 I'd like to open this evening with an activity that I helped create with a colleague of mine, Jessica Zitter, when we started a program called Death Ed. I'll get back to Death Ed a little bit later, but I thought just for you to get a taste of what we're up to tonight, that we would begin with a group activity. So hopefully when you entered the room tonight, you each collected a set of colored beads. Yes, I hear them. Perfect. So what I'm going to invite you to do is I'm going to pass around this jar and I'm going to ask you to do something. I'm going to demonstrate with incorrectly colored beads, but that's just what I have on hand here. So bear with me. So you'll see behind me is sort of a categorization of what the colored beads represent as far as a relationship that you may have experienced a death with. So for example, pretend that this color bead is red. I'm going to put it in the jar because as you've already heard, my father died. And so red represents either a parent or a sibling death that you've personally experienced. So I would drop in my red bead. The next color is orange. And so that would be for a more extended family member, say a grandparent and aunt, uncle or cousin. So I've lost all of my grandparents, but I'm only going to put in one orange bead pretend this is orange. So when we do this with kids, we actually are using candy. So the incentive is they just put in one color to represent all of the relationships that they may have lost and they get to eat the rest. So you'd put in one orange one for all my grandparents. Next is yellow for say a teacher or a coach some relationship in that vein. So I had a skating coach who died. So I put that in there. And then another color green. I have had many cats and dogs in my life. And as you hear for next the next month session, we'll be learning about how we can support each other when we lose our furry family members. So I would put a green in for all the cats in my life. And then last one I would put in we call blue for someone maybe in the stratosphere, maybe I didn't know personally, but when they died, when I learned of their deaths, say Carrie Fisher, when she died or Prince, when he died, it rocked my world when Prince died, even though I never met him, the work that he provided meant a lot to me. So I would drop in a blue colored bead. So even though these colors don't match there, you all have in your hands colors that match. So I'm going to pass this jar around and invite you to drop in the colors that are true for you. If you've experienced a loss in any of these categories put in that color bead. Does that make sense? And then we'll pass the jar back up to the front when it's gone around the room, okay? All the ones that are appropriate for you in your life, if you've experienced loss in these categories, you just put in that color bead no matter how many of those relationships you've lost. Like I said, I've lost 12 cats, but I only would put in one green bead, okay? And we'll just have that circulate around the room. It might take a few minutes, but when it comes back we'll pause and we'll finish that activity, okay? Does that make sense? Okay. All right, so you just drop it in and pass it on, and then it just goes. And we can have you, if you want to start. It's going to be in that attention, so I think you want to wait. Oh, yeah. So we'll have them pause. Welcome. So you've all received the instructions. What we're going to do is we're going to have you pause that right now so we can move forward in the presentation. And because I'm going to ask you, each one of you, to close your eyes and get yourself seated comfortably in your chair and notice your feet on the ground. And I want you to think back to a time in your childhood or your teen years when you experienced a loss. It could be a pet. It could be a move. So you were saying goodbye to family or friends. It could be somebody in your family, a grandparent or a parent. It could be any kind of loss. It could be a goldfish that was important to you. And think about that loss. Just get yourself back into your child's mind. Think about that loss. What did you need? And did you get support? What were you feeling? And did you get what you needed? When you're ready, you can open your eyes, wiggle your toes, get back in the room. I'm wondering, can I see a show of hands? How many of you had a loss in your childhood or teen years? That's a lot of hands. How many of you got what you needed at that time? Oh, that's interesting. I see one hand going up, two hands going up. How many of you did not get what you needed? Yeah. That's why we're here tonight. That's why we're here tonight. Fortunately, we know a lot more about children in grief and how to support them than we did when many of us were children. And we want to be able to talk about that tonight. So you can continue the jar around the room. So I'm going to be talking about children's understanding of death. We adults tend to think of death as being a very concrete, absolute phenomenon. But to young children, death is often one of the most abstract, challenging concepts that they will ever encounter. Think about it. They are far too young to have an understanding of anything that is irreversible and lasts forever. They're not yet able to think abstractly, and they don't have the knowledge or verbal skills yet to identify or articulate their feelings. Also, the way that death is portrayed in cartoons and digital games, they'll see a character getting killed one moment, and in the next scene, they're springing back into life again. As kids grow and mature, they develop an understanding of what death means, how it impacts them, and how to cope with it. Studies have shown that children think about, wonder about, and discuss death differently at all stages of their development. At different developmental stages, kids will renegotiate what loss means to them. So it will mean something different to them at age five and then something they'll have a different understanding when they're 13 and yet another understanding when they're 18. They re-experience and reinterpret the death each time they have new experiences without their person who died and as they change and their needs change over time. It's important when talking to a young child to give clear, honest explanations about death. Avoid sugarcoating the truth, telling half-truths, or giving partial explanations. If you withhold the truth because you're trying to protect the child from becoming more upset, they usually will hear rumors or truth from other children or adults about what happened and then end up feeling mistrustful, angry, or betrayed. Follow their lead when they ask questions, answer directly and simply and then wait for more questions. You can also ask them, what do you think to get a sense of how well they're grasping the information? So I'm going to talk about different ages now. Infants, newborn to 10 months, the mother or the primary caregiver is their main connection to the outside world. Infants can't identify a primary caregiver until they're almost one year old, but when a primary caregiver dies, they will miss their touch, their scent, their warmth, and their manner as that person attended to their needs and a deep bond is broken. They'll also experience death as an absence, a feeling of gone-ness. It's a sudden change for the infant and there's a broken bond. The death of another family member is usually not as traumatic for an infant as the primary caregiver, but they may perceive the caregiver's grief as they're attending to them and react to it, along with changes in their routine and negative stimuli. So they need nurturing, affection, and for things to stay as consistent and normal as possible. Babies ages 10 months to two years. When they're 10 months old, they can express fear, rage, jealousy, anger, and love. When they're becoming two years old, they can recognize adults and sense their moods and emotions. They're not yet equipped, of course, to conceptualize death or understand it, but the death of a primary caregiver again is a very severe loss of a person that they are attached to and they may not be profoundly affected by the death of other close family members. Babies between the ages of 18 months and two years can understand words and use them to express feelings. So they might say, or you might say to them, daddy gone or mommy no more. So just to keep it very, very simple. Children ages two to four years are egocentric. They're curious and very literal and concrete in how they interpret the world. Vague explanations or indirect language will create confusion and try to avoid using euphemisms like passed away, lost to us, or went to sleep. If we say lost to us, a child might think that at some point the person will be found and return again. And if you say went to sleep, the child might be afraid to go to sleep for fear that they're going to die or fear that if a parent or someone else goes to sleep that they're going to die. So they may ask questions repeatedly and they need short, honest answers. Common questions that they might have would include, did you know my mom died? When will she be home? Two to four-year-olds also perceive death as a temporary state. They can equate death with some form of sleeping where a person may awaken at some point and return to full life. They also might believe in degrees of death from kind of dead to really dead and think it happens to just other people. Include basic body functions and stay simple and concrete so you can say something like when people die they can't eat, they can't see, they can't hear, or walk around, they don't poop, laugh, or cry. Their body stops working, their heart stops beating, and they stop breathing. A dead person doesn't get hungry, cold, or scared. You can also refer to pets or dead animals that they might have seen as another way to explain death. To explain the kind of death that happens as a result of old age, illness, or disease, you can say people can die when they get very, very, very, very old or sick. Using multiple varies implies that most humans have a long life and live to old age. If you say very, very, very, very sick, this teaches the child that there are different levels of sick and death only happens to people who are very, very, very sick. You can also add specific religious or cultural beliefs that you might have, and if this is your child it can be very helpful to hold them in your arms. Touch and physical warmth