1. Trauma and Loss for Relative Caregiving Families Brookdale Foundation RAPP Webchat March 14, 2012 Deborah Langosch, PhD, LCSW Jewish Board of Family and Children’s Services New York City (c) JBFCS, CTPI, 3-14-12

2. Webchat Content Principles and concepts about trauma and loss Effective interventions and models Enhancing the emotional well-being of kinship families (c) JBFCS, CTPI, 3-14-12

3. Transitions for Caregivers Role and boundary issues Quality of relationship with parent Sacrifices Ambivalence Rewards Family dynamics No nine month prep time! ©jbfcs, ctpi, d.langosch, 2010 (c) JBFCS, CTPI, 3-14-12

4. The Grandchild’s Experience Loss of parent/s and or siblings Numerous changes and separation issues Loyalty issues Worries about permanency Ensuing Feelings Behavioral Expression Developmental Differences Perceptions based on learning, emotional and physical challenges (c) JBFCS, CTPI, 3-14-12

5. Loss and Trauma All kinship families have experienced loss, but there are many different types such as: Separations Trauma Death Ambiguous Loss (Pauline Boss, 2004) Loss of dreams, hopes and ideals Multiple and complex losses Stigmatized loss All of these circumstances can profoundly effect kinship families. (c) JBFCS, CTPI, 3-14-12

6. The Grieving Process Children and adults mourn differently. Loss of an adult child vs. the loss of a parent. Must grieve to recover from loss. Blocked grief = blocked recovery. Impact of repeated traumatic loss. Risk of increased depression, complicated and or prolonged bereavement. (c) JBFCS, CTPI, 3-14-12

7. Tension between Caregiving and Grieving How do caregivers attend to their own feelings while raising their grandchildren? Adaptive Coping Stiff upper lip/ John Wayne Stance Finding time to grieve Putting their own needs on hold Fears of opening up the flood gates Complicated coping (c) JBFCS, CTPI, 3-14-12

8. Family Secrets Meaning/reason for secrets –Wish to protect the child –Worry about disclosure Kids are quick to pick up on secrets Effect on them –Fears and fantasies –Disruption of trust Am I ready to talk about this? Considering what child can hear and what’s age appropriate (c) JBFCS, CTPI, 3-14-12

9. Interventions: The Three C’s Adapted from Memorial Sloan-Kettering Cancer Center Childhood Bereavement Project Open Communication: Age appropriate and in pediatric doses Consistency: Need for predictability and safety Competency: Supporting the caregivers ability to competently help their grandchild (c) JBFCS, CTPI, 3-14-12

10. Treatment for Traumatic Loss Need to attend to dysregulation before doing grief work Teaching skills that include: feeling identification; relaxation techniques; and connections to feelings, thoughts and behaviors Then it’s safer to proceed with more gradual exposure to the loss (c) JBFCS, CTPI, 3-14-12

11. Kids didn’t like it when adults said…. “I know how you feel.” “It’s been over four months now, you should be over it.” “You shouldn’t be this angry. Being angry won’t bring your brother back.” “You’ll get over it in time.” Adapted from Fernside Online-Resources for Educators – www.fernside.org (c) JBFCS, CTPI, 3-14-12

12. Kids preferred it when adults said… “I’m sorry that Chris died.” “I know it’s hard. It’s okay to cry.” “I can’t know how you feel, but I want to help you in any way that I can.” “I’m ready to listen when you’re ready to talk.” Adapted from Fernside Online-Resources for Educators – www.fernside.org (c) JBFCS, CTPI, 3-14-12

13. Helpful Techniques Creating a safe place Use of cognitive behavioral therapy esp. for traumatic loss Expressive art therapies, such as art,poetry,music, drama, writing Destigmatizing counseling or therapy (c) JBFCS, CTPI, 3-14-12

14. How Can We Help? Psycho-education: Helping caregivers understand how children react and their behavior as indicators Providing support Utilizing a strength and resiliency model Linking families to services Information and referral Advocacy Empowerment (c) JBFCS, CTPI, 3-14-12

15. Services Evaluating the need for services Overcoming the stigma of getting help Cultural considerations Accessing resources Medicare and Medicaid availability for psychotherapy (c) JBFCS, CTPI, 3-14-12

16. Strength Model Resiliency Developing adaptive coping Stress reduction/management skills Role of spirituality as a sustaining force Value of support groups Expanding support networks Self-care (c) JBFCS, CTPI, 3-14-12

17. Best Practice Models Brookdale RAPP grants Loss and Bereavement Programs The Ties that Bind Collaborative Approaches (c) JBFCS, CTPI, 3-14-12

18. Deborah Langosch, PhD, LCSW Jewish Board of Family and Children’s Services New York City 212-632-4760 dlangosch@jbfcs.org Project Director, Kinship Care Program Chairperson, Brooklyn Grandparents’ Coalition Co-Chair, NYC Kincare Task Force Clinical Coordinator, Loss and Bereavement Program (c) JBFCS, CTPI, 3-14-12