Discussion on Grief and Bereavement in young people

1. CHILDREN and LOSS Discussion on Grief and Bereavement in young people Doug Ennals, RSW INCTR Annual Meeting Chennai, 2005

2. Every deathhas a life of its own…

3. We enter the conversation with ourown knowledge, experiences and beliefs about death, grief and bereavementOpportunities for reflection,asking questions, exploring, and creating dialogue in everyday practice Local Knowledge

4. Language of Loss Bereavement– the state of having experienced loss Grief– subjective, personal feelings and reactions to loss Mourning – the private and public processes, rituals and practices to loss

5. Models of Grief Historical Many western models have attempted to help understand the processes of bereavement • linear • series of stages • tasks to be completed • re-investing of emotional energy • processes of ‘letting go’ of attachment to the deceased

6. Models of Grief Emerging Perspectives Through continued bonds, people find places for the deceased in their ongoing lives • Grief is a condition of the human spirit • Constructing relationships with the deceased • Ongoing construction of self and relations to the world we live in

7. Dual Process Model Restoration Oriented Dealing with the many life changes and new roles that are brought about by the death Loss Oriented Involves the emotional and reactive processing of the loss Oscillating between these stressors (Reference: Stroebe and Schut, 1999)

8. Perspectives • Multiple, dynamic processes whereby people find meaning in loss • Moving between the grief and day to day life adjustments • Continual process of coping, adapting, building capacity to move forward • Traumatic grief – survival issues take priority over grief • Political, economic, social, cultural, spiritual and other considerations (Reference: Parkes, Colin M. Mortality: Virtual Themed Issue, 2003)

9. Perspectives “…restoring the fit between the world that is and the world that should be…” (Reference: Parkes, Colin M. Mortality: Virtual Themed Issue, 2003)

10. Children and Loss • Death touches the lives of children regularly • What may seem normal or abnormal for adults may be quite the opposite for children • Children’s expressions of grief are both similar and different from adults • Adjusting to the reality of illness, death, and loss is complicated by: • - children’s developing conceptual understanding of death and dying • - lack of or distortion of information they receive

11. Developmental Considerations Younger Children • Think in more connected ways • Live in the moment • Magical thinking… • Belief that thoughts and • behaviors are cause for events • Anxiousness, distress • Repetitive and physical in their grief

12. Developmental Considerations Children • Developing a better understanding of cause and effect • Detect feelings of others • Building capacity for expressive language • May have many questions and a need for detailed information

13. Developmental Considerations Adolescence • Time of dramatic physiological, cognitive, emotional, spiritual, and social change • Increased sense of self • Quest for knowledge, understanding, awareness of place in the world • Search for meaning and purpose • Increased understanding about significance and realities of dying and the death experience

14. Social and Cultural Considerations Influences • Child-rearing practices • Nature of attachments • How children acquire their understanding of death • Religious and spiritual beliefs about death and bereavement • Age, gender, family position

15. Social and Cultural Considerations Influences • Cause and nature of death - stigmatization? • Roles during illness • Previous loss experiences • Rituals attending death, bereavement and mourning practices • Influences rites of passage, and the norms for ‘appropriate’ grief

16. Perspectives Children’s grief experiences are influenced over time, embedded in developmental, social and cultural contexts in which all experiences exist

17. Windows to Grief • Entering into the grief journey with children requires an embracing of their spirits • Magical, curious, unpredictable, observant, perceptive, spontaneous • Live in metaphor • Need spaces to see, experience, accept, reject, and try on feelings and reactions • Loss of one’s right to be born into a safe world that makes sense

18. Windows to Grief • Companioning children on their grief journey • means using theory as a framework and • your heart as the guide • No formulas • Observant, flexible, patient • Honest • Courage to stay out of the way • Courage to companion • Prepared to be surprised

19. Windows to Grief • Children understand more that they are given credit for • Adults are one of the biggest barriers • Grieving children don’t need to be fixed • Expressions of grief take many paths • Children need, want, and deserve honesty truth, and choices • The best gift is the capacity to listen

20. Into the Circle of Care Ourselves and the team What are my beliefs about grief and bereavement? What are my beliefs about how children should be involved / not involved in end-of-life care conversations? What does the team need to know from the patient and family? What are my comfort levels in sharing information and talking with children? Who on the team could assist in the process?

21. Into the Circle of Care Family and caregivers What does the child(ren) already know? What are the cultural, religious and social practices for this family? How has ritual been practiced? What is the relationship between the child(ren), patient, family and other caregivers? What would be helpful? Invite conversation

22. Into the Circle of Care • Preparation • What to expect • Misconceptions • Expressions of emotion • Providing developmentally appropriate information • Asking children what they understand, how they are making sense of what is happening With children

23. sadness confusion anger protest guilt SEARCH FOR MEANING fear pain hope shock explore invest loneliness

24. What is dead? Am I going to die too? Did I cause it? SEARCH FOR MEANING Who will take care of me? Who am I now? How will I remember?

25. Reflections Children as experts All children are different and their view of the world is unique and shaped by different experiences. When working with a grieving children, we are witness to a profound journey.

26. Reflections Children as experts In our everyday practice, how can we support children as experts and storytellers of their own knowledge and loss experiences?

27. Every deathhas a life of its own…

28. Thank you…