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It's Okay to Remember: General Information Video on Child Traumatic Grief — Transcript

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0:00[Music]
0:10thank you
0:15the national child traumatic stress
0:18network is a federally funded
0:19collaborative initiative of leading
0:21research and clinical institutions
0:23integrated with Community level
0:25treatment centers
0:27the Network's mission is to raise the
0:30standard of care and improve access to
0:32services for traumatized children their
0:34families and communities throughout the
0:37United States
0:38to learn more please visit our website
0:41at www.nctsnet.org
0:47[Music]
0:58all children and adults actively
1:00participating in the production of this
1:02video have completed an informed consent
1:05process and have volunteered freely to
1:07participate in this project children
1:10depicted in this production are either
1:12actors or survivors of childhood
1:15traumatic grief who have completed and
1:17are no longer in active treatment
1:19we thank them for their participation
1:22and contributions to this video
1:43you are looking at the images of fear
1:47helplessness confusion
1:50and even Terror
1:52feelings that occur when children
1:54unexpectedly experience the traumatic
1:57death of a loved one
1:59while it is certainly true that death is
2:02a part of life the pain of losing a
2:05loved one can sometimes consume the
2:07lives of our children in ways that we
2:10are just beginning to understand
2:12and so as parents teachers and Health
2:16Care Professionals as a community and as
2:19a country we are obligated to help our
2:22kids when they need it most it is our
2:25job to reach out to help our children
2:27heal and to remind them that it's okay
2:30to remember
2:41foreign
2:43this is Dr Cohen Dr Judith Cohen is
2:47medical director of the center for
2:48traumatic stress in Children and
2:50adolescents at Allegheny General
2:52Hospital in Pittsburgh
2:54since 1981 she and her colleagues have
2:57been treating Children and Families
2:59forced to deal with the traumatic death
3:01of a loved one due to such circumstances
3:04as shootings stabbings drug-related
3:07deaths and the devastating impact of
3:10inner city gang violence
3:12in 1994 however the center was
3:15confronted with a new challenge that
3:18resulted in looking at the phenomena of
3:20traumatic loss even more closely
3:23late in the afternoon on September 8th
3:25U.S Air flight 427 crashed outside of
3:29Pittsburgh killing everyone on board
3:31in the weeks and months that followed Dr
3:34Cohen and her colleagues witnessed
3:36firsthand the emotional Devastation the
3:39tragedy had caused it was their job to
3:42counsel many of The Grieving children
3:44whose parents unexpectedly died that day
3:48the crash of Flight 427 was the first
3:51time that we had a community level
3:53trauma in which large numbers of
3:55children lost their parents and other
3:57loved ones under very traumatic
4:00circumstances
4:01from these children and families we
4:03learned
4:05that
4:06in circumstances where children
4:08experience both trauma and death
4:12that it's very important for us to
4:14address both the trauma and loss grief
4:17issues together this was a turning point
4:20for our program because we started to
4:23systematically think about how to treat
4:26childhood traumatic grief how to
4:28recognize it and how best to address
4:31those problems in children the tragedy
4:34of flight 427 was an extraordinary
4:37occurrence that profoundly affected the
4:39work of the team in Pittsburgh
4:41unfortunately traumatic events are more
4:44widespread than we often realize
4:46traumatic losses impact children across
4:50the country every day as a result of
4:52accidental death Community violence
4:54medical trauma War natural disasters
4:58motor vehicle accidents and other
5:00unpredictable traumatic events as our
5:03awareness of traumatic grief continues
5:06to grow clinicians and researchers are
5:09trying to understand the impact on our
5:11nation's children and families and the
5:14best ways to help them
5:17[Music]
5:23we know children grieve often very
5:26deeply experts also know that left
5:29unaddressed traumatic grief can
5:31interfere with later development and
5:34potentially lead to Serious emotional
5:36social and behavioral problems in
5:39adolescents or adulthood Dr Alicia
5:42Lieberman is director of the child
5:44trauma research project at San Francisco
5:47General Hospital she has written and
5:49lectured extensively and is a consultant
5:52to government agencies and private
5:54foundations nationally and abroad Dr
5:57Lieberman specializes in treating
5:59traumatized children ages 5 and under
6:03it's quite common for young children to
6:06experience the death of a loved one in
