::Title slide - Grief & Loss in Adoption - Bonni Goodwin, LCSW::

[Bonni Goodwin]
All right, we are ready to go.

[Carlie Van Woerkom]
I want to welcome everyone today to our Lunch and Learn. This Lunch and Learn is being brought to you by a collaboration between Oklahoma Human Services, University of Oklahoma Anne and Henry Zarrow School of Social Work, and the Oklahoma Adoption Competency Network. We appreciate everyone joining during your lunch or noon hour, and we want to get started so we can make sure to respect everyone's time and the great information being discussed today. 
First, let us go over a few housekeeping things for our time together this afternoon. First, we are recording this meeting, so by participating, you are giving your consent to be recorded. Um, please help us reduce distractions so we can all focus and participate. We have muted everyone to make it possible for everyone to hear the speakers. We want you to express your thoughts and questions. So please utilize the chat for this purpose. We will monitor the chat and questions will be touched upon during our Q&A time during the last 15 minutes of the webinar. We want to see you, so if you are willing and you can, please turn on your video. If you are unable to, that's fine also. To receive information about other post-adoption events, please list your name and email in the chat, and we will make sure to add you to your con to our contact list. Remember confidentiality. It is vital that we protect confidential information, so we will not share specifics like names, details about adoption cases, or people. If you are a foster parent attending this training, you'll receive one hour of training credit towards the 12 hours of in-service training that you need each year. These trainings are not yet available as CEU credits for professionals. However, you may submit the certificate to your agency and request and request training credit per your agency's policies. Please indicate in the chat if you would like to receive a certificate of attendance and participation. Now, I'm gonna hand everything off to Dr. Bonni Goodwin, who is today's host.

[Bonni]
Thank you, Carlie. Um, thank you all for being here. I am, um, this, it's a, a con, uh, content that is not always the most uplifting, but the goals today is that we're gonna talk about grief and loss in adoption and also foster care. Um, but then most of the time today, we're gonna spend on, uh, strategies and tools to be able to help process the loss, um, that our kids have experienced.

::Slide - Agenda::

I don't know if you've heard the terminology, "Ambiguous grief" or "ambiguous loss" before. So we're gonna define what that is. Talk about what that means within foster care and adoption. And again, like I said, we're gonna identify ways to navigate through that with, uh, children and adolescents. Okay?

::Slide - Domains of Adoption Competency - Pie chart:: 

So if you've ever heard me share anything ever anywhere, um, I always start with this, this slide because this really, um, gives the heart and soul of what we are focusing a lot of these Lunch and Learns around. It's adoption competency, adoption competent mental health. Um, it's a, it's a, a framework, an understanding of what professionals, especially mental health professionals, really need to have a good grasp on to be able to provide the best and the most knowledgeable support. So the reason I'm sharing it right now is to put up here, what you're seeing in front of you is the 18 competency areas, or domains, that have been defined within adoption competent, uh, mental health. And what I'm gonna do right now is highlight,

::Slide - Domains of Adoption Competency - Camera lens::

you can see some of them changed to a, a bolded text. How many of these domain areas have to do something with loss? So you can see 1, 2, 4, 6, 7, 8, 9, 11, 12, 13, 14, 15, 16. So like the majority of these domains in adoption, competent mental health is really about, or has an element, um, with loss involved in it. Um, so for example, planning and preparing for adoption, what does that mean? We're gonna, we're gonna talk more about what that means for parents, uh, what potential losses they've experienced as they're planning and preparing for adoption. Um, loss is one of the most significant uh, traumatic experiences that we as humans, um, experience whenever you lose a very meaningful relationship. 

::Slide - Loss is at the heart... [picture of a woman holding a photo of a pregnant woman]::

So anyway, you can see here, loss is pervasive in adoption and foster care. It's really at the core, it's at the heart of foster care, adoption, and guardianship.

