Bereavement and Loss Guidance

Fife Council Educational Psychology Service (2018)

This guidance is for education staff, however it may also be helpful to share with parents as appropriate. It should be read alongside Fife Council Guidance on Traumatic Incidents. You may want to consult your link educational psychologist for further information and advice on the numbers below.

Dunfermline – 01383 602379 Central - 01592 583348 Cupar – 01334 659327

Contents

1. Introduction and aims p.3

2. Common reactions to change and loss p.4

3. Developmental understandings of death p. 5

4. Communicating with children, young people and their families p. 9

5. Further supports and what else can help p. 12

6. Considerations for children with Additional Support Needs p. 14

7. Communicating with the school community p. 15

8. Additional information and resources p. 16

9. References and further reading p. 18

1. Introduction and aims

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Sadly many children experience a bereavement during childhood.

92% of young people experience a significant loss before they are 16 years old and up to 70% of schools at any one time will have a pupil on their roll who has experienced bereavement. (www.childbereavementuk.org, 2017).

Information gathered from children who have experienced bereavement and loss has highlighted that children and young people prefer to access support from their natural support network (peers, school staff, and family) rather than external supports.

However, it is also common for those within the support network to experience some uncertainty around how best to respond.

The following document aims to provide guidance around:

Common reactions to loss and change Developmental understandings of death and loss. Communicating with children and families Useful websites and resources Signposting to further reading

2. Common reactions to change and loss

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Remember…If you want to help children through their experiences, are well informed, willing to learn not only from other professionals but the children themselves and the child welcomes your support, you are in an ideal position to support, comfort and guide

a child through ‘emotionally challenging times’.

The Four W’s (Burns, 2010)

It is common for children to show varying behaviours following episodes of change and loss, particularly following an experience of death. It is however important to note that children’s responses to experiences of change and loss are individual to them and can vary according to their age and stage of development and also their previous experiences. There is no right way to grieve.

Some common behaviours or grief responses include:

Difficulty concentrating Increased anxiety Feelings of anger or angry behaviours Physical complaints (headaches, stomach complaints, tiredness) Heightened sensitivity to comments Changes in peer relationships or fall outs Emotionality (crying, guilt, frustration) Regressing to younger behaviour i.e. clinging, bedwetting, using babyish language Taking on a more adult role within the class and at home Increased question asking Separation anxiety Showing little emotion and continuing as if ‘nothing happened’ Memories of any traumatic events appearing in children’s work (e.g. in drawings, notes,

etc).

This is not a complete list and behaviours can change according to the circumstances of the loss, the relationship to the person, individual personality traits and family circumstances. It is important to note that, like adults, children do not respond in one way. As children are often unable to fully verbalise their emotions these feelings are often displayed as behaviours.

3. Developmental understandings of death

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In order to fully understand a child’s response and reaction to experiences of change and loss, particularly following experience of death it is useful to reflect on what the children’s understanding of the situation is. This will allow the child’s responses to be understood within an appropriate age and developmental framework.

This information below is only a guide and children’s understandings of death are influenced by both their developmental level and past experiences. Support should therefore be aimed at a young person’s emotional rather than chronological age. Research has shown that children’s responses to change and loss are also influenced by particular circumstances (Worden, 2002).

These include:

The type of loss/death and surrounding events Relationship of the child to the person deceased Functioning and emotional availability of close adults in family (i.e. of the available parent) Family circumstances (size, socio-economic status, support and communication, other

stressors and level of change and disruption to daily life) Available support from peers and others outside of the family Child’s characteristics (age, gender, self-perception and their understanding of death).

Theories of grief and loss

There are several psychological theories which help us to understand children’s developmental reactions and understanding of grief and loss. The following two frameworks are a useful way to think about grief in a cyclical manner, not as something that happens in linear stages. The frameworks emphasise grief as something that is not straightforward or predictable and which may reappear in different forms throughout our lives.

