Recovering from Childhood Traumatic Grief Leslie K Taylor PhD Louis A Faillace Department of Psychiatry amp Behavioral Sciences Objectives To identify individual and contextual factors that contribute to grief reactions ID: 928562
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Slide1
Making Meaning & Moving Forward: Recovering from Childhood Traumatic Grief
Leslie K. Taylor, PhD |
Louis A. Faillace Department of Psychiatry & Behavioral Sciences
Slide2Objectives To identify individual and contextual factors that contribute to grief reactionsTo increase understanding regarding emotional and behavioral symptoms associated with childhood traumatic grief
To describe ways to support bereaved children, adolescents, and their families
Slide3Key LearningsThe current status of child and adolescent mental health is concerning, and many youth may have experienced increased risk for trauma exposure and traumatic grief as a consequence of the COVID-19 pandemic.
Children and adolescents
experience grief
differently than adults.
Many youth will naturally recover following traumatic losses; however, there are specific signs and symptoms that can indicate the experience of a traumatic loss and warrant further evaluation.
Slide4Children’s Mental Health
: Status update
Slide51 in 5 children ages 3-17 in the United States reported a mental, emotional, developmental or behavioral disorder [2005-2011]
1
In 2016, of the 7.7 million children with a treatable mental health disorder, about half did not receive adequate treatment
2
From 2009-2019, the proportion of high school students reporting persistent feelings of sadness or hopelessness increased by 40%
3
From 2011-2015, youth psychiatric emergency visits to emergency departments for depression, anxiety, and behavioral challenges increased by 28%
4
Mental health concerns can vary across subpopulations
5AND THEN…the COVID-19 pandemic6-9
https://www.parents.com/health/mental/teens-are-in-a-mental-health-crisis-heres-how-parents-can-help/
Slide6During the pandemic:
School closures
10
Loneliness
11
Child maltreatment and exploitation risks
12
Psychiatric inpatient admissions
13https://www.istockphoto.com/vector/mental-health-problems-in-children-gm1076193752-288188266
Slide7https://www.aap.org/en/advocacy/child-and-adolescent-healthy-mental-development/aap-aacap-cha-declaration-of-a-national-emergency-in-child-and-adolescent-mental-health/
Slide8https://www.hhs.gov/about/news/2021/12/07/us-surgeon-general-issues-advisory-on-youth-mental-health-crisis-further-exposed-by-covid-19-pandemic.html
Slide9https://www.cnn.com/2022/02/25/health/children-mental-health-wen-wellness/index.html
https://www.nytimes.com/2022/03/23/magazine/mental-health-crisis-kids.html
Slide10COVID-19 related BereavementDeath of a loved is most frequently identified as the most distressing life event among both adults and youth.14Approximately 1 in 9 people will lose a grandparent, parent, sibling, spouse or child due to COVID19.
15
From April 1, 2020, to June 30, 2021, COVID-19–associated deaths accounted for the loss of parents and caregivers for >140 000 children; the lives of these children are permanently changed by the deaths of their mothers, fathers, or grandparents who provided their homes, needs, and care.
16
States with large populations had the highest number of children facing COVID-19–associated death of primary caregivers: California (16,179),
Texas (14,135),
and New York (7175).
17
Slide11Slide12Bereavement during Childhood
Slide13DefinitionsBereavement: the period of grief and mourning after deathGrief:
a response or reaction to loss that can include physical, cognitive, behavioral, cultural, spiritual and philosophical dimensions
Mourning:
the expression of an experience that is the consequence of an event in life involving loss
Slide14Childhood GriefNormal grief reactions:
-Sadness, sleep problems, deceased interest in family & friends
-Physical complaints: developmental regression
-May be irritable or withdrawn
-Have trouble concentrating
-Preoccupation with the death
As part of the grieving process:
-Accept the reality of death
-Experience and cope with painful reactions
-Adjust to identity changes-Develop and invest in new relationships to help them cope-Making meaning-Continue through normal developmental stages of childhood and adolescence https://www.nctsn.org/sites/default/files/resources//brief_information_on_childhood_traumatic_grief.pdf
Slide15Childhood Traumatic GriefThe experience of the cause of death is perceived as horrifying or terrifying Trauma related symptoms are present, and interfere with the child’s ability to work through the typical bereavement process, to include:
Avoidance and numbing
Physical or emotional symptoms of increased arousal
Trauma reminders, loss reminders, and change reminders
Happy thoughts and memories of the deceased person result in distress
Secondary adversities/losses
https://www.nctsn.org/sites/default/files/resources//brief_information_on_childhood_traumatic_grief.pdf
Slide16Childhood Traumatic GriefCircumstances of death18 - Exposure to graphic medical procedures
- Images of a dying parent
- Exposure to the severe distress of other family members
- Homicide/Suicide
Slide17Childhood Traumatic Grief“Every time I start missing my brother, I keep picturing his face when we found him…”
“I just try not to think about him at all…”
“I’m never going to be able to graduate like Dad wanted because I can’t stop thinking about his suicide and I can’t concentrate in class”
“I want my brother’s death to mean something. But when I start warning kids about drinking and driving, my mind goes back to the night we identified his body, and then I can’t think about it at all…”
From:
Layne, C. M., Kaplow, J. B., Oosterhoff, B., Hill, R. M., & Pynoos, R. S. (2017). The interplay between posttraumatic stress and grief reactions in traumatically bereaved adolescents: When trauma, bereavement, and adolescence converge.
