Bereavement Support (including Pre-bereavement) Working with children and families

Safeguarding your well being and safety 0 1 2 3 4 5 6 7 8 9 10 This should be on your supervision agenda re where do you get support from to be an effective practitioner Smaller groups than today

To be an aware, mindful, knowledgeable and confident practitioner This is what children and young people want, need and expect from adults We need to model this so children and young people can learn how to be aware, mindful, knowledgeable and confident individuals contributing towards a healthy society To develop the self can be a moment to moment experience and it can be done in stages using training opportunities and mindfulness techniques Subject matter can be taught or read in books Skills practice and development can require more time and a structured approach I am going to give over a subject input then we will break for some skills work on the self and what you do to support

In the next half an hour :?!* Grief and trauma Children’s understanding of death Systems Pre-bereavement The professional role Caring for oneself

Grief – psychological adjustment to loss Shock Disbelief Acceptance Denial Anger Blame Try out new things Or experimenting with change Guilt Normal response Deep Despair

Trauma An experience that is overwhelming Fight, flight or freeze response is triggered There can be difficulties integrating the experience physically, emotionally and cognitively into a narrative or memory Vast field. Essential points. Critical incident guidance

Traumatic Qualities Intrusion – thoughts, emotions, pictures, sounds, sensations which come into your experience uninvited Avoidance – staying away from reminders, actively not talking about “it”, pretending, denial Arousal – hyper – state of hyper vigilance - hypo – going to sleep/switching - off Trauma aspect of grief requires to be worked through to enable healthy grieving to occur

Shape to the process of potential grief and trauma experiences

Children come with a history Attachment pattern Secure Insecure ambivalent Insecure Avoidant Disorganised/disorientated A history of losses and experiences which may be traumatic

Children’s understanding of death Develops in parallel with cognitive maturing Below the age of 5 – death is reversible – concrete and magical thinking From 5 to 10 – gradual increase in understanding that death is irreversible – cause and effect – need for detailed information (updates)– males may start to suppress expression of feelings 10 through adolescence – “uh oh! I’m goanna die!” – abstract thinking – long term consequences of loss – peer influences

Children arrive in a context Culture of family functioning Open, closed, chaotic, strict, abusive, loving………… Religious or belief systems Self esteem or cognitive beliefs Age and stage or ability, Gender Religious handouts for funerals. Encourage to seek out information from children and families as an educational opportunity.

What Good Provision for Bereaved Children Looks Like

Pre-bereavement Bereavement care should begin prior to the death of a patient with their carers being assessed for their potential bereavement risk factors Bereavement care pathway Pre-bereavement assessment Either low, medium or high risk Initiate appropriate level of support accordingly

Pre-bereavement continued Anticipatory grief – shielding against pain Openness within the family will be the best foundation for children’s coping, both while the person is still alive and after their death Supporting parents on how to talk with children – process should be started before dying person is too ill to participate

Activities Solution Focussed conversations (Planning) Identify best hopes (outcomes) Scaling – measurement of feelings/pain….. Letter writing/Video recordings (communication) As much as possible normal, family fun activities or introduce new ones which provide the opportunity to express thoughts, feelings, hopes, anxieties, concerns and strengths‘ Include family members in making plans for funeral. Children should be given the choice about taking part and having a role. To be supported in understanding what the ritual involves

Professional Role Human being first Professional and compassionate Does your agency have a bereavement support policy? (pro-active planning/intervention) Agree roles among team around child with an understanding of good practice The child or family chooses you as a safe person to share with seek out support and guidance obtain agreement to plan extra time into sessions, as well as for the period following the death

Caring for oneself Remember that to be of help to the child, you need to take good care of your self The system which provides a service for the child, should make provision to support the staff who support the child Make a list using SF include training and supervision – service improvement plan performance indicators – bereavement support questionnaire relating to quality of staff input

Useful links Bereavement Support Guideline Merseyside and Cheshire NHS Cancer Network Standards for bereavement care in the UK (2001) NICE Supportive and Palliative Care Guidance for Adults (2004) The National End of Life Care Strategy (2008) Childhood Bereavement Network