about many therapeutic moments for these children and families. The activities employed a variety of directive and open-ended techniques. As we would expect, the children and parents created their own meaning and healing. All they needed was the time, space, materials and gentle encouragement from trained therapeutic agents. Humanity at its best.”

Why Aren’t We Preparing Kids for Disaster

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Beal_Photo_sm Guest Blogger Heather Beal is a military veteran with 23 years of crisis management and operational planning experience that she draws upon daily in her battle to raise two well-prepared, happy, curious, and intelligent children. As a trained emergency manager and parent, she saw the need to provide age-appropriate disaster preparedness information to young children in a way that empowered rather than frightened them. She is currently writing additional books to cover a greater spectrum of potential disasters children may face.

“Generally speaking, we do not prepare our children for disaster. We make them hold our hand in the parking lot and talk about the dangers of getting burned by the stove, but we stop short of this really big “disaster” word. When I think about it, I can come up with a few excuses we call reasons as to why we don’t give this topic the attention that we should.

First, like our children, (but usually without donning the superhero capes and masks), we believe that we are invincible. It (the disaster) can’t happen to ‘us,’ it only happens to ‘others.’ Folks – look at Hurricane Harvey, Superstorm Sandy, Hurricane Katrina, the Indian Ocean Tsunami, and any other number of disasters. With that many people affected – the ‘us’ and the ‘others’ are the same people. We need to look at disaster as a probability, not a possibility.

Second, we think talking about disaster will be too scary. I get it. No one wants to tell children anything bad could happen. We all know our children could get terribly hurt running if hit by a car in the parking lot, but we don’t get into explicit details about injury and death. We do however, talk to them about being safe, making good choices, and not doing things that could more likely result in their getting hurt.

We should approach talking about disaster in the same way we approach other learning topics or the consequences of actions or inaction. We don’t need to focus on the destruction a tornado can cause, how their lives could be uprooted, or what other things could dramatically change. We can however, talk about what children need to do to stay as safe as possible.

There are no guarantees in life for anything. We can’t guarantee that a car in the parking lot won’t do something stupid, just as we can’t guarantee the tornado will miss a child’s house, school, or childcare. But we, as parents, as childcare providers, as educators, as caregivers, as emergency managers, and as community members, can arm our children with the tools to succeed. We owe them that.

Sounds good – but how would I know, right? Fair question. A few years ago I tried to explain to my then 4-year old daughter that she and her brother might be woken up in the middle of the night to go into the basement if there was a tornado warning. Of course, it was already dark and stormy (thunder and lightning and everything). Needless to say, I did a very poor job, ultimately scaring her and beating myself up about my failed attempt to mitigate later fear through a botched explanation. Never again I vowed.

That was when I discovered that almost no one was having the conversation with young kids (toddler, preschool, or kindergarten) about disaster. At the same time, I realized that disaster was not going to sit by patiently and wait until my children could calmly and rationally discuss everything at a grown up level. I decided I could develop a way to talk with them in a way that didn’t scare them, but instead empowered them by teaching them what to do and giving them back a little control in a typically uncontrollable situation. They might not be able to stop the disaster, but they could do something to increase their safety within it.

I started Train 4 Safety Press to develop picture books that would teach children what to do “if.” As I conducted research, I discovered a few books out there on the science of disaster, but almost none that taught young children what to do when the disaster was happening. Our first book Elephant Wind tackles what to do during a tornado. Tummy Rumble Quake teaches children about the Great ShakeOut™ and earthquake safety.

Children have a great capacity for building their own resilience. Teaching them how to protect themselves can have an exponential effect. Children could not only help themselves, they could help their classmates, their teachers, their family and their community. Isn’t anything that increases the odds we bring our children home after a disaster worth it? Can we afford not to talk about it?”

And here is a great resource: National Child Traumatic Stress Network

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