GRAND COUNTY SCHOOL DISTRICT

264 South 400 East | Moab, Utah 84532 | 435.259.5317
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Grand County School District Office

DEATH AT SCHOOL  Adapted from Janice Harris Lord, M.A.D.D.

"All available evidence suggests that not to assist the bereaved child in actively confronting the death, is to predispose them to significant pathology and lifelong problems. They may be haunted with a sadness they cannot explain." -Theresa A. Rando, 1984

As a society we are afraid to talk to children about death. We try to shelter them from the harsh realities. We do it in kindness and yet, we are harming the child because we prevent him/her from developing not only skills to cope with loss, but from developing the attitude that death a natural and normal part of life.

Why don't we talk to children about death? We are unsure what to say. We are uncomfortable with death ourselves. We feel the need to protect and shelter. We believe talking about it will create fears and/or anxieties.

Even if we fail to talk to children about death, they learn about it from the world around them. These "learnings" don't always promote the best understandings. Cartoons, books, movies, fairy tales and games all present death as reversible and avoidable. Death is a fate that only happens to the "bad" guys.

Death is an integral part of life. Don't deprive children of this knowledge.

Thousands of school age children die each year. In addition thousands more experience the expected or unexpected death of a parent or grandparent. One of every seven children loses a parent to death before the age of ten.

Now more than ever schools operate "in loco parentis" ? in place of the parent. For many children classrooms become a secondary family, and for some it may substitute as the family. The role of the classroom may be especially important when parents are so distraught over a death that they cannot give their children the attention they need. In these cases, the child loses not only the person who died, but in a sense his or her surviving parent as well.

Teachers and school counselors feel insecure when confronted with death. They believe that honesty is the best policy, yet they are afraid they will say "the wrong thing." Half-truths in the form of cliches are the easy way out, but they are disturbing to children.

The school professional's goal in dealing with a death should be to:

- acknowledge the death honestly.
- allow children to ventilate their feelings.

- offer an outlet for the children's desire to help.

Most important, school professionals must remember that working through grief takes time, and it's an individual process. Holidays, birthdays, and other special events are very difficult when someone loved is no longer alive to share the celebration. Be patient.
  

ELEMENTARY SCHOOL

Death of Parent or Sibling of Classmate

Since the child will be absent from school for several days, the school is usually informed of a parent or sibling's death from a source other than the bereaved child. Children who knew the classmate's parent or sibling may have reacted strongly to the death, but are often overlooked because of their indirect involvement.

Also frequently overlooked are those who did not know the deceased well, but had memorable interactions with them. For example, a young girl accidentally hit her friend's sister with a ball and was unable to convince her that it was an accident. A week later, the girl who had been hit dies unexpectedly, leaving the girl who hit her with extremely distressing feelings of guilt. A child playfully teased by a classmate's older sibling, though he didn't know the sibling well, can react strongly when the news is received of the sibling's death.

Elementary school children can feel very anxious after learning of a death because they are so dependent upon their own parents and siblings. They may worry about what would happen to them if it had been their own parent or sibling who died. For the first time, they may be aware of their own vulnerability to death. Teachers and other school professionals may hear students day, "Children are not supposed to die." Some children may react by becoming fearful, overly cautious, clumsy or aggressive.

If the death of the parent or sibling is upsetting to many students, the Crisis Intervention Team may be called to assist with the initial discussion about death. The principles below are important to all classroom discussions about the death.