::Slide - Loss Exercise - instructions::

So let's do a little exercise here. I do wanna give a disclaimer. Um, you're going to feel feelings in this, uh, in this exercise. Please remember that it is not real. Okay? So when I'm, I'm walking you through these things, um, when I, when you start to get angry or frustrated, just take a deep breath and remember, this is not real, but there's a purpose for you feeling those things. Okay?
So what we're gonna do, um, if you have either pen and paper, or you can just put it like on your phone or somewhere where you can write down a list of 10 things that you want to take with you, because right now what I'm here to tell you is that you have to move. You have to move, and you can only pick 10 singular things. So you can't say family. That's not singular. So it has to be one person, one pet, uh, one thing, and you can only take 10. So I'm gonna give you just a few minutes, and I'm gonna let you pick 10 things that you are going to take with you when we leave. I'm watching you all concentrate very hard, figuring out your 10 things, Okay, if you're not quite to 10, that's okay,

::Slide - Loss Exercise - further instructions::

because I have, I have some bad news for you. Um, in my car, we actually have to pick up a few more people, so I don't have as much room as I thought I did. So you're actually gonna have to only pick five. So out of your list of 10, cross off five and choose only five that you can take with you. So, so give you a minute to pick your five singular people or things.

::Slide- Loss Exercise - more instructions::

Okay? I have, I have more bad news. Um, I, my car broke down, so I actually have to take a scooter and, um, we really don't have much room at all. So I need you now to only pick two. So of your five, please cross out three, and you can only take two singular things or people with you.

::Slide - Loss Exercise Processing::

Okay. What are you feeling right now?

[Kelley Ivey]
I think I was feeling a sense of like, 'cause all my, everything on my list is a person. So when I got to the last five, I was like, okay, that was, that was easy. Like those five make the cut. But then when I had to get it down to two, then I, I felt like, well, which one do I pick? Like, who would need me more? Or like, I felt like I was having to like, I don't know, be disloyal to whoever got cut from the list.

[Bonni]
Yeah. Yeah. No kidding.

[Sarah Antari]
I kind of felt the same way. I kind of felt guilty, like, I've gotta leave somebody. I love them all equally. How do I choose? And then ultimately I chose who would need me the most.

[Bonni]
Mm-hmm.

[Sarah]
But even though it's not real, I have a pit in my stomach.

[Bonni]
I could see it in your face. [laughs] When we were, when we were making the cuts.

[Sarah]
Yes. Yeah. Yeah.

[Bonni]
And you really, you really kind of mentioned this, this next question, what, how did you choose what or who to give up first and which was maybe the hardest?

[Carlie]
Well, mine was similar. It was about people, and it came down to who would need me the most. But also if I could only take two people, who could I leave behind that I would know would have a grownup to help that person, too. So like, I can take care of these, but they're still good.

[Bonni]
Yeah. Yeah. So trying to make sure that those who are little or vulnerable have someone who's there to take care of them. It's a lot of trying to strategize who goes where. What, what was the, what was the hardest for you to cross off?

[Sarah]
Probably giving up my daughter, even though she's an adult and can care for herself.

[Bonni]
Yeah.

[Sarah]
Cutting that tie would be, I mean, that would be horrible.

[Bonni]
Yeah. Yeah. Choosing... you have something to do with this choice of separating an important relationship.

[Sarah]
Yeah.

[Bonni]
And you've already kind of talked about this too, Carlie, you were saying, you know, who, who can I make sure has someone to take care of them? How did you make the choice? Who needs me the most? I heard min-- a couple of you say that, right? So it's like, but, but all of you have pretty much said people were the ones that I kept on my list the longest and the hardest to mark off the list.

::Slide - Most often...::

So when we take that experience and then we look at what we're talking about for our kids who've experienced foster care and adoption for children in foster care, adoption or guardianship, loved ones, those relationships are the first losses, not the last. And also they don't get to choose, right? So just sitting with that for a minute and recognizing what that, what that would feel like or what that does feel like.

::Slide - Other Grieving in Adoption::

