discussion

School Social Work with Grieving Children Lisa Quinn-Lee

The purpose of the research reported in this article was to advance understanding of the work of school social workers with grieving students. This research was aimed at answering the following question; What are school social workers' experiences working with grieving children? There were two steps in this study. Fifty-nine school social workers in the Twin Cities, Minnesota, agreed to participate in the preliminary e-mail survey. Of these partici- pants, 22 school social workers were interviewed in person for approximately 45 to 60 min- utes. This exploratory study required an open-ended, inductive approach using qualitative methods. Interviews were transcribed and coded. Major codes were developed using the guided interview questions. Constant comparison was also used. The data analysis identified four main themes in the responses; (1) harriers to helping grieving students, (2) variations on how grief is defined, (3) social workers' preparation for dealing with grief and loss issues, and (4) referrals of grieving students to outside resources. Subthemes were developed under each theme.

KEY WORDS: children; grief; loss; school; social work

D eath is a part of life, and many children will experience the death of a loved one. According to the Social Security

Administration, in the United States, an estimated 3.5 percent of children younger than 18 years (approximately 2.5 million) have experienced the death of a parent (Haine, Ayers, Sandier, & Wol- chik, 2008). There are 70 million children under the age of 18 in the United States, with 36 million enrolled in kindergarten through eighth grades and 14 million enrolled in ninth through 12th grades (Huxtable & Blyth, 2002). There are more than 15,000 school social w^orkers across the United States who interact with grieving children (Consta- ble, McDonald, & Flynn, 2002). The topic of child- ren's grief, school social work, and the school system is important, because it affects so many people. Social workers "can play a crucial role in strengthen- ing the foundation of a child who suffers the death of a parent" (Hope & Hodge, 2006, p. 125).

REVIEW OF LITERATURE

Grief in School A student's reactions after a loss may include a decline in school performance and difficulty mas- tering new academic material (National Center for School Crisis and Bereavement, 2006). The National Center for School Crisis and Bereavement recommends that "students should be offered addi- tional supports, such as tutoring or participating in

mentoring programs to assist them in maintaining their academic progress before academic failure occurs, which would represent an additional Stres- sor" (p. 6).

School social workers encounter children who have experienced a wide variety of stressful events on a daily basis. Therefore, they need a working knowledge of crisis intervention, grief work, and treatment for posttraumatic stress. Although many school-age children experience grief reactions, "the impact of the death of a parent often is not appreci- ated in all its importance by school personnel," even though it can affect a child's academic performance and social behavior (ZambeEi & Clark, 1994, p. 3). Children in our society are referred to as the forgot- ten moumers (Wolfelt, 2004). Children grieve, but all too often they do not get the opportunity to express their feelings openly.

Holland's (2003) research in England with adults who were bereaved as children found that, for these individuals, returning to school was sometimes a negative experience. In fact, children's return to school was often challenging, with school person- nel and peers not knowing how to respond to them once they returned to school. Children felt ignored, isolated, embarrassed, uncertain, and different, and they thought that their schools gave them little sup- port or understanding.

Holland (2008) stated that schools are in a "uni- que position to help grieving children" (p. 415).

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Even though grief is a family issue, it has the potential to affect children while they are in school, especially because children spend so much of their time in school. Schools can be a safe and supportive place for students. It is important for school staff to establish trust and rapport with grieving students and their families. Staff who acknowledge the needs of griev- ing students can help them cope with their loss.

Children's Grief How one explains death to children and intervenes with them in their grief depends on the children's developmental stage. Age and developmental stage may affect the nature of children's emotional re- sponse to death, understanding of death, and ability to deal with death. Webb (2010) identified three age ranges that correlate with children's response to death.

Children ages two to seven (a) do not understand that death is final, (b) often believe that death is reversible or temporary, (c) believe in magical thinking, (d) may believe they caused the death, (e) may ask repeatedly about the whereabouts of the deceased, (f) may not show outward expected signs of grieving, (g) may be afraid that someone else may die, and (h) may be angry with the deceased (or with the surviving parent or sibling).

