Death and Dying: Communication Strategies for Supporting Children The Consortium for Advancements in Health & Human Services, Inc. Educational Program Development Team: BC Farnham, MSW, MBA; Debbie Favel, RN, MSN, CHPN; Dr. Denise Green; Sheryl Matney, MS; Jenny Gilley Carpenter, LPN.; Karina Lemos, RN.; Elizabeth R. Pugh, LBSW. This program is made possible through a collaborative community-education partnership between The Consortium for Advancements in Health & Human Services, Inc. and the presenting agency. The primary goal of this effort is to increase public awareness and access to hospice care, through the provision of community-based education. Contact Hours are awarded to professionals who complete this program by The Consortium for Advancements in Health & Human Services, Inc. © 2010 The Consortium for Advancements in Health & Human Services, Inc.

Important Information This education program for healthcare professionals was developed by The Consortium for Advancements in Health and Human Services, Inc. (CAHHS) and is facilitated by the presenting agency via a community education partnership agreement. CAHHS is a private corporation and is solely responsible for the development, implementation and evaluation of its educational programs. There is no fee associated with receiving contact hours for participating in this program titled, Death and Dying: Communication Strategies for Supporting Children. However, participants wishing to receive contact hours must offer a signature on the sign-in sheet, attend the entire program and complete a program evaluation form. The Consortium for Advancements in Health and Human Services, Inc. is an approved provider of continuing nursing education by the Alabama State Nurses Association, an accredited approver by the American Nurses Credentialing Center's Commission on Accreditation. The Consortium for Advancements in Health & Human Services, Inc., is approved as a provider of continuing education in Social Work by the Alabama Board of Social Work Examiners, #0356, Expiration Date: 10/31/2014. The course listed above was completed on / / and is approved for 1.0 CEUs. Approval number:79003641. To claim these CEUs, log into your CE Center account at www.ccmcertification.org In most states, boards providing oversight for nursing and social work recognize contact hours awarded by organizations who are approved by another state's board as a provider of continuing education.  If you have questions about acceptance of contact hours awarded by our organization, please contact your specific state board to determine its requirements. Provider status will be listed on your certificate. CAHHS does not offer free replacement certificates to participants. In the event that CAHHS elects to provide a replacement certificate, there will be a $20.00 administrative fee charged to the individual who requests it.

Learning Objective: Participants completing this educational program will be able to do the following: Identify strategies that support communication about death and dying with children.

How Do We Learn About “IT”? Does our family teach us about death? Is what they teach us enough? Do we learn about death through experience? How do our experiences with death impact our lives? How does our culture feel about death? Turn these questions to the audience and get their feedback.

Children Are Familiar with “IT” Even if a family makes the choice to shield a child from the realities of death, he/she is aware of death. Death is everywhere and children often are familiar with the concept of death long before we think they are (Worden, 1991). How do you think children become familiar with death? Allow Discussion with Participants.

Shhhhh…. Let’s not talk about “IT” We simply do not like to talk about things that are uncomfortable or upsetting. We are unsure if we should confront the issue of death or avoid it. Children will seek communication when they are ready for it. Are you ready to talk about death? Do your own feelings as it relates to death and dying effect how you communicate with children?

Talking about “IT” Grief should be acknowledged, not ignored By supporting children through “IT” today, we provide them skills to aid them in future losses (Doka, 2000)

Important Things To Remember When Talking About… “IT”. Past experiences impact our thoughts and feelings about death. Take time to learn about what the child knows already. Ask questions… explore. Always respect cultural and religious beliefs. Is it okay for a healthcare professional to talk about religion with a client? Child Development impacts understanding of death. Is it okay for a healthcare professional to talk about religion with a client?- Ask this to your audience and discuss their feedback.

Overview of Child Development “Infants do not have language skills, however, they do react to physical comfort. When an infant is dying, a comforting touch and holding are as important for the infant as the caregiver. Communicating love can be expressed through a gentle touch and cuddling” (Discussing Death, 2006).

