c ommunication with the dying, the left behind, and the forgotten jocelyn taylor, bs, ccls lindsie...
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Communication with the dying, the left behind, and the forgottenJocelyn Taylor, BS, CCLS
Lindsie Padden, BS, CCLS
Certified Child Life Specialists Child life specialists address the psychosocial
concerns that accompany health care experiences by promoting optimal child development and minimizing adverse effects.
Using play and psychological preparation as primary tools, child life interventions facilitate coping and adjustment under circumstances that might otherwise be overwhelming.
Bachelors degree in child development or related field
Field experience under supervision of a certified child life specialist ◦ 200 hour practicum◦ 600 hour internship
Certification exam
Forms of Communication
Verbal
Non-verbal
Therapeutic play
Medical play
Normalization play
“Play is the child’s symbolic language of self-expression and for children to ‘play out’
their experiences and feelings is the most dynamic and self
healing process in which children can engage.”
-Erik Erickson
Understanding of Death by Age
• Infants and Toddlers (0-2 1/2y)– Separation anxiety– Absorb parent’s emotions
• Preschool (3y-5y)– Temporary – Magical thinking
Understanding of death by age
• School Age (5y-11y)– Finality of death– Can explain difference between
living and nonliving
• Adolescent (12y-18y)– Abstract thinking– See life as fragile
Communication with the dying(Patient)
LanguageFirst conversationComprehension of tough
conversation
HonestyInclusion in conversationMedical staff awareness of patientPick up on social cues
Interventions for patientTools of communication
Including patients in care Explaining medical equipment
and proceduresEncouraging the patient to have a
voiceAdvocating for patient
WishesSilent childCulture/religion
Interventions for patientTools of communication
WorkbooksPrompts for writing, drawingHelp start conversations
Therapeutic activitiesSelf-expression
Interventions for patientTools of communication
Legacy Building
Interventions for patientTools of communication
Funeral Planning
Milestone celebrations
Communication with the left behind(Parents)
ConversationsEncourage honesty
DenialFamilies acceptance process
Interventions for parentsTools of communication
Rapport buildingSupportive Listener Realistic daily goalsHelping parents visualize future
Medical equipmentQuality of life
Identifying Social BarriersAdvocating for care conferencesEncouraging time with patient and
sibling
Communication with the forgotten(Siblings)
First ConversationAssessFill in the gaps
Honest and open communication
Ongoing process
Interventions for siblingsTools of communication
Family Centered-Care◦ Care conference
Conversations◦ Everyone processes differently
Therapeutic Activities◦ Memory making◦ Funeral involvement
Advocating for choices Normalcy Everyone processes differently Developmental Age of Sibling Resources/Workbooks
Obstacles to Communication
Society
Instinct
Medicine
Key points about communication
Silence is okay
You can’t change someone’s personality
Never a one time conversation
There’s no perfect way
No death process ever looks the same
Children often try and protect adults
Common Questions
Question #1: When do I tell the other
children?
Question #2: Should they attend the funeral?
Question #3: Is it OK for them to see the
body?
Question #4: Who should tell the children?
Question #5: What should I say to my child?
Question #6: Will my child need counseling?
References Bell, J. & Esterling, L. (1986). What will I tell the children? Omaha,
NE, University of Nebraska Medical Center Child life Department. Gaynard, J. Wolfer, J. Goldberger, R. Thompson, L. Redburn , & L.
Laidley (Eds., 1998), Psychosocial Care of Children in Hospitals: A Clinical Practice Manual from the ACCH Child Life Research Project (pp. 86-91). Rockville, MD: Child Life Council.
Rollins, J. A. (2005). Relationships in children’s health-care settings. In J. A. Rollins, R. Bolig, & C. C. Mahan (Eds.), Meeting Children’s Psychosocial Needs Across the Health-Care Continuum (pp. 493-515). Austin, TX: PRO-ED, Inc.
Wojtasik, S.P. & White, C. (2009). The story of child life. In R. H. Thompson (Ed.), The Handbook of Child Life (pp. 3-22). Springfield, IL: Charles C. Thomas.