Child Bereavement Research Articles

Paediatric trainees learn how to approach child bereavement with the help of bereaved parents

BackgroundCurriculum mapping exercises highlighted child bereavement as an area where competencies were difficult for trainees to achieve.MethodsIn co-operation with the Child Bereavement Charity, a team of experienced professionals and educators...

Evaluation of a therapeutic residential intervention for traumatically bereaved children and young people

Abstract Child bereavement interventions are rarely subjected to rigorous evaluation, so there is scant evidence in the literature to support their efficacy. This article reports the evaluation of a residential group programme developed by the UK charity Winston's Wish for children and young people and their parents/carers bereaved in traumatic circumstances (murder or manslaughter). A number of validated psychometric measures were taken pre- and post-intervention, and the results indicated positive outcomes for participants. Further research is needed to shed more light on which aspects of bereavement interventions are effective for which children and young people. However, the study does demonstrate that it is possible to conduct scientifically objective and rigorous evaluations of bereavement work with children and young people.

Mapping evaluation of UK childhood bereavement services

Abstract This article reports a study of evaluation strategies and tools currently used within UK child bereavement services. Data were sought from a representative sample of services across the UK on the evaluations’ users, the data requested, and organisations' existing evaluation strategies. The study found that child bereavement services were struggling with a considerable burden of demand for information from a range of users – chiefly funders and commissioners of services. However, a mapping exercise revealed that a considerable amount of the data required by evaluation users was the same, and that it was being obtained from evaluations that services overall were already undertaking. The most common forms of evaluation were post-intervention user satisfaction surveys of core interventions, using self-completion questionnaires. However, collection of basic data was limited and patchy, and evaluations of outcomes and organisational processes and reporting on the findings were less common. Based on the...

A comparative examination of schools' responses to bereavement and the associated needs of the school community in Galway, West of Ireland and Derry, Northern Ireland

The aim and objective of this study is to examine and compare how schools in Galway, Republic of Ireland and Derry in the North of Ireland (cities located within two independent jurisdictions in Ireland) manage and respond to bereavement. To carry out a survey of schools, the ‘Loss in Schools’ questionnaire is considered the most suitable tool. The questionnaire, which contains 10 questions designed to unearth pertinent issues including the needs and concerns of schools, had previously been administered in studies in Hull. Sixty questionnaires were administered in both Galway and Derry, with a return of 38 and 35, respectively. This study illuminates important aspects of the topic. The schools in both Galway and Derry rate bereavement (and parental separation) as highly important in terms of priorities. In terms of policy, some of the respondents in both study sites report that loss is included in their school's policy documents but not formally included in the curriculum. A designated staff member (who would speak to the pupil experiencing the death of a family member or significant other) is evident in 37% of Derry schools and 23% of Galway schools. Some members of staff in both study sites have attended training in bereavement, although the courses are relatively short term. Schools request assistance from other agencies outside the formal schools arena in times of need. In Galway the psychology services are most commonly consulted, while in Derry the Western Education and Library Board Bereavement Counselling teams and Cruse Bereavement Care are identified as additional resources from which help is sought. This paper outlines recommendations on schools' training needs in the area of child bereavement and the request for support to help further develop and formalise school policies.

Evaluation of a British child bereavement service: The user's perspective

This article summarizes the findings from a 3-year independent evaluation of a regional Child Bereavement Service (CBS). The service was commissioned by a Primary Care Trust in Northern England, and funded by a British cancer charity, Macmillan Cancer Support. The need for a CBS was recognized by members of a Palliative Care Group who identified a gap in local services for bereaved children, who may be susceptible to short/long-term psychiatric/psychological disorders. The service was established to offer support for professionals working with bereaved children and their family. Interventions provided by the service included pre/post bereavement support, individual work with the child and/or family, and group work. An evaluation (2004-2007), was conducted to inform service development utilizing semi-structured interviews with parents/carers of service users (n = 20), and semi-structured interviews with healthcare professionals (n = 8). Interviews were recorded, transcribed verbatim, and analyzed using grounded theory methods. Referrals were higher than expected. Sixty per year were anticipated; however, in the first year alone, there were 255 referrals. Health and social care professionals who attended training courses, provided by the CBS staff, expressed confidence in providing bereavement support themselves, or by making appropriate referrals to the CBS. Parents and carers welcomed a service specifically for their children. The CBS is a viable organization that supports bereaved children as expressed in this article.