6:09the early years actually much more
6:12common than we had originally
6:13anticipated
6:15perhaps most painful of all is when a
6:18child loses a parent it is estimated
6:21that five percent of all children in the
6:23U.S experience the death of a parent
6:26before the age of 15. further at least
6:2960 000 children experience the suicidal
6:33death of a relative across our nation
6:35each year
6:37we are finding for example that children
6:39under three are often present when a
6:43sibling or a parent dies in traumatic
6:47circumstances
6:49these are often young children with
6:52young parents and so we have to remember
6:55that young parents don't usually die
6:57because of chronic illness they die
7:00because of accidents or because of
7:03domestic violence or in community
7:05violence the death of a parent or
7:08caregiver is an especially difficult
7:10event for a child
7:12because of the significance of the
7:14parent-child relationship children who
7:17lose a parent are likely to face
7:19particular challenges
7:21for this reason it may be especially
7:24important to ensure that the child is
7:26supported and offered any needed help
7:29and intervention for traumatic grief
7:31reactions
7:32children are much more vulnerable to the
7:36effects of a traumatic death because
7:38particularly when they are dependent on
7:42the person who died
7:43at the moment of the death their
7:46tendency is to turn to the caregiver for
7:49help and so the child is left to his own
7:52devices and young children have very
7:55undeveloped emotional and cognitive
7:58resources to cope with traumatic
8:01circumstances they really need adults to
8:04help them cope with their feelings
8:05because when a child is not developing
8:08well and the child can really move from
8:11a healthy developmental trajectory to a
8:14self-defeating trajectory with long-term
8:17consequences into adulthood
8:19in some cases when children experience
8:22traumatic grief reactions and do not
8:25receive appropriate help or treatment
8:27they can develop more serious problems
8:30that can impact their development and
8:32relationships throughout their lives
8:35foreign
8:38[Music]
8:44traumatic grief is a condition that
8:47children may develop after a loved one
8:49dies under circumstances that they
8:52perceive as traumatic childhood
8:54traumatic grief is a condition in which
8:57children who lose loved ones under very
9:00unexpected frightening terrifying
9:03traumatic circumstances
9:05develop symptoms of post-traumatic
9:08stress and other trauma symptoms which
9:11interfere with their ability to progress
9:13through typical grief tasks because
9:16they're stuck on the traumatic aspects
9:19of the death
9:20this prevents them from being able to
9:23grieve the loss of their loved one
9:25can affect them in profound ways that
9:27can last the rest of their lives Bob
9:30pinus was one of the few people who had
9:33discussed helping children with that
9:34condition Dr Robert pinus is a
9:37nationally recognized expert on children
9:39and Trauma he was a lead consultant
9:42after the Oklahoma City bombing and the
9:44Columbine shootings today he is
9:47co-director of the national Center for
9:49Child traumatic stress
9:51many years ago when I began some of this
9:53work with children who had witnessed a
9:55parent's murder I worked with an 11 year
9:58old girl just about 12 who had been at
10:00home asleep in her bedroom when an
10:03estranged boyfriend for whom there had
10:05been a restraining order came in after
10:07many months away
10:09and shot and killed her mother on the
10:11living room sofa Awakening her so that
10:15she actually became a witness to The
10:16Killing as well as to the aftermath she
10:19found the challenges of this death very
10:22difficult afterwards it was hard for her
10:24to talk about a mother who she dearly
10:27loved without going back to what it was
10:29like to be in that room what happens
10:31afterwards when you're in that
10:33circumstance is the focus is on your
10:35mom's been killed not on what it was
10:37like to be standing at the door and
10:40Frozen in place worried for yourself as
10:42well as for what's happening to your
10:43mother no one was helping her with that
10:46Lisa was emotionally stuck back at the
10:49scene of the murder no normal life
10:52experiences became reminders of the
10:55event often triggering self-destructive
10:57behaviors
10:59if you've seen a fight escalate into a
11:02death then anytime you see conflict you
11:04may expect it to escalate into something
11:07much more serious which means you won't
11:09engage in some of the normal daily
11:11things that might have to go on in
11:13interpersonal life that can become have
11:15a constructive outcome violent
11:17experiences can interrupt gaining that
11:19competency but you need that for school
