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Working With Bereaved Children - A Guide Annexes

By Carolyn Davis,2014-08-12 20:05
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Working With Bereaved Children - A Guide Annexes ...

     ANNEXESANNEXES

    ANNEXES ANNEXES

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1. Emotional resilience checklist 1. Emotional resilience checklist

    ; Emotional resilience diagram ; Emotional resilience diagram

    2. Information sheets for supporting bereaved 2. Information sheets for supporting bereaved

    children children

    ; Breaking bad news to children ; Breaking bad news to children

    ; Funerals and rituals ; Funerals and rituals

3. What you can do practical ideas 3. What you can do practical ideas

    ; Memory boxes and memory books ; Memory boxes and memory books

    ; Role play ; Role play

    ; Questions and Doc Spot session ; Questions and Doc Spot session

    ; Drawing a picture of the person who has ; Drawing a picture of the person who has

    died died

    ; Drawing feelings ; Drawing feelings

    ; Feelings faces page ; Feelings faces page

4. Case studies 4. Case studies

    ; 5 years old ; 5 years old

    ; 10 years old ; 10 years old

    ; 15 years old ; 15 years old

5. Grief Support Programme 5. Grief Support Programme

    ; Family information sheet used when ; Family information sheet used when

    organising groups organising groups

6. Different levels of intervention 6. Different levels of intervention

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     ANNEXESANNEXES

    ANNEX 1 ANNEX 1

    EMOTIONAL RESILIENCE CHECKLIST EMOTIONAL RESILIENCE CHECKLIST

    The following issues, which impact upon emotional resilience, need to be considered when working with a child

    who is faced with bereavement and loss.

    However, it is not definitive and should be used as a guideline only.

    A. AGE AND DEVELOPMENTAL/COGNITIVE UNDERSTANDING A. AGE AND DEVELOPMENTAL/COGNITIVE UNDERSTANDING

    OF THE CHILD OF THE CHILD

    ; Children can understand that someone is missing from a very young age. ; However, children may not understand the permanence of death if they

    are young.

    ; They may display attachment anxiety or „seeking‟ behaviour as a response

    to loss.

    ; It is important to use age and cognitively appropriate language and means

    of engagement. It is also important to use the right words even if the child

    is very young, so as not to confuse them e.g. “The person has died” rather

    than saying “The person has gone away”. Also the correct name for the

    disease should be used.

    B. COMMUNICATION PATTERNS WITHIN THE FAMILY B. COMMUNICATION PATTERNS WITHIN THE FAMILY

    ; Does the family make time for discussions about sensitive issues including

    death?

    ; Do they involve the child in these discussions and use appropriate

    language? - Does the family have a closed/open pattern of communication? ; Do family members allow for the feelings of the child to be validated,

    especially if they are different to the „family norm‟?

    ; Is the family able to make allowances for the anxieties of the child during

    their bereavement?

    ; Who is the decision maker in the family in terms of communication? Who

    is the „holder of information‟?

    C. CHILD'S RELATIONSHIP WITH THE PERSON WHO DIED C. CHILD'S RELATIONSHIP WITH THE PERSON WHO DIED

    ; What is the individual relationship that each child in a family has with the

    patient/person who has died?

    ; How much face-to-face contact did the child have with the person before

    they died? Infrequent contact does not mean a lesser relationship or a

    lesser bereavement response.

    ; Where a child loses a sibling, there is also a loss of position and identity in

    the family as a sibling.

    ; There may be associated difficulties if a child had a difficult or ambivalent

    relationship with the person who died. For example, if a child wished the

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    person was dead and then they died, the child may feel he is omnipotent

    and have associated feelings of guilt.

    D. WHAT IS THE CHILDS UNDERSTANDING OF THE D. WHAT IS THE CHILDS UNDERSTANDING OF THE

    SITUATION? SITUATION?

    ; What information has been given to the child, when and how much? ; Is the parent struggling with the reality of the information? ; Information needs to be provided to the child in a way that is manageable

    (i.e. little and often), while keeping the child appropriately up to date.

