ORIGINAL PAPER

Protectors of Indigenous Adolescents’ Post-disaster Adaptationin Taiwan

Hui-Ching Wu

� Springer Science+Business Media New York 2013

Abstract The study examined the protectors of post-

disaster adaption in indigenous adolescent survivors of a

devastating typhoon in Taiwan. In total, 152 adolescent

participants were recruited from two mountainous districts

that were the most severely destroyed by Typhoon Morakot

(August 7, 2009). A self-reported questionnaire with five

major sections including: (1) sociodemographic informa-

tion and previous traumatic experience; (2) the adolescent-

family inventory of life events and changes; (3) the Family

APGAR Index; (4) the Family Satisfaction Scale; and (5)

the WHO Quality of Life Scale was administered to the

adolescents. Multiple regression was performed to analyze

the collected data. Gender, religion, and perceptions of

overall life changes, family functioning, and satisfaction

with family were found to significantly affected post-

disaster life adaptation in indigenous adolescents. The

findings suggest that clinicians should be more sensitive to

gender differences, strengthen adolescents’ beliefs and

family systems, and minimize transitional post-disaster

experience in order to assist indigenous survivors with

coping with disasters.

Keywords Transition � Family � Indigenous adolescence �Adaptation � Nature disaster

Introduction

On August 7, 2009, Typhoon Morakot brought record

rainfall to Taiwan. Most areas recorded rainfall as much as

2,777 mm (109.3 in.), as reported by the Department of

Statistics, Ministry of Interior (2009). The extreme

amounts of rain caused severe flooding throughout South-

ern and Eastern Taiwan and triggered enormous landslides

in mountainous areas, leading to the deadliest typhoon-

related disaster in Taiwan in 50 years. In total, 85 students

were reported dead or missing, and 13 schools and more

than 40 villages were destroyed.

The worst hit regions were inhabited by Taiwan’s

indigenous tribes, with the Bunun tribe particularly affec-

ted. Villages were either washed away or buried by mud

due to the landslides. Many survivors not only lost family

members but also found themselves homeless and needing

to relocate. Parents were separated from their children by

government agencies that attempted to help the adults

rebuild their lives and enable the children to continue their

education. As a result, the survivors were not only grieving

but were also coping with unfamiliar environments whilst

separated from their loved ones.

Previous studies have shown that the degree of disaster

exposure due to property destruction, death, and serious

injuries can predict the prevalence of posttraumatic stress

disorder (PTSD) and that depression symptoms can hamper

an individual’s adaption to life afterwards (Galea et al.

2002; Norris et al. 2004). However, little is known about

the protective variables for post-disaster adaptation in

indigenous adolescent populations in Taiwan, who largely

live in small and remote communities with limited

resources. Often, a natural disaster would result in near

total destruction of their home environments, requiring

them to relocate from remote tribal areas to urban areas.

Although several studies have investigated the mental

statuses and suicide ideations of adolescents several

months after their survival from natural disasters, they have

not investigated the influence of adolescents’ perceptions

H.-C. Wu (&)

Department of Social Work, National Taiwan University,

No. 1, Sec. 4, Roosevelt Road, Taipei, Taiwan

e-mail: hchingwu@ntu.edu.tw

123

Clin Soc Work J

DOI 10.1007/s10615-013-0448-z

on their life changes or losses and the perceptions of their

families’ abilities to adapt to post-disaster circumstances.

Populations such as ethnic minorities or aborigines who

have been displaced or relocated to unfamiliar environ-

ments have also been neglected in these studies. These

displaced individuals not only have to adapt to life in a

different culture but also need to handle ongoing tasks,

such as rebuilding family schedules and maintaining con-

nections with their own tribes. This study thus attempted to

examine the influence of factors such as gender, religion,

perception of life change and family function, satisfaction

with family, and previous traumatic experience on indig-

enous adolescent survivors’ post-disaster adaptations to

their new living environments.

Factors Affecting Adolescents’ Adjustment to Natural

Disasters

Disaster research has found a high prevalence of psychi-

atric disturbance among youths exposed to disasters

months after occurrence (Lee et al. 2004; McDermott et al.