  • Tell the truth. Before telling the class, get as much information as possible from the family about the death. Tell the class what happened in terms that are appropriate to their own cognitive and developmental levels. For example, children may be concerned about whether the person was in pain, or why someone did not stop the death. If the person died in surgery, the professional and the teacher will need to be able to discuss the rarity of this occurrence and that the surgery itself did not cause the death (if that is true). Accurate information is central to the child's ability to analyze events and draw personally relevant conclusions.
  • Avoid giving unnecessary information that would only serve to distress or confuse the children. Avoid creating mental images of frightening or horrifying sights. Dispel any "Halloween" type myths, which are common among elementary age children. Elementary age children think very concretely. Therefore, explain concretely what happened. Hearing the truth may help to stop rumors. Out of their own anxiety, children will need to talk about the death, and if they don't have accurate information they may distort the truth. For example, other children told a five-year-old boy, whose father was killed by a gunshot, that his father was a "bad guy" because only "bad guys" get killed. Young children especially may need repeated reassurance that rumors are not true.
  • Allow for expression/affirm all expressions. After telling the children set aside at least 30 minutes to allow them the opportunity to share their feelings about it. A student may say, "I'm glad it didn't happen to me." That is a very honest response. It should be affirmed, not as self-centered, but as honest. If a student begins to cry let the child know that feeling sad at a time like this is very normal. Crying over something that is very sad is different from acting like a baby. Overly distraught children should be referred to the Crisis Team or a counselor.
  • Written expressions. Set aside time for written expressions for the bereaved child. Notes, letters, or pictures created for the bereaved child can mean a lot. The class can decide if they want their notes and pictures to be taken to the home before the child returns to school, or if they want to wait until the bereaved child returns. ALWAYS screen these projects before delivering them. Older elementary children can be amazingly cruel out of their own fear and anxiety. Insensitive expressions signal a need for emotional help.
  • Plan for the bereaved child's return. Guide the class in deciding what to say and how to act when the bereaved child returns to school. The subject should not be ignored, yet not every student should expect the bereaved child to want to talk about it. In addition to the death in the family, it is devastating for the bereaved child to be abandoned by friends at school, thus experiencing another psychological loss. Classmates might acknowledge it with a statement like; "I'm glad you're back. I'm really sorry your mother died," and then treat the child as they did before the death. Closer friends might say, "I feel so bad for you and I would like for you to tell me about it when you feel ready."
  • Look for trouble signs when the bereaved child returns. Some elementary age children will want to stay home following a death, possibly out of fear. "Will I die?" or "Will someone else I love die?" are common fears. Staying home should be discouraged. Bereaved children are easily distracted and they are frequently confused and forgetful. Emotional outbursts of anger are common. Stomachaches, headaches, eating and sleeping disorders may increase because grief is physical as well as emotional. When these things happen, children need acceptance and support more than discipline. They need to feel they are loved in spite of their behavior.
Discipline should not be relaxed during bereavement, nor should it be enhanced. Teachers should expect and accept regression in the quality of work of the bereaved student. A graduated curriculum may be necessary. The child may be assigned the same homework, only less of it, to maintain self esteem despite lowered concentration. After school tutoring may become necessary if the quality of the student's work is seriously diminished.

Bereaved children need to tell and retell the story of what happened to them. It helps them process it ? piece by piece until they form their own developmentally realistic understanding of it. As Rabbi Earl Grollman says, "If it is mentionable, it is manageable."
 
 
 Death of a Classmate or Teacher

The death of a classmate or teacher can be almost as devastating as the death of a family member and should be acknowledged as such. If a teacher dies, rather than abruptly introducing an unknown substitute, the principal or counselor should take over the class and assist in transitioning the children to a new and carefully chosen teacher.