    Does the child understand what he has been told?

    ; Does the child's understanding supersede that of the parents? For example,

    does the child „know‟ that the parent is dying, but the parent is himself in

    denial?

    ; What might also impede the parent's own understanding or ability share

    appropriate information e.g. intellectual impairment of parent, mental

    health problems, and drug and alcohol dependency?

    E. SUPPORT NETWORKS AND SYSTEMS E. SUPPORT NETWORKS AND SYSTEMS

    ; Does the family have support networks? It is important to identify and use

    both formal and informal networks and structures e.g. both family based

    and agency based.

    ; Are the networks fully informed of the situation? Are they able to help the

    child at their own pace? It is important to ensure appropriate

    communication between the family and their networks to ensure

    consistency of support and information.

    ; If the major decision maker dies, can the systems support the existing

    parent to provide security within the family?

    ; Where there is an awareness of limited networks and support systems, it

    is important to plan in advance. One important area is the child‟s future

    care. If possible, it is beneficial to involve the dying parent in that process.

    F. ARE THERE ANY PREVIOUS OR CONCURRENT LOSSES IN F. ARE THERE ANY PREVIOUS OR CONCURRENT LOSSES IN

    THE CHILDS LIFE THE CHILDS LIFE

    ; Previous or concurrent losses include divorce, separation, a house move

    and previous deaths.

    ; It is important to understand how people have dealt with previous losses -

    what is their emotional resilience? What was the child's response and

    involvement in previous losses?

    ; Have they worked through these other losses appropriately enough or is

    there significant unresolved loss? Do they employ emotional blocking as a

    means of coping? The current loss can compound previous experience and

    can exacerbate subsequent reactions.

    ; Does the family have a sense of emotional and physical stability? ; Is disruption and „moving‟ used as a means of coping with difficult

    emotional situations? Do significant family members have a history of

    running away from conflict rather than making a sustained effort at

    resolving painful issues?

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    F. OTHER SOCIAL ISSUES F. OTHER SOCIAL ISSUES

    ; How do significant individual family members cope with distressing events?

    ; Are they able to contain their own emotions sufficiently to function in an

    appropriate way?

    ; Is there a history of emotional instability separate to current experience?

    ; Other relevant factors to consider include mental health, substance misuse,

    domestic violence, unemployment and financial issues.

    ; Do family members cope by investing in anger towards other people

    including children?

    ; Is there a history of recurrent relationships or remarriage. Are there issues

    for children regarding „absent parents‟ following

    divorce/separation/secondary losses.

H. ANTICIPATED AND UNEXPECTED BEREAVEMENT H. ANTICIPATED AND UNEXPECTED BEREAVEMENT

ANTICIPATED BEREAVEMENT ANTICIPATED BEREAVEMENT

    ; Difficulties associated with the prolonged periods of illness and disease prior

    to death may result in people feeling both drained but also relieved when

    someone dies because of the emotional energy that is expended. There may

    also be some associated guilt with feeling that way.

    ; The bereavement process is protracted, beginning when the person is

    diagnosed.

    ; It is important for children and families to engage in normal activities at the

    same time as facing the bereavement. Maintained peer interaction is

    important for children.

UNANTICIPATED BEREAVEMENT UNANTICIPATED BEREAVEMENT

    ; Where the death is sudden, reactions include sheer shock and disbelief. There

    is also a lack of preparation and no possibility of saying goodbye. ; There is a risk that the child will be marginalized by the adult‟s experience as

    a result of his/her feelings.

    ; An awareness of a child possibly distancing themselves and withdrawing

    either emotionally or physically may lead a parent to believe that a child is

    coping, but this may set up a pattern of emotional difficulties in the future. ; Suicide raises other complexities as there is an element of „choice‟ around that

    person‟s death. Children may struggle with why a parent would choose to die

    and choose to leave them. They may believe that they could have saved

    person‟s life and experience a loss of self esteem because they could not

    prevent it.

