Strategies for Strategies for Understanding and Understanding and

Assisting the Assisting the Grieving StudentGrieving Student

Presented by Paula J. McCall, PhD, NCSPPresented by Paula J. McCall, PhD, NCSP

National Association of School PsychologistsNational Association of School Psychologists

February 2011 Annual ConventionFebruary 2011 Annual Convention

Nearly five percent Nearly five percent of children under of children under the age of 15 will the age of 15 will experience the experience the loss of a loved one loss of a loved one in their lives.in their lives.

Currier, Holland, & Neimeyer, 2007Currier, Holland, & Neimeyer, 2007

The Loss…The Loss…

May be of a parent, sibling, grandparent, May be of a parent, sibling, grandparent, close friend, or other family member.close friend, or other family member.

May have occurred suddenly or with May have occurred suddenly or with knowledge ahead of timeknowledge ahead of time– However, even children who are “prepared” However, even children who are “prepared”

for the loss are still overcome by the for the loss are still overcome by the intensity of actual grief and loss.intensity of actual grief and loss.

Impacts every individual differently but Impacts every individual differently but always makes some kind of impact.always makes some kind of impact.

Outcomes of LossOutcomes of Loss

Heightened risk for psychological Heightened risk for psychological problemsproblems

Difficulties concentrating and Difficulties concentrating and performing in schoolperforming in school

Increased feelings of fear and sadnessIncreased feelings of fear and sadness Decreased self-esteemDecreased self-esteem Loss of connection with social networkLoss of connection with social network

- Currier, Holland, & Neimeyer, 2007- Currier, Holland, & Neimeyer, 2007

Harvard Child Harvard Child Bereavement Study Bereavement Study

125 children, ages 6-17, who had lost a parent; 125 children, ages 6-17, who had lost a parent; compared to 70 children who were not grievingcompared to 70 children who were not grieving

Common symptoms: crying, anxiety about safety Common symptoms: crying, anxiety about safety of self or others, feelings of guilt about of self or others, feelings of guilt about misbehavior and lack of affection in pastmisbehavior and lack of affection in past

Increased physical complaintsIncreased physical complaints

Increase in accidents and serious illness in first Increase in accidents and serious illness in first year compared to non-bereaved but then year compared to non-bereaved but then returned to normal levels in 2returned to normal levels in 2ndnd year year

- McEntire, 2003- McEntire, 2003

The Good and Bad The Good and Bad NewsNews

Approximately 80% of children in the Approximately 80% of children in the HCBS demonstrated the resilience needed HCBS demonstrated the resilience needed to adjust to the loss in a healthy way.to adjust to the loss in a healthy way.

15-20% continued to demonstrate 15-20% continued to demonstrate significant emotional and/or behavioral significant emotional and/or behavioral concerns 2 years after the lossconcerns 2 years after the loss

- Currier, Holland, & Neimeyer, 2007- Currier, Holland, & Neimeyer, 2007

What Can We Do to What Can We Do to Help?Help?

1.1. Understand typical reactions to Understand typical reactions to grief across age levelsgrief across age levels

2.2. Become familiar with the grieving Become familiar with the grieving process process

3.3. Get to know the child: age, type of Get to know the child: age, type of loss, personal understanding, etc.loss, personal understanding, etc.

4.4. Provide supports to child and Provide supports to child and familyfamily

Emotional Reactions Emotional Reactions to Griefto Grief

Sadness, confusion, despairSadness, confusion, despair Anger, desertionAnger, desertion Fear, anxiety about safetyFear, anxiety about safety GuiltGuilt Confusion, powerlessnessConfusion, powerlessness Adolescents may suppress due to social Adolescents may suppress due to social

pressures, giving the mistaken pressures, giving the mistaken impression that they are unaffected impression that they are unaffected (Fiorini (Fiorini

& Mullen, 2006)& Mullen, 2006)

Behavioral Reactions Behavioral Reactions to Griefto Grief

Anger: acting out, rage toward the one who Anger: acting out, rage toward the one who has diedhas died

