Grief and loss of a caregiver in children: a developmental perspective

Grief is one's response to loss. Each person's expression of grief is unique and influenced by factors such as age, culture, and previous exposure to loss. Whether or not children grieve has been debated, with some proponents stating that children do not grieve at all until they are adolescents, and others asserting that infants are capable of grief. The most common conclusion is that children of all ages do grieve, although their grief is different from that of adults. Children's grief is also closely related to developmental stage, so children of varying ages also grieve differently. Therefore, supporting a grieving child is relative to his or her stage of development. For this reason, it is important for practitioners working with grieving children to understand the manifestations of grief at various developmental stages, to provide competent support to children of all ages who experience loss.     

Perceptions of survivors of loss by homicide: opportunities for nursing practice

Ten adult family members of homicide victims were recruited to participate in interviews describing their experiences related to the loss of their loved ones. A phenomenological approach was used to guide data collection and analysis, resulting in the identification of four major themes. Participants described intense emotional responses and grief complicated by the suddenness, violence, and intentionality of the homicide; engagement in activities that both buffered the emotional effects of the loss and helped them purposefully integrate it into their lives; the strengthening and dissolution of relationships; and a transformative, perpetually evolving post-homicide experience that was viewed as "healing" and that was influenced by many factors. Implications of these findings for research and nursing practice are discussed.     

Juvenile life without the possibility of parole: Constitutional but complicated

The Supreme Court's recent decision in Miller v. Alabama found that juvenile life without the possibility of parole sentences for homicide crimes was unconstitutional if mandated by state law. Thus, allowing this sentence only after an individualized decision determines the sanction proportional given the circumstances of the offense and mitigating factors. This decision, for a number of reasons, does not go far enough in protecting those youthful offenders afflicted with maltreatment victimizations, mental health problems, and/or learning disabilities — all potential links for some adolescents to serious offending and potentially homicide. While the Supreme Court has not protected these youthful offenders from a potential life sentence, there are early interventions and preventative programming that can help decrease serious adolescent offending behaviors. So while many states will, post Miller, allow this life imprisonment sentence, it is only just, in light of the extensive difficulties for many of these adolescents, that their future allows at least the possibility of a parole hearing.     

Helping foster parents cope with separation, loss, and grief

Major changes in planning for children in foster care have resulted in significant changes in the roles of and expectations for foster parents, accompanied by even less attention to the issues of foster families' grief and loss. This article focuses on (1) the many ways foster parents encounter loss and grief on a continuous basis; (2) factors that affect the intensity of the loss and the healthy expression and resolution of grief; (3) problems that can result when the grief of foster parents is not adequately addressed; and (4) ways in which professionals can be helpful to these caregivers around loss and grief.     

Death in Public Child Welfare

Child welfare workers are in a unique position to help children and youth in out-of-home care who have experienced the death of a significant person. This article discusses the response of children to death from a developmental perspective and offers suggestions on how child welfare workers can use an ecological perspective to help youngsters cope with their grief.     

Grief in the initial adjustment process to the continuing care retirement community

This paper examined the transition to continuing care retirement communities (CCRCs) within the framework of anticipatory and disenfranchised grief. Qualitative interviews with 29 residents and 19 adult children were conducted. Three major thematic categories emerged from the data. The first theme reflected ambivalence, dialectics or uncertainty about the CCRC as manifested by the various names assigned to it by respondents. The second theme reflected the acknowledgement of present and anticipatory losses and grief in response to the move. The final theme reflected respondents' disenfranchisement of their grief and loss and their view of the transition in a positive light. In their early adjustment period, residents and adult children are ambivalent about the transition, but often refrain from acknowledging their losses openly because of the image of the CCRC as a status symbol. Open acknowledgement of losses associated with the transition might be beneficial.     

The nameless and the forgotten: maternal grief,sacred protection,and the archive of slavery

ABSTRACT

Death, particularly of enslaved infants and children, cast a long shadow over the experiences of enslaved mothers. Almost half of all enslaved infants died within the first two weeks of birth and another quarter died by age two. Although profit–loss calculations tabulate the frequent deaths of enslaved youngsters, these accounts reveal very little about cultural conventions on maternal grief or how enslaved mothers responded to their children’s deaths. In addition to using the rhetorical to draw attention to the loss women experienced and archival silences on maternal grief, this article challenges the claims that enslaved Africans welcomed and celebrated death because it freed loved ones from bondage and reunited captive Africans with their ancestors. Attention to expressions of grief and evolving grieving practices reveal the transformation of enslaved people’s culture and the invisible suffering of the enslaved, which are sometimes overshadowed by narratives of resistance and the resilience of African culture and black mothers.     

