504 a Shaffer presentation


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504 a Shaffer presentation

  1. 1. Kaleidoscope: Looking at Grief Through the Eyes of a Child Rev. Brian K. Shaffer, CPBS, GC-C, CT Odyssey Hospice Grief Steps Columbus, Ohio 2010 NAGC Symposium Cleveland, OH
  2. 2. REFLECTION: Child of Mourning… Workshop Objectives :  Common Patterns of a Child’s Grief Experience   Developmental Understanding   Spirituality of Children   Risk Factors & Challenges   Tools & Resources 
  3. 3. Common Patterns  EXPRESS “ Children grieve and experience feelings”  EXPERIENCE “ Children learn through the modeling of others”  EDUCATE “ Children experience life as they grow (develop) & learn about themselves and about life”
  4. 4. Common Patterns  EVOLVE “ Children are working into a loss awareness”  EXPRESS “ Children seek channels for their mourning”  EVOKE “ Children (call forth) –emerge as an adult”
  5. 5. Supporting a Child’s Grief <ul><li>4 “Tasks” of Mourning : </li></ul><ul><ul><li>Understanding </li></ul></ul><ul><ul><ul><li>“ to understand and begin to make sense out of what has happened” </li></ul></ul></ul><ul><ul><li>Grieving </li></ul></ul><ul><ul><ul><li>“ to identify, validate and express in constructive ways reactions to the loss” </li></ul></ul></ul>
  6. 6. Supporting a Child’s Grief <ul><li>4 “Tasks” of Mourning : </li></ul><ul><ul><li>Commemorating </li></ul></ul><ul><ul><ul><li>“ to commemorate the life that was lived” </li></ul></ul></ul><ul><ul><li>Moving or Going On </li></ul></ul><ul><ul><ul><li>“ to learn to go on with living and loving” </li></ul></ul></ul>
  7. 7. <Newborn to 3 years> <ul><ul><li>Perception: </li></ul></ul><ul><ul><ul><li>Ability to sense excitement, sadness, anxiety </li></ul></ul></ul><ul><ul><ul><li>Ability to sense when a significant person is missing </li></ul></ul></ul><ul><ul><li>Assessment: </li></ul></ul><ul><ul><ul><li>No understanding of death </li></ul></ul></ul><ul><ul><ul><li>Absorbs emotions of others </li></ul></ul></ul><ul><ul><ul><li>May show signs of irritability </li></ul></ul></ul><ul><ul><ul><li>May exhibit changes in eating, nursing, crying, bowel & bladder </li></ul></ul></ul><ul><ul><ul><li>Depends on nonverbal communication </li></ul></ul></ul>Developmental & Cognitive Levels
  8. 8. <Newborn to 3 years> <ul><ul><li>Interventions: </li></ul></ul><ul><ul><ul><li>Keep normal routines and structure whenever possible </li></ul></ul></ul><ul><ul><ul><li>Be verbally and physically affectionate and reassuring </li></ul></ul></ul><ul><ul><ul><li>Provide warm, loving caretakers when parent or caregiver is absent </li></ul></ul></ul><ul><ul><ul><li>Exhibit healthy coping behaviors </li></ul></ul></ul>Developmental & Cognitive Levels
  9. 9. <3 years to 6 years> <ul><ul><li>Perception: </li></ul></ul><ul><ul><ul><li>Death is reversible, temporary; like going to sleep </li></ul></ul></ul><ul><ul><ul><li>People who die will come back </li></ul></ul></ul><ul><ul><li>Assessment: </li></ul></ul><ul><ul><ul><li>Magical thinking; thoughts, words, actions caused or can bring death </li></ul></ul></ul><ul><ul><ul><li>Death is punishment for bad behavior </li></ul></ul></ul><ul><ul><ul><li>Difficulty handling abstract concepts such as heaven, etc… </li></ul></ul></ul><ul><ul><ul><li>Regressive behaviors; </li></ul></ul></ul><ul><ul><ul><li>Difficulty verbalizing therefore act out feelings; escapes into play </li></ul></ul></ul><ul><ul><ul><li>Repeatedly ask the same questions; hunger for attention </li></ul></ul></ul>Developmental & Cognitive Levels
