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2009 Alliance for Children and Families46

Crss-cultural training can either prte assiilatin f the

cultural utsier an reject inigenus appraches, r it can

seek t prte integratin. (Berry, 1989, p. 201)

Many ulticultural textbks penly iscuss igratin,sciplitical cntrversies, gener rles, an faily

structures in the cultural cntext. Hwever, there is littleexplratin int hw culture affects the way a persn r faily

eals with eath, particularly the eath f a chil. The experiencef eath within the faily syste is cn acrss cultures. Yet,

the expressins f grief an ritualizatin are ften very ifferent.Thus, an iniviuals cultural ientity shul be carefully assesse

when ealing with a grieving faily. Parental grief spawns asubset f characteristics that sees t traverse culture. The eath

f a chil is acknwlege in any cultures as ne f the wrsthuan experiences (Cacciatre, 2007; Kubler-Rss, 1978). This

paper presents a case stuy in hw scial wrkers can enrich their

unerstaning f culture, while attening cpetently t theunique nees f Native Aerican failies experiencing the eath

f a chil.As a result f shifting egraphics in the Unite States, feeral

an state plicy akers, as well as higher eucatin institutins,are becing increasingly cncerne with ensuring cultural c-

HELPING FAmILIES IN CRISIS

Appropriate Bereavement Practice After the

Death of a Native American Child

Joanne Cacciatore

ABSTRACT

Native Aericans an ther inrities are statistically verrepresente in the thusans f infants an yung

chilren wh ie every year. many f these eaths are unpreventable, suen, an unexpecte. Unique ritu-als an beliefs affect the way Native Aerican failies respn t these types f eaths. This paper is a guie

fr scial wrkers an ther caregivers. It exaines best practices fr culturally cpetent care an cnvey-

ing respect fr the Native Aerican faily. It is vital fr scial wrkers t eucate, supprt, an avcate fr

failies f culture in an aware, but nt presuptive, style that allws recnciliatin between tw very ifferent

cultures. A case exaple is prvie t illustrate iprtant iplicatins fr culturally cpetent care when a

chil ies.

petency (Galabs, 2003), which is efine as a set f cngruentbehavirs, attitues, an plicies that ce tgether in a syste,

agency r ang prfessinals an enables that syste, agency rthse prfessinals t wrk effectively in crss-cultural situatins

(Crss, Bazrn, dennis, & Isaacs, 1989, p. 22). Yet, institutinsften fail t prvie apprpriate supprt an interventin fr

failies f clr, failies f the pr, an iigrant failies.These faily nrs an values are ifferent an therefre reain

peripheralize, invaliate, an pathlgize . . . r wrse, invis-ible (mcGlrick, 1998, p. 75).

Crss et al. (1989) recen essential eleents t sensitivepractice with failies f culture wherein the syste wul value

iversity, engage in cultural self-assessent an self-awareness,an supprt aaptatins t iversity. The authrs suggest these

values shul pereate every level f an agency, incluing plicy(p. 8). Schlesinger an devre (1995) suggest the cnscius use

f self is at the cre f scial wrk technique, enabling wrkerst be aware an take respnsibility fr their wn etins an

attitues (p. 58). Weaver (1999) fun in wrking with NativeAericans, huility an a willingness t learn were f the

utst iprtance, an she suggests scial wrkers abannacaeic arrgance (p. 222). She recens scial wrkers

strive t unerstan the cnteprary realities f specific Native

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Aerican clients an learn t tlerate silence as an interventinstrategy (p. 217).

A faily with strng ethnic values an res ay react if-ferently t issues relate t trauatic eath. develping a sense

f cultural cpetence is, therefre, the crnerstne f cultur-ally sensitive care. The Code of Ethics of the National Association

of Social Workers (NASW, 1999) ientifies the nee fr specificcpetencies regaring cultural cpetence an scial iversity,

incluing the nee t have a knwlege base f their clients

cultures an be able t enstrate cpetence in the prvisinf services that are sensitive t clients culture an t ifference

ang peple an cultural grups (1.05). An iniviuals cul-ture inclues any cplex factrs, incluing cuntry f rigin,

ethnicity, faily structure, gener, religin, histricity, an therre abiguus eleents that help efine ientity. Aitinal

anectal ifferences in expressins f grief ay inclue the expe-rience f pain, the nature f the relatinship with an attachent

t the ecease, the persns cunicatin style, the persnsbeliefs abut the cause f eath, attitues twar the ctrs

r ther health care prviers, an treatent they expect anreceive (Cwles, 1996; davihizar & Giger, 2004; Kalish, 1980;

mcGlrick, Aleia, & Hines, 1991; mcGlrick, Garcia-Pret,& Giran, 2005).