And then other aspects of grieving in adoption, other losses. Adoptive parents, like we talked about just a second earlier, um, are parents who are preparing to adopt a sometimes, not all the time, but sometimes they're coming to the table with losses that they've already experienced, infertility and inability to have children, um, biologically or maybe they are, they've already adopted a sibling. And then, um, there's another, another sibling, uh, who's now is, is needs a home, or maybe they were a grandma or aunt and had this specific role in this child's life, and now all of a sudden they've lost that role and are assuming parent role.
And so the process of why some families adopt can sometimes have an inherent sense of loss, uh, within it, loss of relationship, loss of potential and dreams, loss of hopes, um, and then also loss of role. And who am I in this relationship? And then I've heard lots of parents talk about what it feels like to walk through the continued life, uh, of raising the child, but, but recognizing that there's always gonna be some time before they adopted or before they met this child that they were not a part of. And sometimes with our kids, um, we don't even have all of the information about that time. So a lot of parents talk to me about that experience of grieving the lost time, grieving the, uh, inability to be there and to be a part of a child's life at that time. Um, maybe not ever having a picture of what they looked like as a brand new infant. Um, 'cause we all know infant babies look really different, right? Kinda look like little Elmer Fudds. [laughs] 
Um, but, but just the, the reality of recognizing and coming to the place of accepting that I don't have that, and I don't know if I ever will. Similar to what we talk about our kids and having gaps in some of their understanding of, of where they come from. Mentioned this a little bit, but also, uh, dreams and hopes of, of maybe who I might be as a parent, but then also dreams and hopes of what I, what my family will look like and be like. Um, one of the biggest things we, we recognize that can be a challenging thing for parents is, um, these expectations of I now have my child or my children. They're mine, I've adopted. Um, and we're gonna be a big happy family. And, um, and, but there's challenges, right? And there's some hard things. So, um, recognizing that sometimes that feels like ongoing loss as well. 
And then just the reality of a parent becoming a parent in any way, whether it's adoption or whether it's giving birth to a child, or, um, when you take on the responsibility of another tiny human or multiple tiny humans, you are losing flexibility and freedom in your life. And sometimes that can be really hard. Um, it gets, it gets challenging, right? Whenever you're like, "Oh my gosh, my entire life is focused on keeping this human alive, or my entire financial resource is being spent to take this child to all of the therapy sessions and all the doctor appointments and all the things. And dance lessons, and sports lessons, and all of the things are being poured out for this kiddo," which is what we want to do. But sometimes there is that reality check of like, "Oh my goodness, this is a big difference than what life was like before." 
And then also family life prior to adoption, really focusing on our families who, um, kinship relationships. Again, that role change, the shifting from who I was to who I am now, my responsibility, my, uh, interaction with this child is different. Um, also our adoptive homes who have had biological children in the home already, and was, was raising them or maybe even ro-- raised them all the way to adulthood. And, um, now they are, um, they are shifting into what does this now look like? Anytime you add a new human into a system, a family system, into a home, it shifts the entire thing, right? When you're changing something about a machine, it, it, you have to adjust for it in every other area. It's the same kind of thing when you're adding another human to a home, everyone adjusts and everyone shifts and things are just a little bit different. Good and challenging.

::Slide - Ambiguous Loss in Adoption::

