Julie Kaplow, on the left, serves as the Director of the Trauma and Grief Center in Houston, Texas, will be launching the Handle with Care program for children who have witnessed a death.
In August we are focusing on “Back to School” at Evermore. We are giving focus to siblings who have suffered the death of a brother or sister. Returning to school without their siblings can be painful reminder. Being with caring adults and peers who share their experience is extremely important. Bereaved parents are often so devastated by the death of their child, they can’t be there for their surviving children in the way they want to and need to be.
The research makes it clear: For children, bereavement is one of the top reasons they are clinically referred. It’s among the “most distressing life events” for children and adults. What’s more, children who are mourning the death of a family member or friend have a higher risk for depression, substance abuse and other mental or behavioral health problems later in life.
Researcher Julie Kaplow, along with other experts, spell out these facts in a 2018 report that considers a tool used to assess bereavement in youth. The death of a parent, sibling or other relative or friend is a setback for any child, but some children develop unhealthy strategies to cope with the loss. There aren’t enough tools, especially for youth, that clinicians and counselors can use to evaluate whether a child could use extra support.
“We need assessment tools that tell us that this kid is not grieving in a way that’s healthy and we need to find some help,” said Kaplow, considered one of the nation’s top experts and thought leaders on grief and children.
In her many jobs, Kaplow’s work to develop those assessments is part of a multi-pronged approach that she and other researchers are tackling to support traumatized and bereaved children.
Kaplow is director of Texas Children’s Hospital’s Trauma and Grief Center, a Substance Abuse and Mental Health Services Administration-funded center that’s part of the National Child Traumatic Stress Network. The network, which includes 100 sites across the country, aims to raise the standard of care and bolster access to services for traumatized children and their families. The center at Texas Children’s is the only one to focus specifically on grief and bereavement.
Kaplow also serves as chief of psychology at the Houston hospital where she oversees 60 clinical psychologists. And, she is vice chairman for behavioral health at Baylor College of Medicine where she supervises behavioral health initiatives.
Healthy, unhealthy coping
Death is hardly a new topic, but grief and how we cope with it is a newer field of research, especially as it pertains to bereaved children.
“It’s controversial to talk about grief as a psychological problem given that bereavement is a natural part of life,” Kaplow said. “We know that everyone will have to experience a death at some point. We don’t want to pathologize normal grieving. I think there’s been such a push in that direction that it’s been at the expense of recognizing that there are some kids who really do get stuck and who really do need an additional level of support. I think that is what’s hindered the field.”
There are plenty of factors that can help to determine how a child will cope with a death over time, Kaplow said.
“What we know is if children are brought up in a healthy, happy environment, and if somebody dies, those kids, most of the time, will end up still continuing to lead happy, healthy lives,” she said.
“Kids who already bring with them other adverse experiences or a lack of parental support, even before the death, can have more trouble. So can children whose loved one died by homicide or suicide or who are living in poverty or in neighborhoods where violence is the norm,” Kaplow said.
“Maladaptive grieving can manifest in a number of different ways, and that depends on the developmental stage of the child,” she said.
A younger child may exhibit more clinginess, separation anxiety, a new onset of fears or developmental delays. A teenager might get involved in more risk-taking behaviors or even consider suicide. “And that can be either wanting to reunite with the person who died, if that’s part of their belief system, … or just not caring about life anymore,” Kaplow said.
Better treatments
To help those kids, Kaplow and her colleagues have developed evidence-based treatments that are designed to support traumatized or grieving children.
Trauma and Grief Component Therapy can be tailored to an individual child’s specific needs. A child mourning a loved one will benefit from the modules designed for grieving kids. Another child, who has been abused or witnessed violence, but hasn’t experienced a death, can benefit from the trauma modules.
The Trauma and Grief Center’s goal is to raise awareness about the adaptive side of grief, while also helping to identify bereaved youth who may need a higher level of support.
Multidimensional Grief Therapy is for kids who have experienced a death and are struggling. “It’s designed to address the different bereavement-related challenges kids may have,” she said.
Now, Kaplow and her colleagues are training others to provide these therapies to the kids who need them.
Targeting schools
There is much more work to do, of course, to help communities and clinicians assist kids who are mourning. And schools, said Kaplow, where children spend so much of their time, are an obvious place to start.