  • The child or teacher's desk should not be immediately removed. Leaving it as it was for several days may help acknowledge the death. Some classrooms have voted to keep the desk through the remainder of the school year.
  • Get as much information as possible from the family and ask their permission to share it with the class. Ask if they have any objections to students attending the funeral.
  • Tell the class before telling the rest of the school. Ask the class if they would like to attend the funeral if their parents give permission.
  • Tell the truth, allow for ventilation and affirm all expressions. Because the classmates knew the deceased classmate or teacher intimately, their initial focus may be on him or her rather than on their own feelings. After explaining what occurred, you might talk about fond memories of the deceased and ask the children to do the same. Some children, however, will be too numb to reminisce because they are too preoccupied with the death. Some may focus more on their personal loss, such as the child who after his teacher suddenly died asked, "Why couldn't she wait until after the field trip?" Such statements are genuine expressions of loss. If the children will not talk, use a "write a paragraph or draw a picture" exercise that allows expression or memories. Some children are reluctant to talk about their feelings because they fear no one else feels the way they do.
  • Allow breaks. Children grieve intermittently and cannot focus on their grief for extended periods. Resume the regular classroom schedule after the break.
  • Watch for trouble signs among the children such as increased aggression, withdrawal, risk-taking, clumsiness, or regression. After the death of a classmate one boy began to fall down more frequently. He later explained that he fell to hide his crying because he was sure he was the only one still sad about the death.

Death of Grandparents, Non-Primary Family Members and Pets

These deaths are very significant for elementary age children because they are frequently their first encounters with death. When a child mentions such a death, the teacher or counselor should drop everything and listen.

"I'm so sorry. Tell me what happened," opens the door for the child to ventilate. To acknowledge the significance of the death, ask the child to share a few special memories of the person or pet that died. The school professional might then share how she felt when she experienced a similar death. Reassure the child that death is sad and can be frightening for people of all ages, and that even adults have difficulty facing it.

While it will probably not be necessary to devote lengthy classroom time to these deaths, it may need to be acknowledged in the classroom family with the bereaved child's permission. School professionals too frequently overlook the death of non-primary family members and pets as non-significant. The classroom can play a very important role by offering support, structure and companionship during a time when the biological family may be distressed.
  

Protocols

Three Intervention Styles

Enabler…

  • Fosters the "status quo"
  • Acts for the person
  • Enables the existing process - no changes
  • Adds power and energy to the system
  • Denies the problem, compensates, covers
  • Tries to prevent consequences
  • Is equal or inferior
  • Discards personal needs - boundaries are blurry
  • Is trapped, becomes dependent on outcome
                Result: The "helped" feel less capable.

Empowerer…

  • Encourages independence
  • Acts with the person
  • Serves as a resource and gives feedback about the process
  • Encourages more effective use of power and energy
  • Acknowledges the problem but focuses on options
  • Allows consequences
  • Equal
  • Takes care of self - boundaries are clear
  • Remain free, not dependent on outcomes
                Result: The "empowered" feels more capable.

Rescuer…

  • Fosters dependency
  • Acts for the person
  • Tries to remove the person from the process
  • Attempts to replace the person's power and energy with the rescuer's energy
  • Tries to fix the problem, imposes solutions
  • Tries to remove consequences
  • Is the hero, may act superior
  • Acts based on own needs - boundaries are blurry
  • Becomes trapped, is dependent on the outcome
                Result: The rescued feels less capable.
 

Intervention Model for an Individual

A crisis is usually a problem that an individual cannot solve on his or her own. It can be a death, a tragedy or any upsetting event. In helping someone cope during this time the following format may be facilitative:

Develop a relationship:

  • Listen.
  • Encourage the expression of feelings and actively listen.
  • Be accepting and supportive, resist the urge to fix or minimize.
  • Be patient.
Clarify the Problem:
  • A crisis causes confusion and disorganized thinking.
  • Active listening will often assist in clarification and organization.
  • Open-ended questions should be used to clarify the central issues and explore possible alternatives.
Evaluate the Seriousness of the Crisis:
  • It is important to remember that the situation might not seem serious to you but to the person in crisis it may seem hopeless.
  • Hard and fast rules may not apply here.
Assess the Availability of Resources:
  • What personal and community resources are available?
  • Can friends and family assist?
  • Identify those resources that can be used.
Develop a Plan:
  • Planning should be concrete, realistic and appropriate.
  • Some situations may be resolved simply by listening.
  • Some cases may call for common sense advice.
  • Other circumstances may need referral to community agencies.
  • You may need to make the initial contacts. However, allow the individual to do as much as they possibly can. Don't allow them to begin developing an unhealthy dependency.
Follow Up:
  • Report any concerns to parents and administrators.
  • Do not agree to secrecy if there is any potential danger to the person or to others.
  • Offer continued support.
  • Document your actions.
 