I'm gonna check and see. Okay. Um, so in ambiguous loss, what is that specifically? Ambiguous loss is really the, the, what a lot of our kids in foster care and adoption, um, deal with, as in, "Is this loss temporary or final?" Even when the legal finalization has been experienced and, and everyone is saying, this is done and your name changed and everything is legal. A lot of the adoptees that I talk to, uh, say that it still feels temporary. It's, and even if it's really good, um, it doesn't, it doesn't have to be that it's a uncomfortable or bad feeling, but it's just, um, I've heard some describe it as like "on probation." Like they just kind of feel like this is, I'm on probation. Um, and a lot of that I think has to do with the impact of trauma, right?
That you have experienced the loss of a relationship that you never conceived previously would ever be gone, of the loss of this person in your life, and they're gone. And so now it opens up the potential of the reality that that could happen again to you. Um, so it's just kind of, I've also heard it said, I'm sure you guys have heard this phrasing of "Waiting for the other shoe to drop." When, when you experience loss, then you're just kind of holding your breath for a while. Um, especially whenever it's, um, sudden or a quick thing, or a tragic thing that happens, then you just kind of hold your breath for a while waiting to see what the next sudden or tragic or awf-- or thing that you might lose or person that you might lose. So it, it just is this, it shifts your reality. It shifts the experience of what the world feels like and, and how temporary or final relationships are, um, not fully understanding the loss because of limited knowledge of a child's early history. 
So as our kids are growing up, they're having more and more perspective of their own story. Why was I removed from my biological home? Why was I adopted? Um, why did all of these, all of these things happen to me whenever I didn't get the choice? I didn't get to have a voice in this process, and even if I did, it was from a minor's perspective. So everyone else still ultimately got to make those decisions. Um, and so it's hard to process losses and who I am and how I got here when I don't have all of that information.
Additionally, not knowing some of the information about where all of those people are now, that's another really significant thing about ambiguous loss, is when we lose someone to death, to the passing of, of this, of, of, a person that we love and care for, then we have a lot of really specific rituals and traditions and things that we do as human beings that are very societally accepted, um, and expected of us to process and find closure in that loss. So whenever someone dies, then a funeral is planned, a memorial service of some, some sort, um, a way to, uh, you know, deal with, "What does this physically mean in our physical world?" So, um, a grave site, um, an urn, something that we are actually working through decision-making process to get to the place of, "We've done everything that we need to do to, to take care of, um, the loss of this life." Those things, yes, some of it is very tangible and very specific, especially like financial things. It's required and necessary, but also every single thing that we're doing in that decision-making process is helping us pro-- like, come to a point of closure. Um, especially, we were just talking about, my husband and I were just talking about this this morning of, um, the things that we do in funerals and, and how sometimes we think that they're going to be, um, really one, you're gonna feel one way or another. Like, um, if it's a, the viewing, like an open casket or something, and you're thinking, um, I don't wanna see my loved one in there. But then also recognizing that, um, the impact of seeing helps you then really, like a part of this process is a, a little bit denial, right? Like, "Did that really happen?" Um, feeling like, like, maybe you're gonna wake up and someday they're gonna be back. They're just on vacation for a long time. So, so seeing somebody, it actually helps us to, to remind ourselves, no, this is real, this really happened. 
Um, and all of those things lead up to our process of grieving, of what does this mean? And moving through all of the different emotions of, of denial, and then anger, and then, uh, bargaining. We'll talk more about that in a minute. But, but those things help us. In ambiguous grief, in foster care, and in adoption, there is not the loss of relationship to death. So we don't do all of those things. We don't make all those decisions, we don't have a funeral, we don't have a memorial service, and we don't have a burial site. Um, what we have instead is a lot of transition, a lot of moving into different homes, visits with parents. So it's kind of like this ambiguous, um, "I'm gonna see them," and then "I'm not gonna see them," and then "I'm gonna, I mean, like, "When will I see them again?" Um, even again, even if you're told that rights are terminated, now you're gonna be adopted, and this is final. That person is still out there that -- I, I can't tell you how many adult adoptees I talked to who did not have information or relationship with their birth parent. And they tell me a story at least one time in their life where they feel like in the grocery store, they ran into who might've been their birth parent. And it's a really powerful experience for that adoptee. Like it's, I mean, it's emotional and it's very much, and, and I would never take that away from them because it's a meaningful experience, but, but it's, it's pervasive. Um, there's, there's that process of, "I ran into them. I knew it, we knew it, looking at each other, we just didn't say anything," right?
So there's just, there's this way that we as humans try to process this ambiguity of that there's this person out there still. So not fully understanding, uh, what is happening and why all of this happened, um, is really hard to process. Again, I already mentioned this, the socially accepted rituals, defining loss, and then also supporting the grieving process. And then also lack of recognition and validation that these are losses and that they're more, it's, it's not just the initial, being removed from biological parent. That is a huge one. And it doesn't lessen the reality of the impact of separating from biological mom. That is a big, huge loss. But there's also several others. There's losses of other relationships. There's a loss of place. 
Um, I, when I say childhood home, most likely you have something come to your mind, and sometimes a picture that brings emotion of some sort, um, good or bad, there's, we have attachment and connection to place as well as relationships. Relationships is what keeps us alive. That's what we need. But we also have attachment to place. So if you think about your own bed, your bedroom at home, I'm very attached to my bed. Um, I love traveling, but I cannot wait to get back to my own bed that feels like home. And we talk about that, right? Home is where your heart is. Uh, there's no place like home. We talk about home a lot as humans, and that's attachment to place. So when we have multiple moves and multiple transitions, um, we don't always recognize all of those level of losses for our kids and, and, um, and not just those initial big losses of relationship. And what this really means is when you are grieving multiple losses, um, it takes a lot of energy to grieve one. And we have to really, it really, uh, we grieve one at a time. So when you have layered, layered losses, and you can only grieve with a lot of energy one at a time, then it, the process of grieving all of those losses is drawn out, and it's exhausting.
So I had a friend who, um, her sister was involved. She was a victim of the Oklahoma bombing. She was in, in the building. She survived, but her, the rest of her office, there were five others that worked with her in that office, and none of them survived. So she had to grieve the losses of all of those relationships, and it took years after that. I mean, obviously there was other, um, layers to that and the impact of that traumatic, horrific experience. Um, but, but how she described it was she would think about one person, and that's all she could think about for a significant amount of time. She was grieving that person, the relationship that they had, the memories that she had with that person. And then she'd get to, she, she'd feel the emotion and process through it, and then it would, another person would come to her mind until she went through every single one that she lost. So it was a lot of energy and a lot of time.
And we've got babies. We've got our babies who are still processing and dealing with things in front of their faces right now as they're trying to navigate building new relationships. We don't give enough recognition and validation that they're also still simultaneously trying to process all of these things and people that they've lost. That takes time, energy, and a whole lot of space.