will provide a sense of security and trust. I have an example of a four-year-old child that I worked with who would run back and forth between two adjoining playrooms. She would say hello to me and then she'd run into the next room and sit there for as long as she could tolerate being alone and then she'd run back into the playroom where I was waiting. This was her way that she was trying to make sense of the concept of separation and death. But this time, unlike with her mother who died suddenly, she was in charge of when the hellos and goodbyes would happen. Another example is a child who was not old enough to verbalize his feelings but he would bury toys in the sand of a sand tray and he would engage in kind of lost and found ritual where little toys would disappear and then he would find them again as a way of showing his longing for the person who died to return. A year later he created a scene where he added tombstones, flowers, and shells etc. for a goodbye ritual for his person who died. Children ages four to seven are gaining a stronger sense of autonomy. They're exploring the world around them and gaining language skills. Death is still seen as reversible and it is common for them to feel responsible because of their thoughts and wishes. They might say something like, it's my fault. I was mad and wished she would die. They'll ask repetitive questions such as how and why. Ages seven to eleven, by the time children have reached the middle years, they have made significant cognitive and developmental leaps. They're much more socially involved and they're more able to grasp concepts. It's the beginning of logical thinking. It is also a difficult transition period where a child is still wanting to view death as irreversible but they're beginning to see it as final and inescapable. They may also see death as punishment and have a fear of bodily harm and mutilation. It's important to tell children in this age group about a death as soon as possible following the same guidelines that were suggested for children four to seven. Give them as much information as you think they can comprehend. I worked with an eight-year-old girl whose father had died suddenly in an accident and she had a father die that she placed on a table that she called heaven and the father doll would come down at each session and visit the girl doll who was on the floor. When she was finally able to understand that death is permanent, she told me this doll isn't going to be able to come down anymore and visit the girl on the floor so we have to say goodbye and then she created a very beautiful goodbye ritual. Ages seven to eleven, the children have a lot of magical thinking and they think that they somehow caused the death. It's important to reassure them that the death was not their fault and they couldn't possibly have caused it. So I'll be talking about teens and grief later. Thank you. Hi everybody just a quick bio on Pat. Pat Murphy knows the part break of a child who has lost the parent. So 12 years ago she founded Josie's place for bereaved youth and families. Pat named the San Francisco based non-profit after her mom and stepmom. Both women were named Josephine and both passed away when she was young. Pat worked through her grief and therapy and inspired by that process she began to volunteer helping other families and young children through the grieving process. For helping people young people and their caregivers grieve, heal, and grow. Pat was awarded the Bay Area Jefferson Award last year August 2018. Thanks Pat. So this is a topic very near and dear to my heart as is Josie's place. Just briefly we offer support in a group setting to families with children between the ages of five and 18. Children younger than that are not really able to be in a group setting and the groups meet twice a month in the evening either on the first and third Wednesday nights of the month or the second and fourth Thursday nights of the month depending on availability and the parents meet at the same time the parent or surviving caregiver meets at the same time so the entire family receives support and being a non-profit we and with the support of the community were able to offer these services free of charge to the families. So I think it's important for us to know that children experience grief the thoughts and feelings around grief in the same way as adults but they process it differently and it looks different in them. They don't as Andrea said the younger kids don't have the language development they don't have the life experience to know to understand the impact this grief is going to have on their life and as adults we tend to be in grief over a long period of time. Children have natural defenses that keep them from going into overwhelm so they drop into the grief and then they step away. They drop in and they step away. They're not able to sustain strong emotion for a long period of time and so you might see them crying and sad one minute and then the next minute you see them playing and laughing and that can be confusing and it can seem like the kids are doing just fine they're not grieving they're doing great the grief is always there it's just that we don't always see it and they're not always touching it. Children don't like to appear different than their peers they don't want to be treated differently so oftentimes too they'll just keep their grief to themselves so that they don't stand out in school or among their friends and some kids don't even want their peers to know they've had a loss and that can be that can be confusing. We've had kids at Josie's place who keep it to themselves because they tend to get bullied and so they'll pick and choose who hears about the loss. We're going to be showing you well another thing I want to say is children tend not to talk about their grief sometimes in group facilitators will say well Johnny really spoke up a lot tonight it was great we haven't heard him talk before well kids don't always talk about their grief they show us their grief through their behavior and that can look like acting out they might be fighting with their siblings more they might be yelling at their parents we hear that a lot from the parents at Josie's place my kids just yell at me all the time they've got this strong emotion and that's a safe place to bring it out they might be fighting with their siblings more they might just find themselves just more frustrated over typical things just having a stronger reaction because they're carrying so much emotion and so much stress so we're going to be looking at a video that was produced by the Dougie Center up in Portland Oregon they're pioneers in the work of children's grief support you'll be hearing from Donna Sherman who is one of the primary experts on children of grief and you'll get to hear from both parents who attend the groups and also children and I think it's rather than me sitting here and talking about children in grief hearing it from them directly and how it impacts them I think is a much easier way for you to obtain the information so I'm going to put on our video children the children that taught her a lot about how to support kids who've had someone in their family die there is no one way to grieve no right way no wrong way adults tend to be more seeped in their grief children tend more to kind of pop in and out one minute they'll be crying and 10 minutes later they'll be hi I'm going to the party and it can be very confusing I said um you know mommy can't come home because she died and the response was okay can I have a snack and and that was that and as a parent it's like wow where do I go from there every child is going to look a little different some children will cry some won't it doesn't mean that they're not grieving inside many adults have a lot of anxiety about the words to use when telling a child that someone has died my best advice is to take a deep breath to simply very simply share what happened if somebody was going to tell their child that anybody was dead that they should just say it straight up the most important thing is just to be honest if you don't tell them the truth they will make up their own truth and you don't want them coming up with a story that is um completely inaccurate or possibly even worse than what they're already dealing with I had my own issues with having to explain actually how her mom died to her so for a while I explained to her that her mom's heart stopped and that's how she died I saw an opportunity to put my feelings aside and to give her the peace of mind to know that if she goes to sleep her heart is not going to stop that it was because of a substance overdose and um it was tough to tell where it was the hardest thing I ever had to do but I did it and um it opened up some very very significant scientific communication between us they're in a period of building trust if you are not honest with them they never when you're telling the truth and when you're not so it's very important to be honest even when that honesty is hard she ate too many drugs and like when she was sleeping her heart stopped and she died she said thank you for telling me the truth you're the best advocate I've ever asked for and then she began to ask questions about the drugs did you know what they looked like did you know what they were then she started to ask questions about mom's job and what she loved to do it was almost like an unclog some kinds of communication with her that obviously needed to be explored young children may not understand the permanence of death but it takes a while to really get that they're not coming back my daughter Amelia was four when her mother died and she was like okay now I know my mom died but I call her and then it was like I know my mom died but could I just go where she is and what one time she said that she wanted to die because she wanted to see her mom my daughter that was three at the time it took her her late good year to understand and realize that he wasn't coming back home that he was gone forever we'd always say that he went up with Jesus and um she said mommy you know Jesus has had Amelia long enough I wanted to come back home it kind of dug out me every time she asked when is he coming home it was hard to have to keep on explaining to her young children learn by repetition so they ask over and over parents need to have patience with that to look at it as this is our story and we get to tell our stories over and over and in telling them we make