Group Protocol

Establish a relationship and set the tone for the discussion. Model an open, caring and supportive style. Validate the sense of loss. Be directive.

  • Arrange seating to facilitate discussion.
  • Introduce yourself and have students introduce themselves if desired. Explain the group process as appropriate.
  • Ask if there are any questions. Briefly state the facts and dispel any rumors.
  • Express your feelings of sorrow and sense of loss. Use the word "death".
Use reflective listening and empathetic style. Allow an emotional release. Observe participants and assess degree of risk for each. Bring a sense of normality to feelings by validating and valuing each statement.
  • You may want to have students tell you about the deceased, memories, feelings, thoughts, humorous experiences, etc.
  • Discuss the commonality of feelings. Normalize feelings. Feelings are not "good" or "bad".
  • Areas to explore may include guilt, anger, fear or anxiety, shock and sadness.
  • Explore ways to acknowledge the death, show concern for the family and constructive ways to resolve personal feelings (i.e., cards. Letters, talking with others, supporting others, and as appropriate, return to routine activity).
  • Help students identify an adult they can discuss their feelings with (perhaps model how they can start the discussion).
  • Briefly discuss defense/coping skills and how they can help or hurt us.
Summarize and plan. Ask for additional questions or clarification.
  • Re-identify individuals or agencies students can talk to about their feelings and obtain a commitment to use these resources.
NOTE: Students may have cultural or religious beliefs that my cause them to react or cope in ways that are not familiar. These issues should be family discussions and students should be encouraged to talk with their parents.
 
 

The Mitchell Model for Critical Incident Debriefing

Jeffery Mitchell developed a model for debriefing emergency service personnel after a crisis. The model moves systematically from a cognitive level down to emotions and back up to the cognitive level. Some adapting for schools has been done in the following.

Introductions         Guidelines
                                Who's who, goals, rules

Fact Phase            Together everyone recreates the facts
                                Details and varying perspectives related
                                Dispel myths and rumors

Thought Phase     A transition to a more emotional level
                                 Initial thoughts at the time of the incident

Reaction Phase    Share feelings
                                 Share what was the worst part of the incident
                                 Emotions and emotional response

Symptom Phase   Transition back to a more cognitive level
                                 Describe the physical, cognitive, behavioral and emotional reactions
                                 How is the aftermath of the event affecting you now?

Teaching Phase    Remind participants these are "normal reactions of normal people to abnormal events"
                                 Describe common stress symptoms and stress-reduction techniques

Re-entry                  Review support systems
                                Someone to talk with about the incident
                                 Closing comments
 
 

Important Characteristics of the Facilitator Working With Children and Adolescents:
 

  • Is willing to adopt a "teach me" attitude.
        Doesn't always be the expert! Kids will sense this.
  • Has the ability to keep the "child within" alive and nurtured.
Do you play well? You must be able to play in order to work with kids! A child's world is surrounded by play.
Avoid "the hurried child" syndrome.
  • Has the ability to achieve immediacy. Be with them!
  • Is willing to develop a personal theory of helping children.
  • Has the capacity to feel personally adequate and have self respect.
  • Recognizes and accepts ones personal power in the helping relationship with the bereaved child.
  • Expresses a sense of humor.
                    Don't take life too seriously, you'll never make it out alive.
  • Has a desire for continued growth - personally and professionally
  • Has the capacity to be patient.
                    Talk about things other than the death.
   

Adolescent Suicide

Late stage warning signs:

  • Hopeless, helpless feelings
  • Preoccupation with death
  • Communication of preoccupation
  • Expression of intent
  • Increased isolation
  • Increased risk taking behavior
  • Increased feeling of despair, aloneness
  • Saying goodbye
  • Giving things away
  • Making final arrangement, putting things in order
  • Sudden life in mood, appearance and behavior (euphoria)
Intervene and act! In most cases you do not have long.

