POLICY RESEARCH

Evermore provides research, information and policy analysis to professionals and policymakers on critical issues to advance bereavement care in America.

Published Papers 

– Congress Should Amend the Family and Medical Leave Act to Make Child Death a Qualifying Reason for Leave and Job Protection (January 2020)

To date, an estimated 20 million Americans have experienced the death of a child. According to the National Academies of Sciences, Engineering, and Medicine, “Studies continue to provide evidence that the greatest stress, and often the most enduring one, occurs for parents who experience the death of a child.” This stress produces untold health, social and economic impacts.

Unfortunately, few supports exist to help grieving parents remain solvent and productive. In most cities and states, employees have no legal protections if they need to take leave following the death of a child. The exact number of employers that offer bereavement leave is not known; in most cases, however, only three days of paid leave are allowed. 

The federal Family and Medical Leave Act is an appropriate public policy tool to afford some protections to families experiencing the loss of a child. Passage of the Parental Bereavement Act (H.R. 983/S. 559) is advocated to make the death of a son or daughter a qualifying reason for leave under FMLA. The legislation will likely be reintroduced in 2020.

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Papers In The Pipeline 

– Employers Should Offer Bereavement Leave Following the Death of a Child

A child’s death has broad and long-lasting effects on an employee’s wellbeing. Whether the child death tied to a health condition, an accident, a drug overdose, suicide, homicide or gun violence, survivors are at increased risk for negative experiences and outcomes. Compared with other parents, parents who lose a child are more likely to suffer from depressive symptoms, are at greater risk for physical health problems and chronic conditions, and are more likely to experience marital or relationship disruption. The long-term economic ramifications of losing a child—from increased medical expenditures, loss of wages or employment, loss of productivity and reduced future income—are just beginning to be investigated.

Of special concern to employers, child death has substantial impacts on productivity at work. This productivity loss is due somewhat to grieving employees taking leave from work, but results mostly from their not functioning fully in the workplace because of ongoing physical or mental health problems.

Unfortunately, few supports exist to help grieving parents remain solvent and productive. In most cities and states, employees have no legal protections if they need to take leave following the death of a child. Neither is bereavement an acceptable use of unpaid leave under the federal Family and Medical Leave Act.

Some employers recognize this lack of a safety net and offer bereavement leave to their employees. However, this leave is often only three to four days, a period insufficient for most employees coping with the loss of a child. Employers can take steps to overcome the public policy vacuum and ensure their employees who need time away from work to grieve are adequately supported.

I Am Still a Mother: Guidelines for Perinatal Death and Bereavement Care in Hospital Settings

In the United States, about 24,000 babies are stillborn every year, and another nearly 16,000 babies die within the first month of life. Stillbirth and neonatal death occur in almost 1 in 100 births, affecting a large number of families. These deaths are often unexpected and unexplained, leaving families to grieve with little preparation and few answers. Mothers must recover from the physical toll of labor and delivery while simultaneously dealing with the emotional pain of losing a child; partners, siblings, and extended family are also coping with enormous loss.

Unfortunately, medical providers are not always well-equipped to help mothers and families with the unique challenges of infant death. In one small survey of ob-gyn residents, 100 percent of respondents said that management of stillbirth was not adequately covered in medical school, and 90 percent said it was not adequately covered during residency. There are few guidelines for providers or hospitals to follow in the event of perinatal death, and those that do exist often primarily cover the clinical aspects of death (e.g. counseling for genetic testing or autopsy). Receiving compassionate, thoughtful care before and after a stillbirth or neonatal death is critical for the family; the care that is given can “set the stage for the family’s entire grieving process.”

– Death Notification: Setting a Trajectory for Short- and Long-term Coping

Clinicians, emergency services personnel, and law enforcement officials receive extensive training to enable them to perform their jobs in the most professional and effective manner. But when it comes to one of their most sensitive and difficult duties –– telling parents that their child has died –– many of these dedicated professionals have received little or no training or guidance on how to communicate such shattering information in a compassionate and respectful manner. As a result, child death notification is often done in a sub-optimal manner, in a way that, despite the notifiers’ best intentions, can compound the parents’ anguish and negatively impact the grieving process and long-term adjustment.

– Doll Reenactments in Sudden Unexpected Infant Death Investigations: A Practice Worth Examining

Sudden unexpected infant death (SUID) is one of the leading causes of infant death in the US. The Centers for Disease Control and Prevention describe SUID as the sudden and unexpected death of a baby less than 1 year old where the cause of death was not obvious before investigation. In other words, SUID is describes a category of deaths, but itself is not a cause of death. A common example of SUID is sudden infant death syndrome (SIDS), a diagnosis of exclusion that describes the death of an infant death where no cause of death can be determined after investigation. An estimated 3,500 cases are initially coded as SUIDs the US each year. Many of those cases receive a cause of death after full investigation. In 2017, 38 percent of SUID in the US were coded as SIDS, 36 percent unknown cause, and 26 percent accidental suffocation or strangulation in bed. SUIDs are rarely coded as homicides after investigation (0 percent). While rare, it would be inaccurate to suggest that SUIDs are never homicides.

Medicolegal professionals that respond to child death investigations accompany families on what is often the worst day of their lives. While the death of a child of any age is a tragedy, studies of bereaved parents reflect that families who experience the death of an infant are at comparatively high risk for elevated grief severity. Investigative practices for infant death, like doll reenactment, are a key component of both adjudication and prevention, but those practices are conducted at a moment of extreme vulnerability for bereaved parents.

The practice of doll reenactment, wherein family members use a doll to demonstrate the position of the infant immediately before and after their death, is generally regarded by the American medicolegal community as helpful for bereaved families. Evermore’s review of literature does not bear out rigorous research to support that assertion. Further, few training and field guides for death scene investigators (DSIs) provide helpful advice on how to interact with bereaved families. DSIs and other professionals from across the spectrum deserve evidence-based strategies to do their best for parents whose children are suddenly and unexpectedly gone forever.

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