Changes in eating and sleeping patternsChanges in eating and sleeping patterns Withdrawal, internalization of symptomsWithdrawal, internalization of symptoms Regression to activities and needs of a Regression to activities and needs of a

younger childyounger child Attempts to bring the person back through Attempts to bring the person back through

fantasy, bargainingfantasy, bargaining Play that incorporates death and dyingPlay that incorporates death and dying May appear to return to “normal” routine May appear to return to “normal” routine

quickly and easily but will continue to quickly and easily but will continue to demonstrate grief sometimes due to demonstrate grief sometimes due to unexpected triggersunexpected triggers

Cognitive Understanding Cognitive Understanding of Grief and Loss of Grief and Loss

(Fiorini & Mullen, 2006)(Fiorini & Mullen, 2006)

Birth to Age 3 (Sensorimotor, beg. Birth to Age 3 (Sensorimotor, beg. Preoperational)Preoperational)– Do not understand concept of death Do not understand concept of death

or foreveror forever– Recognize absence but may expect Recognize absence but may expect

to returnto return

Intervention: allow to cry, regress, Intervention: allow to cry, regress, attach; help label emotions attach; help label emotions

Cognitive Understanding Cognitive Understanding of Grief and Loss of Grief and Loss

(Fiorini & Mullen, 2006)(Fiorini & Mullen, 2006)

Ages 3-5 (Preoperational)Ages 3-5 (Preoperational)– Magical thinking: they have powers to Magical thinking: they have powers to

control world; they should have been able to control world; they should have been able to stop the person from dyingstop the person from dying

– Egocentric: cannot see another’s perspectiveEgocentric: cannot see another’s perspective– Beginning to understand what death means Beginning to understand what death means

but still may believe it is reversiblebut still may believe it is reversible

Intervention: listen to concerns, answer Intervention: listen to concerns, answer questions, prepare for changes, allow for as questions, prepare for changes, allow for as much choice and control as is possible much choice and control as is possible

Cognitive Understanding Cognitive Understanding of Grief and Loss of Grief and Loss

(Fiorini & Mullen, 2006)(Fiorini & Mullen, 2006)

Ages 5-9 (Concrete Operational)Ages 5-9 (Concrete Operational)– Developing understanding of death as Developing understanding of death as

final, irreversible, and inescapablefinal, irreversible, and inescapable– Resulting feelings of powerlessnessResulting feelings of powerlessness– May believe that their actions May believe that their actions

somehow contributed to the death, somehow contributed to the death, especially if suddenespecially if sudden

Intervention: answer questions, Intervention: answer questions, encourage outlets encourage outlets

Cognitive Understanding Cognitive Understanding of Grief and Loss of Grief and Loss

(Fiorini & Mullen, 2006)(Fiorini & Mullen, 2006)

Ages 9-12 (end Concrete Operational, Ages 9-12 (end Concrete Operational, beg. Formal Operational)beg. Formal Operational)– Beginning development of abstract reasoningBeginning development of abstract reasoning– Often ask “What if” questions about past and Often ask “What if” questions about past and

future eventsfuture events– Increased emphasis on friends, desire to not Increased emphasis on friends, desire to not

stand out or appear differentstand out or appear different Ages 12 and up (Formal Operational)Ages 12 and up (Formal Operational)

– Exploration of what death means, attempts Exploration of what death means, attempts to integrate the experience into their own to integrate the experience into their own identityidentity

The Grieving ProcessThe Grieving Process

Worden’s “Tasks of Mourning”Worden’s “Tasks of Mourning”– To accept the reality of the lossTo accept the reality of the loss– To work through the pain of griefTo work through the pain of grief– To adjust to an environment in which To adjust to an environment in which

the deceased is missing (external, the deceased is missing (external, internal/identity, and spiritual)internal/identity, and spiritual)

– To emotionally relocate the deceased To emotionally relocate the deceased (as protector, supporter, provider of (as protector, supporter, provider of values to now follow) and move on values to now follow) and move on with life with life

- - Perschy, 2004Perschy, 2004

The Grieving ProcessThe Grieving Process

Wolfelt’s Model of Mourning for Wolfelt’s Model of Mourning for TeensTeens– Acknowledge the reality of the deathAcknowledge the reality of the death– Move toward the pain of the lossMove toward the pain of the loss– Remember the person who diedRemember the person who died– Develop a new self-identityDevelop a new self-identity– Search for meaningSearch for meaning– Let others help you now and alwaysLet others help you now and always

