1. Psychosocial Issues Jeanine Penzo, LICSW Spinal Cord Injury Service VA Boston Healthcare System, West Roxbury campus

2. Initial Reactions Recognition of the experience of loss Adjustment to that loss Acceptance/Adapting to one’s own timeframe

3. Grief Definition: Natural response to the loss of bodily function and the loss of one’s previous way of life.

4. Stages and Cycles of Grieving Kubler - Ross Theory * Denial * Anger * Bargaining * Depression * Acceptance Practical Application of Theory in Life

5. Adjustment to Recovery Learning new ways to do old things Building skills and resilience, both emotional and physical. Modifying expectations and lifestyle.

6. Environmental Influences Employment and career Social Relationships Aids, appliances and compensatory strategies Appropriate Services Support of family members and significant others Needs of others in family

7. Later and Delayed Reactions Responses to day –to- day events Responses influenced by: * Fatigue * Levels of support * Expectations: Disappointed/Fulfilled * Expectations: Frustrated/Satisfied

8. Primary Caregiver * Grief * Caregiver burden * Mutual concerns about each other * Supports for caregivers * Importance of communication and listening

9. Self-Advocacy Self-esteem Communicate and Listen effectively Navigate the environment and making connections Take responsibility for your life Ask Questions and Seek answers

10. Substance Abuse The harmful use of alcohol and other drugs that affect mood and thinking. Overuse of prescription medications Illegal drugs Do you have a problem? What to do?

11. Mental Health Reactions: for example, * anxiety * depression Intervention to address emotional needs Follow-up and leaving the door open for future support

12. Discussion Questions Comments Feedback