In the next six months, Kaplow plans to launch the Handle with Care program in Houston. Already in West Virginia and San Antonio, the program provides a way for police to alert school principals when a child has witnessed a death. From there, the child’s teacher can monitor them for post traumatic stress disorder and refer them to the school counselor, if needed.
Another major initiative is to ensure that school-based clinicians and teachers are trained to identify PTSD symptoms and children who are not coping well with their grief.
“Bereavement has been one of those sleeper traumas that not a lot of schools have paid close attention to,” Kaplow said. “What we’re finding is that bereavement is the №1 predictor of school failure above and beyond any other form of trauma and that includes sexual abuse, physical abuse and witnessing domestic violence.”
“Knowing bereavement is the most prevalent form of trauma, we definitely need to be helping teachers to ask questions and be more direct about inquiring about a recent loss,” she said. “We know that it’s uncomfortable for people. We don’t want to bring it up. But we also know it’s never harmful to inquire about how a child is coping after a death.”
Two grieving mothers seek efforts to bring transparency, safety to college abroad programs
Ros Thackurdeen remembers the hype as she sat through a college study abroad session with her youngest son Ravi at Swarthmore University.
“It was pretty exciting,” Thackurdeen said. “I wanted to go on it. You had students who talked about their experiences … You didn’t hear anything bad about it.”
But there was no happy ending for Ravi, who ended up on a study abroad trip to Costa Rica to study global health and tropical medicine. In April 2012, program leaders took Ravi’s group on a surprise trip to Playa Tortuga which, Thackurdeen has since learned, is considered one of the country’s most dangerous beaches. A local fisherman found Ravi’s body two days later.
“I thought it was study abroad’s first death,” Thackurdeen said. But, not long after, she searched study abroad student death on Google and was surprised by what she found — 85 pages of links and stories about the deaths of other college students like Ravi. She started printing out the stories, filling up binders with information and reaching out to officials with questions about safety measures.
“I wanted them to see the faces because I was seeing faces and that was hitting me really hard,” she said. “That is somebody’s child just like my child, and they too are going through the same pain that I’m going through.”
Through her research, Thackurdeen eventually met Elizabeth Brenner, whose youngest son Thomas died while studying abroad in India in September 2011. Together, the two founded Protect Students Abroad, a nonprofit that is working on efforts to prevent fatalities on study abroad programs and provide transparency so parents and students can make smart decisions.
“I can’t abandon this,” Brenner said. “I wouldn’t know how to abandon this. It’s really, really hard. But there is, at this point, because of everything that’s happened and because of the person that I am now, no other choice.”
No mandatory reporting
Study abroad programs are growing. The Institute of International Education’s 2018 Open Doors report found that the total number of U.S. students studying overseas grew by 2.3% in 2016–17 when compared to the year before. About 10% of the country’s undergraduate students study abroad.
But, said Brenner and Thackurdeen, parents and students often know little about the programs.
“If the third party program appears on the university’s website and if they appear in a study abroad forum, most parents and students assume that the home university has eyes on the program,” Brenner said. ”Nothing can be further from the truth. And on the backend of it, if it goes wrong, every single parent we have met with talk about how far the programs will scurry away [saying] ‘This isn’t our program. We have nothing to do with this.’ There isn’t a requirement. Parents find out on the backend, and the waivers are really, really tight.”
For both Brenner and Thackurdeen, that lack of support and transparency is part of the problem. For many parents who are grieving a child who died overseas, it can be almost impossible to find out the details of their death.
“There’s no mandatory reporting at all,” said Brenner. “So, potentially, you will get the narrative that they would like to have been true. … We know of families who really struggle to figure out what really happened to their child.”
Brenner and Thackurdeen are luckier. For Brenner, a student newspaper reporter took an interest in the case. Together, the two traveled to India and were able to find out what happened. Students who were on the trip with her son also provided some answers. Thackurdeen got answers from a couple who were taking a walk on the beach and witnessed what happened, along with some of the other students who were on the trip.
“You may spend the rest of your life not knowing what happened and not getting the truth from anyone,” Brenner said. “It adds a whole different layer to the experience.”