- Perschy, 2004- Perschy, 2004

The Grieving Process: The Grieving Process: Core IssuesCore Issues

Predictability of eventsPredictability of events Mastery and control over livesMastery and control over lives Development of self-image Development of self-image

– Tend to have a more negative view of own Tend to have a more negative view of own performance while also seeing selves as more performance while also seeing selves as more maturemature

Sense of belongingSense of belonging– Tend to withdraw sociallyTend to withdraw socially

Fairness and justiceFairness and justice– Comparisons to others’ “perfect” livesComparisons to others’ “perfect” lives

- Perschy, 2004- Perschy, 2004

The Grieving ProcessThe Grieving Process

Grief can manifest differently in each Grief can manifest differently in each person, and it may come and go person, and it may come and go throughout lifethroughout life

Key triggers to returned feelings of Key triggers to returned feelings of sadness and loss include:sadness and loss include:– HolidaysHolidays– Birthday and death anniversaryBirthday and death anniversary– Experience of another death Experience of another death – Rites of passage (graduation, big birthday, Rites of passage (graduation, big birthday,

etc.)etc.)

Getting to Know the Getting to Know the ChildChild

Consider age and developmental level Consider age and developmental level when preparing for meeting.when preparing for meeting.

Have plenty of materials available: stuffed Have plenty of materials available: stuffed animals, markers and paper, books, etc. animals, markers and paper, books, etc.

Begin with a basic statement and question Begin with a basic statement and question (“I understand that you had something (“I understand that you had something sad happen. Can you tell me about it?”) sad happen. Can you tell me about it?”) and allow child to guide conversation.and allow child to guide conversation.

Encourage use of materials for expressionEncourage use of materials for expression Allow and accept silence Allow and accept silence

Getting to Know the Getting to Know the ChildChild

Key Information to Obtain about Key Information to Obtain about Child:Child:– Current understanding of the lossCurrent understanding of the loss– Current emotional stateCurrent emotional state– Desire to share Desire to share – Support system, both family and friendsSupport system, both family and friends– Possible secondary losses (i.e., financial Possible secondary losses (i.e., financial

difficulties due to loss of income)difficulties due to loss of income)

Which Interventions Which Interventions Work?Work?

Bereavement interventions for Bereavement interventions for children have the greatest impact children have the greatest impact when they:when they:– Occur within a short period of time Occur within a short period of time

following the lossfollowing the loss– Target children who are demonstrating Target children who are demonstrating

high-risk concerns showing significant high-risk concerns showing significant difficulty with adjustment to the lossdifficulty with adjustment to the loss

– Focus on normalizing grief Focus on normalizing grief - Currier, Holland, and Neimeyer - Currier, Holland, and Neimeyer

(2007)(2007)

Individual Individual InterventionsInterventions

Allow the child to talk about the person who has Allow the child to talk about the person who has died and their emotionsdied and their emotions

Discuss how life was before and how it has Discuss how life was before and how it has changedchanged

Educate the child about grief, normalize the Educate the child about grief, normalize the experienceexperience

Provide outlets such as puppets, drawing, and Provide outlets such as puppets, drawing, and pretend playpretend play

Share books related to grief, read them together Share books related to grief, read them together and discussand discuss

Help the child set goals related to personal well-Help the child set goals related to personal well-beingbeing

Assist the child in identifying sources of emotional Assist the child in identifying sources of emotional and social supportand social support

Individual Individual InterventionsInterventions

Guide the child in changing negative cognitions to Guide the child in changing negative cognitions to positive onespositive ones– Encourage to share stories about when the person Encourage to share stories about when the person

was alive and not only the experience of the deathwas alive and not only the experience of the death– Encourage identification of personal strengths and Encourage identification of personal strengths and

accomplishments in this processaccomplishments in this process– Encourage use of positive self-statementsEncourage use of positive self-statements– Encourage identification of ways to experience joy Encourage identification of ways to experience joy

again nowagain now Encourage identification of a commemorative activity Encourage identification of a commemorative activity

and assist in its implementationand assist in its implementation– Balloon release (with letter or poem)Balloon release (with letter or poem)– Memorial Memorial – Making of a vase to put flowers in on special daysMaking of a vase to put flowers in on special days– Creating an album of the person’s lifeCreating an album of the person’s life

The Story of DahliaThe Story of Dahlia

What We Can What We Can Learn from DahliaLearn from Dahlia

Children must balance their own grief with the Children must balance their own grief with the grief of others in the home; they must be given grief of others in the home; they must be given time to process their own.time to process their own.

