Early Childhood Trauma

People often say that 'children are so resilient,' which may be accurate, but only when given the necessary resources and support. We will look at adverse childhood experiences (ACEs) and their effects on children, youth, and the adults they become. We will also look at why Indigenous children and youth are overrepresented in Canada's foster system and the difficulties surrounding 'aging out' of the foster care system. Then, we will explore the world's aging population and the challenges older individuals face in their 'golden years.' Lastly, we will examine the many issues of homelessness and how individuals without a home and family support can still find the strength to carry on, be resilient, and have hope for a better future. Childhood Trauma Child trauma refers to a scary, dangerous, violent, or life-threatening event that happens to a child (0-18 years of age). This type of event may also happen to someone the child knows, and the child is impacted by seeing or hearing about the other person being hurt or injured. For more than a decade, the state of childhood in Canada has declined. Canada ranks 30th out of 38 affluent nations for protecting the well-being of children, according to UNICEF –a significant drop from 12th place in 2007. As a country, we have been going in the wrong direction for far too long. (Raising Canada, 2020) • The statistics are alarming: One-third of children in Canada do not enjoy a safe and healthy childhood, one in three Canadians report experiencing abuse before the age of 15, one in five children live in poverty, and suicide is now the leading cause of death for children aged 10 to 14. (Raising Canada, 2020) • Childhood is threatened for millions of children from all walks of life, but the odds are particularly stark for Black, Indigenous (First Nations, Métis and Inuit) and other racialized children. Systemic racism impacts children in many ways: they are more likely to experience adverse childhood experiences such as poverty and abuse, are more likely to be overrepresented in the child welfare and juvenile justice systems, and are more likely to be suspended or expelled from school. (Raising Canada, 2020) Types of Child and Youth Trauma When a child or youth feels intensely threatened by an event they are involved in or witnesses, we call that event a trauma. There is a range of traumatic events or trauma types to which children and adolescents can be exposed. Sadly, the list of traumatic events that children and youth may experience is a long one. Let's look at each of these trauma categories briefly. Early Childhood Trauma – Early childhood trauma generally refers to the traumatic experiences that occur to children aged 0-6. Because infants' and young children's reactions may differ from older children's, and because they may not be able to verbalize their reactions to threatening or dangerous events, many people assume that young age protects children from traumatic experiences. A growing body of research has established that young children may be affected by events that threaten their safety or the safety of their parents/caregivers, and their symptoms have been well documented. These traumas can be the result of intentional violence—such as child physical or sexual abuse or domestic violence—or the result of natural disasters, accidents, or war. Young children also may experience traumatic stress in response to painful medical procedures or the sudden loss of a parent/caregiver. Intimate Partner Violence – Intimate Partner Violence (IPV), also referred to as domestic violence, occurs when an individual purposely causes harm or threatens the risk of harm to any past or current partner or spouse. While abuse often occurs as a pattern of controlling and coercive behaviour, an initial episode of abuse may also be cause for concern. Tactics used in IPV can be physical, sexual, financial, verbal, or emotional against the partner. Individuals may also experience stalking, terrorizing, blame, hurt, humiliation, manipulation, and intentional isolation from social support and family. IPV can vary in frequency and severity. Children are often the hidden or silent victims of IPV, and some are directly injured, while others are frightened witnesses. Children with IPV exposure are more likely to have also experienced emotional abuse, neglect, physical abuse, and community violence. Medical Trauma – Pediatric medical traumatic stress refers to a set of psychological and physiological responses of children and their families to pain, injury, serious illness, medical procedures, and invasive or frightening treatment experiences. Medical trauma may occur as a response to a single or multiple medical events. Physical Abuse – Physical abuse is one of the most common forms of child maltreatment. Legal definitions vary from state to state, but broadly, physical abuse occurs when a parent or caregiver commits an act that results in bodily injury to a child or adolescent, such as red marks, cuts, welts, bruises, muscle sprains, or broken bones, even if the injury was unintentional. Bullying – Bullying, also known as peer victimization, is a deliberate and unsolicited action that occurs with the intent of inflicting social, emotional, physical, and psychological harm to someone who is often perceived as being less powerful. Bullying typically happens repeatedly and is a form of aggression and harassment that prevents someone from enjoying a safe, stress-free living, learning, or working environment. The harmful effects of bullying may be exacerbated by the frequency, pervasiveness, and severity of the behaviour, as well as the power differential between the perpetrator and the target. Bullying can be physical (hitting, tripping, kicking, etc.), verbal (name-calling, teasing, taunting, threatening, and sexual comments), and social (spreading rumours, embarrassing someone in public, being purposefully exclusive). Cyberbullying includes sending negative, harmful, and false content electronically via text messages or email, as well as posting mean text or hurtful pictures online through social media, blogs, etc. Sexual Abuse – Child sexual abuse is any interaction between a child and an adult (or another child) in which the child is used for the sexual stimulation of the perpetrator or an observer. Sexual abuse can include both touching and non-touching behaviours. Non-touching behaviours can consist of voyeurism (trying to look at a child’s naked body), exhibitionism, or exposing the child to pornography. Children of all ages, races, ethnicities and economic backgrounds may experience sexual abuse. Child sexual abuse affects both girls and boys in all kinds of neighbourhoods and communities. Terrorisms and Violence – Families and children may be profoundly affected by mass violence, acts of terrorism, or community trauma in the form of shootings, bombings, or other types of attacks. The impact will vary depending on the nature of the event and the experiences of children and families during and afterward. Some adults and children may have been physically injured and will require medical treatment and long-term rehabilitation. Some may worry about the safety of family members and friends or need to adjust to the death of a loved one. Children and teens may react differently depending on their age and prior experiences. How long it takes to recover depends on what happened to each child and family. Over time, many will return to regular routines, while others may struggle. It is essential to be supportive and understanding of different reactions. Refugee Trauma – Many refugees, especially children, have experienced trauma related to war or persecution that may affect their mental and physical health long after the events have occurred. These traumatic events may occur while the refugees are in their country of origin, during displacement from their country of origin, or in the resettlement process here in Canada. Traumatic Grief – While many children adjust well after death, other children have ongoing difficulties that interfere with everyday life and make it difficult to recall positive memories of their loved ones. A child may have a traumatic reaction after a death that was sudden and unexpected (e.g., through violence or an accident) or a death that was anticipated (e.g., due to illness). If the child’s responses are severe or prolonged and interfere with their functioning, the child may be experiencing Childhood Traumatic Grief. Community Violence – Community violence is exposure to intentional acts of interpersonal violence committed in public areas by individuals who are not intimately related to the victim. Common types of community violence that affect youth include individual and group conflicts (e.g., bullying, fights among gangs and other groups, shootings in public areas such as schools and communities, civil wars in foreign countries, or “war-like” conditions in Canadian cities, spontaneous or terrorist attacks). Although people can anticipate some types of traumatic events, community violence can happen suddenly and without warning. Consequently, youth and families who live with community violence often have heightened fears that harm could come at any time and experience the world as unsafe and terrifying. In addition, although some types of trauma are accidental, community violence is an intentional attempt to hurt one or more people. It includes homicides, sexual assaults, robberies, and weapons attacks (e.g., bats, knives, guns). Sex Trafficking – Child sex trafficking involves the giving or receiving of anything of value (money, shelter, food, clothing, drugs, etc.) to any person in exchange for a sex act with someone under the age of 18. Sex trafficking is experienced by children of all ages, races, and socioeconomic circumstances and occurs in urban, suburban, and rural communities, land-based nations, and other tribal communities. Children who are trafficked in Canada may be Canadian citizens or children who are brought to Canada from other countries. Disasters – Natural disasters include hurricanes, earthquakes, tornadoes, wildfires, tsunamis, floods, and extreme weather events such as blizzards, droughts, extreme heat, and wind storms. These events can lead to many adversities for children and families, including displacement, loss of home and personal property, changes in schools, economic hardship, loss of community and social support, and even the injury and death of loved ones. Complex Trauma – Complex trauma describes both children’s exposure to multiple traumatic events—often of an invasive, interpersonal nature—and the wide-ranging, long-term effects of this exposure. These events are severe and pervasive, such as abuse or profound neglect. They usually occur early in life and can disrupt many aspects of the child’s development and the formation of a sense of self. Since these events often occur with a caregiver, they interfere with the child’s ability to form a secure attachment. Many aspects of a child’s healthy physical and mental development rely on this primary source of safety and stability. Adverse Childhood Experiences (ACEs) Adverse childhood experiences encompass various forms of physical and emotional abuse, neglect, and household dysfunction experienced in childhood (0-18 years). ACEs have been linked to premature death as well as to various health conditions, including those of mental illness and substance use problems in adulthood. ACEs can also negatively impact education, job opportunities, and earning potential in adulthood. Let's look at what events are considered Adverse Childhood Experiences (ACEs). The ACEs Study In 1985, there was a study conducted by Dr. Felitti at a weight loss in San Diego, California. All participants of the weight loss clinic were hundreds of pounds overweight and had gained much of their weight over a short period. Despite their success, many participants quit the weight loss program despite losing significant amounts of weight. The researchers were perplexed by this and decided to interview the participants to understand what was happening to these individuals. Over the next five years, the researchers then studied 50,000 participants annually regarding how physical, sexual, and emotional abuse, physical and emotional neglect, and household dysfunction impacted a person’s physical health. Below is the list of risk factors associated with a higher ACE score. The Adverse Childhood Experiences (ACEs) Questionnaire The ACEs Questionnaire (Felitti et al., 1998) is a 10-item measure of childhood trauma. The questionnaire assesses ten types of childhood trauma measured in the ACE Study. Five are personal: physical abuse, verbal abuse, sexual abuse, physical neglect, and emotional neglect. Five are related to other family members: a parent who’s a person with alcoholism, a mother who’s a victim of domestic violence, a family member in jail, a family member diagnosed with a mental illness, and the disappearance of a parent through divorce, death or abandonment. Take the test below to determine your ACE score. For each "yes" answer, score one point. As your ACE score increases, so does the risk of disease and social problems. An ACE score of 3 or more is considered high. QUESTION ANSWER Prior to your 18th birthday: 1. Did a parent or other adult in the household often or very often… Swear at you, insult you, put you down, or humiliate you? or Act in a way that made you afraid that you might be physically hurt? Yes = 1 point No = zero 2. Did a parent or other adult in the household often or very often… Push, grab, slap, or throw something at you? or Ever hit you so hard that you had marks or were injured? Yes = 1 point No = zero 3. Did an adult or person at least 5 years older than you ever… Touch or fondle you or have you touch their body in a sexual way? or Attempt or actually have oral or anal intercourse with you? Yes = 1 point No = zero 4. Did you often or very often feel that no one in your family loved you or thought you were important or special? or Your family didn’t look out for each other, feel close to each other, or support each other? Yes = 1 point No = zero 5. Did you often or very often feel that … You didn’t have enough to eat, had to wear dirty clothes, and had no one to protect you? or Your parents were too drunk or high to take care of you or take you to the doctor if you needed? Yes = 1 point No = zero 6. Was a biological parent ever lost to you through divorce, abandonment, or other reasons? Yes = 1 point No = zero 7. Was your mother or stepmother: Often or very often pushed, grabbed, slapped, or had something thrown at her? or Sometimes, often, or very often kicked, bitten, hit with a fist, or hit with something hard? or Ever repeatedly hit over at least a few minutes or threatened with a gun or knife? Yes = 1 point No = zero 8. Did you live with anyone who was a problem drinker or alcoholic or who used street drugs? Yes = 1 point No = zero 9. Was a household member depressed or mentally ill? or Did a household member attempt suicide? Yes = 1 point No = zero 10. Did a household member go to prison? Yes = 1 point No = zero ACEs Score So, if you add up all of your 'yesses' from the questions asked above, you've got your ACE score. Now what? The ACEs Study is important because it found links between childhood trauma and long-term health, behaviour, and social consequences among adults. But remember that the ACE score isn't a crystal ball; it's just meant as guidance. It tells you about one type of risk factor among many. It doesn't directly consider your diet or genes or whether you smoke or drink excessively — just a few other significant influences on health. Remember this, too: ACE scores don't tally the positive experiences in early life that can help build resilience and protect a child from the effects of trauma. Having a grandparent who loves you, a teacher who understands and believes in you, or a trusted friend you can confide in may mitigate the long-term effects of early trauma, psychologists say. Below are the behaviours and the physical and mental health conditions linked to a higher ACE score. Protective Childhood Experiences (PCEs) In the last few years, researchers have started to examine the impacts of positive childhood experiences (PCEs) on children and adults. In 2019, a team of researchers — Dr. Christina Bethell, Jennifer Jones, Dr. Narangerel Gombojav, Dr. Jeff Linkenbach, and Dr. Robert Sege — found a dose-response association between positive childhood experiences and adult mental and relationship health among adults who had experienced ACEs, irrespective of how many ACEs they had. This means that it’s essential to have positive childhood experiences, no matter how much adversity you have. And if you have a lot of adversity and a lot of positive childhood experiences, you are less likely to suffer the consequences of ACEs. However, if you have no positive childhood experiences and few ACEs, the implications of the ACEs are more likely to appear. Protective factors can be at the individual, family, and community levels. Protective Factors Individual and Family Protective Factors: Families who create safe, stable, and nurturing relationships, meaning children have a consistent family life where they are safe, taken care of, and supported Children who have positive friendships and peer networks Children who do well in school Children who have caring adults outside the family who serve as mentors/role models Families where caregivers can meet the basic needs of food, shelter, and health services for children Families where caregivers have college degrees or higher Families where caregivers have steady employment Families with strong social support networks and positive relationships with the people around them Families where caregivers engage in parental monitoring, supervision, and consistent enforcement of rules Families where caregivers/adults work through conflicts peacefully Families where caregivers help children work through problems Families that engage in fun, positive activities together Families that encourage the importance of school for children Community Protective Factors: Communities where families have access to economic and financial help Communities where families have access to medical care and mental health services Communities with access to safe, stable housing Communities where families have access to nurturing and safe childcare Communities where families have access to high-quality preschool Communities where families have access to safe, engaging after-school programs and activities Communities where adults have work opportunities with family-friendly policies Communities with solid partnerships between the community and business, health care, government, and other sectors Communities where residents feel connected to each other and are involved in the community Communities where violence is not tolerated or accepted Foster Care Foster children in Canada are known as permanent wards (crown wards in Ontario). 'A ward' is someone, in this case, a child, placed under the protection of a legal guardian and is the government's legal responsibility. There are approximately 78,000 kids in care across the country. The majority of foster children – 29,590, or about 62% – were aged 14 and under. The wards remain under the government's care until they "age out of care." This age is different depending on the province. Indigenous Children and Youth in Foster Care In Canada, under 10 percent of children are Indigenous, yet they represent over half of the children in foster care, according to the 2016 Canadian Census. This situation continues to worsen today. In March 2020, 69% of children and youth receiving services in care were Indigenous, although Indigenous children only make up approximately 10% of the child population (ages 0-18) in Alberta. The reasons for this heartbreaking statistic are complex and multifaceted; however, "The reasons why Indigenous kids go into foster care are driven by poverty, poor housing, substance misuse, and mental health and domestic violence, due to the multi-generational trauma of residential schools," says Blackstock, the executive director of the First Nations Child and Family Caring Society of Canada. Let's take a look at why indigenous children and youth are overrepresented in Canada's foster care system. Ageing out of Foster Care In most jurisdictions, a child can be a ward up to age 18, when they “age out” of the system. At that point, many provinces offer certain provisions to former wards—a topped-up welfare cheque, ongoing meetings with a care worker, support for post-secondary education, or therapy. But at a certain point, often at age 24, that disappears, and former wards are on their own. In the spring of 2020, the current Alberta UCP Government dropped the maximum eligibility age for these benefits from 24 to 22, affecting over 500 young Albertans. Typical outcomes for youth who age out of care include low academic achievement, unemployment or underemployment, homelessness and housing insecurity, criminal justice system involvement, early parenthood, poor physical and mental health, and loneliness. Building Resilience in Children and Youth We tend to idealize childhood as a carefree time, but youth alone offers no shield against the emotional hurts, challenges, and traumas many children face. Children can be asked to deal with problems ranging from adapting to a new classroom or online schooling to peer bullying or struggles at home. Add to that the uncertainties that are part of growing up in a complex world, and childhood can be anything but carefree. The ability to thrive despite these childhood challenges arises from resilience skills. Building resilience—the ability to adapt well to adversity, trauma, tragedy, threats, or even significant sources of stress—can help our children manage stress and feelings of anxiety and uncertainty. Demographic Ageing Demographic ageing is a country's population distribution shift towards older ages. It is usually reflected in an increase in the population's mean and median ages, a decline in the proportion of the population composed of children, and a rise in the population of older people. Population ageing is widespread worldwide and most advanced in highly developed countries. Still, it is growing faster in less developed regions, which means that older persons will be increasingly concentrated in the world's less developed areas. Population ageing arises from two possibly related demographic effects: increasing longevity and declining