Pushing for passage
Together, Brenner and Thackurdeen want to prevent other families from suffering similar heartbreaks. The two are working to secure the passage of two federal bills that would provide families with more transparency when a student dies on a study abroad program and help other families make informed decisions about which program to send their child on.
“One of the first things that surprised me was finding out after Thomas died that it was his program’s 12th death,” Brenner said.
Both bills, which have bipartisan support and have been introduced in the U.S. House and U.S. Senate, tackle the issue from different angles and, Brenner and Thackurdeen said, are needed.
Named after Thackurdeen’s son, the Ravi Thackurdeen Safe Students Study Abroad Bill amends the Higher Education Act of 1965 to require colleges and universities to report safety incidents, including deaths, accidents and illnesses requiring hospitalization, sexual assaults and events that generate a police report.
The American Students Abroad Act requires that the U.S. Department of State share consular reports of U.S. citizen deaths abroad to the Centers for Disease Control and Prevention, so that the CDC can analyze the data to uncover patterns and find ways to prevent these deaths and injuries.
Despite their own family’s experiences, both Brenner and Thackurdeen still support opportunities to study abroad. Each have two other children who went overseas on study abroad trips.
“We hear back from programs and colleges that this will hamper us, cut into study abroad growth,” Thackurdeen said. “That’s just not going to happen. One of our student interns is going on her study abroad. She’s very much aware from working with us of some of the dangers, and she’s using that information to ask questions and educate herself about it.”
For parents and students who are contemplating a study abroad program, Brenner and Thackurdeen have some advice.
#1 Educate yourself
Check out Protect Students Abroad’s website to learn more about the safety issues for students traveling abroad. “It’s really learning, firsthand, from what we’ve gone through and taking that information and asking better questions and doing some of the research,” Thackurdeen said.
#2 Make sure your child’s prepared
Encourage your child to read local newspapers from the area where they are traveling and remind them about the importance of being aware of their surroundings at all times.
#3 Ask the hard questions
Seek out statistics about injuries or deaths. Ask about safety measures. Make sure you truly understand the relationship between your child’s home university, the study abroad program and the host country.
“They may not be in alignment or communicating with each other even though it looks like they are from the website or from the study abroad forum your child went to or the literature that has come home with your child,” Brenner said.
#4 Read the waiver
Said Thackurdeen: “Look very hard at the waiver before they sign it. If you are uncomfortable with the language of it, speak to a personal attorney. It’s not about money. It’s about having your day in court.”
“And getting the truth,” added Brenner. “How many of us are fighting to just get the facts about what happened to our child.”
Brenner and Thackurdeen encourage others to ask their U.S. Senator and U.S. Representative to support the two bills in Congress, S. 1572 and S. 1575 in the Senate, and H.R. 2875 and H.R. 2876 in the House.
June 2013, during recovery from what was supposed to be a routine heart catheterization to assess his heart condition, Ron Kelly’s son’s heart failed. Doctors weren’t able to revive 16-year-old Jon. Today Ron helps other grieving fathers, particularly those in the workplace.
After struggling with identity after his son’s death, Ron Kelly helps other men mourn
*Evermore is dedicating this Father’s Day week to bereaved dads who will always be fathers.
R. Glenn “Ron” Kelly’s son was supposed to make it.
Jon was born in 1997 with a rare and potentially deadly heart condition, but doctors were optimistic. He’d need medical intervention, including three open heart surgeries before the age of two to rebuild his heart, but, they said, he’d live a full life.
“He had a wonderful childhood,” Kelly said. As a teenager, Jonathan picked up golf, and the family moved to a golf course community where he could play all the time.
“The year that he passed, he was in line to be the first freshman to make the high school golf team,” said Kelly of his only child. But, in June 2013, during recovery from what was supposed to be a routine heart catheterization to assess how he was doing, Jon’s heart failed. Doctors weren’t able to revive the 16-year-old.
Ron Kelly said his son Jonathan had a wonderful childhood. As a teen, he picked up golf, and the family moved to a golf course community where he could play all the time.
“I take a lot of comfort that I got to hold him when he took his last breath,” Kelly said. “To me, that meant a lot. Not at first, but it certainly does now.”
Still a dad?