    ; The child may display vigilant behaviour around the surviving parent, and

    searching behaviours - searching for clues on why the parent died, recalling

    situations, playing the events over.

I. INVOLVEMENT OF CHILD IN ENDINGS I. INVOLVEMENT OF CHILD IN ENDINGS

    ; There should be an awareness of families who do not involve the child,

    especially as often this is an indication that the child‟s feelings are not being

    validated.

    ; It is important for the child to be involved in the family process of saying

    goodbye. It is OK for a child to see their parent cry.

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    ; Children‟s magical thinking needs to be considered in terms of the finality of

    death.

J. OTHER J. OTHER

    ; How long after the initial period of bereavement is normal functioning

    impaired? e.g. school attendance, appropriate role of parent.

    ; Does the parent and child have the ability to live their life without the

    bereavement being the major focus?

K. CHILD PROTECTION ISSUES K. CHILD PROTECTION ISSUES

    ; Programme organisers need to have a good understanding of local statutory

    agencies and NGO‟s and the role they play in supporting families and

    advocating for the rights of a child.

    ; If possible, there should be good, well established networking arrangements

    between relevant groups and agencies.

    ; Grief Support Programmes cannot (and do not have to) physically support

    everyone who is bereaved. There should be criteria set down for appropriate

    referrals as well as an awareness that families with specific additional issues,

    may fit into another agency‟s remit that is specialising in that area.

    ; It is important that families are „signposted‟ (directed) to other agencies

    where their needs can be better met elsewhere. Grief should not be

    „professionalised‟ – i.e. only dealt with by one agency.

    ; It is vital that workers are able to observe whether a parent‟s emotional

    strengths are so depleted that they are unable to provide emotional or

    practical support to a child through the bereavement process. Other statutory

    agencies need to be made aware of the situation, not only in cases of physical

    and verbal aggression, but in situations where a parent‟s normal functioning is

    so impaired that the child is being neglected. It is important for workers to

    have an awareness of possible indicators of abuse and neglect. ; If such severe difficulties arise, workers should encourage parents to seek

    medical or specialist psychological help. Medication should not be ruled out at

    this point as it may be needed as a short term measure.

L. CONFIDENTIALITY L. CONFIDENTIALITY

    ; 100% confidentiality cannot be maintained when working with children and

    families.

    ; There must be an ongoing awareness both of issues that affect children and

    families aside from their bereavement, as well as other organisations or

    agencies that are working with this vulnerable population.

    ; Workers need to be alert to a child being unnecessarily afraid, being unable to

    concentrate, losing weight, displaying overly sexualized behaviour and being

    unkempt. Child protection issues (where the child is at risk) override the need

    to maintain confidentiality.

    ; Issues may also need to be raised with other agencies if a child has become

    the main carer for the parent who is dying.

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     ANNEXESANNEXES

     EMOTIONAL RESILIENCE

     DIAGRAM

     WHAT IS THE AGE AND DEVELOPMENTAL/

     COGNITIVE

    UNDERSTANDING OF THE

    CHILD?

     WHAT ARE THE WAS THE CHILD COMMUNICATION EXCLUDED FROM THE PATTERNS WITHIN THE ‘ENDING’? FAMILY?

     WHAT BEHVIOUR IS THE

    CHILD DISPLAYING? WHAT IS THE CHILD’S

     RELATIONSHIP WITH IS THIS ‘ANTICIPATEDTHE PERSON WHO IS OR ‘UNANTICIPATED’ ILL/HAS DIED? BEREAVEMENT?

    ARE THERE ANY OTHER WHAT IS THE CHILD’S RELEVANT SOCIAL UNDERSTANDING OF THE ISSUES THAT ARE SITUATION? IMPACTING UPON THE

    CHILD?

    HAS THE CHILD

    SUFFERED ANY WHAT ARE THE CHILD’S

    PREVIOUS LOSS? SUPPORT NETWORKS

     AND SYSTEMS?

