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Supporting suddenly bereaved children and young people seminar minutes, July 2011

These seminars took place on 5 July 2011 at Association of British Insurers, London, and 12 July 2011 at Bishopgarth Police Training Centre, Wakefield. The seminars were kindly sponsored by Fentons Solicitors LLP.

Introduction and overview of Brake's work supporting suddenly bereaved children and young people
Julie Townsend, Campaigns Director & Deputy Chief Executive, Brake

All too often when somebody dies, children and young people are the forgotten mourners, excluded from the grieving process due to the misguided notion that it is better to keep them shielded from the situation. In reality, children not only have the right to grieve, but it could cause problems later in life if children are not allowed to grieve. Research shows that it is better to keep children and young people informed about a death which has occurred, and to ensure that they have access to the correct support to meet their needs.

Common reactions to a sudden death include:

  • Difficulty comprehending death
  • Denial
  • Shock
  • Physical Symptoms
  • Need for information and questions answered

Children and young people experience the same range and intensity of emotions as adults do, they merely express them differently. This can make it challenging for adults supporting or caring for them. Common behaviours include:

  • Changeable emotions
  • Reverting to 'normal' life
  • 'Bad' behaviour
    • Confusion, frustration, unpredictable emotions
    • Misdirected aggression, temper, mood swings
  • 'Good' behaviour
  • Protecting grieving adults
  • Afraid of being overwhelmed

Brake's Sudden Death Forum has produced two resources for adults who are supporting children and young people through a sudden death; "Someone has died in a road crash" and "Someone has died suddenly". These resources each consist of a book and a guide to help adults talk to children about some of the practical and emotional issues around a sudden death.

The books feature two main characters, Amy and Tom. There is a section within each book called "Your feelings matter more than anything", which offers non-prescriptive advice to children about some of the different emotions they may or may not experience, whilst explaining that these emotions are normal. It tackles various emotional states, including; crying; anger (channelling this in a safe way); guilt/ blame (reassurance that they weren't to blame); isolation (assurance that they are not alone and making sure that these feelings are not compounded by being excluded by other children); things that other people say (making children resilient to this); not wanting to do anything (helping children to be happy again and encouraging new activities).

Key ways to help:

  • Develop knowledge and understanding of children's common reactions to grief and their support needs.
  • General support and signposting for the child and whole family.
  • Looking out for signs of gaps in support or additional problems – e.g child protection issues.
  • Communication with bereaved children, which should consider the following:
    • Clear, no room for misinterpretation
    • Acknowledge possibly sensitive subjects
    • Allow children to talk and tell their story
    • Involve children in decisions
  • Communication with others:
    • Other adults supporting the child
    • Classmates and friends
  • Encourage parents and carers to give children the opportunity to ask questions, and answer honestly.
  • Help parents and carers to be well-informed.
  • Suggest activities they can do to encourage children to express their feelings.

Legal implications for families following a sudden death
Joanna Bailey, Partner, Fentons Solicitors LLP

Minutes coming soon

Supporting suddenly bereaved children – a personal perspective

L, bereaved mother and Brake volunteer

L shared her experience of supporting her two children, T and O, following the death of her son W, who was just 8 years old. W died when an HGV vehicle crashed into the back of the family car as they were going on holiday. T was 6 years old and O was just 3.

Key messages from L about how she supported her children:

  • It's important to keep normal boundaries in place - at first it was easy for us to give the children what they wanted but in hindsight it would have been better to be firmer and keep our normal rules in place.
  • Three or four months later, T got into football. There had been many things that he'd rejected or stopped doing since the crash, because they reminded him of W, but football was a completely new activity. A message I'd pass on to other families is encourage children to take on new things, if that's what they need to do. Sometimes children know what they need to do, and you just need to help them to pursue this.
  • It was also very helpful to talk to T about W. T found it easier to talk about memories of W, but when it came to talking about what had actually happened, T found this very difficult and often didn't want us to talk about it.
  • O was very young at the time and didn't really understand what was happening. It is only really in the last few months that she is beginning to understand what happened. Although we all talk about W a lot, O says that she doesn't really remember him.
  • Some very good advice that I received about talking to your children about bereavement was to make sure that you do talk to your child – and let them know that they can say whatever they want. Try not to cry every time you talk about it, as they will stop wanting to talk about it for fear of upsetting mum and dad.