11:22you need that for later life you need
11:24that for later events that happen in
11:25life another common symptom of childhood
11:28traumatic grief is depression
11:31but depression is a common occurrence
11:34after traumatic bereavement so you now
11:37have a child who may have both traumatic
11:39stress and depressive
11:41conditions which can take a real heavy
11:44toll on Child Development and may carry
11:48long-term consequences for the child An
11:51Unexpected death particularly when it is
11:54traumatic generates
11:57what we call secondary adversities which
12:00are unexpected
12:03dresses in the way the family conducts
12:06the everyday life of the family and of
12:09the child secondary adversities can
12:12include such challenging issues as a
12:15change in the primary caregiver for the
12:17child a change in the child's place of
12:19residence or School A disruption to the
12:22family's Financial stability or even
12:25involvement with law enforcement or the
12:27judicial system
12:29all these are questions that the family
12:31is grappling with often without guidance
12:35and it's important for the therapist to
12:39raise these questions and to participate
12:42as a partner in coming up with decisions
12:47that will be supportive of the child we
12:51now know that the thousands of children
12:52who witness the violent or traumatic
12:55death of a loved one every year are
12:57extremely vulnerable without careful
13:00intervention the symptoms of childhood
13:03traumatic grief could have lifelong
13:05consequences that impact not just the
13:08child but also families friends and
13:11communities
13:18how can children become unstuck from
13:21dwelling on the traumatic circumstances
13:23of the death
13:24there are established treatments for
13:26bereavement and post-traumatic stress
13:29disorder in the past decade researchers
13:32have begun to adapt them for the
13:34treatment of childhood traumatic grief
13:39in September of 2001 this groundwork
13:43proved vital more than 10 percent of New
13:46York City public school students had
13:48family members who were involved in some
13:50way in the World Trade Center attacks
13:53for these children it was a traumatic
13:55experience unlike any they had ever seen
13:58before Dr Robin Goodman had worked for
14:01many years with child cancer patients
14:04following the attack on the World Trade
14:06Center she collaborated with an expert
14:08in trauma Dr Alyssa Brown to develop a
14:12clinical and research program for
14:14bereaved children and families of the
14:16911 disaster their work was based on
14:19previous research done by colleagues in
14:22Pittsburgh and the national child
14:24traumatic stress Network the tragedy
14:26provided an opportunity to apply the
14:29best research to real-world problems
14:33working with bereaved children who have
14:36been bereaved for all different reasons
14:38you start to realize that some do better
14:41and some are not doing better after a
14:43period of time and you wonder why and
14:47when 9 11 happened there was a big group
14:50of children that all had a very specific
14:52traumatic experience and then it started
14:55to make sense that the traumatic aspect
14:58of that kind of a death really might be
15:00what's interfering with kids ability to
15:03kind of grieve you know what we think of
15:06as typical and sometimes helpful way
15:09when children had an experience like
15:11this you realize it's a rather
15:13significant event in their life what you
15:15want to help them do is figure out a way
15:18to integrate the experience into their
15:20life and have it become part of their
15:22life as they move on not the only part
15:26of their life
15:28working with children bereaved by 9 11
15:30you really got to see this kind of a
15:33condition where there were constant
15:35reminders in the media there were Street
15:38namings there were TV shows there were
15:40books and those
15:42prompted and triggered all sorts of
15:45reactions in kids and their parents
15:47after 9 11 it was very clear how a
15:51traumatic situation can really affect
15:54one's reactions to the loss and depth of
15:58someone that's so special and makes it
16:00more complicated
16:02researchers and clinicians who have
16:05worked with and studied children
16:06experiencing traumatic grief reactions
16:09have found that children's reactions to
16:12traumatic reminders about the person who
16:14died or reminders of how the person died
16:17can be particularly challenging the
16:21child may become distressed when
16:23different people places or situations
16:26trigger upsetting thoughts and memories
16:29in therapy the child comes to identify
16:32and understand the triggers and how to
16:35cope with them
16:36experts on child traumatic grief have
16:40identified three main types of traumatic
16:42reminders that can be distressing for