Children ages seven to 11 (a) may have an inabil- ity to deal with death, (b) may use denial to cope with the loss and may act like the death did not occur, (c) may hide their feelings in an effort not to seem childish, (d) may do their grieving in pri- vate, (e) may feel guilty and/or different from peers because of the death, (f) may express anger or irri- tabihty rather than sadness, (g) may overcompensate for feelings of grief by becoming overly helpful and engaging in the caretaking of others, (h) may develop somatic symptoms of hypochondria, and (i) may have anxiety due to an increased fear of death.

Children ages nine to 12 (a) may feel helpless, frightened, or numb, (b) may behave in a manner younger than their years, (c) may feel conflicted between the desire to behave in an adult manner and the wish to be taken care of as a child, (d) may experience guilt about teen behaviors, (e) may use anger to defend against feelings of helplessness, and (f) may respond in a self-centered or callous way.

Children's grief differs from adults. Children's immature cognitive development interferes with

their understanding about the irreversibility, uni- versality, and inevitability of death. They have a limited capacity to tolerate emotional pain. Child- ren's acute feelings of loss may occur in spurts over many years, and children are sensitive about being different from their peers. Children have limited ability to verbalize their feelings but are able to express their feelings in play therapy (Webb, 2010).

By using the various theories of grief as a guide, social workers can help students work through grief. For example, the dual-process model (Stroebe & Schut, 1999) depicts grief as an oscillating process in which a bereaved individual uses two different ways of coping with loss: loss orientation and resto- ration orientation. Loss-orientation coping refers to the person's acceptance of the suffering and involves the grief work. Restoration-orientation coping refers to attempts to sort through various life changes and find ways to cope with these changes; it provides respite or distraction from suffering. School social workers can help students accept the loss and find ways to cope with it.

Effective Interventions with Grieving Children It is important to make the distinction bet-ween bereaved children who are struggling with adapta- tion to the loss and those who have serious adjust- ment disorders. The treatment and interventions for children who are experiencing serious emo- tional and behavioral difficulties following a loss will be very different from the interventions offered to children who are coping more adequately (Wor- den, 1996).

Models of intervention with bereaved children include peer groups, individual counseling, family interventions (including communication, family readjustment, and problem solving), and a combi- nation of these (Worden, 1996). Activities for intervention include art activities (drawing, clay modeling, making puppets), writing activities (journahng, letters, hsts, memorials), memory book making, storytelling activities, and games. Intervention activities are intended to help bereaved children by facilitating the various tasks of mourning, providing children with acceptable outlets for their feelings (including ways to address their fears and concerns), helping children get answers to their questions, and helping counter children's misconceptions about the death (Wor- den, 1996).

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Because children only cope as effectively as the adults around them (Anewalt, 2010), the best way to support grieving children is to work with the adults closest to them. Informing, including, and involving parents and key adults is critical. School social workers could meet with parents at a time and a place that is convenient to parents, perhaps meeting at the parents' place of employment or vis- iting them at home in the evening or on the week- end. School systems should provide education and trainings for all personnel, including information on grief, loss, death, trauma, and normal and compli- cated signs of grief in children (Anewalt, 2010; Goldman, 2000).

In addition to undergoing training on how to identify and respond to a grieving chud, adult care- takers must also advocate for these children. For instance, caretakers and school personnel could (a) pemiit the child to leave the room if needed with- out explanation; (b) suggest the child choose a des- ignated adult to talk with; (c) choose a designated place for the child to go within school as a safe space; (d) allow the child to call home; (e) invite the chOd to visit the school nurse as a reality check; (f) assign a class helper; (g) create private teacher time; (h) give the child more academic progress reports; (i) modify some work assignments; and (j) inform faculty, the Parent—Teacher Association, parents, and children ofthe child's loss (Goldman, 2000).

