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Bereavement Support (including Pre-bereavement)

Bereavement Support (including Pre-bereavement). Working with children and families. Safeguarding your well being and safety. 0 1 2 3 4 5 6 7 8 9 10. To be an aware, mindful, knowledgeable and confident practitioner. In the next half an hour : ?!*. Grief and trauma

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Bereavement Support (including Pre-bereavement)

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  1. Bereavement Support(including Pre-bereavement) Working with children and families

  2. Safeguarding your well being and safety 0 1 2 3 4 5 6 7 8 9 10

  3. To be an aware, mindful, knowledgeable and confident practitioner

  4. In the next half an hour :?!* • Grief and trauma • Children’s understanding of death • Systems • Pre-bereavement • The professional role • Caring for oneself

  5. Grief – psychological adjustment to loss Shock Disbelief Acceptance Denial Anger Blame Try out new things Or experimenting with change Guilt Deep Despair

  6. Trauma • An experience that is overwhelming • Fight, flight or freeze response is triggered • There can be difficulties integrating the experience physically, emotionally and cognitively into a narrative or memory

  7. Traumatic Qualities Intrusion – thoughts, emotions, pictures, sounds, sensations which come into your experience uninvited Avoidance – staying away from reminders, actively not talking about “it”, pretending, denial Arousal – hyper – state of hyper vigilance - hypo – going to sleep/switching - off

  8. Children come with a history • Attachment pattern • Secure • Insecure ambivalent • Insecure Avoidant • Disorganised/disorientated • A history of losses and experiences which may be traumatic

  9. Children’s understanding of death • Develops in parallel with cognitive maturing • Below the age of 5 – death is reversible – concrete and magical thinking • From 5 to 10 – gradual increase in understanding that death is irreversible – cause and effect – need for detailed information (updates)– males may start to suppress expression of feelings • 10 through adolescence – “uh oh! I’m goanna die!” – abstract thinking – long term consequences of loss – peer influences

  10. Children arrive in a context • Culture of family functioning • Open, closed, chaotic, strict, abusive, loving………… • Religious or belief systems • Self esteem or cognitive beliefs • Age and stage or ability, Gender

  11. What Good Provision for Bereaved Children Looks Like

  12. Pre-bereavement • Bereavement care should begin prior to the death of a patient with their carers being assessed for their potential bereavement risk factors • Bereavement care pathway • Pre-bereavement assessment • Either low, medium or high risk • Initiate appropriate level of support accordingly

  13. Pre-bereavement continued • Anticipatory grief – shielding against pain • Openness within the family will be the best foundation for children’s coping, both while the person is still alive and after their death • Supporting parents on how to talk with children – process should be started before dying person is too ill to participate

  14. Activities • Solution Focussed conversations (Planning) • Identify best hopes (outcomes) • Scaling – measurement of feelings/pain….. • Letter writing/Video recordings (communication) • As much as possible normal, family fun activities or introduce new ones which provide the opportunity to express thoughts, feelings, hopes, anxieties, concerns and strengths‘ • Include family members in making plans for funeral. Children should be given the choice about taking part and having a role. To be supported in understanding what the ritual involves

  15. Professional Role • Human being first • Professional and compassionate • Does your agency have a bereavement support policy? (pro-active planning/intervention) • Agree roles among team around child with an understanding of good practice • The child or family chooses you as a safe person to share with • seek out support and guidance • obtain agreement to plan extra time into sessions, as well as for the period following the death

  16. Caring for oneself • Remember that to be of help to the child, you need to take good care of your self • The system which provides a service for the child, should make provision to support the staff who support the child

  17. Useful links • Bereavement Support Guideline • Merseyside and Cheshire NHS Cancer Network • Standards for bereavement care in the UK (2001) • NICE Supportive and Palliative Care Guidance for Adults (2004) • The National End of Life Care Strategy (2008) • Childhood Bereavement Network

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