Grief; Helping Handout for School and Home (PDF)

Grief: Helping Handout for School and Home SHANE R. JIMERSON, JACQUELINE A. BROWN, & MIHYA WEBER INTRODUCTION Most children will experience the death of a close or special person before they have graduated from high school. Although death is a natural part of the life cycle, grief can be difficult and may create challenges at home or in school. Support from teachers and caregivers—parents, grandparents, and other adults providing care for children—following a death is helpful to foster healthy bereavement (Worden, 2009). As families are typically the primary sources of support for grieving students, caregivers should have a basic understanding of typical reactions they may observe and know how to identify children who require additional support. In addition, caregivers’ grief reactions and responses to a death will influence the experience of the student. Teachers interact with the grieving student each day at school, so they may provide support and assistance in navigating the cognitive and social demands of school while bereaved (Brown & Jimerson, 2017). Sometimes students adapt and adjust to the loss with little support, identifying and expressing their feelings and incorporating the loss into their life in a healthy way; but there are also times when the student faces considerable challenges following a loss; for instance, the student may be very depressed and unable to focus on school or interact with friends. Therefore, support from caring adults is important. WHAT TO CONSIDER WHEN PLANNING INTERVENTIONS AND SUPPORTS Reactions and adjustment following the death of a close or special person vary across individuals and are influenced by their developmental level. Therefore, no two students will react to a loss in the same way. There is no right or wrong way to react to a loss, and reactions are influenced by many factors in addition to age. For example, students with a history of mental health problems may be more likely to experience severe or prolonged negative reactions. Similarly, students receiving special education services at school may have fewer coping strategies, making their reactions similar to those expected in younger children. There are some general developmental trends that can help caregivers and teachers understand typical and atypical reactions of grieving children. For example, preschool-age children may view the death as temporary or reversible. Sadness, confusion, and anxiety are among the most common grief responses, and they are likely to be observed in children of all ages. Developmental Level Although there are expected and natural reactions to a death, teachers and caregivers should consider the child's developmental level when deciding whether intervention is needed (Brown, Jimerson, & Comerchero, 2015; Dogan-Ates, 2010). Behaviors that may raise concerns in the weeks following a loss and warrant further attention include the following: Preschool age • Decreased verbalization, appetite, or physical activity • Increased anxiousness (e.g., clinginess, fear of separation), agitation, or aggressive behaviors • Regressive behaviors (such as increased bed- wetting and thumb-sucking) Elementary school age • Difficulty concentrating or inattention • Somatic complaints (such as headaches, stomach problems) HELPING HANDOUTS: SUPPORTING STUDENTS AT SCHOOL AND HOME Usage is restricted to educational, noncommercial use by the purchaser. Purchase at www.nasponline.org/publications | S3H6–1 This handout is taken from Bear, G. G., & Minke, K. M. (2018). Helping Handouts: Supporting Students at School and Home. National Association of School Psychologists. Available at: www.nasponline.org/HHportal  • Sleep disturbances (e.g., nightmares, fear of the dark) • Repeated telling and acting out of the event • Social withdrawal • Increased irritability, disruptive or aggressive behavior • Increased anxiety or regressive behaviors (e.g., clinging, whining) • Depression, guilt, or anger Middle and high school age • Flashbacks (such as recurring thoughts and repetitive recalling of the events) • Emotional numbing or depression • Nightmares • Avoidance or withdrawal from relationships • Increased problems with friendships • Substance abuse, drug use, or other risky behaviors Individual behaviors may not be a major concern; however, if such behaviors persist for weeks or present challenges for healthy adjustment, then caregivers and teachers should communicate with the students and, when needed, help them access support. The Grief Process Grief does not follow a predetermined pattern or sequence. However, there are some common tasks that youth (and adults) may experience after the death of a loved one. Youth may experience some or all of these tasks, in varying intensity, at the same or different times, and various aspects may be repeated. Common tasks of mourning during the grief process include the following (Worden, 2009): • Accept the