“Is Daddy Coming Back in a Minute?” and other questions children might ask

Making SENSE of traumatic bereavement: A trauma informed approach

Recognising the widespread impact of trauma and stress, and the potential for re-traumatisation is key to supporting individuals who have experienced a traumatic bereavement. In this blog, psychological trauma consultant and clinical adviser to Sudden, Nicola Lester discusses the SENSE trauma-informed approach to support, which she originally developed in collaboration with the Tim Parry Johnathan Ball Peace Foundation.

The SENSE model is a trauma-informed approach to support suddenly bereaved people and was first developed in response to the Manchester bombing in May 2017, as a way of structuring the delivery of support in the immediate aftermath of the attack. Since then it has been adapted and used across a variety of different contexts both in the UK and overseas in the Middle East and Afghanistan.

The SENSE model is underpinned by an understanding of best practice in the field of psychological trauma and informed by the six principles of trauma informed practice to create a structured approach to the delivery of support as part of an early intervention approach. Adopting a ‘trauma informed’ approach to bereavement care provides a framework for organisations and professionals providing support to bereaved families in the aftermath of a traumatic loss.

Fostering resilience and coping

A trauma informed approach is one which recognises the widespread impact of trauma and stress and the potential for re-traumatisation. It actively seeks to reduce this possibility by understanding what is needed to foster resilience and coping and by promoting opportunities for recovery.

It is comprised of six key guiding principles to underpin practice:

  1. Safety – ensuring physical and emotional safety
  2. Choice – restoring choice and control
  3. Facilitating connections
  4. Supporting coping
  5. Responding to identity and context
  6. Building strength

Bereavements which occur under external traumatic circumstances may be regarded as traumatic. This is a term indicating the interface between trauma and loss, where in such circumstances grief symptoms are overlaid with trauma symptoms. In fact, because the impact of sudden, traumatic loss is so devastating, it may result in symptoms of post traumatic stress disorder (PTSD), meaning that the bereaved are faced with the dual task of mourning the loss as well as coping with the trauma that accompanied the death.

In addition there is growing recognition that the processes which occur after a bereavement may also leave the bereaved family susceptible not just to the effects of primary grief but may also serve to exacerbate their distress, as they are required to navigate a myriad of medical, legal and criminal processes, which may prioritise organisational procedures and requirements over the needs and wishes of the bereaved family.

Supporting bereaved families to navigate such processes, increasing their sense of voice and capacity to actively participate is essential and a key part of the support which is provided by the Sudden service and the SENSE model provides an effective way to structure the delivery of this care. In addition, the five stages of the SENSE model are designed to respond to the immediate practical and emotional needs of those who are bereaved, support their coping, mobilise and strengthen their access to social support and identify and address their longer-term support needs by engaging them with relevant services and professionals.

The five interventions of the SENSE model

The SENSE model is comprised  of five interventions: Stabilisation, Education, Normalisation, Social support and Engagement; all of which have been recommended as best practice by both the National Institute for Health and Care Excellence and the broader trauma literature.

In creating the word ‘SENSE’, the order of the letters in turn reflect the chronology in which the interventions should be offered. For example, as part of an early intervention approach the emphasis is on stabilisation to ensure the physical and emotional safety of the person affected and that their immediate needs are met.

This is followed by providing information and education about the signs and symptoms of trauma and promoting an understanding of how trauma may affect someone as a way of ‘normalising’ or validating their experiences and offering reassurance. We recognise that for many in our society death and loss remain taboo subjects shrouded in both secrecy and judgment about how people should be coping and grieving when they are bereaved.

Helping people to understand how they feel and validating their experiences by providing a non-judgemental space in which to access support is intended to shift the focus from how someone should be coping to instead to support and enhance how they are coping recognising their resilience.

