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Grief in-service

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Grief and the Family Child Life Intern Molly Pearson Summer 2014
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Page 1: Grief in-service

Grief and the

Family

Child Life Intern Molly

Pearson

Summer 2014

Page 2: Grief in-service

GR

IEFThe normal process of

reacting to a loss.It

is a process that helps us

adapt to change so that we

can return to life with

vitality and hope.

MedicineNet.com

Page 3: Grief in-service

Sta

ges o

f Grie

f

Eliza

beth

Küble

r-Ross

Denial: A

defense

mechanism

that buffers the

initial shock

Anger: When

reality and its

pain re-emerge

Bargaining:

Often the need

to regain

control

Depression:

The reaction to

practical

implications

relating to the

loss

Acceptance:

Coping with

the loss

Page 4: Grief in-service

Who Deals with

Grief & Who Can

We Help?

The Whole Family

Page 5: Grief in-service

Who D

eals w

ith G

rief

& W

ho C

an W

e H

elp

Patients with disabilities

AmputationsSpina Bifida

Cerebral Palsy

Osteogenesis Imperfecta

Scoliosis

Muscle Dystrophy

Juvenile Arthritis

Other Orthopedic

Conditions

Page 6: Grief in-service

Who D

eals w

ith G

rief

& W

ho C

an W

e H

elp

Parents; single, divorced,

step, adoptive parentsSiblings

Grandparents

Other relatives and

community members

Page 7: Grief in-service

Grie

f Resp

onse

Facto

rs

Age

Stage of mental and emotional

development

Patterns of interaction and

communication within his/her

family

Grief can be reoccurring and in

doses

Show grief through play/activities

rather than tell their grief- may

appear unaffected

Page 8: Grief in-service

A loss may interrupt a child’s

developmental tasks

Children are sensitive about

being different

Children have a difficult time

putting their feelings into

words.

Children are quick to blame

themselves

Page 9: Grief in-service

Young children may not

understand that a loss is final,

irreversible or certain: grief

may be delayed into later

developmental years.

Children lack experience and

social skills.

Children may sacrifice their

personal needs.

Page 10: Grief in-service

Com

mon R

eactio

n

Afte

r Dia

gnosis o

r loss

Anguish

Envy

Self-blame

Sadness

Anger

Anxiety

Isolation

Bitterness

Self-image/

Self-esteem

issues

Sleeping

problems/nigh

tmares

Change in

appetite

Nader & Salloum, 2011

Shear, 2012

Page 11: Grief in-service

Oth

er G

rievin

g

Resp

onse

s

Mental reactions to grief

Thinking that the loss didn’t really

happen

Difficulty in making decisions

Thinking everyone is watching you

Thinking you are different from

everyone else

Self-destructive thoughts 

Page 12: Grief in-service

Oth

er G

rievin

g

Resp

onse

s

Physical reactions to

grief

Headaches

Tightness of the throat

Shortness of breath

Fatigue

Loss of appetite and sleep,

Page 13: Grief in-service

Types o

f

Grie

vers

Intuitive Griever:

heightened experience

and expression of

emotion

Instrumental Griever:

use cognitive behavioral,

problem-solving

approach

Nader & Salloum, 2011

Page 14: Grief in-service

Developmental Grieving

InfantsNader & Salloum, 2011

No cognitive understanding of

loss, but can grieve.

Difficulty identifying or dealing

with loss.

Crying excessively, fretting

persistently, separation anxiety,

and irritability.

Changes in feeding, bowel

movements, and sleeping

patterns

Page 15: Grief in-service

Developmental Grieving

ToddlersNader & Salloum, 2011

Egocentric

Mirror caregiver reactions

Separation anxiety,

nightmares/fear of sleeping

Regression and irritability

May have trouble

concentrating

Behavioral outburst

Page 16: Grief in-service

Developmental Grieving

Preschool AgeNader & Salloum, 2011

Magical Thinking

May experience grief reactions

of toddlers

Self-blame- causes the loss

Regression and aggression

Behavioral issues:

internal/external

Page 17: Grief in-service

Developmental Grieving

School AgeNader & Salloum, 2011

Anger, anxiety, depression

Fear about safety for self and

other loved ones

See self as different from other

children; stigmatized

Feel of loss of control

Concerns with isolation

Page 18: Grief in-service

Developmental Grieving

Pre-AdolescentNader & Salloum, 2011

Intellectualize the loss,

curiosity to understand the

details of the loss

Interest in religion

Difficulty identifying and

dealing with feelings

Aware that they are different

from other children

Page 19: Grief in-service

Developmental Grieving

AdolescentNader & Salloum, 2011

Abstracting thinking/reasoning.

Develop understanding of meaning

and/or greater effect of loss

Preoccupied with own thought

process.

Concerns about how others are

thinking and saying about them.

Feel different and that nobody

understands them.

May reject religion and adult

support.

Page 20: Grief in-service

Pare

nta

l Grie

vingCan re-experience

disparity between their

actual parenting

experience and their

idealized parenting

experience.

Whittingham, Wee, Sanders, & Boyd, 2013

Must deal with multiple

losses as their child will

not have a normal life

cycle nor will they, as

parents. Patrick-Ott & Ladd, 2010

Page 21: Grief in-service

Sto

ry“The hopes and dreams for the

life of my first some were dying

a slow death. The growing

realization that Josh would be in

my life, fully dependent on my

care for the rest of his life... I

was sad for Josh and his own

losses – skills, opportunities, and

milestones. No driver’s license.