more sense of them it's not unusual for children to really want to know where the person who died is now and what I recommend is that the parent tell the child where they truly believe the person is now that may be their life has ended they don't live anymore they don't exist and it may be they're in heaven with God or anything in between the important thing is to be honest and authentic with what you believe and create that ability for the child to discuss it further with you I think my dad's in heaven right now I think um to die means that you're gone but not like gone forever ready to care come back to life forever and you're just dead their spirit is like I don't think that can ever go away my name is Cassidy my dad died there are all kinds of different emotions that can be associated with the death everywhere from no reaction to outburst of anger withdrawal sadness sometimes children are relieved that someone has died often there is guilt it felt like I didn't spend a long time with him so God it's like okay you're gonna spend a long time with him I'm gonna have him die so he doesn't get any more time with you and I know it's not my fault now but it just kind of felt like it wasn't my fault then grief sometimes shows up in our bodies common symptoms include what children describe as a heavy feeling aches difficulty sleeping or loss of appetite parents should consult with a medical doctor if these physical symptoms interfere with daily life or well being my brother and there's the astronauts it's not at all unusual when someone dies for children to have a heightened fear that everyone around them will die and also for their own safety it's like well if you die I won't have anybody there for me he's asked me when are you gonna die and I told him that I don't know and I've also told him that I have a plan in case I were to die and that there's so many people who love him and he told me they would take care of him I hated the fact that he would ask me that question as a four or five year old but didn't it was a logical question I guess anytime she's gonna separate from either my husband or I she always comes over and she goes mom I love you and she wants to give me a kiss now she knows that this could be the last time she sees us I can't fix it I can't take that anxiety away from her one of the things that makes it hard to talk with children about death it's hard to see them in pain obviously we can't take their pain away we can't bring the person back but the way that we can be most helpful is to acknowledge their pain the other night we were reading a book that had a dad in it and he stopped me reading and he said I don't like this story because I don't have a dad and even if you were to get remarried I had a stepdad I'd never have my dad again I said you're right nothing can change that and that's really hard and if you can just sit in that place of pain with the child there's a bonding that happens and that child will open up to you and at the end I was tucking him into bed and I'm thinking like are you okay and he goes mom it's really okay you know because my dad's inside of me and he's in the earth and he's in the sky it's not unusual for children to feel angry when someone dies at first I felt really sad and as it went on I started feeling actually kind of angry he would just go into these rages every day like multiple times a day I would try to hold him and sometimes he would kick and hit me because adults don't know exactly what to do with that kind of anger they may tend more to give the message don't be angry instead of finding positive ways to channel that anger seeing my child's pure anger was really uncomfortable for me but what I realized with talking with my counselor was it's okay to be angry it's the actions that you take when you're angry that some of those aren't okay we started doing that credit system where he could earn credits for making a good choice when you're angry parents can simultaneously support their children's emotions and also insist that their behavior remains safe and appropriate they're not all angels all the time so she uses mom's death to get at me sometimes if I'm yelling or I'm talking sharp or disciplining or whatnot she'll she'll talk about how much she misses mom and I have said you know what I understand you miss your mom I miss your mom too right now you are in trouble some children will react to a death by pushing themselves to perform it may not seem like a problem but children can be burdened with too much pressure from responsibilities they take on despite the pain kids still need to be kids play is how they make sense of the world one of the ways that a parent can find out what's going on with their child is to play with them she's a pretend dog and um I pretend her father is cocoa and they pretend um like this happens like coca-dye they lie coca-dye they lie like that another way that children benefit from play is to get the physical expression out of their bodies and children need to know that they're not alone when I went back to school people found out about it and just in the hallways they would just say that we're sorry and it was awkward because I could kind of just tell that they didn't understand I want to be around someone who really understood me and so that's what the Daddy Center has done for me I decided we should use this game when a death occurs one of the most common experiences whether you're three eight or fifty is a sense of loss of control it's helpful and important to give them whenever possible choices what do we do on the anniversary of a death for example any little thing and give give your child control over just I think helps them feel better about the world in a nice case she was always able to pick out a clothes she wore to school it didn't make any difference to me what she wore and it made a huge difference to her when someone dies the routines change the chores change a lot of things in that child's life have changed it's important to try to have some predictability and some routine having said that there needs to be some flexibility don't be wedded to having to have dinner at five o'clock on the dot every day some children will revert to younger behaviors but it's a temporary thing and I think it's perfectly normal to want to have more nurturing when you're hurting right after my son passed away both of my kids had to sleep with us I got a lot of stuff said to us there too won't be sleeping with you and I said you know what for them if it's okay and they're going to be able to sleep the whole night because they're sleeping in my room I don't care allow a little bit of time for the child to really be able to make sense of what's going on because it will pass it took them probably a good eight months that they slept in our room until I finally said what can I do for you and they said we would like a big picture of Emilio in our room they let you know when they're ready to go and do the next step of their process I think it's a good idea for a parent to check in regularly with their child's teacher to make sure that things are on track she had a lot of trouble concentrating at school I really had to educate the teachers that you know this isn't something she's doing on purpose and I don't want her punished for it because she really can't help it make a plan with the teacher on how to handle the times at school when your child becomes overwhelmed my teacher would give me pebbles at the beginning of a day and when I would and I would give her a pebble every time I wanted to be alone so I could just go be alone in the office or ever friends and family can also be a great resource when people actually offer to bring you meals or to take care of your kids let them because they can't bring back whoever it is that that died they can certainly do something to make your life easier and you know most of us when you know a tragedy strikes like this it's very hard to function often all of the studies that have been done so far have very clearly shown that for children who've experienced a death the mental health physical health emotional health of the parent is one of the if not the most impactful influences on how the child will do so it is important for parents to make sure that they are modeling self-care which includes it's okay to cry but it's really the responsibility of the parent to ensure that they are getting the kind of support and help they need so their child doesn't feel that he or she has to parent them they closed it right after she died so so as children go through different developmental stages as they grow older they're going to be asking different kinds of questions they have different abilities to understand and I think that not only is it normal but also healthy throughout our lifetimes to continue to look at how does this affect me what does it mean my mom died I was four I wasn't feeling anything that as soon as I got into like second grade I started understanding like whoa and so that's when really I started crying and like really feeling it like not having the mom that's there to be there for you now and that's great I feel like myself steam isn't right so like it just it changes but you're like because you start to understand more and more I don't think we have very good rituals in our sort of mainstream American culture for remembering a person who has died and live in a society instead that says you need to put this behind you you need to forget you need to move on and the kids that we listen to say I don't want to forget what you think would probably lead me hard for me actually got to make me feel better my computer as I came around and my brother and I made a bunch of videos on that and when I watched the just this kind of videos we moved and I just feel like he's not there with me you know we wanted your stories we want you to share memories that kind of thing because that's all we have left when we talk about Amelia's mom now it's always just one of the great stories it's just we have fun and we laugh and she's gonna ignore her mom through pretty much her best moments now the sadness is still there but but there's also quite a bit of happiness that we're able to share as a child at two or three will they really remember I don't I don't know if they will I kind of doubt it but what we do have is lots and lots of photographs and over time they will have those photographs to hear the stories know what was going on or even make up their own stories so um he likes