The following case study shows the ways that support is given, how the type of support can change depending on the situation and how the relationship between a family and their Family Support Worker can develop, sometimes in a short space of time.
A TIME LINE OF FAMILY SUPPORT WORK
I first met Sophie’s family in hospital where she was receiving chemotherapy and within two months of her diagnosis of osteosarcoma (a rare type of bone cancer).
I listened as the parents safely and honestly expressed their mixed emotions of anger and frustration, together with their concerns (particularly as they considered there had been a delay in obtaining a diagnosis). Being able to voice these feeling/thoughts helped them to process and start to come to terms with the turmoil in their lives and it was humbling to realise they had been able to do this within the first hour of my introduction.
It soon became clear about the additional difficulties they were experiencing - both non drivers, managing two other children (one school age, one preschool age), main treatment being at a hospital some miles from home, serious financial restraints - all this together with the understandable disbelief of the situation they and their previously very healthy daughter were now in.
Initially, my support was to co-ordinate my visits between hospital and their home. Sophie’s dad was resident at hospital with Sophie for many weeks but it was important for the family to have opportunities to be together as much as possible and also for the parents to have ‘time out’ together. During this period I spent time getting to know Sophie and her siblings - giving them individual attention with games, crafts and activities or just watching DVDs together.
It was then planned for Sophie to have major surgery to remove part of her hip and thigh bone, at another hospital even further away, so I remained with Sophie at hospital on the day her parents travelled to London for an in depth pre-surgery consultation, maintaining telephone support with the parents throughout the day.
Since Sophie’s diagnosis it became clear that the family’s accommodation was totally unsuitable for her needs, her father had to carry her up a flight of stairs to their council flat and once inside, space was limited and would not be suitable for wheelchair access. This situation became more urgent once the date of surgery was known and my support was given by liaising with the Occupational Therapist to encourage to ‘keep things moving’.
During the time that Sophie was in London for her surgery the family were allocated suitable accommodation, Dad returned home and it was my privilege to take him to the new address to start preparations for the relocation.
By this stage I had been supporting the family for two months.
Sophie’s intensive treatment was continuous between her local hospital and the specialist oncology ward for the next four months and the strain of the family being split (mum remained resident in hospital with Sophie) was taking its toll on them all.
My support during this period was varied, depending on the priority needs of family members at any one time, for example:
- Sophie - for company, chats and activities;
- siblings - visits to Sophie, voicing concerns/anxieties and fun outings;
- parents - respite, both individually and as a couple, emotional support, transport, shopping, advocacy support at meetings with consultant;
- grandparents – emotional support;
- medical and ancillary staff – liaison on behalf of family.
About two months later, Sophie’s parents were given the devastating news that her cancer was spreading in spite of the chemotherapy treatment and there may be the possibility of more surgery. Extra emotional support was necessary at this stage and it later followed that I upheld the parents’ wishes for Sophie to continue as normal life for a child of her age as possible; so in the following months I spent quality time with Sophie and her siblings on outings, art and games activities including taking family on a couple of trips to animal shelters as they had promised Sophie a dog on completion of her chemotherapy!
As Sophie was attending school part time and her brother was also a pupil at the same school, support to the staff was given by close liaison and joint meetings (including parents and multi disciplinary staff) to ensure maintaining a consistent way of handling the situation and avoiding inappropriate information being shared with the close local community.
After about three months of keeping life as normal as possible the parents were then informed that there were no other treatment options and that there was only a short prognosis of time. Again emotional support was increased particularly at this time as the parents experienced mixed feelings of shock, disbelief, anger, failure, fear and hopelessness and were in need of much reassurance and encouragement.
I worked alongside the family, helping - by listening to their thoughts/feelings, acknowledging their fluctuating emotions and in particular one poignant shopping trip was with Sophie’s parents and grandmother when we were looking for Christmas decorations, the parents having realised this would be Sophie’s last Christmas and they naturally wanted to make it extra special not only for Sophie but for their memories too.
L-R: Siblings Ben, Emily with Sophie taken a month before she died
It was three weeks after Christmas that one morning I received a phone call from the school (the result of close liaison) advising me that the family wanted my help as Sophie had been admitted as an emergency to hospital after collapsing at school just an hour earlier. I was able to initially speak to Sophie’s siblings in that phone call to give them reassurance and tell them I would see them later in the day.
I then made contact with the family and confirmed care provision for the siblings and arranged to meet Sophie’s parents at the hospital.
Due to Sophie’s sudden deterioration my support changed to ‘end of life care’ and arrangements were hastily made with the hospital at the parents request to return Sophie home where she could remain with her family.
Sophie’s father and I went on ahead to prepare and bring Sophie’s bed down to the living room and collect the siblings from a relative. This was all completed in time for Sophie’s return by ambulance. As she was on high medication and very very sleepy I prepared the siblings on how she would be and encouraged them to still speak to her as they would normally – Sophie’s parents also appreciated knowing this as they were afraid, shocked and unaware of what to expect.
I remained with the family until late and offering to support them overnight but as they became more in control of the situation I left arranging to contact them in the morning.
This contact came much sooner however and was made by Sophie’s father through Rainbow Trust’s 24-hour telephone service to inform me that Sophie had passed away. When I returned the call he was naturally very upset and shocked and told me that Sophie had died about an hour previously and he did not know what to do or what to tell the children, I responded by encouraging him to ensure the family have this precious time with Sophie, no need to rush anything and I would visit straight away to help them.
That day I remained with the family all day and the support given covered a full range of emotional and practical issues:
- preparation and explanations to the siblings at each stage throughout the day;
- emotional support for parents and grandparents;
- information and guidance on procedures;
- phone calls on behalf of family;
- liaison and arrangements with funeral director;
- liaison and guidance – at their request – with the school, with suggestions on how to inform the pupils;
- shopping for basics;
- booking appointment to register the death.
At the family’s request and based on their needs my support over the following ten days involved daily visits and included helping with registering the death and close liaison with the funeral director on behalf of the family. I also accompanied the family during a visit to see Sophie in the Chapel of Rest and prepared the siblings about what to expect at the funeral and attend the funeral.
Support then continued as bereavement support, beginning with regular weekly visits encouraging the parents to:
- to reflect and share memories of Sophie;
- to acknowledge the effect of the pressure/stresses of the past 18months;
- to give reassurance of ‘normality’ of their various behaviours/feelings;
- to give time to the siblings and check on any underlying worries/questions and give them the opportunity to talk about Sophie;
- to consider memory box items and keepsakes for each member of the family.
Visits were then given fortnightly and practical issues were addressed, in particular the financial difficulties then being faced due to a large reduction in benefits and debts from the extra expenditure incurred giving Sophie a good Christmas. With the parent’s permission I liaised with a Community CAB worker who then frequently visited the family and negotiated on their behalf which has led to some feeling of stability for the parents.
Support has continued with intermittent visits and phone calls especially when Sophie’s birthday anniversary approached some three months after her death and arrangements were made then to mark the occasion.
Bereavement support will continue with visits as necessary, both for the parents and the siblings, together with telephone calls and in particular support will especially be given at Christmas and the anniversary of Sophie’s death