Empowering the bereaved person

The normalisation of symptoms coupled with education, introduces the idea of empowering the person and their wider social support network to monitor their symptoms and where necessary to facilitate early referrals to formal psychological services, which is known to improve outcomes over the longer-term. The importance of social support in both reducing the impact of stressful life experiences and in protecting those affected from going on to develop PTSD and other mental health difficulties is well established, suggesting that it is essential to assess the presence and availability of social support as the fourth stage of intervention.

The final stage is engagement; either encouraging engagement with specialist support services; promoting the individual’s engagement with their wider social support network or assisting them to re-engage with their own values and goals and to regain a sense of purpose and control. At this final stage we plan for the longer-term to ensure access to relevant and appropriate services capable of providing the right support, at the right time based on an understanding that everyone is unique and affected by traumatic bereavement in different ways.

Delivering the SENSE model

The five stages of the SENSE model can be delivered in a variety of different ways, including face to face, via email, telephone and online. Whilst it is suggested that the five stages are implemented in chronological order to provide a sense of structure and purpose, each stage can be delivered as a standalone intervention, depending on the needs of those you are working with. It may be beneficial to explain the stages, as this will help the person to feel that they are making progress, particularly if you build in regular opportunities for review.

About the author

Nicola Lester is a psychological trauma consultant and clinical adviser to Sudden and Brake, the road safety charity.

Half a million people in the UK set to face a sudden bereavement in 2020

Sudden’s Chief Executive Mary Williams announces a new report, Help when the worst happens, published in response to COVID-19. It outlines how the challenging circumstances of this pandemic are affecting bereavement, and the measures that need to be taken to ensure needs are met. 

In 2020, due to COVID-19, people are being bereaved in sudden and shocking ways, under remarkably difficult social circumstances, and at far greater numbers than ever before. In response, we have published an urgent Sudden report, Help when the worst happens, about meeting the needs of people bereaved in these difficult times.

The report explains that sudden deaths in the UK are set to more than double this year to 100,000, with COVID-19 accounting for almost half that number. This will likely leave half a million people in the UK facing the very complex challenges of a sudden bereavement of a close family member, challenges which are exacerbated by ongoing social-distancing restrictions that can cause isolation.

This report aims to shine a light on those challenging circumstances, outline the appropriate systems of support, and reveal the poor outcomes that bereaved people could suffer without proper care. Charities and health experts are rightly calling for an urgent focus on funding and development of the provision of bereavement support this year. Sudden deaths, from COVID-19 or any other circumstances, can affect anyone at any time so support must be wide-spread.

In previous times of mass bereavements with acute needs, we have not known how to help; we do now. The combined expert opinions that have underpinned Sudden’s advice to practitioners over the years, as a provider of professional development regarding early care of bereaved people with acute needs, teach us that sudden and shocking bereavements require an immediate and clinically-informed crisis response from day one onwards. Help is particularly key through the early weeks (the shock period, before grief support services and mental health services, are appropriate to signpost) as well as in later months. The report outlines how support should be assigned according to need, for example, with the impact bereavement can have on mental health. This immediate psychosocial response for people with acute needs must be accessible, have capacity, and be tailored to address an individual’s unique emotional and practical needs.

Without the proper support, we know people bereaved in challenging circumstances can suffer a range of poor outcomes that negatively affect them, their families, the wider community and even our economy. With support, provided in evidence-based, timely and straightforward ways, people are more likely to move forwards into a positive future.

Help when the worst happens calls for bereavement and support charities, health and social care agencies, community leaders, and government to work with urgency, together, to secure these futures for the sake of us all and in the name of humanity. Click here to read the full report.

To help Sudden answer the call of anyone suffering a sudden bereavement, please donate to our charity.

About the author

Mary Williams OBE is chief executive of Sudden. Sudden is a global initiative to help people bereaved by any sudden cause and also to help the professional standards of their carers. Mary is also chief executive of Brake. Brake is a road safety charity providing the National Road Victim Service in the UK for families bereaved by death on the road, including an acclaimed and government-backed national helpline and information service. Brake also operates globally and has a domestic branch in New Zealand too.