to say well I have more of my dad's blood than I have of yours because I'm a boy but mostly I'm me I'm an awareness from the rest of the day there's no magic finish line when are you over it it's not something you get over it's the wrong terminology hopefully you get through it in a transformative way that is you can transform the the tragedy and the loss into increased understanding and awareness of the importance of life and relationship no people have told me that she is that she's an old soul and that she's you know wise she doesn't take things for granted and she just seems to be more compassionate in general than you would expect of most twelve-year-olds can we aces no sorry if you can't still find humor in life if you can't still find joy in life what's left you have to trust yourself to move into the newness of your life and as a parent to just step forward into life that is so different than it was before so I just wanted to mention that the content some of the content of the video you just saw is could be very emotionally impactful especially if you had a loss similar to one that was shown in the film so just a reminder to make sure that you get any support you might need after this program for anything that might have come up just make sure that you attend to it so the Dougie Center is my real go-to I took their training on how to set up a program our work at Josie's place is based on the model of their peer-to-peer grief support and I can pick up the phone at any time if I need advice and there'll be somebody there to help me with it whatever we're dealing with at Josie's place so one of the things that Donna said is that research shows that the physical mental and emotional health of the surviving parent or primary gear caregiver is the most important determinant of how well a child will respond to the loss so I think it's really important that we look at for the parents of these children that they are practicing self-care and that means making sure that they're getting plenty of sleep that they're eating well not abusing drugs or alcohol limiting sugar caffeine taking breaks from their grief and their responsibilities knowing that especially if it's a parent that has died a spouse that they're now an only parent they're a single parent and they have all the responsibilities of the household they're grieving themselves and they're raising grieving children so getting exercise is important Donna mentioned asking for help and understanding that that might change day to day and I know that a lot of the parents that come to Josie's place feel they've been pretty self-contained they've been able to pretty much handle themselves and now their life is really different and it could be hard for them to ask for help and yet asking for help is really really important so they get support for themselves they get support for their own grief and they just get a break so if you know a family that has a grieving parent and grieving children ways that you can provide support is setting up play dates with the kids driving the kids to and from school or other activities walk their dog do their laundry bring over food and it's really important that you give them specific ways that you can help because they're not always going to know who's can show up to do a particular thing they're not going to always know what they need but if you know them well you know their routines and you know how you can help them and give them a break the other thing is invite them to social events they may pass they may not be ready but as we all know grief can be really isolating and people tend to sort of pull back if they are not comfortable themselves without a support somebody or how to feel comfortable with the various emotions that come up for the families I remember my sister had a friend who was angry all the time and she really had she sort of stepped back a bit she wasn't sure how to be with that anger if you know the family well and you know you can expect those kinds of reactions be there show up and be there for the long haul because this isn't gonna this kind of loss you don't get over it as Donna says you never get over it but you're going to be working with it living with it for quite some time and so having people that can really show up and be there for the long haul is really important so the other thing I want to say is with children be a good listener and understanding the children don't always talk about their grief but when they're ready be there to listen and don't be real quick to give advice let them take the lead and and it's really important not to push them to talk because that's not their normal way of processing their grief I'm gonna go over a few minutes here Joy just because there's a part here that I think is really important Donna said that telling the truth is really important and there's two kinds of losses that are especially difficult for parents to talk about with children the first is suicide and we have told families that we really encourage them to tell the children how the parent has died prior to their coming to Josie's place and we can walk them through how to do it and there's been research done on people who attempted suicide but didn't complete it and they've been able to do functional MRIs when they can you can go in and look at how the brain is functioning and what they've found is that there's a part in the frontal lobe of the brain the part that manages impulse control and the part that manages problem solving they have found that the that part of the brain is compromised in some way it could be from stress it could be from substance abuse it could be from injury or illness and it's just not functioning properly so if you think of the brain as an organ of the body separate from the mind think of it as like the heart the heart is there to beat and pulse the blood through your veins and your lungs are there to feed your body with oxygen if they're not functioning well somebody could die well if your brain isn't functioning properly if you're having thinking errors because that part of your brain has been compromised you can if you're feeling depressed if you're feeling emotional psychic physical pain and you can't see your way out from it and you you don't feel like there's any hope or help you might do something to harm yourself that causes your death and if we can explain that to children and in a way that de-stigmatizes suicide you know we'll have kids at joseph's place say you know when we go around the circle and say how our person died my dad's brain was sick and that's the truth and the child doesn't have to feel responsible you know maybe they were angry with their person before they died and then they killed themselves you know daddy's brain mommy's brain wasn't working properly um and and they weren't making the right decisions what's also important when you're talking about that is to say that it one can get help if you're feeling depressed if you're in emotional pain or physical pain and we don't want the children to think that just because someone in their life or they are depressed that means they're gonna die by suicide um and you can just say to them if you're ever having thoughts about harming yourself it's really important that you talk to a caring adult or talk to me you know with the parent and we can get your help we can support you um so i think again it's like you're building trust with the kids and if they're thinking that you're not able to tell them the truth then what else are you're not being truthful about and then that gets them concerned and worried and they could hear accidentally from somebody else and that could be a real shock you know why didn't you tell me it's much easier for them to hear it from a caring adult um who can explain it in the appropriate way a homicide again is a really hard death to talk about and you want to make sure that you're creating a sense of safety in their environment because they're gonna not feel so safe after somebody that they love has been killed and so um also be prepared for really strong emotional responses explosive anger rage wanting to get revenge and it's important that we we normalize and acknowledge those feelings feelings aren't good or bad they just are but we can find healthy and safe ways to express the feelings or we can go in the other direction and so we want to to point them in the direction of healthy and safe you don't want to give them a whole lot of detail again only answer the questions they're asking um shield them from the media um they don't need to watch the news if it's in the news um and again talk with them how can we feel safe at home how can we how can you feel safe at school how can you feel safe in the neighborhood so that they know that people are looking out for them and helping keep them safe so i think i just in summary want to talk about um you know the video pointed to this that the typical feelings that you will see besides um sadness in children is anger we're biologically programmed to feel anger in the face of loss we they will feel anxiety um and they may feel guilt and you don't want to take the feelings away you don't want to say to them oh you shouldn't feel guilty you reflect back what you're hearing i'm hearing you're feeling guilty i understand that i'm feeling some guilt too but you need to understand that you did not cause your person's um death and maybe there's some woulda coulda shouldas you know maybe you said something or did something that you wish you hadn't um or that you wish you had maybe you didn't tell mom or dad before they died that you loved them and now that you wish that you could and so you can sit with the child and say let's talk now about what you might say maybe you want to write a letter to your person and so they can express those feelings and get them out and get support around them see what else um you want to be able to reflect back what you're hearing and what what's really important is that you're using the child's words because we tend to use words that children might not understand and if you're using the child's words then they know they're being heard and one of the most important things for a griever is to be understood so if you can reflect back using their words summarizing what they say they know they're being heard and understood so i think rather than talking more about those feelings um after we've heard from andry about teens and grief and dawn about the work she's done with teens