Childhood Bereavement: A Critical Public Health Issue

By Michaeleen Burns posted 08-11-2020 22:13


It was distinct a pleasure to participate in the NASN 2020 Virtual Conference in July. During a time of incredible grief and loss, a message of hope and healing for students and school personnel is essential. I was impressed by the thoughtful questions posed and wish I had more time to speak with you all. You asked questions about complex situations that highlight the need for more grief resources in schools and communities.

Below are responses to some of the questions we were not able to address, but these brief answers feel inadequate. I welcome you to reach out to our team if you want to talk further or to bring grief awareness training to your school community.

Q: Anecdotally we see a lot of parental death in our large urban district. Do you see different statistics of loss in different demographics or populations?

Yes! Judi’s House and JAG Institute, in partnership with the New York Life Foundation, developed the Childhood Bereavement Estimation Model (CBEM) to understand variations in bereavement by factors such as population density. Our 2020 CBEM results show that 1 in 14 children in the U.S. will experience the death of a parent or sibling by age 18. Our 2018 CBEM State Reports explored differences in rural and urban communities. In about a third of the states, childhood bereavement rates increase as you move to more rural communities—especially in communities with high Native American/American Indian populations.

Our 2020 CBEM resources provide rates of childhood bereavement rates due to parent death loss by county. Here you can explore county level results in your state. For example, in Baltimore City, MD, the CBEM indicates 10.3% of children will experience the death of a parent by age 18. In comparison, in rural Talbot County on Maryland’s eastern shore, the CBEM shows that 4.8% of children will experience parental loss.

Q: Does your organization work with those only experiencing a death, or do you consider significant loss for other reasons for grief in students, such as the loss of normalcy due to COVID? When we return to school this fall, both students and staff will return still going through the grief process, but at different stages and layers. Can you offer how school districts and school nurses can contribute to assisting students and staff to work through the grief from COVID-19?

Judi’s House works specifically with bereavement; therefore, we only serve children and families who have experienced a death loss. We recognize that there are many other types of losses that can bring on significant grief reactions. We field calls from community members who are caring for children with a parent who is incarcerated, deported, or absent due to substance misuse or other life circumstances. In these situations, we partner with other community resources to ensure these families are connected to providers with competence and expertise that best meets the family's needs.

The loss of normalcy due to the coronavirus has universal impact. It is affecting student and staff alike. School personnel and administrators who acknowledge this significant change and conscientiously and mindfully provide supportive spaces to speak about the impact, will open doors to individual and community level processing that can lead to unity and solutions. At the same time, we must summon a healthy dose of grace and forgiveness as we navigate these unprecedented times. None of us have lived through a pandemic. We are going to make mistakes. Although it is not a road map to follow, we know that when we come together, we can do hard things. We recommend that schools and community organizations look to the quality social emotional programming already establish as a foundation.

Q: Do you have any materials for the Spanish speaking parents? We are in a rural community with a lot of migrant farm worker families.

Yes! Judi’s House offers programs in Spanish and English. Almost all our resources are available in both languages. I’ve pasted links to some of our most popular resources below. I hope they are helpful to you and your community.


Common Questions about Children and Grief/Preguntas Comunes Sobre Niños y el Duelo

Explaining Death to Children/Explicar la Muerte a un Niño


Home-based Grief Activities/Actividades en casa para el Duelo


Caregiver Workshop Video Series/Videos para la Crizana de Niños

Q: I am a bit of an emotional sponge and can wear my emotions plainly on my face.  I don't feel any more upset than another, but I am an incredibly easy crier.  Do you have any tips for getting tearful when dealing with a student's sadness?

We probably would not be in the helping field if we did not have a healthy dose of empathy. We tell caregivers at Judi’s House that grieving children want to be seen, heard and felt. “Feeling felt” is a term coined by Dr. Dan Siegel who studies interpersonal neurobiology. Dr. Siegel shared that when we are authentic with one another, we open doors for deeper connection that can facilitate growth and healing. In our professional work with children, we must monitor our emotions and make sure that we keep the focus on the child’s experience while genuinely reflecting the impact their story has on us. If you feel that you need to control your tears, try tensing and relaxing your muscles. (Pro tip: Your gluteus maximus will be the least perceptible.)