  10. 10. <3 years to 6 years> <ul><ul><li>Interventions: </li></ul></ul><ul><ul><ul><li>Keep normal routines and structure; discipline </li></ul></ul></ul><ul><ul><ul><li>Provide opportunities to play, draw, etc.. </li></ul></ul></ul><ul><ul><ul><li>Read books on death & loss with child; teachable moments; involve in “farewell” ceremonies/rituals </li></ul></ul></ul><ul><ul><ul><li>Help to verbalize feelings and feelings; identify reactions </li></ul></ul></ul><ul><ul><ul><li>Be honest and tell the child if you do not have an answer </li></ul></ul></ul><ul><ul><ul><li>Explain in concrete language (No euphemisms or clichés!) </li></ul></ul></ul><ul><ul><ul><li>Gently confront magical thinking </li></ul></ul></ul><ul><ul><ul><li>Make sure child does not feel responsible for death </li></ul></ul></ul>Developmental & Cognitive Levels
  11. 11. <6 years to 9 years> <ul><ul><li>Perception: </li></ul></ul><ul><ul><ul><li>Beginning to develop intellect; take things literal, concrete </li></ul></ul></ul><ul><ul><ul><li>Beginning to relate cause and effect; consequences </li></ul></ul></ul><ul><ul><ul><li>Attributes life to things that move </li></ul></ul></ul><ul><ul><li>Assessment: </li></ul></ul><ul><ul><ul><li>See death as a taker or spirit that comes and gets us </li></ul></ul></ul><ul><ul><ul><li>Fear that death is contagious and you can catch it </li></ul></ul></ul><ul><ul><ul><li>Curious about what the body looks like </li></ul></ul></ul><ul><ul><ul><li>Connects death and violence </li></ul></ul></ul><ul><ul><ul><li>Asks concrete questions </li></ul></ul></ul><ul><ul><ul><li>Blames self for death (Guilt); difficulty expressing feelings verbally </li></ul></ul></ul><ul><ul><ul><li>Worry about how the deceased can eat, breathe, etc.. </li></ul></ul></ul>Developmental & Cognitive Levels
  12. 12. <6 years to 9 years> <ul><ul><li>Interventions: </li></ul></ul><ul><ul><ul><li>Talk with child; ask questions; use teachable moments </li></ul></ul></ul><ul><ul><ul><li>Make sure child does not feel responsible </li></ul></ul></ul><ul><ul><ul><li>Identify specific fears and feelings </li></ul></ul></ul><ul><ul><ul><li>Provide opportunity for play, draw, etc… </li></ul></ul></ul><ul><ul><ul><li>Address distortions and perceptions </li></ul></ul></ul><ul><ul><ul><li>Be honest and tell child if you do not have an answer </li></ul></ul></ul><ul><ul><ul><li>Help them share bad dreams </li></ul></ul></ul><ul><ul><ul><li>Help them with positive memories of the deceased </li></ul></ul></ul><ul><ul><ul><li>Avoid clichés; use specific concrete words (No euphemisms!) </li></ul></ul></ul><ul><ul><ul><li>Allow participation in “farewell” ceremonies/rituals </li></ul></ul></ul>Developmental & Cognitive Levels
  13. 13. <9 years to 13 years> <ul><ul><li>Perception: </li></ul></ul><ul><ul><ul><li>Maturing of understanding of death; concrete operational thinking; understand cause and effect </li></ul></ul></ul><ul><ul><ul><li>Greater awareness of finality of death & its impact upon them </li></ul></ul></ul><ul><ul><ul><li>Needs detailed explanations; able to compartmentalize </li></ul></ul></ul><ul><ul><li>Assessment: </li></ul></ul><ul><ul><ul><li>Concerned with how their world will change; loss of relationship; fragile independence </li></ul></ul></ul><ul><ul><ul><li>Reluctant to open up (withdrawal); questions have stopped </li></ul></ul></ul><ul><ul><ul><li>Delayed reactions; increased anger, guilt </li></ul></ul></ul><ul><ul><ul><li>Disrupt relationships with peers </li></ul></ul></ul><ul><ul><ul><li>Self conscious about their own fears (of own death, other family, etc..) </li></ul></ul></ul>Developmental & Cognitive Levels