Adolescent Psychiatry, 7
(4), 266–285.
https://doi.org/10.2174/2210676608666180306162544
Slide18Separation Distress -the challenge of connectionExistential/Identity Distress -the challenge of purpose
Circumstance-Related Distress
-the challenge of manner of death
Multidimensional Grief Theory
Kaplow, J.B., Layne, C. M., Saltzman, W.R., Cozza, S.J., & Pynoos, R.S. (2013). Using multidimensional grief theory to explore effects of deployment, reintegration, and death on military youth and families. Clinical Child and Family Psychology Review, 16, 322–340.
Slide19Supporting bereaved children and their families
Slide20“Effective support with somebody you know is going through a grief reaction is the attitude of open listening and accepting whatever they're saying, and not feeling pressure about giving advice or somehow taking that feeling away from them.”Ted Rynearson, M.D.
https://speakinggrief.org/get-better-at-grief/supporting-grief/support-not-comfort
Slide21What to say (or not say)?
Slide22What to do (or not do)?Don’t expect the person grieving to know what they wantProvide a list of specific options and let them decide what would be most helpful
Ask questions (!) before helping
https://speakinggrief.org/get-better-at-grief/supporting-grief/how-to-offer-support
Slide23Developmental ConsiderationsDiscuss with the parent/guardian what the knows/has been told about the death eventIndirect or abstract terms can be confusing Being concrete about death, and characteristics can help facilitate adaptive reactions
Examples
Death is irreversible and is not a temporary separation
All functions end completely at the time of death
Everything that is alive eventually dies
There are physical reasons why someone dies
Slide24Signs and SymptomsSchool problemsAggressionExcessive guiltApathy or depressionCumulative lossesSocial withdrawal/isolation
Self-destructive behaviors
Suicidal ideation or behaviors
These signs and symptoms may intensify during:
-Holidays
-Transitions to a new grade or school
-Special events, award ceremonies, or graduations, anniversaries
-Rites of Passage
Slide25Support from School & Community Professionals
Make contact with the family and express support
Work with the family to determine
what the child has been told and what they understand
How the child will be supported in school if they get overwhelmed or upset
How to balance flexibility and structure
Any changes to the pupil’s emergency contacts; keeping in touch with the family
How the child’s needs and wishes will be reviewed over time
Therapeutic work – making a memory book / box / jar
Slide26Assessment and TreatmentPosttraumatic stress symptoms - Child & Adolescent Trauma Screen (CATS)
-
Child PTSD Symptom Scale for DSM-5 (CPSS-5)
https://istss.org/clinical-resources/child-trauma-assessments
Grief and bereavement
-Persistent Complicated Bereavement Disorder Checklist
-
Inventory for Complicated Grief–Revised for Children (ICG-RC)
-
https://www.nctsn.org/treatments-and-practices/screening-and-assessments/measure-reviewsTrauma focused cognitive behavioral therapy- Psychoeducation, Emotional regulation,Cognitive coping, Trauma Narrative & Reprocessing, Safety PlanningTrauma & Grief Component Therapy for Adolescents - Modular treatment approach - Foundational Knowledge and Skills, Working Through Traumatic Experiences, Working Through Grief Experiences, Looking to the Future
Slide27UTHealth Trauma & Resilience CenterTrauma focused treatment for school aged children (6-18)
Phone: 713-486-2630
Email:
TRC@uth.tmc.edu
https://med.uth.edu/psychiatry/research/centers/trauma-and-resilience-center/
Slide28https://speakinggrief.org/get-better-at-grief/supporting-grief/say-their-name
Slide29Resources National Center or School Crisis and Bereavement: https://www.schoolcrisiscenter.org/
Traumatic grief fact sheets:
https://www.nctsn.org/what-is-child-trauma/trauma-types/traumatic-grief
Speaking Grief:
https://speakinggrief.org/
Ideas for supporting bereaved:
https://www.childbereavementuk.org/information-remembering
Ideas for remembering for school/college communities:
https://www.childbereavementuk.org/information-school-projects-for-remembering Supporting child/teen understanding of death: https://www.childbereavementuk.org/information-childrens-understanding-of-death Death and Loss (Including Pets): https://mindedforfamilies.org.uk/Content/death_and_loss_including_pets/The Bereavement Box – Nurture UK: https://www.nurtureuk.org/ourservices/publications/programmes/bereavement-box
Slide30References 1Perou, R., Bitsko, R. H., Blumberg, S. J., Pastor, P., Ghandour, R. M., Gfroerer, J. C., Hedden, S. L., Crosby, A. E., Visser, S. N., Schieve, L. A., Parks, S. E., Hall, J. E., Brody, D., Simile, C. M., Thompson, W. W., Baio, J., Avenevoli, S., Kogan, M. D., Huang, L. N., & Centers for Disease Control and Prevention (CDC) (2013). Mental health surveillance among children--United States, 2005-2011. MMWR. Morbidity and Mortality Weekly Report Supplements, 62(2), 1–35.
