The active witness: Social work care of children and families at the time of child death

The Royal Children's Hospital, Melbourne, is a large tertiary paediatric hospital and primary paediatric trauma centre. One of the more difficult realities of this setting is that not all children survive. End-of-life and immediate bereavement care of families at the time of the death of their child is an integral part of hospital social work. The work draws on a variety of theoretical frameworks and skills, and requires nuanced, responsive reading of family cues as well as carefully crafted systemic work. The clinician listens and bears witness in the immediate aftermath of the death, intervening on multiple levels to foster connections and to facilitate the honouring and leave-taking of the child in the singular way that each family desires. This article describes the knowledge that informs acute bereavement care, and the principles that guide social work clinicians in enacting this knowledge with respect for the particularity of each family.