Every suicide threat or discussion should be taken seriously!

Parents should be notified.

Action should be taken.

Do not make any promises or "pacts" with any students.
 
 

Suicidal Intervention & Interview Strategy

Establish rapport

  • Empathetic listening
  • Share concern
Gather information
  • What is the person's general state of mind?
  • What is the stress level?
  • Check other behavior ? drugs, alcohol, sleepy, acting out, etc.
  • Explore intentions, fantasies ? Have you thought about harming yourself? How? When? What is the pay off?
  • Has anyone close to you attempted suicide?
Assess ability to function
  • Coping skills
  • Support from family, friends, others
  • Self image
  • Other resources
ACT! Establish a concrete plan
  • Immediately contact parents and other professionals
  • STAY WITH THE STUDENT
  • Share your concern
Follow Up
  • Document all actions and contacts with parents, students, others
  • Monitor the student
     

Responses to Suicide and/or Death

Suicide is the one murder in which the killer is also the victim. This makes grieving more complex. With teens it is especially important to neither minimize, sensationalize or glorify suicide.

SHOCK

Some individuals may initially appear remarkably non-reactive. In fact they are in a state of shock and not yet able to accept the reality of the death. The shock provides insulation, it is necessary.

Response: Above all remain calm. Convey your concern verbally and non-verbally. Show a willingness to listen when the students are ready.

GUILT

Typically, students who knew the victim may move from blaming others to blaming themselves. "If only I had talked to him more."

Response: Here particularly it is important to introduce the reality principle. One person cannot assume total responsibility for the aid of another.

ANGER AND PROJECTION

Some students will look for someone to blame. Initially this may be directed at important adults in the victim's life ? including school staff. "Why did they let it happen?" Some expression of anger must be allowed.

Response: If appropriate, share similar feelings. However, a realistic view of the suicide must be maintained. There are limits on how much responsibility we can assume for another person or their actions.

ANGER AT THE VICTIM

This is common even by those not closely connected to the victim. "How could he do this to us?"

Response: Give permission for such expressions by normalizing them, tempered by questioning if the victim fully realized the impact of the act.

ANXIETY

Students will begin worrying about themselves. "If he could kill himself because he was upset, maybe I could or my friends could too."

Response: Discussion should be guided towards helping students differentiate between themselves and the victim. Explore other options for problem solving.

RELIEF

Once the normal distortion of feelings is resolved, students can allow themselves to feel the sadness of the loss and begin the healing processes.

Response: Guard against encouraging a pseudo-mourning process before students have worked at resolving their conflicts over the death.
   

Communicating with the Media about Suicide

The Public Information Committee of the American Association of Suicidology has provided the following guidelines for news media. These are intended to be general statements to assist you in the responsible presentation of information about suicide.

To discourage or minimize imitative or "copycat" suicides avoid:

  • reporting the specific details of the method
  • descriptions of suicide as unexplainable (e.g. "He had everything going for him.")
  • reporting romanticized versions of the reasons for the suicide(s) (e.g., "We wanted to be together for all eternity.")
  • simplistic reasons for the suicide (e.g., "Boy commits suicide because he has to wear braces.")
In addition the print media can reduce the imitative effect by:
  • Printing the story on the inside page.
  • If the article must go on the front page, print it below the fold.
  • Avoid the work "suicide" in the headline
  • Avoid printing a photo of the person who committed suicide.
In general it is important to report a suicide in a straightforward manner so that:
  • The suicide does not appear exciting.
  • The suicidal person does not seem admirable
  • No approval of the suicide is evidenced
To encourage the alternatives to suicide it is helpful to:
  • Present alternatives to suicide (e.g., calling a suicide prevention center, obtaining counseling, etc.)
  • Whenever possible present examples of positive outcomes of people in suicide crisis.
  • Provide information on community resources for those who may be suicidal or who know people who are.
  • Include a list of suicidal warning signs:
               Suicide threats
                Statements revealing a desire to die
                Previous suicide attempts
                Sudden changes in behavior (withdrawal, apathy, and moodiness)
                Final arrangement (such as giving away possessions)
                Sleeplessness, loss of appetite, hopelessness