reality of the loss. It is important for the student to understand that the loved one is dead and will not return. • Process the pain of grief. The student must both acknowledge and work through the emotional pain that goes along with the death. • Adjust to a world without the deceased. When a loved one dies, the student may experience external adjustments (e.g., changes in parenting roles), internal adjustments (adjusting to a new sense of self), and spiritual adjustments (challenge of one's beliefs and values about the world). • Find an enduring connection with the deceased in the midst of embarking on a new life. This task requires the student to find a place for the dead loved one within memories, while continuing with life. Reactions to the death are also affected by the circumstances of the death and the behaviors of adults. Typically, the closer the relationship a child had with the deceased, the more severe the reactions. However, other factors must also be considered. For example, some losses, such as the death of a parent, can often be accompanied by a variety of other losses, including a move, a change in the family's financial situation, or the impaired caregiving abilities of the surviving parent. More intense and persistent grief reactions are likely when multiple losses have occurred. Additionally, the death of a sibling or of a close friend, and sudden or traumatic deaths, homicides, suicides, or otherwise unexpected deaths, are typically more difficult to grieve. Common Considerations Regarding Grief and Loss Caregivers and teachers should have a basic understanding of the grief and mourning process as it relates to youth, to provide them with appropriate support. Some of the following considerations will help teachers and caregivers understand the experiences of students: • Bereavement takes time. The most intense period is typically the first 6 months following the death; however, the experience of grief is likely to continue for years. It is common for students to revisit various emotions and reactions on the anniversaries of a death and as significant life events occur (e.g., graduation). If grief reactions are debilitating or disrupting the child's adjustment, then referral to professional support, such as a grief counselor, may be warranted. • Communication with children about bereavement can help. Adults may try to shelter youth from their own grief reactions, anticipating that this may cause them more pain. However, students will be aware of the behavior that is demonstrated, and when loved ones are openly sad, they will learn that mourning is natural and okay. • Students often benefit from participating in funerals or memorials. Funerals and other memorial services are a natural way to begin the mourning process, and often provide structure and convey a sense of commonality. Attendance should be encouraged. However, when children are not comfortable with certain aspects of the S3H6–2 | Grief This handout is taken from Bear, G. G., & Minke, K. M. (2018). Helping Handouts: Supporting Students at School and Home. National Association of School Psychologists. Available at: www.nasponline.org/HHportal  service (e.g., if there is an open casket), it is best to respect their wishes and not force or deny the opportunity to participate during the services. It is important to prepare youth for the particular service, sharing information in advance about what to expect, and discussing their ideas and answering questions after the services. • Explain death in clear terms. Death is a complicated concept that may be difficult to understand, especially for younger students. However, speaking in broad or vague terms may lead them to incorrect assumptions. For example, a student who is told that the dead loved one “fell asleep” may assume that sleep is a risky behavior and fear sleeping. RECOMMENDATIONS FOR HOME AND SCHOOL Communication and support from caregivers and teachers is valuable for grieving students. The way family members grieve following a death will influence how a child grieves. When caregivers can talk about the death, express their feelings, and provide support following the death, children are better able to develop healthy coping strategies. Caregivers and teachers are encouraged to do the following: 1. Talk about the loss, as this gives students permission to talk about it too. Acknowledge that grief can be difficult, confusing, and variable, with the range of emotions changing day to day. 2. Ask questions and listen. Asking open-ended questions will help you learn about the child's understanding of the death, as well as the child's physical and emotional reactions. Individuals are unique, and they will grieve in their own ways. Open-ended questions encourage youth to share their own perspectives about what they are experiencing. These conversations will help adults understand what supports may be most helpful. 