PROBLEM AND SIGNIFICANCE There is a great deal of infonnation in various dis- ciplines on grief and loss; ho^vever, there is not as much information on how to help students or school communities deal with grief and loss. The topic of grieving children appears "very minimally throughout the social work literature" (p. 107) and it is "very important for social workers to further investigate children's grief. . . so that we can know how best to intervene" (Hope & Hodge, 2006, p. 106). Death is a part of life, and schools need to enhance their response to grieving children. The available literature indicates there is a need for school personnel to learn how death affects the stu- dent and the school community, and there is a need for schools to develop specific plans to respond to a death, including in-service training programs around grief and loss (Klicker, 2000).

Schools are not just buildings or classrooms but are conceptualized as communities of families and

school personnel engaged in the educational pro- cess; school social workers assist in making schools real communities (Constable, 1992). For some chil- dren, school is a respite from their problematic home life; for others, school is a source of anxiety and stress (Huxtable & Blyth, 2002). The larger community and societal context affects schools; if social supports are not present for children and their families to buffer the consequences of issues and problems affecting them, school success is unlikely (Allen-Meares, 2004).

There are many grieving students in school dis- tricts throughout the country (Anewalt, 2010). Outside a child's immediate family, the most signif- icant environment is the school. Consuming most of children's weekday hours, school is their primary source of social relationships and activities. School personnel play an important role in helping students cope with their grief (Anewalt, 2010).

Grieving children often experience some initial depression and anxiety. Although this is normal, these feelings can sometimes linger and become problematic. Grief can sometimes lead to more seri- ous mental health issues. Social workers are the largest group of mental health providers in the United States (NASW, n.d.), and it makes sense that they would provide mental health services to students in the schools.

School social workers who are clinically trained can differentiate between normal and problematic grief, depression, and anxiety. If school social work- ers are given enough time to work with grieving, depressed, and anxious students, they can help decrease these symptoms, improve students' func- tioning, and help them feel better emotionally.

School social workers help students and families with coping with stress; family issues (divorce, domestic violence, financial, parenting); gdef and loss issues; medical and mental health issues; par- ent education; physical and educational neglect; physical, sexual, and emotional abuse; pregnancy; relationship concerns; school-related concerns (ab- sences and truancy, academic achievement, bully- ing, dropout prevention, harassment, misbehavior, school avoidance, special education, tardiness, underachievement); sexuality issues; and substance abuse (School Social Work Association of America [SSWAA], 2012). Because school social workers help many students with myriad concerns, it would not be surprising if there is not enough time for them to assist grieving children.

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Social workers need to be available to all stu- dents, not just students with special needs or in spe- cial education. Schools need to enable every student to reach her or his full potential (Constable, 1992). School social workers are in an excellent central position to work with all types of students, issues, problems, and needs, particularly those resulting from changes in family structure (Consta- ble, 1992). To provide assistance to the entire stu- dent population, school social work involvement must be increased in a multitude of issues and prob- lems that students are facing, including grief (Con- stable, 1992).

METHOD

Research Question The purpose of this research was to advance the understanding of the work of school social workers with grieving students. This research was aimed at answering the question: What are school social workers' experiences working with grieving chüdren?

Design The exploratory nature of the study required an inductive, open-ended approach. The purpose was to uncover rich meaning and thick description to aid in a better understanding of school social work with grieving children. The data analysis pro- cess included discovering themes and pattems and the relationships among them, which in tum would lead to increased knowledge and understanding.

This study consisted of two stages. School social workers from the Minneapolis-Saint Paul, Minnesota, metropolitan area were invited to participate in a preliminary, six-question e-mail survey and a 45- to 60-minute in-person interview. This study was approved by the institutional review board at the University of Minnesota.

Sample The sample consisted of school social workers in the Minneapolis-St. Paul metropolitan area. The par- ticipants were licensed as school social workers by the Minnesota Department of Education and the Minnesota State Board of Social Work with one of the following licenses: licensed social worker, licensed independent social worker, and licensed independent clinical social worker.

