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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

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
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

the obstacle course
The Obstacle Course
  • Coming Apart
  • Waiting and Hoping
  • Repairing
  • Resilience
traumatic reactions
Traumatic Reactions


  • Overwhelming fear and anxiety

crying, screaming, pleading

talking, running, unfocused

  • Anger, confusion, denial

blaming, controlling, distrusting

  • Shutting down and withdrawal
spiritual agony
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?
helping the family in crisis
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
stages of crisis coping
Stages of Crisis Coping

Old Normal

New Normal

(Nieuwenhuizen, 2008)

decision making
  • “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.”
guilt and forgiveness
Guilt and Forgiveness
  • “I can’t remember, but maybe it was my fault.”

Forgiveness of self

  • Letting go of blame

Forgiveness of others

iii repairing spiritual concepts
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

spiritual concepts
Spiritual Concepts
  • Relationship to others and the world

Tolerance for others

Unity with others

Sense of belonging

Sacredness of life

spiritual concepts17
Spiritual Concepts
  • Relationship to Greater Power

Unconditional love



Belief or faith that one is not alone

Spiritual practices






ongoing struggles
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)

the will to meaning
The Will to Meaning
  • Broken in an uncaring world?


giving up

no solutions

  • I will survive!


spiritual coping

making a way

  • The expectation of Joy

(there’s a pony in here somewhere)

  • Optimism

(good things can happen; the future is open)

  • “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

creating the work arounds
Creating the Work-Arounds
  • Problem-focused coping

stop-and-think alternatives

  • Emotion-focused coping


self acceptance

(Peleg et al., 2009)

living in the present planning the future
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)

keep on keeping on
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.


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.