Grief Manual 3k271w

Coping with Loss: A Grief & Bereavement Manual

By: Alana Miller, Angie Colón, Jessica McKenna,

Kristy Eagle, and Paulina Hernandez Luna

Table of Contents What is Grief?

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What can Grief look like?

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Do’s & Don’ts of Grief

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Types of Grief

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7 Stages of Grief

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Cognitive Behavioral Therapy (CBT)

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Pedro-Carroll’s Children of Divorce Intervention Program (CODIP)

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Narrative Therapy: RE-membering

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ASCA Position Statements

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NASP Position Statements

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Community Resources

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References

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Appendices

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What is

?

Grief is what you experience when you have suffered a loss. "Loss" is the key word here because grief not only applies to the way you feel after the death of a loved one but also to the way you feel whenever you suffer the loss of something valuable to you. “It is estimated that 25% of For example, grief often follows a divorce, separation or breakup of a relationship, loss through fire or theft, loss of a job, the shattering of a life-long dream, the loss of one's youth, loss of control, the loss of one's role as a parent when children leave home, and the loss of one's health, eyesight or hearing. In looking at and understanding grief in a broader sense, you may be grieving for something almost your entire lifetime. Fortunately, the grief you experience over your many losses differs in intensity and longevity. (Helen Fitzgerald, http:// www.childhoodbraintumor.org/information-forpatients-and-families/-articles/item/60-grief101-some-common-facts-and-characteristics-of-grief)

children in the United States will be exposed to at least one ‘‘high magnitude’’ traumatic event by the age of 16, and 75% of children will experience the loss of a family member or friend by the age of 10” (Kerig, Sink, Cuellar, Vanderzee, & Elfstrom, 2010)

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What can

look like?

Emotional shock and at times an apparent lack of feelings, which serve to help the child detach from the pain of the moment Regressive (immature) behaviors, such as needing to be rocked or held, difficulty separating from parents or significant others, needing to sleep in parent’s bed or an apparent difficulty completing tasks well within the child’s ability level Explosive emotions and acting out behavior that reflect the child’s internal feelings of anger, terror, frustration and helplessness. Acting out may reflect insecurity and a way to seek control over a situation for which they have little or no control Asking the same questions over and over, not because they do not understand the facts, but rather because the information is so hard to believe or accept. Repeated questions can help listeners determine if the child is responding to misinformation or the real trauma of the event (According to National Association of School Psychologists)

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Types of Grief Type

Description

Normal

There is no normal and typical way to grieve. No timelines and varies between people.

Anticipatory

Grieving before the event has even happened (Long term illness). Can be related to loss of dreams, future plans, family roles, etc. This type of grief can help people prepare for the loss.

Complicated

Debilitating, long lasting, can impair your ability to engage in daily activities.

Chronic

Does not subside and can last over a long amount of time. Complete distress with no signs of improving or feeling better.

Delayed

Suppressed grief with grief symptoms that show up much later than the event and much later than is typical.

Distorted

Intense, Extreme and Atypical reaction. Odd changes in behavior and destructive behavior.

Cumulative

When the person experiences a second loss while still grieving a first loss.

Prolonged

Prolonged and tense. The person spends a lot of time contemplating death, longing for reunion and unable to adjust to life without the person they lost.

Exaggerated

Intensification of normal grief responses. Can include nightmares, self destructive behaviors, drug abuse, thoughts of suicide, abnormal fears and emergence of psychiatric disorders.

Secondary Loss

When a loss impacts many parts of a person’s life. In addition to the main loss, it’s grief over other things lost as a result of the first loss.

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Types of Grief (continued) Type

Description

Masked

Symptoms of grief impair daily functioning but the person does not recognize them as grief. These feelings are masked as physical symptoms or other maladaptive behaviors.

When a person’s culture, group, or community make them feel like their loss is not significant or valid. This happens when the death is stigmatized, the relationship is seen as insignificant, the loss is not a death or the relationship is stigDisenfranchised matized by the society.

Traumatic

Normal grief responses that are combined with traumatic distress as a result of the loved one dying in a frightening, horrifying, unexpected or violent/traumatic death.

Collective

Grief felt as a group -such as a community, society or country. Causes can be war, natural disasters, terrorist attacks, mass casualties, natural tragedy or death of a public figure.

Ambiguous

Losses that lack clarity. Different views of who or what has been lost.

Inhibited

Shows no outward signs of grief. The person inhibits the grief and can lead to physical manifestations and somatic complaints.

Abbreviated

Short lived grief. Role of deceased could be filled quickly, could be little attachment to those who have ed away or could be able to accept and integrate the loss because it was anticipated.

Absent

Shows no signs of grief, acts like nothing has happened. Described as complete shock or denial. Can be concerning if it goes on for an extended amount of time. (www.whatsyourgrief.com) 7

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Cognitive Behavioral Therapy (CBT) What is CBT? Cognitive Behavioral Therapy (CBT) focuses on changing the way someone feels about a specific activating event by changing the way that they think about that same event. Using both behavioral and cognitive techniques to accomplish these goals, “CBT has generated more empirical research than any other psychotherapy model” (Corey, 2013). The ABC Framework, a central tool of CBT, provides a model for visually mapping out a person’s feelings and behaviors so that the student/client can fully understand their own emotions.