1. Tasks of Mourning Framework (Willian Worden, 2002)This framework proposes that the four key tasks when grieving are:

To accept the reality of the loss To process the pain of the grief To adjust to a world without the deceased To find an enduring connection with the deceased in the midst of embarking on a new life.

2. Dual Process Model of Bereavement (Stroebe and Schut, 1999) This framework suggests that grief has a dual process where we move between feeling a sense of loss and a sense of restoration or coping. It identifies that individuals need time both to confront the feelings of loss and also to have times where they do not. This is a useful framework to use when thinking about how children and young people respond to their grief, jumping in and out of their feelings of loss e.g. they may appear to be enjoying time with friends but in a short space of time be worried and anxious.

This means that children may need support for grief at different developmental stages or key transition points in their lives. We cannot presume that a child coping at one time point will cope

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at a different time point in the future. It is important thus to keep connected with the young person and adjust support as needed.

Developmental understandings of death

Understanding of death and loss What do I need?

From 0 – 2 years old

No concept of death

The experience is of separation from a familiar person, who may also have provided care, nourishment and emotional support

The child may show insecure behaviours such as distress at being separated from familiar adults, disrupted eating and sleeping

The care giver or surrogate care giver should provide basic care and consistency of routines to try to maintain a sense of security.

Provide reassurance and warmth.

Early years Early understanding of death and loss

Do not understand that death is final and may ask questions such as what the person will eat, or how they will sleep.

Do not understand ‘abstract’ thinking or concepts such as, “Daddy’s gone to sleep” or “gone on a journey.”

Sensitive to separations (do not yet have an understanding of time).

Children within this age range are most dependent on adults.

They require an emotionally available adult to help manage and express their emotions consistently.

To be listened to, be allowed to ask repeated questions and for adults to give clear explanations. The need to ask questions is a sign the child is attempting to make sense of their world.

Time to play and opportunities to

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Impact of early separation on increased stress level and early attachment to care givers.

Beginning of ‘Magical Thinking’ (child may believe that they caused the death, or that they can bring the person back).

talk and discuss their worries.

Recognition that all feelings are okay.

Early to middle primary

Start to understand that death is irreversible and universal.

Increase interest in death and physical reactions such as the process of dying.

Increasing abilities to understand perspectives of others. This may lead to difficulty with peer groups, or feeling that they are different to their peers.

May show physical symptoms to unexpressed emotions.

It is important that children are given clear answers to their questions. Curiosity is a natural response and if children are not given answers to their questions they will tend to make up their own.

Children may have difficulty expressing emotions and need an adult to model that feelings are okay. Common phrases such as you are ‘being such a brave boy’ tend to emphasise that it is a good thing to not express emotion.

Reassurance that they did not cause what happened.

Late primary to adolescence

Children between 9-13 are beginning to reflect on the ‘abstract’ notion of death and are aware of its finality.

Abstract notions of death can cause great anxiety for children. It is useful for them to know that they have someone to talk to and answer their questions, even if you don’t have all the answers.

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They are more aware of abstract notions such as justice, fate and understandings of life after death.

Increased emphasis on peer relationships which may be affected when experiencing change and loss.

Increased awareness of their own mortality.

Begin to question your explanations, ideas and what happened. Incidences of magical thinking may appear again.

Experiences of other transitions, difference between wanting to become more independent and yet vulnerable may create increased anxiety.

Experiences of varying emotions and increase in mood swings will require patience and consistency from adults close to them.

Young people will require regular reassurance that their feelings are okay.

Permission to ask questions and honesty in the responses which you give them.

4. Communicating with children, young people and their families

What can I say?

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What do I need? I need to know that I will be cared

for and feel safe I need to know that it wasn’t my

fault and to know the factsI need clear information

I need to feel important and involved

I need routine and stability I need someone to listen to meAdapted from J. William Worden

(2001) Grief Counselling and Grief

The first step in identifying appropriate supports for a child is to speak with the family. Every family has different beliefs, supports and coping mechanisms and it’s important to take account of the family’s view about what they think may help.