we're going to talk about the kinds of activities you can do with children to help them in expressing their grief uh in exploring it and understanding it and finding ways outside of talking um to work through the feelings and release some of the strength of the emotions it's a quick bio and andria andria bass is a licensed marriage family therapist and art therapist she's the associate director of josey's place she's worked at hospice by the bay as a youth bereavement specialist and at camp erin which is a summer camp for grieving youth having a brother with life-threatening illness led her to the work that she does today with grieving children and families thank you i'm gonna talk a little bit about teens understanding of death and teen grief unlike children adolescents are able to conceptualize death they see it as permanent and irreversible and they're capable of abstract thinking now but like children teens can only sustain strong emotions for a short period of time and then they need to take a break from their grief dr allen wall felt who's a child grief specialist says that teens are no longer children yet neither are they adults with the exception of infancy no developmental period is so filled with change as adolescents leaving the security of childhood the adolescent begins the process of separation individuation where they're pulling away from their parents as they try to discover who they are as unique individuals and develop their own sense of self with their brains under construction and raging hormones and all kinds of academic and social challenges and pressures the death of a parent or sibling can be a particularly devastating experience during an already difficult turbulent period it's important to realize that teens may exhibit grief differently than young children or adults their grief may be masked by other behaviors such as acting out substance abuse eating disorders or engaging in other risky behaviors adolescents are likely to experience losses that are sudden unexpected and traumatic one out of 20 youth experience the death of a parent or sibling by the age of 18 a parent may die of a sudden heart attack a brother or sister may die in a car accident or a peer may take their own life in the U.S. the three leading causes of death and adolescents are accidents suicide and homicide so during a time when adolescents most strongly identify with their peers they're also facing their own mortality at a time when usually they feel pretty omnipotent and losing a friend can also just be a really difficult time for an adolescence because they're so peer oriented and they tend to gravitate towards other peers for support as they pull away from adults in their separation individuation process they can be more isolated in their grief it may be hard for them to find other teens who have also experienced a significant loss and in a school setting it can be difficult for teachers sometimes to assess whether a student is having a difficult time coping with a loss or even knowing if a loss has occurred support may also be lacking for teens because of social expectations that are often placed on them if there's a death in the family they might be expected to be grown up and support other members of the family like the parents or their younger brothers or sisters when an adolescent feels a responsibility or a pressure to care for the family then they don't have the opportunity or permission to mourn and if a parent dies while an adolescent has been pushing the parent away or they've had conflicts this can cause a sense of guilt and unfinished business in addition a teen might be worried about the financial and emotional security of the family will our family survive this death they may wonder also since the teen years are the time when teens start to separate from their family a death in the family can pull them back into the family and interrupt their developmental growth adolescence is also a time of spiritual questioning part of the development of identity during adolescence is asking what is it that I believe in they can often be very philosophical and or existential when it comes to matters of life and death and they might have more developed beliefs about death about spirituality religion and what happens after death they might might also feel anger towards god if if they had a belief in god how could god allow something like this to happen adolescents supporting grieving teens need to encourage them to explore their spirituality and grief in an honest and open way teens are also more likely to turn to the internet or other social media for support and opportunities to memorialize their person who died while there can be good information and social support online this is not always the case so to find ways to provide grieving teens with other ways of receiving support can be important so that they don't have to feel so alone or different in in their grief so this can be through grief support groups for teens or camps for youth who have experienced a loss like Camp Aaron or comfort zone camps when providing support to teens it's helpful to be aware of the following younger teens ages 12 to 14 tend to be very self-conscious as if they're on stage and the whole world is watching them they also may be very private and not necessarily want to talk about how they're feeling so be respectful of their needs and limits and let the teen know that you're available to talk with them anytime that they want and when they feel ready middle teens ages 15 to 16 often feel invincible and have a tendency to try to counteract their vulnerability after having a loss by engaging in risky behaviors like driving fast being sexually active abusing alcohol and drugs etc and while we humans live in the center of our emotional brains until we're in our earlier mid 20s so to do teens and so this makes it more difficult for them to have developed impulse control or problem solving as adults have the intense emotional feelings that teens experience can be very scary and confusing to them teens often enjoy individual or group creative projects such as drawing writing poetry photography and collecting music that their person liked or that sues them in their grief older teens age 17 and 19 grieve in a similar way as adults they're more willing to talk about their grief and they can be more philosophical about the meaning of life and death than younger teens many have learned from their loss about the importance of not taking people in situations for granted and also about the preciousness of each moment and as pat said how adults respond when someone love dies has a major effect on how teens will react to a death sometimes adults don't want to talk about the death assuming that by doing so they're going to cause their teen to feel even more sadness or pain but the reality is very simple teens grieve anyway so teens need caring adults to confirm and to role model to them that it's all right to be sad and that we can feel a multitude of emotions when someone dies they usually also need help understanding that the hurt they feel now won't last forever when ignored teens may suffer more from feeling isolated or alone in their grief than from the actual death itself all right so i'm going to switch gears just a little bit and talk about something related to grief and communication with teens but we're going to move it upstream a little bit so the activity we began the evening with i'm going to step away for a moment and get this job thank you for anyone who came in late i invited all of you to pick up a collection of beads that represented relationships we may have experienced a death in and we do this activity with teenagers in high school i've actually also done it with young children in grade school and when we have the children drop in their respective relationships at the end we hold the jar up for everyone to see in the room as a beginning process of saying why are we talking with healthy young people about death why would we have this conversation this is distinct from where they've already openly experienced a loss and have come to a place like josey's place instead i'm talking about meeting students in school where everyone is presumably healthy and well why would we want to start a conversation around death and we open with this activity and we raise the jar in front of the classroom after they've put their in their case candies in and i ask them what do you notice about this jar what do you notice and i'm going to ask you what do you notice if you can see up close from far away what what are some of the things you can say you see in this jar what do you see anyone many many right so both many in number and many in color diversity and that's exactly what every single classroom says those two things right away there are more candies in their case in the jar than there are people in the room and all the colors are represented and yet these are children we're teenagers that are presumably healthy living their lives and what they quickly realize is we all have experienced loss we tend to keep it to ourselves as you've heard grief isolates us or we self isolate we keep it quiet but the minute we reveal it this way suddenly we're not alone suddenly we each have something in common and there's a reason to talk about this so that's our icebreaker activity if you will when we ask the teens we have them fill out a survey to describe some of the losses they've personally had here's just one example that they can have more than one and they're sophisticated in their thinking about it when we ask them to to rate it was this a difficult experience for you or was it easy for you they're like it depends what kind of question is that I mean these are really thoughtful human beings that want to talk about this when we open the door for them to talk about it the other thing we would ask them are some communicate at some topical questions to just see what is their baseline understanding of some of the services that are available to help people in end-of-life care so things like hospice and palliative care and they answer the way that teens do idk I don't know this is also true for plenty of adults and plenty of people in health care so they're not alone and we again create an opening to talk about these things instead of keeping them quiet so one of the questions my colleague and I wanted to ask ourselves was you know is there a benchmark is there a place for us to begin instead of reinventing the