Support received for the family:

  • The Brake support literature was helpful as it helped them to think of things such as letting the children see W and say goodbye.
  • The school had a special educational needs co-ordinator who put the family in touch with a counsellor for T, from the Local Education Authority. However, it seemed that they were more geared towards helping adolescents and didn't have a clear policy in place for a child as young as 7 years old. It's vital that such agencies have appropriate policies and procedures in place for different age groups, and don't miss out certain age groups from these policies.
  • About two years down the line, the family organised some counselling with a child psychologist for T through their solicitor. This was more helpful than the previous support for T, perhaps because he was a bit older and could voice his feelings more, and had a better understanding of what had happened.
  • The counsellor was able to identify some aspects of his behaviour which were problematic (such as him refusing to go to bed as he did not want to be alone) and suggested ways to help – such as getting an audio-tape out of the library to help him settle down.
  • The counsellor talked to T about his separation anxiety and provided him with reassurance – that just because he couldn't see his mum, she was still there, and would come back.
  • L was present for T's counselling, which helped reassure T, but it also helped L to learn some techniques too that she could use on a day to day basis.
  • The school were also really helpful at this time. T was very keen to get back to school as soon as possible and it was good for him to have some normality. They suggested one particular teacher that he could go to if he needed some help, or if he didn't feel well or wasn't coping, and it was reassuring for him to have this point of reference.

The impact of sudden bereavement on children and young people
Erica Brown, Vice President, Acorn Children's Hospices & Principal Research Fellow in Palliative Care Coventry University

It is important to realise that for suddenly bereaved children and young people, life can and will never be the same again. Once a child has experienced trauma it may be very difficult for them to believe that the equilibrium of life can be restored. They need to go through the process of bringing their deceased loved one from the past, to the present, and beyond into the future with them.

Every person is unique and responds differently to grief. Children and young people respond to shock in a similar way to adults, they just express these emotions differently as they have less life experience to help them deal with traumatic situations. Sudden death has a particularly large impact on people as there is no time to anticipate the grief – and this is particularly overwhelming and confusing for children and young people. It is important to encourage children to describe the levels of emotions which they are feeling – as this not only helps you to support them better, but it helps the child to see the process of moving through their grief.

Children's stress reactions are normal human responses to unanticipated, sudden, frightening events. The possibility that the event may reoccur is likely to increase the trauma the child experiences.

Children's' responses to traumatic events include:

  • Fear of new situations
  • Anxiety
  • Anger
  • Withdrawal
  • Lethargy
  • Tiredness/sleep disturbance
  • Psychosomatic illness/accident proneness
  • Hyper-vigilance
  • Changed eating behaviour
  • Concentration difficulties
  • Pessimism about the future
  • Low self-esteem
  • Inability to form new relationships.

How well children cope with trauma is dependent on several interrelating factors:

  • Cognitive development
  • The presence of primary carers
  • Significant others in the child's life
  • The child's capacity to express emotions
  • The maintenance of familiar routines
  • The stability of the home environment
  • Levels of support from within and outside the child's home
  • Culture
  • Media attitudes
  • Time

Behaviours can differ across the different age groups of children and young people, from regressive behaviour and incontinence in pre-school and primary age children; to truancy, inappropriate sexual behaviour or anti-social behaviour in adolescents and young adults.

Children may overhear adult conversations which may lead to them trying to piece information about the death together. They may also repeatedly ask questions about what has happened and may need to hear this many times. It is vital that they have information about the death conveyed to them in age and cognitively appropriate ways, in easily understood language and clarifying any confusion or misunderstanding around what has happened.

The death may also trigger many difficult questions about life for the child, and their identity, as their sense of self and sense of the world around them is brought into question.

Children and young people need open and honest communication and opportunities to: talk about the person who has died; express grief; to build memories of the person who has died and to be involved in rituals.