There are no right or wrong things to say. However the following information provides a list of ‘best practice’ for you to consider when talking with children experiencing change and loss.

Before talking with children it is important to consider the following alongside the family:

What type of change and loss the child is experiencing Relationships and past family experiences What the child already knows about the event How the child learned about this (in particular regarding death or traumatic events) How the death has been explained to the child Who else knows about what has happened If the family have expressed a way for this to be communicated to the child and more

widely What supports the child and family already have in place Your own experiences and relationship with the child

Asking these questions prior to talking with the child will give you time to prepare and think about the best way to communicate with them.

Communication should…

Be clear

All communication regarding change and loss should be clear and avoid the use of euphemisms. When dealing with difficult circumstances such as death or traumatic events it is easy to want to ‘soften’ the blow and protect children. In fact this could be detrimental to a child’s ability to make sense of the event. For example phrases such as “He’s gone to sleep” or “passed away” may lead a child to wonder just when exactly they will return or create more fear and anxiety. It is best to use language that is concrete, succinct and developmentally appropriate.

Be honest

Being open and honest continues to build trust in your relationship and allows children to develop effective coping strategies to deal with difficult situations in the future. It is okay to say that you are upset when hearing of a child’s experiences. Being honest with a child about how you are feeling or not knowing what to say to them makes them realise that you care about them and are trying to help. Try not to say that you know how they feel or to give advice on what they should do or how they should be feeling.

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“Talk does not solve all problems, but without talk, we are even more limited in our ability to help”

Clinical Centre National Institute of Health

What do I need? I need to know that I will be cared

for and feel safe I need to know that it wasn’t my

fault and to know the factsI need clear information

I need to feel important and involved

I need routine and stability I need someone to listen to meAdapted from J. William Worden

(2001) Grief Counselling and Grief

Be given in a direct and open fashion

It is true that when children are not given adequate information that they will make up their own stories to fill the gaps. These are often much worse than the truth! Children experiencing change and loss need information given to them in a direct and open way in order to reduce fear and anxiety and allow them to start making sense of what has happened.

Maintaining openness in the class is also vital for children who feel they do not want to talk and will give opportunities for them to talk when they feel ready to.

However it is important to realise that openness is not always socially or culturally acceptable and it is important to find out what information the child already has and perhaps to offer parents advice and support in talking to their child about difficult events. It is also important to take into account various religious understandings of death and loss.

Allow children to ask questions

Children when faced with any change or loss in their life often begin to ask more questions in order to make sense of what is going on for them. This is sometimes a daunting prospect as these questions are often difficult to face or to answer. It is ok not to know the answer to all questions and to simply say “Let me think about it and I will answer you later” or “I don’t know”. It may also be useful to specify a given time during the day for children to ask questions and to have open discussions about their thoughts, fears or worries. Repeated question asking does not mean that your answers aren’t good enough but that the child is simply exploring their own thoughts and feelings. So allow for repetition. It is important that you actively listen by giving your full attention, not interrupting the child and reflecting back what they have said to you to let them know you have heard and understood them.

Allow opportunities to talk about feelings

It is important that adults around the child model that feelings are okay and that there are no right or wrong ways to feel. Children need to realise that they are not the only ones to ever feel like that and to be reassured by a consistent, caring adult. By talking and being supported to put a name to their emotions children will be able to develop their own ways of coping. It is also important that children are given space to have fun and to express their feelings in different ways- change is often exhausting! Opportunities for creative play, drama and expressive art in the classroom will aid discussion about feelings without putting a child on the spot to talk about feelings that they haven’t yet made sense of. It’s important that children know it is ok to be happy again; this is not a slight on the deceased person. Likewise it is fine for adults to smile whilst interacting with the child as well as showing sadness.