‘I Want to Bring Him from the Aeroplane to Here’: The Meaning of Animals to Children of Refugee or Migrant Backgrounds Resettled in Australia

Separation from animals with whom children have caring relationships can lead to considerable loss and grief, perhaps especially in the case of migration. This article reports on a thematic analysis of interviews undertaken with children of migrant or refugee backgrounds who had resettled in Australia. Findings suggest that children who spoke about animals framed their experiences in ways that either evoked a sense of loss with regard to animals or referred to animals as engendering a safe haven following resettlement. The article concludes by exploring potential service responses and encourages a focus on animals' needs in the context of migration.     

The bad and the ugly: ethical concerns in participatory photographic methods with children living and working on the streets of Lima,Peru

Visual methods are particularly well suited for getting at the ways in which children living and working on the street understand their socio-spatial environment, and can bridge gaps between researcher and researched. In this study, adolescents who live and work on the streets of Lima are asked to take photographs, documenting their lives and their socio-spatial environments. While participatory methods such as photovoice can bring children and adolescents into the research process and can provide significant benefits to research and its participants, the introduction of photographic methods with marginalised populations carries with it important ethical concerns. This article explores the various critiques of documentary photography, and ethical concerns that arise when using visual methods, including issues of exploitation and intrusion in research with adolescents living on the streets. It also examines the ways in which researchers must continuously reassess their methodological practices in order to protect the best interests of the participants involved.     

Wellbeing of children and adolescents with special health care needs in the child welfare system

Children and adolescents in child welfare have the highest rates of chronic conditions and disabilities of any studied child population. The purpose of this study is to determine the wellbeing of children and adolescents with special health care needs (SHCN) in child welfare compared to their peers without SHCN. Wellbeing was measured using the Child and Adolescent Needs and Strengths (CANS) assessment; children and adolescents were assessed on the domains of Life Domain Functioning, Traumatic Stress Symptoms, Behavioral/Emotional Needs, Risk Behaviors, and Child Strengths. Scores on the CANS were compared between initial entry into the child welfare system and 18 months later. This is the first study to assess wellbeing over time of children and adolescents with SHCN in the child welfare system. This study found that children and adolescents with SHCN had increased wellbeing over an 18-month period. By the 18-month assessment, children and adolescents with SHCN presented similarly to their healthy peers, indicating that wellbeing improved more for children and adolescents with SHCN than those without SHCN across several domains of wellbeing. Children and adolescents with SHCN still had significant needs compared to children and adolescents without SHCN in the area of Life Domain Functioning. Adolescents (ages 12–18), with and without SHCN, had greater needs and fewer strengths compared to children (ages 6–11) both initially and 18 months later. Children and adolescents without SHCN also improved over the 18-month period. While this study specifically measured needs and strengths, the findings show that the wellbeing of children and adolescents, as measured across a variety of domains, improved while in child welfare.     

Psychological response to disasters: focus on adolescents

The effects of disasters may predispose many adolescents to psychological stress, which can interfere with their growth and development and disrupt their intrapsychic homeostasis. This may lead to negative long-term health outcomes and hamper normal development. Many nurses view traumatic events involving children, including adolescents, as the most frequent and stressful critical incidents. There is a need to address psychological emergency preparedness for mass disasters with the development of protocols and practice guidelines. Assessing and managing physical injuries may take priority in emergencies, but incorporating rapid, cost-effective mental health assessments for children and adolescents is essential.     

Mothers living with suicidal adolescents: a phenomenological study of their experience

Adolescents who exhibit suicidal behaviors have a devastating effect on their mothers, but unfortunately, the mothers' experience is often the hidden dimension in the family. Currently, there is a considerable lack of research into the maternal experience of living with a suicidal adolescent. This phenomenological study describes and enhances the understanding of what life is like for 6 mothers living with suicidal adolescents. The data were collected through unstructured interviews. Thematic analysis using van Manen's methodology identified six themes: failure as a good mother, the ultimate rejection, feeling alone in the struggle, helplessness and powerlessness in the struggle, cautious parenting, and keeping an emotional distance. From these themes, the essence, "multiple loss and unresolved grief," was captured. The findings have implications for nursing education, practice, and research. In the provision of quality family-centered care, nurses can be educated and guided in their interventions by phenomenological research that recognizes the importance of the maternal perspective in the experience of living with suicidal adolescents.     

Children removed from home by court order: Fathers' disenfranchised grief and reclamation of paternal functions

The study, based on in-depth interviews with 15 fathers in Israel, reports on fathers' emotional reactions to the court-ordered removal of their children from home. The findings show that all the fathers experienced the removal as a traumatic event, which utterly devalued them and annihilated their paternal identity. Although they suffered intense pain and loss well after their children were removed, their grief was disenfranchised as friends and family accused them of allowing the removal to happen. With this, most of the fathers acclimated to the removal and even reported an expansion of their parental identity. The discussion suggests some theoretical conceptualizations of their intense feelings of pain and loss.     

