In this video we will talk on the protection and risk factors for kids and pre-teenagers in massive emergencies. Before we begin we must make some concepts clear. What is a protecting factor? The protecting factor is a detectable feature, that is, perceptible on a person, a family or a community which favors human development in general, health and the reaction to a critical incident. On the other side, a risk factor is a detectable feature which can point out a bigger chance of having or suffering any kind of damage. Also for health, for recovering after an emergency and in general terms in any situation in the life. It is important being able to distinguish between protecting factors and risk factors from the other two similar concepts which aren't exactly the same, which are vulnerability and resilience. What is vulnerability? It's the chance that a risk or a damage happens. This vulnerability can be of three kinds: genetic, familiar and psychosocial. And you might be wondering, which is the difference with the risk factor? Well the vulnerability people, families, communities have is independent from the situation in which we are immersed. Instead, the protecting and the risk factors have a really important situational load and they strengthen or diminish our vulnerability. And resilience? Maybe you have heard of resilience. Resilience is a concept that comes from physics. And in physics it designs the capacity a body has to recover its original shape after being subject to a very high pressure. Let's take a sponge, if we press it it becomes thin, but if we stop pressing it it goes back to its original shape. Instead, we will probably need to make more pressure on a stone to deform it, but, once we've pressured it, it will break down, and it will never be able to recovery its original shape. With this physics analogy, in psychology and as an answer to critical incidents and emergencies we call resilience to the capacity of persons, families and communities of recovering after an incident, a crisis with the less damage possible. This capacity has a more or less innate part. Which means people, families and communities have a determined amount of resilience. But despite the resilience nature has given us, we can always strengthen our capacity, our resilient answer. And it is usually what the answer to emergencies and the psychological first aid application is about. So let's now see and focus, after making these basic concepts clear, in protecting and risk factors for the recovery from an emergency. We will have a general view to all the factors and then watch each one separately. The most recent studies have proved that the main protecting and risk factors are related to four axis, to four different variables. On one side the kid's and teenager's own characteristics and his familiar context. On the other side, the success' characteristics. That is, what happened, how did it happen, which effects does it have or how will it affect the kid's life as well as the affected families. Third place is the emergency managing. And in fourth place, clearly as a protecting or risk factor we have the attention and the monitoring received either by the kids and mostly on the families during the six months after the impact. It is very important that you see that protecting factors and risk factors are actually two sides of the same coin. The same fact can be a protecting factor in a situation and a risk factor in another one. So now when we talk about them we will have opposite pairs depending on if they act as protectors or negatively influence on the answer to what happened. What do we know about how they modulate the answer to an emergency in the kids' or teenagers' own features? We know that a healthy base personality structure, that is, a kid, a teenager whose structure, whose way of acting, of responding, whose ability to manage emotions is healthy, has more possibilities of leaving without too many sequels from an emergency than a kid that has previous adaptive or behavior problems. We know that a very important variable is the kind of attachment a kid has. Attachment is the way kids bond to their parents. It is the kind of bond, the quality of the bond kids have with their parents or main carers. If this bond is safe the prognosis in the answer to the critical incident of the kids is way better than if the attachment is unsafe, anxious or avoiding. We also know that a medium or high intellectual level and mostly a good ability to solve problems are a protective factor, while having problems to understand at a cognitive level which are the things that happen and even having an intellectual disability will be a risk factor. This variable that has been discussed sometimes is related to the fact that, on the contrary to what we thought before, cognitive maturity doesn't increase the risk perception. On the contrary, cognitive maturity allows us to understand that the fact, that the crisis, the incident is a punctual fact and so the kid can distress. While a more limited intellectual capacity difficults the kid and the teenager when trying to understand whether this will happen again and so increase the anxiety level. Although formerly people thought that it was backward, that a diminished intellectual capacity protected kids because they wouldn't realize the risk they had been under, we've made clear this is not true and nowadays we know, because studies proved it, that it's the opposite. We know that a good ability to solve problems and conflicts in kids protect them and that a difficulty to face conflicts, an avoiding pattern of confronting problems is a risk factor. Not because there is any kind of similitude between a critical incident and a normal conflict, in example, during the playground, but because the resources kids need are similar. Another factor is the cohesion, the affection, the communication in the familiar core. The more cohesion and communication in a family, the more capacity the family has to jointly manage what has happened and of protecting itself, and so, kids, from negative effects. We also know girls have a better response, a better recovery than boys during a critical incident. It looks like in kids, the fact of being a male is a vulnerability factor, with higher risk. This is something to which I think we still don't have a technical answer, but statistic analysis prove that. And finally it is a fact that having suffered other stressing vital events such as a death, a parental divorce, a serious illness before the incident is clearly a risk factor. It looks like accumulating critical incidents difficults the response to them. Let's now describe which are the protective and risk factors regarding the incident or emergency itself. Thanks to studies we know that the most important factors are not suffering mortal victims in the direct familiar context and the fact that the kid or teenager hasn't been