Allow the right not to talk

Children also have a right not to talk about their experiences and this can be distressing for adults to witness. It is important to recognise that although talking is the main way in which adults communicate when experiencing difficulties it is often not for children. Therefore instead of pressuring children to talk, look for opportunities when it might be ‘right’ to mention what has happened. Children may also express their feelings and thoughts through their behaviour. If a

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child becomes overly withdrawn, providing opportunities for circle time, group discussions or a simple worry box will promote open communication. Continual withdrawal from activities or distressing expression of emotions should be discussed further with the family.

Be in your own personal style - make sure you be yourself!

Simply by being you, by listening, caring and keeping consistent routines and behaviour boundaries in place you are supporting a child who is experiencing change and loss. It is therefore important to look after yourself and use your own emotional supports when dealing with difficult situation.

Talking about change and loss with the whole class

It is important that experiences of change and loss are not seen as taboo and something that is not spoken about. When talking about change and loss with a whole class it is important that individual experiences are taken into account. It is vital that staff are given time to discuss a consistent plan on how to manage a child coming back into school and to talk with the child about what they want the rest of the class to know. It is often good for others to know to stop rumours or misinformation being spread. A good way to manage emotions within a class or to stop rumours being spread is to specify a time to talk and discuss the event.

5. Further supports

For children who appear to struggle over time changes can be made and simple educational supports put in place to best support their learning. The following list has been taken from research around how to best support children who are grieving however can be adapted for other children experiencing a wide range of change and loss.

Do not attract attention to the child in the class without them being prepared. The amount of support given to a child should be dependent on their wishes. Remember

this may change on a day to day basis. A consistent plan for education and support should be developed with all staff and the

school management A child should be given an opportunity for time out if they want. Adapt work to allow a child to experience success. Give praise and feedback on work based on how the child is coping at present not on their

previous level of ability. Understand that the child’s level of concentration may be affected which in turn will affect

their work in class.A, Dyregrov (2008) (See Grief in Children 2nd

Edition: A Handbook for Adults)

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What else can help?

Some children – siblings and friends - may not need, or want, additional support in place following a bereavement. Prior to this always ask the child what they would find helpful.

Some examples include:

Peer support - Using friendship groupings already in place to support the child to come back into school and class (e.g. placing them next to their friends or more mature social group)

Calm space / time out - An opportunity to take ‘time out’ in a quiet or calm space for a specified amount of time during the day

Cuddly toys / special object - Giving children a cuddly toy/comforter to manage times when they need a cuddle or reassurance

Help children to create their own rituals or special events - When a child has experienced bereavement it is important to give them opportunities to remember who has died. Some children may like to create a ritual or special event, perhaps with the class or on their own. Developing memory boxes, letter writing, photo collages or art projects can all be used for children to respond to a loss in a personally meaningful way. These activities are often useful when the child is beginning to make sense of their loss and is looking for ways to talk about and remember special things about who they have lost.

Expressive Activities - Opportunities for children to express their emotions in non-verbal ways also help them to begin to piece together and make sense of what has happened. The use of drawing, colouring and play is helpful in giving children control over what has happened.

Some children may use expressive activities to recreate an event. Often this can be extremely specific to the event and detailed. This can often be disturbing for adults around the child. If you are concerned around the nature of a child’s play, drawing or other expression of emotions please discuss this with a member of the school management.

Reading Together - Stories and related activities are a great way to explore issues with a whole class or with an individual child. A list of useful books to use with children experiencing change and loss has been provided in the additional information section of this text.

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6. Considerations for children with Additional Support Needs

When talking about death and bereavement with a child with Additional Support Needs there may need to be additional considerations.

- Think about where the child is in relation to the developmental understandings of death. If you are not sure, aim for a lower level and then increase the complexity of discussion if you feel the child has grasped the key concepts.

- For children with complex needs, death may be experienced as an absence or abandonment without an understanding of why. Visual tools and using examples from the lifecycle of animals and plants may be useful in considering death as irreversible.

- If staff are communicating a death, make sure that the person doing this is a known and trusted adult and that the child is in an environment where they feel safe and comfortable.

- Ensure information is kept brief, factual and literally accurate. Consider using visual supports or symbols if these are part of a child’s usual means of communication. Drawing up a simple social story may be beneficial.

