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Supporting Children When Someone in the Family Dies

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Supporting Children When Someone in the Family Dies. Julia Samuel Founder Patron & Trustee. Factors affecting the grieving process. Situational Stress Factors. Witnessing or hearing the death Manner of death Circumstances surrounding the death Conflict between relatives

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Supporting Children When Someone in the Family Dies

Julia Samuel

Founder Patron & Trustee

slide3
Situational Stress Factors
  • Witnessing or hearing the death
  • Manner of death
  • Circumstances surrounding the death
  • Conflict between relatives
  • The police investigation
  • Powerlessness
  • Cultural and spiritual factors
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Circumstances

of death/dying

Relationship with

person who died

‘Recovery’

environment

Ourselves,

personality,

background

Factors affecting

the grieving process

children and young people
Children and Young People

Physical & Mental Health

  • Bereaved children visited their GP more frequently (1998 Lloyd Williams, M. & Wilkinson, C.)
  • Bereaved children were found to be more likely to develop symptoms such as headaches, stomach aches (1996 Worden, W.)
  • Between 50-66% bereaved children show distress and depressive symptoms which may persist over time (2006Ribbons McLardy, J.)
definition of trauma
Definition of Trauma

The person’s response involved intense fear, helplessness or horror

(In children this may be expressed instead by disorganised or agitated behaviour)

Criterion A2 of DSM-IV-TR PTSD

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There is evidence to suggest that traumatic memory is encoded in the brain in a different way than non-traumatic memory
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Sight

Smell

Sound

Fear Network

Feeling

Taste

Touch

Physiological

Thought

© David Trickey

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Memory or thought suppressed or avoided

Maintenance Cycle of Avoidance

Memory not processed

Intrusions e.g. memories, images, dreams, thoughts

Original fear,

horror, helplessness

© David Trickey

common reactions after a frightening event
Common reactions after a frightening event
  • Nightmares
  • Memories or pictures of the event unexpectedly popping into the mind
  • Feeling as if it is actually happening again
  • Not wanting to think or talk about the event
  • Avoiding anything that might remind them of the event
what bereaved families need
What Bereaved Families Need
  • Knowledge
  • Your time
  • Comfort & reassurance
  • Space and time to grieve
  • Someone to share their journey
  • Ways to express their grief
  • Help to build their resilience
  • To be allowed to have a break from the pain
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How children make sense of what has happened will depend on a number of factors, including their stage of development
up to 6 months
Up to 6 months

Concepts:

Withdrawal of care and nourishment from a familiar person

Emotional withdrawal of carer

Likely feelings and behaviours:

abandonment

insecurity

anger

cries in protest

disrupted sleep and feeding routine

6 months 2 years
6 months – 2 years

Concepts:

Developing ‘object constancy awareness’

Begins to have mental image of person when absent and can ‘miss’ them

Likely feelings and behaviour:

Protest and distress

Withdrawal

Separation anxiety

No interest in food or toys

Searching behaviour

2 5 years
2 – 5 years

Concepts:

Establishing that he/she is a separate person

Interested in the idea of death in birds, animals etc

Understands that death is a part of natural order but lacks ability to appreciate its finality and irreversibility

‘Heaven’ is a physical place: concrete thinking

  • Likely feelings and behaviour:
  • Expectations of return - sadness and disappointment
  • Constant questions
  • Anxiety about physical needs
  • Fear of the dark when going to sleep
  • Toilet regression
  • Clinging/marked increase in separation anxiety, even when left for short periods
5 8 years
5 – 8 years

Concepts:

Age of magical thinking

Believe they can influence events with thought and behaviour

Developing ‘conscience’ so can feel guilt about what their supposed power brings about

May think independent events at time of death ‘caused’ it

Fuller understanding of concept of death

  • Likely feelings and behaviour:
  • Can fear death of others
  • Especially ‘good’ to compensate for sense of badness, which they believe contributed to the death
  • Behave badly and therefore draw the punishment they ‘deserve’
  • Compulsively caring towards surviving adults or siblings (especially girls)
  • Cover up sadness by behaving as if nothing happened
  • ‘Is big now’ and fears behaving in an infantile way
8 12 years
8 – 12 years

Concepts:

Begins to have an adult concept of death as permanent separation

Develops fear /understanding of own mortality, especially in case of sibling death

Can imagine how the death will alter his/her future

Likely feelings and behaviour:

Will display many symptoms of adult grief, but expressed in childish ways

May develop anxiety about their own health for fear they may die too

Preoccupied at school and social withdrawal

12 years
12 + years

Concepts:

Puberty – time of great change

Feelings of ambivalence – separation/dependency

Moving from familial ties to increased involvement with peers

Becoming aware of issues of life, death and meaning of life

Likely feelings and behaviour:

Similar to those of adults but have strong inhibitions about expressing them, partly to be ‘grown up’ and partly to avoid being different in their peer group

May lead to apathy, withdrawal, depression

May express anger in anti-social ways e.g. stealing

May take grief outside family

how do i talk to a child about death
How do I talk to a child about death?

