Family Rhythms & The Blues: A Family Care Approach to Bereavement The FORUM on Behavioral Sciences Deborah A. Taylor, Ph.D. Central Maine Medical Center FMRP 09/25/2009

Today’s Agenda The Words We Use - What They Mean Personal experience with death - reflection Risk factors that complicate family bereavement A “family friendly” practice of identifying and treating bereaved families Once the family screens “+”, what can you ask or say? Assessing bereaved families Bereavement interventions Cinema Clips - A Teaching Tool

Bereavement Stats Nearly 20% of Americans experienced the death of a family member in 2008 Nearly 5% of American children under 18 yo lose 1/both parents to death Up to 25% of all pregnancies end in miscarriage/abortion Liberal definition of “family” 50% of bereaved family members will develop “depressive” symptoms Only 10% of those will develop MDE (1:20)

Definitions Bereavement State of having lost a significant person to death Grief Personal response to that loss Family Grief The weave of personal grief and family rules/expectations re: bereavement Mourning Public expression of loss

Movie Clip Ordinary People Suicide of Older of 2 Sons Questions: 1. What is your reaction to mother? To son? 2. What do you surmise about “family grief”?

Death Experience Questionnaire See handout – Appendix A Let’s review content/instruction Take 10 minutes to complete

A Difference in Expectations Average grieving process is years, easily lasting 3-4 years with loss of long term spouse or parent losing a child Most people in the bereaved’s person’s life will want them to “move on” after 3-6 months

Risk Factors related to Family Grief Gender/Age/Kinship Family (dys)function* Unfinished business **/****

Movie Clip The Big Chill Suicide of Member of College Clique Reunion for the Funeral Pay attention to the Unfinished Business expressed in this clip.

Risk Factors related to Family Grief Gender/Age/Kinship Family (dys)function* Unfinished business **/**** Prior experience Mode of death Family rules/guidelines re: grieving* Social Support*** Cultural Expectations Who is left? (see chart at end of handout)

A Systematic Approach to Identifying Bereaved Families Involvement Community connection Screening during visits –“Have you had any significant losses in the past year? Reviewing obits –Exercise

Obit Review Exercise – A Teaching Tool (see handout for obits) What does the obituary tell you about the family? What information is available about history of bereavement? What risk factors can you identify? Who would you want to focus on and why?

If family screens “+” Tell me about your loss – did you anticipate it? How have you responded in the past when someone you know has died? Do you have people to talk, cry, and remember with? What concerns you the most now?

Movie Clip Steel Magnolias Mother’s adult daughter dies after years of illness (diabetes leading to renal failure) What stands out in this clip?

Assessing Bereavement Make screening a habit Be knowledgeable about normal stages and recognizing complicated bereavement Examine family differences Look out for the children**** Fido and Fluffy too!

Bereavement Interventions Encourage the story (family mtgs) Normalize (differences in family) Grief Education –Anticipatory guidance –Ongoing support Health Maintenance –Routines, rest, diet, exercise ID/focus on high risk grievers Mark date significance (chart)

Summary Routinely screen for bereavement Recognize factors that complicate individual & family bereavement Stay in touch over time last movie clip

Movie Clip Step Mom A mom creates memories with her children as she is dying

Cinema Education Clips Ordinary People –To demonstrate family rules and the difference in the way members grieve –Scene: Son on chair outside in winter ~ mother joins him The Big Chill –To quickly demonstrate the power and impact of unfinished business –Scene: Friends in car in funeral procession conversing about death

Cinema Education Clips Steel Magnolias –To demonstrate the powerful benefit of social support –Scene: Mother in cemetery with group of friends Stepmom –To demonstrate the impact of terminal illness on families as well as to highlight the concept of making memories and reducing “unfinished business” –Scene: Parents tell children about terminal illness; Mother creates memories for children