Abstract
TITLE: Occupational Therapy’s Role in Children and Adolescents Experiencing Grief
PRESENTER: Michelle Michaels, OTDS
MENTORS: Dr. Adam Carter, PhD., LCPC (IL), LPC-S (TX), NCC, CCMHC, FT & Dr. Reagan Bergstresser-Simpson, OTD, OTR/L
This doctoral capstone project consisted of dual advocacy for occupational therapy services for children and adolescents experiencing grief. This consisted of collaborating with the National Alliance for Children’s Grief (NACG) by conducting a webinar and creating resources advocating for occupational therapy services. In addition to educating the grief community, future occupational therapy practitioners were educated on children’s grief through a presentation consisting of intervention resources and case study simulations. The overall goal of this project was to educate and advocate for occupational therapy services to increase participation in occupations among children and adolescents experiencing grief. The other main goal of this project is to help provide alternative therapy options for children with grief to improve overall wellbeing and quality of life. Through the duration of this capstone project, I completed the requirements of key deliverables such as completion of occupational therapy resources for the NACG, completed 3 CEU courses, created mental health intervention resources and 2 case studies, presented a webinar for the NACG, and presented my capstone project for a group of occupational therapy students. With the increase of children experiencing grief, I am hoping that this capstone project provided advocacy to incorporate occupational therapy services among this population. It is important to continue a sustained connection between child grief professionals and occupational therapists to improve the overall wellbeing of children and adolescents experiencing grief. Further research is needed in children’s grief and occupational therapy services to provide evidence-based occupational therapy interventions towards this population.
KEYWORDS: Occupational therapy, Children & Youth, Children’s grief, Education, Advocacy, Mental Health
Project Description
This project was among the first to emphasize the important role occupational therapy can play in supporting children experiencing grief. In order to support this population, this project consisted of connecting the grief community and occupational therapy through education and advocacy. This doctoral capstone project consisted of two parts to help improve the quality of life and overall wellbeing of children and adolescents experiencing grief.
Working with the NACG
This project collaborated with the National Alliance for Children's Grief (NACG) to educate members on occupational therapy services in the form of a webinar and resources. Keep reading to view details on webinar and created resources below.
Educating future occupational therapy practitioners
The other part of this project included educating current occupational therapy students at Huntington University on the effects of grief on children and adolescents and how to improve the quality of life and overall well being in this population. Students were educated through presentations, intervention resources, and case studies. Keep scrolling to view resources.
Project Mission Statement
To educate and advocate on the influence and benefit of occupational therapy services in the lives of children experiencing grief through collaboration with the National Alliance for Children's Grief through resources and a webinar.
Project Vision Statement
To enrich children and adolescents experiencing grief with therapeutic occupation-based interventions and resources to promote well-being and quality of life through education and advocacy.
Project Overview
Site Information
Project done in collaboration with the NACG.
Site Location: Huntington University (Fort Wayne Campus)
Occupational Therapy Practice Areas
Children & Youth and Mental Health
Areas of Focus
Education and Advocacy
Target Population
Through the NACG Webinar
- Counselors
- Social workers
- Bereavement support professionals
- Members of the NACG
Through occupational therapy interventions and resources:
- Occupational therapy students at Huntington University
Need for Project
1 in 12 children in the US will experience the death of a parent or sibling by age 18.
That is 6 million children in the United States that will be experiencing grief. This statistic was determined by Judi's House through the Child Bereavement Estimation Model in 2023. (Judi's House, 2023). Children experiencing grief is rising and is a problem.
Needs Assessment
A Three Phase Model - Needs Assessment was completed in the development process of this capstone project collected through research and personal interviews. These interviews included local and national leaders for children's grief. The local leader interview was conducted with Ellen Roemke, the Director of Volunteers at Erin's House for Grieving Children in Fort Wayne, Indiana. The national leader interview was conducted with Vicky Jay, the CEO of the NACG.
Indicators:
- Limited resources and research
- Rise in children under the age of 18 experiencing grief
- Increase in grieving centers for children across the country
- Lack of awareness of the role, benefits, and utilization of OT services
Data and Analysis
Previous needs assessment survey directed towards school-based OT’s was conducted indicating a significant number of students experiencing behavioral reactions to grieving and were not being treated (Miliken, 2007).