Children can benefit from sharing their grief with Children can benefit from sharing their grief with others in the home.others in the home.

Young children may best express themselves Young children may best express themselves through modes such as drawing while older may through modes such as drawing while older may prefer verbal discussion and written outlets.prefer verbal discussion and written outlets.

A safe private environment allows for honest A safe private environment allows for honest expression and normalization.expression and normalization.

Balloon liftoffs can offer a sense of closure while Balloon liftoffs can offer a sense of closure while also providing a visual sense of “where” the also providing a visual sense of “where” the person is for younger children.person is for younger children.

Short-term grief interventions can be effective.Short-term grief interventions can be effective.

The Story of JasmineThe Story of Jasmine

What We Can What We Can Learn from JasmineLearn from Jasmine

We must consider the primary and secondary losses in We must consider the primary and secondary losses in grief; in Jasmine’s case, this was not only the loss of the grief; in Jasmine’s case, this was not only the loss of the baby but also of the identity she had created for herself.baby but also of the identity she had created for herself.

Normalization and education of the grief process is Normalization and education of the grief process is critical.critical.

Adolescents may not be able to connect their emotions Adolescents may not be able to connect their emotions and behaviors to their loss and may need guidance.and behaviors to their loss and may need guidance.

Some students may not be ready to commemorate; they Some students may not be ready to commemorate; they instead may find comfort in other activities such as instead may find comfort in other activities such as journaling.journaling.

Peers can be unaware of the impact of their comments; Peers can be unaware of the impact of their comments; we must help adolescents find positive sources of we must help adolescents find positive sources of support. support.

Goal-setting is an important method of re-focusing the Goal-setting is an important method of re-focusing the student to their own life so that they can envision more student to their own life so that they can envision more than where they are now.than where they are now.

When Loss Impacts When Loss Impacts the Schoolthe School

If a traumatic event has occurred, the If a traumatic event has occurred, the trauma must first be handled before trauma must first be handled before the loss can be explored.the loss can be explored.– Processing of what happened and Processing of what happened and

students’ reactions to it can help in exiting students’ reactions to it can help in exiting from the shock and frozen state from the shock and frozen state (Perschy, 2004).(Perschy, 2004).

Teachers and other staff may also be Teachers and other staff may also be experiencing grief and should be experiencing grief and should be offered opportunities to discuss it as offered opportunities to discuss it as well as resources.well as resources.

When Loss Impacts When Loss Impacts the School: Examplethe School: Example

Sudden loss of beloved mother of twin girls in the 3Sudden loss of beloved mother of twin girls in the 3rdrd gradegrade

Administration sent out letters to parents notifying Administration sent out letters to parents notifying them of the lossthem of the loss

Classroom meetings the next day to answer student Classroom meetings the next day to answer student questions questions – Discussion included how to react to the students when Discussion included how to react to the students when

they returnedthey returned Students made cardsStudents made cards

– Teachers were instructed to look for drawings, Teachers were instructed to look for drawings, statements, or emotional reactions that indicated statements, or emotional reactions that indicated difficultiesdifficulties

Follow-up with individual students and their parents Follow-up with individual students and their parents when abnormal or intense reactions were notedwhen abnormal or intense reactions were noted

Follow-up with father of girls to ensure that they had Follow-up with father of girls to ensure that they had the support and resources they neededthe support and resources they needed

Bereavement GroupsBereavement Groups

Recommended when multiple students have Recommended when multiple students have been impacted by a common loss or when been impacted by a common loss or when multiple students have experienced a loss multiple students have experienced a loss within a short period of timewithin a short period of time

Provides mutual support, a sense of Provides mutual support, a sense of community, development of relationships, community, development of relationships, normalization, a safe outlet, and an normalization, a safe outlet, and an opportunity for students to help, question, and opportunity for students to help, question, and encourage each other encourage each other (Murthy & Smith, 2005)(Murthy & Smith, 2005)