16:45children
16:46there are three kinds of reminders that
16:48children may experience with
16:51or difficulty
16:53the first is a try drama reminder and a
16:56trauma reminder is any person place
16:58situation or prompt that will make the
17:03child think about the traumatic nature
17:05of the death the other kinds of
17:08reminders are loss reminders and change
17:12reminders lost reminders are any
17:15situation or person or place that
17:18reminds the child of the person who's
17:21died the third type of reminders a
17:24change reminder and this is related to
17:26secondary adversities that children may
17:29experience as a result of the death of a
17:31parent or other loved one a change
17:33reminder is anything that reminds the
17:36child that their circumstances in life
17:38have changed as a result of the person's
17:40death so trauma loss and change
17:43reminders can segue into trauma symptoms
17:46and can interfere with the child's
17:49ability to grieve the deceased person if
17:52children don't address the trauma
17:55reminders
17:57either by creating a trauma narrative or
18:00through some other method of directly
18:03confronting their traumatic memories
18:06they are likely to avoid those reminders
18:09this can lead to Children believing that
18:11they don't have an ability to cope with
18:13upsetting feelings so that the only way
18:15to cope is by avoiding or even becoming
18:18emotionally numb
18:20clinicians and researchers from the
18:22national child traumatic stress Network
18:24representing diverse professional
18:27backgrounds and areas of expertise have
18:30collaborated and agreed on the most
18:32helpful aspects of treatment for
18:34childhood traumatic grief the treatment
18:37incorporates elements used by experts
18:40with a more traditional Psychotherapy
18:42approach and those using a more
18:44structured skills-based format these
18:48intervention techniques have been shown
18:50to be effective and should be
18:52individualized to the family's personal
18:54and cultural beliefs
18:56treatment should also be adapted to the
18:59specific needs of young children groups
19:01and teams it is often best to help the
19:05child experiencing childhood traumatic
19:08grief cope with both the trauma and the
19:11grief related reactions
19:13in the context of a strong and trusting
19:17therapeutic relationship the child and
19:19therapist can begin the gradual process
19:22of coping with a traumatic loss one way
19:26this is done is by first helping the
19:28child and parent learn specific skills
19:31for managing distressing thoughts
19:33feelings and behaviors such as their
19:36worries guilt nightmares or avoidance
19:41a beginning step is to teach the child
19:43to identify and better control his or
19:47her reactions to unpleasant reminders
19:49and memories
19:51only when the clinician believes the
19:53child has gained these new skills and is
19:56ready the child begins the process of
20:00confronting his or her traumatic
20:02experience in a safe trusting and
20:05controlled environment one method for
20:09helping the child deal with a traumatic
20:11death is by having the child tell his or
20:14her story through the creation of a
20:17trauma narrative
20:19a trauma narrative can be told in words
20:21drawings or other creative activities
20:24appropriate to the child's interest and
20:27developmental level
20:29completing the narrative can help reduce
20:31traumatic grief reactions and allows the
20:34child to better engage in healthy
20:37activities focused on more positive
20:39memories
20:43Lauren entered therapy after witnessing
20:46the death of her young sister
20:49after a gradual process where Lauren's
20:51therapist worked with her to identify
20:54and cope with distressing traumatic
20:56reminders and memories Lauren was ready
21:00to address what happened to her sister
21:02Lauren worked closely with her therapist
21:05to describe her painful experience in
21:08the form of a trauma narrative
21:10what follows is an example of how a
21:13trauma narrative was utilized as part of
21:16a successful treatment experience
21:18The Narrative of Lauren's memories is
21:21told in her own words and drawings
21:30my sister died
21:34she was five and a half years old
21:37on a day like any other eight-year-old
21:39Lauren was playing on a second floor Sun
21:42porch with her younger sister Kelsey
21:44Lauren briefly left the porch when she
21:47returned she couldn't find her sister
21:50I looked around the house and she wasn't
21:52there
21:54Kelsey had climbed through a window of
21:56the porch and fallen from a second story
21:58window to the ground below
22:03I was staring at her her eyes were
22:06closed
22:07Lauren immediately ran to get her father
22:10[Music]
22:11's on the ground
22:14inside my dad was holding Kelsey's head
