The Return to Happiness program (RTH) uses play therapy to help children who have experienced disasters, community violence, death and other traumatic events. It encourages children to share their feelings about difficult situations through fun activities such as storytelling, games, art, music, crafts, acting, puppetry and more. We talked to Tamara Groeneveldt, program coordinator from the Student Support Services Division (SSSD). This division took the lead in helping to provide the training on Sint Maarten, in collaboration with UNICEF Netherlands. Primary school teacher Kimberley Duzong also shares her experiences with the program.

 Xiomara has not experienced many trauma cases since working at SSSD. She believes that the word ‘trauma’, especially since the passage of Hurricane Irma, is being used too loosely: just because one experiences a distressing event such as a natural disaster, or even abuse, it does not mean that these experiences will result in a child developing Post Traumatic Stress Disorder (PTSD). “The local use of the word trauma generally implies the presence of PTSD. However, a child’s level of distress and suffering oftentimes depends on factors such as resilience and the presence of a social network.”

“When a traumatic event happens, let us say a death in the family – it is normal to be sad, have trouble concentrating, be angry, feel lonely and have a multitude of other feelings or display out of the ordinary behaviours. However, if these feelings are not dealt with properly, this might lead to various issues on a long-term basis. If the child is not able to resolve the hurt in a positive manner, if no outlet is provided, it can impact the child in a profound way, which can result in PTSD.”

“In regard to the passage of Hurricane Irma, I would like to stress that many children who experienced the hurricane did not develop a trauma/PTSD. Of course, some children become nervous when it is windy outside, in fact, even adults become a bit tense when we hear the wind blowing, but this is a normal reaction to an extra ordinary experience. Our children tend to be more impacted by the aftermath of a hurricane: inadequate housing, unemployed parents, food shortages, than the actual hurricane itself.

“Prolonged suffering, which results in high levels of stress, impacts the way you look at yourself and others, and it impacts the way you react and function. Research even shows that prolonged suffering can change your DNA.”

That brings Xiomara to the subject of intergenerational trauma. This can be a direct result of unresolved suffering and distress: persons who were abused during childhood can end up in an abusive relationship or abuse their own children later on in life, if they were unable to resolve their early childhood issues, says Xiomara. “Treating intergenerational trauma can be very challenging, if one is not aware of his or her deeply engrained habits and patterns.”

Emotional distress is also a lot harder to prevent or treat if your environment is not providing the needed resources. “For example, we have poverty on Sint Maarten, which can result in prolonged stressful situations and suffering. There are limitations to what I can do, if a child and its family lack basic needs such as shelter, food, water, health. Then the suffering continues. If we, as a community, do not address the larger issues, we will continue the cycle of suffering and distress. We oftentimes try to fix the child or fix the family, but at times the pathology lies within the environment and not within the individual or the family.”

“I remember treating a child who was being neglected by her mother. Her mom and grandmother were also neglected as children. This is a case of intergenerational trauma as we discussed earlier. Attempts were made to expose the pattern to the parent, but this failed. I then tried to assist this child to come to the realization that she is worthy despite of her experiences. However, she needed to hear this from significant others within her network. The stronger a child’s network, the better you can prevent or resolve the suffering.”

There is such a thing as ‘post traumatic growth’ after having experienced a distressing event, explains Xiomara. “Instead of focusing on suffering and distress, we can also focus on the positive things that occur because of negative experiences. Research has discovered that a traumatic event can lead to positive changes. If children, for example, discover that a neighbor cares, that a teacher will protect them, that they can overcome this obstacle – it shows them that they are cared for, are safe, and are strong enough to overcome a challenging situation. Therefore, professionals who work with children can play such an important role in helping to reframe things.”

PTSD is actually a western concept, Xiomara says. “In the 1970’s after the Vietnam War, the term became especially popular within the anti-war movement. The West has held on to the notion that all people experience suffering in the same way, but this is not true. Different societies have different terms and standards for suffering and distress.”