No first date. No first job

interview. No marriage and

children”Patrick-Ott & Ladd, 2010

Page 22: Grief in-service

Sib

ling G

rievin

g

Increase risk for emotional

and behavioral problems

Anger and jealousy

towards disable sibling

Scared for their

brother/sister and

themselves

Feel forgotten and not an

important part of the

family Sharpe, D., & Rossiter, L., 2002.

Page 23: Grief in-service

Gra

ndpare

nts

Initial reaction is similar to

those of parents

Place self-blame

Want to shoulder some of the

burden and help out

Fear and concerned about

grandchild’s future and

uncertainties Lee & Gardner, 2010)

Page 24: Grief in-service

Life

styl

e

Adapta

tions

Alterations/adaptions to

daily living activitiesMoving to first floor

bedroomRe-learn ambulationUsing assistive devices

Installing handrails and

ramps in the homeIncrease time to

complete tasks and travelRequired rest periods

Dietary modifications

Page 25: Grief in-service

Life

styl

e A

ltera

tions

Conti

nue

Decrease physical activitiesMedical expenses-

budgetingPreventions and precautionsEnvironmental changes

Extra time planning

outings

Page 26: Grief in-service

Pati

ent

Copin

g

Given honest, age appropriate information

and involved in decision

making processSupport groups and

campsPlay to learn, process

new information, and to

adapt.Keep open communication linesEdgar-Bailey & Kress, 2010

Page 27: Grief in-service

Pare

nta

l Copin

g

Adaptive coping strategiesCommunication with

health professionals &

school staffSocial supportOptimistic outlook/reframingSpending time with

spouseHaving a hobbyWhittingham, Wee, Sanders, & Boyd, 2013

Page 28: Grief in-service

Sib

ling C

opin

g

HonestInfo at age appropriate

levelOpen for questions and

to share feelingsOkay to cry with themSet time aside for them

each dayLet them visit sibling in

the hospitalReassure them they are

important and lovedWilliams et al., 2002

Page 29: Grief in-service

Fam

ily C

opin

g

Positive reinterpretation and growthInstrumental/emotional

social supportActive copingAcceptancePlanningSuppression of competing activitiesWang, Michaels, & Day, 2011

Page 30: Grief in-service

How

Can W

e

Help

?

ListenInclude the pt. and his/her

family in the treatment plan

processEducate about the disability/diagnosis and

beneficial resourcesAllowing them to grieve in

their own waySilence, but being present

Build rapport with the family

Believe in child’s ability to

recover and grow

Page 31: Grief in-service

Who C

an H

elp

?

Child life/Rec Therapy

Physical TherapyOccupational Therapy

TherapistDoctors/NursesSocial WorkCare Coordinator

Other Medical StaffTeachers/TutorsSchool Counselor Local Church

Page 32: Grief in-service

Refe

rence

s

Axelrod, J. (2006). The 5 Stages of Loss and Grief. Psych Central

Edgar-Bailey, M., & Kress, V. E. (2010). Resolving Child and Adolescent Traumatic Grief: Creative Techniques and Interventions. Journal of Creativity in Mental Health, 5(2), 158–176.

Harvey, J. H., & Miller, E. (1998). Toward a psychology of loss. Psychological Science, 9, 429.

Lee, M., & Gardner, J. E. (2010). Grandparents’ Involvement and Support in Families with Children with Disabilities. Educational Gerontology, 36(6), 467–499.

MedicineNet.com

Nader, K., & Salloum, A. (2011). Complicated Grief Reactions in Children and Adolescents. Journal of Child & Adolescent Trauma, 4(3), 233–257.

Patrick-Ott, A., & Ladd, L. D. (2010). The Blending of Boss’s Concept of Ambiguous Loss and Olshansky’s Concept of Chronic Sorrow: A Case Study of a Family With a Child Who Has Significant Disabilities. Journal of Creativity in Mental Health, 5(1), 73–86.

Sharpe, D., & Rossiter, L. (2002). Siblings of children with a chronic illness: A meta-analysis. Journal of Pediatric Psychology, 27(8), 699–710.

Shear, M. K. (2012). Getting Straight About Grief. Depression & Anxiety (1091-4269), 29(6), 461–464.

Wang, P., Michaels, C. A., & Day, M. S. (2011). Stresses and Coping Strategies of Chinese Families with Children with Autism and Other Developmental Disabilities. Journal of Autism & Developmental Disorders, 41(6), 783–795.

Whittingham, K., Wee, D., Sanders, M. R., & Boyd, R. (2013). Predictors of psychological adjustment, experienced parenting burden and chronic sorrow symptoms in parents of children with cerebral palsy. Child: Care, Health & Development, 39(3), 366–373.

Williams, P. D., Williams, A. R., Graff, J. C., Hanson, S., Stanton, A., Hafeman, C., … Sanders, S. (2002). Interrelationships Among Variables Affecting Well Siblings and Mothers in Families of Children with a Chronic Illness or Disability. Journal of Behavioral Medicine, 25(5), 411–424.


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