3. Be prepared to discuss the death and feelings about it repeatedly. Younger students should be encouraged to talk about, draw, or even act out the details of the death, as well as their feelings about it, the deceased person, and other changes that have occurred in their lives. Bibliotherapy is an evidence-based intervention in which parents and teachers read a book about death with their child or student and talk and ask questions about the child's reactions (e.g., Heath & Cole, 2012). These conversations help children increase their understanding of the death, why it occurred, and how to cope with difficult feelings. 4. Give children important facts about dying at an appropriate developmental level. This information may include helping them accurately understand what it means to be dead. For younger students, this explanation might include helping them understand that the person's body has stopped working, and that it will never again work. 5. Help children understand the death and prevent false reasoning about the cause of the event. In some instances, children will link a death with their own behaviors, blaming themselves and feeling very guilty, leading to complicated bereavement and depression. Providing explanations of the actual cause of death that are developmentally appropriate is helpful when children blame themselves. 6. Set an example of healthy grieving by being open about feelings of sadness about the death. Share how you are incorporating the loss into your life in a meaningful way, for instance, celebrating the individual's life and contributions. Both at home and in the classroom, adults can help children by acknowledging the feelings associated with grief, modeling ways of communicating those thoughts and feelings with others, and highlighting the positive memories and meaning that the deceased individual contributed to their lives. 7. Create structure and routine for children so they experience predictability and stability. Typically, returning to school and extracurricular activities provides a return to routines and helps students adapt to changes in their lives. School and activities also provide an opportunity for students to interact with peers, which can be helpful. Also consider accommodations that may be needed as a child adapts to a loss. For instance, modifying expectations and sensitivity to activities or homework that require sustained attention, concentration, energy, and cognitive demands are important in supporting bereaved youth. 8. Take care of yourself. Caregivers need to be physically and emotionally healthy. Prolonged, intense grieving or unhealthy grief reactions, such as substance abuse, will prevent adults from providing support to grieving children. Mindfulness- based stress reduction is another evidence-based strategy that is effective for both grieving adults and children. For example, part of taking care of yourself Usage is restricted to educational, noncommercial use by the purchaser. Purchase at www.nasponline.org/publications | S3H6–3 This handout is taken from Bear, G. G., & Minke, K. M. (2018). Helping Handouts: Supporting Students at School and Home. National Association of School Psychologists. Available at: www.nasponline.org/HHportal  may include practicing deep breathing (breathing meditation) or mindful check-ins (checking to see how you are feeling at the present moment). You can also teach these strategies to children to help them better deal with their emotions (see Renshaw, 2012, for a review of how to help children by using mindfulness-based practices). 9. Acknowledge that mourning will take time. Bereavement is a process that occurs over months and years. Be aware that normal grief reactions often last longer than 6 months, depending on the type of death and the relationship with the student. 10. Take advantage of community resources. Services such as grief counseling and support groups can be especially valuable for adults or children who could use help developing strategies to cope with grief and loss. Community hospice organizations often have lists of professionals who provide support for children and families. RECOMMENDED RESOURCES Websites http://www.aacap.org/aacap/families_and_youth/facts_ for_families/FFF-Guide/Children-And-Grief-008.aspx The website of the American Academy of Child and Adolescent Psychiatry offers valuable information about grieving children for parents and teachers. It provides basic information about what one may anticipate as well as helpful information about strategies to support bereaved children. http://www.compassionbooks.com/store/ This website provides books for adults and children about grief and can be used to support children, teens, and adults following a loss. Many books address different types of loss and emphasize healthy coping after a loss. http://www.nasponline.org/resources-and-publications/ resources/school-safety-and-crisis/addressing-grief The website of the National Association of School Psychologists provides multiple handouts, such