When telling sad news:

  • Environment – take the child somewhere quiet and private but where possible to a familiar place
  • Avoid euphemisms and metaphors – use language appropriate to the child's developmental age
  • Ask children what they want to know – encourage questions
  • Give information that is factually correct
  • Repeat the information and check that the child understands what has been said
  • Be prepared to listen again and again and again.

Adults may erroneously presume that all children are emotionally fragile. In truth many children and young people are hardy and resilient. They have remarkable inner strength and determination to get on with living.

Supporting suddenly bereaved children and young people in an education setting
Ann Rowland, Director of Bereavement Services – Child Bereavement Charity

Death and bereavement happens to ordinary families, to ordinary children and young people and to ordinary schools. Death used to be a more common occurrence in society and was dealt with by a community as a whole – today there is more separation and mysticism surrounding death.

The way in which children are treated when someone important in their lives is lost or dies has a profound effect on their future ability to manage their lives. When a child or young person is bereaved, they need an adult to support them and to share their journey. The school has an important role to play in supporting suddenly bereaved children and young people.

A school bereavement policy may include the following things:

  • Sample letters
  • Guidance identifying roles and responsibilities
  • Guidance for parents
  • Outline for breaking bad news/assembly plan (assemblies may be more appropriate as a commemorative event rather than breaking bad news)
  • Lesson plans around bereavement
  • Cultural and religious information
  • Poems and words
  • Links to local organisations for signposting - such as an educational psychologist
  • Helpful websites
  • Books and resources around grief

It is important to normalise death and grief for children and young people – this can be encouraged by covering the subjects within lesson plans and CBC can offer guidance on this. Example objectives for lesson plans around death and grief:

  • To present death and dying as a natural and inevitable part of all our lives by including it, when appropriate, within the curriculum.
  • To help reduce some of the taboo.
  • To raise awareness among our pupils that there is no "right way" to grieve and many different responses.
  • To enable children to be more prepared should the death of someone important happen to them.
  • To enable pupils to have a greater understanding of the needs of bereaved friends, thereby reducing bullying.

There are a number of places in which this could fit into the curriculum including; Media Studies; Geography; Current Affairs; History; PSHE; Art; Visual Arts; Reading; Visits.

Every child is unique and will respond to and deal with grief in a different way. Factors affecting the grieving process include:

  • The circumstances of the death
  • Relationship with the person who died
  • Development level, personality, family
  • 'Recovery environment' – such as the structure of the family and supporting role

Educators are in a unique position to help bereaved children and young people – schools are often the one constant that all children and young people have in their lives. Children and young people need:

  • To understand the reality of what has happened

How educators can help:

    • Liaising with the family to get accurate information
    • Break bad news to children and young people
    • Send cards or pictures
    • Organise a remembrance event or time to talk about it
    • Ask pupils how they can help grieving pupil
    • Think through return of bereaved pupil
    • Let pupils see that staff are sad but that things do continue
  • Opportunities to communicate and express their feelings

How educators can help – encourage young people to:

    • Put together a memory book
    • Draw or write about feelings they are experiencing
    • Keep a memento with them
    • Express feelings through art/music/drama
    • Use books: story or workbooks
    • Create a peer bereavement support group
  • Help to adjust to life without the dead person

How educators can help:

    • Have a system in the register to alert staff
    • Being aware of and planning ahead with the curriculum: mother's day, subject topics, trips etc
    • Use correct title etc. when writing home
    • Talk about the dead person
    • Encourage to have fun and reassure that it is ok to laugh
    • Consider future changes of class and school

Looking after yourself:

  • Be prepared to be emotionally affected
  • Talk to friends and colleagues, share experiences
  • Remember your professional boundaries
  • To be of help to the child, you need to take care of yourself

www.childbereavement.org.uk/for_schools

The importance of the family unit in supporting suddenly bereaved children and young people
Shelley Gilbert, CEO – The Grief Encounter Project

Shelley Gilbert presented an interactive session based on group discussion and role play, in order to explore family dynamics during the grieving process, and look at how the family might support each other, and each individual's needs. This session ended with a role play performance to explore how a family might support each other through this difficult time.