What to do:

  • Intervene and act immediately
  • Discuss it openly and frankly
  • Show interest and support
  • Get professional help
     

Other Helps

With elementary students remember:

Don't use child-like talk. Children depend on their world having specific, reliable and predictable expectations. They are dependent. You are an adult. Talk like an adult. Adjust your vocabulary to their level. Slow down your communication.

Watch and listen. Listen to what they are saying. They will guide. If you listen you will know their needs. Consider the child in the context of the family, they mirror what is going on in the family. BE PATIENT.

Grief outlets often take concrete forms. Children are more sensitive to change. They do not have the cognitive skills to deal with changes. Maintain routine and stability. Let the children make cards, a memory box, write letters and color pictures. Allow the child to comfort others. Children cannot sustain long periods of grieving, plan for "chunks" of grief over a longer period of time.

They may not follow your thinking. Be open and honest. Avoid cliches or euphemisms. Adult logic does not match a child's, especially feelings and wants (egocentric). Death is not contagious, help them differentiate. Children especially enjoy stories, allow them to see and feel the emotions of others through stories. With your guidance let them construct meaning.

Let them teach you. Be willing to 'sit in the back seat and let them drive.' You don't always have to be the expert. Do not reject their emotions.

Practical guidelines with teens:
  •     Rumors become law
  •     Peers are paramount
  •     They may be as confused as you are so use attentive listening.
  •     Do not lecture,  explore
  •     Be specific in your communication (write it down)
  •     Define what is important, stress it
  •     Define what is unimportant, ignore it
  •     Recognize with teens that their perception is reality
  •     Be familiar with Adolescent Developmental Tasks
  •     Facilitate mourning needs
  •     Know when to be serious and when to use humor
  •     Know when to refer
It is normal for teens to:

                Engage in limit testing; rebelliousness
                Increase reliance on peers
                Be egocentric
                Have increased sexual awareness
                Be impulsive, lack common sense

RED FLAGS: Signs of need for extra help

  • Suicidal ? REFER NOW
  • Chronic depression, low esteem, sleeping disorders, etc.
  • Isolation from family and friends
  • Academic failure or over-achievement
  • Dramatic change in personality, attitude
  • Eating disorders
  • Drug and alcohol use
  • Fighting / legal troubles
  • Inappropriate sexual behaviors
     

Developmental Theories of Grief

The following is a rough guide for thinking and language differences at different grade levels. Remember, THIS IS A GUIDE ONLY. Children are very unpredictable and have their own timetables for development. Be sensitive to individual differences. Also, remember that you are got getting children through grief but rather helping them with the process. Most researchers would agree that bereaved children do not grieve 'in a certain way'. Each student's response, cognitive, emotional, spiritual and physical are as varied as the personalities of children. An individual child should not be stuffed into a textbook category. However, the developmental stage of a child will have an impact on mourning.

"We must let each bereaved child teach us what grief is like for him." -Wolfelt

Infancy - Toddlers

  • No concept of death
  • Reacts to the emotion in others
  • Changes in normal patterns (sleep, eating, clinging)
  • Crying, restlessness, fussier, vomiting
  • Regression of toilet habits
            Helps:
                                Structure and routine will bring some comfort
                                Offer physical comfort