  14. 14. <9 years to 13 years> <ul><ul><li>Interventions: </li></ul></ul><ul><ul><ul><li>Encourage discussion of their concerns; teachable moments </li></ul></ul></ul><ul><ul><ul><li>Provide and encourage expressive experiences (writing, drawing, music, etc…) </li></ul></ul></ul><ul><ul><ul><li>Address impulse toward acting out; identify their feelings; talk about how things are different </li></ul></ul></ul><ul><ul><ul><li>Allow some regressive behaviors (i.e. play) </li></ul></ul></ul><ul><ul><ul><li>Be honest and tell a child when you do not have an answer </li></ul></ul></ul><ul><ul><ul><li>Gently relieve child from attempts to take on adult responsibilities; maintain discipline and structure </li></ul></ul></ul><ul><ul><ul><li>Reassure the child that he/she did not cause the death </li></ul></ul></ul>Developmental & Cognitive Levels
  15. 15. <13 years to 18 years> <ul><ul><li>Perception: </li></ul></ul><ul><ul><ul><li>Mature understanding of death </li></ul></ul></ul><ul><ul><ul><li>May use formal operational thinking </li></ul></ul></ul><ul><ul><li>Assessment: </li></ul></ul><ul><ul><ul><li>Death is viewed as interruption; death as enemy </li></ul></ul></ul><ul><ul><ul><li>Increased vulnerability related to changes/loss occurring </li></ul></ul></ul><ul><ul><ul><li>Sense of future becomes part of their psychology </li></ul></ul></ul><ul><ul><ul><li>Increased risk taking in effort to reduce anxiety or to defy fate </li></ul></ul></ul><ul><ul><ul><li>May intellectualize or romanticize death </li></ul></ul></ul><ul><ul><ul><li>May act indifferent to death of someone (protect their own feelings) </li></ul></ul></ul><ul><ul><ul><li>May show full range or affect or almost no affect at all </li></ul></ul></ul>Developmental & Cognitive Levels
  16. 16. <13 years to 18 years> <ul><ul><li>Assessment: </li></ul></ul><ul><ul><ul><li>Wants to grieve with his/her own peers; not adults </li></ul></ul></ul><ul><ul><ul><li>May need permission to grieve </li></ul></ul></ul><ul><ul><ul><li>Suicidal thoughts </li></ul></ul></ul><ul><ul><ul><li>Repress sadness, feels anger and depression; denial </li></ul></ul></ul><ul><ul><ul><li>Escapes; (risk taking behaviors) </li></ul></ul></ul><ul><ul><ul><li>Emotional withdrawal; egocentrism </li></ul></ul></ul><ul><ul><ul><li>Difficulty with long term plans </li></ul></ul></ul><ul><ul><ul><li>May show greater integration of future with present and past; </li></ul></ul></ul><ul><ul><ul><li>Questions religious or faith or belief system </li></ul></ul></ul>Developmental & Cognitive Levels
  17. 17. <13 years to 18 years> <ul><ul><li>Interventions: </li></ul></ul><ul><ul><ul><li>Don’t assume they can handle problems without help, support; but allow time for solitude/reflection </li></ul></ul></ul><ul><ul><ul><li>Be available, but don’t push; listen </li></ul></ul></ul><ul><ul><ul><li>Help them find peers or trusted adults for support </li></ul></ul></ul><ul><ul><ul><li>Give permissions for regression </li></ul></ul></ul><ul><ul><ul><li>Be honest and say when you do not have an answer </li></ul></ul></ul><ul><ul><ul><li>Resist in relieving adolescent burden of adult responsibilities </li></ul></ul></ul><ul><ul><ul><li>Help impulse control toward reckless behaviors </li></ul></ul></ul><ul><ul><ul><li>Discuss feelings of helplessness </li></ul></ul></ul><ul><ul><ul><li>Talk without criticism or judgment </li></ul></ul></ul><ul><ul><ul><li>De-romanticize death; avoid clichés </li></ul></ul></ul>Developmental & Cognitive Levels
  18. 18. The Spiritual Side of Grief <ul><ul><li>Children ask tough questions </li></ul></ul><ul><ul><li>Children mimic adult behaviors </li></ul></ul><ul><ul><li>Children need rituals, routines and active participation </li></ul></ul><ul><ul><li>Children crave sanctuary </li></ul></ul><ul><ul><li>Children seek the help of others </li></ul></ul><ul><ul><li>Let the children be a gift to you </li></ul></ul>