Purposive samphng is the dominant strategy in qualitative research; this type of sampling seeks information-rich cases that can be studied in depth

(Patton, 1990). A convenience sample of 105 school social workers was selected based on the fol- lowing criteria: (a) currently licensed in Minnesota as a school social worker, (b) currently employed as a school social worker in Minneapolis-St. Paul, and (c) currently a member of the Minnesota School Social Workers Association (MSSWA). Approxi- mately 105 school social workers were sent an invi- tation via e-maü to participate in both parts of the study. Fifty-nine school social workers agreed to participate in the preliminary e-maü survey. Subse- quently, 22 school social workers who agreed to participate in the second part of the study were interviewed in person for approximately 45 to 60 minutes.

To obtain a list of possible participants, I con- tacted the MSSWA to obtain a list of names and e-mail addresses of school social workers who belong to this organization. There are approxi- mately 105 school social workers who belong to the MSSWA and work in Minneapolis-St. Paul schools, and all of these members received an e-mail invitation to participate in the study. Of the 105 e-mails sent, 10 came back as undeüverable. Therefore, only 95 participants received the e-mail invitation. The e-maü invitation stated that con- sent was implied if they chose to complete the survey. Individuals who were interested in parti- cipating in the preliminary six-question Internet survey clicked on the link from the e-maü and completed the survey. Individuals who were inter- ested in participating in the 60-minute, in-person interview provided me with their name and contact information.

Data Collection The first question that participants were asked was, "Have you worked with grieving students?" Only participants who answered yes to that question could proceed with the rest of the survey and the subsequent interview. There were no participants who answered no to the first question; therefore, all participants participated in the complete e-maü survey.

One week later, I followed up by again contacting possible participants via e-mail and asking them to participate in the study. No participant was compen- sated for volunteering to be part of this study. Before in-person interviews, each participant signed a con- sent form. The in-person interviews were face-to-face and were audio recorded and transcribed.

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Instrument Two instruments were used in this study. The fint instrument was a six-question survey distributed to social workers in the Minneapolis-St. Paul metro- politan area. The survey consisted primarily of open-ended questions about what experiences they had working with grieving children, including types of services they had provided. Participants were also asked to describe the death the child was grieving (who died and how the person died). Last, they were asked if they would agree to be interviewed further on the topic.

The second instrument was an interview with six open-ended questions. These questions asked par- ticipants to describe their experiences working with grieving children in the schools, the losses the stu- dents had experienced, and barriers to helping grieving students. All who volunteered to be inter- viewed {N= 22) were asked the same questions. The last question in the interview asked participants if there was anything else they wanted to add to the intervie'w.

Data Analysis Data analysis was completed on both the online sur- vey and the in-person interviews. The researcher completed the transcription, the coding, and the data analysis. There were no preliminary codes. Data analysis on the six-question preliminary survey began immediately and continued as more res- ponses were received. The sixth survey question was used to identify those participants who were willing to be interviewed, and the researcher con- tacted these subjects immediately. The researcher collected survey data via the Web site https:// www.surveymonkey.com, which also notified the researcher when responses were received. Data analysis on the in-person interviews began immedi- ately after transcription. As soon as possible after transcription, the researcher began coding to sepa- rate and categorize the data using NVivo 9 analysis software (QSR International Pty Ltd., 2010). Cod- ing grounded the analysis in the actual data.

Triangulation—using different or multiple sources of data, methods, investigators, or theory —affords research credibility (Lincoln & Guba, 1985). The researcher used several techniques to address credibility: data triangulation, methods tri- angulation, a second (interrater) coder, and mem- ber checks. The coding unit was at the level of a phrase, and each coding unit could be placed into

only one category. Each of the two coders inde- pendently coded the data. During the course of the first coding, each coder placed participant responses into various themes. The two coders then met to delineate themes and agree on the labels. During the second coding, each coder placed responses into the themes and subthemes. If the two researchers disagreed about which theme to categorize the response, they discussed it until they both agreed.

Lincoln and Guba (1985) discussed the confirm- ability of research, which is the degree to which the researcher can demonstrate the neutrality of the research interpretations, through a "confirmability audit." The researcher of this study provided an audit trail consisting of raw data, analysis notes, reconstruction and synthesis products, process notes, personal notes, and preliminary develop- mental information (Lincoln & Guba, 1985).