fertility. Geriatric Mental Health Mental health problems are common among seniors and may include isolation, affective and anxiety disorders, dementia, and psychosis, among others. Many seniors also suffer from sleep and behavioural disorders, cognitive deterioration, or confusion states as a result of physical disorders, medications, and surgical interventions. Undertreated Mental Health Issues Seniors are often undertreated for mental health problems. The Canadian Mental Health Association (CMHA) has determined some reasons why this may be the case, including: Symptoms can be mistaken for other conditions: Many seniors have multiple health problems. It’s sometimes difficult to tell the difference between signs of physical and mental illness. Also, symptoms of mental illness may look different in older adults. Discrimination and stigma: Some people are unwilling to ask for help for fear of what others think and how they may be treated. There are still many negative and mistaken attitudes around mental illness that fuel discrimination and stigma—and make it harder to reach out for help. Believing it is too late in life to make changes: Seniors, family members, and others can believe it is too late to do anything about poor mental and physical health in older age. It is never too late! Physical and financial challenges: Getting to treatment can be challenging for many older people with mobility issues. So is the cost of treatment. Not all mental health services are publicly funded. Seniors without private insurance may be unable to pay for services that aren’t covered. Service availability: Everyone’s treatment needs are different, and sometimes, the right services and community support aren’t available when people need them. Early Warning Signs of Mental Illness to Watch for in Older Adults If you know a senior who is exhibiting any of the symptoms listed below, encourage them to reach out to a professional who can help diagnose and treat mental illness. Some seniors may be reluctant to seek help independently, making it essential that you are there to support and encourage their treatment. Let's look at some indications that a senior may need additional mental health support. Memory Issues – Memory issues are incorrectly considered a normal part of the aging process by many, which causes mental illnesses to go often unrecognized until they have advanced significantly. Memory problems can be a warning sign of mental illnesses such as Alzheimer’s and dementia in older adults. Signs of this memory loss may include misplacing belongings, repeatedly asking for the same information or forgetting important dates. Changes In Personal Care – Often, a person with mental health issues will stop adhering to their regular personal care routines. A noticeable change in appearance might signify that a person cannot successfully stick to their former routines related to personal appearance. While this will look different for everyone, changes in personal appearance that may be a sign of a mental illness include forgoing bathing or skipping previously standard individual care tasks, such as applying makeup. Social Withdrawal – Individuals who have mental illness often become socially withdrawn. Notice your loved one losing interest in activities they used to be excited about or avoiding regular social engagements. It may be because they are suffering from a mental health issue that makes these things difficult. For example, they may blow off weekly card games with their friends because they struggle to remember how to play. Changes in Mood – A change in disposition often accompanies mental illnesses, such as depression and Alzheimer’s. Your loved one may go from carefree to anxious, upbeat to depressed, or confident to confused. If these mood changes last more than a couple of weeks, a more severe cause may be driving their altered personality. Poverty in Older Adults The poverty rate among Canadian seniors is one of the lowest in the world. Five percent live below Statistics Canada’s low-income cut-offs and 7.2 percent below the Organization for Economic Co-Operation and Development (OECD) poverty measure. Among the Canadian seniors who do live in poverty, 80 percent are single, and 75 percent of those who are single are women. The leading cause of poverty among single seniors is the drop in benefits for the surviving spouse when the primary income earner dies. Benefits can shrink significantly if the surviving spouse has not worked. Older adults with a lower income are less likely to be physically active, less likely to access preventative health services, and more likely to engage in unhealthy behaviours, which results in higher healthcare costs. The Cost of Poverty on the Aging Generation Poverty impacts the overall health and well-being of older individuals in this country and could contribute to longevity and lifespan in those with chronic conditions. Seniors need to talk with practitioners in their area to pinpoint resources to augment their existing medical coverage and increase their access to available services. Some things that impact the overall health of seniors living in poverty include: Access – Money may not buy happiness, but it can improve access to healthcare, services, and providers. For those lacking financial resources, different approaches are available through local, provincial, and federal government programs. Preventative Care – When someone lives in poverty, there may be some deficiencies in preventative care. A lack of resources could lead to seniors not engaging in health promotion activities and delaying medical treatment, impacting the practicality of the diagnosis and treatment options. This could exacerbate a chronic condition or cause complications later. Nutrition – If an individual has to choose between rent and groceries or can’t afford healthy, nutritious food, their health may be affected. Good nutrition and adequate vitamins can help prevent many medical issues and problems from an imbalanced or unhealthy diet. Food programs are available in many regions to supplement the daily nutrition of seniors in their jurisdiction; this might be something your provider, practitioner, or caregiver can assist with. Stress – Face it: money can cause stress, and a lack of money for bills, food, or everyday expenses can wreak havoc on anyone with or without pre-existing medical issues. Money is the primary cause of stress in over 70% of reported cases. Stress can exacerbate and perpetuate many severe health risks, from insomnia and mood disorders to stroke and heart attack. Some ways to help put seniors’ minds to ease a bit when money has them down include these suggestions: Try talking to them openly, but don’t lecture or shame them regarding money. Remind them that most people struggle with finances, so they are not alone. Bring a few groceries or things you know your senior will use rather than offering money, which could hurt their pride. Reassure them that their needs will be met. Fear and worry can turn into depression. Ask the senior’s provider about programs that could help with groceries or home repairs, such as fixing a leaking roof. Does the senior belong to a church? Often, churches offer support and financial relief for things parishioners need. Long-Term Planning – Seniors should have advanced directives to outline their preferred care if they cannot choose. The options in palliative care, hospice, assisted living availability, and skilled nursing provisions are limited for those lacking insurance or resources to cover them. There are programs and plans to help make accommodations more accessible, so speak with your provider or community case managers for more information. Financial hurdles can impact medical care, affecting overall health and well-being. Seniors living on fixed incomes are most at risk of neglecting chronic conditions, overlooking symptoms, or being misdiagnosed when they face obstacles to visiting healthcare providers. Long-term planning may help ensure more options later, though this may not be vital for those struggling to live from paycheck to paycheck. Elder Abuse Elder abuse is an intentional act or failure to act that causes or creates a risk of harm to an older adult (age 60 or older). The abuse usually occurs at the hands of a caregiver or a person the elder trusts. Common types of elder abuse include: Physical Abuse – Physical abuse is when an elder experiences illness, pain, injury, functional impairment, distress, or death as a result of the intentional use of physical force and includes acts such as hitting, kicking, pushing, slapping, and burning. Sexual Abuse – Sexual abuse involves forced or unwanted sexual interaction of any kind with an older adult. This may include unwanted sexual contact or penetration or non-contact acts such as sexual harassment. Emotional or Psychological Abuse – Emotional or Psychological Abuse refers to verbal or nonverbal behaviours that inflict anguish, mental pain, fear, or distress on an older adult. Examples include humiliation or disrespect, verbal and non-verbal threats, harassment, and geographic or interpersonal isolation. Neglect – Neglect is the failure to meet an older adult’s basic needs. These needs include food, water, shelter, clothing, hygiene, and essential medical care. Financial Abuse – It is the illegal, unauthorized, or improper use of an elder’s money, benefits, belongings, property, or assets for the benefit of someone other than the older adult. Risk Factors for Perpetration of Elder Abuse Individual characteristics which increase the risk of a senior becoming a victim of elder abuse include functional dependence/disability, poor physical health, cognitive impairment, poor mental health, and low income. A combination of individual, relational, community and societal factors contribute to the risk of becoming a perpetrator of elder abuse. They are contributing factors and may or may not be direct causes. Having a better understanding of these factors that contribute to the risk of becoming an abuser can help identify various opportunities for prevention. Individual Risk Factors Current diagnosis of mental illness Current or past abuse of drugs or alcohol Current physical health problem experience of disruptive behaviour experience of traumatic events High levels of stress Poor or inadequate preparation or training for caregiving responsibilities Inadequate coping skills Exposure to or witnessing abuse as a child Social isolation Relationship Risk Factors High financial and emotional dependence upon a vulnerable elder Past family conflict Inability to establish or maintain positive prosocial relationships Lack of social support Societal Risk Factors There are specific characteristics of institutional settings, such as nursing homes and residential facilities that can increase the risk for perpetration, including: Staffing problems and lack of qualified staff Staff burnout and stressful working conditions Loneliness in Older Adults According to Statistics Canada, as many as 1.4 million elderly Canadians feel lonely. Loneliness can increase the risk of many health problems and unhealthy habits. An effect of loneliness that is often overlooked is the impact it can have on a senior’s mental and physical health. Tips for Overcoming