wheel when it comes to talking about taboo subjects with adolescents and the answer is absolutely there is something it's called sex ed and sex ed has been taught for decades now in many many different ways and there's plenty of data demonstrating the difference the positive impact it has on helping young people make educated decisions you give them language they can talk about it you give them knowledge they can make choices and we said well then that's what we're going to do so we created death ed modeled after sex ed our tagline being slightly distinct abstinence is not an option so given that death is not not something we can abstain from until elon musk or google changes that um we created a curriculum that is really intended at its heart to empower youths to become their own advocates for their own life their own well-being all the way to the end of their life as well as the people around them that they care about and we do this by teaching them the language giving them language around death as well as teaching them how to actually identify what their values and priorities are and then practicing how to communicate that so as I said we begin with this to make it relevant we were taught by our students we created a an expert panel to help educate us on developing the curriculum one of whom's in the room and they made sure that we did three things first of all use candy whenever possible that will keep their attention and engagement second use media wherever possible so whether it's video audio anything in that genre don't just lecture that's the worst format for teaching and then the third is to do things in an interactive and engaging way so activities so the media that we use throughout our curriculum for example one of the things we want to impart on on um our students is where do we get our information and how do we know it's reliable information and for the most part we get our information from the media so television and movies teach us about death and Grey's Anatomy being in the in the context for the the adolescents the teenagers being a popular and well um watched television series that has a lot of death involved and a lot of medical interaction involved and we can ask the teens we showed them a clip and we said is this real watching someone die and be brought back to life in a hospital is that real and they could quickly say no we know that's not real but then when we ask well what is real you know some have personal experiences and they then begin to open up you've given them permission but for those who haven't they don't know where to go and so we offer them some reality checks so we show a documentary um a film uh if you haven't seen called extremis on netflix that really is in the emergency room of a real local hospital here in oakland watching families watching patients watching the health care system uh work with people grappling with life and death and showing the reality of it not what's right not what's wrong simply what's real we also then look at other um pieces of video to look at other aspects of death including rituals cultural approaches to how do we support someone at the end of life how do we support someone after they've died what do we do with bodies what are the the funeral rituals and so um these are some examples and we've also used theater so plays and then ideally given that we're in a library literature there's plenty so then as i said we really focus on communication training and there's an activity if any of you who have been regulars at this series participated in an event um hosted by a couple of my colleagues um using a deck of cards that help us really explore our values as we sort out what matters to me most and what really doesn't matter to me if i imagine myself really at the end of my life we do this activity with the students so this isn't something that only people who are sick can do or only adults can do we do this with people who are young enough excuse me are capable of reading so these are these cards are written at the fifth grade reading level fourth grade reading level so i played it with people as young as eight years old and they're able to really articulate the things that matter to them and i'm going to show a brief video of two of the uh adolescents playing i put those down so these are healthy high school kids we paired them up or put them in groups of three or four and invited them we gave them instructions on how to use these cards and then start a conversation with each other and they all could do it and the feedback that we got was pretty profound in that the difference it made for them as well as their own enthusiasm to want to go home and play with their family and say i need to do this with my parents i need to do this with my grandparents and that really is our ultimate intention is to have our youth lead the change in our society of how we can talk about this and how we can prepare ourselves for what is inevitable so that it doesn't come as such a shock and it doesn't stay in the dark and behind closed doors so as i said some of the curriculum now that we do starts to look at rituals and cultural um approaches to death so we focused um recently on day of the dead and we invited the students not to make afrendas for someone who's died but we switched it up a bit and we actually invited them to make afrendas for themselves so if you're not familiar with an afrenda it's an object like this a way to gather objects that remind you of someone that you've loved dearly who's died and to put their favorite things together like on an altar and put their photo there as a way to really have them be present and invite their spirit back into our lives and the the movie coco really focused on that tradition it's a beautiful film but like i said we switched it up and we invited the students to bring in an object that reminded them of themselves or if someone were to walk by and they saw it they would say yes i know who that is without telling them the premise and then after discussing and describing afrendas we then said and now we'd like you to make one for yourself using that object and this next photo is actually one of the students interpretation he said the most important thing to me i can't put in the palm of my hand i can't put on an altar it's me writing a song it's me playing music and he wrote a song in 20 minutes time about himself that he would want his friends and family to know and each of the students created their own version of that in about 20 or 30 minutes time it was extraordinary they knew exactly what it was and what was the most exciting was as we were doing this work one of the students said wait wait wait i don't want us to go around and show here's what i created for myself i want us to guess who it is and speaking to the power of how adolescents identify within their peer group the extraordinary experience of having each of these students be identified by their peers saying i know exactly who that is because they love to rock climb or i know exactly who that is because they love to write was so validating to have yourself be so known i think that's true for adult as well but certainly for adolescents where the peer acknowledgement is profound so much of this work ultimately isn't about our dying as much as it is about what matters most to us while we're alive and having these things be known by the people who love us who can support us in having them and have ourselves be known and at the same time than the bonuses and then you get to know these people will support you all the way through to the end of your life and beyond we also then work on advanced care planning and advanced directives one of the phenomenon that again in our society we take for granted when you turn 16 you go get your driver's license and at the dmv they gave you a little checkbox and say do you want to be an organ donor but there's no one at the dmv who's actually going to talk you through that who's actually going to talk about what it means what you just signed up for or didn't and we break that down and say you know when you come of age to drive a car this is a conversation you really want to understand and before you go off to college or before you get your first job and you're 18 you know what you're now legal and you get to decide who you want to speak for you if you become seriously ill and you can't speak for yourself it doesn't automatically have to be your parents and let's think that through let's think about what matters to you so we have them actually work through all this and then the last one would be again what would we want done with our bodies when we're done with them when we die and what are the different ways around the world that we think about that and this is an ongoing evolution now with green burials there's plenty to talk about so the students are really excited and here's just a hint of some of the feedback I love how they write and whatever color they can get their hands on but mostly the students are not afraid of this they're hungry for more just like sex ed they're grateful that someone would speak straight to them and give them the permission to talk about what we all again have been touched by and will continue to be touched by so that's death ed okay so one thing that I want to say is that people will say to us it must be really hard to work with grieving children it must be really sad and serious and the truth is it's not because kids are kids first and they're griever second and when we have our evening groups we have our activities we have our icebreakers we have our activities that touch on the emotions of grief how to be them with them in healthy and safe ways resources we have that support us through our grief things that support our self-esteem because that tends to drop when children have had a significant loss they don't feel like themselves they feel different than their peers their person that was you know one of their major supports is no longer there so we have those activities and then we've touched their grief and then they go out and play and they create all different kinds of games sharks and minnows is the big one right now they play soccer they play hide and seek they do all sorts of things and they connect really quickly in these groups they have incredible compassion for each other and they feel comfortable because they can be themselves they don't have to hide their grief they don't have to explain it and they're not alone that's the most