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the handbook used by health care professionals in the West and much of the world and is viewed as the authoritative guide to diagnosing mental health disorders. However, culture is often not taken into consideration, Xiomara says. “How people interpret and display suffering differs per culture. Here in Sint Maarten, people’s emotional distress is often displayed through the experiencing of physical symptoms. We see complaints such as hypertension, headaches, body pains, etc. It is important to remember this in relation to diagnosing trauma here.”

When she came back to Sint Maarten, she realized that she could not just copy-paste the theories and practices that she had learnt in the Netherlands. Each society, culture and person is different and this should be observed and adapted to be effective. “But there is one rule that always applies: creating a strong network for your client is very important. When counselling a child, I always involve the larger system: parents, family members, teachers, doctors, court of guardianship, police – whomever I can work together with to positively strengthen the child’s network.”

NGO’s and religious institutions also play a big role in assisting children and their families on the island, Xiomara says. “It might be hard to solve our systemic issues quickly, but in the meantime, our government can provide support to institutions that provide a safety net for children. Once a child has a strong network, the chance that he will overcome a traumatic situation is much higher.”

Leona is a psychologist by profession but prefers to be called a counsellor or therapist. “When people hear the term ‘psychologist’ they often think of someone who tells you what to do and magically solves your issues. However, the term ‘counsellor’ or ‘therapist’ is associated with supporting people through a process. People know from the get-go that they will receive guidance but will have to do the work themselves to make a change.”

Guidance (or instruction) and understanding are qualities that Leona believes can go a long way in parenting a child or helping someone out. To achieve this, she believes in maintaining ‘open communication’ with the children and the families that she gives counsel to. Keeping in close communication with families, especially those in crisis, helps them to know that someone is there supporting them through their time of trial.

She believes communication should also be considered when preparing a child for a disaster such as a hurricane: “We live in a hurricane-prone area, so hurricanes are a fact of life. We have to be careful not to make this more dramatic than it needs to be. As children growing up our parents did not sit us down to talk about hurricanes. We hear about them when they shared ‘old-time stories’. Whenever a storm was coming, we saw our parents prepare by gathering basics like, water, flour, sugar, powdered milk, kerosene for the lamps, matches, flashlight, radio, and batteries. We boarded up the windows and waited for the storm to pass. It was all very matter-of fact. We need to remember what worked for our forefathers and bear in mind that not all children will experience a storm the same way; some will cope well, while others will need help processing.”

Each child has his or her own feelings, thoughts and opinions. It is the job of the parents to guide those feelings, thoughts, and opinions in the best way possible. They may know when children feel safe, scared, happy or sad, as they are there to help them navigate those feelings and put them into perspective. This is why routine, structure and discipline are so important. Children need boundaries to feel safe. What you communicate to your children is important. When children know what to expect, it gives them something to work towards. The better your child knows you, the better you will be able to advise and guide him or her by providing a good example for them to follow. Children will not always do what you say, but they will always do what you do.”

“It isn’t always, of course. It is tough to always listen and consider the feelings of people around you, especially if you are in a stressful situation yourself.  It all comes back to routine, structure and discipline. We all make mistakes and can react badly in certain situations, which is normal. When there is order in your home or family environment, children know what is expected and may be less likely to be traumatized when things change unexpectedly, such as is the case with hurricanes. Research shows that children who have been raised with a sense of routine, structure and discipline are better able to cope with major life changes.”

“The first hurricane I remember living through was Hurricane Hugo in 1989. I don’t remember feeling scared, I think my dad and mom kept calm, which also kept me calm. Yes, there was some damage, but life just continued. Hurricane Luis made more of an impression on me. However, I think it may have been more traumatic for my dad because he had to make sure we did not get hurt. Again, I think because he stayed so strong, I remember feeling safe.”

