Supporting Grieving Students - Stanford Children's Health (PDF)

Supporting Grieving Students A HAndbook for TeAcHers And AdminisTrATors  ii | stanfordchildrens.org  Supporting Grieving Students A HAndbook for TeAcHers And AdminisTrATors Supporting Grieving Students | iii  iv | stanfordchildrens.org  Created by the Family Guidance and Bereavement Program, Lucile Packard Children’s Hospital Stanford. This content was created by Stanford Children’s Health with information courtesy of the Dougy Center. Special thanks to the LPCH Auxiliaries Program for sponsorship. Supporting Grieving Students | v  ConTenTS introduction ix Module 1 | Understanding Grieving Children 2 Common Responses of the Grieving Child or Teen 4 How to Tell When Students Need Additional Help 5 Module 2 | Developmental Issues of Grieving Students 6 The Grieving Infant and Toddler 8 The Grieving Preschool Child 9 The Grieving Elementary School Student 10 The Grieving Middle School Student 12 The Grieving High School Student 13 Module 3 | How Teachers Can Help Grieving Students 14 Your Important Role In Helping Students Cope with a Death 15 Groundwork for Dealing with Grieving Students in Your Class 15 Module 4 | optimal Support for Grieving Students at School 16 Helping All Students Understand Death 17 Ongoing Support for a Grieving Student 17 How Teachers Can Help Grieving Families 21 Words and Actions that Offer Comfort and Invite Communication 23 Words and Actions that Don’t Offer Comfort 24 Common Difficult-to-Manage Behavioral Grief Reactions 25 Key Points to Remember 26 Frequently Asked Questions 28 What Administrators Can Do to Help Grieving Students and Families 29 Module 5 | Grief Triggers 30 Be Aware of and Sensitive To “Trigger Events” 31 Things a Teacher Can Do to Minimize Triggers 32 vi | stanfordchildrens.org  Module 6 | Teasing and Rejection 34 Things a Teacher Can do to Minimize Teasing and Rejection 35 Module 7 | Delayed Grief Reactions and Cumulative Loss 36 Delayed Grief Reactions 37 Cumulative Loss 37 Module 8 | Cultural and Religious Considerations 38 Dia de los Muertos 39 Module 9 | Special Considerations 40 Death by Suicide 41 Murder or Violent Death 41 Accidental Death 42 Deaths that Traumatize the School Community 42 Module 10 | A Teacher’s Grief 44 resources 48 Books and Websites for Teachers 48 death and dying booklist for children 49 Picture Books 49 Fiction 51 Nonfiction 53 Bibliotherapy (Young Adult) 56 Literature review 63 Supporting Grieving Students | A Handbook for Teachers & Administrators | vii  viii | stanfordchildrens.org  Introduction This handbook for teachers was written from our work with grieving children. We listened to their stories about navigating educational and social complexities at school and heard how important their teachers were to them. We noticed opportunities for teachers to positively influence children’s grief experiences at school, and after we conducted a survey with Bay Area teachers it became clear to us that teachers also crave more knowledge and skills to be genuinely helpful to their grieving students. So, to meet these needs, this manual was created. Grief is truly an individual experience. every person has a unique subset of physical, emotional, cognitive, social, and spiritual reactions to loss, and these reactions vary in intensity and quality throughout time for the rest of his or her life. People of all ages, even babies, grieve in their own way, and it’s important for the adults in children’s lives to be sensitive to their unique grief and supportive as they journey forth. Children’s grief in general differs from adult grief in a few ways. Children’s understanding of death, their ability to talk about it, and the manifestations of their grief can all look different at different developmental levels. Young children often cannot express their mixed- up feelings of grief well verbally, so it comes out in their behaviors, play, and/or artistic expression. In addition, young children generally cannot sustain a near constant level of intense feelings such as despair and longing the way grieving adults do. Young children need breaks from grief to play, laugh, and hope for the future; they dip in and out of their grief. Teens are more verbal and tend to process loss similarly to adults, but they also need breaks to just be a kid at times. In our experience, what grieving children need most is the presence of understanding adults, the experience of being loved and cared for, opportunities to exert some control in their lives, and time to express their feelings (verbally, physically, behaviorally, artistically, etc.). If you can provide any of these, you will help your student in his or her healing. We hope this manual will be a guide. Supporting Grieving Students | A Handbook for Teachers & Administrators | ix  Module 1 | Understanding Grieving Children • Typical grief responses • When to refer for professional mental health care The following section was reproduced with permission from the Dougy Center for Grieving Children publication Helping the Grieving Student, copyright 2004. Supporting Grieving Students A HAndbook for TeAcHerS And AdmInISTrATorS 2 | stanfordchildrens.org  Grieving is very hard work for students. It influences all areas of the student’s life—academic, social, physical, emotional, spiritual, and behavioral. Students cannot control where or when they will be affected by their grief. Although some students will be able to talk about their feelings, many others may express their grief primarily through their behavior and play. You may see a student who becomes more aggressive on the playground or who shows no fear, or another who becomes withdrawn and quiet. Still others may show grief with physical symptoms such as stomachaches or headaches. Because each student grieves differently, we cannot predict how an individual student