2Whitney, D.G. & Peterson, M. (2019). US national and state-level prevalence of mental health disorders and disparities of mental health care use in children. JAMA Pediatrics, 173(4), 389-391. doi:10.1001/jamapediatrics.2018.5399
3Centers for Disease Control and Prevention. (2020). Youth Risk Behavior Surveillance Data Summary & Trends Report: 2009-2019. Retrieved from https://www.cdc.gov/nchhstp/dear_ colleague/2020/dcl-102320-YRBS-2009-2019-report.html
4Kalb, L. G., Stapp, E. K., Ballard, E. D., Holingue, C., Keefer, A., & Riley, A. (2019). Trends in Psychiatric Emergency Department Visits Among Youth and Young Adults in the US. Pediatrics, 143(4), e20182192. https://doi.org/10.1542/ peds.2018-2192
5 McLean, C. P., Asnaani, A., Litz, B. T., & Hofmann, S. G. (2011). Gender differences in anxiety disorders: prevalence, course of illness, comorbidity and burden of illness. Journal of Psychiatric Research, 45(8), 1027–1035. https://doi. org/10.1016/j.jpsychires.2011.03.006
6Salk, R. H., Hyde, J. S., & Abramson, L. Y. (2017). Gender differences in depression in representative national samples: Meta-analyses of diagnoses and symptoms. Psychological Bulletin, 143(8), 783–822. https://doi.org/10.1037/bul0000102
7Hedegaard, H., Curtin, S. C., & Warner, M. (2020). Increase in suicide mortality in the United States, 1999–2018. NCHS Data Brief, (362), 1-8. Hyattsville, MD: National Center for Health Statistics.
8Bridge JA, Horowitz LM, Fontanella CA, et al. (2018). Age-Related Racial Disparity in Suicide Rates Among US Youths From 2001 Through 2015. JAMA Pediatrics, 172(7):697–699. doi:10.1001/jamapediatrics.2018.0399
9Reiss F. (2013). Socioeconomic inequalities and mental health problems in children and adolescents: a systematic review. Social Science & Medicine (1982), 90, 24–31. https://doi. org/10.1016/j.socscimed.2013.04.026
10Hawrilenko M, Kroshus E, Tandon P, Christakis D. The Association Between School Closures and Child Mental Health During COVID-19. JAMA Netw Open. 2021;4(9):e2124092. doi:10.1001/jamanetworkopen.2021.24011Loades, M. E., Chatburn, E., Higson-Sweeney, N., Reynolds, S., Shafran, R., Brigden, A., Linney, C., McManus, M. N., Borwick, C., & Crawley, E. (2020). Rapid Systematic Review: The Impact of Social Isolation and Loneliness on the Mental Health of Children and Adolescents in the Context of COVID-19. Journal of the American Academy of Child and Adolescent Psychiatry, 59(11), 1218–1239.e3. https://doi.org/10.1016/j.jaac.2020.05.00912De Boer, C., Ghomrawi, H. M., Bouchard, M. E., Linton, S. C., Tian, Y., & Abdullah, F. (2022). Effect of the COVID-19 pandemic on presentation and severity of traumatic injury due to physical child abuse across US children's hospitals. Journal of pediatric surgery, 57(4), 726–731. https://doi.org/10.1016/j.jpedsurg.2021.06.01413Reece, L., & Sams, D. P. (2022). The impact of COVID-19 on adolescent psychiatric inpatient admissions. Clinical child psychology and psychiatry, 27(1), 112–121. https://doi.org/10.1177/1359104521103066614Kaplow, J.B., Saunders, J., Angold, A., & Costello, E.J. (2010). Psychiatric symptoms in bereaved versus nonbereaved youth and young adults: A longitudinal epidemiological study. Journal of the American Academy of Child and Adolescent Psychiatry, 49, 1145-1154. 15Verdery, A. M., Smith-Greenaway, E., Margolis, R., & Daw, J. (2020). Tracking the reach of COVID-19 kin loss with a bereavement multiplier applied to the United States.
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16https://www.nih.gov/news-events/news-releases/more-140000-us-children-lost-primary-or-secondary-caregiver-due-covid-19-pandemic#:~:text=From%20April%201%2C%202020%20through,%2C%20security%2C%20and%20daily%20care.
17Hillis S, Unwin HJT, Chen Y, et al. Global minimum estimates for COVID-19-associated orphanhood and deaths among caregivers: A modelling study. Lancet 2021 [published Online First: July 20, 2021]
18
Layne M. Christopher *, Kaplow B. Julie , Oosterhoff Benjamin , Hill M. Ryan and S. Pynoos Robert , The Interplay between Posttraumatic Stress and Grief Reactions in Traumatically Bereaved Adolescents: When Trauma, Bereavement, and Adolescence Converge, Adolescent Psychiatry 2017; 7(4) .
https://dx.doi.org/10.2174/2210676608666180306162544
19
Speakinggrief.org