Occupational therapy practitioners are trained and skilled to not only identify mental health problems but also assess and provide interventions to children and youth who need skilled services (Arbesman, 2013)
Interviews indicated a need for occupational therapy services to address the specific needs of each child as they adjust to the changes with grief (V. Jay, personal communication, April 14, 2022).
Literature Review
Childhood is a crucial period of growth and development, but when a child is exposed to trauma this causes neurological, physiological, and psychological changes. Trauma causes structural changes in the brain that affect cognitive and physical functioning (Dye, 2018). Occupational therapy practitioners are trained and skilled to not only identify mental health problems but also “to understand how to assess and provide interventions to children and youth needing intensive services” (Arbesman et al., 2013).
How does grief and trauma affect children?
Trauma during childhood can cause neurological, psychological, and physiological changes in the growth and development of a child (Dye, 2018).
Trauma causes structural changes in the brain that effect cognitive and physical functioning (Dye, 2018).
Exposure to trauma can cause changes to physical, social-emotional, and behavioral health in children and youth (Campbell, 2016).
The most reported behaviors associated with school-aged children who were experiencing grief are the inability to focus, decreased motivation, and disruptive behaviors (Milliken, 2007).
How can occupational therapy services help?
By identifying children in need of mental health interventions and providing evidence-based interventions using expressive therapies, cognitive-behavioral modalities, and stress management strategies and activities (Davis, 1999).
By providing grief and trauma interventions that focus on peer and social intervention, children were compliant with adult directives and social rules and norms and participating in task-focused behaviors to help with social-emotional regulation in children and adolescents (Arbesman, 2013).
Addressing the common behaviors related to grieving that effect participation in the occupation of formal education participation such as inability to focus, decreased motivation in learning and schoolwork, and disruptive classroom behaviors (Milliken, 2007).
Project Completion and Outcomes
Outcome Measure 1
In order to demonstrate an in-depth knowledge in Children & Youth and Mental Health, I developed resources for the purpose of improving the overall quality of life and participation in occupations of grieving children.
Outcome Measure 2
In order to demonstrate an in-depth knowledge in Children & Youth and Mental Health, I presented on the influence and benefit of occupational therapy services for children experiencing grief in the form of a webinar for the NACG.
Project Deliverables
Project deliverables needed to be completed to finish capstone project. However, most deliverables were exceeded with additional artifacts.
Completion of resources to increase participation in occupations for the NACG
This deliverable was completed by creating 15 handouts and providing slides to collaborated webinar with the NACG. These resources included:
Completion of 3 CEU courses
A total of 9 CEU courses were watched during the duration of the 14 weeks of this doctoral capstone experience. A total of 11 additional webinars/videos were watched to help increase my knowledge on grief in children.
CEU courses taken on OccupationalTherapy.com
- Mental Health First Aid Awareness
- Sensory Integration and Processing 101
- Back To The Basics When Looking At Maladaptive Behavior
- ACEs: Research for Understanding the Early Experiences of Young Children
- Management of Pediatric Incontinence
- Mental Health of Adolescents: Psychosocial Occupational Therapy for Adolescent Populations
- Towards A Better Understanding Of Self-Regulation And BEST Strategies In Partnership With Moira Peña Sensory Workshops
- Yoga Tools For Schools (K-5): Mindful Movement For Pediatric And School-Based Therapists
- Fun, Practical, Client-Centered Activities to Encourage Social Emotional Development in Pediatric Practice
Including several webinars available on the NACG website for members to learn more about grief in children.
Creation and completion of mental health intervention resources and 2 case studies.
Created to for future occupational therapy practitioners to be able to refer back to in practice. The intervention resource consists of 35 separate PDF documents that educated about grief, how it may present in children, and mental health interventions to try. All are available to download. View some slides from the presentation below:
Case Studies
Presentation in the form of a Webinar for the NACG
Presentation of capstone project to a group of occupational therapy students.
I had the honor of presenting to two classes of occupational therapy students on my doctoral capstone project. Within these presentations I provided intervention ideas and provided resources to the students that they may utilize later as practitioners.