The death left Kelly and his wife reeling. Kelly, a former Marine and cop, grappled with an identity crisis and tried to quash any emotion. After his son was born, he had walked away from a career serving others to work as an executive in the defense industry and focus on being a father. But, after his son died, he didn’t know if he could still call himself a dad.
“I went back to work where I could control things,” he said. “I would go back as the number two man in a large company and control my environment and repress my grief in that way. I’d walk by pictures of Jon and avoid looking at them. I was repressing the grief, but I was still wondering, ‘Who was I? Was I still a parent?’”
Six months after his son’s death, said Kelly, “I think Jon came to me and said, ‘How dare you.’ He asked, ‘Are you still a Marine?’ Of course I’m still a Marine. ‘Are you still a cop?’ Part of being a cop will be in me for all my life.”
Then, Kelly said his son asked him, ‘How do you think you’re not still my father?’ It was a good point.”
It was a watershed moment for Kelly, who realized that he needed to let himself grieve. But as he looked for healthful ways to mourn his son, he found few resources.
“There was nothing out there for men by men,” he said. “I had to strike out on my own. I met some wonderful people in the field who nurtured me on my way. I studied human emotions and why we are the way we are.”
As he navigated his grief, he decided to share what he learned with other men by writing a book. And that book, “Sometimes I Cry in the Shower: A Grieving Father’s Journey to Wholeness and Healing,” launched a new career that’s focused on helping men and working with employers to build grief-friendly workplaces.
“It’s been a wonderful opportunity to go out and help others heal,” he said.
Today, Kelly is the author of four books, including “Grief in the Workplace,” “The Griefcase: A Man’s Guide to Healing and Moving Forward in Grief,” and “Grief Healings 365: Daily Inspirations for Moving Forward in Your New Normal.”
Before his son’s death, for example, his managers would stop by his office each morning to let them know what their plans were for the day.
“When I lost Jon, I came back to work and nobody stopped by my door anymore,” he said. “It’s a small anecdote alone, but think about what that did for productivity.”
Those managers just didn’t know what to say, said Kelly. And they weren’t trained in advance to know how to interact with Kelly upon his return.
Now, he said, “I’m going around to businesses and civic organizations and advocating the care and feeding of the bereaved once they return to work.”
Those efforts don’t have to take up a lot of time and money, Kelly said. It can be as simple as sharing, with the employee’s approval, details about how their loved one died before they return, so they aren’t bombarded with questions from curious co-workers.
It also could include teaching managers to spot signs that an employee might need to take a break from time to time. Giving those employees a little grace, said Kelly, “beats rehiring fees and retraining costs and turnover costs.”
Kelly recommends that grieving employees take off their “grief mask,” and be honest about the moments when they need a few minutes outside the office to take a walk.
Serving once more
For Kelly, his work, now a full-time job, has helped him in his own grief. But, he said, he’s also taking a cue from Jon.
“All those years, as Jon was going through interventional trips to the doctors (for his heart condition), he also voluntarily put himself up for research,” Kelly said. “And in his own words, he said, ‘I am helping out other children who were born after me with the same condition.’ He was serving.”
And now Kelly, the Marine and cop, is serving once again.
Bea’s parents — Rachel and Erin Alder say they are “extraordinarily pleased” by Seattle City Council’s unanimous vote for paid bereavement leave and were thankful for the support they received throughout the process.
City employees no longer face impossible choice: to mourn their child or keep your job
This week, the Seattle City Council passed “Bea’s Law,” which extends paid family care leave benefits to city employees when their child dies. It is possibly the first paid bereavement law in the nation and a model for other forward-thinking elected leaders at all levels to follow.
The city ordinance is named after city employee Rachel Alder’s infant daughter Bea, who died in November 2017, only 36 hours after being born. Alder brought the issue to the city’s attention after she had to borrow paid time off from co-workers to take time away from work after her daughter died.
“Bea’s Law” is named after city employee Rachel Alder’s infant daughter Bea, who died in November 2017, only 36 hours after being born. Photo: Soulumination
Evermore executive director Joyal Mulheron commended Rachel Alder for her courage and advocacy to honor her daughter Bea and pioneer better support for bereaved parents.
“Bea’s parents Rachel and Erin are honoring their daughter in such a powerful way. On behalf of bereaved parents everywhere, I thank them and Seattle’s City Council for drafting and passing a landmark law that can be an example for elected leaders across the nation,” Mulheron said.