Bereavement challenges in a time of pandemic

After a death from COVID-19, and after a death from any cause in a time of pandemic, there are bereavement challenges that are new and hard, for both bereaved people and their carers. In this blog, Sudden chief executive Mary Williams OBE discusses the impact of death on families and bereavement services at this time of COVID-19 and applauds the efforts of the bereavement NGO community to offer support.

While governments still battle the spread of COVID-19, a new challenge is emerging: the challenge to help bereaved people in a time of pandemic.

A death from COVID-19 is a shocking, sudden death after a short and increasingly severe illness. To prevent infection, it is usually not possible for families to say goodbye in a normal way.

A death from any cause in a time of pandemic brings additional challenges for everyone who is bereaved. For example, it is ill-advised, or forbidden, for people to meet and hold a normal memorialising event such as a funeral. People whose normal cultural or religious practices involve washing or dressing a dead person’s body are now prevented from doing these things.

Governments are rightly concerned about the perils of isolating people through ‘lockdowns’ that aim to contain the virus, particularly the potential harm to people who are suffering major life challenges, such as poverty, addiction, and problems relating to mental health and physical health. There is also the enormous challenge of being both isolated and bereaved.

As we applaud our medical practitioners for saving so many lives, for those families who are bereaved by COVID-19 (and also by any other causes, particularly sudden causes) their challenges are just beginning.

For some people bereaved at this time, there are acute practical challenges that require immediate intervention from health and social services. For example, imagine the needs of an elderly person with dementia, perhaps also suffering from COVID-19, who was previously cared for by their partner who has died.

For all people who are suddenly bereaved at this time, there will be a range of challenges, compounded by the need for social distancing. Contact from family, friends, carers, and basic human needs, such as to have a hug, are prevented. Or these things are restricted to people with whom the bereaved are self-isolated.

Bereavement charities and mental health services around the world are working to ensure we help, as best we can, with the resources we have. A wealth of information is being published online and bereavement helplines are open.

Across the world, we are all having to help each other in new, and often virtual, ways. We are blessed with the power of phone lines and the internet to enable many people to access information, talk and share their feelings and thoughts online, at a time when, cruelly, it is not possible to say goodbye to someone who is dying, it is not possible to help prepare their body for a funeral event, it is not possible to safely hold a mass gathering of family and friends to mourn and celebrate.

We know, from the findings of academia and practitioners, that early care of suddenly bereaved people is very important. It can prevent the onset of serious conditions such as post-traumatic stress disorder (PTSD) that can blight lives for years.

People who have been bereaved suddenly need to be looked after in the early weeks. They need to feel safe. They need to be informed about symptoms of sudden bereavement so they are prepared. They need to feel supported, through simple tips regarding self-care at this time.

The good news is that meeting suddenly bereaved people’s practical needs and giving them information and support to enable self-care can really help make a difference to their mental health outcomes and enable a normal grieving process.

I applaud all bereavement services for rallying together, to help people bereaved by any cause, including COVID-19, in these very challenging times, and urge a focus on a straightforward approach that helps people through the early weeks in practical, simple ways that enable people to feel safe and supported.

About the author

Mary Williams OBE is chief executive of Sudden. Sudden is a global initiative to help people bereaved by any sudden cause and also to help the professional standards of their carers. Mary is also chief executive of Brake. Brake is a road safety charity providing the National Road Victim Service in the UK for families bereaved by death on the road, including an acclaimed and government-backed national helpline and information service. Brake also operates globally and has a domestic branch in New Zealand too.

How Do Children Respond To Sudden Death And Trauma?

After a traumatic event or sudden bereavement, children can react in very different ways. Several inter-relating factors that can influence how well a child copes. In this blog, bereavement expert Erica Brown discusses the impact that trauma can have on children, and provides advice on how children can best be supported.

Sudden deaths such as road crashes occur unexpectedly, turning everyday experiences upside down and destroying the belief that ‘it couldn’t happen to us’.

