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The Journey Through Spiritual Crisis. Helping Children and Families Find Hope. Presenters: Margo Richardson, Chaplain; Ann Romanczuk, Chaplain; Suzanne Owens-Pike, Lead Chaplain at HCMC. HCMC Pediatric Traumatic Brain Injury Program. Medical Co-directors: Andrew Kiragu, MD

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The Journey Through Spiritual Crisis

Helping Children and Families

Find Hope

Presenters: Margo Richardson, Chaplain; Ann Romanczuk, Chaplain; Suzanne Owens-Pike, Lead Chaplain at HCMC

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HCMC Pediatric TraumaticBrain Injury Program

Medical Co-directors: Andrew Kiragu, MD

Armantina Espinosa, MD

Program Coordinator/Social Services:

Kary Lehman, LGSW


Specialists: audiologist, chaplain, child life, dietician, interpreter, neuropsychologist, neurosurgeon, opthamalogist, intensivist, neurologist, nurses, occupational therapist, resident physicians, physical therapists, social worker, speech language pathologist

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The Obstacle Course

  • Coming Apart

  • Waiting and Hoping

  • Repairing

  • Resilience

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Traumatic Reactions


  • Overwhelming fear and anxiety

    crying, screaming, pleading

    talking, running, unfocused

  • Anger, confusion, denial

    blaming, controlling, distrusting

  • Shutting down and withdrawal

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Spiritual Agony

  • Why is God allowing this to happen?

  • Why am I being punished?

  • Will God answer my prayer to heal my child?

  • Will God punish the person who did this?

  • What did I do to cause this? If only I had . . . Can things be put right again?

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Helpingthe family in crisis

  • Physical – offer presence, help with phoning, water, chairs, clothing, tissues

  • Emotional – “I will help you get through this.” Non-anxious, quiet presence that reassures

  • Mental – listen to and normalize their experience, provide information, get them answers to their questions about loved one’s condition

  • Spiritual/Religious – offer prayer if family desires, ritual items of meaning, offer to phone their faith leader

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Developmental Stagesand Spirituality

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“We love you!You are ourprecious child!”

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Stages of Crisis Coping

Old Normal

New Normal

(Nieuwenhuizen, 2008)

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  • “We’re not sure what will happen when we extubate him. Do you want us to re-intubate him if that happens?”

  • “We can’t wean her off the vent. She will need a tracheostomy and a peg for tube feeding. We need your consent.”

  • “We predict he will have deficits.”

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“We will do whateverit takes to get our son back.”

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Guilt and Forgiveness

  • “I can’t remember, but maybe it was my fault.”

    Forgiveness of self

  • Letting go of blame

    Forgiveness of others

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III. Repairing:Spiritual Concepts

  • Relationship to Self

    Hope Faith

    Purpose in Life Strength

    Meaning in Life Idealism

    Part of Self that is Inviolable

    From McColl et al, “Spiritual Issues Associated with Traumatic-Onset Disability.” In Disability and Rehabilitation, 2000

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Spiritual Concepts

  • Relationship to others and the world

    Tolerance for others

    Unity with others

    Sense of belonging

    Sacredness of life

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Spiritual Concepts

  • Relationship to Greater Power

    Unconditional love



    Belief or faith that one is not alone

    Spiritual practices

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Spirituality and Disabilityfrom McColl, et al

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Ongoing Struggles

  • Grief

    “partial death” & prolonged mourning

  • Relationships

    accepting the new me; burying the old me

  • Others’ ignorance and prejudice

    bullying at school

    (Zinner, 1997)

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The Will to Meaning

  • Broken in an uncaring world?


    giving up

    no solutions

  • I will survive!


    spiritual coping

    making a way

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  • The expectation of Joy

    (there’s a pony in here somewhere)

  • Optimism

    (good things can happen; the future is open)

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  • “I’ve got the power!” (Snap, 1990)

  • Locus of Control (Peleg, et al, 2009)

    external-fosters dependency, helplessness, blaming, seeking control of others, fear

    internal-fosters confidence, hope, spiritual center of value, seeking control of self, trust

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Creating the Work-Arounds

  • Problem-focused coping

    stop-and-think alternatives

  • Emotion-focused coping


    self acceptance

    (Peleg et al., 2009)

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Living in the PresentPlanning the Future

  • “I know we can make it if we try, yes we can, can”

    The Pointer Sisters

  • Child-centered

  • Lived spiritual experience and beliefs of child are primary

  • Accepting deficits and planning for support

(Miller, 2006)

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Keep on Keeping On

“Now let us begin. Now let us rededicate ourselves to the long . . . but beautiful struggle for a new world.” ~ Rev. Dr. Martin Luther King, Jr.

References l.jpg

Dawson, Deirdre R. et al. “Return to Productivity Following Traumatic Brain Injury: Cognitive, Psychological, Physical, Spiritual, and Environmental Correlates.” Disability and Rehabilitation, 29(4):301-313, 2007.

Frankl, Viktor. The Will to Meaning. New York: Penguin Books, 1969.

Johnstone, Brick et al. “Relationships among Spiritual Beliefs, Religious Practises, Congregational Support and Health for Individuals with TBI.” Brain Injury, 23(5):411-419, 2009.

Macauley, Robert, MD. “Spirituality in Childhood.” from course at University of Vermont Medical School, 2007.

McColl, Mary Ann et al. “Spiritual Issues Associated With Traumatic Onset of Disability.” Disability and Rehabilitation, 22(12):555-564, 2000.

Miller, Lisa. “Spirituality, Health and Medical Care of Children and Adolescents.” Southern Medical Journal, 99(10): 1164-1165, 2006.

Nieuwenhuizen, Louis. “Psychospiritual Symptoms in Times of Crisis.” Chaplaincy Today, 24(2):3-13, 2008.

Peleg, Gil et al. “Hope, Dispositional Optimism and Severity of Depression Following TBI.” Brain Injury, 23(10):800-808, 2009.

Zinner, Ellen S. et al. “Grief Reactions of Mothers of Adolescents and Young Adults with TBI.” Archives of Clinical Neuropsychology, 12(5):435-447, 1997.