Loneliness in Seniors Below are eight tips to help an older loved one overcome their loneliness and social isolation: Take time to listen – Sometimes, the best thing you can do for a person is to listen. Having you there to listen can help your loved one feel less alone. Actively engage your loved ones in conversation, asking questions and encouraging them to express themselves. It may not come quickly, but your willingness to learn will go a long way. Develop a plan – In addition to listening, take the time to learn about your loved one’s interests and develop a plan to incorporate them into everyday life. If your loved one enjoys music, try taking them to a show or encourage them to join a community choir. If that is too much, simply taking an hour to share an activity with your loved one can significantly impact you. Start a new hobby – Learning something new is the best way to keep your brain young. Encourage your loved one to take up a new hobby to stay active and meet new people. Suggest that they join a book club, start a knitting circle, or head to the local community center to participate in weekly activities. Bridge the gap – For aging parents, grandparents, and others struggling with loneliness, finding someone to connect with may not be as difficult as imagined. One of the best opportunities is to join your loved one with younger relatives. Grandchildren, nieces, and nephews can learn a lot by spending time with older family members, and it may help your loved one feel more youthful and more included in family activities. Take a class or seminar – If your loved one is still mobile, encourage them to take a class or seminar to get out of the house and meet new people. Check with your local community center or community college because many places offer free courses for seniors. Also, ask around at your local library to see what events are coming up. Teach someone something – If taking a class is too much of a commitment for your loved one, allow them to teach you something instead. Take what you have learned by listening to your loved ones and asking them to teach you something. Even if all they can offer is wisdom and helpful advice, it will help bring meaning to their life and restore some child-parent or grandchild-grandparent dynamics that can sometimes be lost when children start caring for their aging parents. Give back – Volunteering provides various benefits for lonely seniors, both physical and mental. In addition to promoting physical activity, volunteering keeps the brain active. According to the National Institute on Aging, participating in meaningful activities can lower the risk of dementia and physical health problems in seniors. Plus, it will get your loved one out of the house and into a community. Adopt a pet – While an animal might not be an equal substitute for human companionship, studies show that caring for a pet can provide physical and mental benefits. Having a pet can trigger chemical reactions in the brain that reduce cortisol levels and increase serotonin production. Plus, having a pet around will make the home feel less empty. Seniors Overcoming Loneliness Let's look at some examples of how seniors overcome loneliness and social isolation in significant ways through connections with others. Resilience in the Older Population "Resilience thinking" in older adults allows them to recover from adversity, thrive with a sustained purpose, and grow in a world of turmoil, change, and chronic illness. It is a regenerative capacity that maintains health and function in the face of loss, disability, or disease. Let's look at how some seniors have used their resilience to live their best lives in their 'twilight years.' Researchers studying resilience in older adults and its effects note several characteristics of people who can face challenges and successfully navigate their way to the other side. According to a study published in Geriatric Nursing that looked at the impact of resilience in old age, critical characteristics of high resilience fall into three categories: mental, social, and physical. Mental characteristics include adaptive coping styles, gratitude, happiness, mental health, and optimism/hopefulness. Social characteristics include, among other things, community involvement, contact with family and friends, a sense of purpose, and strong, positive relationships. Finally, physical characteristics center around the ability to remain physically independent and mobile, enjoy good health and believe that one is aging successfully. Homelessness The Canadian definition of homelessness is “the situation of an individual, family, or community without stable, safe, permanent, appropriate housing, or the immediate means and ability to acquire it.” It is important to note that this definition does not fully encompass every experience of homelessness. Different groups are affected differently, and every individual’s experience is unique. Who Experiences Homelessness in Canada? Homelessness is a widespread social concern in Canada and many other developed countries. More than 235,000 people in Canada experience homelessness in any given year, and 25,000 to 35,000 people may be experiencing homelessness on any given night. People experiencing homelessness in Canada are pretty diverse in terms of age, gender, and ethnic-racial background. However, some groups are more at risk of becoming homeless, including single adult men, people dealing with mental health issues or addictions, women with children fleeing violence, and Indigenous people. There is also an assumption that homelessness is an urban phenomenon. Homelessness also exists in rural areas and on reservations, even if it is less visible than it is in cities. Adults between the ages of 25-49 make up 52 percent of those experiencing homelessness in Canada. Seniors (65 years and older) comprise a small percentage of the Canadian homeless population (less than 4 percent) of shelter users. However, seniors and older adults (50-64) are the only groups whose shelter usage has increased over the past decade. Causes of Homelessness There are various myths and misconceptions around the issue of homelessness. Some believe that it is a choice; there is the idea that people experiencing homelessness can pick themselves up “by the bootstraps” if they want to and that they are unhoused merely because they are lazy. However, homelessness is not a choice, and there are many reasons why people experience homelessness, including the lack of structural support for those experiencing poverty, job loss, and inadequate discharge planning for those leaving hospitals, correctional facilities, and mental health facilities. What Leads People to Become Homeless? Homelessness can be caused by a combination of factors, such as: Poverty Unemployment and precarious employment Migration toward urban centers Shortage of affordable housing Withdrawal of health and social welfare income supports Divorce, relationship, or family breakdown Family violence Lack of social or family support Addictions (drugs or alcohol, compulsive gambling) Stigmatization of mental health problems or drug dependency and lack of adequate services Institutionalization and the lack of support or services for those transitioning out of youth centers, detention, mental health hospitals, etc. Discrimination based on origins, age, or sexuality Low levels of schooling, social isolation, and low self-esteem Physical or mental health problems Indigenous Homelessness Indigenous peoples (Métis, Inuit, First Nations) are over-represented in Canada’s homeless population. While they account for 4.3 percent of the Canadian population, they represent between 28 and 34 percent of the homeless shelter population. Indigenous homelessness is particularly acute in many Canadian cities. About one in 15 urban Indigenous people are homeless, compared with the average of one in 128 non-Indigenous people across Canada. In other words, urban Indigenous people are about eight times more likely to be homeless than the non-Indigenous population. Definition of Indigenous Homelessness in Canada Indigenous homelessness is a human condition that describes First Nations, Métis, and Inuit individuals, families, or communities lacking stable, permanent, appropriate housing or the immediate prospect, means, or ability to acquire such housing. Unlike the standard colonialist definition of homelessness, Indigenous homelessness is not defined as lacking a structure of habitation; instead, it is more fully described and understood through a composite lens of Indigenous worldviews. These include individuals, families, and communities isolated from their relationships to land, water, place, family, kin, each other, animals, cultures, languages, and identities. Importantly, Indigenous people experiencing these kinds of homelessness cannot culturally, spiritually, emotionally, or physically reconnect with their Indigeneity or lost relationships (Aboriginal Standing Committee on Housing and Homelessness, 2012). Causes of Indigenous Homelessness Indigenous experiences of homelessness can be directly correlated to the ongoing impacts of colonization, including Residential Schools, the Sixties Scoop, displacement from land, culture, and resources through the Indian Act, and the intergenerational trauma rooted in the ongoing process of colonization. Existing social issues in Indigenous communities, including familial dysfunction, substance use, addictions, health issues, and community violence, can be directly linked to these unresolved historical and cultural intergenerational traumas contributing to high incarceration rates, high suicide rates amongst youth and Indigenous pathways into homelessness. Youth Homelessness Youth homelessness refers to young people between the ages of 13 and 24 who are living independently of parents and caregivers and, importantly, lack many of the social supports deemed necessary for the transition from childhood to adulthood. In such circumstances, they do not have a stable or consistent residence or source of income, nor do they necessarily have adequate access to the support networks necessary to foster a safe and nurturing transition into the responsibilities of adulthood. In Canada: 20 percent of homeless people are between the ages of 13-25. 