important piece is they don't feel no longer do they feel alone so Andrea and I are going to talk about some of the activities we've done with kids to help them because words aren't always talking isn't always how they express themselves so we give them tools to help them with that and I'm going to go through these kind of quickly and I want to mention that there is a resource handout pay attention to the handouts is resource handout that has the website for the Dougie Center and it also has different kinds of books activity books things you can do with kids online bookstores and the like so do do um grab one of those before you leave so the first one I do I do with the kids um during intake when I'm meeting the family and I have them I draw like a gingerbread person and I have them do a little legend on the side and I'll say you know what are the feelings that you've experienced since your person died and then I'd say well what color would you you think of when you have that feeling and they would they don't hesitate they usually know exactly what color the feeling is and it can be really different for each child and then I say you know we really feel grief in our bodies where do you feel these different feelings in your body and let's you can draw them in in the color that you've assigned to that feeling and show us where you feel that and there's usually no hesitation they know exactly where they're feeling the feelings and I think it helps them to know that yeah they do feel different because their bodies are different you know grief affects our bodies it affects our emotions it affects our brains and we tend to have like grief fog and maybe we have trouble remembering things we have trouble concentrating it affects us socially and it affects us spiritually it affects us in every way and they really get to see that yeah and I really feel it in my body and that's normal also what you can do is you can if you're in a group setting is you wouldn't do this with a teen but with children you draw the outside of their body you trace an outline and then in the film it's really important to give children the choice and that's also true in terms of how do I choose to respond to what's going on inside of me and so I just take you you know just a piece of paper that you cut in a circle or you can use a paper plate and make like you know you cross this way and vertical and horizontal lines and you've got your eight you know pieces of a pie and we ask the kids and you can kind of brainstorm with them if you're feeling angry what are healthy and safe things you can do to express your grief and what we've really done is we've we actually put arrows on it and a little thing where they can spin it and they can you know the spinner like okay I can walk away I can take a breath I can talk to my parent I can go for a run you know whatever it is that's going to help them dispel some of that anger so they're not taking out on themselves or other people another thing that we've done is and this is another one of my favorites it's a first aid kit for grief if you were going to go camping you want to be prepared in case you get hurt you don't expect to but you might we don't always know when we're going to have a grief burst we don't always know when we're suddenly going to feel overwhelmed by emotion and so we give them a little container and we say what would you put in your grief kit your first aid kit if you're having a grief burst and I know for me I would put in reminders you know get exercise get enough sleep eat well I would definitely have chocolate in there and I might have music and it could be music that calms me or music that reminds me of that person and I'm wondering what if anybody has ideas what they would put in their grief kit or a child that you know what they might want to put in their grief kit photographs yes memories are so important yes something soft and soothing yes tissues definitely you might want to put a journal in just anything that gives you comfort we there was a parent at Josie's place who during the holidays her son whose dad had died was having a particularly difficult time and she said I ran out of ways to comfort him I just didn't know what to do and I said maybe there's something you did at Josie's place that can help you right now and he went to his room and he got his grief kit his first aid kit and I was there when he created it and I remembered the things he put in it his father was Japanese and you know these little Japanese sayings in there and that's that was the medicine he needed was his first aid kit then I also have this is something you can I think we're just across about a dollar a little bit more a little bit more than a dollar you can get this at Michael's we do something where we work with masks you can also use a paper plate it can be something really simple and we talk about inside and outside feelings and we normalize the fact that we don't always want to spill everything that we're feeling internally into the world and that's especially true for kids so we talk about what are the faces what are the feelings what are the thoughts that you project out into the world and that goes on the front of your face your mask and then what are the things you keep inside which is good to have good boundaries you're not going to share it with everybody maybe you share it with your parent or you share it with your best friend and you want to normalize what those things are too and then if you're in a group setting and the kids can share their masks they're going to find that a lot of them have some of the same things on the inside and also show very different things and similar things on the outside um so some other things that we've done with the kids at Josie's place in which I've also done in different school groups that I've had for students grieving a loss is making a memory box and you can use any kind of box or cigar box that the child or will decorate and if they want to bring in a photograph of their person who died they can add that onto the box or inside of the box and then if they have any special mementos or objects that either belong to that person or connect them with that person or remind them of that person they can place that inside of the box we've also had kids write down on strips of paper different memories that they have about their person and place that inside of the box and you can do the same thing with picture frames you can buy wooden picture frames for a dollar each at Michael's arts and crafts and then invite kids to decorate the picture frame and whatever that way they want including putting stick different kinds of stickers on it you can buy stickers that say mother father grandma or whatever and and then they can bring in a photograph of their person who died to place in the frame or if they want to draw a picture of that person or if they have a program from a memorial service they can choose to put whatever they want inside of that frame another project that we've done has been um this can be either writing or for children who don't yet write um they can either dictate to you what they want to say or they can draw in this the way it was the way it is now and the way I wanted to be so under the way it was they can write or draw about what was your life like when your person was still alive what was it like at home what were you like in the middle the way it is now what is your life like now what's it like in your family or how are you now how have you changed how are things different for you and under the way I wanted to be is more about wishes and dreams for the future and often a child will write that the way they wish it would be is that their person was back in their life again another project that we've done is power shields and this is a good way to provide resources for children during times that they might be really missing their person or feeling upset or alone or confused we have a shield you can just draw the shape of a shield and in one quadrant it says my safe place so you can invite them to imagine what would your safe place be for you would it be somewhere outdoors in nature would it be in your room in your bed it can be anywhere and so they can draw that or write about that under my safe place and then imagine going there anytime that they need to if they're having a hard time or feeling scared or just needing a comforting place in the next quadrant it has animal helpers so that they can think about different animals maybe animals that are really powerful and strong or animals that are really cuddly any any kind of animal or imaginary creature or whatever that they can think of that they think that they might want to call upon when they're feeling alone when they're needing help when they're wanting to feel more brave or just you know needing support and the other quadrant is people who love and support me so you can have them think about who are the people in their lives that love them that will be there for them whenever they need it they can write down the names of those people or draw pictures to represent those people and then in the last quadrant is my favorite superhero so if there's a particular superhero that they really like that again they would want to imagine could come there and be with them when they're feeling alone when they're missing their person when they need help they could draw or write about about that figure and another thing that we've done at Josie's place have been making what's called scream boxes so this is a great way to express anger you get a cereal box and you stuff it with paper towels or tissues and then you get a paper tube from paper towels from the inside of paper towels and after the box is stuffed you cut a hole in the top part of the box where the tube can fit through and you put the tube about halfway into the box and then tape it securely so it's like that and you also stuff the tube with some paper towels or tissues and then they can decorate the outside of the box in any way they want and then what happens with the scream box is anytime they feel like they need to scream they can just scream into this and it muffles the sound of their scream so they can scream as loud as they want and not have to worry about other people hearing them and these have been really popular activities for the kids very effective so I think we're going to open it up for the time we have remaining for questions I think Janet was going to help facilitate okay so um the first