    IS THE CHILD SUFFERING

    ANY CONCURRENT LOSS?

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    ANNEX 2 ANNEX 2

    INFORMATION SHEETS FOR SUPPORTING INFORMATION SHEETS FOR SUPPORTING

    BEREAVED CHILDREN BEREAVED CHILDREN

    BREAKING BAD NEWS TO CHILDREN BREAKING BAD NEWS TO CHILDREN

    ; IT IS IMPORTANT THAT CHILDREN ARE TOLD AS SOON AS POSSIBLE ; IT IS IMPORTANT THAT CHILDREN ARE TOLD AS SOON AS POSSIBLE

    THAT SOMETHING HAS HAPPENED THAT SOMETHING HAS HAPPENED

    ; A FAMILY MEMBER OR SOMEONE WHO KNOWS THE CHILD WELL ; A FAMILY MEMBER OR SOMEONE WHO KNOWS THE CHILD WELL

    SHOULD BE THE PERSON WHO BREAKS THIS NEWS, AS THEY KNOW SHOULD BE THE PERSON WHO BREAKS THIS NEWS, AS THEY KNOW

    THE CHILD BEST THE CHILD BEST

    ; IT IS IMPORTANT TO REMEMBER TO PROVIDE AGE APPROPRIATE ; IT IS IMPORTANT TO REMEMBER TO PROVIDE AGE APPROPRIATE

    INFORMATION LITTLE AND OFTEN. USE SIMPLE LANGUAGE LIKE INFORMATION LITTLE AND OFTEN. USE SIMPLE LANGUAGE LIKE

    CANCER, DEAD AND DYING - DO NOT USE PHRASES SUCH AS GONE CANCER, DEAD AND DYING - DO NOT USE PHRASES SUCH AS GONE

    TO SLEEP OR GONE AWAY TO SLEEP OR GONE AWAY

    ; FIND OUT WHAT THE CHILD ALREADY KNOWS OR THINKS AND USE ; FIND OUT WHAT THE CHILD ALREADY KNOWS OR THINKS AND USE

    THEIR LANGUAGE AND UNDERSTANDING THEIR LANGUAGE AND UNDERSTANDING

    ; GIVE CHILDREN PERMISSION TO EXPRESS THEIR FEELINGS, ; GIVE CHILDREN PERMISSION TO EXPRESS THEIR FEELINGS,

    QUESTIONS AND WORRIES AND ACKNOWLEDGE THAT THERE IS NO QUESTIONS AND WORRIES AND ACKNOWLEDGE THAT THERE IS NO

    ONE WAY TO FEEL ONE WAY TO FEEL

    ; RECOGNISE THE CHILD'S INDIVIDAUL RELATIONSHIP WITH THE ; RECOGNISE THE CHILD'S INDIVIDAUL RELATIONSHIP WITH THE

    DYING PERSON DYING PERSON

    ; USE DIFFERENT METHODS TO HELP CHILDREN EXPRESS THEIR ; USE DIFFERENT METHODS TO HELP CHILDREN EXPRESS THEIR

    THOUGHTS AND FEELINGS E.G. BOOKS, DRAWING, PLAYING THOUGHTS AND FEELINGS E.G. BOOKS, DRAWING, PLAYING

    ; MAKE SURE SCHOOLS AND OTHER AGENCIES INVOLVED WITH ; MAKE SURE SCHOOLS AND OTHER AGENCIES INVOLVED WITH

    FAMILIES ARE AWARE WHAT IS HAPPENING FAMILIES ARE AWARE WHAT IS HAPPENING

    ; OFFER CHILDREN THE OPPORTUNITY TO TALK TO HELPFUL PEOPLE IF ; OFFER CHILDREN THE OPPORTUNITY TO TALK TO HELPFUL PEOPLE IF

