1. Emotional/Physical Impact on Parents/Siblings following Child's Death

I'm completing research with a psychologist, physician, grief counselors, clergy and a health journalist regarding the emotional and physical impact the death of a child has on the parents and siblings. Through my work with patient safety and support group services, I've encountered thousands of parents/siblings grieving the loss of a child at all ages by all causes. We are all different but the similarities deserve further scrutiny and analysis. Dated research on the topic has been proven invalid.

Thank you for your participation in the survey. You will help other families by sharing your thoughts.

Dale Ann Micalizzi
Advocate/Advisor for Pediatric Safety and Transparency in Medicine
email: micalizzidag@aol.com
Justin's HOPE at the Task Force For Child Survival and Development http://www.taskforce.org/justinhope.asp

* 1. Are you the Child's Mother, Father or Sibling?

* 2. What was the cause of death and year?

* 3. Essay question:
a. Your education?
b. Your profession?
c. Divorced since death?
d. Did child live in your home?
e. Other children in family?
f. Religious or spiritual?
g. If angry, who are you angry with?

Of interest: Do you work in the healthcare sector?
Do you work in education? Are you a stay at home parent?

* 4. What physical conditions did you develop following the death?

* 5. Did you receive medical treatment for your physical condition?

* 6. What emotional problems did you develop following the death?

* 7. Did you receive medical treatment for your emotional condition?

* 8. On a scale of 1 being least (on left) and 10 being most (on right), what is your level of GUILT that parents/siblings often experience following the death?

  N/A
Immediately following
One year following
Ten or more years following

* 9. On a scale of 1 being least (on left) and 10 being most (on right), what is your level of SADNESS that parents/siblings experience following the death?
(N/A button is not available for this question so please leave blank or write in "other" box if it does not apply.)

 
Immediately following
One year following
Ten or more years following

* 10. What or who did you find most helpful in assisting you through the grieving process and why?

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