hurt. But also are protective factors keeping the own home, that is, although it is destroyed or must be reformed, kids can go back to what their home was, keep their personal belongings, their toys, their personal objects and, this is very interesting, the fact that other school partners or friends are also affected. You might wonder why, because the fact that a community, a whole apartment block, a whole street affected makes kids feel less strange. "Well, this happened to me but also to my friends so I can share and feel part of a collective to which something bad happened, but it looks like I'm not the only one affected. We also know that the same factors can act as risk factors, that is, if there is a death in the familiar context or the own kid is hurt, it will probably difficult his answer, his recovery. The fact that the house is totally destroyed and we can't go back to it will obviously cause an important damage, because kids relate their safety to the place where they live, to the place where they sleep, and if it changes their response will be harder. And maybe losing toys and personal objects isn't as serious as losing their house but it also affects them negatively. During psychological first aid we will mostly remark the factors that protect the impact management itself, that's why this is the space in which psychological first aid like you and me are risking the effectiveness of what we are going to do, in this sense it is very important knowing which are these protecting factors. The most important is that, through the application of psychological first aid and other measures we keep activation levels as low as we can. To help you understand, the activation level refers to the nerves, the amount of screams, the amount of anxiety. The more calm and quiet the incident management is, the more we are protecting both minors and adults from the impact. This happens due to the contention of the parents' or main carers activation levels and their fear and anxiety contention. If we reach the point in which the family, the carers that are with the kids also keep low activation levels and that they are contained in their reactions, we are ensuring or at least easing a good answer in the minor. A third factor is the comfort capacity the family has, the carers have to calm their sons. And it's important to have this clear because here we can influence. In a massive emergency management, both you and I can help the parents and main carers to comfort, to inform, to apply psychological first aid to kids but through their parents, because that's much more effective. This way we will make kids feel safer and the risk of effects will diminish. It is very important that minors stay all the time or as much time as they can with their family and carers, if not all of them at least a part. This is a clear protective factor which has a lot to do with the impact management and is relatively easy to accomplish. But it is also important receiving a good information level so that kids know what is happening, and so that they can, at their level and with the vocabulary they can understand, to have vision of what happens and being able to understand more or less how what is happening will affect them, because this diminishes their fantasies. Usually kids imagine things worse than they really are. So having information is a wide important protection factor, as well as being quickly taken to a safe place after the impact. Being able to be in a place where the home features can be more or less reproduced, like a normal house, helps the kids' answer. The next factor is reestablishing as soon as possible the routine previous to the impact. If the kid went to the nursery school, make him return there as soon as we can, if he goes to the school, make him return to the school as soon as we can. And now in the next slide you will see the risk factors, because the same factors we just saw as protectors in a determined moment can aggravate and difficult the kids' recovery. This will happen if there's a low contention level and a lot of nerves, a lot of activity, so it will be if the minor isn't contained and he is too nervous and activated. It will also be a risk factor that main carers or parents can't contain and comfort the minor or we can't do better, a risk factor is being separated from the referent adults, not receiving information, staying close to the impact place in an unsafe or provisional place. In example, there are studies which prove that having kids, in tents, as it happens in many refugee camps, in a clearly provisional context almost duplicates the risk of suffering negative effects after a critical situation on the impact of, in example, a natural disaster. It also difficults a lot the recovery of the kids keeping exceptional behavior for too long, that is, not going to school, not being able to play, not being able to go back to the activities previous to the incident and of course this includes not going back to school. Let's go now and see the protective and risk factors regarding the monitoring offered to the families after the impact moment. About protective factors it seems that the most important part, the most important factor is having some orientation for parents, this doesn't mean a therapy, this means that there is a professional, even through phone assistance to which families can make questions about what is bothering them. This orientation, preferentially available 24 hours a day, has a really important effect, not only because of to the concrete answer they can offer the family but also because it diminishes their anxiety levels. And I especially want to remark this. In most of the emergencies, if we act correctly we will give families a document in which some things are explained. But parents or main carers are also affected, they understand some things and have doubts about some others. Being able to calm down these doubts will help calming down the family, contain it and make it able to manage the kid, and as we have seen this is the main part of the minor protection regarding the success' impact. It is also a protective factor being able to talk, play or represent what happened in many ways. And it finally is if after three or four weeks we haven't started seeing any improve in the answer. All kids give an acute stress answer, but acute stress must be corrected during these first three or four weeks. Correcting doesn't mean making it disappear, it means diminishing, if it doesn't, it is important and a clear risk factor being able to receive specialized assistance. Obviously not applying these protective factors is also a risk factor, so if parents are disorientated, if parents are anxious, if they don't know what to do, if kids don't have a place in which they can process what happened or don't receive assistance after these four weeks, their response to the emergency will probably get complicated.