2005). However, it has also been found that adolescents

tend to adjust to the upheaval in their lives and form new

friendships in places where they have been relocated

(Smith and Carlson 1997; Walsh 2007).

The way in which young people adapt depends on

several factors, such as age, gender, disaster type, location,

frequency, predictability, suddenness, warning time,

severity, intensity, types of destruction experienced, sights

and sounds during the event, injury, damage, death of loved

ones, aftermath and preparation, prevention methods, and

different assessment methods (Smith and Carlson 1997;

Gavranidou and Rosner 2003; FEMA 2005; Norris 2005;

Thienkrua et al. 2006). Other factors include the kind of

exposure they had experienced prior to the event; the extent

of loss of psychosocial support systems and community

resources (Fullerton and Ursano 2005; Stevens and Slone

2005; Vigil and Geary 2009); as well as the disruption to

their families, the loss of their friends and classmates,

anxiety about relocation, and their perceptions of life

changes (Evans and Oehler-Stinnett 2006). However, this

adaptation process can be complicated by re-traumatiza-

tion. For instance, episodic displays of trauma-induced

symptoms in one family member can trigger secondary

traumatization or psychiatric impairment in other family

members, especially in children and adolescents (Kilic

et al. 2003; Fothergill and Peek 2006; Caruana 2010).

Meanwhile, how they respond depends on their individual

developmental stage, their peers’ responses, their family’s

functioning, and their satisfaction with their families.

Indeed, McFarlane (1987) has reported that separation

from parents in the immediate aftermath and disturbed

family functioning are more critical determinants of

adolescents’ responses to natural disaster than the direct

exposure experienced by them.

Moreover, Repetti et al. (2002) have suggested that ado-

lescent adjustment is best understood within the social con-

text of multiple factors, specifically within a family-related

system, which have been linked to a wide range of outcomes.

Proctor et al. (2007) have suggested that a negative family

environment might increase children’s vulnerability to

serious stressors such as natural disasters, while a positive

family environment might buffer or facilitate adjustment to

adverse life events (Garmezy et al. 1984). Both Osofsky

(2002) and SAMHSA (2005) have also reported that parents

play an important role in helping their children understand

and cope psychologically with a disaster. These studies,

however, did not examine indigenous populations or overall

adaptation. Therefore, this study attempted to determine the

role of the family in predicting indigenous adolescents’ post-

disaster adaptation.

Relocation and Adaptation in Early Adolescents

Relocation, a major issue in the aftermath of a large-scale

disaster, may increase psychological morbidity and reduce

the possibility of the social support that the victims might

have previously received from neighbors, religious groups,

family members, and recreation, because many would have

been destroyed, displaced, or in a state of disarray (Ful-

lerton and Ursano 2005; Uscher-Pines 2009). In major

disasters, many family members and friends are often

affected, disrupting familiar support systems (Evans and

Oehler-Stinnett 2006). Moreover, survivors of community-

wide disasters are likely to encounter considerable ongoing

stressors, such as homelessness, the threat of an epidemic,

supply worries, discontinued education, bureaucratic iner-

tia, and the inconveniences of living in temporary accom-

modations away from familiar social networks, which can

amplify the original trauma (Caruana 2010). Recovery and

adaptation is particularly difficult for displaced early

adolescents.

Relocation has also been associated with higher levels of

ecological stress, crowding, isolation, and social disruption

(Lazarus et al. 2002), because recreational activities in

evacuation centers are often limited to watching television,

listening to the radio, visiting friends, and daily routines. In

addition, survivors of disasters often need to relocate sev-

eral times until they, or the authorities, find a more per-

manent place to rebuild their lives. This frequent disruption

would certainly increase the social, environmental, and

psychological stress experienced by the survivors, increase

their vulnerability, and have negative social and economic

ramifications (Riad and Norris 1996; Badri et al. 2006).

