Prevalence By the time a child finishes high school 40% will experience the death of a peer 20% will have witnessed a death
Prevalence continued (National Center for Health Statistics, 2011)
Prevalence continued (National Center for Health Statistics, 2011)
Magnitude of the problem Mourning a peer can be devastating Adolescent grief can be: Personal Intense Intermittent Overwhelming The belief that peers are too young to die, can cause: Trauma Life-long changes (Malone, 2007).
Magnitude continued (Dyregrov et al.,1999). How long did it take or do you think it will take you to get over the grief?
Looking at Behavior Children and adolescents do not grieve REALITY: All children and adolescents grieve (Adams et al., 1999).
Looking at Behavior continued Children and adolescents should not be allowed to attend funerals and/or take part in other commemorative rituals REALITY: Attendance and participation gives youth the opportunity for communal support and to ask questions and talk about their feelings (Adams et al., 1999).
Looking at Behavior continued School staff are neither prepared nor competent to deal with a student who is grieving REALITY: Teachers and school staff play an important role in dealing with students who are grieving (Adams et al., 1999).
5 Stages of Grief 1.Denial 2.Anger 3.Bargaining 4.Depression 5.Acceptance
Multicultural Considerations Grieving is a personal process PSCs must examine values, beliefs, and biases Religion is an essential part of culture Religion may or may not provide a forum for grief
Cultural Attitudes Asian Americans (Buddhist, Taoist, Confucian) – stoic attitudes, internalization of guilt may result in depression. African Americans (often Christian) – physical manifestations of grief (crying) and great emotion. Mourn by dressing in white. Haitian American (various religious practices) - physical manifestations of grief (crying) and great emotion Hispanic Americans (Roman Catholic) – emotional expressions of grief are encouraged. Saying the rosary. Making commitments European Americans (religious, ethnic and cultural traditions vary) – subdued bereavemen t. (National Association of School Psychologists, 2003).
Cultural Attitudes continued Jewish Observances Emotional needs of survivors are considered very important Mourning continues for 1 year Islamic Observances Varies greatly between countries in which Islam is practiced Death is considered an act of God and is not questioned Crying cleanses the soul Christian Observances Emphasis is placed on the idea of the deceased attaining “everlasting life” (National Association of School Psychologists, 2003).
Socioeconomic and Age Considerations The majority of adolescent deaths occur among adolescents living in homes with the lowest household income Race/ethnicity of adolescents who lost a friend in the past year: 29% African American 27% Hispanic 18% Caucasian 11% Asian Age range of adolescents who lost a friend in the past year: 17-18 year olds, 28% 15-16 year olds, 26% 12-14 year olds, 16% African American girls, between the ages of 17 and 18, from lower socioeconomic households are the most at-risk. (Malone, 2007).
Gender Considerations Adolescent death impacts more girls than boys Girl's have wider social network A study based on 4,023 adolescents found the following: 23% of girls and 19% of boys are likely to experience peer death in the past year Girls tend to have stronger emotional reactions to the death of classmate 38% of girls report that they will never get over a classmate's death 9 months later 0% of boys report that they will never get over a classmate's death 9 months late (Melhem et al., 2003). (Dyregrov et al., 1999).
LGBTQ Considerations Difficult transitions Especially from elementary to middle school Increased bullying Higher risk of anxiety and depression Increased risk of suicidal ideation (Birkett et. al, 2009). LGBT youth are exposed to high levels of victimization and higher rates of past-year suicide attempts Less social support Fewer resources to cope Higher severity of victimization experiences (Almeida et. al, 2009). Recent media attention of LGBTQ suicides
Current Event Discussion MIchigan High School Video Clip Group discussion If you were the professional school counselor at this Michigan high school, what interventions would you employ? When? For whom?
Strategy Designate support areas Establish rooms for counseling/peer support 1-on-1 & group counseling Community outreach Provide resources Contact local providers Media Communication Establish a PIO (Public Information Officer) 1.Develop a strategy Confirmation of all facts Funeral/memorial services Disclosure/ethical issues Notify teachers & staff Mandatory staff meeting Notify students & families Small group settings A letter home (National Center for School Crisis and Bereavement, 2010).
Interventions and Strategies Grieving responses that students identified as helpful 44%, talking it out 19%, thinking about it alone 13%, exchanging self-comforting explanations 8%, physical release via activity or crying Successful coping involves Expressing feelings about loss Having feelings validated and normalized Problem solving Creating and relying upon sustained and supported relationships (Malone, P. 2007 & McNeil, J, et. al, 1992)
Interventions and Strategies continued Emotional Written Disclosure Example prompt: "We are asking you to write about Fabrizio’s recent and unexpected death for the next 15 minutes. We want you to write about your deepest thoughts and feelings regarding this event, especially those you did not reveal to anybody. The important thing is that you let go and get in contact with your deepest emotions and reflections. Write about the event, how you experienced it and how you feel now.” Advantages Promotes psychological well-being and facilitates enhanced control over emotions Identifies strengths Brief and cost effective Helps predict student recovery Flexible usage Disadvantages Inconsistent evidence Lacks in reduction of: PTS disorder, problem internalization, anxiety, and depression (Margola, D., Facchin, F., Molgora, S., & Revenson, T., 2010).
Interventions and Strategies continued The Impact of Event Scale 15 items that measure PTS symptoms Measures distress on a 4 point Likert scale Cut-off score determines risk for PTS The Hogan Sibling Inventory of Bereavement Assesses grief after the death of a sibling 46 questions with 2 subscales (Dyregrov, A., Gjestad, R., Wikander, A., & Vigerust, S., 1999). Task Oriented Group Intervention 3 months of weekly 60-90 minute sessions Facilitated by 2 PSCs Phase 1: Creating & Relating In a safe environment student relate to each others’ experiences through creative expression Journaling, poetry, drawing Phase 2: Coping Thoughts and feelings of loss and grief are normalized Psycho-educational info Coping strategies are introduced Phase 3: Transitioning (Malone, P., 2007).