    THEY ARE FINDING IT HARD TO TALK TO FAMILY MEMBERS OR THEY ARE FINDING IT HARD TO TALK TO FAMILY MEMBERS OR

    PEOPLE CLOSE TO THEM PEOPLE CLOSE TO THEM

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    FUNERALS AND RITUALS FUNERALS AND RITUALS

    SOME FACTORS TO CONSIDER WITH FUNERALS AND ENDING RITUALS SOME FACTORS TO CONSIDER WITH FUNERALS AND ENDING RITUALS INCLUDE: INCLUDE:

    ; ALTHOUGH SOME PARENTS MAY BE ANXIOUS ABOUT CHILDREN ; ALTHOUGH SOME PARENTS MAY BE ANXIOUS ABOUT CHILDREN

    SEEING THEM BEING VERY UPSET, IT IS IMPORTANT FOR CHILDREN SEEING THEM BEING VERY UPSET, IT IS IMPORTANT FOR CHILDREN

    TO BE GIVEN THE OPPORTUNITY TO SAY GOODBYE, TO BE INVOLVED TO BE GIVEN THE OPPORTUNITY TO SAY GOODBYE, TO BE INVOLVED

    IN ENDING RITUALS, AND TO BE A PART OF THE FAMILYS GRIEVING IN ENDING RITUALS, AND TO BE A PART OF THE FAMILYS GRIEVING

    PROCESS PROCESS

    ; CHILDREN CAN MANAGE DEATH/DYING/FUNERALS BETTER THAN ; CHILDREN CAN MANAGE DEATH/DYING/FUNERALS BETTER THAN

    MANY ADULTS MAY ANTICIPATE, BUT THEY REQUIRE PREPARATION MANY ADULTS MAY ANTICIPATE, BUT THEY REQUIRE PREPARATION

    AND FOR INFORMATION TO BE HANDLED SENSITIVELY AND FOR INFORMATION TO BE HANDLED SENSITIVELY

    ; CHILDREN NEED TO BE GIVEN HONEST AND CLEAR INFORMATION TO ; CHILDREN NEED TO BE GIVEN HONEST AND CLEAR INFORMATION TO

    BE ABLE TO MAKE AN INFORMED CHOICE AS TO WHETHER TO ATTEND BE ABLE TO MAKE AN INFORMED CHOICE AS TO WHETHER TO ATTEND

    THE FUNERAL THE FUNERAL

    ; IT MAY BE HELPFUL FOR PARENTS IF THERE IS A PERSON PRESENT ; IT MAY BE HELPFUL FOR PARENTS IF THERE IS A PERSON PRESENT

