Children understand and react to loss differently than adults and thus have unique needs as they work through grief. Pathways Center for Grief & Loss, a program of Hospice & Community Care—the largest hospice care provider in Pennsylvania—is a free community resource that supports bereaved children and their families through individual and group sessions, as well as an annual camp that offers one-on-one guidance and support.

Pathways’ services are free, and they do not bill insurance. Although Pathways is part of Hospice & Community Care, its support services are available to anyone, regardless of whether or not their loved one died in hospice care.

Diane Kulas, children’s services coordinator for Pathways, explains that their trained staff approaches children’s grief based on their developmental age. Elementary-aged children, for example, often think differently and tend to be very egocentric, sometimes believing they have control over what happens around them.

“During their grieving process, sometimes children think that they are responsible for their loved one’s death,” Kulas says. “We must be careful, so they don’t automatically blame themselves or place guilt on themselves in thinking that they did something to cause their loved one’s death.”

Children also process grief in the moment, often experiencing a trigger, followed by an intense grief reaction and then returning to their usual behaviors.

As kids get older, they begin to think more abstractly and see layers of their grief, akin to adults. Adolescents tend to feel grief more throughout the day. As they change, they develop a deeper understanding of the relationship they lost with that person.

Pathways’ staff members assess children but also look at the entire family. “We look at how the children are behaving,” Kulas says. “Often, parents or caregivers don’t know how kids are feeling because they are not talking about it, and kids don’t have the language to express it. Parents or caregivers see differences in behaviors, such as struggles in concentrating at school or more aggressive behaviors. We look at those behaviors to get more insight.”

Pathways offers individual sessions that start with an initial assessment, examining the child’s relationship with the deceased, their understanding of death, their strengths and where they are struggling most.

The program encourages the involvement of parents or caregivers in the sessions, as adult education and confidence are key to supporting the child. Kulas notes that children and adolescents are often reluctant to share their grief with a parent or caregiver. “They are often aware that their parent or caregiver are grieving as well. They don’t want to add burden to the caregiver, even though the parent or caregiver are asking the child to share their feelings.”

Pathways’ staff members work with kids individually, encouraging them to share what was discussed in sessions with their parent or caregiver. This helps start conversations and educates adults on how to best support their child.

The Family Support Series consists of six-week family group sessions held in the fall, winter and spring. Children and teens are divided into peer support groups, where they work with other kids that have also experienced a loss. They learn how to identify and talk about their grief, developing coping skills, and engaging in commemorative activities to help process their emotions. Adults attend an education group to learn how to support bereaved children through consistent discipline, open communication and active listening.

The series brings together children and teens with similar loss experiences, helping to normalize feelings, share experiences and grieve the death of a loved one.

Camp Chimaqua—named for the Cherokee word meaning “lover of nature”—is Pathways’ three-day overnight bereavement camp, held the third weekend in May. Open to children ages 6 to 12, each child is paired with an adult volunteer “buddy” that provides consistent companionship, support and guidance throughout the camp experience.

At Camp Chimaqua, kids learn healthy ways to process grief while also enjoying fun non-grief-related camp activities.

Kulas emphasizes that it can be difficult for adults to understand how younger children express grief. Parents might see a burst of grief, followed by what seems like “normal” behavior and mistakenly believe their child is doing okay.

“There’s also a general misconception for anyone grieving that there’s a time frame where we should be ‘over it.’ We’re never over it,” Kulas points out. “Grief can become present to us for a variety of different reasons. As a child grows, they understand feelings differently. They also get a different sense of the relationship they had with the person, which can often retrigger grief as they hit different developmental milestones like a graduation, which reminds them that someone in their family isn’t there. They see the person in a different way and reexperience grief in different, new ways.”

Families can access Pathways’ services by calling and expressing their needs or concerns. “We’ll talk over the phone, and I’ll ask about what’s happening in the family—the whole family needs to be involved,” Kulas says. “We’ll do that initial contact and assessment, and work with the family to develop a plan to move forward.”

Kulas notes that sometimes other stressors, such as a new school environment, may also need to be addressed alongside grief. Pathways’ assessments can help rule out or rule in grief-related issues. “We can help educate parents, so we encourage them to call, even if they are unsure of what’s happening,” she says.