Q: Can you address Kubler-Ross’s “stages of grieving”?

If you had a course or a seminar on grief in your education, it likely touched on Dr. Elizabeth Kubler-Ross’s Stages of Grief theory. The theory organically developed out of Dr. Ross’s work with patients who were facing their own death. Over time, the stages were adopted and applied to grieving individuals. I had the pleasure of attending a presentation by Dr. Ross’s son, Ken Ross, at the National Alliance for Grieving Children Symposium a couple years ago. He shared that his mother never intended for her work to become a linear model of grief or to promote strict adherence to the idea that we must experience each stage. Indeed, this interpretation often takes the focus off what we need to talking about, GRIEF!  Dr. Ross’s academic partner, Dr. David Kessler recently discussed the theory, its misinterpretation, and introduced a sixth stage, finding meaning, You can hear him discuss it in a recent podcast with Dr. Brené Brown.

For grieving children, the journey towards healing rarely follows a direct sequence of steps that arrive at a destination, but rather encompasses a multitude of experiences that can vary by the hour and evolve over a lifetime. Along the way, grieving individuals contend with and manage a vast array of grief reactions. Bereaved children need caring adults to play an essential role in establishing a connected and safe environment for grieving. Psychologist William Worden’s proposed Tasks of Grieving provide an understandable framework for children's bereavement. 

Thank you for being part of the Grief Protective Factors for students in your community.

Q: I work in a district that sees a lot of community violence. The students at my school almost seem "de-sensitized" or "numb" to death and dying among their families, friends, and peer groups. What guidance would you give to school nurses dealing with students in those types of districts?

Traumatic losses such as homicides, suicides, and overdose deaths, are challenging in and of themselves, sometimes resulting in traumatic grief. When mixed with consistent community violence and historical racism and oppression, desensitization and loss of hope is not unusual. As helpers, it is important that we acknowledge and normalize that this numbing is likely serving as a protective coping mechanism. For youth in these communities, violence may be an everyday occurrence. Typically youth do not have the power to change the systems that support the violence. By beginning with this recognition and gaining common understanding, we can:

  • Identify the aspects of their experience that the student can control,
  • Generate healthier coping strategies, and
  • Discuss the harmful impact desensitization. 
Finally, we can hear from youth the ways they think adults can be part of the solution. 

Q: Does violent death vs anticipated death generally have different grief responses?

While there are common grief reactions, our responses to the death of someone we love are as unique as we are. How each of us interprets and processes loss is complex and nuanced. While violent deaths tend to be more traumatogenic, research demonstrates that children can have trauma reactions to anticipated deaths too. Witnessing a loved one’s decline from fit and healthy to being confined to a bed and unable to care for oneself can lead to traumatic grief too. Similarly, some who experience suicide loss report an anticipation of the death. They note watching the deceased suffer in their daily life and express relief that they are free from pain. Asking open-ended questions such as, “How did you respond when you learned about their death?” or “What has their death meant to you?” can help provide space for a student to share more about their unique grief reactions.

Q: Being from Oklahoma, we had to go through the grieving process with our students when one of our own students had her father killed by an officer - then through the anger when the officer was acquitted. How do we assist our students in this scenario?

First of all, thank you for being on the front lines of supporting students who are trying to figure out how to manage the big rocks in life. All too often this work is complicated by systems that are rife with injustice and inequity. When a child is grieving a death that is deemed a crime, many more big rocks are heaped on, such as law enforcement, court systems, and media. The story of the death is taken over by journalists, defendants, and attorneys. In addition to the untimely and unjust loss of someone special, the family is robbed of the privacy and sacredness of grief. Even when they share in the outrage and anger, it can be disorienting. Providing the bereaved family room to grieve in their own way can give some of the power back. In this space we can listen to their wants and follow their lead.

Members of the community are grieving too. Community healing is necessary. Time to process may be paired with opportunities to protest, engage in activism, and participate in actionable change. The National Center for School Crisis and Bereavement and the Coalition to Support Grieving Students both offer suggestions on how to convene and support students after a tragedy.

Thank you again for your time attention to this important public health issue. I want to invite you to watch this brief video. It show the lessons bereaved children have taught us over the years and I wanted to share them with you.