(Corey, 2013)

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Why use CBT for Grief? It is believed that when a person is experiencing grief, it is important to be able to distinguish between what a healthy reaction is to grief and what may be considered prolonged dysfunctional grief (Malkinson, 2010). CBT can help in creating more rational ways of thinking making their grieving a healthier process. Using Cognitive Behavioral Therapy as a treatment approach to grief has shown improvements when compared to other methods. Evidenced-based studies have found that, “CBT was more valuable in treating complications in bereavement” when compared to other methods (Malkinson, 2010). Exposure, cognitive reconstruction, and writing are among the various strategies evaluated to measure the effectiveness of CBT.

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Trauma Focused CBT 

11 empirical studies that have shown positive impacts and effectiveness of this type of treatment (“Trauma Focused”, 2012)



Kerig, Sink, Cuellar, Vanderzee, & Elfstrom (2010) found that this particular type of CBT is a “well-validated approach for treating traumatic grief in children and adolescents”, making it a great resource for school-aged children.



There is also evidence that this approach works well with students from various backgrounds, both cultural and ethnic. In addition, has been used successfully in a variety of languages and countries



Can work in as little as 12 sessions

Results from TF-CBT A reduction in PTSD symptoms Improvements in: depression, anxiety, behavior problems, and trauma-related shame and other symptoms linked to the grieving process (“How To Implement”, 2004) If your school district is interested in implementing Trauma Focused Cognitive Behavioral Therapy, a full Implementation guide can be found here.

Limitations of TFCBT May not be appropriate for:  Students whose primary problems include serious conduct problems  Students who are acutely suicidal  Students who actively abuse substances

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**This acronym serves as a guide to which steps should be taken, all of which are used with TFCBT. It is important to that while each student will experience these general steps, each treatment will be individualized to each student’s personal trauma or grief situation. 12

Example of CBT Counseling Session with Student Background Information: Abby is a student in the fourth grade who was adopted by her grandparents since her biological father was not able to take care of her. She considers her grandparents as her own biological parents. Abby experienced a very traumatic event a couple of months ago when her grandpa (“father”) died from lung disease. Abby has not been able to express her emotions about her “father’s” death but continues to show signs of anger. The counselor has been using CBT to help Abby deal with the grief from losing her “father” . This also helps Abby maintain positive memories since she was not able to properly say goodbye. Counselor: Hi Abby, it’s nice to see you again. Abby: Hi… Counselor: How is your week going so far? Abby: It’s okay. People keep asking how I am feeling and if I feel better...but I am tired of having to repeat the story of what happened. People don’t get it, when I tell the story that’s it... there’s nothing else to tell!!! Counselor: I can understand how having to express your feelings could be making you feel upset. Repeating a story that makes us feel unhappy can be very difficult. Abby: Exactly! I just want to move on and not have to what happened. Counselor: I see. Abby do you last week when we spoke about the stages of grief? It’s okay that you are unable to talk about what happened. It could take a long time before you are comfortable and ready to talk. Abby: Yes. Counselor: Well, I just want to remind you that it’s okay if you don’t want to talk about what happened. I want you to that when you feel ready to express your emotions and feelings about how you felt and continue to feel after your father’s death; I will be willing to listen. Abby: Yes I understand, thank you. Counselor: I also want to remind you that in order for me to help you, I will need to ask more questions about the events, thoughts and feelings you’ve experienced. This will help us to slowly understand how you feel and how we can work together in order for you to start coping with the loss of your father. This will happen when you are ready, so please, do not feel that you have to do it rght now. Do you understand everything I have just said? Abby: Yes I do. Counselor: I know you are tired of repeating the story but I would like to invite you to try telling your story from a different perspective. Imagine your story is like a movie script and you are the director. As the director, you will be describing the emotions, feelings and actions of the event so that the actors can show it exactly how it happened. We can record it and you can listen to it when we are done. If you don’t like it, we can try it again. How does that sound? Abby: Really? HaHa. Well, actually, that does sound like fun. Okay, I want to try it. Counselor: Great! We can start whenever you are ready, okay? Abby: Yes, well, “my mom put her head down on his chest to listen for his heartbeat, and it went bum, bum, bum, bum and it stopped. And then my dad just died. I had never seen anybody die, and that was really scary. I was crying a lot and hugging people. Those people made me feel a little better not to be alone” Counselor: That was great! I really appreciate that you shared your story with me. Would you like to hear it? Abby: Yes, please! Haha. (counselor plays recording for client) Abby: It sounds funny but this helps me to express how I feel. I just wish I could have said goodbye to him before he died. I was playing with my friends and I didn’t really see my dad that day. **In this session, trauma narration was the particular technique used in order for Abby to be able to tell her own story. (Adapted from Kerig, Sink, Cuellar, Vanderzee, Elfstrom, 2010)

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Pedro-Carroll’s Children of Divorce Intervention Program (CODIP) What is CODIP? CODIP is grounded in cognitive behavioral therapy and child development therapy. CODIP is a school-based, preventively oriented intervention program designed to help groups of children between the ages of 5-14. CODIP creates a ive group atmosphere in which children can share divorce-related feelings, clarify common misconceptions, and reduce feelings of isolation and builds competence by teaching problem-solving, communication, and anger control skills to help children cope adaptively with challenges posed by parental divorce (Pedro-Carroll & Cowen, 1985).