Aim:

to give enough accurate information in an understandable manner, so that the child can answer ‘how’ and ‘why’ in a way that makes sense

how do i talk to a child about death22
How do I talk to a child about death?
  • Be honest
  • As soon as possible: or may undermine confidence in adults
  • Begin talking to the child about what he/she experienced or noticed - beginning with the child’s experience makes it harder for the child to deny his own fears and feelings and gives permission for him to trust his own observations
  • Use the adult reality, facts and words as simply as possible: use the word ‘dead’, not ‘asleep’ or ‘lost’
how do i talk to a child about death23
How do I talk to a child about death?
    • Give child permission to figure out what has happened by letting him/her ask questions as often as wants
    • Answer questions accurately – say “I don’t know” if you don’t and encourage the child to share his feelings by asking what he/she thinks
  • Watch out for the child’s tendency to blame him/herself
  • Give clear message it was not his/her fault
  • Encourage child to remember and talk about the person who has died, to strengthen positive memories
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My wife was treated as having lost someone she loved. I was treated as having lost someone I was responsible for A Bereaved Father
culture
Culture
  • We all come from a family culture
  • In times of stress, people revert to their culturally acquired coping mechanisms
  • We must never assume a person’s cultural background will dictate their needs and the practices to be followed in bereavement
  • We need to ask people what is important to them
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A Dual Process Model of Coping with Bereavement

Stroebe & Schut (1999)

Everyday Life Experience

Restoration-oriented

Attending to life changes

Doing new things

Distraction from grief

Denial/avoidance of grief

New roles/identity/ relationship

Loss-oriented

Grief work

Intrusion of grief

Breaking bonds/ties

Denial/avoidance of restoration changes

tasks of mourning
Tasks of Mourning

To accept the reality of the loss

To experience the pain of grief

To adjust to an environment in which the person who has died is missing

To emotionally relocate the person and move on with life

J William Worden

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We offer ourselves

There are no answers and no explanations adequate to justify the injustice of a baby or child dying ……

…but involvement, the sharing of one’s humanity, will make a difference

in working with grieving families we all bring our own
In working with grieving families we all bring our own:
  • hurts and losses
  • feelings about loss by death
  • desire to care for others
  • ability to reach out and involve ourselves
  • inability, when overpowered by the tragedy of a child grieving and our own sadness
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What makes it especially difficult for us:
  • Concerns children
  • Normalises what is abnormal
  • Situation has parallels in your own life
  • Situation occurs when you are exhausted, in personal crisis
  • Work climate not supportive
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AUTONOMIC NERVOUS SYSTEM

IS OUR EMOTIONAL SYSTEM WHICH RESPONDS TO

EXTERNAL DEMANDS. SEEKS TO KEEP US IN A STATE

OF HOMEOSTASIS THROUGH AFFECT REGULATION

AROUSAL RESPONSE: SYMPATHETIC

WIND DOWN RESPONSE: PARASYMPATHITIC

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Care providers are helped by:
  • the mutual support of colleagues
  • education and training
  • debriefing soon after events
  • supervision and mentoring which acknowledge emotions

Standards for Bereavement Care

Paediatric Intensive Care Society

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Care providers are helped by:
  • an open and caring attitude from senior staff
  • an atmosphere where staff feel able to express their feelings
  • the opportunity to access psychological help if required

Standards for Bereavement Care

Paediatric Intensive Care Society

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We must take the initiative to care for ourselves so that we can feel good about ourselves and our work
supporting yourself
Supporting Yourself

Be aware of your own limitations

Access support and supervision to meet your needs

Look after yourself physically, emotionally and spiritually

Notice any changes in sleep, eating and mood patterns and take action

Cherish yourself – you are special

Energise yourself by taking regular exercise

Dent & Stewart (2004)

survival factors
Survival Factors
  • Understanding our own emotions
  • Somewhere safe to express feelings
  • Access to regular support and supervision
  • Clarity about boundaries of our role
  • Ways to relax mind and body
  • Being part of a supportive team
  • Life outside work!
look after yourself
Look After Yourself
  • Accept your need for support, both practical and emotional
  • Be aware of what support is available to you
  • Establish who is going to provide this
  • Take responsibility for asking for what you need
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Website

www.childbereavement.org.uk

Families Discussion Forum

Professionals Discussion Forum

Support and Information Line

01494 568900

Email: [email protected]

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