RESULTS

When the data obtained from both methods used in this study were triangulated, the findings were con- sistent. Of the 59 participants who responded, 43 provided services at the elementary school level, 19 at the middle school level, and 15 at the high school level. Many social workers pro'vdded services at more than one level.

Of the 59 participants who completed the online survey, 56 pro'vided social work services to grieving children. The 10 services provided, in order of fre- quency, were (1) individual counseling, (2) group counseling, (3) family counseling, (4) referrals/ resources, (5) education and training on grief and loss issues, (6) bibliotherapy, (7) play therapy, (8) art therapy, (9) memorial services, and (10) advo- cacy. Fifty-five participants stated that the students they worked with were grieving the death of a par- ent, 46 said the students were grieving the death of a grandparent, 38 said the students were grieving the death of a pet, 30 said the students were grieving the death of a sibling, 28 said that the students were grieving the death of a friend, and 20 said the stu- dents were grieving the death of someone else (including deaths of principals, teachers, aunts, uncles, cousins, stepparents, and other relatives). School social workers said that students experi- enced loss from a wide variety of types of deaths, including natural causes, stillbirths, homicides, sui- cides, car accidents, cancer, drownings, shootings, heart attacks, and bicycle accidents.

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Grieving students were referred to school social workers by several sources, including teachers, principals, parents, students themselves, friends of students, school nurses, and community profession- als. Several participants stated that they learned about students' losses from the media and then con- tacted the students to offer support.

The themes that were identified are not unfamil- iar to school social workers. Similar themes have been identified in other areas of school social prac- tice. However, the area of school social work prac- tice related to grief and loss has not been explored as closely as other areas of school social work.

Four main themes were identified: (1) barriers to helping grieving students, (2) variations on how grief is defined, (3) social workers' preparation for dealing with grief and loss issues, and (4) referral of grieving students to outside resources. Sub- themes were identified under each theme. These themes and subthemes were identified from both parts of the study, but they were primarily drawn from the interviews. T h e themes and subthemes identified from the data are illustrated in Figure 1.

Theme 1: Barriers to Helping Grieving Students Participants reported many barriers to their effec- tiveness in helping a child through the stages of

grief. Some of the barriers were minor, such as par- ents being difficult to reach because they work, but some of the barriers directly affected social workers' ability to help the child. Major barriers included parents, teachers, limited time, limited resources, religious barriers, and lack of space to meet with groups of students for counseling.

Parents. Participants reported that the greatest bar- rier they experienced was either parents or teachers, both of whom seemed to think that grief counseKng interfered in some way with their rights and respon- sibilities. Many participants said that parents often saw them as part of "the system" that was there not to help the families recover but instead to separate the families. Parents did not want to be questioned about how they raised their chud. Almost all of the social worken reported that they often encountered resis- tance from parents when it came to counseling chil- dren. For example, participant 7 commented on parents' mistrust of school social workers;

Language barriers, sometimes families have mis- trust of social workers; you are going to remove my kids. If one of their children dies, am I going to get blamed for the death. Sometimes the families are really hard to reach. They are hard to get a hold of, to find out what is exactly going on. They will keep the kids out of school

Figure 1: Themes and Subthemes

Parents Teachers Time Resources Spiritual No private space

y

/ /

Barriers to helping grieving students

^ \

X\ Variations on how grief is defined

Death Divorce Change Other losses

V

Special courses Little preparation On-the~job experience

Social workers' wide range of preparation for dealing with grief and loss issues

Referring grieving students to outside resources Time

Resources Outside agencies Community groups Why it is necessary

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for a long period of time and if you ask about that, they get defensive.

Some parents believed the social worker was invading the family's privacy. Participant 3 summed up the privacy issue the best:

We say that in my school that I can see children one time without a parent's consent, and after that they have to sign a consent form. So, if for some reason, the parent were to say no, like if a parent, because, and I think this is a legitimate thing too, I mean, these are cominu- nity schools, do they want the school to know everything that is going on in their family? Well, maybe not. I respect their confidentiality and their privacy and that they might not want this looked at within the school for privacy sake and you know, that's where all the neighbors of this child are going, and you know that's how schools work.

