NATIONAL CENTER FOR PROSECUTION OF CHILD ABUSE
Volume 17, Number 4, 2004
Serving Those Left Behind:
Crisis Intervention in Child Fatality Cases
By Susanne M. Walters1
Al Killen-Harvey, L.C.S.W2
The Death of a Child
To quote Harriet Sarnoff-Schiff from her book The Bereaved Parent, “The death of a child is frequently called the ultimate tragedy. I believe this to be true. But it is a tragedy that must not be compounded by allowing everything around you to die also.”3 In the child abuse investigation field the worst case that can come across one’s desk is a child fatality. All too often, we as professionals are unprepared to deal with the emotions and feelings that surviving family members experience when a child dies due to abuse or neglect. This may be due in part to our lack of training and/or experience in this area and may also be a result of our own issues related to abuse and death. In this article, we will examine suggestions for successfully working with surviving family members.
What Do We Know?
Each day in the United States, three children die from child abuse related injuries. Most of these children are under the age of five. “More children (age four and younger) die from child abuse and neglect than any other single, leading cause of injury or death for young children.”4 A parent or caretaker causes most of these deaths. Statistics collected between 1976 and 1997 reveal the following about child homicide cases: 27% of the children were killed by their mothers, 27% were killed by their fathers, 6% by another relative, 24% by other acquaintances, 3% by strangers and 12% by a person whose relationship to the child was unknown.5
Survivors often experience intense emotions surrounding the death of a child. Some of the more common feelings include shock, sadness, guilt, social isolation and grief. These “feeling states” can cause increased strain in personal relationships, decreased capacity to function and perform effectively at work, and a general sense of powerlessness and hopelessness.
While there has been much written about the general stages of grief, it is vitally important to remember that we all ultimately grieve in our own unique way. However, various factors can influence how one grieves and therefore what kind of support might be most beneficial. Key factors include the following: resiliency (the ability to “rebound” from stressful or traumatic events); the relationship between the survivor and the deceased; family cohesion; a spiritual/religious belief system; social/community supports; access to services and other socio-economic factors. To understand better the more universal process of grieving, consider the following example of a “stage model” of the grief process.
The Five Phases of Grief7
1. Shock. Shock is a general term used to describe one common response to trauma. When people are in shock, they may go through a period of disbelief, which acts as a buffer that emotionally “protects” them from the full effect of the loss. This may manifest as confusion, restlessness, anxiety and/or emotional withdrawal. Physical symptoms may include muscle tension, heavy perspiration, pacing and fidgeting. When someone is experiencing shock, it often appears that he or she is in denial or doesn’t really understand what has happened. It is very important that those who are responding to someone in shock NOT attempt to make the individual face reality immediately. It might be useful to think of shock as a person’s “emotional air bag” that is attempting to protect the individual. We can actually do further harm by forcing someone to face a trauma before he or she is emotionally prepared to do it.
2. Awareness of Loss. During the next stage, the loss of the child becomes more tangible. An emotional bond has been irrevocably broken and, as a result, feelings of anger, sadness, despair and/or depression may begin to emerge. A preoccupation with seemingly minor or insignificant things or events is often seen. Parents often do not want anyone to touch their child’s room or belongings as they attempt to preserve their memories. This may be particularly difficult for investigators who need to examine the child’s room or take some of his or her belongings as evidence. This process evolves over time and can result in a “roller coaster” of emotions, i.e., the parent/survivor may seem generally fine and very cooperative one day and then angry and defensive the next day. It is important not to take this personally, but to keep in mind that it is part of the process of grieving.
3. Guilt. “Survivor guilt” is particularly strong when a child dies. The death of a child before a parent disrupts the natural order and is one of the most difficult stressors any human being can experience. During this stage, parents may begin to blame themselves for the event that caused the death. A parent may self-blame with remarks like “if I hadn’t let her walk home from school” or “if we had never moved to this house/neighborhood,” etc. For investigators, it may be difficult during this stage to differentiate between an admission of legal culpability and a statement of emotional guilt and grief. For mental health providers, this stage may be when recommendations are made for mental health services. Particularly with individuals who have a history of depression, this can be a volatile and dangerous time. Because the first two phases of the grief cycle are so physically and emotionally exhausting, the survivor needs to conserve energy and may withdraw at this point. A deep desire for the deceased child to be with them can cause despair; survivors may begin to turn inward in order to face the loss. This in turn may lead to emotional venting or “grief work” that is necessary to move on. During this period, survivors may also experience extreme fatigue, stagnation, and a weakened immune system.