question here is how do you prepare a child when a parent or close friend is dying I think that again you know you need to tell them the truth about what's going on you know explain to them depending on their age at a level that they can understand what's happening and see whether they have questions um you know if the the person has cancer or some kind of disease you can talk with them a little bit about what that's about and how there's different kinds of cancer and some cancer can move very quickly others can be a lot slower there are treatments that can help and sometimes the doctors will do everything that they can and they're still not able to prevent the person from dying it's really important to prepare a child when someone is ill so that they don't suddenly find out that the person has died and they'll they may repeatedly ask you the same kinds of questions and just to acknowledge how hard it is to see a person who's ill and it's almost as if you're losing them before they've even died as the child witnesses the person becoming weaker not able to do what they've always been able to do to just you know be able to really acknowledge that and to also talk with them about whether there's something that they want to let this person know before they're not around anymore is there something that you want to say to them is there something that you want to do so that they don't have any regrets down the line that I wish I had said this or I wish I had done that so those are a few suggestions I would just add that there's something called legacy work and so often what we do in hospice and palliative care field is actually work with families to create either physical legacy projects something as simple as handprints that will often have the children come if it's an adult or even if it were a sibling to actually paint the person who's dying paint their hands and imprint them on paper on pillowcases on sheets and often what we find is at first the children are a little skittish the whole family is but the minute you bring out the color and the paint it breaks the tension it breaks the fear this sense of can we touch them are we going to hurt them or anything of this nature suddenly the entire room shifts stories start to be told you start to hear laughter everyone's hands start to get painted you start creating imagery with all of these handprints it's really quite extraordinary and when we've done this in the hospital even then the medical staff get involved and it just shifts the experience and after the person dies the stories that the families then have are quite different than if we hadn't had the children involved or had left it mysterious particularly if they die outside the home in the hospital and suddenly they vanish instead this is now part of this storytelling for the rest of their lives so that's an example the other is actually having auditory or visual letters so now with you know the advent of these things you know you can videotape anybody anywhere and particularly adolescents and even younger than adolescents are quite facile with these and so being able to create videos and stories and these types of legacies in the moment are quite profound and there are apps specifically for it but just the phone itself can do it so I would add that as part of the acknowledging process of someone as they're approaching death but you can do this your entire life as well so I have an easy one here quick answer where's Josie's place located we rent space and are per use spaces from a church in the inner sunset district it's at the corner 14th in Judah and we don't give out the address since we're only there when we're there so yeah and it's it's got parking nearby it's close to public transit it's right on the end Judah line and the line on I guess it's a 71 on Lincoln Way so it's very accessible and if you have any more questions about that you can always talk to us afterwards yeah we can stay this is an interesting question does the Kubler Ross model of grief apply to children the Kubler Ross model of grief applies to people who are dying um rather than to people who are grieving what we tend to talk about is what William Warden who's an expert in grief um talks about and that's what are the tasks of grief and we simplify them for children the first task is to acknowledge the death and children have to understand death to be able to acknowledge it and sometimes we're helping them with that what is dead and what is alive the second task is to feel the feelings and to think the thoughts and we work with that a lot and the third is to move the relationship from one of physical presence to one of memory so that we can reengage in life and form new attachments and interact in other relationships and it's not this is not a linear process it's something that is very we go in and out of and up and down through and for the third task we work a lot with memories um with um you know maybe creating an altar or a place in the house where when you walk in the door you can say hello to your person because that table is there um showing that we have continuing bonds and then that's normal and healthy to have continuing bonds um and also to be able to preserve their their life through memory so here's another one um how best to deal with other family members who believe it's inappropriate to tell the truth about a death to a three-year-old that's a really really important question and what I'll usually say to somebody is what is it that you're trying to protect the child from and if you dig below the surface you'll find that they're really protecting themselves and that it's hard for them to see the emotions of the children and to see a child grieve um and there's there tends to be fear and anxiety about how is the child going to react well I'll tell you I was four years old when my mother died and my father told me and looked over and my brother was crying so I started to cry I didn't know what it meant so a three-year-old you know the three-year-old needs to know the person is gone and they need to relearn the person is gone and they will continue to ask well when can I go see grandma when can I go visit mom until they start to understand that death is not reversible so I think the question is what what is the person what is the family member fearing um children have the right and the need to grieve and they have the right and the need to have information that's truthful um and you know again it's like that really gets into family dynamics but that's what I would say to the person that's reluctant to have the child hear the truth and we had a mom come to Josie's place um professionals had told her her son was four when his dad suicided and um she was told it was too scary to tell the child and then I encouraged her when he came to us at five that she do tell him and she said I just wish I had told him from the get-go because now he's got something new and difficult to process on top of what he was already processing and I wish I had just told him from the start just a couple of questions um asking about where death ed is offered and um and so we've taught it in two schools one in the east bay where my colleagues children were in at head race and the other where it's ongoing still is at a school here in san francisco called bright works an extraordinary school um but we're certainly open to I'm certainly open to bringing it to other schools um anyone who's open to it we'd be delighted to create curriculum for them here's one um that is very good um how young children how can young children understand cremation and does doing the body after the death aid acceptance of grieving I think it's really important and we tell parents to give the child choice you know choice about whether or not they attend the funeral or memorial service and if they want to participate if they want to see the body or not I think I know for me personally if I can see the body or know that there's ashes in an urn and I can attend some sort of ritual it brings it home that yes this person really has died and they're not coming back um I think we just need that you know sort of breaking through our denial in terms of um how young children um can understand cremation an explanation I heard was really helpful and that is we know that if the person's body is put in a coffin and in the ground that eventually all the cells will break down and the body will turn to ash more quickly it's very simple you don't have to say you know that they're burned in fire the child might want more information and if you feel they're old enough and can handle it you can explain that but if you just say would they have a process where we can heat up the um the body and that speeds the process okay um this question is asking about the PTSD effect in childhood um that's post traumatic stress disorder and this involves um it looks like it was a child who was a passenger in a car accident and experienced sudden death um of I'm assuming family members and you know this can be an example if the child has been diagnosed with PTSD which um can present different behaviors like um hypervigilance always being on guard um agitation a lot of anxiety or the opposite which can be um a hypo arous state where the child is kind of detached disconnected kind of spacey um it can you know often be a good idea for the child to be referred to a therapist that can work with them around this um a lot of the kids in the san francisco school district that i've worked with um are walking around with PTSD you know living in neighborhoods where there's a lot of community violence and gang shootings and suicides and homicides and teaching different kinds of skills can really help such as how can we stay in the present moment how can we calm and soothe ourselves how can we ground ourselves if we're dissociating um how can we find um a safe place inside of ourselves so there's a lot of different ways to work with PTSD and depending on how severe it is for it for the child you know it might be really helpful for them to be able to work with a therapist i also want to mention too that a death doesn't have to have been a traumatic death for a child to experience trauma it could be it depends on their own psychic inner psychic life it depends on their relationship with the person their age so even though it could be natural causes a child could still experience trauma um please come up to ask the speakers questions if you'd like thank you so much Don, Pat, Andrea