Although the social workers acknowledged the difficulty that they faced because of the way that parents perceived their role in schools, they main- tained that parents did not understand how a child- ren's grief influenced their school behavior and achievement.

Teachers. Teachers were also considered a barrier to helping children. The social workers reported that teachers did not like children leaving the instructional classroom. According to the school social workers interviewed, teachers believe it is more important that the child remain in the class- room regardless of the situation. Participants said that teachers do not cooperate when the school social workers want to meet with students during class time. Participant 1 described the situation:

In the school system, the barrier I run up against most often is teachers not seeing that. . . there are some teachers who don't think that school is the time or the place to deal with per- sonal issues. And so they will struggle with a student leaving their classroom and that type of thing.

Overall, social workers cited feeling very frus- trated with the lack of support from teachers. One participant wondered if teachers realized that the only time a social worker could see the students

was during school time. Some participants thought that teachers were not being sensitive enough to the needs of these grieving children.

Time. Many participants stated that there is not enough time in the school day to handle the issues and problems of grief and loss. Though many social workers try to create groups for grieving children so that they can receive comfort from others who are experiencing the same pain, participants reported that there is very little free time during a school day in which to hold these group sessions. Likewise, there is almost no possibility of conducting any type of group after school. Many participants in this study thought that their job of helping children cope with life's stresses was considered to be sec- ondary to the child's academic performance.

Resources. Many participants stated that there are not enough resources allocated to helping students with grief and loss issues. School social workers cited both time and money as resources that are lacking. Often school social workers have to pay for special books or games that children can use during counseling sessions. Participants reported having to be very creative with the limited resources they do have.

Spiritual Issues. Participants described the spiri- tual implications of answering children's ques- tion regarding the whereabouts of deceased loved ones. Because of the separation of church and state, discussions of spiritual and religious issues must be hmited in public schools. School social workers stated that the spiritual aspect of grief, death, and loss is often an important part of a student's coping experience, but that they are limited as to how much they can discuss this issue. School social workers in this study agreed that it was important to honor the separation of church and state, but they also acknowledged that it is important to be open to comments the children themselves might make about religion and where people go after they die. Some participants thought that spiritual- ity was a big challenge for them when dealing with grieving children. School social workers reported that it was necessary to deal with spirituality on some level in their jobs. Participant 6 described a technique for addressing spiritual issues in public schools:

I think that one thing that is really interesting is the religion aspect and being in a public school. The one way I get around that, is by saying to a

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child, where do you think your grandma is? I can't share my beliefs with them and I would never try to convince them, but I have said oh, so you think that your grandma is in heaven, what do you think she is doing up there? I won't discourage their belief, hut I think spiri- tuality and the separation of church and state and what I can talk about with the student is the biggest harrier.

Need for Private Space. Participants mentioned that they often lack private office space where they can meet with students, yet it is important to provide confidentiality and privacy so that students feel comfortable. As Participant 4 noted.

My office space is a barrier. I don't really have a private, confidential area to meet with some- body who might want to share.

They also noted that private spaces are necessary for meeting with parents.

Theme 2: Variations on How Grief Is Defined Participants discussed students' grief related to the death of a parent, extended family member, and student. However, participants mentioned that children grieve because of all sorts of losses and that it is necessary to keep an open mind about the definition of grief and loss for the students. School social workers gave examples of many types of grief and loss that students experience, which include divorce, sexual abuse, absent parents, devel- opmental transitions, moving, peers, and change. Thus, a child's grief comes in many unanticipated forms. Participants also discussed how a student's grief affects the larger school community and peer group. Participant 16 commented that losses other than death can cause students to grieve:

Just about even with regard to divorce, when par- ents have to separate, there is a grieving process that goes along with that. Relocating, coming into a new environment that can cause grieving because they had been moved to a new state for whatever reason, or you have a new student come in and they start making new friends and then they are uprooted again. Grief conies in düFerent shapes and fomis—not just death.