Children’s responses to trauma

A road crash where someone dies is a traumatic event, and children’s responses to the trauma they experience will vary widely. For some children, reactions will be minimal or short-lived, whereas others will experience anxiety, fear and phobias. Sleep disturbances are also common, and many children have problems at school, both with their learning and their behaviour.

Little is known about children’s individual responses to traumatic events, or why some children are more vulnerable than others. A child’s individual personality, and the amount of time that they were exposed to the event, can influence their response. Severe reactions are linked to the suddenness of the event, and the degree to which the child was rendered powerless during the trauma.

Stress reactions in children are complex, but they are in fact normal human responses to unanticipated sudden and frightening events. The child’s world has become unpredictable. In some cases, the nature of the trauma seems to determine the nature of the stress. If the trauma involved noise, some children may experience more intense reactions. Likewise, injury or threat to life may cause particularly severe traumatic responses. Other factors such as the duration of exposure to the trauma, and whether the event was experienced in isolation or with other people, can play a significant part in how a child responds.

Imagery

Matt was 12 when he witnessed a fatal road crash. He was returning from school at the end of the day. It was dark and raining. Suddenly, in front of him, a car overtook an oil tanker and hit a car coming in the opposite direction. The cars hit head on and one was thrown under the wheels of the tanker, leaving only the rear visible.

For Matt, imagery of the event is one of the recurring effects of trauma: “It all happened so fast and to this day I can remember thinking, ‘Oh my God, there is going to be a prang!’ The noise of the skidding and of the metal buckling under the tanker wheels keeps haunting me. It is as if a recording has been made in my mind and it keeps replaying all the time. I am just dozing off at night and I hear the dreadful skidding and squealing of brakes.”

Some children experience a phase of denial and numbing immediately after a stressful event. After this phase the child may be confronted with intrusive, repetitive recollections of the event, including nightmares and flashbacks.

Searching for meaning

All survivors of traumatic events need to make sense of their experience. For children there may be questions such as ‘Why did it happen to me?’, ‘Why did I survive?’ and ‘Why do I feel the way I do?’

Many children believe they were in some way responsible for what happened. Others may be confused about why they were singled out to witness the event. Why a child has survived when others haven’t may pose a myriad of questions to which there are no definitive answers. These questions often lie at the heart of survivor guilt.

Children may also battle with the intensity of their emotions and may not have the language to describe how they feel. Some may not have experienced intense emotions before, and it is not unusual for them to attempt to repress unknown feelings. The world is unfamiliar and frightening.

Coping and support

How well a child copes after a traumatic event is dependent on several inter-relating factors. These include the child’s cognitive ability and capacity to express emotions, the maintenance of familiar routines and levels of support from within and outside the child’s home.

For anyone supporting a child who has experienced trauma, there are both proactive and reactive ways of giving support.

Proactive ways of supporting children include providing opportunities for the child to communicate their experiences, acknowledging the trauma they are experiencing, and allowing opportunities for them to integrate the traumatic event into their life and to move on. The help of specialist support networks may also be required.

More reactive ways of giving support include reassuring the child that their response is normal, keeping routines as normal as possible and encouraging the child to join in activities with their peers. It’s also important to work closely with other professionals who are supporting the child’s family.

About the author

Erica is a qualified teacher and has worked in a variety of roles in the Education and University Sectors. She has experience of teaching Early Years classes and has worked as a Senior Teacher, Head of Department and Head Teacher in Special Schools.

Erica’s academic career has included roles as Senior Lecturer, Principal Lecturer and Principal Research Fellow. She has also worked as Head of Research and Development of Care at Acorns Children’s Hospice and Head of Special Education at Oxford Brookes University.

Erica’s recent research interests have involved supporting children and families who are experiencing loss, and in 2012 she was made a fellow of The Royal Society of Arts in recognition of her work with life-limited children, young people and their families.