22:17I felt sad and a little scared
22:21they called the ambulance and waited the
22:24long minutes for it to arrive
22:27in Lauren's case her parents brought her
22:30to therapy about six months after the
22:33death of her sister and she still
22:36experienced as you would expect a lot of
22:40anxiety sadness
22:43nightmares difficulty sleeping
22:46and even some avoidance
22:49she avoided playing in the backyard for
22:52example because that's where she found
22:54her sisters every time she would
22:57experience a daily reminder of her
22:59sister
23:00even a positive memory that would
23:03simultaneously trigger the traumatic
23:06memories so that the usual grieving
23:09process would be halted or interrupted
23:13so
23:15creating this trauma narrative is a way
23:18to help the child
23:20guide the child through telling their
23:22story just a little at a time gently
23:25guiding them through it but always
23:26encouraging them to move forward
23:30I don't think people particularly
23:32children have the ability to just walk
23:36their way instinctively through those
23:38trauma responses it really needs a
23:41special kind of guidance the trauma
23:43narrative is just one step in the
23:46process of healing the full therapy
23:48process can take many months
23:51I think parent involvement in this
23:54treatment protocol is really critical
23:57it also happens to be very complicated
24:00because
24:01oftentimes the parent or caregiver is
24:04having their own traumatic grief
24:06response
24:09Lauren's father rode to the hospital in
24:11the ambulance with Kelsey driven by
24:24finally the doctor emerged and conveyed
24:27the awful news
24:33I mean we definitely weren't prepared
24:36I mean you read it in the paper things
24:38happen you always think it's not going
24:39to happen to you it's not going to
24:40happen to us I mean we feel we're pretty
24:43good parents a bunch our kids and then
24:46you know an accident happens
25:16it helped all of us we watched Lauren
25:18grow every day and
25:22Kelsey's just still you know Kelsey
25:25she's just She'll always be five years
25:27old and
25:29and that's that's really hard that she's
25:31not going to grow up I mean she'd be
25:33nine years old today
25:35[Music]
25:43another important thing we know about
25:45kids in this situation is you can't
25:47always tell by looking so what you have
25:50to do is look at how they're behaving
25:53sometimes what they're not saying or
25:55what they're not doing parents and
25:57professionals and teachers have to look
25:59at their children and think about what
26:01might be going on that is unspoken
26:04unfortunately there's often a tendency
26:06to think either that kids will get over
26:08something that's awful or that it wasn't
26:12that bad for a child and both of those
26:15kinds of attitudes aren't helpful for
26:16kids that have childhood traumatic grief
26:18because violence and Trauma are often
26:22concentrated in urban neighborhoods the
26:24there are hundreds of communities across
26:26the country faced with the reality of
26:29childhood traumatic grief every day
26:32traumatic loss is one of many types of
26:35trauma faced by our nation's children
26:37exposure to trauma can also result from
26:40such issues as community and domestic
26:42violence abuse maltreatment medical
26:46trauma natural disasters and other
26:49traumatic events the problem of child
26:52traumatic stress is so prevalent that
26:54the U.S federal government decided to
26:56take action and form the national child
26:59traumatic stress Network
27:02the network was established in 2001
27:04through a congressional initiative and
27:07is administered by the U.S Department of
27:09Health and Human Services Substance
27:11Abuse and Mental Health Services
27:13Administration it spans the nation and
27:16includes the expertise of leading
27:18universities hospitals and Community
27:21treatment centers
27:23the national child traumatic stress
27:25Network allows experts such as doctors
27:27Cohen Goodman Lieberman and pinus to
27:31collaborate effectively in establishing
27:33standardized treatments for childhood
27:35traumatic grief and other forms of child
27:38traumatic stress the Network's mission
27:41is to raise the standard of care and
27:44improve access to services for
27:46traumatized Children and Families across
27:49our nation
27:51the national child traumatic stress
27:53network is a very unique Federal
27:56legislation
27:57it's Unique in a number of different
27:59ways first of all it's a very large
28:03child mental health initiative
28:05addressing a population of Children and
28:08Families that often has not gotten much
28:11attention within our society we know
28:15that very few children who have these
28:17kinds of experiences of getting care
28:18right now we have some preliminary