Theme 3: Social Workers' Preparation for Dealing with Grief and Loss Issues There was a wide range of preparation for dealing with grief and loss issues. Some school social workers had a tremendous amount of background, training, and preparation, and others had almost none. Some social workers learned how to deal with stu- dent grief entirely on the job, leaming through trial and error. There was no standard of education or training that social workers received regarding grief and how to help grieving children. Often, social workers who had a personal interest in the topic of grief and loss sought out education and training on the subject. Most did not receive specialized training in grief and loss issues but rather chose to take elective courses or trainings on the topic. Grief was not a required topic in their social work training.

Special Courses. Several of the school social workers noted a special interest in taking courses to help them deal with grieving children because they believed that their graduate training had not placed enough emphasis on this topic. Participant 20 described pursuing grief and loss training outside of a formal academic program:

Initially the graduate program I was in, we were only allowed three choices of électives. I still wish that I had had grief and loss as an elective. I initiated leaming about it because I . . . knew I needed more information. Fortunately I had some experience with groups, hut even when I started out as a social worker at this end, I had a lot of great mentors. I really sought the help that I needed. I do reading, I talk to my colleagues, I go to conferences.

Little Preparation. At least half of the school social workers reported that they had little prepara- tion for dealing with grieving children. Some said that they do not deal with grief that often. These participants expressed their anxiety over dealing with death and reported that they were unsure of how to cope with a grieving child. For example, participant 7 stated,

I feel Uke the jack of all trades, the master of none. You feel Uke you know just about enough about everything but you are not a master of any.

On-the-Job Experience. T w o participants said that they had learned how to deal with grieving children through on-the-job experience. They,

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too, had not received training, so they did what they could when presented with the problem. The fol- lowing statement by participant 16 represents some- one who learned through experience:

I feel comfortable. I have been around awhüe. If I can't help, I feel really good knowing that there other places that this chud can get help that they need.

Theme 4: Referring Grieving Students to Outside Resources All of the participants said that outside referrals are a necessity for a variety of reasons. First, not enough resources or time exists in the educational system for school social workers to deal with long-term grief issues. Second, some social workers do not feel pre- pared to deal with grief and loss issues. Third, some students need famüy therapy to cope and recover from certain types of grief and loss, and family ther- apy may be outside the scope of the school social worker's job description. Fourth, students need and want assistance and resources when school is not in session. All participants acknowledged the need to rely on outside sources to support grieving children. The following statements by two of the participants represent the overall comments of the participants. Participant 20 stated,

I can't give all the support. The more support you have the easier it is to go through that heal- ing process. I believe that the more support that you can add, the more it helps that student.

Similarly, Participant 5 encouraged referrals to outside sources, stating,

I always let parents know that there are some other resources out there, because my part with the child is only 30 minutes, say once a week for 6 weeks' time, and kids usually need more than that.

LIMITATIONS

There were several limitations to this study. First, the transferabüity of the findings in this study is lim- ited because the participants all came from a specific geographical area in a specific state. Minnesota's requirements regarding who can become a school social worker may be different. It is possible that, in some states, a prospective school social worker may need to have formal grief training; however.

in Minnesota there is no such requirement. Hence, the barriers that these participants face in the execu- tion of their jobs may not be the same barriers faced by school social workers in other areas of the United States.

Second, only those school social workers who be- long to the MSSWA were included in the study, and therefore, results wül be limited only to those mem- ben. Not au school social workers in Minneapolis- St. Paul belong to the MSSWA.

A third limitation of the study is the small sample size. Although 59 school social workers completed the online survey, only 22 participants were inter- viewed. This is only a smaü number compared with the overall number of people (1,774) who are licensed in Minnesota as school social workers. For this reason, these findings cannot be generalized to a larger population.