While the federal Family and Medical Leave Act gives eligible employees up to 12 weeks of unpaid leave to care for a new child, recover from a health setback or look after a spouse, child or parent who is ill, it does not include time off for parents to grieve the death of their son or daughter. The death of one’s child is a major omission among the list of conditions that qualify a worker for leave.
380,000 grieving families
The number of bereaved parents affected by shortsighted employment policies should create a sense of urgency for elected leaders to act. Each year, more than 380,000 children, from stillbirth to age 54, die, and hundreds of thousands of parents are left to mourn them.
One industry survey found that 69 percent of employers give parents just three days off after the death of their child. And when a parent is mourning after a miscarriage or stillbirth, that number drops to just 62 percent of employers who allow workers to take bereavement leave.
That’s hardly enough time for a parent to bury a child, much less seek support for managing an immense life change. And when forced to return to work too soon, it’s likely parents won’t be in a state-of-mind that will allow them to be productive and focused on the job or in a position to cope long term.
Research shows that grieving parents deal with long-term difficulties, including higher risks for other mental and physical health issues, along with decreased productivity at work and even lower earnings.
Leaders in two states and a city also have taken action.
Illinois’ Child Bereavement Leave Act requires employers who have at least 50 employees to provide up to 10 days of unpaid bereavement leave. Employees can use the time to attend the funeral, make arrangements after the death or just grieve.
In Oregon, the state’s Family Leave Act requires employers with 25 or more employees to give workers 12 weeks of unpaid bereavement leave.
And Tacoma, Wash., workers earn an hour of paid sick leave for every 40 hours worked. The law specifies bereavement of a family member, including a child, as a qualifying reason to take the leave.
On the national level, there also is a growing movement to expand the Family and Medical Leave Act. In February, the Parental Bereavement Act, originally introduced in 2011, received bipartisan support in the U.S. House and U.S. Senate. The bill would allow grieving parents of children under 18 years to take unpaid leave under FMLA. We’ll have more about the two dads who are behind the bill here on Evermore’s blog later this month.
Impossible choice
More, of course, must be done to support bereaved parents on the job.
“At Evermore, we regularly hear from parents who are faced with a tough choice: Will they take the time they need to mourn their child and lose their job in the process? Or, will they go right back to work in a vulnerable state without the support needed for long-term coping?,” Mulheron said.
Evermore is encouraging readers to contact their elected leaders at federal, state and municipal levels to extend FMLA to bereaved parents and provide paid leave where possible.
Because as Mulheron said: “No grieving parent should ever be forced to make that impossible decision.”
Bryan Burgess was killed in action during a 2011 deployment to Afghanistan just 16 days before he was scheduled to return home — a few weeks shy of his 30th birthday.
Telling and re-telling the story of his son’s life and sacrifice pulled Terry Burgess from deep depression
In the early morning hours before Terry Burgess learned that his son Bryan had been killed in action in Afghanistan, he had a vivid dream.
“We’re in this outdoor movie theater, me and Bryan,” Terry remembers. “He’s on the movie screen in his combat uniform and there’s a glass coffin beside him. He steps into the coffin and, when he lays down, he turns into my little boy Bryan, like seven or eight years old. Then little boy Bryan steps out of the coffin and becomes Bryan the soldier again. He gives me a salute and then the movie screen just goes — bam — white. That’s when I woke up to the phone ringing.”
The call was from Bryan’s wife, Tiffany, with the news that Bryan was gone. Terry and his wife Beth would receive an official notification through a visit from Army officers later that morning.
The next days and weeks were a whirlwind of events honoring Bryan. They met with their Casualty Assistance Officer from the Army, whose job it was to handle paperwork, and anything else they needed for a year.
Soon the cards and letters slowed, then stopped coming, Terry said. “The casseroles stop, people stop checking on you, and you’re just isolated.”
“After his funeral, after we got home from all the ceremonies, I just sank. I just literally sank. I was unemployed, I was laid off, I had no purpose,” he said.
Terry’s wife Beth was afraid for him. “He would just spend days and days and days just sitting… not talking, not eating, just sitting. While I’m at work, I’m terrified that I’m going to come home, and that he’s going to be gone, and I don’t know what to do about that….it was a very, very scary time,” she said.