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Target Audience The program consists of four manuals that target age groups based on developmental characteristics Students of all genders and ethnicities are able to use the program. Kindergarten and first grade Second and third grade Fourth through sixth grade Seventh and eighth grade

Programs main goals: 1. To reduce the stress of parental divorce by providing a ive environment 2. To build skills that can help children cope with the various challenges related to parental divorce

History of CODIP CODIP was first implemented during 1983 in Rochester New York , at 5 suburban schools. Since then, CODIP has be implemented in over 500 schools throughout the United States.

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Evidence Based Practice CODIP has been replicated and subjected to empirical evaluation. PedroCarroll and Jones (1985) determined efficacy of the program by assessing parents, teachers, group leaders and children. Teachers reported that students displayed less shy-anxious behaviors and learning issues while improving social skills, tolerance, adherence to rules and assertiveness. Parents and leaders reported similar results. Children reported less anxiety than the control group. A replication with different participants yielded the same results (Pedro-Carroll et al., 1986) Three additional quasi-experimental trials of CODIP have shown significant positive program effects on internalizing and externalizing problems, competence, and adjustment compared with non randomized control groups (Connolly & Green, 2009) (Velderman, Pannebakker & De Wolff, 2011). In a replication using second and third grade urban children, pre- and post- intervention results indicated that CODIP children reported greater improvements on measures assessing feelings about self and family and coping abilities than children from either divorce or intact comparison groups (Alpert-Gillis, Pedro-Carroll, and Cowen, 1989).Results from that study infer that the program can be used for various ethnicities and socioeconomic background. (Pedro-Carroll & Jones, 2005)

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“About half of all marriages end in divorce. Two thirds of divorce involve children. 20% of children who experience divorce have a variety of psychological and social difficulties that follow them through adulthood. As adults, they are 2x more likely to experience mental illness, substance abuse, and failed relationships.” (Desrochers, 2004)

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CODIP’s Curriculum 10 -15 sessions ranging from 45 to 60 minutes. Curriculum is divided into four different categories. 

The first set of sessions addresses children's divorce-related feelings and understanding of family changes, providing children with an opportunity to get to know one another and share their feelings and common experiences. These sessions also focus on clarifying children's misconceptions about divorce, and books and film are used interactively to convey an understanding of family transitions

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In the second set of sessions, children are taught self-statements and techniques for resolving interpersonal problems. A key distinction is made between problems beyond the children's control (e.g., parent reconciliation) and those within their control (e.g., appropriate ways of communicating their feelings).

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In the third set of sessions, anger and other common divorce-related feelings are addressed using puppet play for young children and role-play for older children. Common divorce-related problems are acted out with real-life examples of effective ways of solving problems.

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The final set of sessions focuses on evaluating the group experience and discussing feelings around completion of the program (directly quoted from website) This is used in place of role play session. SEE APPENDIX FOR ADDITIONAL INFO ABOUT CODIP

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Narrative Therapy Re-Membering Groups “The term narrative implies listening to and telling or retelling stories about people and the problems in their lives. In the face of serious and sometimes potentially deadly problems, the idea of hearing or telling stories may seem a trivial pursuit. It is hard to believe that conversations can shape new realities. But they do. The bridges of meaning we build with children help healing developments flourish instead of wither and be forgotten. Language can shape events into narratives of hope.” (Freeman, Epston, & Lobovitz, 1997)

Key Points of Narrative Therapy 





Narrative counselors encourage clients to tell their own stories which carry their own meaning (Nafziger & DeKruyf, 2013). The counselor is there to collaborate, not be an authority figure or fix things for the client (Monk & Winslade, 2007). Respect for the client and the client’s knowledge and story is of utmost importance (Monk & Winslade, 2007).

As a counselor you should… 





 

Invite clients to share their story or experience in a new way. Assist clients in finding their strengths and unique options for their story. Externalize the problem – “The problem is the problem. The person is not the problem.” (Monk & Winslade, 2007) Help clients find a preferred story. Understand that all outcomes will be unique, just the clients you work with. 19

What are Re-Membering Groups? Re-membering groups are grief groups that use narrative practices to help students re-member their lost one, not forget about them or move away from them. They are based on the idea that our identities are created by a “club of life” which include “.” These have helped play a role in our life and how we see ourselves, they are a part of our story. Re-membering Groups help link the client’s and member’s lives together, which can help reduce isolation and grief. (Russell & Carey 2002) Re-membering groups avoid the “letting go” or “saying goodbye” that is traditionally encouraged and invites students to continue relationships, through stories, with their dead loved one. For many, the typical response to losing a loved one is to sever the relationship but re-membering helps students find creative and deliberate ways to keep their loved one close to them as a resource for living. By keeping their dead loved ones present, students are not separating themselves from their loved ones and are taking a less ive role in their own grief. (Granados, Winslade, De Witt & Hedtke, 2009) However, re-membering groups are not just recalling the past or reminiscing, it is “…the reincorporation of the dead person’s voices, stories, love and hip in the ongoing community of the living” (Granados et al., 2009). 20

Counselors help their students re-member by: -Having them introduce their loved ones to the group (Who was it that died?) -Sharing Relationship stories (Meaning of that person in the student’s life) -Acknowledge cultural rituals about death (No right or wrong way to grieve) -Creating hip cards (Cards that contain memories, pictures and sayings that the student can keep with them) -Deconstructing messages about death and grief (What had the world told the students about their grief – what worked or didn’t work for them?) -Using the voice of the dead loved one as a resource (Bring the voice of the loved one forward- students imagine what the person would say) These activities, along with others, can help students shift their grieving from what has been seen as lost to what is now renewed. It encourages them to move forward by bringing the voice of the loved one with them, not by letting go of their loved one. (Granados et al., 2009).

