1. Bereavement Support (including Pre-bereavement)
Working with children and families

2. Safeguarding your well being and safety
This should be on your supervision agenda re where do you get support from to be an effective practitioner
Smaller groups than today

3. To be an aware, mindful, knowledgeable and confident practitioner
This is what children and young people want, need and expect from adults
We need to model this so children and young people can learn how to be aware, mindful, knowledgeable and confident individuals contributing towards a healthy society
To develop the self can be a moment to moment experience and it can be done in stages using training opportunities and mindfulness techniques
Subject matter can be taught or read in books
Skills practice and development can require more time and a structured approach
I am going to give over a subject input then we will break for some skills work on the self and what you do to support

4. In the next half an hour :?!*
Grief and trauma
Children’s understanding of death
Systems
Pre-bereavement
The professional role
Caring for oneself

5. Grief – psychological adjustment to loss
Shock
Disbelief
Acceptance
Denial
Anger
Blame
Try out new things
Or experimenting with change
Guilt
Normal response
Deep Despair

6. Trauma An experience that is overwhelming
Fight, flight or freeze response is triggered
There can be difficulties integrating the experience physically, emotionally and cognitively into a narrative or memory
Vast field. Essential points. Critical incident guidance

7. Traumatic Qualities
Intrusion – thoughts, emotions, pictures, sounds, sensations which come into your experience uninvited
Avoidance – staying away from reminders, actively not talking about “it”, pretending, denial
Arousal – hyper – state of hyper vigilance hypo – going to sleep/switching off
Trauma aspect of grief requires to be worked through to enable healthy grieving to occur

8. Shape to the process of potential grief and trauma experiences

9. Children come with a history
Attachment pattern
Secure
Insecure ambivalent
Insecure Avoidant
Disorganised/disorientated
A history of losses and experiences which may be traumatic

10. Children’s understanding of death
Develops in parallel with cognitive maturing
Below the age of 5 – death is reversible – concrete and magical thinking
From 5 to 10 – gradual increase in understanding that death is irreversible – cause and effect – need for detailed information (updates)– males may start to suppress expression of feelings
10 through adolescence – “uh oh! I’m goanna die!” – abstract thinking – long term consequences of loss – peer influences

11. Children arrive in a context
Culture of family functioning
Open, closed, chaotic, strict, abusive, loving…………
Religious or belief systems
Self esteem or cognitive beliefs
Age and stage or ability, Gender
Religious handouts for funerals. Encourage to seek out information from children and families as an educational opportunity.

12. What Good Provision for Bereaved Children Looks Like

13. Pre-bereavement
Bereavement care should begin prior to the death of a patient with their carers being assessed for their potential bereavement risk factors
Bereavement care pathway
Pre-bereavement assessment
Either low, medium or high risk
Initiate appropriate level of support accordingly

14. Pre-bereavement continued
Anticipatory grief – shielding against pain
Openness within the family will be the best foundation for children’s coping, both while the person is still alive and after their death
Supporting parents on how to talk with children – process should be started before dying person is too ill to participate

15. Activities Solution Focussed conversations (Planning)
Identify best hopes (outcomes)
Scaling – measurement of feelings/pain…..
Letter writing/Video recordings (communication)
As much as possible normal, family fun activities or introduce new ones which provide the opportunity to express thoughts, feelings, hopes, anxieties, concerns and strengths‘
Include family members in making plans for funeral. Children should be given the choice about taking part and having a role. To be supported in understanding what the ritual involves

16. Professional Role Human being first Professional and compassionate
Does your agency have a bereavement support policy? (pro-active planning/intervention)
Agree roles among team around child with an understanding of good practice
The child or family chooses you as a safe person to share with
seek out support and guidance
obtain agreement to plan extra time into sessions, as well as for the period following the death

17. Caring for oneself
Remember that to be of help to the child, you need to take good care of your self
The system which provides a service for the child, should make provision to support the staff who support the child
Make a list using SF include training and supervision – service improvement plan performance indicators – bereavement support questionnaire relating to quality of staff input

18. Useful links Bereavement Support Guideline
Merseyside and Cheshire NHS Cancer Network
Standards for bereavement care in the UK (2001)
NICE Supportive and Palliative Care Guidance for Adults (2004)
The National End of Life Care Strategy (2008)
Childhood Bereavement Network