    AT THE FUNERAL. THIS PERSON CAN SUPPORT A CHILD IF A PARENT AT THE FUNERAL. THIS PERSON CAN SUPPORT A CHILD IF A PARENT

    DOES NOT FEEL ABLE TO DO SO, OR CAN ACCOMPANY THE CHILD IF DOES NOT FEEL ABLE TO DO SO, OR CAN ACCOMPANY THE CHILD IF

    HE WANTS TO LEAVE THE CHURCH HE WANTS TO LEAVE THE CHURCH

    ; CHILDREN MAY WANT TO WRITE A LETTER OR DRAW A PICTURE TO ; CHILDREN MAY WANT TO WRITE A LETTER OR DRAW A PICTURE TO

    PUT INSIDE THE COFFIN. THEY MAY BE CURIOUS ABOUT WHAT THE PUT INSIDE THE COFFIN. THEY MAY BE CURIOUS ABOUT WHAT THE

    BODY WILL LOOK LIKE, WHAT THE COFFIN IS LIKE, WHETHER YOU BODY WILL LOOK LIKE, WHAT THE COFFIN IS LIKE, WHETHER YOU

    CAN FEEL THE BODY, WHAT THE ROOM/CHURCH/GRAVE WILL BE CAN FEEL THE BODY, WHAT THE ROOM/CHURCH/GRAVE WILL BE

    LIKE. IT IS IMPORTANT THAT THEY KNOW THAT PEOPLE MAY BE LIKE. IT IS IMPORTANT THAT THEY KNOW THAT PEOPLE MAY BE

    CRYING AND BE UPSET. A VISIT TO THE CHURCH OR CEMETERY CRYING AND BE UPSET. A VISIT TO THE CHURCH OR CEMETERY

    BEFOREHAND MAY ASSIST A CHILD BEFOREHAND MAY ASSIST A CHILD

    ; THE MORE INFORMATION A CHILD HAS BEFORE A FUNERAL AS TO ; THE MORE INFORMATION A CHILD HAS BEFORE A FUNERAL AS TO

    HOW IT MAY BE, THE LESS OVERWHELMING THE EXPERIENCE HOW IT MAY BE, THE LESS OVERWHELMING THE EXPERIENCE

    ; THE NATURE OF THE FUNERAL AND RITUAL WILL DEPEND UPON A ; THE NATURE OF THE FUNERAL AND RITUAL WILL DEPEND UPON A

    PERSON'S COUNTRY, CULTURE AND BELIEFS PERSON'S COUNTRY, CULTURE AND BELIEFS

    ; IT IS ALSO IMPORTANT TO EXPLAIN TERMS SUCH AS DEAD, ; IT IS ALSO IMPORTANT TO EXPLAIN TERMS SUCH AS DEAD,

    CEMETERY, BURIED, CREMATION. EXPLANATIONS MUST BE CEMETERY, BURIED, CREMATION. EXPLANATIONS MUST BE

    TRUTHFUL, BUT AGE APPROPRIATE TRUTHFUL, BUT AGE APPROPRIATE

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    ANNEX 3 ANNEX 3

    WHAT YOU CAN DO - PRACTICAL IDEAS WHAT YOU CAN DO - PRACTICAL IDEAS

EXAMPLES OF ACTIVITES YOU CAN USE WHEN WORKING EXAMPLES OF ACTIVITES YOU CAN USE WHEN WORKING

    WITH BEREAVED CHILDEN WITH BEREAVED CHILDEN

MEMORY BOXES AND MEMORY BOOKS MEMORY BOXES AND MEMORY BOOKS

    A child might want to make a box or container in which to keep their precious mementos. It can be anything from a shoebox covered with pictures and painted or coloured in, to a wooden box with special drawers to keep things like photos, letters, jewellery, clothing, in fact anything that reminds them of the person who died. It may also be a memory box that their parent who died made for them with special messages for the child.

    A memory book might include memories, special stories, family history, and significant events that the child wants to remember about their parent or the person who died.

ROLE PLAY ROLE PLAY

    A child might use dress ups and toys to enact what happened when the person died or a significant event they attended e.g. a funeral. This may be an event that they did not understand and need to re-enact to gain more understanding or an event that they did not get to be a part of, such as seeing the person after they died.

QUESTIONS AND DOC SPOT SESSION QUESTIONS AND DOC SPOT SESSION

    This is often used in the St Helena Hospice Grief Support Programme with the 5-10s group and the teens group. Children are encouraged to write any questions they may have about: the person's illness; how they died; what happened; feelings; and anything else they want to raise. They then place them anonymously in a box. A session is arranged with one of the hospice doctors to answer these questions and others the children may have. By providing this support within a group, children may hear answers to questions they had thought of but never asked, or information explained that they had not understood before.

    This type of session can work equally well on a one to one basis with a child who may want time to raise some questions individually with a medically trained person, either a doctor or a nurse. It can be helpful if this person has either a history about the person who died beforehand or has been involved in their care.

DRAWING A PICTURE OF THE PERSON WHO HAS DIED DRAWING A PICTURE OF THE PERSON WHO HAS DIED

    A child may wish to draw a picture of the person who died, or of a special memory or of a place that reminds them of that person and may then want to

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    talk about how that makes them feel, what they remember about the person, what was important about the place, and whether they have they gone back there again.

DRAW