Native American Culture

There are re than 550 Aerican Inian an Alaskan Native

tribes in Nrth Aerica (ortiz, 2002). The feeral gvernentfficially recgnizes re than 300 f thse tribes (Nichls,

1998). Abut 39% f Native Aericans in Nrth Aerica live ntribal lan, an abut 61% live in urban areas, where se egree

f acculturatin is likely (Harvar Prject, 2004). There is vasthetergeneity ang Native Aerican tribes. Garrett an Garrett

(1994) have ientifie egrees f acculturatin alng a cntinuu,

efining traitinal as a state wherein iniviuals ay r ay ntbe fluent in the English language, but generally prefer t speak, aswell as think, in their native language. They ay als hl tra-

itinal values an beliefs while practicing nly traitinal tribalcusts an eths f wrship (Garrett, Tlanusta, & Eugene,

2000, p. 3).Traitinal Native Aerican tribes are rich with their wn

cultural respnses an rituals after eath. Fr exaple, Cleents,Vigil, mann, & Wilks (2003)in bserving Navaj, r dineh,

traitinsescribes eath rites as an elabrate fur-ay prepara-tin an burial f the by in which failies actively urn an

ispssess their persnal belngings: The eceases hair is tiewith an eagles feather t syblize their return he . . . an the

ecease was burie in the failys hgan (p. 23). on the furthay pstrte, relatives cleanse theselves thrughly, as if

washing away the nee fr further urning. After the furthay, urners nt speak the nae f the ecease, fearing that

ing s will sun back the persns sul. In Hpi culture, lifeis cyclical, fr birth t eath t rebirth, with each persn [as

a] uality f sul an by (Leing & dickinsn, 1990). Upneath, the ecease are ffere new naes t carry int the after-

life. The Siux Inians bury a traitinal hatchet in the casket twar ff ens.

Se Aerican Inian tribes have strng feelings abut eath.Nature etaphrs are palpably integrate int their lives as they

incrprate these iages int stries f eath an the afterFr exaple, the butterfly is use as a sybl f everlasting

an can be a cfrt t the faily facing eath (Cherry, 19The Wilik-wilik Waashaashut, r Butterfly dance, is a ri

representing the transfratin f the caterpillar int a buttemst believe the spirit lives n even after eath, an they are

accepting f the eath an ying prcess than Western cultBlack Elk teaches Lakta fllwers the first an st ipr

peace ces within the sul f huans when they realize t

relatinship, their neness with the universe an all its pwAn at the center f the universe wells Wakan-Tanka (G

resiing within each persn (Rice, 1991).Aerican Inians ften rely n their interpersnal relatinsh

fr scial, etinal, spiritual, an seties financial suppuring a crisis. Tribal hierarchy, eicine en, an traiti

Aerican Inian garb, incluing healing feathers an prabeas, ay play an iprtant rle fr faily an tribal eb

many Aerican Inian tribes accept their unique prcesseritualizatin as a way t live in sacreness (Rairez, 1999), f

ing a cping style that is cngruent with their syste f kinsan sense f spirituality.

Cunicating with a Native Aerican faily ay be clenging fr a persn wh lacks knwlege f their culture.

heritage-cnsistent Native Aerican values listening. Lng ps f silence an an inirect style by Aerican Inian clients

perplex caregivers. Se prfessinals ay istakenly viewsilence, use f etaphrs, an inirectness as resistance r l

f unerstaning (Suttn & Nse, 1996; Weaver, 1998). NaAericans ay avi irect r sustaine eye cntact an ay

enstrate affect, even uring a crisis. Thus, effective cnicatin beces the very funatin fr which the relatin

between the wrker an client prgresses (Napli, 1999; SuttNse, 1996; Weaver, 1998).

Aerican Inians perceive tie as cyclical rather than lin

(Herring, 1990). Tie is nt rganize in structure calenbut rather it is cntrlle by nature, seasns, an inivi

rhyth. This cul affect hw the faily respns t a crisis satin an their ability t seek utsie supprt r assistance aft

chils eath. Burial rituals ften take re tie an are an ingral part f their Native Aerican culture. Failies are unlik

t rush their way thrugh the burial r creatin prcessaitin, an autpsy is usually frbien in the Svereign Nat

many tribes als prhibit pstrte cntact with the eceaan se tribes iscurage rgan natin.

In many Native American tribes, soul-

searching, meditation, and ancestor prayer

may play a role in providing an altered

state of consciousness that is necessary for

some to discover meaning in the loss.