Early adolescents, a particularly vulnerable group, have

to deal with the stress and anxiety of living in shelters and

Clin Soc Work J

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the uncertainty of whether they will have a place to live in

when the shelters close. The insecurity associated with

relocation can have an adverse impact on a resettled pop-

ulation that has already lost shelter, land, cultural assets,

sanitation, social support networks, and education oppor-

tunities and that fears further loss (Badri et al. 2006). The

stress experienced by early adolescents could intensify to

the point of secondary traumatization due to a lack of

living and education facilities and of health and family

care. Wickrama and Kaspar (2007) found that prolonged

displacement increases the risk of mental health problems

and erodes hope for the future. Walsh (2007) suggested that

people, especially children, have an acute need to know

that they can rely on others for support, comfort, and

safety. Therefore, the loss of family function associated

with prolonged displacement can increase the risk for

psychiatric morbidity in the young adolescent group. In

particular, girls were found to have more negative out-

comes and use more social support in the face of stress than

boys (Smith and Carlson 1997; Gavranidou and Rosner

2003).

Post-disaster Family Function

Parents play an essential role in their children’s adaptation

in the face of stress and trauma (Salmon and Bryant 2002;

Kilmer and Gil-Rivas 2010). Research in Western societies

has suggested that authoritative parenting associated with

positive parent–child relationships fosters confidence,

which may reduce trauma-induced emotional difficulties

(Conger et al. 2002). As connection with others is of fun-

damental importance to children and adolescents, facili-

tating reconnections with their parents and parental figures

is a primary goal in disaster-related intervention (Hagan

2005). However, there have been few studies on the role of

family functioning in children’s reactions to disasters (Yule

et al. 1999; Kilic et al. 2003).

Walsh (2007) found that family functioning could be

disrupted, especially with complex, ongoing, or recurrent

trauma, as experienced by those living in war, conflict, or

recurring flood areas. Cohan and Cole (2002) found that

even intimate partner violence, child abuse, and sexual

violence are more prevalent after disasters. Thus, family

involvement might be critical to successfully treat dis-

tressed youths, because parenting strengths such as effec-

tive monitoring can protect teens from negative influences

(Rowe and Liddle 2008). Joshi and Lewin (2004) also

noted that parents’ functioning may be an important

determinant of stress reactions in youths following disas-

ters. Furthermore, Peng et al. (2006) have found that for

aboriginal adolescents, family communication is related to

satisfaction with quality of life.

Anecdotal studies have found that family/parent–child

relationships in remote mountainous villages are often

closer, stronger, more supportive, and warmer, and there is

generally closer monitoring of the children, which contin-

ues through adolescence (Yeh 2011). The indigenous

population tends to be more optimistic and positive than

the Han Chinese population in Taiwan. They also tend to

value collectivism even more than their Han Chinese

counterparts do. In a disaster context, the indigenous peo-

ple would therefore be more reliant on their own rela-

tionship-based or kinship-based social networks than on

relief agencies (Bhugra and van Ommeren 2006).

Thus, although the relocation of parents and adolescents

affected by Typhoon Morakot to two separate locations

might have been practical, it might have had adverse

effects on families, because the importance of family and

social support might have been overlooked by authorities

either unaware or insensitive to the culture of these people.

Cross-cultural researchers often emphasize the importance

of considering both universal and culture-specific aspects

of life or quality of life when evaluating survivor adapta-

tion. Hence, although these people were provided food and

shelter, it is unknown to what extent the disruption of

family functioning has affected their children’s adaptation

to the circumstances forced upon them by the disaster and

the authorities attempting to resolve their problems.

Indeed, it has been established that children’s social and

cultural contexts and reciprocal interactions with caregiv-

ers and other important social network members within

their environments influence their cognitive, emotional,

and behavioral responses to daily events (Lewis 2000).

On the basis of the existing literature (Smith and Carlson

1997; Gavranidou and Rosner 2003) and anecdotal find-

ings, this study hypothesized that teenage girls would be

more vulnerable than teenage boys and that those who

possessed religious beliefs, perceived less life changes,

were not severely injured, had stronger family function,

and felt more satisfied with their family would be better

adapted to the post-disaster environment. That is, individ-

ual factors such as gender, religion, perceived life change,

and previous traumatic experience as well as family factors

such as family function and satisfaction with family would

predict adaptation in displaced indigenous adolescents who

were separated from their parents. This study was con-

ducted by analyzing the data collected from a self-reported

questionnaire administered to 152 relocated indigenous

junior high school students from two mountainous villages

9 months after Typhoon Morakot, when they had already

returned to their respective villages or had moved perma-

nently to other areas. The scales embedded within the

questionnaire allowed us to determine the associations

between life changes, transition, and perceptions of family

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function and satisfaction with family on adolescent

adaptation.