“Depending on their age, children can assist in the preparation around the house. You can take them along to get supplies, listen to the weather forecast together, etc. If they have questions, answer them but do not dramatize the experience. Let them know what they can expect and let them know what to do to stay safe.

Also, I think one thing we have to keep in mind when talking with our children about disasters, or other ‘scary’ subjects, is that they might not be scared in the first place. Do not project your own fears onto them. Every person, every child, reacts differently to situations – what you might find scary, might not be so to your child. If your children say they are ‘ok’ and they are not acting ‘unusual’ – then believe them.”

“By reinforcing all I have talked about here. For example, schools should teach preparedness and help their students deal with the aftermath of a disaster. This is often done through informational classes, activities, or excursions. Some schools also invite people that deal with disaster situations to give presentations, such as firefighters or nurses.

In addition, when students learn and share with their classmates, it helps normalize the situation and makes them feel like they aren’t alone. Learning from each other increases our empathy and gives us different perspectives on a situation.”

“I like to remember this simple rule: we are not the only person experiencing us; we do not exist in isolation. It is important to self-reflect and realize how your actions affect others.
When it comes to preparing children for natural disasters, it is important to provide structure, communicate well and model the best behavior possible. And help them process their thoughts and feelings in the aftermath.”

“If every child must learn, then every parent, family, and community must be part of the process, this is the motto of the Student Support Services Division (SSSD),” explains Olga Mussington-Service, head of the Ministry of Education, Culture, Youth & Sport’s SSSD. The SSSD helps to empower students to achieve maximum academic, intellectual, and social growth. This is achieved by providing consultative support to school teams, interventions with students and their parents, and collaboration with community agencies.

The SSSD was created after government restructuring post 10-10-10. Olga Mussington-Service, as the head of this new agency, was charged with building the division from the ground up. She figured that she “did not have to reinvent the wheel” and started by looking into what other countries and relevant government ministries in the region were doing to provide support services to students. She found that Barbados had one of the oldest Student Support Services Units (SSSU) in the region. “I traveled to Barbados and worked at the SSSU for a week to observe and learn what I could. They really embraced me, and I drew a lot of inspiration from their work.” Once back on Sint Maarten, Olga started writing operational procedures and processes and creating the relevant forms to fit the St. Maarten situation after consultations with local stakeholders. The next step was to hire staff for the division.

Today, almost 10 years later, the SSSD facilitates a wide range of services to ensure that they meet their mission, vision and objective. These services are aligned with the core tasks of the division. Their first priority is supporting students so they can reach their full potential. The SSSD does this by offering services such as speech-language pathology, psychological services, counselling, social work services, educational diagnostics, career guidance, parent and student workshops, crisis intervention, training and development, psychosocial preparation and response in emergencies, special education diagnostic assessment, and facilitation of Labour Oriented Education testing, to name a few.

The SSSD strengthens this network by extending their counselling services to parents of their clients, as well as providing workshops to educators and parents. Workshops can include informative sessions on issues such as bullying, discipline or anger management. The SSSD also runs a monthly parent support group and parents interested in joining this group may contact the division. “Schools can also request workshops. For example, last year we spent a lot of time focusing on bullying prevention in schools,” adds Olga. “When necessary we also collaborate with the Court of Guardianship, Foundation Judiciary Institutes, the Juvenile Department of the Police Force and the Ministry of Health, Social Development and Labor, to name a few.”

Lastly, some might not know that the SSSD provides crisis response. When a school and their students are going through a traumatic event, such as a death of a teacher or student for example, the SSSD works with the school’s care team in their response. Crisis response is very important to the head of the division as this is an area that she focused on during her graduate studies. “We have also been working with schools to update and formalize their school safety and emergency plans, evacuation procedures, and emergency drills for disasters such as earthquakes and fire”, Olga says.

For more information, you can contact the SSSD at 5431235, email studentsupportservices@sintmaartengov.org or visit their Facebook page.