IMPLICATIONS FOR PRACTICE

This study generates knowledge and better under- standing not only of school social work in general, but also of the particular nature of school social work with grieving chüdren. This study will serve to help school social workers and other school staff to recognize a forgotten population—grieving stu- dents—and inform schools about how social work- ers can help these chüdren. It brings awareness to the issue of school social work with grieving stu- dents, which has been ignored in the past. Perhaps schools, social workers, and parents will be inspired to advocate for increased services. This study could assist parents and guardians of grieving children in deciding whether they want to obtain additional support for their children when they experience a loss. The findings could encourage school adminis- trators, school social workers, teachers, and other school staff to discuss barriers to helping grieving chüdren. This, in tum, may assist them in finding ways to overcome these barriers so that they may help these chüdren maintain both emotional health and school performance.

The findings from this study generated a number of ideas for school administrators, social workers, teachers, staff, parents, and chüdren in dealing •with grief and loss issues.

• Increase services for grieving children. School social workers should be encouraged to ask their supervisors if they can identify, assess, and provide these services. If, subsequently.

Q U I N N - L E E / Schoo/ Socia/ Work with Grieving Children 101

services do not increase, more social workers may recognize the need to refer grieving chil- dren to other resources.

• Educate parents and teachers about child- ren's grief.. Infomiation can be sent via letters, teacher in-services, one-on-one discussions, books, and videos. When informed, these individuals may be more inclined to seek out the services of a school social worker or obtain additional support for their grieving children.

• Facilitate communication hetween com- munity and school social workers. Better communication can decrease the duplication of services and allow a more efficient way of organizing and utilizing resources and services.

• Collaborate with families. Families should be seen as part of the solution and part of the team.

• Inform social 'work degree programs about the preparedness of their graduates. Programs can evaluate whether grief and loss should be covered in greater depth and length in bachelor's and master's degree curricula.

• Use the skills of listening, encouraging, and problem solving e to help grieving students. Because working with grie'ving stu- dents does not require different knowledge or skills, school social workers should use the knowledge of grief and loss that they gained throughout their social work education (per- haps in areas of child welfare, gerontology, dis- abihties) as a parallel to grief around death.

• Provide ideas to support the research that states intervention is necessary for griev- ing children. The themes and subthemes in this study reveal areas where interventions can be provided and where further research is needed.

• View parents and teachers as part of the service delivery system. School social work- ers need to help parents and teachers make the link between the social workers' efforts with students and parents' and teachers' goals for these students. It is important for social work- ers to show how their services can complement and support rather than threaten the roles of teachers and parents (Bronstein & Abramson, 2003).

• Collaborate with teachers. "Collaboration between social workers and teachers is critical in order to maximize students' achievement in

school" (Bronstein & Abramson, 2003, p. 323). School social workers can help teachers under- stand the connection between psychosocial intervention and improved academic perfor- mance, shew teachers that their emphasis on academics is valued, and enhance teachers' roles and ability to teach (Bronstein & Abram- son, 2003).

• Address the issue of time as a barrier. This study introduced the idea of the community- school partnership and after-school program- ming as ways to attend to children's psychosocial issues that impact their class performance.

• Find creative ways to address spirituality. Students may raise this issue with social work- ers. Spirituality is often a part of grief, and it is natural for children to want to discuss it. How- ever, some school social workers are anxious about discussing spiritual issues in school. It would be helpful for school social workers to have some training on how to talk to students about this issue so they are more comfortable. Also, social workers should take a holistic view and collaborate with spiritual leaders in the stu- dents' lives, so students receive all the spiritual support they want or need.

This study revealed areas in which improvement or further study is needed. Based on the literature, most grieving children simply want someone to lis- ten to them. Social workers should be reminded that it is acceptable to not have the answers and that, in fact, they should not have the answers. Instead, they should listen and ask students ques- tions, support them, and keep the dialogue open. They should encourage students to continue talk- ing about spiritual issues and to talk with their fam- ily. School social workers can take on roles that best address the needs of bereaved students in the schools. CS

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Lisa Quinn-Lee, PhD, MSSW, LICSW, is assistant pro- fessor. Social Work, University of Wisconsin-Eau Claire, 105 Gaifield Avenue, Eau Claire, WI54702; e-mail: quinnllm@ uwec.edu.

Original manuscript received March 13, 2012 Final revision received August 27, 2012 Accepted September 14, 2012 Advance Access Publication April 22, 2014

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