A Meta-Analysis of Interventions for Bereaved Children and Adolescents

The main objective of this review was to provide a quantitative and methodologically sound evaluation of existing treatments for bereavement and grief reactions in children and adolescents. Two meta-analyses were conducted: 1 on controlled studies and 1 on uncontrolled studies. The 2 meta-analyses were based on a total of 27 treatment studies published before June 2006. Hedges's g and Cohen's d were used as measures of effect size and a random-effects model was applied. Results yielded small to moderate effect sizes. Interventions for symptomatic or impaired participants tended to show larger effect sizes than interventions for bereaved children and adolescents without symptoms. Promising treatment models were music therapy and trauma/grief-focused school based brief psychotherapy.

Grief and Depression: Treatment Decisions for Bereaved Children and Adults

Grief and Depression: Treatment Decisions for Bereaved Children and Adults

Where is the evidence base? Mental health issues surrounding bereavement and HIV in children

Parental illness can affect child and adolescent psychosocial well‐being. Mental health effects of parental bereavement generally and HIV‐related bereavement specifically have been poorly explored in children. HIV‐related illness has a number of specific features that may directly affect mental health considerations. Infection is clustered in families. Bereavement is often multiple. Death is often preceded by severe illness and multiple opportunistic infections. AIDS is stigmatised, which may impede disclosure, social support and adjustment. In low‐income countries where HIV infection is concentrated, access to palliative care as well as medical care may be limited. This review systematically identifies studies on HIV and bereavement in children. Searches of electronic databases for relevant articles revealed 14 studies examining bereavement with sufficient measurement and controlled methodology providing standardised behavioural and emotional outcome measures. Scrutiny of the results revealed the majority (12: 86%) recorded an adverse behavioural or emotional impact on the child. A detailed analysis of the studies provides insights to risks as well as protective factors that may inform future interventions. Only one systematic intervention was identified whereby a coping skills intervention had positive and long‐lasting effects. This paper examines urgent future needs and the requirement for evidence‐based policy and provision.

Piloting a Therapeutic Residential for Children, Young People and Families Bereaved through Suicide in Northern Ireland

Families bereaved by suicide can experience an extremely intense and complicated grieving process. This can be associated with a range of difficulties and can put bereaved family members at risk of a range of problems. In recognition of this, Barnardo's Child Bereavement Service piloted a two-day residential programme (integrating separate therapeutic sessions for children and parents and joint outdoor pursuits). Five families (seven adults and eight children) participated in the pilot residential; of these, six adults and six children also participated in the evaluation. The residential was evaluated using semi-structured interviews with the parents, children and staff. The resultant data were evaluated thematically. Families reported positive outcomes in several domains. Children reported themselves to feel less alone, more confident and happier. Parents found the residential beneficial and reported themselves better able to cope with their own, and their children's, grief. Staff reported the residential to be a positive experience for the families and themselves, and felt privileged to have been involved in the project. This evaluation points to the utility of residential programmes to assist families bereaved by suicide. Implications for practice are discussed.

A comparative study of the child bereavement and loss responses and needs of schools in Hull, Yorkshire and Derry/Londonderry, Northern Ireland

This paper reports the findings from a study of schools' responses to child bereavement in Hull, Yorkshire and Derry/Londonderry, Northern Ireland. In order to gain an insight and compare how schools in both geographical areas respond to and manage bereavement, the questionnaire ‘Loss in schools’ was selected as an appropriate tool. It has been utilised on previous occasions in Hull and shown to be an effective method of highlighting the issues, needs and concerns of schools. Some significant and important issues emerge in the results of the present survey. While schools rate child bereavement and parental separation highly in terms of their priorities, there is a shortfall in the number of schools in both study sites that have a formal procedure or policy in place around the management and response to death and loss. Although there is evidence that a number of staff have attended training in loss and bereavement, schools in Derry/Londonderry and Hull report that they have sought help from other agencies in times of need. For example, the Western Education and Library Board Bereavement Team and Cruse Bereavement Care (Derry/Londonderry) and the Educational Psychology Service (Hull) are identified. Schools are asking for help and support to develop policies and to gain the knowledge and skills they require to respond with confidence to a child who experiences a loss.

