Children experiencing grief & Loss

1. This interactive Power Point has been created to help you, as a professional, become aware of how children grieve. Children experiencing grief & Loss When you see this star, click the mouse or press the space bar to move to the next slide Tammy Hatt, Jon Eaton, Naomi Caban

2. “Bereavement services cannot make children feel not sad, but they can help them understand and acknowledge their loss.” Barbara Monroe, director of St Christopher's Candle Project in London

3. Did You Know?

4. Did You Know?

5. Definitions

6. Grief Cycle the conscious or unconscious refusal to accept the facts and reality of death They become angry with themselves and the deceased for not having control Bargaining is a vain expression of hope that the death is reversible When a child realizes there is nothing that can be done to bring a parent back, they are overwhelmed with sadness and grief The person is ready and actively involved in moving on to the next phase of their lives

7. Implications of Attachment Theory John Bowlby

8. Impact on Development Children experience negative physical and emotional repercussions in response to bereavement. Grief and trauma may be overwhelming at their limited stage of development. Fearfulness Sickness Irritability Overwhelming Guilt Aggressiveness Regression (such as Anger bed wetting, thumb Rage sucking, fetal Withdrawal positioning) Depression Nightmares Sleep Disturbance Anxiety Headaches

9. Teenagers often start to develop their own philosophical views on life and death and may react to their own fears by taking risks in their own lives. In this way, they’re confronting death and attempt to overcome the fear by maintaining their control over mortality. Developmental Stages Between ages 5-9, they may begin to grasp that death is final but not yet personal. By ages 9-10 and through adolescence, they may realize that death is irreversible and that they too will die someday. Young children are concrete thinkers. We must use terms they can understand. They simply do not have the cognitive ability to process the finality of death and often believe the person will come back to life as if they’re on vacation or temporarily gone away. Pre-school age children believe that death is reversible. It is merely temporary and impersonal. Remember that they do not have the coping skills or life experience that adults have to utilize during the grief process. They’re known to express their grief through actions rather than words.

10. Research has been shown to link early loss to short term psychosomatic problems. Many children will continue to experience psychological pain and disruptions in the subsequent developmental stages. Factors other than the loss itself may have a greater impact on the development of bereaved youngsters. Research These factors might include circumstances surrounding the death (i.e. murder, suicide, sudden death, long illness, etc.), child’s relationship with surviving parent, nature of relationship with deceased, access to social services and support systems, preceding life changes, and level of cognitive development.

11. When Families Grieve In this primetime special, Sesame Workshop presents personal stories about coping with the death of a parent. Katie Couric joins Elmo and his furry friends to model communication between adults and children. They’ll also offer thoughtful suggestions and strategies that help the whole family. Click on the picture for a link to this video

12. Helping children cope with bereavement at the different developmental stages Source: Kirwin & Hamrin (2005)

13. Myths about Bereavement Children do not grieve – Young children may be unable to verbalize or may hide feelings – they may speak through their behavior and play Children experience few losses – They experience loss routinely at school, with friends, special pet, and friends Adults want to protect children – Adults may not have the energy or necessary knowledge to help children Children recover quickly from grief – Child’s grief is intertwined with their developmental process. There are some predictable or orderly stages that a child proceeds through grief – No two people are alike and neither are any two children. Everyone grieves in their own way. Children who experience bereavement will grow to up to become maladjusted adults – Children who receive compassionate care and early interventions can heal and grow from the bereavement experience. Children should not attend funerals – Funerals provide the structure for people of all ages to comfort each other, to mourn openly, and to honor the person who died. Source: Kirwin & Hamrin (2005)

14. Myths about Bereavement Misconceptions exist about how effectively developmentally disabled children articulate their perceptions and feelings about traumatic experiences, death, and the subsequent impact of the events that follow. Their experience and expression of grief may differ for this population. Their reactions may not adequately be recognized, interpreted, or managed therapeutically, compounding their distress. Although perhaps viewed as different or unusual they may or may not really understand the concept of death and the subsequent changes. They may not immediately grieve or as would be expected of others.

15. Culture Cultural Expectations What is wrong with our culture? Most societies have wakes and funerals to formalize death and honor the deceased. Many cultures have extensive mourning rituals as well. Old cultures are much more natural in their mourning. For example, Mexicans go and visit graves on a regular basis. They bring food, enjoy a feast, and converse with the dead. Our deceased are usually dressed up, wearing makeup and otherwise appear as if they’re sleeping. How far have we come in terms of accepting our own mortality? We are still very much death phobic. Death at one time was an integral part of life as people died at home surrounded by loved ones. Today the living have become isolated from the dying strengthening the notion that death is taboo adding great fear and mystery to the subject.

16. School policy – click on the answer Schools in the US… are not prepared for dealing with a students bereavement have set policies and access to professionals to help with bereavement

17. correct!!! When a crisis occurs, schools are viewed by children and families as a place to turn for help and support. Most educators, school administrators and even school mental health professionals have had only limited professional training to equip them to develop and implement an effective school crisis response system and to provide bereavement support to grieving students.

18. wrong!!! When a crisis occurs, schools are viewed by children and families as a place to turn for help and support. Most educators, school administrators and even school mental health professionals have had only limited professional training to equip them to develop and implement an effective school crisis response system and to provide bereavement support to grieving students.

