12 strategies for working with young people who have experienced grief and loss - Calm Kid Central

Helping Kids with Worry, Anxiety and Stress - Professional

12 strategies for working with young people who have experienced grief and loss

Many children and young people we will work with have grief and loss experiences.  One data source estimates 1 in 15 children experience the death of a parent or sibling by the age of 16, and another study found 80% of 11-16 year olds say they have experienced the death of a “close” family member or friend.  Many children also experience other significant losses – for instance the “loss” of the family unit through parental separation, sudden loss of a family home (house fire/disaster), the death of a pet, loss of some aspect of health/mobility, or the loss of a favourite or treasured activity or possession.

Given bereavement is such a common experience for young people and as professionals it is helpful to be aware of how we can support children and teens through grief and loss experiences.

1.    Information giving:  helping children and young people understand what has occurred and what will happen next

Young people often do not have knowledge or life experiences which help them understand a range of grief and loss situations.  For example:  unlike adults, often young children don’t always understand that death is irreversible and that a person/pet will not “come back”, or what to expect in a funeral service.  Children and young people may not understand what occurs when parents/caregivers divorce, how common illnesses are treated or managed and what emergency services workers do in times of crisis/flood/fires.

A simple way we can help young people who are grieving is to provide clear information about what has happened in their lives and what might happen next.   Of course children and young people will often not spontaneously ask questions or tell us what they are confused about – so sometimes we need to initiate this ourselves as we work with them.  Exactly how we do this will depend greatly on the young person and the context in which we are working, but for example we might say things like:

Do you understand what has happened with X/to Y?
Do you want me to explain anything about X/Y/Z/?
Often young people don’t know what happens when X/in Y situation – would you like me to tell you what I know about this?
Is there anything you are feeling confused about?
Do you have any questions about what happens next/what has happened?

When we answer questions, we should try to avoid using adult like jargon (“passed away”, “lost”) and provide clear and specific information.  We can also ask for feedback about the information we provide (Does that make you feel more or less confused?  Do you have questions about what I have just said?).

Providing information as a professional can be such a valuable support for grieving young people, because they often can’t get this information from adults in their family networks (or don’t want to “upset” them).

Research backs this up – one study found that adults communicating in open and clear ways with children after a loss by adults has been linked with their better adjustment (Raveis, 1999).

2.    Help children and young people to identify their grief feelings and reactions and the grief of others

Noticing and being able to label grief reactions has long been a central part of supporting adults with grief reactions.  It is also important to do this for young people.   There are two reasons for this.  First, when young people know their own (and their family members’) feelings and experiences are “normal” they are less likely to be distressed and worried about having or noticing these experiences.  Secondly, when young people can themselves identify grief feelings, it helps them to then be able to communicate them.

There are many ways we can help young people identify grief experiences, and in doing so, normalize these.  Here are a few ways we might introduce the topic.

“When someone dies/X happens/we lose something important to us, people have many different feelings like sadness, anger, worry, loneliness.  

People also sometimes feel guilty about things/relieved about other things or just feel numb.   

All of these feelings are normal and a way of our brains trying to cope with what has happened? 

Have you noticed any of these feelings?”  Have you noticed XX (ie your mum/sister/someone else who experienced the loss) having any of these feelings?

“When someone dies/X happens/we lose something important to us, people have different things happen to their brains/bodies.  like having trouble thinking/remembering things/feeling sick/having headaches  Have you noticed any of these feelings?”

We can also use books and poems to provide information about normal grief reactions.  There are hundreds of books written to explain or explore grief concepts to and with children and adolescents.  A Google search for “children books grief” is a simple way of accessing a list (I often prioritise books written by psychologists working in the field).

As well as exploring and explaining concepts, and inviting young people to “talk” about these feelings and experiences, we can also invite or set up ways of them expressing their experiences in ways which do not use language.   For example:

Would you like to use this (paper/clay/craft materials) to show me/others what it has been like for you?
Some kids/teens like to write a blog/story/poem/create videos about their story/experiences.  If you’d like to do that I could help by….
We could use these puppets/figurines to pretend they are…
Would you like to play this game AS IF…(acting out a situation)

It is important to notice that there is a great deal of variation in how much different children/ adolescents want to or are able to talk about, express or share their grief experiences.  Some young people want to and are able to talk/express/share easily and for longer periods of time, with a lot of detail about them – and others are not able or do not want to talk very much at all, and “shut down” a conversation very quickly.   Some research suggests there are gender differences, with girls more likely to describe their grief emotions/experiences in more detail than boys (Dyegrov et al, 1994).    Not surprisingly, there is also some suggestion that prior levels of verbal fluency and expressiveness are related to how much young people talk about/express their grief experiences.