28:21evidence that the kinds of treatment
28:23we're discussing are effective in
28:25decreasing not only children's traumatic
28:28grief but also their post-traumatic
28:30stress disorder symptoms their
28:32depression their anxiety their behavior
28:34problems and we also have some
28:37information that suggests that parents
28:39who participate in this treatment also
28:42resolve their own post-traumatic stress
28:44disorder and depressive symptoms through
28:47efforts of the national child traumatic
28:49stress Network we are beginning to make
28:51great strides in the treatment of child
28:54traumatic stress reactions such as child
28:56traumatic grief we know that every child
29:00is unique and each responds differently
29:02based on culture developmental level and
29:06other variables but in the end they all
29:09have one thing in common they are
29:11suffering and need our help
29:20medical and mental health professionals
29:23have learned much from the violent
29:25events of recent decades both about the
29:28effect of trauma on kids and ways to
29:31help as the word spreads fewer and fewer
29:34kids and families will suffer we hope
29:38that for children with traumatic grief
29:40once they've completed treatment
29:42although the traumatic loss will always
29:45be a sad memory it will be something
29:47that hopefully will make them stronger
29:50that they can grow from and
29:53particularly we hope that they will see
29:56it as only one event in their lives
29:58rather than making their Central
30:00identity
30:01one of a victim children are having to
30:05deal with very adult-sized problems
30:07these days in terms of violence and
30:09Trauma and death and it really takes the
30:12adults to show these kids where they can
30:15get help and that it's okay to get help
30:17because kids really depend on the
30:20grown-ups to take care of them and do
30:22the right thing more than just the facts
30:24of the death what truly it's like to be
30:27under those circumstances but but to
30:30allow yourself to get into that world
30:32it's not an easy world to get into it's
30:34one that always would rather not be
30:36happening to anyone but
30:39um we've learned to not only to
30:42legitimize and understand but to
30:44appreciate the complexity of those
30:46experiences and the ways in which being
30:50helped with the reminders of trauma and
30:52the lost reminders how children come out
30:55on the other side so that they come out
30:57with extremely constructive views about
31:00how they'd like to make the world better
31:06Lauren and her parents successfully
31:08completed therapy while the memory of
31:11Kelsey's death will always be with them
31:13as a family they have made this
31:15experience into a positive part of their
31:18lives
31:19now in a position to help others
31:21struggling with similar problems Lauren
31:24and her parents were pleased to share
31:25their story for the making of this video
31:27in fact the song you are listening to
31:30was written by Lauren's father in honor
31:33of Kelsey I think of you I think of you
31:38[Music]
31:41amidst the problems of today's society a
31:45vision is emerging while we will never
31:47be able to completely eliminate the
31:50suffering in our children's lives every
31:52day we are learning that there are ways
31:55to help every day parents teachers and
31:58Health Care Professionals all across the
32:01country are proving that health is on
32:04the way together as we strive for a
32:07brighter future we can help our children
32:09understand that there is hope that they
32:12can heal and it's okay to remember
32:17[Music]
32:20if you are a parent caregiver or other
32:23concerned adult worried about a child
32:26who may be experiencing childhood
32:28traumatic grief reactions please consult
32:31with a qualified medical or mental
32:34health care provider who works with
32:36children in your community
32:39practitioners are strongly encouraged to
32:42seek out additional consultation
32:44training and Supervision in order to
32:47develop your expertise related to
32:49Childhood traumatic grief and its
32:52treatment for additional resources
32:54please consult the companion training
32:56video and print curriculum
32:59to learn more about childhood traumatic
33:02grief or other issues related to child
33:05traumatic stress please visit our
33:07website at mctsnet.org
33:10[Music]
33:13thank you
33:14[Music]
33:24I think of how much you like your mother
33:29very loving and caring you will let no
33:33other if it could be before I go to
33:36sleep
33:37and thank God it's the end of the day
33:41and the last hour we
33:44think of how much you were like your
33:48mother
33:49very caring and loving like no other I
33:54think of you I think of you
33:59I do
34:06foreign
34:11[Music]
34:19[Music]

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