The key findings from this exercise are as follows:

  • The importance of listening to children's stories from their points of view
  • Children need to be heard and understood, not pitied
  • Transition can be particularly hard for bereaved children and young people (for example – moving to secondary school) because their experience of change is so negative
  • Need to consider impact on babies who won't remember the person who died, but who will grow up in a house of loss with an empty space
  • Bereaved parents often feel sense of failure as they can't protect family from this pain, or because they don't have all the answers
  • Professionals are often thrown into intimate, often overwhelming situations and are expected to be able to help and to solve problems – often without being fully informed or prepared

www.griefencounter.org.uk

Wakefield 12 July 2011

Supporting suddenly bereaved children – a personal perspective
F – Bereaved father and Brake volunteer

F shared his experience of supporting his six year old daughter C after the death of his daughter A, aged 12. A was tragically killed in a road crash in 2008.

Key messages from F about how he supported his daughter:

  • One thing that C really needed at this time was normality. She was discharged from hospital very quickly as F wanted to get her home. He wanted family and friends to talk about what had happened, and to talk about A, but some people just didn't want to do this, and this was difficult.
  • The Brake Amy and Tom book took F and C through every step of the grieving process. It had some very practical ideas of what to do – such as signing a contract to agree that they must talk about A or what had happened whenever C wanted to. It's something F would recommend to other families, to come to a mutual agreement about talking – because it can be hard, but it's important to do it.
  • The book also talked about the court process and explained that drivers who break the law are punished. F and C talked about the "naughty boys" who caused the crash, and C was very angry about this.

Support from other agencies:

  • The school were absolutely fantastic in supporting C and her family. C went back to school quite quickly. Some of F's relatives wanted her to stay at home but F wanted her to get back to normal. At school it was business as usual.
  • When C first returned to school she had to be in a wheelchair for some time, and the school went out of their way to accommodate her. The school let the children behave as normal around C - which she really needed – kids can be very empathetic and her classmates were supportive.
  • It was made clear that C could talk to her own teacher, or the headteacher or school secretary, if she needed to. It was made very clear to her too that if she needed to come out of class, or if she needed her dad, then that was absolutely fine.
  • The family took C to see a child psychologist a couple of months after the crash. The psychologist asked her to draw lots of pictures about how she was feeling. C didn't really find this helpful. It may work for other people but it didn't seem to help C - she just wanted to know why she had to talk to this lady she didn't know.
  • One thing that the child psychologist said to F that was very helpful, was that there was nothing wrong with his daughter – that she was dealing with everything in a normal way. This was reassuring as F had lots of concerns about how C was coping.
  • One thing they did very well as a family was to keep trying different things to get through it. If one thing wasn't working for us, then they went down another route instead and got support from elsewhere.

When somebody dies
Sue McDermott, Acting National Director – Rainbows GB

Every school should have a procedure in place to be followed when the school community is plunged into grief. Their response should be a planned and tested one. School communities need to:

  • Review their bereavement and loss policy and procedures
  • Have a planned and appropriate response when learning of the death of a member of the community
  • Recognise and plan for their important ongoing work with those who grieve

It is vital that schools develop their own policy for the best way to respond and work through a bereavement – this includes the immediate response, but also ongoing support for the bereaved children and families. It is vital that all staff understand the policy as the whole school community may be involved.

How schools can develop a 'plan'

  • Decide who will take the lead in developing this policy – taking into account that it may be challenging to persuade all staff that dealing with bereavement is a school responsibility
  • Review current procedures and policies in place for when there is a death in the community, discuss staff reflections on past experiences
  • Involve all staff in the planning stages
  • Create a school policy statement and have a framework for procedures
  • Include additional material such as information for parents, appropriate words to use
  • Be aware of extra resources/services/websites – it is vital to signpost families open to specific and appropriate support – this means identifying services in advance and knowing what's available
  • Identify areas for and further staff training or development

Additional resources to support the development of the plan could involve case studies, and information about children and young people's reactions to death and their experience of the grieving process.

School policies should give a structure to supporting suddenly bereaved children and young people, without forcing them to take a specific route through the grieving process – it should allow for the needs of individuals.