Preschoolers

  • Concept of death is difficult
  • Death is thought of as temporary or reversible
  • The dead have bodily functions
  • Engage in magical thinking
  • May seem unaffected, ask 'inappropriate' questions to adults, or ask questions repeatedly
  • Bed wetting
  • Bewildered, lack of understanding of scary feelings with an inability to verbalize them
  • 'Baby talk' or other regression
  • May reenact death during play
  • Think they can cause the death
  • No concept that they can die
            Helps:
                                Offer words for feelings (i.e., sad, numb, 'ouchie ' inside)
                                Be supportive
                                'Death' play is okay, offer some guidance in the play
                                Don't offer half-truths
                                Answer questions concretely and repeatedly

Kindergarten - Second Grades
This age group is more fluent in language. However, they continue to rely on senses. If this is true, then these students will have issues regarding what they might have seen, smelled or heard. Safety concerns may exist, such as "Can I walk down that street?" or "Who will take care of me now?" Remember, the thinking for these children is very concrete. . There is limited ability to reason. Distractibility is higher. Plan short interventions. It is also helpful to model or explain 'feeling' words. This age group should be singled out for special concern. They have not sufficiently developed social skills to enable them to defend themselves.

  • May understand that death is final, have little ability to cope
  • Magical thinking is common
  • Panic, "who will take care of me"
  • Fear of losing control in front of others
  • Helpless and passive
  • Generalized fear
  • Cognitive confusion (do not understand the danger is over)
  • Difficulty identifying what is bothering them
  • Lack of verbalization - selective autism, repetitive nonverbal traumatic play
  • Sleep disturbances (night terrors and nightmares; fear of going to sleep; fear of being alone especially at night)
  • Anxious attachment (e.g., clinging to parents)
  • Regressive symptoms (thumb sucking, enuresis, regressive speech)
  • Anxieties related to incomplete understanding about death; fantasies of 'fixing' the dead; expectations that a dead person will return
  • Feelings expressed by behavior
            Helps:
                                Provide support, rest, comfort, food, and the opportunity to play or draw
                                Reestablish adult protective shield
                                Give repeated, concrete clarifications
                                Provide emotional labels for common reactions
                                Help to verbalize general feelings and complaints
                                Separate from physical reminders such as the place where the trauma occurred
                                Encourage them to let their parents know
                                Provide consistent care (e.g., assurance of being picked up from school)
                                Tolerate regressive symptoms in a time-limited manner
                                Give explanations about the physical reality of death

Third - Fifth Grades
This age group no longer relies heavily on sensory input but begin to think in abstraction ('what might be'). They are beginning to organize more with reason. More outward grieving may be seen. Grief may continue to be related to concrete loss and disruption. For instance, "Who will I play with?" "What do we do with the desk?" "Who will help me with math?" You will begin to see some organization and social grieving. Issues may remain concrete and safety may still be a concern. Attention and ability to focus is improving. Continue to explain and model feeling words. Small plans can be developed for feelings that are confusing.

  • Preoccupation with their own actions during the event; issues of responsibility and guilt
  • Specific fears triggered by traumatic reminders
  • Retelling and replaying of the event (traumatic play)
  • Fear of being overwhelmed by their feelings (of crying, of being angry)
  • Impaired concentration and learning
  • Sleep disturbances (bad dreams, fear of sleeping alone)
  • Concerns about their own and others' safety
  • Altered and inconsistent behavior (e.g., unusually aggressive or reckless behavior, inhibitions)
  • Somatic complaints
  • Hesitation to disturb parent with own anxieties
  • Concern for other victims and their families
  • Feeling disturbed, confused and frightened by their grief, fear of ghosts
  • May hang back socially/academically
  • Act out because they don't understand how to handle feelings

Helps:
     Allow time and give permission to mourn
     Help them to express their secretive imagining about the event
     Help them to identify and articulate traumatic reminders and anxieties; encourage them not to generalize
     Allow them time to talk and act it out; address distortions and acknowledge normality of feelings and reactions
     Encourage expression of fear, anger and sadness in your supportive presence
     Support them when they report dreams; provide information about why we have bad dreams
     Help them to share worries; reassure with realistic information
     Help them to cope with the challenge to their impulse control (e.g., acknowledge "it must be hard to feel so angry")
     Help identify the physical sensations they felt during the event
     Offer to meet with children and parent(s) to help the child let the parent know how they are feeling