::Slide - Helping to Resolve Losses...::

So now let's shift to helping to resolve losses. So this is, uh, this is not an exhaustive list, but these are some thoughts and ideas, things, strategies and tools, um, that are ways to be able to help children and adolescents and young adults be able to process this ambiguous loss as well as, uh, loss of any, of any sort.

::Video - "BC Forster Basics: Grief & Loss" 

The first thing here is this short. It's about a five minute video that talks through some of what we just talked about, but, but ends with a really good perspective on how we can help.

[Video starts, piano music plays]
[Various illustrations and words appear on screen throughout the video to accentuate narration]

[Narrator]
Grief is the result of a loss that holds substantial meaning. Any number of loss situations can cause a grief experience, which may be short-lived or last an undetermined amount of time. Unacknowledged grief from an experience of loss can be debilitating and cause ripple effects long into the future. Potent emotional turmoil due to grief can lead to many issues, such as illness due to a compromised immune system, emotional problems such as depression or withdrawal from other people, and further losses such as relationships and opportunities.
When helping a child through an experience of loss, the first task is to assist with acceptance of the reality of the loss. To a child, removal from their family or a severed relationship for a long period of time can be too much to understand. It will take time to go through the process of accepting the new environment they find themselves in before this acceptance settles in. Typically, a child will exhibit searching behavior. They may watch the street for a parent's car, wait for a phone call, or convince themselves that a parent will pick them up from school. They may expect to be returning to mom or dad at any moment and not understand the reasons why they can't go home. They may think that if they act out, hey will be sent home. Children and adults alike will often engage in denial of the facts of a loss.
Denial represents the first stage of the natural grieving process. There are five commonly acknowledged stages of grief: denial, anger, bargaining, depression, and finally, acceptance. Someone who is grieving tends to cycle through these stages many times until the process is complete. Part of accepting the reality of a loss is to realize that returning to the previous state before the loss took place is impossible. Grief manifests emotionally, behaviorally, and physically. It is necessary to acknowledge and work through the feelings of grief. Not to do so may result in increased behavioral or emotional challenges. Grieving may look like anger, sadness, irritability, withdrawal from relationships, confusion, distractibility, despondency, self-harming behaviors, or even excitability among many other things.
The journey through the grieving process is assisted through ongoing conversations and openly expressing feelings. Open, honest acknowledgement of the mourner's feelings and reassurance that this is a normal process is very comforting. As a caregiver, engaging in open conversation about the grief process facilitates ongoing monitoring of a child's progress, and allows you to alert the child's worker about any concerning behaviors. Other means of assisting through the grieving process, includes: creating activities to express the feelings we can't find words for, vigorous and leisurely physical activity, a healthy diet, and of course, plenty of rest. Giving way to grief is often stigmatized as unhealthy, demoralizing, depressing, and self-indulgent. Those individuals who are constantly distracted from their feelings or who avoid their experience of grief may show signs of ongoing behavioral or emotional problems. Whatever the circumstances of any major loss, feelings of yearning are likely to recur throughout life during important occasions, or when there are significant reminders of a loss.
Although sometimes alarming and frustrating, these times of recycling grief emotions can be ideal for assisting children and adults who have not fully processed their grief to revisit the fullness of the loss and better understand what has happened to them. For those who have experienced a profound loss in their lives, the process of grieving assists them in identifying a way to reflect on their loss appropriately, in order to go on living effectively in the world. Grieving ends when the mourner no longer has the need to replay the memory of the instance of loss, when the intense need to keep company with the hurtful event is stopped, then healing is underway. With your support, those who grieve know they have a safe place to express their pain. You don't have to do anything really. Just listen. Ask some questions to show your interest, offer comfort, and be someone they can trust to safely witness their pain and sadness.
[Video ends]

::Slide - Leaning in::