Effective For:  Elementary, Middle and High School Students  All cultures  Individuals or Groups 21

Evidence of Narrative Therapy: Evidence for this intervention is limited. The results from the students were informal and anecdotal. However, the from students who have participated in these groups has all been positive.

Limitations of Narrative Therapy: 





Can be perceived as not accepting the reality of death. Re-membering groups are not yet a common practice in schools, so they may not be accepted by all. Can be difficult to measure outcomes.

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Curriculum for a Re-Membering Group (O’Brian, 2009) (Retrieved from jeannineobrian.weebly.com) Lesson Plans Adapted from Granados et al., 2009, & Hedke, 2012 Session 1 Time: 50 minutes Topic: Introduce the dead Materials - journals - pens - chart paper - marker(s) - journal questions written/printed out

Activities 1. Make group rules/guidelines (including confidentiality and “you should…” statements) 2. Group introduce themselves and introduce the person who has died (Briefly.) 3. More detailed introduction of people who have died in dyads. Then each pair shares with the group. Facilitators might ask... a. Can you introduce me to your loved one? b. Tell me about the person who died. c. What things did they enjoy in life? d. What were their professions? e. What were their hobbies and interests? f. What kind of things did you enjoy about them? g. What did it mean to have them in your life? 4. Introduce the concept of journaling exercises, and get started if there is time. Besides in group this week, when are the times that you notice a connection with your loved one who has died? i. Are there some times more than others that you notice this connection? ii. Do you notice this connection more when you are alone or when you are with other people? iii. Are there stories, songs, rituals or sayings in particular that remind you of this person and your connection with him/her? Meet with students briefly during sessions 1 and 2. Remind them to do the journal entry if they haven’t. (Have extra copies of the prompt on hand) SEE APPENDIX FOR FULL RE-MEMBERING CURRICULUM

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ASCA Position Statements The Professional School Counselor and Student Mental Health (Adopted 2009) The American School Counselor Association (ASCA) Position Students’ unmet mental health needs can be a significant barrier to student academic, personal-social and career development; and even compromise school safety. Professional school counselors do not provide long-term therapy in schools to address psychological disorders; however, they must be prepared to recognize and respond to student mental health crises and needs, and to address these barriers to student success by offering education, prevention, and crisis and short-term intervention until the student is connected with available community resources. The Rationale Schools are often one of the first places where mental health crises and needs of students are recognized and initially addressed (Froeschle & Meyers, 2004). Research indicates that 20% of students are in need of mental health services, yet only one out of five of these students receive the necessary services (Kaffenberger & Seligman, 2007). The School Counselor’s Role Professional school counselors are knowledgeable and skilled in working with students who are struggling with developmental or mental health issues, and must provide a comprehensive school counseling program in an effort to promote academic, career and personal/ social development and success for all students. Comprehensive school counseling programs span the continuum of care provided to students and their families, and are consistent with professional school counselors’ commitment to student success. Professional school counselors should:  Provide responsive services including internal and external referral procedures, shortterm counseling or crisis intervention focused on mental health or situational (e.g. grief, difficult transitions) concerns with the intent of helping the student return to the classroom and removing barriers to learning ASCA POSITION STATEMENT ON STUDENT MENTAL HEALTH CAN BE FOUND AT, https:// www.schoolcounselor.org/asca/media/asca/PositionStatements/ 24 PS_StudentMentalHealth.pdf

NASP Position Statements THE IMPORTANCE OF SCHOOL MENTAL HEALTH SERVICES The National Association of School Psychologists (NASP) advocates for the provision of coordinated, comprehensive, culturally competent, and effective mental health services in the school setting which include prevention and early intervention services as well as therapeutic interventions. These services should emphasize competence enhancement, prevention of mental illness, education, early intervention, and coordination of intensive interventions to adequately address student mental health needs. ADDRESSING MENTAL HEALTH PROMOTION WITHIN THE CONTEXT OF SCHOOLS Schools are the logical point of entry for services to promote the mental health and social and emotional competence of students. For nearly half of children with emotional disorders who receive any intervention, schools are the sole providers. Moreover, schools frequently are the primary providers of mental wellness promotion efforts for children.

ROLE OF SCHOOL PSYCHOLOGISTS School psychologists are uniquely qualified to provide comprehensive, cost-effective, mental health services. They are trained to integrate the knowledge and skill base of psychology with their training in education, learning, child development, and educational systems. School psychological services include but are not limited to consultation; the formulation of behavioral intervention plans and behavior management; provision of direct mental health services for individual and small groups; assessment; development, implementation, and evaluation of prevention and intervention programs; crisis intervention; and referral processes. School psychologists are also uniquely trained to bridge the gap between schools and community agencies because their training emphasizes culturally-competent practice, prevention science, mental health services, and ecologicalsystems theories. They facilitate communication and collaboration with community agencies and related professionals, school personnel, and families. As change facilitators, they engage in systems consultation and the promotion of public policies to the education and mental health of children. NASP POSITION STATEMENT ON SCHOOL MENTAL HEALTH SERVICES CAN BE FOUND AT, http://www.nasponline.org/about_nasp/positionpapers/MentalHealthServices.pdf 25