Child Development: Toddlers “For toddlers and young children, use concrete language. Avoid misleading terms for death, such as "sleep" and "passed away." A young child may be afraid to go to sleep if it is associated with death” (Discussing Death, 2006).

Child Development: Young Children “Young children may ask very direct questions about death, if given the opportunity. It is important to be honest and consistent with your response. If they ask a question that you do not know the answer to, it is acceptable for you to say so, rather than make up an answer. Children at a very young age can detect falseness in an answer. They may also receive inconsistent information if answers from different people are misleading or avoid the truth” (Discussing Death, 2006).

Child Development: Teenagers “Teenagers may want to discuss death with a friend or someone other than a parent. Encourage communication in any manner that will help the child express his/her fears and concerns” (Discussing Death, 2006).

Talking About “IT” Can Offer Challenges Children ask difficult questions. What are some question that may be difficult to answer for you as a healthcare professional? Misconceptions of death can create psychosocial issues for children. What type of issues? How do you as a healthcare professional assess and respond? What type of intervention will address these identified psychosocial issues? Ask the participants any questions they would have a hard time answering. Also, ask the audience if they have ever had a difficult time answering questions and how they handled the situation.

Showing Emotion: A Good or Bad Thing? Showing feelings and emotions are a normal part of the grieving process. Presenting these feelings and talking about the person who has died helps children not feel isolated or afraid. It is important to let children know they did not cause the death nor did they have any control over the situation (Kaneshiro & Zieve, 2009).

Typical Childhood Bereavement Behaviors Sense of shock Being sad Feeling angry Possible guilt Clinging Acting out Becoming uninterested in school Decrease in sleeping and eating Behaving younger than their age Complaining of physical pain (Kaneshiro & Zieve, 2009) Ask participants: Has anyone seen any other behaviors expressed by children in bereavement?

Signs There May Be a Problem Long-lasting denial or avoidance of feelings Reoccurring crying spells Depression and/or suicidal thoughts Continuous anger or sadness Withdrawal from social situations Extreme separation anxiety Criminal behavior or promiscuity Decrease in performance at school Continuing problems with sleep Appearance of an eating disorder (Kaneshiro & Zieve, 2009)

The Psychosocial Needs of Children Facing Terminal Illness or Death of a Significant Individual Time to be a child Communication/listening/expression of fears or anger Independence and control Spiritual and cultural needs should be respected and provided for. Permission from loved ones to die or mourn Comfort in knowing they are not alone in the dying or grief process Limit setting (Discussing Death, 2006).

Common Questions Families Have About Death and Children Should children visit people who are dying? Should children attend funerals? Should families send children away during a death? When is the best time to talk to a child about death? Have your participants answer these questions. Discuss their answers as a group.

Understanding The Needs of the Grieving and/or Dying Child Clear, honest and developmentally appropriate information. Reassurance that basic needs will be met. Exploration related to fantasies and fears about death. Freedom of expression Opportunity to experience and express religious and cultural rituals. The CHANCE to say “goodbye” (Discussing Death, 2006).

Most Importantly, Children need… TO TALK ABOUT “IT”

References Discussing death with children. (2006). Retrieved February 20, 2006, from The Medical Center of Central Georgia Web site: http://www.mccg.org/‌childrenshealth/‌content.asp?pageid=P03046 Doka. K. J. (2000). A guide to children’s grief. Retrieved February 1, 2010, from the PBS Web Site: http://www.pbs.org/wnet/onourownterms/articles/children.html Kaneshiro, N. K., & Zieve, D. (2009). Discussing death with children. Retrieved February 1, 2010, from The University of Tennessee Medical Center Web site: https://www.utmedicalcenter.org/encyclopedia/1/001909.htm Worden, J. W. (1991). Talking to children about death. Retrieved February 20, 2006, from Buddhist Hospices & HIV/‌AIDS Web site: http://www.buddhanet.net/‌r_talkcn.htm Online Resources: http://www.agast.org http://www.growthhouse.org http://www.journeyofhearts.org http://www.selfgrowth.com http://www.compassionatefriends.org http://www.wiregrasshospice.org

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