Future Implications for OT
With the amount of children experiencing grief on the rise, there is a huge opportunity and need for occupational therapy services among this population.
An increase in research and evidence-based interventions is needed for children experiencing grief.
A sustained connection is needed between grief specialists and occupational therapy practitioners to help improve the quality of life of children and adolescents experiencing grief.
With an increase in children's grief centers across the country, there is an opportunity for community-based occupational therapists to practice within these centers to help improve the quality of life and services available for children with grief.
About Me:
Hello everyone, I'm Michelle Michaels!
I am the project manager of this doctoral capstone experience, I am a third year occupational therapy student at Huntington University. I am extremely passionate about my project due to my personal experiences with childhood grief following the death of my mother. I am honored to be able to use my past experiences with childhood grief to help advocate and help children experiencing grief, but advocate and be among the first to collaborate occupational therapy role in children's grief.
Add me on LinkedIn
Responsibilities
Completion of 560 hours minimum
Complete all deliverables by the end of the 14-week DCE
Completion of biweekly consultations with expert and faculty mentor. With a minimum of 7 documented times with each mentor.
To collaborate and effectively communicate with all members of stakeholder team.
Meet my Stakeholder Team
A special thank you to my stakeholder team for all the assistance throughout my Doctoral Capstone Experience
Adam Carter, Ph.D, LCPC (IL), LPC-S (TX), NCC, CCMHC, FT
Expert Mentor
Title
Former National Clinical Director for the NACG, current consultant with the NACG.
Area of Expertise
Children and adolescent grief support
Roles in Capstone Project
Provide insight, feedback, and suggestions in area of expertise through the duration of the project
Help guide webinar process and provide expectations of project
Monitor and evaluate project progress and performance
Communicate biweekly during DCE via email, text, or Zoom. Communication prior to starting project will be done once a month via email.
Dr. Reagan Bergstresser-Simpson, OTD, OTR/L
Faculty Mentor
Role in Capstone Project
Provide feedback, suggestions, knowledge and guidance throughout the capstone process
Provide years of occupational therapy knowledge to apply to project
Communication done biweekly through email, text, or Zoom call during doctoral capstone experience.
Curricular Threads
Christ
Grief can affect every aspect of someone’s life, including spirituality and faith.
Scholarship
Through expanding my knowledge and collaboration with mental health professionals, I was able to educate and advocate for occupational therapy’s role in children’s grief.
Service
To be among the first to provide a sustainable connection and advocacy for occupational therapy services to support children’s grief.
Special Thank You to
Erin's House for Grieving Children
For providing resources, letting me tour the facility, ask questions, and provide information for my local leaders interview.
A special thank you to Ellen Roemke, the Director of Volunteers at Erin's House for additional communication, support and resources provided to aid the development and execution of my doctoral capstone experience.
References
Arbesman, M., Bazyk, S., & Nochajski, S. M. (2013). Systematic review of occupational therapy and mental health promotion, prevention, and intervention for children and youth. American Journal of Occupational Therapy, 67, e120–e130. http://doi.org/10.5014/ajot.2013.008359
Campbell, C., Roberts, Y., Synder, F., Papp, J., Strambler, M., & Crusto, C. (2016). The assessment of early trauma exposure on social-emotional health of young children. Children and Youth Services Review, 71, 308-314. https://doi.org/10.1016/j.childyouth.2016.11.004
Davis, J. (1999). Effects of trauma on children: Occupational therapy to support recovery. Occupational Therapy International, 6(2), 126-142. https://doi.org/10.1002/oti.93
Dye, H. (2018). The impact and long-term effects of childhood trauma. Journal of Human Behavior in the Social Environment, 28(3), 381-392. https://doi.org/10.1080/10911359.2018.1435328
Judi’s House (2023). Childhood bereavement estimation model. Judi’s House. https://judishouse.org/research-tools/cbem/
Milliken, B. E., Goodman, G., Bazyk, S., & Flinn, S. (2007). Establishing a case for occupational therapy in meeting the needs of children with grief issues in school-based settings. Occupational Therapy in Mental Health, 23(2), 75-100. https://doi.org/10.1300/J004v23n02_04
Full Reference List Available Upon Request
Credits:
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