Community Resources ASCA Resources  

http://www.schoolcounselor.org/magazine/blogs/may-june-2008/the-grievingschool https://www.schoolcounselor.org/school-counselors-/asca-resourcecenter/death-dying-grief/journal-articles

NASP Resources  

http://www.nasponline.org/resources/principals/School-Based%20Mental% 20Health%20Services%20NASSP%20Sept%202006.pdf http://www.nasponline.org/resources/mentalhealth/mhtips.aspx

Helpful Articles & Online Resources  

     

http://www.washingtonpost.com/blogs/answer-sheet/wp/2015/01/17/what-not -to-say-to-grieving-students-and-other-tools-to-help-bereaved-kids-at-school/ http://www.childhoodbraintumor.org/information-for-patients-and-families/ -articles/item/60-grief-101-some-common-facts-and-characteristics-ofgrief http://www.childrengrieve.org http://www.whatsyourgrief.com/ http://www.dougy.org/ http://www.schoolcrisiscenter.org/ (Letters) http://grievingstudents.scholastic.com/ http://www.nctsn.org/trauma-types/traumatic-griefhttp:// www.nationalallianceforgrievingchildren.org/national-poll-bereaved-childrenteenagers

San Diego County Resources    

San Diego Access and Crisis Line Call 2-1-1 or (858) 300-1211 or (800) 479-3339 Families Helping Families (The Jenna Druck Foundation—Greif Groups) (619) 294-8000 San Diego Hospice - Bereavement Department (619) 278-6371

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References Alpert-Gillis, L. J., Pedro-Carroll, J. L., & Cowen, E. L. (1989). The children of divorce intervention program: Development, implementation, and evaluation of a program for young urban children. Journal of Consulting and Clinical Psychology, 57, 583- 589. Child Welfare Information Gateway. (2012, August). Trauma-focused cognitive behavioral therapy for children affected by sexual abuse or trauma. Washington, DC. Children of Divorce Intervention Program (CODIP). Retrieved from http://www.nrepp.samhsa.gov/ ViewIntervention.aspx?id=220 Connolly, M. E., & Green, E. J. (2009). Evidence-based counseling interventions with children of divorce: Implications for elementary school counselor. Journal of School Counseling, 26, 1-37. Corey, G. (2012). Theory and practice of counseling and psychotherapy. Belmont, CA: Brooks/Cole Corey, G. (2013). Cognitive Behavioral Therapy. In theory and practice of counseling and psychotherapy (9th ed., Student ed.). Belmont, Calif.: Wadsworth. Desrochers, E. J., (2004). Divorce: a parents' guide for ing children. Retrieved from http://www.nasponline.org/resources/parenting/divorce_ho.aspx Epston, D., Freeman, J. & Lobovits.D (1997). Playful approaches to serious problems: Narrative therapy with children and their families. New York, NY: Norton & Company, Inc. Granados,S. Winslade, J., De Witt, M., & Hedtke, L. (2009). Grief counseling groups for adolescents based on re-membering practices. Journal of School Counseling, 7(34), 1-26.

Helping children cope with loss, death, and grief tips for teachers and parents (2003). National Association of School Psychologists. Retrieved from http://www.nasponline.org/resources/ crisis_safety/griefwar.pdf J O’Brian. (2009). Small-group bereavement counseling with middle school students. Retrieved from jeannineobrian.weebly.com Kerig, P. K., & Sink, H. E., & Cuellar, R. E., & Vanderzee, K. L., & Elfstrom, J. L. (2010). Implementing trauma-focused cbt with fidelity and flexibility: A family case study. Journal of Clinical Child & Adolescent Psychology, 39, 71327 722. doi:10.1080/15374416.2010.501291

References Klein Velderman, M., Pannebakker, F. D., & De Wolff, M. S. (2011). Child adjustment in divorced families: Can we successfully intervene with Dutch 6- to 8-year-olds? Retrieved from https:// www.tno.nl/ media/4524/stoere_schildpadden_2nd_ed_140603_2014r_10697.pdf Malkinson, R. (2010). Cognitive-Behavioral Grief Therapy: The ABC model of rational-emotion behavior therapy. Psychological Topics, 11(6), 289-305. Nafziger, J.& DeKruyf, L. (2013). Narrative counseling for professional school counselors. Professional School Counseling,16(5), 290-302. Pedro-Carroll, J. L., & Cowen, E. L. (1985). The children of divorce intervention program: An investigation of the efficacy of a school-based prevention program. Journal of Counseling and Clinical School Psychology, 53, 603-611. Pedro-Carroll, J. L., Cowen, E. L., Hightower, A. D., & Guare, J. C. (1986). Preventive intervention with latency-aged children of divorce: A replication study. American Journal of Community Psychology, 14, 277-290.

Russell, S. & Carey, M. (2002). ing: responding to commonly asked questions. The International Journal of Narrative Therapy and Community Work, (3). The National Child Traumatic Stress Network. (2004). How to implement trauma-focused cognitive behavioral therapy. (Version no. 2). Los Angeles, CA. Winslade, J.M. & Monk, G.D. (2007). Narrative counseling in schools: Powerful & brief. Thousand Oaks, CA: Corwin Press

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Appendix A-1

Children of Divorce Intervention Program (CODIP) How to Implement Cost is $125.00 per manual Can be purchased at https://www.childrensinstitute.net/programs/codip How to know if the program is working? Program provides instruments to evaluate children’s behavior and social/ emotional literacy. There are pre-tests and post-tests.