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Hwever, it is iprtant nt t rule ut ptins such as theautpsy, rgan r tissue natin, r the pprtunity t hl r

see the chil wh ie siply because the faily is AericanInian. depening n the egree f acculturatin, se failies

ay nt ahere t the scial prscriptins f the tribe. S whereasit is iprtant t be aware f their general beliefs, scial wrkers

an ther caregivers are bligate t unerstan the client, allw-ing fr ifferences base n the iniviual, faily syste, an

circustances (Saleebey, 2001).

Culture, Mourning, and Child Death

Acrss cultures, cn experiences after a chils eathsuch

as iscnnecteness fr friens an faily, abannent ffaith, islatin, an guiltcan create ultiple ileas fr

failies. Shaking their belief in the rer f the wrl, this type ftrauatic lss ften fsters a sense f ttal helplessness. Spiritual-

ity can play an iprtant rle, acrss cultures, in helping failiest heal an iscver eaning after a chils eath (Frankl, 1998).

In any Native Aerican tribes, sul-searching, eitatin, anancestr prayer ay play a rle in prviing an altere state f

cnsciusness that is necessary fr se t iscver eaning inthe lss. The scial wrker can the fllwing t encurage an

facilitate an pen ialgue that enables, epwers, an engagesNative Aerican failies:

Ask perissin t act.

Ask abut their rites an rituals, culture, religin, an belief

syste. Caregivers can hubly ait their wn lack f

knwlege, becing willing stuents an helpers.Ask fr their stry. Give the a vice. Enable the t tell an

retell their stry within their wn cultural unerstaning ancntext.

Ask faily ebers what nging nees they have, an try

t facilitate thse nees.Finally, be aware f an el their nnverbal cunica-tin styles back t the. Fr exaple, if wrking with heri-

tage-cnsistent, Native Aerican faily ebers wh avisustaine eye cntact, nt attept t ake eye cntact.

Instea, respectfully aapt t their cunicatin style.

mcGlrick et al. (1991) ientifie five questins that prfes-sinals shul cnsier f particular iprtance t failies f

culture after a trauatic eath:

What are the culturally prescribe rituals fr anaging the1.ying prcess, the eceases by, the ispsal f the by,

an ceratin f the eath?What are the failys beliefs abut what happens after eath?2.

What es the faily cnsier t be an apprpriate e-3.tinal expressin an integratin f the lss?

What es the faily cnsier t be the gener rules fr han-4.ling the eath?

d certain types f eath carry a stiga (e.g., suicie r still-5.birth), r are certain types f eath especially trauatic fr

that cultural grup (e.g., hicie r eath f a chil)?

This ialgue buils a trusting relatinship in which a truesense f cultural cpetence is achieve. In the case f chil

eath, it is even re iprtant that the prfessinal appracheach faily with sensitivity t cultural cntext as well as sensitiv-

ity t the nees f a new cultural cntext: failies trauatize bya chils eath. With respect t the culture f grief, there are three

istinct rles that ay be helpful acrss cultures.The first is an educational role, r family education, which

serves t intruce grieving failies t their ptins. It prviesthe pprtunity t engage in rituals that ther grieving parents

have fun t be helpful, such as hling the chil wh ie, cl-

lecting eents, r calling upn spiritual leaers t hl prayercerenies. Caregivers shul take this pprtunity t eucate

the faily abut institutinal prcesses such as the autpsy prce-ure (if applicable) r vital recrs prtcl, grief respnses, c-

unity resurces, an fllw-up care. The secn, psychosocialpresence, is ften represente nnverbally an cunicate by

reaining available an present with the faily in the face f pr-fun grief. Nel Nings efines ethical caring as a relatinship

that flurishes thrugh utuality, unerstaning, an cpas-sin (Fliners, 2001). Here, it beces iprtant t enstrate

respect fr the failys culture, which inclues facilitatin fculturally cpetent rituals, supprt f the faily syste, an

epathic cunicatin. Finally, Native Aerican failies aynee scial wrk prfessinals t act as advocates on their behalf,

particularly when the faily is unfailiar with lcal laws.The fllwing case stuy fr the authrs wn experience is

ffere as an exaple f the three rles f the scial wrker asfaily eucatr, psychscial supprter, an avcate. (Nte: All

naes have been change.)

Case Study in Cross-Cultural Mourning

The call cae in early n Saturay rning, an there was anurgency in the eical exainers vice. As the faily liaisn fr

the cunty crners ffice, I turne y car arun an heae fr

wntwn. I arrive at the eical exainers ffice t fin theeical exainer waiting fr e.Why is this ne s urgent? I inquire.