Methods

Participants

Data for this study were collected from surveys completed

by junior high school students who had resided in villages

of varying sizes in two severely affected districts: Taoyuan

District and Namasia District. The surveys were adminis-

trated to 152 adolescents who referred by the indigenous

social workers. Many schools and houses had either been

ruined or designated as unsafe in these districts after the

disaster. School-aged children had to be airlifted to school

dormitories and their parents, airlifted to bases immedi-

ately after the disaster. The children continued their formal

education in groups and, if the circumstances permitted,

with their former teachers. Most of the students were able

to visit their parents during the weekends. These students

were recruited about 9 months after the disaster through a

name list provided by three junior high schools that the

students were attending before the disaster, and they par-

ticipated with their parents’ or guardians’ consent. They

had already been reunited with their families and had either

returned to their villages or had moved to permanent

locations by the time the study was conducted. As the

interviews were performed either in small groups or indi-

vidually, it took approximately 6 months to recruit and

interview the participants. All potential participants were

informed about the study orally and in writing by the

researcher. Each parent or guardian then provided written

informed consent, and each adolescent provided written

assent as well.

Measures

The questionnaire comprised 101 items divided into 5 sec-

tions: (1) socio-demographics including gender, religion,

and previous traumatic experience, (2) items from the ado-

lescent-family inventory of life events and changes

(A-LIFE), (3) the Family APGAR Index, (4) the Family Sat-

isfaction Scale (FSS), and (5) the short version of the WHO

Quality of Life Scale (WHOQOL–BREF). The Chinese

versions of the WHOQOL, APGAR, and FSS have been

previously administered to Taiwanese of Han Chinese origin

and has been confirmed to be valid and reliable. A-LIFE was

translated from English to Mandarin Chinese by a researcher

and subsequently reviewed by school counselors of indige-

nous descent to ensure cultural sensitivity. A bilingual

scholar then back translated the Chinese versions into Eng-

lish. The WHOQOL–BREF questionnaire served as the

measurement for the dependent variable ‘‘adaptation,’’ and

socio-demographic factors (i.e., gender and religion, previ-

ous traumatic experience), the A-LIFE, the family APGAR

Index, and the FSS served as measurements for the inde-

pendent variables (hypothesized protectors).

WHOQOL–BREF, the Proxy for Adaptation

The WHOQOL–BREF, which has been used previously to

measure adaptation (Bishop 2005), was used in a similar

manner in this study. It comprises 28 items that cover four

broad domains: (1) physical health, (2) psychological

health, (3) social relationships, and (4) environment (Har-

per and Power 1998), with greater satisfaction in the var-

ious domains representing better adaption. Internal

consistency (Cronbach’s a coefficients) for the Chinese

version ranged from .70 to .77 for the four domains and .91

for the entire questionnaire (Yao et al. 2002).

Adolescent-Family Inventory of Life Events and Changes

(A-LIFE)

Sense of loss was measured by the A-LIFE scale. The

A-LIFE is a 50-item instrument designed to measure an

adolescent’s perceptions of life events and changes expe-

rienced by his or her family within the past year. The

A-LIFE scale covers six domains of changes: (1) transition,

(2) sexuality, (3) loss, (4) responsibility and pressure, (5)

substance use, and (6) legal conflict. Each item is a state-

ment regarding whether the participant had issues with the

items under each sub-domain at least once within the year

leading up to the questionnaire. ‘‘Yes’’ was assigned a

value of 1 and ‘‘no,’’ a value of 0. Analysis of reliability for

this scale has been reported to yield high internal consis-

tency coefficients of .82 for total recent changes and .84 for

total past life changes (McCubbin and Thompson 1991).

Similarly, the Cronbach’s as of the Chinese version used in

our study were .84 for total recent changes and .67 for total

past life changes respectively.