[Bonni]
So there was a lot in that video, um, and it ended with the encouraging thought that's on this, this screen as well. Really, a lot of the work of grieving is needing to, to talk about it, to feel it, to lean into it, to let yourself feel all of those feelings that we don't like to feel. We don't like to feel anger, we don't like to feel sadness, we don't like to feel confusion and stuck. Um, but what's really important is that we allow ourselves to feel that and not avoid it. Um, it's not easy in our society because grieving, as the video said, is stigmatized. Um, you are given how many days off of work? Whenever you lose someone, um, that you love, to death. What is it like three days typically? Something like that. Um, that's not enough, right? That's not even close. That's barely even coming to the reality of, um, that this just happened to me. 
So then thinking again about the ambiguity of the losses and the layers of losses and the ongoing chronic loss that our kids from foster care and adoption are processing through. Um, it, it's really confusing to feel that way for a long amount of time. And, and very quickly, we as a society no longer give the grace and the, um, space to feel those things based off of what we've just lost. We expect all of, all of us to move on fairly quickly and to just keep going and to find good things, uh, build new relationships, fill the holes in your heart with new things. But in reality, that's not natural. That's not a part of who we are as a human being.
So allowing our kids to feel these feelings can be really terrifying when they're in anger, right? I think, uh, actually, if you look at the list of, uh, um, diagnoses in the DSM that are focused on children and adolescents, and you think about what does anger and grief look like? Um, it, it's pretty reflective. Conduct disorder, defiance, aggression, um, right? Like anger, especially whenever it's stifled and misunderstood, um, can get really messy. So we have to figure out safe and appropriate ways for our kids to be able to process and express these feelings. Not just happiness, not even just sadness, but anger as well.

::Slide - 2 images of the characters 'Joy' and 'Sadness' from the movie "Inside Out".

One of my favorite tools that I've used, um, as a therapist with kids and adolescents is the beautiful movie Inside Out. Because if you remember the story, um, this shows Joy, who has a very strong opinion about Sadness and feels like Sadness needs to be very quiet and in the back of the room. And Sadness continues to mess everything up. But in the process of the whole movie and the story, Joy comes around and realizes that actually, Sadness is the key. Sadness is necessary for Riley, who, uh, is the main character, uh, to, to become whole again. In the end, she, Riley was moved across, uh, to a different state, dramatically different, uh, environment, very different friends, different school, and everything shifted for her. And she, if you remember, she gets really, she tries to avoid feeling sad, um, tries to push it away and, and stuff it down. And she ends up, what? Do you guys remember? What, where Riley's headed whenever she, when Joy wakes up and realizes?

[Bonni]
Anyone?

[Carlie]
That when she was on the bus leaving, she had run away.

[Bonni]
Yeah. Yeah. She was like super hard and running away, running away from home, leaving her parents, leaving relationships, hardening herself, right? Separating herself. But then all of a sudden, and of course this is when you're watching these characters in her brain, Joy realizes what's happening, and she runs to get Sadness, and she says, Sadness, you are the key. We need you. So finally, Riley starts crying and starts feeling the emotion and runs back to her parents and cries and expresses her feeling of, "I am so sad." And her parents, what do they do? They wrap her up and they say, they, I think they even say, I can't remember exactly, but I think they even say, "We didn't know. Like you weren't showing us. You weren't telling us." 
And that's one of the biggest important things to understand about kids and adolescents, is that not always do they know what they're feeling or how to express it. So it's important for us to, to recognize and have a foundational understanding of, we want them to express, it's critical that they express and feel these things, but they might not know how to navigate it themselves. In this grace-- great book, "The 20 Things Adopted Kids Wish Their Parents Knew," it says like, a whole chapter is focused on, "I need your help where I don't know how to process." "I don't even know what I'm feeling, and I need your help as my parent, as the adult, um, to help me understand what is happening." Because otherwise, think about the times when you felt overwhelmed and you felt so many emotions that you don't even know what, when somebody asks you, "Are you okay?" You're like, "I'm fine," because you don't even know what to say because you're like, "I'm not fine." "I'm far from fine, but I have no idea what to tell you about how I feel right now. I just don't feel good."