29 percent of homeless youth identify as LBGTQIA2S+ 31 percent of homeless youth identify as Indigenous. The Prevalence of Youth Homelessness Over the year, the number of young people who wind up homeless is at least 35,000, and on any given night, there may be 7000 homeless youth. Homeless youth may be temporarily living in hostels, staying with friends, living in 'squats,' renting cheap rooms in boarding houses or hotels, or living on the streets. They may also be living with parents or relatives but be at imminent risk of losing their shelter. The reality is that over time, many homeless youth move between these various housing situations. Thus, it can be argued that it is the instability of their housing situation that characterizes their status as homeless youth. The Consequences of Homelessness on Youth Homeless and at-risk youth are more likely to experience: Increased risk of exploitation, trafficking, and abuse. Increased risk of mental health and additions Greater risk of involvement with the justice system. Higher risk of school dropout and employment instability. Difficulty leaving the streets, leading to chronic homelessness. Lack of social support. Housing instability LGBTQIA2S+ Youth Homelessness LGBTQIA2S+ youth experience higher levels of homelessness than their peers. It’s estimated that between 25-40 percent of youth experiencing homelessness in Canada identify as LGBTQ2S+ compared to 10 percent of non-homeless youth. Many sexual and gender-diverse youth grow up in homes with family members that are not accepting, supportive, or affirming. Often, coming out to family leads to homelessness. Some youth may run away from home because of abuse or discrimination from their family members. Others may be thrown out of their family home. Where do they go? Some LGBTQIA2S+ youth will end up in protective custody, but often, they will run from those settings, too, back to homelessness. Others will end up couch-surfing friends’ houses or living rough on the street, in parks and alleys, places not intended for human habitation. Very few youth who identify as LGBTQIA2S+ will choose to seek refuge in the shelter system, as many youth report discrimination and feel more vulnerable and unsafe in shelters compared to 'living rough' on the street. Youth facing homelessness are often forced to leave the education system to survive. This lack of education and specialized support significantly increases LGBTQIA2S+ youths’ odds of remaining homeless into adulthood. Resilience in Homelessness Homelessness constitutes a traumatic period that adversely impacts health and quality of life outcomes. Resilience in homeless people is significantly negatively influenced by mental disorders (e.g., psychotic and depression disorders), which are frequently present in this population group. The potential mitigating effects of resilience on quality of life levels in people experiencing homelessness are under-researched. We know that further interventions and services to enhance resilience mechanisms and strategies are warranted to improve this population group's mental health and quality of life outcomes. Key Takeaways • Adverse childhood experiences (ACEs) encompass various forms of physical and emotional abuse, neglect, and household dysfunction experienced in childhood. ACEs have been linked to premature death as well as to different health conditions, including those of mental illness and substance use problems in adulthood. In the last few years, researchers have started to examine the impacts of positive childhood experiences (PCEs) on children and adults. Protective factors (individual, family, community) protect people and decrease the possibility of experiencing ACEs. In March 2020, 69% of children and youth receiving services in care were Indigenous, although Indigenous children only make up approximately 10% of the child population in Alberta. Typical outcomes for youth who age out of foster care include low academic achievement, unemployment or underemployment, homelessness and housing insecurity, criminal justice system involvement, early parenthood, poor physical and mental health, and loneliness. The ability to thrive despite these childhood challenges arises from resilience skills. • Mental health problems are common among seniors and may include isolation, affective and anxiety disorders, dementia, and psychosis, among others. Many seniors also suffer from sleep and behavioural disorders, cognitive deterioration, or confusion states as a result of physical disorders, medications, and surgical interventions. Seniors are often undertreated with mental health problems. Elder abuse is an intentional act or failure to act that causes or creates a risk of harm to an older adult. The abuse usually occurs at the hands of a caregiver or a person the elder trusts. Loneliness can increase the risk of many health problems and unhealthy habits in the elderly population. "Resilience thinking" in older adults allows them to recover from adversity, thrive with a sustained purpose, and grow in a world of turmoil, change, and chronic illness. • Homelessness is not a choice, and there are many reasons why people experience homelessness, including the lack of structural support for those experiencing poverty, job loss, and inadequate discharge planning for those leaving hospitals, correctional facilities, and mental health facilities. Urban Indigenous people are about eight times more likely to be homeless than the non-Indigenous population. Indigenous experiences of homelessness can be directly correlated to the ongoing impacts of colonization, including Residential Schools, the Sixties Scoop, displacement from land, culture, and resources through the Indian Act, and the intergenerational trauma rooted in the ongoing process of colonization. Homeless and at-risk youth are more likely to experience an increased risk of exploitation, trafficking, and abuse, increased risk of mental health and addictions, greater risk of involvement with the justice system, higher risk of school dropout and employment instability, difficulty leaving the streets leading to chronic homelessness, lack of social support, and housing instability. It’s estimated that between 25-40 percent of youth experiencing homelessness in Canada identify as LGBTQ2S+ compared to 10 percent of non-homeless youth. Further interventions and services to enhance resilience mechanisms and strategies are warranted to improve this population group's mental health and quality of life outcomes. It’s your reaction to adversity, not adversity itself that determines how your life’s story will develop. - Dieter Friedrich Uchtdorf Threats to resilience are all around us. All people experience adversity, whether it was something that happened to them or a loved one as a child or some traumatic event they faced as adults. But, without these traumatic events, one can't become resilient, as it is through surviving adversity that you build and maintain your resilience. Let's start by looking at adult trauma, including grief and loss. Then, let's take a closer look at the effects of living through a natural or man-made disaster. And finally, we will explore what happens to people 'in the long term' after they have endured these types of traumatic events. Reactions to Trauma People have different reactions to traumatic events. For example, those living through the same natural disaster can respond differently despite experiencing the same event. The symptoms of trauma range from mild to severe. Many factors determine how a traumatic event affects a person, including: their characteristics the presence of other mental health conditions previous exposure to traumatic events the type and characteristics of the event or events their background and approach to handling emotions Emotional and Psychological Responses to Trauma A person who has experienced trauma may feel: denial anger fear sadness shame confusion anxiety depression numbness guilt hopelessness irritability difficulty concentrating They may have emotional outbursts, struggle to cope with their feelings or withdraw from others. Flashbacks, where a person relives the traumatic event in their mind, are common, as are nightmares. Physical Responses to Trauma Along with an emotional reaction, trauma can cause physical symptoms, such as: headaches digestive symptoms fatigue racing heart sweating feeling jumpy Sometimes, a person will also experience hyperarousal, or when someone feels as though they are in a constant state of alertness. This may make it difficult to sleep. Individuals may also go on to develop other mental health issues, such as depression, anxiety, and substance abuse problems. Intergenerational Trauma Intergenerational trauma (sometimes referred to as trans- or multigenerational trauma) is defined as trauma that gets passed down from those who directly experience an incident to subsequent generations. Intergenerational trauma may begin with a traumatic event affecting an individual, traumatic events affecting multiple family members, or collective trauma affecting the larger community, cultural, racial, ethnic, or other groups/populations (historical trauma). In 1988, one study showed that children of Holocaust survivors were overrepresented in psychiatric referrals by 300%. The subjects were selected based on having at least one parent or grandparent who was a survivor. Intergenerational trauma was first identified among the children of Holocaust survivors, but recent research has identified intergenerational trauma among other groups, such as indigenous populations in North America and Australia. What are Examples of Intergenerational Trauma? Some common examples of intergenerational trauma include: Domestic violence Alcohol and drug addiction Child abuse and neglect Refugees Survivors of combat trauma and war-related trauma How Intergenerational Trauma Manifests Itself Here’s a sampling of manifestations of generational trauma in adults: Emotional numbing and depersonalization Unresolved and complicated grief Isolation and withdrawal Hyper-vigilance Fearfulness Memory loss Anger and irritability Nightmares Inability to connect with others Lack of trust in others Substance abuse Recurring thoughts of death, dying, and suicide For school-age children or teens, the signs of intergenerational trauma may be more evident inside an academic setting. For example: Disciplinary issues Poor grades Cutting classes Dropping out When observing a family collectively suffering from intergenerational trauma, some trends warrant closer examination, such as: Any talk about feelings is dismissed and viewed as a “weakness.” Acute over-protectiveness of children and elderly family members — even when no danger is present Very tepid emotional responses to extreme events Very wary of “outsiders” Falling quickly into conflict with each other and those “outsiders.” Coping with Intergenerational Trauma The impact of generational trauma is significant. A parent or grandparent who never genuinely healed from or explored their trauma may find it very difficult to provide emotional support to a family member suffering from their trauma. Sadly, many families “cope” with inter-generational trauma by employing two unhealthy coping mechanisms: Denial – refusing to acknowledge the trauma that happened Minimization – ignoring the impact of the trauma and making the traumatic experience appear smaller than it is How family members “cope” with inter-generational trauma can set the precedence for younger generations. For example, a grandparent who refuses to examine the impact of her trauma may be teaching her grandchildren (intentionally or unintentionally) to ignore the effects of their trauma. Sooner or later, the trauma is likely to be triggered by something. Trauma is not something you can hide from, no matter how hard you try. Reflection Moment Subsequent generations can pass down trauma and its outcomes. The same can be said for resiliency. Therefore, you must take serious steps to address this debilitating scenario. Here are a few to consider about your own family: Do intergenerational trauma patterns that exist within your family? Can you recognize attitudes that may keep your family stuck? Can you develop compassion for yourself and others for enduring past and present