Family APGAR Index

The Family APGAR consists of five items evaluating the

participants’ perceptions of family function, with one item

for each of the following categories: adaptation, partner-

ship, growth, affection, and resolve (Smilkstein 1978; Chau

et al. 1991). Each item was answered on a 3-point fre-

quency scale ranging from 1 (almost never) to 3 (usually).

The higher the total score was, the better the participant’s

perception was of family function. The Cronbach’s a of the

Chinese version of the Family APGAR was reported to be

.72 when used with Taiwanese adolescents (Ko et al.

2009).

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123

Family Satisfaction Scales

The 10-item form of the 14-item FSS developed by Olson

and Wilson (1989) was used. This scale assesses the sat-

isfaction of family members with family closeness, cohe-

sion, flexibility, and communication. All of the items are

rated on a 5-point scale ranging from 1 (dissatisfied) to 5

(extremely satisfied). Administration to a sample of 2,465

family members found the 10-item scale to have high

internal consistency, a = .92 (Olson et al. 2006); the

Cronbach’s a for our Chinese version was .89.

Data Collection

This study used a non-probability, purposive sampling

technique to select a convenience sample from a surviving

population of indigenous adolescents. The questionnaire

was administered with the assistance of indigenous social

workers. The participants were informed that their answers

were confidential, that their participation was voluntary,

and that their personal data could only be accessed by the

researcher who would report it in an aggregate manner.

Each participant provided informed written assent and

parental/guardian consent.

All research participants were referred to the study

directly by the indigenous social workers in two branches

of a local social service organization, known as Taiwanese

World Vision. This study was approved by the participat-

ing schools and the collaborating sites.

Data Analysis

Quantitative data were coded and analyzed. Descriptive

data are presented as means and standard deviations.

Multiple regression analyses were conducted to test the

hypotheses of the study. An obtained p value of .05 or less

was considered statistically significant. All statistical

operations were performed using SPSS 16.0.

Results

In total, 152 indigenous adolescents (69 boys, 83 girls)

ranging in age from 11 to 15 years (mean age = 13 years)

participated in this study. Most of them live (96.1 %) with

two or more family members (M = 4.84). Of the partici-

pants, 90.10 % held Christian beliefs (i.e., Protestant or

Catholic) and 10.5 % (16 participants) had had previous

traumatic experiences (i.e., another natural disaster or

family violence) before Typhoon Morakot. After the

disaster, 94.7 % were relocated to school-based dormito-

ries for one semester (Table 1).

Six protective variables were investigated. Multiple

regression analysis revealed possible protectors for overall

adaptation in early adolescents (Table 2). Adaptation was

found to be significantly influenced by gender (b = -.74,

b = -.17, SE = .30, p B .05), religion (b = -1.22, b =

-.21, SE = .42, p B .01), perception of overall life changes

(b = -4.00, b = -.21, SE = 1.31, p B .01), family

Table 1 Demographic data for the indigenous adolescents

N %

n 152 100.0

Gender

Male 69 45.4

Female 83 54.6

Age (years)

11 18 11.8

12 36 23.7

13 43 28.3

14 48 31.6

15 7 4.6

Religion

None 2 1.3

Eastern 12 7.9

Western 137 90.1

Others 1 .7

Number of family members

One 6 3.9

Two and above 146 96.1

Having previous traumatic experience

Yes 16 10.5

No 136 89.5

Being relocated

Yes 144 94.7

No 8 5.3

Table 2 Predictors of indigenous adolescents’ post-disaster adapta-

tion in Taiwan

Adaptation/quality life

Variable

Constant 15.397***

Gender -.171*

Religion -.205**

All change -.212**

Family function .318***

Satisfactory with family .195*

Previous traumatic experience .043

R2 .319

F 11.141***

DR2 .290

N = 152; * p B .05; ** p B .01; *** p B .001

Clin Soc Work J

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functioning (b = 1.43, b = .32, SE = .35, p B .001), and

satisfaction with family (b = .33, b = .20, SE = .13,

p B .05). The previous traumatic experience was not found

to significantly influence the adaptation of indigenous ado-

lescents. This might be because few of the participants had

suffered previous traumatic experience. Five variables

(gender, religion, perception of post-disaster life changes,

satisfaction with family, and family functioning) had a

combined significant impact on post-disaster adaptation

(F = 11.141, p B .001). The female adolescents had more

difficulty adapting to the disaster than the males did, that

those who held Christian beliefs (i.e., Protestant or Catholic)

tended to adapt better than the others, and that participants

who perceived less life changes and who were more satisfied

with their families and family functioning adapted better to

the post-disaster quality of life. Positive family function

accounted for the greatest variance in adaptation in HRQoL

(b = .32 vs. b = -.17, b = -.21, b = -.21, and b = .20).