4. Healing. At the outset, it is important to state that not everyone is able to heal from the loss of a child. For many individuals, healing from the loss of a child will become the remainder of their life’s work. They may have periods of time where things feel somewhat “back to normal.” These periods, however, may be unexpectedly interrupted by periods of renewed grief and loss. Like grief itself, healing is a unique and personal experience. Family, friends and even many in the social service arena often inadvertently pressure survivors to “get on with things” before they may actually be ready to do so. The greatest support we can give a grieving survivor is often simply to respect that each individual has to decide for him or herself how and when, and in what form, healing will take place. Much healing time is used as a search for meaning. Survivors may also begin to experience feelings of forgiveness toward themselves and maybe even toward the individual(s) that caused the fatality. Support groups for parents who have lost a child may be an appropriate resource at this stage of the grief process. While most would prefer to forget painful experiences such as this, it is not fully possible to do. Ironically, remembering and talking about the loss of a child may be one of the key facilitators of the healing process.
5. Renewal. Renewal is signaled by a new self-awareness – survivors are ready to accept the reality of their reconfigured life. They are learning to live without the child and they begin to once again incorporate new activities into their lives.
Roadblocks to Services
Engaging survivors is difficult enough due to the staggering loss they are facing, but roadblocks within the system can exacerbate these problems. In some cases, the surviving members of the family may be ashamed because of the stigma associated with child abuse. Non-offending caregivers may blame themselves, and may feel that the outcome would have been different if they had intervened. Disparities in the criminal justice system, whether perceived or real, can also affect our relationships as service providers for these families. For instance, a poor Latino family in an area traditionally underserved for Latinos might assume that the system in general will be unable to help them. Alternatively, the parents of a murdered gay teen might perceive an anti-gay bias within their local police department.8
Ways to help9
Engaging these families properly is critical. Professionals need to be aware of the person’s state of mind in order to take appropriate steps. The group Parents of Murdered Children10 offers these “Suggestions from Survivors” to improve the relationship between surviving family members and service workers:11
- Be compassionate.
- Refer to victim by name.
- Keep in touch.
- Be truthful.
- If information must be withheld, explain why.
- Encourage survivors to write down questions and the answers they receive.
- Explain plea bargains.
It is good practice to have all written materials for survivors readily available. This allows the service provider to explain the materials verbally and then leave them with the parent to review at a later time. It is also useful to make a follow-up contact later in the case to offer any services that may have been declined initially.
If death notification is part of your job, make sure that you have had proper training. It is extremely important that only trained professionals conduct death notifications so that the survivor will receive the information in the most sensitive manner possible. When you are on the scene, allow the survivor to talk. This will slow down the process and help the survivor gain a sense of control. It also allows the survivor to work through the incident and builds rapport between service provider and the survivor.
Additionally, it is important that service providers attend to their own feelings that may emerge as a result of being involved in a child fatality case. Our own histories of loss and abuse may be reactivated and a “secondary trauma” effect can occur.
The final suggestion: Listen. As Catherine de Hueck Doherty said, “With the gift of listening comes the gift of healing, because listening to your brothers or sisters until they have said the last words in their hearts is healing and consoling. Someone has said that it is possible ‘to listen a person’s soul into existence’.”12
1 Consultant, APRI’s National Center for Prosecution of Child Abuse. Ms. Walters previously served APRI as Victim-Witness Specialist.
2 Lead Social Worker, Chadwick Center at Children’s Hospital, San Diego.
3 Sarnoff-Schiff, Harriet, The Bereaved Parent, Crown Publishing, NY (1977) pg xiv (introduction).
4 This includes falls, choking on food, suffocation, drowning, residential fires, and car accidents. Statistics from Childhelp USA website www.childhelpusa.org/abuseinfo_stats.htm
5 U.S. Department of Justice, Bureau of Justice Statistics
6 For a complete list of Survivor Problems see the Parents of Murdered Children Website located at www.pomc.com/problems.cfm.
7 For a complete discussion on the phases of grief see Sanders, Catherine, M. How to Survive the Loss of a Child. Prima Publishing (1992). 8 For guidelines in working with survivors from diverse populations, see Chapter
8 of the National Victim Assistance Academy Manual, entitled “Respecting Diversity: Responding to Underserved Victims of Crime.” The chapter can be accessed at www.nvaa.org/assist/chapter8.html.
9 For a discussion on how to assist survivors of homicide see the Parents of Murdered Children Website located at www.pomc.com/professionals.cfm.
10 Parents of Murdered Children is a national organization with local chapters that provides support to surviving family members of murdered children, adult or minor. POMC can be reached at 100 East Eighth Street, Suite B-41, Cincinnati, OH 45202, (888) 818-POMC, e-mail: email@example.com.
11 For a survivor generated list of ways to improve the relationship between victims, families and law enforcement please see Parents of Murdered Children Website located at www.pomc.com/tips.cfm
12 DeHueck-Doherty, Catherine, Paustinia, quoted in “Victim Empowerment: Bridging the Systems–Mental Health and Victim Services Providers,” Office for Victims of Crime publication for training, Erie, PA, May 2000, pg. 14.