struggles? Can you begin productive conversations with family members about trauma? Can you learn about your family members' experiences and coping mechanisms? These primary goals help halt the momentum of generational trauma while creating new, positive narratives. What is Grief? Grief is a natural response to loss. It’s the emotional suffering you feel when something or someone you love is taken away. Often, the pain of loss can feel overwhelming. You may experience difficult and unexpected emotions, from shock or anger to disbelief, guilt, and profound sadness. The pain of grief can also disrupt your physical health, making it difficult to sleep, eat, or even think straight. These are normal reactions to loss—and the more significant the loss, the more intense your grief will be. Types of Grief Since the experience of grieving following the loss of someone or something important to you tends to be unique to you, it’s difficult to label any grief as either “normal” or “abnormal.” However, some types of grief fall outside the expected symptoms and reactions described above. Anticipatory Grief As the name suggests, anticipatory grief develops before a significant loss occurs rather than after. If a loved one is terminally ill, for example, you have an aging pet, or you know that your retirement or job loss is imminent, you may start grieving your loss before it has fully unfolded. Disenfranchised Grief Disenfranchised grief can occur when your loss is devalued, stigmatized, or cannot be openly mourned. Some people may minimize the loss of a job, a pet, or a friendship, for example, as something that’s not worth grieving. You may feel stigmatized if you suffered a miscarriage or lost a loved one to suicide. Complicated Grief The pain at a significant loss may never completely disappear, but it should ease up over time. When it doesn’t—and it keeps you from resuming your daily life and relationships—it may be a sign of complicated grief. Complicated grief usually arises from the death of a loved one, where the loss has left you stuck in a state of grief. Coping with Loss Coping with the loss of someone or something you love is one of life’s biggest challenges. You may associate grieving with the death of a loved one—which is often the cause of the most intense type of grief—but any loss can cause grief, including: Divorce or relationship breakup Loss of health Losing a job Loss of financial stability A miscarriage Retirement Death of a pet Loss of a cherished dream A loved one’s serious illness Loss of health and the ability to do things as usual Loss of a friendship Loss of safety after a trauma Selling the family home Even subtle losses in life can trigger a sense of grief. For example, you might grieve after moving away from home, graduating from college, or changing jobs. Myths and Facts About Grief Myth: The pain will go away faster if you ignore it – Fact: Trying to ignore your pain or keep it from surfacing will only make it worse in the long run. For natural healing, it is necessary to face your grief and actively deal with it. Myth: It’s important to “be strong” in the face of loss. – Fact: Feeling sad, frightened, or lonely is a normal reaction to loss. Crying doesn’t mean you are weak. You don’t need to “protect” your family or friends by putting on a brave front. Showing your true feelings can help them and you. Myth: If you don’t cry, it means you aren’t sorry about the loss. – Fact: Crying is a normal response to sadness, but it’s not the only one. Those who don’t cry may feel the pain as deeply as others. They may have other ways of showing it. Myth: Grieving should last about a year. – Fact: There is no specific time frame for grieving. How long it takes differs from person to person. Myth: Moving on with your life means forgetting about your loss. – Fact: Moving on means you’ve accepted your loss—but that’s not the same as forgetting. You can move on with your life and keep the memory of someone or something you lost as an essential part of you. As we move through life, these memories can become more and more integral to defining the people we are. Tasks of Mourning There are different theories about how a person adjusts to loss. One widely accepted model describes four tasks of mourning: Accept the reality of the loss. Experience the pain of grief. Adjust to life without the person being physically present. Find new ways to remain connected to the person who has died. Losing Someone to Suicide Learning that a friend or loved one has committed suicide is often a very shocking experience. It adds another layer of pain and confusion to the understanding of loss and can complicate the grieving process. The shock can be so tremendous and acceptance so difficult that denial of suicide is not uncommon. The suicide of a friend or loved one can raise feelings of guilt, anger, blame, and shame for the survivors. For example: A person may feel guilty, thinking that some signal was missed or more could have been done. However, it is pointless for the survivors to blame themselves or others. The reasons for suicide are complex, and there may have been no clues at all. Anger is also a typical response. It’s not unusual to see family and friends as the cause of the suicide. Or young people might feel anger towards themselves or even at the person who died. There can be a strong urge to blame and hold somebody accountable. Feelings of shame are also possible because of the stigma attached to suicide. So it may be difficult for young people to talk about their feelings with others. Also, others may shy away from the topic and be unsure of what to say. It is expected to experience a jumble of mixed feelings when someone close takes their own life. But friends and family will want to help. Survivors need to let others know what they need. How to Deal with the Grieving Process While grieving a loss is an inevitable part of life, there are ways to help cope with the pain, come to terms with your grief, and eventually, find a way to pick up the pieces and move on with your life. Acknowledge your pain Accept that grief can trigger many different and unexpected emotions Understand that your grieving process will be unique to you Connecting with others and seeking social support through joining a support group to talk about our pain, our suffering, and the emotions we experience. Some people also find it helpful to turn to their faith for further help to cope Searching for meaning by creating a foundation or charity has also helped some move through the grieving process Take care of yourself physically. Eat healthy meals at regular times; engage in some daily exercise (even walking for 15 minutes can be beneficial); engage in proper sleep hygiene despite insomnia you might experience; and Refrain from unhealthy coping methods, such as nicotine, caffeine, or alcohol. Recognize the difference between grief and depression. Signs of major depression associated with grief could include intense feelings of guilt, hopelessness, or worthlessness; suicidal ideation; reduced psychomotor activity (slowing down of thoughts, speech, or physical activity); inability to engage in our daily responsibilities or activities. Reflection Moment Think about a loss you have had in your life. It can be a person, a thing, or even an ideal. How did you recover from that loss? You may still need to recover, or maybe you never will. Below is a video of actor Andrew Garfield describing his grief at the recent loss of his Mother. It is a very unique (and my favourite) description of grief. What is a Disaster A disaster is a severe disruption to the functioning of a community occurring over a short or long period that causes widespread human, material, economic, or environmental loss that exceeds the ability of the affected community or society to cope using its resources. Natural hazards or man-made hazards can cause disasters. In this module, we will focus on natural hazards and man-made hazards. Natural Hazards Natural hazards are defined as unexpected and uncontrollable environmental threats that have the potential to impact humans and other animals or the environment. They can be geophysical, hydrological, climatological, meteorological, and biological. Geophysical a hazard originating from solid earth (such as earthquakes, landslides, and volcanic activity) Hydrological caused by the occurrence, movement, and distribution of water on earth (such as floods and avalanches) Climatological relating to the climate (such as droughts and wildfires) Meteorological relating to weather conditions (such as cyclones and storms) Biological caused by exposure to living organisms and their toxic substances or diseases they may carry (such as disease epidemics and insect/animal plagues) Natural Hazards Versus Natural Disasters Natural hazards and natural disasters are related but are not the same. A natural hazard is the threat of an event that will likely have a negative impact. A natural disaster is a negative impact following an actual occurrence of a natural hazard if it significantly harms a community. Worst Natural Disasters of the 21st Century Man-Made Disasters Man-made disasters are the results of human intent, negligence, or error involving a failure of a man-made system. They include complex emergencies, conflicts, industrial accidents, transport accidents, environmental degradation, and pollution. Man-Made Hazards Man-made hazards are societal and economic threats caused by human action or inaction and occurring in or close to human settlements. They cause environmental damage, destruction of property, and loss of life. Examples include industrial accidents, transportation accidents, nuclear and chemical disasters, biological threats, cyber-attacks, terrorism, acts of war, and climate change. Industrial Accidents – Mines, factories, and other industrial centers have been at the heart of some of history's worst accidents. These places can contain volatile materials or undergo immense structural stress due to the labour conducted there. In worst-case scenarios, these sites can suffer from explosions or collapse, leading to loss of life and potential environmental damage. Transportation Accidents – Anyone driving a car knows that getting from point A to point B can sometimes be dangerous. Errors in judgement, minor technical malfunctions, and even the interference of animals can cause serious problems. When these problems occur with mass transit vehicles like trains, plains, or boats, those problems can be disastrous. Nuclear & Chemical Disasters – Though they've been infrequent since the discovery of nuclear fission in the 1930s, there have been a few instances where attempts to harness nuclear power have gone awry. These disasters can leave miles of land uninhabitable for decades or even centuries. Leaks of dangerous chemicals can have a similar effect, though these are generally less severe. Biological Threats – A biological threat is an infectious disease with the potential to spread and cause an outbreak. Infectious diseases are illnesses caused by germs (such as bacteria and viruses). Some contagious diseases require close contact between two people, like when people speak to each other. Cyber Attacks – A cyberattack is any offensive maneuver targeting computer information