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- Answer the child’s questions as they arise – which may mean answering the same questions repeatedly. Answer simply, and honestly, and at an appropriate level for the child’s understanding. Give enough information to answer the child’s question, but without adding a confusing amount of detail.

- Follow the child’s lead – if they are indicating a need to talk or to have their feelings acknowledged, encourage as appropriate. Watch for changes in behaviour to indicate the child is struggling more than they can communicate and offer support as needed. Outlets such as using musical instruments or sensory materials may allow the child a means to express how they are feeling.

- Some children may need support to understand where and when is a safe place for them to talk about their grief. Social stories or comic strip stories can be helpful in supporting them to recognise social boundaries and norms.

7. Communicating with the school community

Ensure you discuss with the family what their wishes are about communicating with the wider school community, particularly if this involves the death of a child.

This may involve:

Speaking individually to children and their families who were particularly close to the child Information being shared with individual classes A school meeting or assembly A letter to parents

A letter to parents should include:

factual information about the event the immediate school response for supporting pupils (e.g. class discussions, key staff which

pupils can access for support, opportunities to express feelings) information on funeral arrangements, a memorial service or another way of marking the

death, as appropriate to parents’ wishes (this may include e.g. a memory book, special assembly)

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the school response to monitoring pupil welfare in the longer term (identifying pupils who may require further individual support where the bereavement is impacting on their day to day functioning)

8. Additional information and resources

There are a range of available resources including websites and online activities, age appropriate books and DVDs that aim to provide information for teachers and professionals supporting children experiencing ‘change and loss’. A list of these resources is provided below.

Websites and online resources

https://childbereavementuk.org/

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http://www.winstonswish.org.uk/

http://help2makesense.org/

http://www.childhoodbereavementnetwork.org.uk/

http://www.crusescotland.org.uk/

http://hopeagain.org.uk/

http://www.griefencounter.org.uk/about/

http://seasonsforgrowth.org.uk/

http://www.understandingchildhood.net/posts/bereavement-helping-parents-and-children-cope-when-someone-close-to-them-dies/

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https://www.chas.org.uk/

The Compassionate friends. https://www.tcf.org.uk/

NHS Palliative Care - Palliative Care Counselling Service is available to provide support to families/carers of patients who have been referred to the specialist Palliative Care Service. Specialised support can also be offered to children and young people. Cedar House, Willow Drive, Kirkcaldy KY1 2LF Tel : 01592 648 004

Books and work books

Books are an ideal way to address issues regarding change and loss both with individual children for use with a whole class. A range of books are available that aim to explore issues such as death, illness, divorce, change of family circumstances in age appropriate ways.

A sample list of websites which detail a wide range of books for age and stage are detailed below.

Partnership for Children:

Good Books for Tough Times Age 5-8

http://www.partnershipforchildren.org.uk/uploads/BookList_Booklet%20for%20web.pdf

http://www.partnershipforchildren.org.uk/GBTTHome/GBTT4.html

Good Books for Tough Times Age 9-12

http://www.partnershipforchildren.org.uk/GBTTHome/good-books-for-tough-times-9-12/Books_bereavement_9-12.html

Child Bereavement Network Useful Books

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http://childbereavementuk.org/wp-content/uploads/2016/05/19-Books-and-Resources-Key-Stage-3-and-4.pdf

9. References and further reading

Burns, D M. (2010) When Kids are Grieving: Addressing Grief and Loss in school. First Skyhorse Publishing.

DyreGrov, A. (2008). Grief in Children: A Handbook for Adults. Jessica Kingsley Publishers. London

Worden, W. (2002). Children and Grief. When a Parent Dies .Guilford Press: New York

Worden, W. (2001) Grief Counselling and Grief Therapy. A Handbook for the Mental Health Practitioner

Stroebe M. & Schut H. (1999).The dual process model of coping with bereavement:

rationale and description. Death Studies. 1999 Apr-May; 23(3):197-224.

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