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Appendix B-1

Curriculum for a Re-Membering Group Session 2-6 + Pre/Post Surveys (O’Brian, 2009) (Retrieved from jeannineobrian.weebly.com) Lesson Plans Adapted from Granados et al., 2009, & Hedke, 2012

Session 1 – Please see page 23 of this manual for session 1 curriculum Session 2 Time: 50 minutes Topic: Unpacking the language of grief Materials - Journals - Pens - Additional blank paper and something to write on (table, book, whatever) - White board or chart paper - Markers - Journal question written out/printed Activities 1. Facilitator asks about the experience of the first session and journal writing 2. Students work in dyads to answer: What kinds of things did people say to you before your loved one died or since his or her death about how you were supposed to feel, think, or act? Students write down their answers, not judging or discounting, just recalling. 3. When time is up, the group comes back together and shares what they talked about in pairs. The facilitator writes down answers on the whiteboard. 4. The facilitator asks about cultural messages that came from things like sympathy cards, TV, religious leaders, friends, etc., and adds to the white board. 5. Students evaluate the comments. Of these messages, what has been helpful? Of these messages, what has not been helpful? 6. Journaling (There probably won’t be time, but have prompts just in case a student wants to journal for HW) If you were to give advice to a person facing similar experience, knowing what you know now about what is helpful and what is not, what might you tell them? Meet with students in between sessions 2 and 3 to remind them to bring their object and/or picture. Meet with them on TUESDAY & WEDNESDAY before group on Thursday.

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Appendix B-2

Session 3 Time: 50 minutes Topic: Stories of strength Materials - Journals - Pens - Typed list of comments, words, phrases that the group came up with in session 2 (print one for every student) - Students’ photos and items - Journal question written out/printed Activities 1. Revisit session 2, ask students if they have any lingering thoughts. 2. Sharing items and photos Questions to ask (during sharing) to bring out stories of strength include: a. What do you ire about how (the deceased) faced challenges in life? b. What were his best moments? c. How did she live with adversities? d. In what ways did the deceased rise to the challenge of hardships surrounding his own death? e. What do you think she would appreciate about why you selected this picture or item? f. What does he know about you that would let him know you could manage the challenges in front of you? g. What might she see you succeeding at in the near or distant future? 3. Journaling (just in case we need an extra activity) - What were your loved one’s moments of greatness in life? - What strengths did your loved one have that you would like to keep close to you? - What would he or she say are your own moments of greatness? - What difference would you like this to make in your life as you the stories of strength?

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Appendix B-3 Session 4 Time: 50 minutes Topic: Finding the voice of the deceased Materials - Journals - Pens - Journal question written out/printed Activities 1. Reflect on session 3. If applicable, ask students about a question from Session 3’s journal exercise: What would your loved one say are your moments of greatness in life? 2. ing conversation a. If your loved one were here, what would he say he valued about you? b. What would she say she appreciated about how you were during her illness? (if applicable) c. What would he say he appreciated about how you have handled things since he died? 3. Additional reflective questions a. If you were to your loved one’s words, how might it make today, tomorrow, or whenever easier to bear? b. When you imagine her words of advice living within you, how might you access these words when you need them? 4. Journaling exercise (start during session) Please write a letter from your loved one to yourself. In it, please talk about the things you mentioned in the group. What does your loved one value and appreciate about you? ** Students are asked to bring pictures between sessions 4 and 5 for the re-membering cards**

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Appendix B-4 Session 5 Time: 50 minutes Topic: Stories of Strength (2) Materials - Journals - Pens - Journal question written out/printed - construction paper - scissors - glue sticks - writing utensils Activities 1. Review Session 4’s journal exercise - invite students to read the letters they wrote, and use the letters as a starting point for conversation. 2. Re-hip card activity – Students will make a collage like creation on construction paper. They will write words and phrases related to the person they’ve lost. Hopefully the discussions and journaling exercises in previous groups will lead students to have thoughts on hand. Facilitators will use a copier to shrink the collages down to the size of a typical hip card and laminate them. **Students are asked to bring a picture and/or item of someone who helps keep alive memories of the person who died** Remind students to bring the item between sessions 5 and 6.

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Appendix B-5 Session 6 Time: 50 minutes Topic: Expanding the club Materials: - Journals - Pens - Journal question written out/printed - Collage materials from session 5 Activities 1. Students share the pictures/items they brought with them. Facilitators say… a. Please introduce the group to people in the pictures b. How have they come to know your loved one? c. Who else shares your stories, love and memories of your loved one? d. What is it that they would say they value about your deceased loved one? 2. Give students time to finish up their collages from session 5 3. Reflecting on group a. What has touched you about meeting other people who have died? b. What stories of strength and love have you heard about from others in the past six weeks that have made a difference in your life? c. What would your loved one say that he values about what you have done in the past six weeks in this group? d. If there were one thing your loved one would want others to know about what it means to have her stories shared here, what would she say? 4. Post-group evaluations will be completed a different day, in the office, 1 on 1.

