Background Children with developmental disabilities have wide-ranging social, developmental, and communication challenges impacting their grieving process. This narrative review examined the literature relating to the grief experiences of children with developmental disabilities to identify implications for practice and areas for future research. Methods The literature review was conducted using five databases, and a hand search of dissertations with original research, due to the sparse body of published works. Results Nine works were included in the review, which were thematically synthesized into three categories: (1) Understanding of death concepts, (2) Social-emotional responses to loss, and (3) Disenfranchised grief. Conclusions Children with developmental disabilities are affected by loss, even if their comprehension of death concepts is impacted by their level of disability. They may experience challenges due to changes in routines and concrete thinking, and are at risk of disenfranchised grief. Future research is needed to inform developmentally appropriate grief interventions.

Teens with intellectual disabilities experience disenfranchised grief, as they are often excluded from death education and rituals. Such exclusion can impact opportunities to understand the concepts of death and process the loss. This paper examines the psychometric properties of the limited existing tools designed to measure the understanding of concepts of death in parentally bereaved teens with intellectual disabilities (ID) who are included in after-death rituals as compared to those not included. A literature search uncovered no tools for the concept of death understanding for teens with ID, but four related tools were examined due to their potential proximal applicability. Though further development would be needed, the EsCoMu Scale and the Concept of Death Questionnaire showed the most potential use for this population. Further research is needed to develop a tool specific to teens with ID that takes into account the developmental, cognitive, and social aspects of their grieving experiences.

Background Certificate of need (CON) laws are state-based regulations requiring approval of new healthcare entities and capital expenditures. Varying by state, these regulations impact hospices in 14 states and DC, with several states re-examining provisions. Aim This cross-sectional study examined the association of CON status on hospice quality outcomes using the hospice item set metric (HIS). Design Data from the February 2022 Medicare Hospice Provider and General Information reports of 4870 US hospices were used to compare group means of the 8 HIS measures across CON status. Multiple regression analysis was used to predict HIS outcomes by CON status while controlling for ownership and size. Results Approximately 86% of hospices are in states without a hospice CON provision. The unadjusted mean HIS scores for all measures were higher in CON states (M range 94.40-99.59) than Non-CON (M range 90.50-99.53) with significant differences in all except treatment preferences. In the adjusted model, linear regression analyses showed hospice CON states had significantly higher HIS ratings than those from Non-CON states for beliefs and values addressed (β = .05, P = .009), pain assessment (β = .05, P = .009), dyspnea treatment (β = .08, P < .001) and the composite measure (β = .09, P < .001). Treatment preferences, pain screening, dyspnea screening, and opioid bowel treatment were not statistically significant ( P > .05). Conclusion The study suggests that CON regulations may have a modest, but beneficial impact on hospice-reported quality outcomes, particularly for small and medium-sized hospices. Further research is needed to explore other factors that contribute to HIS outcomes.