will grieve. It is important to remember that many grieving students will focus on their grief first and schoolwork second. They cannot change this response, even if they would like to. Consequently, teachers who allow their students time and support for healing provide a real gift to them. Those who imply that the child has been grieving long enough can create additional problems, since the child not only feels unheard but has additional, unneeded stress about her school performance. Module 1 | Understanding Grieving Children | 3  because each student will express grief uniquely, some students will exhibit several of the behaviors listed below and others may show none. common responses of the Grieving child or Teen Academic • Inability to focus or concentrate • Failing or declining grades • Incomplete work or poor quality of work • Increased absences or reluctance to go to school • Forgetfulness, memory loss • overachievement, trying to be perfect • Language errors and word-finding problems • Inattentiveness • Daydreaming behavioral • noisy outbursts, disruptive behaviors • Aggressive behaviors, frequent fighting • noncompliance with requests • Increase in risk-taking or unsafe behaviors • Hyperactive-like behavior • Isolation or withdrawal • Regressive behaviors that hark back to a time when life felt safer and under control • High need for attention • Hypervigilance about the surviving parent emotional • Insecurity, fear of abandonment, safety concerns • Concern about being treated differently from others • Fear, guilt, anger, rage, regret, sadness, confusion • “I don’t care” attitude • Depression, hopelessness, intense sadness • overly sensitive, frequently tearful, irritable • Appears unaffected by the death • Preoccupation with death, wanting details • Recurring thoughts of death or suicide social • Withdrawal from friends • Withdrawal from activities or sports • Use of drugs or alcohol • Changes in relationships with teachers and peers • Changes in family roles (e.g. taking on the role of a deceased parent) • Wanting to be physically close to safe adults • Sexual acting out • Stealing, shoplifting • Difficulty being in a group or crowd Physical • Stomachaches, headaches, heartaches • Frequent accidents or injuries • Increased requests to visit the nurse • nightmares, dreams or other sleep difficulties • Loss of appetite or increased eating • Low energy, weakness • Hives, rashes, itching • nausea or upset stomach • Increased illnesses, low resistance to colds or flu • Rapid heartbeat spiritual • Anger at God • Questions of “Why me?” and “Why now?” • Questions about the meaning of life • Confusion about where the person is who died • Feelings of being alone in the universe • Doubting or questioning previous beliefs • Sense of meaninglessness about the future • Change in values, questioning what is important 4 | stanfordchildrens.org  end Dougy Center publication excerpt. behaviors that suggest complications in the grieving process and indicate the need for a referral to a mental health professional include: • Suicidal thoughts or behaviors • Chronic physical symptoms without organic findings • Depression with impaired self-esteem • Persistent denial of the death with delayed or absent grieving • Progressive isolation and lack of interest in any activity • Resistant anger and hostility • Intense preoccupation with memories of the deceased • Taking on the symptoms of the deceased • Prolonged changes in typical behavior • The use of alcohol and/or other drugs • Prolonged feelings of guilt or responsibility for the death • Major and continued changes in sleeping or eating patterns • Risk-taking behaviors that may include identifying with the deceased in unsafe ways How to Tell When Students need Additional Help Most children and teens are in and out of their grief. They experience sadness, anger, and fear, but also are able to have fun and engage in activities. This is a normal grief response. Prolonged or chronic depression, anger, withdrawal, or fear over a period of several months may indicate that the student needs professional help in dealing with the loss. If a child or teen displays severe reactions or you notice disturbing changes in behavior, professional intervention should be sought. Although it is not unusual for children or teens to talk about wanting to join the deceased or to die, any signs of suicidal talk or other self-destructive behavior or language should be taken seriously. The student should be referred for an evaluation. If a child or teen is experiencing physical pain or problems and doctors have not found an organic reason for the pain, professional counseling or therapy may be helpful. Having physical symptoms following a death is not unusual. However, if they become problematic or debilitating, or persist over time, professional help from a qualified mental health professional is in order. Module 1 | Understanding Grieving Children | 5  Module 2 | Developmental Issues of Grieving Students • The Grieving Infant and Toddler • The Grieving Preschool Child • The Grieving elementary School Student • The Grieving Middle School Student • The Grieving High School Student The following section was reproduced with permission from the Dougy Center for Grieving Children publication Helping the Grieving Student, copyright 2004. Supporting Grieving Students A HAndbook for TeAcHerS And AdmInISTrATorS 6 | stanfordchildrens.org  The developmental level of the student, rather than the chronological age, will determine how a child grieves. If the student’s behavior does not match his or her appropriate age or developmental level, it does not mean that the student has a problem or is doing something wrong. It is important to remember that each student grieves in his or her own way and on his or her own timeline. Module 2 | Developmental Issues of Grieving Students | 7