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Appendix B-6

Pre-Group Survey 1) Who was the loved one you lost, and what was their relationship to you? ___________________________________________________________________________

2) When did you lose this person? ___________________________________________________________________________ 3) On a scale from 1-10, how much grief and sadness do you have when thinking about your loved one? 1 2 3 4 5 6 7 8 9 10 4) In addition to grief and sadness, what other feelings have you experienced in connection to the loss of your loved one? ___________________________________________________________________________ ___________________________________________________________________________ 5) What are some things that have been helpful to you when grieving? (what has made you feel better?) ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ____________________________________

6) What is your hope for your time in group with us (how could group be most helpful for you)? ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ____________________________________

7) Is there anything else that we should know before starting group? ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ____________________________________

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Appendix B-7

Post-Group Survey 1) On a scale from 1-10, how much grief and sadness do you have when thinking about your loved one? 1 2

3

4

5

6

7

8

9

10

2) In addition to grief and sadness, what other feelings have you experienced in connection to the loss of your loved one? ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ _______________ 3) What part(s) of group did you find helpful? ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ _______________ 4) What did you DISLIKE about group? ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ _______________ --5) What else should we know about your group experience? ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ _____________________________________

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Appendix B-8

My ______________ is Always with me A ing Journey Written and Illustrated by ______________

My ______________ is always with me. My ______________ was a ____________________ and___________________ person. He/she taught me to____________________ . My ______________ loved____________________. I this every time I am ____________________ . Sometimes, I ____________________. He/she is always with me when I am____________________. I imagine that my ______________ would be happy if he/she was to see me____________________. He/she would know how happy____________________ makes me. He/she would be proud of me for____________________ . He/she loved____________________. My ______________ especially liked____________________. I wonder if____________________ are messages from he/she. When I____________________, I imagine my ______________. My Family and I always him/her when ____________________ I my ______________ even at____________________. Someday I will tell my kids about my ______________. I hope they will like knowing my ______________ like I do. I have seen places and imagined ____________________. I loved to be with my ______________. People tell me stories about him/her. My ________ always tells me that he/she was____________________. ____________________tells me that he/she was. Looking at pictures lets me see that he/she looks____________________. ____________________look just like him/her. I like to introduce people to my ______________. I like to tell people who didn’t get a chance to meet him/her all about him/her. I have told ______________ all about him/her. I have also told ____________________ all about him/her It was nice to tell____________________. My ______________ had____________________. My ______________ is always with me!

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Appendix B-9

My Grandma is Always with me A ing Journey Student Sample

My Grandma is always with me My Grandma was a kind and thoughtful person. She taught me to love other people. My Grandma loved her family. I this every time I see something she owned. Sometimes, I her when we both went to the park. She is always with me when I am sleeping in my dreams. I imagine that my Grandma would be happy if she was to see me at the park looking at squirrels. She would know how happy she makes me. She would be proud of me for thinking of her. She loved me so much. My Grandma especially liked cats. I wonder if she is always with me. When I hear her, I imagine what she looked like. My Grandma and I would always go to the park, when she was alive. I my pancakes even at Rosa’s restaurant. Someday I will tell my kids about her. I hope they will like knowing my Grandma like I do. I have seen places and imagined that she went there. I loved to wear her jewelry. People tell me stories about her. They tell me that my Grandma looked like Snow-white when she was a kid. Looking at pictures lets me see that my Grandma was beautiful. My Grandma and I look just alike. I like to introduce people to my friends. I like to tell people who didn’t get a chance to meet her all about her. I have told everybody all about her. It was nice to tell how she looked. My Grandma is beautiful. My Grandma is always by me and loves me!

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Appendix C-1

Sample Letter to Parents Date Dear Parent, It is with deep regret that we inform you about a recent loss to our school community. On (INSERT date), (INSERT name of the deceased)¹ (INSERT brief facts about the death)². This loss is sure to raise many emotions, concerns, and questions for our entire school, especially our students. Our school (and INSERT name of school district, if applicable) has a Crisis Intervention Team made up of a professionals trained to help with the needs of students, parents, and school personnel at difficult times such as this. At our school (or INSERT name of alternative school), we have counselors available for any student who may need or want help or any type of assistance surrounding this loss. We encourage you, as parents, to also feel free to use our resources. We have enclosed some information that may be useful to you in helping your child at home. If you would like additional information or need assistance, please do not hesitate to (INSERT name of Communications Coordinator or Counseling Services Coordinator) at (INSERT phone number). We are saddened by the loss to our school community and will make every effort to help you and your child as you need. Sincerely, (Type the name of the signer and title. This letter is usually signed by the principal, superintendent, or crisis team coordinator) Examples of information to insert in the opening paragraph: ¹John Smith, one of our 9 grade students Mrs. Jones, who taught 7 grade English th

th

²was killed in an automobile accident died after a long-illness died suddenly died by suicide (before inserting this information, be sure the immediate family is fine with this information being released) http://www.schoolcrisiscenter.org/