Interventions and Strategies continued Interventions for Individuals with Disabilities Some students with disabilities may lack understanding of: Death Death rituals Grieving process Group Interventions Grief wheel Exercise: Making a toolbox of things that help us feel happier (memory box) Exercise: Releasing balloons with a goodbye message Positive indications from evaluations and surveys (Boyden, P. et al., 2010).
Community Resources The Bereavement Center 69 Main Street, Tuckahoe, NY 10707 914.961.2818 ext 317 http://www.thebereavementcenter.org/index.php Center for Bereavement 118 East 93 Street, Suite 1C, New York, NY 10128 212.289.8570 http://centerforbereavement.com/index.html Camp Good Grief P.O. Box 141046, Staten Island, NY 10314 888-507-4474 http://campgoodgriefsi.org A Caring Hand: The Billy Esposito Foundation 305 Seventh Avenue, 16th Floor, New York, NY 10001 212-229-CARE(2273) http://www.acaringhand.org 1-800-LIFENET For a list of programs in New York State, please visit : http://www.nationalallianceforgrievingchildren.org/programs-new-york http://www.nationalallianceforgrievingchildren.org/programs-new-york
Grief/Bereavement Discussion 1.Have you lost a classmate? 2.If so, describe the circumstances surrounding the death. What caused the death? How old were you? What was the relationship (best friend, acquaintance) with the person that passed away? How were you affected? 3.What, if any, services were provided to the students, staff, and community? 4.Who provided these services? 5.How could have the delivery of support services been improved?
References National Association of School Psychologists. (2003, March). Understanding cultural issues in death. In NASP resources. Adams, D., Corr, A., Davies, B., Deveau, E., de Veber, L.L., Martinson, I., Noone, M., Papadatou, D., Pask, E., Stevens, M., Stevenson, R. (1999). Children, Adolescents, and Death: Myths, Realities, and Challenges. Death Studies, 23/5, 443 – 463. Allmeida, J., Johnson, R., Corliss, H., Molnar, B., Azrae, D. (2009). Emotional distress among LGBT youth: The inﬂuence of perceived discrimination based on sexual orientation. Journal of Youth and Adolescence, 38, 1001 - 1014. Birkett, M., Espelage, D., Koenig, B. (2009) LGB and questioning students in schools: The moderating effects of homophobic bullying and school climate on negative outcome. Journal of Youth and Adolescence, 38, 989-1000 Brigman, G., Goodman, B. (2009). Group counseling for school counselors: A practical guide. Portland, ME. Walch Education; 2nd edition. Dyregrov, A., Gjestad, R., Wikander, A., & Vigerust, S. (1999). Reactions following the sudden death of a classmate. Scandinavian Journal of Psychology, 40(3). Faschingbauer, T. R., Zisook, S., & Devaul, R. (1987). The Texas Revised Inventory of Grief. Biopsychosocial aspects of bereavement. Washington, DC: American Psychiatric Press.
References continued Facchin, F., Molgora, S., Margola, D., & Revenson, T. A. (2010). Cognitive and emotional processing through writing among adolescents who experienced the death of a classmate. Psychological Trauma: Theory, Research, Practice, and Policy, 2(3), 250-260. doi:10.1037/a0019891 Feigelman, W., & Gorman, B (2008). Assessing the effects of peer suicide on youth suicide. The American Association of Suicidology, 38(2), 181-194. Malone, P. (2007). The impact of peer death on adolescent girls: A task-oriented group intervention. Journal of Social Work in End-of-Life & Palliative Care, 3(3), 15-23. Margola, D., Facchin, F., Molgora, S., & Revenson, T (2010). Cognitive and emotional processing through writing among adolescents who experienced the death of a classmate. Psychological Trauma: Theory, Research, Practice, and Policy, 2(3), 250-260. McNeil, J., Silliman, B., & Swihard, J. (1992). Death of a student: Implications for secondary school counselors. American School Counselor Association, 40(1), 55-60.
References continued Melhem, N., Day, N., Shear, K., Day, R., Reynolds, C., Brent, D. (2003). Predictors of complicated grief among adolescents exposed to a peer’s suicide. Journal of Loss and Trauma, 9(21), 34. National Association of School Psychologists. (2003, March). Understanding cultural issues in death. In NASP resources. Retrieved March 2, 2011, from http://www.nasponline.org/resources/principals/culture_death.aspx http://www.nasponline.org/resources/principals/culture_death.aspx National Center for School Crisis and Bereavement. (2010, December). Retrieved March 6, 2011 from http://www.cincinnatichildrens.orghttp://www.cincinnatichildrens.org Rheingold, A.A., Smith, D.W., Ruggiero, K.J., Saunders, B.E., Kilpatrick, D.G. & Resnick, H.S. (2004). Loss, trauma, exposure, and mental health in a representative sample of 12-17 year-old youth: data from the National Survey of Adolescents. Journal of Loss and Trauma, 9(1), 10-19. U.S. Department of Education, Emergency Response and Crisis Management (ERCM) Technical Assistance Center (2007). Coping with the death of a student or staff member. U.S. Department of Health and Human Services, Center for Disease Control and Prevention, National Center for Health Statistics (2011). Health, United States 2010 with special feature on death and dying. Retrieved from http://www.cdc.gov/nchs/data/hus/hus10.pdf#027http://www.cdc.gov/nchs/data/hus/hus10.pdf#027