Activities vary by age and level of students Activities vary by age and level of students but may include identification and exploration but may include identification and exploration of emotions, discussion and sharing of the of emotions, discussion and sharing of the loved one, commemoration, and preparation loved one, commemoration, and preparation for moving onfor moving on

ReferencesReferences

Currier, J. M., Holland, J. M, & Neimeyer, R. A. (2007). The Currier, J. M., Holland, J. M, & Neimeyer, R. A. (2007). The effectiveness of bereavement interventions with children: A effectiveness of bereavement interventions with children: A meta-analytic review of controlled outcome research. meta-analytic review of controlled outcome research. Journal Journal of Clinical Child and Adolescent Psychology, 36of Clinical Child and Adolescent Psychology, 36(2), 253-259. (2), 253-259.

Fiorini, J. J., & Mullen, J. A. (2006). Fiorini, J. J., & Mullen, J. A. (2006). Counseling children and Counseling children and adolescents through grief and loss. adolescents through grief and loss. Champaign, IL: Research Champaign, IL: Research Press.Press.

McEntire, M. (2003). Children and grief. McEntire, M. (2003). Children and grief. ERIC Digest, ERIC Digest, EDO-PS-03-6. Retrieved January 8, 2011, from . Retrieved January 8, 2011, from http://ceep.crc.illinois.edu/eecearchive/digests/2003/mcentirhttp://ceep.crc.illinois.edu/eecearchive/digests/2003/mcentire03.pdfe03.pdf

Murthy, R., & Smith, L. (2005). Murthy, R., & Smith, L. (2005). Grieving, sharing, and healing: A Grieving, sharing, and healing: A guide for facilitating early adolescent bereavement groups. guide for facilitating early adolescent bereavement groups. Champaign, IL: Research Press.Champaign, IL: Research Press.

Perschy, M. K. (2004). Perschy, M. K. (2004). Helping teens work through griefHelping teens work through grief (2nd (2nd Ed.). New York: Routledge.Ed.). New York: Routledge.

Other ResourcesOther Resources

Buscaglia, L. (1982). Buscaglia, L. (1982). The fall of freddie the leaf: A story of life for all The fall of freddie the leaf: A story of life for all ages. ages. Thorofare, NJ: SLACK Inc.Thorofare, NJ: SLACK Inc.

Fahy, M. (1989). Fahy, M. (1989). The tree that survived the winter. The tree that survived the winter. New York: New York: Paulist Press.Paulist Press.

Jackson, A. R. (2004). Jackson, A. R. (2004). Can you hear me smiling: A child grieves a Can you hear me smiling: A child grieves a sister. sister. Child & Family Press.Child & Family Press.

Johnson, M. (1982). Johnson, M. (1982). Where’s Jess: For children who have a brother Where’s Jess: For children who have a brother or sister die. or sister die. Centering Corporation.Centering Corporation.

Kaplow, J., & Pincus, D. (2007). Kaplow, J., & Pincus, D. (2007). Samantha Jane’s missing smile: A Samantha Jane’s missing smile: A story about coping with the loss of a parent. story about coping with the loss of a parent. Magination Press.Magination Press.

Stiles, N. (1984). I'll miss you, Mr. Hooper. New York: Random House.

Thomas, P. (2001). I miss you: A first look at death. Barron’s Educational Series.

Wolfelt, A. (2000). Healing your grieving heart for kids: 100 practical ideas. Ft. Collins, CO: Companion Press.

Wolfelt, A. (2001). Healing your grieving heart for teens: 100 practical ideas. Ft. Collins, CO: Companion Press.

Other ResourcesOther Resources

Compassionate Friends: a national network of Compassionate Friends: a national network of support groups and resources for parents support groups and resources for parents and siblings grieving for a child of any age and siblings grieving for a child of any age www.compassionatefriends.orgwww.compassionatefriends.org

New Song Center: Phoenix-based program New Song Center: Phoenix-based program offering programs and resources for grieving offering programs and resources for grieving children www.hov.org/new_song_center.aspxchildren www.hov.org/new_song_center.aspx

The Dougy Center: Portland-based program The Dougy Center: Portland-based program offering programs and resources, including offering programs and resources, including special links for children and teens, related to special links for children and teens, related to grief www.dougy.orggrief www.dougy.org