Little Tears, Big Fears - Tears, Big Fears Working With Children Experiencing...

Click here to load reader

  • date post

  • Category


  • view

  • download


Embed Size (px)

Transcript of Little Tears, Big Fears - Tears, Big Fears Working With Children Experiencing...

  • Little Tears, Big Fears Working With Children Experiencing

    Anticipatory Grief

    C. Caryn Kondo, MSW

    Clinical Director New Song Center

    Jenni Rogers, MS, CCLS

    Child Life Supervisor HonorHealth

  • How do you feel?

  • Understanding Anticipatory Grief

    The complex interaction between feelings, thoughts, and physical reactions to

    learning and living when someone we love

    is dying.

  • Factors that Influence Grief

    Culture and Spirituality

    Nature of Illness and Death

    Past Experiences and Losses

    Relationship to Person


    Developmental Stage

    Parental Attitudes and Communication

  • Child



    Complex Involvement





    Caregiver Medical


  • Important Parenting Considerations

    The overwhelming need for parents to continue to be active and purposeful to

    their family.

    Piloting: Navigating through the challenges Providing: Giving in order to meet family needs Protecting: keeping the family safe Preserving: Maintaining roles and functioning *Price, et al. International Journal of Nursing Studies (48), 2011

  • Children and Anticipatory Grief

    The journey from diagnosis to dying is often filled with complex emotions and stressful

    challenges for all family members.

    There is no clear or consistent road map for this challenging journey.

    Understanding the connection between

    the challenges and needs for children

    is important.

    Children especially have many needs in helping them navigate.

  • Importance of Assessment

    How are the kids doing? vs There have been a lot of changes

    happening lately, do you mind sharing with

    me what that has been like for your kids? If the kids were here, what would they say

    has been going on? How would they

    describe (the situation)?

  • A Word About Temperament

    Type A rule followers high achievement standards for themselves

    and others dont really show emotions too much really holding us all together

    The more emotional one we know when they are mad, sad, happy easy going havent been home very much

  • Complex Challenges

    Exploring the complex challenges families face provides a more complete picture and

    approach to understanding and working

    with children when family member is


  • Complex Challenges Dealing with Changes

    Experiencing High Emotional Stress

    Maintaining Family Roles /Responsibilities

    Finding Support

    Managing Multiple Compounding Losses

    Moving On..Letting Go

  • Challenges and Needs

    In order to face these challenges in a way that allows for healthy growth and coping;

    children have to have their primary needs


  • Primary Needs for Children

    To Experience Security and Safety

    To be Told the Truth

    To Express Themselves

    To be an active family member

    Remain a Child

  • Developmental Considerations

    Infants to Toddlers (0-4)

    Young School-age (5-8)

    Older School-age (9-12)

    Teens (13-18)

    Young Adults (18-21)

  • Phases of Anticipatory Grief

    1. Illness and Diagnosis Explaining illness and disease to children.

    We just found out that Mom has a big sickness that she may not get better like other little illnesses. It is called____________.

    2. Treatment Phase When Working hard to get healthy isnt

    working. The medicine Mom was taking is not working to

    stop the illness. The sickness is making her body very weak. We going to make sure she is in no pain.

  • Phases of Anticipatory Grief

    3. Terminal Phase

    Explaining Death to Children in age appropriate ways.

    Mom is having a very hard time. Her body is going to stop working. She may not respond to

    you, but keep talking she knows you are here.

    4. Dying

    Including and preparing children for the process very important.

    It looks like we do not have much time; what would you like to do to say good bye to mom?

  • Answering Difficult Questions

    Is it ok for me to cry in front of my child?

    Are there words/phrases I

    should avoid?

    How much should I tell my child?

    How do I prepare them for the hospital


    What if my child asks if I am going to die?

    How do I answer if they ask why this is


    How involved or notification do they


  • Step By Step Disclosure

    1. What does child know?

    2. Do they understand basic human body?

    3. How is the disease impacting body?

    4. How did treatment & medications impact

    the body?

    5. What is happening now?

  • The elephant in the room

    Are they going to die?

  • Creating Conversations

    What have been common barriers to creating conversations between parents

    and children?

  • Encouraging Coping

    Tap into past positive coping style

    Understanding the silent treatment

    Be Creative

    Keep asking questions and checking in

    Give them positive and helpful jobs Help parents to choose their battles and

    be a safe place

  • Allowing for Creative Expression

    Ways to help Children Express their Emotions Safely:

    Use play, art, music and movement. Make an anger pillow to work out frustrations. Use clay to work through emotions. Bang pool noodle on ground. Create an art journal. Keep active children active. Give children choices when they are available. Make time for normal activities.

  • What Adults Can Do:

    Be a Good Listener: Children need love, support and guidance. Being

    Listened to is healing.

    Be Reassuring: Acceptance and reassurance helps children feel safe

    and secure.

    Be Honest: Honest and open communication leads to greater trust

    and healing.

    Be Flexible: Allow for some rule breaks.

  • What Adults Can Do:

    Be Patient: Working through anticipatory grief challenges takes


    Be Aware: Find time to focus on the child. Watch their behavior

    and monitor any changes or red flags.

    Be Open: Allow for the expression of their feelings in as many

    different ways as possible. Give them choices. Seek

    out assistance when you need it.

  • Encouraging Legacy

    Photograph Day to Day life Activities

    Voice Recordings

    Tangible items (lovey)

    Cooking together/recipes

    Use caution with cards and letters

  • Top Ten Guidelines for Helpers

    10. Always remember to take care of yourself.

    9. Know your comfort level.

    8. Bring age appropriate toys, games, supplies.

    7. Remember that children are not small adults.

    6. Put yourself at childs level. 5. Accept and respect childs emotional state. 4. Talk to the child, not at or about them.

    3. Be able to play.

    2. Take your cues from the child.

    1. Always be honest and real.

  • Toolbox of Toys

    Create your own tool box of child friendly supplies and activities.

    Basic human body book Model Magic Markers/Crayons/Coloring Sheets Scavenger Hunt with Bugs Crocodile Dentist Uno

  • Book Resources

    Adults: How to Help Children through a Parents Serious Illness by

    Kathleen McCue

    Preparing the Children: Information and ideas for Families Facing Terminal Illness by Kathy Nussbaum

    A Tiny Boat at Sea by Izetta Smith

    Children: Lifetimes: The beautiful way to explain death to children by

    Bryan Mellonie

    Waterbugs and Dragonflies:Explaining Death to Young Children by Doris Stickney

    When Death Walks In by Mark Scrivani (teens)

  • How do you feel now?