SeeSaw is a service for families who live in Oxfordshire. If a family has no connection to Oxfordshire we will signpost to the organisation covering the area they live in. However, we may offer support to families if a child attends a school in the county. Our ‘pre’ bereavement service will also often offer support if a parent or sibling is receiving treatment for their illness through Oxfordshire hospitals and hospices.
After there has been a bereavement, families can contact us directly and ask for support. We ask for the family to make the contact rather than a professional. When someone in a family is dying the palliative care team around the family may make contact with us to refer a family, with the permission of the family. Older young people can refer themselves but we usually prefer to have the permission of their parents/carers if we can.
We offer advice and support to parents and nursery and school staff on how to talk to young children about death and dying and what is a ‘normal’ reaction for their stage of development. Generally, children under 5 have not yet reached the stage of development where they have an understanding about what death means and the impact the death will have on their life. Because of this we don’t usually offer direct work with children of this age.
Does SeeSaw offer support to children and young people when a family member other than a parent or sibling is dying or has died?
Generally, the death of a parent or sibling has more consequences and impact for children and young people than the death of another family member or of a friend. A change to the family unit will affect family dynamics, can bring about other changes such as a move of home, and often has economic consequences. This is less likely to be the case with another family member; however, we do recognise that grandparents or other relatives can be significant figures in some families and may be caregivers for children and young people.
We will always make an assessment based on the individual circumstances to determine what type of support is most appropriate, within our limited resources.
SeeSaw was set up to offer grief support to children and young people as there was no service in Oxfordshire offering this; however, there are services offering bereavement support and counselling for adults. We signpost over 18s to these services.
Our support for families is child focused. We support the adults in the family to understand their child’s grief and how they can communicate with and support them. We don’t offer support for the parent’s grief. We signpost adults needing bereavement support to local services offering this.
People often approach us asking for counselling and can find it confusing when we say we offer grief support. The work we do is often child led, is a mixture of information, advice, practical strategies, guided activities and resilience building. For that reason, we do not describe it as counselling but we would say it often has therapeutic outcomes.
When someone is dying it can be a confusing and disruptive time for children. They see a parent or sibling looking ill, having medical treatment, in hospital or a hospice but the adults around them may not always be explaining what is happening. They want to protect the children from the situation. Sometimes the children may not see the person who is dying because it would be too upsetting for them. We work with families when someone is dying to help them to think about the situation from the point of view of the children in the family.
What do they know? What do they need to know? What don’t they need to know? When should they be told information? What will happen to them after the person has died?
We work alongside the family helping them to think these questions through and suggesting the words they can use that would help children to understand. We will usually continue to work with the family for a period of time after the death to support them through the funeral and whilst they are adjusting to the changes to their family life.
Depending on the age of the child and the nature of the death we may work with them in different ways. Often when a significant person has died when a child is very young they feel they don’t have a sense of that person and they don’t have many memories. We may work with them individually to capture the memories they do have and to work with the wider family to provide their memories of the person.
Sometimes a child may not have an understanding of how someone died, and why, and may need help to reconstruct the ‘story’ to make sense of it. Some young people may feel stuck or lost and need help to express their feelings and to identify some strategies for managing them and forming a support network. Some may just need the reassurance that how they feel is OK and some may want to focus on how their life has changed since their parent or sibling has died, and how they can adjust to it.
SeeSaw recognises that it can feel isolating when you have a family member who has died. It can help to know that your family is not the only one to have gone through that experience. Because of this we offer 2 or 3 family events each year as an opportunity for families to get together, do some activities and make connections. One of our events is held in Wytham Wood and involves a nature walk and outdoor activities. At our ‘Preparing for Christmas’ event we invite families who are facing their first Christmas after a close family member has died. We focus on how they will manage this and what they might need to think about and plan for.
We aim to respond to all initial enquiries and referrals within 24-48 hours, although it may be longer at very busy periods. We may then offer telephone advice or we may visit a family to make an assessment. If we offer to work directly with a child or young person we will allocate a worker to do this and it may mean there is a period of waiting until one of our team becomes free to take the work on.
No. SeeSaw will often offer advice and information to families immediately after there has been a death. Families often have questions about what to say to children, should children be included in the funeral and depending on the nature of the death there may be an inquest or police investigation which can be highly stressful. In the early stages we offer to listen, explain what to expect in terms of children’s reactions and advise parents on what to look out for and how to respond. We will often suggest that the family can return for support and advice at any stage.
For families where there is already professional involvement we will assess whether grief support is best provided by us or by another person already known to the child. We try to avoid introducing another person into the family if there are already several agencies working with them already as it can be overwhelming and counterproductive. In the case of a sibling death through illness we will usually signpost families to Helen House or Clic Sargent and more suited sources of support.
Seesaw’s objective is to meet the needs of all bereaved children in Oxfordshire, which includes children with additional needs. We have workers who have experience in this area however, we are aware that some children with additional needs have different communication styles and needs that require more expertise. We find that the people who work closely with a child are often the best people to help them with their bereavement. We can offer information, advice and training for staff and professionals to help them to support the bereaved child in an environment where they feel comfortable and feel secure, without the added challenge of meeting a new person.
Where we have carried out an assessment with a family and there are a number of risk factors for a child or young person, such as self-harming, suicide attempts or suicidal ideation (thinking about and planning suicide), drug and alcohol misuse, we may say that we cannot undertake grief work. In these circumstances we would suggest that a referral to CAMHS is made as CAMHS can hold the responsibility of managing that risk where SeeSaw can’t.
Grief work involves thinking about the death of a significant figure and can make children and young people feel worse for a while until they get to a point where they can see a benefit. If a young person is vulnerable and does not have a stable base, or a strong support network, it could increase the risk of them harming themselves. In some circumstances we may agree to work in partnership with another agency, such as CAMHS, who is able to assess and monitor the risk.
For a child or young person to be able to undertake grief work they need to be willing and able to engage. Sometimes there are factors present which make it harder for them to engage (see questions above re self-harm) or they may be in crisis and they may need mental health interventions first before they can undertake grief work. In those circumstances, we will wait for statutory agencies to stabilise the situation, monitor the risks and provide mental health expertise.