::Slide - Activities to Help Children Grieve::

Here's some ideas. A Loss Box. A loss box is a really cool, very simple tool. It is often a shoebox or any kind of box. The important thing is that the box has a lid. So, um, the loss box can be actually a good companion to like, a Life Book. We have another Lunch and Learn that talks about Life Books and the importance of them and how to do them. A life book really helps tell the story. A loss box can be a good companion with a life book to be a place that holds the things that have been lost. And the reason why we want to hold them is because, again, it's going against the societal processes where we say, first of all, "You haven't really lost anything because we don't recognize your losses. Um, but you also should be over it." So a loss box and holding those things is a way for us to say here, "Actually, we recognize it and we know it's important, and I know that you need to hold some of those things dear." So the loss, what goes in it is really open. A lot of times it'll be pictures, um, little stuffed animals, anything that reminds that child of the things and the people that they've lost. Um, sometimes it's written letters or descriptions. Sometimes it can even be the life book that is kept in the loss box for a while until the child is, um, is ready to take that life book out of the loss box. 
The reason why the lost box needs to have a lid is because that allows the child to feel like they have some control. So when you are grieving, when you are in, in those feelings, it feels very overwhelming and it feels, uh, confusing. And I've heard some people describe that "I feel like I'm gonna fall off the cliff and never come back." And so it, it's a lot. It feels, it kind of floods, is what it feels like more so than allowing us to feel it, it feels like it's flooding. And so, um, if w-- if you can teach children and adolescents and young adults, "Hey, you actually have, you don't have control over when the feelings come all the time, but you actually have some, some, uh, some choice in this." And, and so the way to do that is to, when you feel those feelings coming on, you feel sad, you feel angry, you're thinking of memories, something triggers. You can go get your box and you can take that lid off and you can let yourself feel. You can, uh, write a new letter. You can cry, you can scream, um, you can talk to me, you can process. And then when you're tired and you're ready to go back, or you have to go back to school or to a job, you put that lid back on and you pick the times that you pick, pick that loss box up and, and allow yourself some grieving time. So it helps balance and it helps give a little bit more control into the, the hands of the child. Um, I mentioned writing letters. 

::Slide - Goodbye Letters::

What I talk about a lot is this goodbye letter process where, um, so here's, here's the brain science to it. When you are feeling a lot of feeling, it's a part of your brain. Like in an MRI scan, if you've ever seen those, when the brain is active, it looks like electricity, like it lights up on an MRI scan. So there is a feeling center in your brain. When you are feeling those things and you have to then put words to describe what they are, the activity in your brain is shifting to verbal, the verbal center of your brain, 'cause you have to find the words and then you have to express it. Then when you're writing, you're utilizing your hand. So it's the, the small, um, can't remember what it's called right now, but it's the small muscle movements right of where you have to transfer. Your brain is working and it's literally working the feelings out onto paper. It changes your brain chemistry to talk. It changes your brain chemistry to write. 
So writing a letter, um, to say goodbye to the people that have been lost, the experiences that have been lost, the places or the things that have been lost, you are working it out, processing it. Um, and, and honestly, it can be shared with people or even with the person if there's some type of relationship still with birth parent, um, or just kept in that loss box for your own processing. Sometimes I've even had kids who just destroy it after they write it out, especially if there's a lot of anger that they're just trying to, to, to get out, um, than just, um, ripping it into pieces or destroying it. So thinking about what do you need to say goodbye to, and then taking that opportunity to write, to work, work it out.

::Slide - Activities to Help Children Grieve (reshown)::

Okay. I know we're short on time, so I'm gonna go a little fast, be the, uh, through the rest of these. But balloon letters is another similar idea of a goodbye letter, but instead of, um, keeping it, you get a helium filled balloon or two. And, um, you definitely, anytime I would do this with a kid in therapy, I would say no identifying information. 'Cause you never know when those balloons are gonna pop. And if someone sees this letter, you don't want it to have your name or anybody's name on it, but you can still put feeling and, and words onto this paper, a goodbye. You tie it to those balloons. And the most therapeutic thing is standing outside and watching it go up into the sky until it's gone. Like you cannot see it, it will go very, very high. Um, and that is a really emotional experience.
Animal-assisted therapy. Um, I'm excited, I've, uh, reached out to a couple equine assistance therapy places in Oklahoma that have, uh, there's some really, really powerful things that animals can do for us in grief and in attachment, uh, losses that we can't always do for each other. So, animals, pets, um, it also helps build attachment and, and learning how to care for, for another human, uh, not human, living thing. Lots of beautiful things with animal assisted therapy.
Art and music is another way to express. So when you, if words are hard, identification is hard, then art and music, colors, can really help, um, develop a child's ex, uh, ability to express until words can come.
So art and music, and then mindfulness, um, there's so many resources for mindfulness.