systems, networks, infrastructures, or personal devices. An attacker is a person or process that attempts to access data, functions, or other restricted system areas without authorization, potentially with malicious intent. Cyberattacks can be part of cyber warfare or cyberterrorism depending on the context. Terrorism – Terrorism is a deliberate criminal act committed with the intent to create a state of fear in the public. It is usually done by a person or group aiming to further a political or ideological point of view. An example of terror is mass shootings, bombings, Acts of War – An Act of war is an action by one country against another to provoke a war or an action during a declared war or armed conflict between military forces of any origin. Climate Change – Climate change refers to long-term shifts in temperatures and weather patterns. These shifts may be natural, but since the 1800s, human activities have been the main driver of climate change, primarily due to the burning of fossil fuels (like coal, oil, and gas), which produces heat- trapping gases. Burning fossil fuels generates greenhouse gas emissions like a blanket wrapped around the Earth, trapping the sun’s heat and raising temperatures. Worst Man-Made Disasters of the 21st Century Disaster Risk Disaster risk is the likelihood of loss of life, injury, or destruction and damage from a disaster in a given period. Disasters are sometimes considered external shocks, but disaster risk results from the complex interaction between development processes that generate exposure, vulnerability, and hazard conditions. Therefore, disaster risk is viewed as the combination of the severity and frequency of a hazard, the number of people and assets exposed to the hazard, and their vulnerability to damage. What Makes People Vulnerable to Disasters? Vulnerability refers to how a hazard or disaster affects human life and property. Vulnerability to a given hazard depends on: Proximity to a possible hazardous event The population density in the area proximal to the event Scientific understanding of the hazard Public education and awareness of the hazard Existence or non-existence of early-warning systems and lines of communication The availability and readiness of the emergency infrastructure Construction styles and building codes Cultural factors that influence public response to warnings Poverty and Disaster Vulnerability Less developed countries are generally more vulnerable to natural hazards than industrialized countries because they lack hazard understanding, education, infrastructure, building codes, etc. Poverty also plays a role. Poverty leads to poor building structure, increased population density, and a lack of communication and infrastructure. How Do We Reduce Our Vulnerability? We cannot entirely avoid disasters, but we can prepare for and address them. We can also prevent hazards from leading to disasters by helping communities to be ready, reduce their risks, and become more resilient. These prevention efforts and coordinated responses to disasters save lives and lessen their impact on communities. The Cost of Disasters Financial Toll Natural and man-made disasters have astronomical costs associated with risk management, planning, rescue, and recovery, often in the billions of dollars. These costs can pose a heavy financial toll on governments, businesses, and private citizens. In Canada alone, the economic cost of disasters has soared by 400% since the 1980s. This is primarily due to increasingly severe weather affecting disaster-prone urban areas characterized by high-density populations and high-value assets. Weather data suggest that natural disasters are rising worldwide due to increased building in vulnerable areas and the effects of climate change. The Loss of Life Natural and man-made disasters can also cause uncalculatable costs in both the loss of life and injuries suffered by survivors. Let's look at the number of fatalities for the most deadly natural and man-made disasters in history. The Impact of Disasters on Children Beyond the immediate trauma and harm caused by disaster exposure, children also may suffer longer-term physical, psychological, and educational deficits. Children who have experienced a disaster are much more likely to have: Physical health problems – Young children who experienced a natural disaster within the past month showed a 9 to 18% increase in acute illnesses, depending on the outcome examined (e.g., diarrhea, fever, respiratory illness). Researchers found exposure to disasters predicted heightened somatic symptoms (e.g., headaches, nausea, and lethargy) in children. Mental health symptoms – As many as 50% of children report post-traumatic stress symptoms after experiencing a disaster, such as recurring thoughts about the tragedy, hypervigilance, or difficulty sleeping or concentrating. Children exposed to disasters also often experience depression symptoms, such as feeling sad or losing interest in activities, and symptoms of anxiety, such as fears and worries about safety. Chronic mental health symptoms have been observed among children even four years after a disaster event. Lower school attendance and trouble learning – Natural disasters often disrupt children’s learning because many schools are closed, interrupting children’s attendance. Further, trauma exposure can alter brain anatomy and functioning, inhibiting learning and memory processes. For example, children exposed to disasters report trouble concentrating (a common symptom of post-traumatic stress), which can interfere with learning at school. Why are children at risk for mental health issues after a disaster? Mental stress from a disaster can be more complex for children because they understand less about the situation, feel less able to control events, and have less experience coping with difficult situations. Disasters can be particularly hard on children who have experienced trauma in the past or already have a mental, emotional, developmental, or behavioural disorder before the event occurs. Which children are the most vulnerable to disasters? Children are more likely to have physical health, mental health, or learning problems if they: Were exposed to other forms of violence or trauma after the disaster. After the 2010 Haiti earthquake, youth who experienced violence, compared to their peers, reported higher mental distress, suicidal ideation, and number of sexual partners. Were exposed to potentially life-threatening disasters like seeing trees fall, windows break, being injured, or witnessing someone hurt. Thought their life was in danger during the disaster. Experienced multiple stressors in the recovery period after disasters, such as parents changing or losing jobs, moving to a new home or a new school, or a death or illness in the family. Missed school days. Children who miss school for extended periods after a disaster are more likely to have lower grades or drop out. Are members of underserved or marginalized groups. Children living in poverty, children who are minorities, and children living in temporary or unstable housing are particularly vulnerable because such social contexts amplify the chance that they will experience the risk factors listed above. How can parents and caregivers help children cope after a disaster? Give children opportunities to talk about what they went through or what they think about it. Please encourage them to share concerns and ask questions. Allow children to be with you or another trusted adult who can help them feel safe, calm, and connected and give them hope. Limit exposure to mass media coverage of the disaster and its aftermath. Children directly exposed to a disaster can become upset again if they see or hear reminders of what happened. Encourage children to take action directly related to the disaster. This can help them regain a sense of control and manage their feelings. For example, children can help others after a disaster, including volunteering to help the community or family members in a safe environment. Children, especially young children, should NOT participate in disaster cleanup activities. Work with teachers and other adults who see children in different situations to share information about how each child copes. Children may need mental health support from a professional specializing in children's emotional needs following a disaster. What can be done to reduce risk and help children impacted by disasters? Invest in school infrastructure and remediation efforts. Many schools were not designed to withstand disasters. Unsafe schools increase the risk of children being exposed to physical harm and extended educational disruption during and after disaster events. Increase the availability of evidence-based mental health services. Multiple evidence-based programs have been shown to decrease mental health symptoms among children exposed to traumatic events. Placing these mental health services within schools can increase their accessibility for children and their families. Target services to the most vulnerable children. The effectiveness of response efforts can be enhanced by replicating evidence-based service models and targeting services to the most vulnerable children. Vulnerable groups include children with high levels of disaster exposure or stressors, children reporting high levels of mental health symptoms, and children with limited resources. The Impact of Disasters on Adults Going through a disaster places you at risk for emotional and physical health problems. Stress reactions after a disaster look like those seen after trauma. Like many causes of trauma, natural disasters can be sudden and overwhelming. The most immediate and typical reaction to a calamity is shock, which at first manifests as numbness or denial. Quickly—or eventually— shock can give way to an overemotional state that often includes high levels of anxiety, guilt, or depression. Common Reactions in Adults after a Disaster: Trouble falling asleep or staying asleep Sadness, depression, hyperactivity, irritability, or anger Having no feelings at all or feeling numb A lack of energy or feeling exhausted all the time Lack of appetite or the opposite, eating all the time Trouble concentrating or feeling confused Social isolation, reduced or restricted activities Thinking no one else is having the same reactions as you Headaches, stomachaches, or other body pains Misusing alcohol, tobacco, drugs, or prescription medications to cope Helpful Steps for Adults after a Disaster Eat, hydrate, exercise, and get rest regularly; taking care of your body reduces the adverse effects of stress. Avoid using alcohol, tobacco, and other drugs to manage distressing emotions; these substances often make things more complicated in the long run and can cause problems. Find healthy ways to relax, such as breathing exercises, meditation, mindfulness, calming selftalk, and soothing music. Engage in fun and restoring activities, including exercise, hobbies, and social activities. Keep informed about new information and developments. Use credible sources of information to avoid speculation and rumours. Limit exposure to television and social media content about the disaster; overexposure can increase distress. Stay connected with friends, family, neighbours, and colleagues