Beth started looking for organizations that could help Gold Star parents and couldn’t find much. “There was a lot out there for the widows — understandably — and for kids and moms. But there was almost nothing for dads,” Beth said.
A documentary film changes everything
More than a year after Bryan’s death, the producers of a documentary called “The Hornet’s Nest” contacted Terry and Beth. The film used footage collected by an embedded journalist who traveled with Bryan’s unit in Afghanistan. Helmet and hand-held cameras captured the 360-degree firefight with the Taliban that claimed Bryan’s life, and included an interview with Bryan, talking about how much he missed his children. The film’s producers asked Terry and Beth to screen a rough cut of the film, hoping to earn the approval of the Gold Star families before releasing it to the public.
“Beth got me out of bed and got me cleaned up,” Terry said. They traveled to Dallas to watch it. “And there was Bryan in his army uniform on screen. It was a slap in the face for me.”
Terry felt he suddenly understood what his dream on the morning of Bryan’s death had been about. “I thought, ‘that’s what Bryan was trying to tell me,” says Terry. “I can’t just spend my life mourning the loss of my little boy. The innocent little boy had to die when Bryan became a soldier. Now he wants me to salute him back however I can.”
Bryan’s story reflects others’ combat experience
For over a year, Terry and Beth toured with the film, visiting military bases and colleges and other venues. Every time they watch it, “it rips us apart,” Terry said. “But I tell people that it saved my life.”
Terry, Beth and the other families involved in the film were asked to speak at each screening. “It was a lot of holding hands and squeezing hands… a lot of tears,” Terry said. “It was kind of cathartic for us because we got to tell Bryan’s story to so many people who wouldn’t have heard it otherwise.”
Bryan with his children Makya and Zander.
The screenings also gave them an opportunity to help educate the public about the ways that combat changes the lives of the veterans who survive.
“Bryan changed the very first time he went to Iraq and came home. He was a completely different person. And it was very hard to connect with him,” Beth said. “A lot of what we did was just to help everybody understand everything that the guys were going through when they came home, because they all carry a huge amount of survivor’s guilt.
Reaching other Gold Star fathers
Last year, Terry published a memoir about the family’s experience of losing Bryan titled When Our Blue Star Turned Gold. It’s given him a broader audience to continue to tell Bryan’s story and reach out to other parents, especially fathers.
Bryan and his dad Terry, who started Gold Star Parents retreat and network.
“My biggest hope is to reach more dads,” Terry stressed. “There is a very high suicide rate among Gold Star dads. The more of them we can reach, and save, or just help…. We just want to let them know they’re not alone.”
New speaking engagements and publicity for Terry’s book, including an interview on NBC’s Today show, have helped to fill the annual retreat he and Beth created for Gold Star parents. They aim to keep making room for any parent in need.
“We tell Bryan’s story,” Beth said. “And we help as many people as we can to tell their stories.”
America salutes Terry and Beth
As the nation searches for ways to recognize another Memorial Day weekend, they can draw inspiration from a 2011 American Airlines flight. Following Bryan’s funeral, Terry and Beth boarded a flight to head home. They were crouched in the very last row of the plane, emotionally exhausted. The Casualty Assistance Officer, who had been with Terry and Beth since Bryan’s death notification, contacted the airlines.
Touched by their sacrifice and Bryan’s service, the pilot took time to meet the Burgess’. Sitting across Terry and taking Beth’s hands he said, “I want you all to know how very, very sorry I am for your loss. I’m fixing to be deployed to Afghanistan myself.” They shared stories of Bryan and appreciated the compassion and comradery.
As the plane approached its destination, the pilot announced, “We have parents of a fallen soldier on the plane. I would appreciate it if everyone would stay seated and let them disembark first. Let them go home.”
With Beth carrying their newly received flag in her arms, fellow passengers stood still, applauding them as they disembarked. As they passed through first class, a veteran stood up and saluted Terry and Beth.
In that moment, America stood with Terry and Beth. They were not alone.
*Read more in the story of how Bryan’s dad recognized his son’s caring, protective nature early and continues to honor him: “A Legacy of Protecting Others.”