However there is no research (at least that I am aware of) suggesting that the less a young person “talks” about their grief,  the more problems they experience.  This means as adults it is important we make space for, and invite children/young people to talk about their grief experiences but not to push for them to do so, or worry excessively when they do not.

Sometimes we need to reassure parents/caregivers about this also – as children/young people “not talking” is a common concern for parents.

3.    Help adults accept children and young people’s periods of “normal” functioning

Most people who experiences grief have periods of intense grief, and periods of time with less intense grief experiences.  However some authors believe children and young people may have even greater variation between these episodes.  In other words, grieving children and young people may have periods of time in which they laugh, play games, make jokes, want to see friends and react very similarly to how they did prior to the loss.  Some young people may feel guilty about this.  Some adults also find this disturbing and wonder if the young person is “processing” the loss in helpful ways.   We can reassure both young people and their caregivers that these periods of “regular functioning” are normal and support them to accept both their intense experiences of grief, as well as the periods of time in which they act/cope without showing grief.

4.    Provide reassurance about “secret” fears and sources of guilt

Many young people have fears and sources of guilt which they feel they cannot talk about in case of upsetting someone, or because of shame.  For example, they may believe they have done something to contribute to the loss, or are doing something to make things worse for family members.  They may be secretly afraid of further losses, or feel ashamed of some feelings they are experiencing in relation to the loss.  These secret fears and guilty feelings obviously increase suffering for young people.  We can help by proactively asking about some common fears/sources of guilt .  For example (and depending on the child’s age):

Some kids/teens are afraid that this will happen to them/happen again/to someone else.  Is that something which you think about?  Would you like to tell me about this?
Some people wonder whether it have been better if this happened to them.  Does that come into your head?
Some kids/teens think there are things about this which might have been their fault in some way?
Lots of kids/teens have other worries or things they feel guilty about thinking or saying.  Do you have any things like this in your head which you would like to share?

Young people are sometimes more likely to confide in us as professionals about these feelings than to their parents/caregivers or others who are also grieving, as they see us as a neutral party less likely to be distressed by their disclosures.

Again, using other forms of communication other than talking can work better for some young people to help them express their fears/sources of guilt.  This might include drawing, text messages, or “acting out” concerns.

5.    Helping children find appropriate ways to remember and acknowledge their loss (or to make meaning from it)

Research suggests that young people who are given permission or allowed to remember and talk about what they have lost usually adjust better to a loss than those who are discouraged from doing so (Raveis, 1999).   This doesn’t mean we should push young people to do this – as stated above, some young people will be more open and able to share and express than others – but it does mean we should provide opportunity for this to happen.

Young people can remember, “honour” and talk about what has been lost in a variety of ways including:

Creation of and sharing/looking at photo books/photo boards
Space for conversations about the loss – eg asking children/young people to their favourite memories of what they have lost, what they think someone would be doing/saying
Wearing special items of clothing/jewellery
Drawing pictures, creating videos, setting up social media/blog/digital accounts
Craft/clay/making of items to keep or share
Visits/outings to graves/sites of remembrance
Playing particular games/doing particular activities done “in memory”
Sharing memories (verbally, show and tell, stories/poems, pictures) with peers and classmates
Anniversary celebrations

For some young people, another way of remembering their loss is “making meaning” from it.  This might mean raising awareness of an issue, fund raising, sharing their experiences or learning about something related to the loss.

6.    Help children develop a plan for “waves” of intense grief

Like adults, young people have periods of time in which they experience grief more intensely.  These periods of time might be predictable (ie when they are reminded of their loss due to an event or situation in their life) or unpredictable (something minor might “trigger” a memory or thought about their loss).

We can help young people to know that “waves” of grief are normal, and also to help them generate a plan to help them cope through intense experiences of grief.

It can be helpful to do this in advance.  How we introduce the idea will of course vary according to age and situation, but some of the following sentences might be appropriate:

Usually when we are grieving, there are moments and times when we have a very strong sadness.  We can’t take these away, but we can have a plan for how to get through these.  Different people do different things to cope with those feelings.  Would you like to talk about what to do when these happen?

There are four different parts of a plan we can have.  We don’t have to have all of these, or any of these – they are just ideas.  The parts of the plan are: 1) things to do to keep our brain busy; 2) Ways to move our body and be physically active; 3) Ways to spend time remembering what we have lost, and 4) people to talk to or be with.