The faily rejecte the autpsy . . . . Theyre fr the reserva-tin. This is a real prble fr us, the eical exainer replie.

It is a cultural tab, I suppse.I respne, Well, nt the autpsy.

Then I reebere the law. An autpsy ustbe perfre nall suen chil eaths in ur state. The nly exceptin is when

the eath actually ccurs n the Svereign Natin. Althugh thischil live n the Svereign Natin, he was transprte by heli-

cpter t a lcal chi lrens hspital, where he later ie. I began trealize the seriusness f this case.

I apprache the faily in the parking lt, walking twarthe slwly. There were tw ile-age cuples an a very

yung cuple staning in clse prxiity. A ile-age an,Henry, wh I later ientifie as the paternal granfather,

steppe frwar, setting hiself clearly apart fr the grup. Hewas irecting e t cunicate with hi an n ne else. Thus,

I intruce yself t hi nly, nt appraching r aking eyecntact with any ther faily eber. I invite hi insie the

cunty ffices, an he brught his faily insie. I ffere Henrywater an tissues fr his faily, an I assure hi that I wul act

as their avcate, ing y best t help.As I cntinue t irectly aress nly Henry, I expresse y

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What happene t hi? I aske. She explaine that Jsha evelpe an intestinal bstructin that becae infecte.

ie f sepsis.Bth the eical exainer an I went int the waiting r

t infr the faily. I spke irectly t Henry an, as the cal exainer listene, his hea rppe. The faily began

cry as I explaine the cause f Jsephs eath. Henry reaietinless.

I sai, I just s srry, Henry. d yu have any questins t

I can answer fr yu?N, he sai quietly.

Henry, wul yu like t see Jseph? I aske.Fr the crner f y eye, I saw Jsephs yung ther lk

wie-eye. She sai nthing.Henry respne, N, n, n. We nt want t see hi.

ust nt.There was cplete silence in the r. Cncerne that I

have ffene Henry, I quickly aplgize, explaining that I unfailiar with their beliefs. I wante t give the se t

alne as a faily, s I aske perissin t leave. When I returt the waiting r, Henrys wife ieiately aresse e.

Janne, we want t see Jseph. We have ecie t see hishe sai.

Henry ne in affiratin. I went int the back ffice iiately an prepare a sall ffice fr the t use. I ae a

ut f an ffice esk, putting layers f blankets an pillws I brught in enugh chairs fr everyne an ie the lig

I returne with Jsephs by a few inutes later, wrappe ware blanket.

Henry quickly st up an lke irectly at e. He paua ent, lke wn at Jseph, an then gently he tk h

fr y ars. His face sftene. Everyne was quiet. Hehel Jseph in his ars an began t talk t hi in their na

language. He kisse his feet, his ars, an his cheeks. Wit

inutes, everyne becae very etinal. Henry tie a sachealing feather, use earlier that ay by the eicine an,Jsephs shirt, an then Henry passe the chil t his wife.

re than tw hurs, each faily eber ha a turn t g-bye.

At ne pint, I went t leave, telling Henry I wante t gthe private tie. He grabbe y ar an aske, Please,

with us. Tw hurs later, they sai their final g-byes areluctantly, hane Jseph back int y ars.

The faily waite fr e in the parking lt. I expresse sypathy again. I tl the that I wul be available any t

they ha a questin r neee anything in the future. I thanthe fr their patience an sai y final g-byes. Jse

yung ther yelle ut acrss the parking lt. I stppe at r f the ffice an turne. She walke twar e, an the

ers fllwe. She wrappe her ars arun e, began t cry.Thank yu s uch, she sai ver an ver.

Her yung husban cae up behin her, ebracing us bth began t cry, als thanking e. Then, ne by ne, the granp

ents surrune e in an ebrace.I learne hw t be a stuent that ay. I learne abut patie

an silence. I learne hw t set asie y wn beliefs t hclients. An the greatest teacher that ay was a yung by na

Jseph, wh I shall never frget.

recgnitin f their tragey.Henry, I just s very srry. I cannt iagine hw ifficult

this ust be fr yu an yur faily, I sai. Then, I aske in avery quiet vice, Can yu tell e yur stry?