Making visits better: the perspectives of parents,foster parents,and child welfare workers

Mothers of children recently placed in foster care, foster mothers, and child welfare workers participated in semistructured, clinical interviews focusing on the challenges of parent visitation with young children. Mothers described their feelings of grief, trauma, and rage about the forced separation from their children and stressed the importance of emotional expression and communication during visits. Child welfare workers described the complexities of supporting emotionally close parent-child interactions while monitoring and assessing parental behavior during visits. Foster mothers described the importance of preparing children for visits and the difficulties of supporting the children afterward. Implications of understanding mothers', foster mothers', and child welfare workers' perspectives on enhancing the quality of visits with young children are discussed.     

Revising a medication education program on an inpatient child and adolescent psychiatric unit

Adherence to a medication regimen can be challenging for children and adolescents with mental health disorders. Medication education can be a beneficial tool for nurses to help promote adherence to psychotropic medications. This article describes an initiative to improve medication education offered to children and adolescents and their families on an acute child and adolescent inpatient unit in a mental health facility. Strategies included adding a game to medication education groups, creating and distributing medication education handouts, and developing and implementing medication education sessions for parents. When used by the patients and families, the interventions were appreciated. Having successful interventions in place may help meet the diverse educational needs of this population as nurses seek to improve medication adherence.     

Specialist assesstnent services for child abuse and neglect

This paper describes the Child Protection Service, Flinders Medical Centre, South Australia, a specialist assessment service for infants, children and adolescents following allegations of abuse and neglect. The psychosocial and medical services provided for infants, children, adolescents and their families are outlined briefly and the Child Protection Service's view that the assessment process can and needs to be therapeutic is discussed. Data was provided about the age and gender of infants, children and adolescents seen and the number of families referred on for longer-term therapeutic intervention. The unit's philosophical stance, affecting its clinical practice and interagency and consultation service, is described, as is its research focus. The paper also raises a number of issues that warrant further and detailed attention. These include the need for workers to monitor and attend to their emotional responses while working in the area of abuse and the destructive potential of denial that may consequently and subtly impact on professional practice. The tendency for professionals and the wider society to ignore the impact of physical abuse is also raised.     

Child Aware Practice in Adult Social Services: A Scoping Review

The development of “child aware” practice is about the capacity and capability of adult health and social service providers to identify and respond to the needs of children. A scoping review of the literature considered five adult adversities associated with family stress and reduced parenting capacity: mental illness, alcohol and substance abuse, homelessness, intellectual disability, and domestic violence. Although there are specific needs for children pertaining to particular adversities, there was substantial commonality of potential effects. These included emotional and psychological difficulties, physical and mental health problems, academic difficulties, language delays, peer difficulties, stigma, trauma reactions, loss and grief, instability, and social exclusion. How children react to difficulties in their family depends upon various protective factors, a child's frame of reference, and other dynamics within the family that can offset risks. The findings aim to inform policy, program development, and practice in adult social services, enhancing their responsiveness to children.     

My Assistant and I: disabled children's and adolescents' roles and relationships to their assistants

The purpose of this grounded theory study was to describe how children and adolescents with restricted mobility perceive their assistant with a focus on their roles and relationships with one another. The group investigated consisted of 13 children and adolescents with restricted mobility from northern Sweden, aged from 8 to 19 years. The analysis resulted in five categories: 1, the replaceable assistant; 2, the assistant as mother/father; 3, the professional assistant; 4, the assistant as a friend; and finally 5, my ideal assistant. In each category the child/adolescent was seen in relation to the assistant, i.e. the main story 'My assistant and I' from different perspectives. The findings showed that relation towards/from the assistant were both mutual and non-mutual, and that there were relations that by the children/adolescents were perceived as ambivalent and unequal. The findings are discussed on the basis of the significance of these roles and relations in the children and adolescents' development.     

Supporting families: Outcomes of placement in voluntary out-of-home care for children and young people with disabilities and their families

Parents caring for children and young people with disabilities typically have extensive additional demands on their time and resources. This added pressure can significantly impact well-being and mental health. In extreme circumstances, parents may seek an out-of-home placement for their child. Previous research has looked into factors that influence decisions for families to place their child into out-of-home care but little is known about outcomes for these young people and their families. The Supporting Families study aimed to explore the impact of a voluntary out-of-home placement on young people with disabilities, and consequences for their families. Fourteen parents/carers, twenty six case managers, six accommodation services' managers, and four young people with disabilities participated in face-to-face and telephone interviews and focus groups. Participants reported a range of outcomes for young people in care. Positive outcomes included increased levels of respect for themselves and others, an improvement in independent living skills, and reductions in challenging behaviours. Negative outcomes centred on their experiences of grief, loss and rejection, as well as behavioural problems. Positive and negative outcomes were also found for families. For many parents/carers there was a reduction in perceived stress and caring load, as well as improved mental health and wellbeing for them and the child's siblings. However, parents/carers often experienced ongoing feelings of guilt, grief and loss. The study adds to knowledge about outcomes of being in voluntary out-of-home care for this small but vulnerable group of young people in care and their families.