7.    Help with managing tasks of daily lives

Young people who are managing grief, like adults, often find tasks of daily life – like socializing, chores, homework, paying attention at school, getting enough sleep, getting sufficient nutrition – more difficult to manage than before the loss.  Depending on the situation, there are a range of reasons for why daily tasks might be more difficult, but these include the effects of grief on cognitive function, energy and the ability of others to play their usual roles.

We can help young people by negotiating or adjusting expectations for a while.  This means asking specific questions about routines and tasks.  For example:

Is there anything hard or tricky about this week?
What are the “small things” that just make things harder?
Is there anything in particular coming up which you feel is just too hard?

We then might be able to help young people in negotiations with teachers/schools, helping young people find the words to ask for help/share information with friends or do problem solving in other practical ways.

8.    Assisting with returning to routines and activities

While young people often do need to have the expectations associated with daily living reduced for a time, it is usually helpful for children and young people to return to a routine, and have meaningful activity in their lives as soon as they feel ready.

Sometimes as professionals it can be helpful for us to “give permission” for families to do this.  Adults are sometimes worried that children/young people who have experienced a loss might not be ready to return to school, be involved in their usual sporting/extra curricular activities, or be expected to do some level of chores/take responsibility for their possessions etc.  We can reassure families and young people themselves, that when they feel ready it is helpful for routine and activities to resume.

 

9.    Monitor children for traumatic symptoms

Most children who experience loss, even those which objectively seem to be significantly traumatic, do not go on to experience post-traumatic stress disorder or other mental health conditions (Cohen & Mannarino, 2004).  However, a small minority do develop these disorders and it is important for us to monitor and assess whether this has occurred for the bereaved children we work with.  Symptoms to be on the look out for include:

Persistently and deliberately avoiding anything related to their loss or trauma (keeping in mind as stated above that some avoidance is normal) even though this avoidance causes them sorrow or problems
Using drugs and alcohol as a way of coping
Having frightening and persistent “flashbacks” of something related to the loss
Feeling like there is no hope at all for change and/or feeling suicidal

It is important to work directly on these symptoms (or refer and get support from other mental health professionals) if any of these symptoms or behaviours occur.

10.  Provide hope and encouragement to young people

It is important for children’s well-being that they have hope for the future.  They will look to adults to provide this.  We want to – without minimizing their emotions or grief experiences – reassure them that they (and people they love) can and will have meaningful lives with important, valued achievements and times of love and joy – even despite experiencing loss.

Walking the line between providing hope and not minimizing distress is a tricky business – if done poorly we can come across as uncaring and unsympathetic.  However, it may be appropriate, depending on our relationship with the young person to tell young people about research which suggests most young people do recover from grief.   For example, Melham et al (2011) found that  90% of children/young people who experienced the bereavement of a parent had significantly reduced grief reactions after 3 years.  Bonanno et al (2002) also found that a pattern of “resiliency” (recovering well from a bereavement) was much more common than “common” or “chronic” grief.

If we are providing this hope and reassurance, it is important to do it not in the moments when young people are feeling and experiencing it most strongly as this can be invalidating.  It is usually best to wait for times when they appear to be feeling a little more optimistic.  It can also be useful to ask permission to talk about recovery and hope, for example:

Would you like me to tell you about how other young people cope after a while of grieving?  Of course this takes a while but it might help to know that most people/kids/teens who….(insert loss) don’t feel like this forever.  I think you/others… will feel more hopeful and enjoy life more as time goes on.

You will always remember xxx/the time when we had xx.  We will always miss….sometimes.  I believe you/others will make a new life now that which includes….

11.  Help children and young people have support over the long term

While most young people do recover well from even the most traumatic of losses, it is important to acknowledge that even young people who are generally coping very well are likely to experience some grief experiences (which may be small or intense) long after their loss.

In part this is because young people experience much more change and new events in their lives than adults.  For example, children who experience a loss in primary school will start high school, getting a new job, start new relationships and so on – all after their loss.  These new life events often trigger new grief reactions as young people realise and remember again their loss in their new life situation.  Some research suggests that up to 30% of children experience increase in grief reactions after 9 months (Melham et al (2011).

As professionals, if we can be available intermittently for young people over the long term, this can be very helpful (for example, them having our contact details, permission and ability to contact us as needed over a period of months or years).   However, we might not always be able to do this.  If this is the case, it can be helpful to talk with young people about the fact that grief reactions may come up later for them – and who and how they can get support as the weeks and months pass.

We can also write up a “support plan” for them to use, they might have this on their phone or device or we can speak with family members

12.  Self care

Working with children and young people who have experienced grief and loss is of course a potentially difficult and heart rending task.  It is essential we practice advanced self care, get supervision and support and care for ourselves as we do this work.

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