Henry explaine that his gransn, Jseph, ha been a healthy,thriving 18-nth-l. He becae ill very suenly, an after

the nset f a high fever, the parents cnsulte with the eicinean. When the eicine ans attepts t heal Jseph were

unsuccessful, Henry urge the yung parents t take hi t the

clsest eical center. Fllwing the avice f the granparents,they tk Jseph t the clinic. (I ntice that, as Henry tl the

stry, he avie any irect eye cntact. This behavir was cn-trary t ther interactins Ive ha with failies in crisis. Still,

taking his lea, I ae a cnscius effrt nt t lk irectly in hiseyes. There was als significant istance, abut fur feet, between

Henry an yself uring this tie. The ther ebers f thefaily were sitting in chairs behin hi. N ne else in the faily

aresse e r ae eye cntact at this pint.)Shrtly after their arrival at the eical center, Jseph ha a

seizure. Ill equippe t hanle a peiatric eergency, the ei-cal tea airlifte hi t the chilrens hspital, where, espite

valiant effrts t save hi, he was prnunce ea a few hurslater. mystifie, the attening physicians sent Jsephs by fr

autpsy an infre the faily, wh then began t prtest theprceure.

As Henry tl the stry, the ther faily ebers began tquietly cry, huling in the crner f the cuch, hling n

tightly t ne anther.We nt perit autpsies where we ce fr. It interferes

with the ascensin f the spirit. It is a vilatin f ur custs,he insiste.

Epathically, I reassure hi that I wul be their avcate,an I tk a few inutes t explain the usual prtcl at the

eical exainers ffice.

Henry, I will y best t explain this t the ctr. may Ileave yu fr a few inutes an talk t the ctr, I aske, anIll return in abut 15 inutes?

With his cnsent, I went int the back ffice, where nly neeical exainer wrke n Saturay. I talke t her abut

the faily an reinfrce the nee t respect their culturalbeliefs. Unerstaning the ilea, she agree t wrk n ther

slutins.If we can start with x-rays an labratry tests, we ay be able

t fin the cause f eath withut having t autpsy. Will theyallw this? she inquire.

Back in the waiting r, Henry agree t this ptin. Tgetherin silence, we awaite the answer that wul ce tw hurs later.

occasinally, Henry le his faily in native prayers, spken sftlyuner their breath. I felt re cfrtable as y unerstaning

f their culture was eepening. I reaine with the the entiretie, sitting n the ther sie f the r an reaining silent.

The eical exainer aske t see e thrugh the securitywinw partitining the waiting area fr the back ffices. This

wul be the first tie the faily ebers ae eye cntact withe. Henry lke at e an I lke back.

Ill be right back, I sai sftly, excusing yself t the backffice.

The eical exainer ha fun the cause f eath withutneeing t perfr an autpsy.

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Conclusion

Every sciety has evelpe rituals arun birth an eath. Ritual

is a pwerful part f culture, haile by se as the antite tpwerlessness (miller, 1999). Culturally cpetent practice with

Native Aerican failies requires bth a willingness t learnabut the thers culture an sensitivity t the iprtance f their

expressins f culture within the larger cunity. Whereascultural nrs nee t be cnsiere after the trauatic eath f

a chil, it is als very iprtant t treat each persn as an ini-viual an each faily as a culture f its wn. Failia l grief after

a chils eath is ften s evcative there is likely t be n pre-ictable teplate fr cping, even fr within traitinal Native

Aerican r inigenus cultures.Wrking twar an aware, but nt presuptive, respect-base

treatent interventin requires prfessinals t unerstan theircunities. Scial wrkers shul take the tie t bece

failiar with the priary cultures in their cunities (Gray,2004; Hrn, 2005) an assess a Native Aerican clients level

f acculturatin rather than aking assuptins base n theliite infratin ffere by appearance r ther persnal char-

acteristics (Garrett et al., 2000, p. 3). The egree f acculturatincan affect iniviual ientificatin with their culture f rigin,

an thus chices abut care shul be relate by the faily insteaf presue by a scial wrker. With a iverse an ever-changing

egraphy, it is vital fr scial wrkers t eucate, supprt, anavcate fr failies f culture in an aware, but nt presup-

tive, style that allws recnciliatin between tw very ifferentcultures (Garrett et al., p. 5). By allwing bereave parents t

lea an instruct, the health care prvier can give the a sensef cntrl ver their situatin that ay reuce pr psychlgical

utces later.

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Joanne Cacciatore, Phd, mSW, FT, is fellw in thanatlgy, Schl f ScialWrk, Cllege f Public Prgras, Arizna State University. Crrespnenceregaring this article can be aresse t the authr at Janne.cacciatre@asu.eu

r ASU West Capus, CHS/SW, 4701 W. Thunerbir R., Glenale, AZ 85306.

manuscript receive: Nveber 7, 2007

Revise: February 11, 2008

Accepte: February 12, 2008

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