This model explained 32 % of the variance (R2 = .32,

p B .001), as seen in Table 1.

Discussion

The study found post-disaster life adaptation of indigenous

adolescents to be significantly influenced by gender, reli-

gion, perceptions of overall life change, family functioning,

and satisfaction with their families. Except for previous

traumatic experience, five variables significantly predicted

adaptation in indigenous adolescents (Table 2).

Relocation and loss due to disasters require people to

face great changes in how they navigate within their

environments. If unsuccessful, they may face misunder-

standing and discrimination and be considered as malad-

justed by people in the new environment. The participants

in this study were forced to relocate to either a plain or an

urban area. In these unfamiliar places, there was a high

probability that their own social networks were disrupted,

as they were separated into groups and relocated to various

military bases. In this study, the participants’ ability to

adapt was significantly influenced by changes in overall

life, especially with transitions such as their parents having

new jobs or their having to attend new schools. They might

also have had to handle additional responsibilities if

another family member became ill, injured, or was no

longer able to perform certain tasks. This would have

influenced their perspectives of family functioning and

subjective satisfaction with their families.

However, family function and community connected-

ness are foundations for coping with a catastrophic event

(Walsh 2007; Kayser et al. 2008). If functions and con-

nections are troubled or estranged, distress is intensified

(Walsh 2007). This appears to be especially true for the

adaptation of young people to post-disaster life. Tui-

comepee and Romano (2008) found an association between

poor family functioning and behavioral problems among

Thai adolescents exposed to the 2004 tsunami, which is

consistent with the results of this study.

While family functioning may play an important role in

adaptability, adolescents’ subjective perceptions of their

families’ abilities to function may play a greater role in

their adaptation. This is supported by the results of our

study, which found that adolescents’ subjective perceptions

of family functioning and satisfaction with their families

were essential in predicting the level of adaptation. The

results also correspond with those of Bokszczanin (2007).

Moreover, previous studies have suggested that parents can

serve as a critical ‘‘protective’’ function for their children

and increase the likelihood of successful coping and

adaptation while reducing the likelihood of maladjustment

(Hafstad et al. 2010; Luthar et al. 2000).

In total, 90 % of the present study’s participants were

Christians. This study findings support those of Calhoun and

Tedeschi (1999), who found that families’ belief systems,

which are often rooted in cultural and spiritual traditions and

are sources of comfort and support, are important consider-

ations when studying perceptions of traumatic experiences

and coping strategies. Religion, particularly Christianity,

was found to predict adaptation in adolescents. Christian

missionaries often concern themselves with forgotten or

less-fortunate populations. Accordingly, the missionary

community has paid much more attention to the 14 indige-

nous tribes in Taiwan, which were mostly relegated to

mountainous, often hard to reach areas where churches, not

temples, are more common. As much as 90 % of Taiwan’s

indigenous people grew up in villages ministered by various

Christian churches. To some extent, the Christian church has

been viewed as an important contributor to how the indige-

nous adolescents in Taiwan respond to disaster and adapt to

new circumstances.

Gender has been found to predict adaptation in stressful

events in our study and in that of Smith and Carlson

(1997); girls appear to be at higher risk of experiencing

distress than boys (Chen et al. 2002; Chang et al. 2005;

Bokszczanin 2007; Galea et al. 2008). Similarly, the girls

in this study were found to be more vulnerable to stressful

life events than boys. This may be due to the tendency of

teenage girls to use social support as the main coping

mechanism, followed by wishful thinking, worries, and

self-blame, whereas boys tend not to use such coping styles

(Gavranidou and Rosner 2003). Therefore, family dys-

function may have had a particular impact on female

adolescents’ coping mechanisms and level of satisfaction

with their families.