to give and receive support. Helping one another aids in healing. Learn what local health care and other resources are available; use and share this information to help yourself and others. Remind yourself and others that it's normal to have many different feelings, as well as “good days” and “bad days” as a natural part of recovery. Seek assistance from a health care professional if your distress remains high after several weeks, you are having persistent trouble functioning at work or home or thinking about hurting yourself or someone else. Post Traumatic Stress Disorder (PTSD) PTSD develops when the symptoms of trauma persist or get worse in the weeks and months after the stressful event. PTSD is distressing and interferes with a person’s daily life and relationships. Symptoms include severe anxiety, flashbacks, and persistent memories of the event. Another symptom of PTSD is avoidance behaviours. If a person tries to avoid thinking about the traumatic event, visiting the place where it occurred, or avoiding its triggers, it can be a sign of PTSD. PTSD may last for years, although treatment can help people to manage their symptoms and improve their quality of life. Risk factors for developing PTSD include: previous trauma physical pain or injury having little support after the trauma dealing with other stressors at the same time, such as financial difficulty previous anxiety or depression Most people who experience a traumatic event do not develop PTSD. The National Institute of Mental Health estimates that the lifetime prevalence of PTSD in the United States is 6.8%. Trauma and Resilience 8 Ways to Build Resilience in the Face of Trauma Resilience adapts well to adversity, trauma, tragedy, or significant stress. Resilience involves behaviour, thoughts, and actions that can be learned. Below are eight ways to increase your resilience to recover from a traumatic event. Accepting What Has Happened to You – Trauma comes as a shock to many. It’s common to think bad things only happen to other people, and it's challenging to cope when they find themselves in a situation they never expected. Some people can rebound from trauma quicker if they can accept reality and learn to live with their changed circumstances. Build your Connections – You often see people united through grief or a traumatic event. They may have nothing else in common except the event that brought them together. Sometimes, talking to someone with a shared experience helps recover. You don’t feel as alone because you know others who have been through something similar. Volunteering can help build self-worth and give you a sense of purpose. Connecting with people and helping others can help you grow resilience. Keep the Event in Perspective – As traumatic as the event may have been, it’s essential to think of the good things you have in your life. You may have lost someone or something dear to you, but you still have others that bring you joy. Look to the future and think about how you can look back on this time and be proud of how you accepted the difficult change and focused on the circumstances you can influence. Focus on your Relationships – The pain caused by traumatic events can cause some people to isolate themselves. But it’s essential to allow your friends and family to support you through a traumatic time. Having compassionate friends by your side can help you keep your skills in resilience. People often look back on their trauma and say their friend or family member helped them through it. Take Care of your Physical Self – Stress is a significant factor in trauma, and it doesn’t just play havoc on the mind; there are many physical symptoms of stress. Try to counter the stress by looking after yourself with proper nutrition and quality sleep. Getting in some daily exercise can help with anxiety and depression. Set Yourself Some Goals – Having some realistic goals can help you move forward after a traumatic event. Even minor accomplishments can make you feel better, so start small and work toward larger goals. Think about one thing you can do daily to help you move in your desired direction and then achieve it. Practice Mindfulness – Mindfulness can help restore hope and deal with situations requiring resilience. Whether journal writing, yoga, prayer or meditation, mindfulness allows you to recall things you’re grateful for. Get Professional Help – Trauma can have long-term effects on your physical and mental health. Seeing a psychologist can assist you in developing a strategy for moving forward and recovering from your experiences. A psychologist with expertise in the treatment of trauma can help you focus on the aspects of your life that you can control, build your resilience, and deliver appropriate treatment if required. Treatment for PTSD Psychotherapy for PTSD focuses on identifying symptoms and triggers, as well as learning skills to manage them. Cognitive-behavioral therapy (CBT) is one therapy used for PTSD. CBT employs different strategies, including: Exposure therapy: Gradually exposing people to the trauma they experienced in a safe way to help them learn how to face and control their fear Cognitive restructuring: Helps people make sense of their traumatic memories People who face stigma and discrimination are more vulnerable to PTSD. Therefore, treatment for trauma needs to be tailored to a person’s culture and beliefs. Providers need to be informed about how factors like race, immigration status, housing insecurity, poverty, gender identity, sexual orientation, and age influence ongoing trauma. Post-Traumatic Growth (PTG) Post-traumatic growth (PTG) is a theory that explains this kind of transformation following trauma. It was developed by psychologists Richard Tedeschi, Ph. D., and Lawrence Calhoun, Ph. D., in the mid-1990s. PTG holds that people who endure psychological struggle following adversity can often see positive growth afterward. Examples of Post Traumatic Growth Post-traumatic growth comes in different ways – sometimes as selfless help to others or occasionally as genuine self-understanding and acceptance. Here are some examples of how post-traumatic growth can look in real life: An ideal illustration of post-traumatic growth is parents who have lost their child to cancer, raising money for different cancer organizations or charities. Survivors of terrorist attacks often become friendlier and more accepting of others. Much of their behavioural change owes to the trauma they had faced. Another bright instance of post-trauma growth is war victims and soldiers who return safely from battle and gain a broader perspective on life. People who lose someone dear at a tender age are much more grateful and appreciative for what they have than others of their age. For example, a child who has lost his mother knows the value of motherly affection and would likely be more emotionally mature than other children her age. Couples who remarry after losing their first spouse often develop a deeper and more transparent relationship. The earlier trauma they had faced in the past drives them to value the present and improve the quality of their interpersonal relationships. Reflection Moment Think about a traumatic event that has happened to you or to someone else you know or know of. Are you able to identify any positive outcomes? Maybe you can't, and that is OK. Perhaps you have never considered a positive outcome resulting from a tragedy before. It can be difficult to imagine anything good coming from a person's hardship and suffering. Still, I challenge you to think of one example of a positive outcome or consider the possibility, as remote as it may seem. Perhaps this may be the beginning step to building one's resilience. Key Takeaways • Adult trauma(s) may be witnessed or experienced and can occur in many forms, including physical abuse, sexual abuse or assault, neglect, domestic violence, community violence, war, and natural disasters. Intergenerational trauma (sometimes referred to as trans- or multigenerational trauma) is defined as trauma that gets passed down from those who directly experience an incident to subsequent generations. Sadly, many families “cope” with intergenerational trauma by employing two unhealthy coping mechanisms: denial – refusing to acknowledge the trauma that happened and minimization – ignoring the impact of the trauma and making the traumatic experience appear smaller than it is. • Grief is a natural response to loss. It’s the emotional suffering you feel when something or someone you love is taken away. You may experience difficult and unexpected emotions, from shock or anger to disbelief, guilt, and profound sadness. The pain of grief can also disrupt your physical health, making it difficult to sleep, eat, or even think straight. You may associate grieving with the death of a loved one—which is often the cause of the most intense type of grief —but any loss can cause grief. Learning that a friend or loved one has committed suicide is often a very shocking experience. It adds another layer of pain and confusion to the understanding of loss and can complicate the grieving process. While grieving a loss is an inevitable part of life, there are ways to help cope with the pain, come to terms with your grief, and eventually, find a way to pick up the pieces and move on with your life. • A disaster is a severe disruption to the functioning of a community occurring over a short or long period that causes widespread human, material, economic, or environmental loss that exceeds the ability of the affected community or society to cope using its resources. Less developed countries are generally more vulnerable to natural hazards than industrialized countries because of a lack of hazard understanding, education, infrastructure, building codes, etc. Poverty also plays a role - poverty leads to poor building structure, increased population density, and lack of communication and infrastructure. Both natural and man-made disasters have astronomical costs associated with risk management, planning, rescue, and recovery, often in the billions of dollars. These costs can pose a heavy financial toll on governments, businesses, and private citizens. Natural and man-made disasters can also cause uncalculatable costs in both the loss of life and injuries suffered by survivors. • The most immediate and typical reaction to a calamity is shock, which at first manifests as numbness or denial. Quickly—or eventually—shock can give way to an overemotional state that often includes high levels of anxiety, guilt, or depression. PTSD develops when the symptoms of trauma persist or get worse in the weeks and months after the stressful event. PTSD is distressing and interferes with a person’s daily life and relationships. Post-traumatic growth (PTG) is a theory that explains that people who endure psychological struggles following adversity can often see positive growth afterward. The Posttraumatic Growth Inventory (PTGI) measures the extent to which survivors of traumatic events perceive personal benefits, including changes in perceptions of self, relationships with others, and philosophy of life, accruing from their attempts to cope with trauma and its aftermath. Trauma is a fact of life. It does not, however, have to be a life sentence. - Peter A. Levine