::Slide - Screenshots of images from Mindful.org site, Monster Meditation video, Calm app, Headspace app, and Insight Timer app.::

And here's, I don't know if any of you have heard of Monster Meditation. I actually have a clip on my next slide that we're not gonna have time to watch, but it is precious. Um, they walk through so many calming strategies and meditations, uh, for kids, like littles, to be able to, um, work through and, and understand the ability to calm your breathing slow and, and be able to focus in your, your thought process. So these two are for kids. Mindful is a great website. Um, a lot of our youth like to do the apps. These two, Headspace and Calm, are very popular, but they also are, uh, you have to pay a small subscription fee, I think. So, one that is free is Insight Timer, and it's an app that goes on your phone and it just has meditation, um, little mindfulness things that you can play, just a few minutes. Um, I know several people who use Calm for going to sleep at night. Um, they will tell, I think there's, um, reading stories to you and they're very calm and soothing. Um, and people, several people go to sleep with those. So mindfulness practice is the helping the brain settle and calm and be focused on the here and now. Because grief takes us in the past. It takes us anxiety for the future. And when you can take, give your brain rest, then it's very, very good for your body and your, um, brain.

::Slide - Video (not played) described by Bonni::

So this is a really sweet one. Elmo talks about, uh, he's struggling to settle his body and calm his brain to go to sleep. Um, again, I'm not gonna play it, but I highly recommend the monster meditation from Sesame Street. So I'll pass through. 

::Slide - Activities to Help Children Grieve (reshown again):: 

Um, these things, again, there's another video we won't have time for, but the video goes into helping children understand where in their body they feel feelings, and then utilizing tools to help their bodies calm. So like in the video specifically, it has a bottle, uh, sensory bottle, um, where they put water and some type of like, baby oil and then glitter. And then whenever you, and then you have to, uh, glue the lid on with a hot glue gun. 'cause you don't wanna exploding anywhere and you don't wanna use glass bottles, but plastic bottles that can be thrown. Um, and then you shake it up and that glitter is everywhere. And, and these kids in the video talk about, that's what my brain feels like when I'm mad or when I'm upset. And then I set the bottle down and I watch the glitter calm and it helps my brain calm. So it's really cool ways to teach kids about their own brains and their bodies and how those things are connected with feelings. Um, but also is a tool to help them regulate, help them have an external regulation, um, in you, but then also in a tool like a sensory bottle. 

::Slide - How Are You?::

And then the last thing that I wanna point out here is it's hard to walk with people who are grieving. Grief is pervasive. It's a human experience. And even if you aren't the one who experienced the loss, or if you have your own losses, which chances are you do, and you're watching and walking and loving someone who has some fresh loss, it brings up your losses because even though the video says it kind of portrays it in a way where you're gonna be okay and you kind of get past it, I don't think that's true. Loss is something, it's an adjustment to a new reality. Every time something is lost, especially a really important relationship, you are, you're adjusting. Um, there's a lot of arguments about what, what the conclusion of grieving is. Um, some people say it's just peace, a peace with what's happening. And that doesn't mean that that peace is consistent for the rest of my life. So being mindful of, where are you? Um, especially when your kid is having, um, a resurgence of, of anger or sadness. How are, how are you doing?
Because you're gonna need some extra energy to help co-regulate and help support and listen to your child as they're feeling these big, hard feelings. And so being mindful of, are you recognizing your own losses? Are you recognizing your own need for grief? And how are you processing that? Who's your person? Where's your place? Maybe some of these tools will be things that could be helpful for you as well when you're processing enough of your own to be able to be there for your child. 

::Attendees visible::

Okay. I'm gonna go ahead and stop sharing. We have just a couple minutes to see if there are any, uh, questions or anything that, that y'all thought of while we were going through that. Okay. Awesome. Well, Carlie, I will pass it back over to you. Thank you very much.

[Carlie]
Thank you so much, Dr. Goodwin. We want to thank everyone for joining us today. In the chat, you will find the QR code that will take you to the Adoption Competency page on OKfosters.org There you will find resources and links to our next events that are wrapped around supporting adoptive families. If you are needing a training certificate, let us know and we'll email one to you shortly. Also, please complete the survey at the link below to provide feedback over this session. Thank you all for being here today.