Although we found that gender, religion, perceptions of

life changes, family function, and satisfaction with family

Clin Soc Work J

123

predicted indigenous adolescents’ adaptation to disaster,

previous traumatic experience was not found to be a sig-

nificant predictor, which differs from the results of Norris

(2005) and Thienkrua et al. (2006). This might be because

few participants in this study were exposed to trauma.

Limitations

This study has several limitations. First, the uniqueness of

the disaster as well as the time of assessment might have

had a significant impact on the types of adaptation repor-

ted. Second, this is a cross-sectional study conducted

approximately 9 months post-disaster and on only two

districts; therefore, the results might not accurately portray

the adolescents’ adaptation. In other word, this is not a

representative sample. Third, its focus on one sub-culture

limits generalizability. Fourth, the severity of exposure,

perceived life endangerment, and the percentage of par-

ticipants who lost family members were not assessed. The

length of exposure and interactions among protectors were

not investigated as well; these variables might have

affected the ability of survivors to adapt after a disaster.

Finally, the domains of the WHOQOL (i.e., physical,

psychological, social relationships, and environment)

should have been analyzed separately to determine if the

contributing factors are similar across domains. Therefore,

further research is needed to address these limitations.

Implications

This study findings suggest that clinicians should not only

obtain factual information such as gender, family func-

tioning, support system, and community connection, but

also examine beliefs that foster blame, shame, and guilt,

because adolescents, especially female adolescents, often

hesitate to confide in other people due to embarrassment.

Moreover, unless distressed symptoms are manifested

behaviorally, parents may be unaware that their children

are not adapting well. Therefore, clinicians (i.e., school

social workers) should conduct comprehensive bio–psy-

cho–social evaluations and be more sensitive to adoles-

cents’ school performance and interpersonal and family

relationships in order to determine adjustment accurately.

Social workers could educate parents on how to interpret

their children’s emotional and behavioral reactions at

home. Therefore, the school system needs to collaborate

with the family system to form a comprehensive safety

network for adolescents’ post-disaster adaptation.

As religion was found to be an influential protector,

community social workers could use this knowledge to

identify personal, relational, and spiritual resources that

adolescents or their families drew on in past hardships and

apply them to present circumstances. For instance,

teenagers could be encouraged to attend youth fellowships,

be reminded of how their families overcame hardships in

the past, or to have faith that their situations would

improve. Furthermore, social workers can collaborate with

clergies at local churches to provide a comfortable, sup-

portive, and private environment for self-expression.

It is essential to normalize and contextualize distress,

draw out strengths and active coping strategies for

empowerment, and mobilize family and social support for

ongoing adaptation. Thus, clinicians need to facilitate

family relationships, the realignment of family roles and

functions, and the rebuilding of lives, homes, livelihood,

kinship, and societal connections such as ethnic heritage or

religious communities. It is important to help family and

community members share concerns about the division of

responsibility or negligence, come to terms with situational

limitations, and learn from past experiences to guide future

actions. Social workers could also organize stress-man-

agement groups for caregivers. According to Kayser et al.

(2008), most interventions should be done within the

context of the family, community, culture, and religion.

In summary, this study found that indigenous adolescents’

gender, religion, the perceptions of overall life change and

family functioning, and the satisfaction with their families

affected how well they adapted after a regional disaster. The

findings suggest that clinicians should be more sensitive to

gender differences, strengthen adolescents’ perceptions of

beliefs and family systems, and minimize post-disaster

transitions in order to assist indigenous adolescents in coping

with disasters. Future studies should focus on the mecha-

nisms underlying the associations between family functions

and satisfaction with family on adaptability.

Acknowledgments This study was sponsored by National Science

Council, Taiwan, ROC (NSC99-2420-H-002-008).

Conflict of interest All authors declare no conflict of interest.

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Author Biography

Hui-Ching Wu is an associate professor at Department of Social

Work, National Taiwan University in Taipei, Taiwan and licensed

social worker with a PhD degree in social work practice track from

Columbia University School of Social Work (CUSSW). My specialty

and research interests are mental health, family and quality of life.

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