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Appendix C-2

Sample Letter to Staff Date: To: All Staff From: INSERT NAME OF SCHOOL Crisis Team Re: INSERT NAME OF DECEASED The recent death of (Insert Name) (has OR is expected to make) a significant impact on our entire school community. Our crisis team has been mobilized to respond to this tragic event. On (insert date), (Insert name of deceased)¹ (INSERT brief facts about the death)². We expect a variety of reactions to this loss from our students, parents, and of our staff. Some of these reactions may be mild, others may be more intense. To effectively assist all of our school community, an emergency staff meeting will be held at (Insert time) on (Insert date) in the (Insert place such as the cafeteria or other large area). At that time, our crisis team will provide further details and answer questions. We will also discuss how to present the information to our students. In the meantime, please refer all inquiries from outside sources to (Insert name of the Media or Communication Coordinator). With students, you can acknowledge that this death has occurred. However, please avoid discussion of any details; simply tell students that the school staff will provide information to everyone shortly. Please refer any student who appears to be in crisis or having significant difficulty to (Insert name of Counseling Services Coordinator). As this tragedy has also effected our staff, we encourage you to also seek assistance from (Insert name of Counseling Services Coordinator), if desired. Emergency Staff Meeting Time: Date: Location: If you have any questions or concerns before the meeting, please (Insert name of Crisis Team Coordinator).

Examples of information to insert in the opening paragraph: ¹John Smith, one of our 9 grade students Mrs. Jones, who taught 7 grade English th

th

²was killed in an automobile accident died after a long-illness died suddenly died by suicide (before inserting this information, be sure the immediate family is fine with this information being released)

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Appendix C-3

Sample Information for Students This information should be given to teachers and other staff to read to students at a designated time to share with the entire student body (e.g., homeroom or first/second period) It is with sadness that I tell you about a loss to our school family. On (INSERT date) (INSERT name of deceased) (INSERT fact about the death). I understand that many of you my have upsetting feelings and questions about (INSERT name of deceased)’s death. I will try to answer any questions that I can. If you would like, we will take the remainder of this class period to talk about what has happened. At times like this, it is okay to have many different feelings, including sadness, anger, and disbelief. It is okay to cry. Together, we can talk about whatever you may be feeling or want to talk about. If I can not answer your questions, or you would like to talk to someone privately, there are rooms now available (INSERT where rooms are located). Anyone who would like to go to talk to someone in the rooms may do so now. I will give you a . Determine which students would like to leave for a room. Ask the remaining students if they have any questions or comments they would like to share. Take time to answer and to talk as the students’ desire. If there is not lengthy discussion, consider quiet seat work rather than lesson plans as usual.

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Appendix D-1

Developmental Grief Responses Age 2-4 Developmental Stage/Task Egocentric. Believe world centers around them. Narcissistic. Lack cognitive understanding of death and related concepts. Limited language skills. Concept of Death Death seen as reversible, as abandonment, not permanent. Common statements: “Did you know my mom died? When will she be home?” Grief Response Intensive response but brief. Very present oriented. Most aware of changes in patterns of care. Asking questions repeatedly. Signs of Distress Regression: changes in eating and sleeping patterns, bed wetting, general irritability and confusion. Possible Interventions Short, honest answers, frequent repetition, lots of reassurance and nurturing. Consistent routine. Play is their outlet for grief.

Age 4-7 Developmental State/Task Gaining a sense of autonomy. Exploring the world outside of self. Gaining language. Fantasy wishing and thinking. Initiative phase seeing self as the initiator. Concerns of guilt. Concept of Death Death still seen as reversible. Personification of death. Feeling of responsibility because of wishes and thoughts. Common statements: “It’s my fault. I was mad and wished she’d die. Grief Response More verbalization. Great concern with process. How? Why? Repetitive questioning. May act as though nothing has happened. General distress and confusion. Signs of Distress Regression: nightmares, sleeping and eating disturbed. Possible violent play. Attempts to take on role of person who died. Positive Interventions Symbolic play using drawings and stories. Allow and encourage expression of energy and feelings through physical outlets. Talk about it.

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Appendix D-2

Developmental Grief Responses (continued) Age 7-11 Developmental Stage/ Task Concrete thinking. Self-confidence develops. Beginning of socialization. Development of cognitive ability. Beginning of logical thinking. Concept of Death Death seen as punishment. Fear of bodily harm and mutilation. This is a difficult transition period, still wanting to see death as reversible but beginning to see it as final. Grief Response Specific questions. Desire for complete detail. Concerned with how others are responding. What is the right way to respond? Starting to have ability to mourn and understand mourning. Signs of Distress Regression: school problems, withdrawal from friends. Acting out. Sleeping and eating disturbed. Overwhelming concern with body. Death thoughts (desire to one who died). Role confusion. Possible Interventions Answer questions. Encourage expression of range of feelings. Explain options and allow for choices. Be available but allow alone time. Symbolic plays. Allow for physical outlets. Listen and allow for talk about the death.

Age 11-18 Developmental Stage/Task Formal operational problem solving. Abstract thinking. Integration of one’s own personality. Concept of Death A more “ADULT” approach. Ability to abstract. Beginning to conceptualize death. Work at making sense of teachings. Grief Response Extreme sadness. Denial. Regression. More often willing to talk to people outside of family and peer . Risk taking. Traditional mourning. Signs of Distress Depression. Anger often towards parents. Suicidal thoughts. Non-compliance. Rejection of former teaching. Role confusion. Acting out. Possible Interventions Encourage verbalization. Allow for choices. Encourage self motivation. Listen. Be available. Do not attempt to take grief away. http://www.dougy.org/grief-resources/developmental-grief-responses/

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