Middle School
Loss of other significant relationships becomes a major issue. Adolescents may be beginning to think in abstract terms and forming their own opinions about death. They are making a transition from the 'hero parent' to the 'faltering world'. Often teens experience confusion over death, while at the same time having a sense of invulnerability. 'Social grieving' can often become a problem. Students may show grief or not show grief to fit in. commiseration, promised and 'pacts' become warning signs. Relationships with peers are paramount. Adolescents may have to develop new friendships ? this can be frightening for some. Use their increasing ability for organizing to develop plans and strategies for coping.

High School
This is the beginning of transition into adult development. Peers continue to be important but individuality becomes increasingly significant. Worry about death and a realization of their vulnerability becomes an issue. A loss may trigger stress reactions in other areas of life. Just because they are talking doesn't mean we need to fix this. 'Social grieving' becomes an issue but should be lessening.

  • Understand death cognitively but only beginning to wrestle with it spiritually
  • Protest the loss by acting out, withdrawing, drug/alcohol use
  • Think mainly older people die
  • Feel life has been unfair to them show anger, fear, loss
  • Feel they must show control to others but may be feeling upset inside
  • May act out a search for meaning. Engage in dangerous activities that test their own mortality
    • Helps:
      - Acting out behavior should be tolerated if the teen or others are not being harmed.
      - Withdrawal is normal in the short-term. Long-term withdrawal is a signal of need for extra help.
      - A teen's normal egocentrism can cause him to focus exclusively on the effect the death has had on him and his future. After he has had time to explore the issue, encourage him to consider the impact of the death on the larger social group (family, friends, etc.)
      - Encourage this search for meaning to 'why' questions about life and death, unless the search may be harmful to the teen or others.  
       

Critical Incident Stress Information

You have experienced a traumatic event or a critical incident. A critical incident is any event that causes one to experience unusually strong emotional reactions. These emotions have the potential to interfere with our ability to function. Though the event may be over you may now be experiencing some strong emotional or physical reactions. It is very common, in fact quite normal for people to experience emotional after shocks when they have passed through a horrible event.

Sometimes the emotional after shocks or stress reactions appear immediately after the traumatic event. Sometimes they may appear a few hours or a few days later, and in some cases, weeks or months may pass before they appear.

The signs and symptoms of a stress reaction may last a few days, a few weeks, or a few months and occasionally longer, depending on the severity of the traumatic event. With understanding and the support of loved ones the stress reactions usually pass more quickly. Occasionally the traumatic event is so painful that professional assistance from a counselor may be necessary. This does not imply craziness or weakness. It simply indicates that the particular event was just too powerful for the person to manage alone.

Consider these suggestions for the first 24 to 48 hours:

  • Alter periods of exercise with periods of relaxation.
  • Structure your time…keep busy
  • Reassure yourself that you are normal and you are having normal reactions. Don't label yourself 'crazy'.
  • Talk with others. Talking about it is healing.
  • Reach out, people do care. Spend time with others.
  • Maintain as normal a schedule as possible.
  • Avoid the use of drugs and alcohol. Don't complicate the problems with substance abuse.
  • Give yourself permission to feel rotten…it's normal!
  • Keep a journal. Write through those sleepless hours.
  • Do things that feel good to you.
  • Realize that those around you are also under stress.
  • Don't make any big life changes.
  • Do make routine daily decisions. Regain control.
  • Eat regular meals ? even if you don't feel like it.
  • Get plenty of rest.
  • Flashbacks are normal ? don't fight them. They will decrease in time and become less painful.
Seek professional help from a mental health provider or your physician if you feel overwhelmed. It's okay. These people are trained to help you deal with these strong emotional reactions. It is not a sign of weakness!

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