19. The National Center for School Crisis and Bereavement The lives of children are too frequently touched by crises that may include the death of family members, friends, or others important in a child's life. When this occurs, learning, behavior and relationships can be impacted. The National Center for School Crisis and Bereavement (NCSCB) can provide guidance for you and your child’s school to understand and meet the needs of your child and family. The National Center for School Crisis and Bereavement at Cincinnati Children’s Hospital Medical Center was established in 2005 with initial support from the September 11th Children’s Fund and the National Philanthropic Trust and supplemental funding from Procter & Gamble. Click on the picture for a link to this website

20. Normalize ~ We need to change our perception of death from abnormal to normal. Children in 2020 – How We Can Help Educate ~ Children whose parents/caregivers are actively involved in the child’s grief process often cope more effectively. Allow ~ Children should be allowed the freedom to express their grief, even at inopportune times. Intervene ~ Therapeutic art such as drawing and painting. Play therapy and music can be healthy outlets. Group therapy, CBT, encouraging them to share stories, write, and remember. Secure ~ Loving guidance, support, reassurance, and warmth will help their sense of security and stability. Avoid euphemisms!

21. Developing Social Policy Worldwide, schools are developing more formal responses to managing loss and building their own in-house expertise. This is probably not the case for underdeveloped countries who are struggling with actual physical survival. There’s a need for additional research on how gender, age, socio-economic status, ethnicity, and culture impact childhood bereavement Follow-up on the long term effects of treatment are also warranted. To improve research in the field, reliable and valid measures for different age groups need to be developed. They need to be developed, applied, and evaluated in children and adolescents with different types of bereavement and without comorbid PTSD. It is important to look at future studies regarding bereaved youth who show clinical distress but not yet clinical symptoms. This would help with preventative interventions. Intervention for children and adolescents are very different and studies on either population are small, even a small number of controlled studies could change the result of our current evaluations.

22. Conclusion The death of a parent is a major stressful event for children and their families. This traumatic event can bring serious psychological and social distress to bereaved children and their families. Children who are not supported in the early phases of grieving can develop serious emotional and behavioral problems that can lead to the development of some major psychiatric disorders. Providing early prevention support programs for surviving parents and bereaved children can help both the parents and the children adapt to their losses. These structured programs can decrease the risk of complicated grief in bereaved families.

23. Other Videos of Interest • Helping Children Cope with Grief I • Helping Children Cope with Grief II • Helping Children Cope with Grief III • Hospice Expressive Therapy for Children • Camp Erin • Mourning Star Center Click a link for more videos

24. Thank You For Your Time We would like to thank you for viewing our Power Point presentation. If you would like to contact us regarding any information you have read, please leave your questions or comments on the class’ blog

25. References Archer, J. (1999). The Nature of Grief: The Evolution and Psychology of Reactions to Loss. New York: Routledge. Blewitt, P. & Broderick, P.C (2006). The Life Span: Human Development for Helping Professionals. (2nd ed.). Upper Saddle River, NJ: Pearson Education, Inc. Kubler-Ross, E. (1969). On Death and Dying: What the dying have to teach doctors, nurses, clergy and their own families. New York: Macmillian. Lohnes, K., & Kalter, N. (1994). Preventive Intervention Groups for Parentally Bereaved Children. American Journal of Orthopsychiatry, 64(4), 594-603. Retrieved June 27, 2010, from Psycharticles database. National Association of School Psychologists. (2003). Helping Children Cope with Loss, Death, and Grief: Tips for Teachers and Parents. Retrieved June 27, 2010 from http://www.naspweb.org/resources/crisis_safety/griefwar.pdf National Institutes of Health. (2006). Talking to Children about Death. Patient Information Publications, p. 1-14. Redwood, D. (1995). Interview with Elizabeth Kubler-Ross M.D. Retrieved June 27, 2010 from http://www.healthy.net/scr/interview.asp?Id=205 Zambelli, G., & DeRosa, A. (1992, October). Bereavement Support Groups for School-Age Children : Theory, Intervention, and Case Example. American Journal of Orthopsychiatry, 62(4), 4884-493. Retrieved June 28, 2010, from Psycharticles database.

26. References Alison, P. (2008). How do children grieve? Community Care, 1734, 18. Kirwin, K., & Hamrin, V. (2005). Decreasing the risk of complicated bereavement and future psychiatric disorders in children. Journal of Child and Adolescent Psychiatric Nursing, 18(1), 62-78. McClatchey, I., Vonk, M., & Palardy, G. (2009). Efficacy of a coamp-based intervention for childhood traumatic grief. Research on Social Work Practice, 19(1), 19-30. Mitchell, A., Wesner, S., Garand, L., Gale, D., Havill, A., & Brownson, L. (2007). A support group intervention for children bereaved by parental suicide. Journal of Child and Adolescent Psychiatric Nursing, 20(1), 3-13. Rosner, R., Kruse, J., & Hagl, M. (2010). A meta-analysis of interventions for bereaved children and adolescents. Death Studies, 34(2), 99-136. Tracey, A., & Holland, J. (2008). A comparative study of the child bereavement and loss responses and needs of schools in Hull, Yorkshire and Derry/Londonderry, Northern Ireland. Pastoral Care in Education, 26(4), 253-266.