as Helping Children Cope With Loss, Death, and Grief, that provide basic information about working with children following a loss. https://www.schoolcrisiscenter.org The National Center for School Crisis and Bereavement provides adults with helpful information about supporting bereaved children. Books Brown, J. A., & Jimerson, S. R. (Eds.). (2017). Supporting bereaved students at school. Oxford, UK: Oxford University Press. This book offers adults a comprehensive review of contemporary strategies that may be used to support students at school. The emphasis of the book is on foundational knowledge and practical, easy-to-implement strategies. Grollman, E. A. (2006). A complete book about death for kids. Omaha, NE: Centering Corporation. This book is written for children and includes information about death, dying, and the feelings you may have when someone you love dies. The book also includes information about burial, cremation, the funeral, and the cemetery. Krasny Brown, L. (1998). When dinosaurs die: A guide to understanding death. Boston, MA: Little, Brown Young Readers. This book, which is for younger children, explains death, dying, and coping with grief and loss in simple and accessible language for young kids and families. Lehmann, L., Jimerson, S. R., & Gaasch, A. (2001). Mourning child grief support group curriculum. Philadelphia, PA: Brunner-Routledge. (Preschool, Early Childhood, Middle Childhood, and Adolescent Editions.) Available online at https://www.routledge.com/products/ search?keywords=jimerson This curriculum is a resource for helping children and teenagers learn about mourning, with the aim of facilitating healthy variations of mourning and positive adaptations following a loss. There are curricula for four different age groups; preschool- age children, children in kindergarten through Grade 2, children in Grades 3 through 6, and teenagers. Related Helping Handouts Depression: Helping Handout for Home Depression: Helping Handout for School Happiness and Self-Esteem: Helping Handout for School and Home Trauma: Helping Handout for Home Trauma: Helping Handout for School S3H6–4 | Grief This handout is taken from Bear, G. G., & Minke, K. M. (2018). Helping Handouts: Supporting Students at School and Home. National Association of School Psychologists. Available at: www.nasponline.org/HHportal  REFERENCES Brown, J. A., & Jimerson, S. R. (Eds.). (2017). Supporting bereaved students at school. Oxford, UK: Oxford University Press. Brown, J. A., Jimerson, S. R., & Comerchero, V. A. (2015). Cognitive development considerations to support bereaved students: Practical applications for school psychologists. Contemporary School Psychology, 19, 103–111. doi:10.1007/s40688-014-0018-6 Dogan-Ates, A. (2010). Developmental differences in children's and adolescents' post-disaster reactions. Issues in Mental Health Nursing, 31, 470–476. doi:10.3109/01612840903582528 Heath, M. A., & Cole, B. V. (2012). Strengthening classroom emotional support for children following a family member's death. School Psychology International, 33, 243–262. doi:10.1177/0143034311415800 Renshaw, T. (2012). Mindfulness-based practices for crisis prevention and intervention. In S. E. Brock & S. R. Jimerson (Eds.), Best practices in school crisis prevention and intervention (2nd ed.; pp. 401–422). Bethesda, MD: National Association of School Psychologists. Worden, J. W. (2009). Grief counseling and grief therapy: A handbook for the mental health practitioner (4th ed.). New York, NY: Springer. ABOUT THE AUTHORS Shane R. Jimerson, PhD, is a professor at the University of California, Santa Barbara. He has extensive experience in supporting bereaved children. He is a coeditor of Supporting Bereaved Students at School, published by Oxford University Press, and a coauthor of the Mourning Child Grief Support Group Curriculum published by Taylor and Francis. Jacqueline Brown, PhD, is an assistant professor of school psychology at the University of Montana. She has considerable expertise related to supporting bereaved children and is a coeditor of Supporting Bereaved Students at School, published by Oxford University Press. Mihya Weber, BS, is a doctoral student at the University of California, Santa Barbara. Her research interests focus on understanding and supporting the social, emotional, behavioral, and mental health of children at school. Dr. Jimerson and Dr. Brown have a financial interest in the book Supporting Bereaved Students at School, recommended in this handout. © 2018 National Association of School Psychologists, 4340 East West Highway, Suite 402, Bethesda, MD 20814—(301) 657-0270 Usage is restricted to educational, noncommercial use by the purchaser. Purchase at www.nasponline.org/publications | S3H6–5 This handout is taken from Bear, G. G., & Minke, K. M. (2018). Helping Handouts: Supporting Students at School and Home. National Association of School Psychologists. Available at: www.nasponline.org/HHportal