Some items to take into consideration as part of the school bereavement policy:

  • As soon as the death is known to the school have a senior member of staff talk to the immediate classmates about what has happened
  • Stamp out any gossip and offer support for those who may be affected
  • Send a condolence card and consider encouraging classmates to do the same
  • When the child returns to school talk to them about what has happened, if they would like to talk about it (be careful not to patronise them)
  • Ask them how they would like teachers to act and be sensitive to this
  • Teach other children what to say in this situation – have lesson plans around grief and bereavement
  • Be aware that school is somewhere for the child or young person to escape what is going on at home
  • Be tolerant of homework and other work commitments – evenings may well be spent grieving and talking
  • If a parent had died, talk to the spouse if they come into school. Show them that the school cares and wants to help
  • Remember the anniversary
  • Be aware of areas in the curriculum which may bring back memories
  • When another death occurs be aware of bringing back memories for children who have previously experienced a death in their family

By considering these points and having an effective bereavement policy in place, you can make a terrible situation a bit less stressful for a grieving family.

www.rainbowsgb.org

An integrative model of grief – family systems
Angela Trinder, Director – Bereavement Training North West

The combination of grief and stress following a sudden death often disables our coping strategies and impairs our ability to function. The dynamics found in sudden death from accident, disaster, suicide, murder, terrorism and war have vastly different treatment approaches than if death had been anticipated or natural.

The family systems theory suggests that individuals cannot be understood in isolation from one another—families are systems of interconnected and interdependent individuals, none of whom can be understood in isolation from the system. Grief occurs on multiple levels: an individual level, a family level, and a societal level. Looking at a family systems approach to grief allows us to focus on individual and family strengths and coping processes.

Each family has certain roles in place, for example, the most basic roles are "mother" "father" etc, but beyond this there are also expectations about how each member of the family should act – one person may be "the organised one" another may be "the clown" etc. Families also develop "rules" in terms of how their family operates – this may include how they act towards each other when someone is angry, how much they discuss problems with people outside the family, etc.

Individual mourning tasks

  1. Accepts the reality of the loss
  2. Works with pain and grief
  3. Adjusts to the loss
  4. Emotionally relocates

(Individual tasks from Worden.W.1991)

Family mourning tasks:

  1. Communicate about the loss
  2. Allow mourning to occur
  3. Realignment of family roles
  4. Realignment of outside roles

(Family tasks Gilbert.K.R. 1996)

These tasks have interrelating areas – for example, accepting that the death has occurred happens on two levels – intrapersonal and interpersonal. If one member of the family has not accepted the reality of the death, but is confronted by another who has, they have the choice to either continue in denial by distorting the message, or to accept the reality themselves.

Experiencing the pain and grief is similarly interrelated. For instance if a member openly cries and is emotionally upset around other family members, but is ignored, they may learn to inhibit the expression of sorrow, and therefore fail to mourn fully. By not allowing open expression of feelings, the family member's interactions may become less genuine and more superficial. This can create difficulties coping with grief and loss.

Research confirms that particular factors play a significant part in helping us to build up our resilience to cope with loss:-

  • Support Circle – positive relationships with supportive family, friends, colleagues and community
  • Self Worth – believing in one's own value and worth – every person's life matters.
  • Sense of Competence – knowing your own strengths, abilities and skills – and using them.
  • Life Skills – learning and practicing skills such as problem solving, decision making, communicating and asking for help when needed.
  • Flexibility – being able to adjust and bend a little as situations change – recognising that it won't always be as it is now and sometimes putting up with things is needed.
  • Creativity – trying to approach things in new ways and look at things with fresh eyes from different angles.
  • Sense of Humour – being able to laugh at things, put things into perspective and not resent others laughing, it may relieve tension.
  • Perseverance – giving things a go, despite days of setbacks.
  • Self Care – caring for personal needs as a way of building up one's strength.
  • A Hopeful Outlook – looking beyond the present to a more positive future ahead – understanding that things can become better.

Adapting to life without the loved one and adjusting to new family roles, involves adapting the family's previous understanding of normality. A generic model of grief will not be a perfect match with the grief of an individual or family. We need to utilise research on models, stages and theories in order to support families which allows for the different ways of coping with loss within each family system.

www.bereavementtrainingnorthwest.co.uk

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