  19. 19. Secondary Losses “ Children grieve what they miss and can’t get back” – Dr. Linda Goldman 7 Categories:  Relationship  Environment  External objects  Self-esteem  Skills & Abilities  Routines & Habits  Protection of the Adult World
  20. 20. Factors & Influences <ul><li> Family dynamics & Social interaction </li></ul><ul><li> Negative messages </li></ul><ul><li> Adult modeling </li></ul><ul><ul><li>Peer approval/disapproval </li></ul></ul><ul><ul><li>Relationship with the deceased </li></ul></ul><ul><li> Previous loss experiences </li></ul><ul><li> Ethnic/Cultural/Gender/Religious expectations & stereotypes </li></ul><ul><li> How the loss took place </li></ul>
  21. 21. Risk Factors & Challenges <ul><ul><li>Changes in mood or behavior; overburdened emotions </li></ul></ul><ul><ul><li>Bodily functions; health problems; persistent nightmares </li></ul></ul><ul><ul><li>Change in play; socialization; peers </li></ul></ul><ul><ul><li>Vandalism; property damage </li></ul></ul><ul><ul><li>Mental health issues; persistence depression </li></ul></ul><ul><ul><li>Abuse, neglect, domestic violence; physical fighting </li></ul></ul><ul><ul><li>Violence; criminal behavior; defiance </li></ul></ul><ul><ul><li>Changes in school performance </li></ul></ul><ul><ul><li>Withdrawal and isolation (extreme) </li></ul></ul><ul><ul><li>Increase in risk-taking behaviors </li></ul></ul><ul><ul><li>Access to weapons; plans for hurting self, others, animals </li></ul></ul><ul><ul><li>Intense need to win; competitiveness </li></ul></ul><ul><ul><li>Exposure to violence; obsession with/interest in violence </li></ul></ul><ul><ul><li>Frequently shut out or shunned </li></ul></ul>
  22. 22. A Child’s Response to Death <ul><ul><li>Case Studies: </li></ul></ul><ul><ul><ul><li>Cindy (age 4) </li></ul></ul></ul><ul><ul><ul><ul><li>“ Death of grandfather” </li></ul></ul></ul></ul><ul><ul><ul><li>Jeff (age 10) </li></ul></ul></ul><ul><ul><ul><ul><li>“ Death of mother” </li></ul></ul></ul></ul><ul><ul><ul><li>Angie (age 17) </li></ul></ul></ul><ul><ul><ul><ul><li>“ Death of mother” </li></ul></ul></ul></ul>
  23. 23. Tools and Resources <ul><li> Play groups; peer groups </li></ul><ul><li> Creative expressions (sand, art, music, writing, journaling, animals, puppets) </li></ul><ul><li> Memory collages, books, scrapbooks, webpage, trees, benches, gardens </li></ul><ul><li> Bibliotherapy </li></ul><ul><ul><li>Day/Weekend/Resident Camps </li></ul></ul><ul><ul><li>Holidays/Holydays/Rituals/Family Celebrations & Gatherings </li></ul></ul>
  24. 24. Closing Thoughts & Questions REFLECTION: See this Child…
  25. 25. Bibliography/References <ul><ul><li>Cassini, K. Death and the Classroom . Griefwork. 1989 </li></ul></ul><ul><ul><li>Corr, Charles & Donna. A Handbook of Childhood Death and Bereavement . Springer. 1996. </li></ul></ul><ul><ul><li>Doka, KJ. Children Mourning, Mourning Children . Taylor & Francis. 1995 </li></ul></ul><ul><ul><li>Ferry, J & Bouton, B. Helping Children Cope with the Illness and Death of a Loved One . Bridges Center. 2005. </li></ul></ul><ul><ul><li>Fitzgerald, H. The Grieving Child . Simon & Shuster. 1993 </li></ul></ul><ul><ul><li>Goldman, L. Life and Loss: A Guide to Help Grieving Children . Taylor & Francis. 2005 </li></ul></ul><ul><ul><li>Grollman, Earl. Bereaved Children and Teens: A Support Group Guide for Parents and Professionals . Beacon Press. 1995 </li></ul></ul><ul><ul><li>Koren, W & Espeland, P. Helping Children Cope with the Loss of a Loved One, A Guide for Grown Ups . Free Spirit Publications. 1996 </li></ul></ul><ul><ul><li>Parga, E. No Child Should Grieve Alone . The Solace Tree. 2007 </li></ul></ul><ul><ul><li>Shelly, J. The Spiritual Needs of Children . InterVarsity Press. 1984 </li></ul></ul><ul><ul><li>Worden, JW. Children and Grief: When a parent dies . Guilford Press. 1996. </li></ul></ul>