Bereavement: Signs, Symptoms, and Course

<p>In his paper “Mourning and Melancholia,” Freud described five features of melancholia, “ … a profoundly painful dejection, cessation of interest in the outside world, loss of the capacity to love, inhibition of all activity, and a lowering of the self-regarding feelings to a degree that finds utterance in self-reproaches and self-revilings, and culminates in a delusional expectation of punishment. He felt that mourning includes these same symptoms, except for the last. Freud believed that mourning is not a pathological condition and that it subsides with time; interfering with it was useless and potentially harmful. Indeed, the loss of a loved one is a universal experience that may be one of the most significant and traumatic life events that people face. Nevertheless, most people cope with loss with minimal morbidity. For a minority, the death of a loved one may lead to increased use of substances (alcohol, benzodiazepines, and other hypnotics), the development of a psychiatric illness like chronic depression, or even greater mortality. </p> <h4>ABOUT THE AUTHORS</h4> <p>Paula L. Hensley, MD, is with the Department of Psychiatry, School of Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM. Paula J. Clayton, MD, is with the American Foundation for Suicide Prevention, New York, NY.</p> <p>Address correspondence to: Paula L. Hensley, MD, 2118 Central Ave. SE Suite 37, Albuquerque, NM 87106; or e-mail: <a href="mailto:phensley@salud.unm.edu">phensley@salud.unm.edu</a>.</p> <p>Dr. Hensley and Dr. Clayton have disclosed no relevant financial relationships.</p> <h4>EDUCATIONAL OBJECTIVES</h4> <ol><li>Describe the symptoms of bereavement in adults and children.</li> <li>Recognize the signs that an individual is experiencing difficulty with the course of bereavement.</li> <li>Discuss the morbidity and mortality of bereavement in adults. </li> </ol>

Problematic Emotions and Maternal Grief

The study was an empirical examination of the relation of personality proneness to "problematic social emotions"--envy (Dispositional Envy Scale), jealousy (Interpersonal Jealousy Scale), and shame and guilt (Personal Feelings Questionnaire-2)--to maternal grief (Perinatal Grief Scale-33) following miscarriage, stillbirth, neonatal death, or infant/child death. The 441 women who participated in the study were enrolled from the Website, e-mail contact lists, and parent support groups of an organization that offers information and support to bereaved parents. All four problematic emotions were positively correlated with maternal grief. Envy, jealousy, and guilt made significant unique contributions to the variance in maternal grief. Overall, time lapse since the loss and the four problematic emotion predispositions explained 43% of the variance in maternal grief following child bereavement.

A Developmental Psychopathology Framework of the Psychosocial Needs of Children Orphaned by HIV

In addition to the obstacles to a successful resolution of grief normally faced by children whose parents have died, children orphaned by AIDS may face additional psychological and social challenges. However, limited attention has been paid to psychosocial and developmental needs of children orphaned by HIV/AIDS, particularly in resource-poor countries or regions. In this article the authors review the global literature on child bereavement and AIDS orphan care experiences in developing countries and present a developmental psychopathology model of the psychosocial issues facing AIDS orphans. The authors identify gaps in the literature and provide suggestions for future research on AIDS orphans in resource-poor countries and regions. They emphasize that future studies need to assess the status of behaviors and mental health of children orphaned by AIDS within a developmental framework, identify those individual and social factors associated with grief, and examine the long-term impact of quality of care, developmental maturation, and attachment with caregivers on the psychosocial well-being of AIDS orphans.

A Parent's Experience of the Couple Relationship After Child Bereavement in South Africa

The objective of this qualitative, exploratory, descriptive and contextual research was to explore and describe a parent's experience of the couple relationship after child bereavement in South Africa. Participants were nine parents as well as the researcher who lost children. An auto-ethnographic strategy was utilized to connect personal with cultural. The research included nine in-depth interviews with seven mothers and two fathers. Data were analyzed using a descriptive method of open coding. Trustworthiness was ensured through credibility, confirmability, transferability and dependability procedures. Parents experienced extreme challenges from their loss. Adjustment could be faclitated through enhancing communication skills, expression of emotions and re-membering activities.

Whose Recovery, of What? Relationships and Environments Promoting Grief and Growth

This article explores the concept of recovery in the wake of a loved one's death, using a cultural and developmental systems approach to understanding child, adult, and family bereavement outcomes as evolving, interdependent adaptive responses to changed circumstances of development within highly specific contexts in intergenerational time and cultural space. An integrative life span perspective on developmental psychopathology and resilience emphasizes the multi-dimensional nature of grief responses and their interweaving with ongoing and new interdependent adaptive strategies designed to accomplish specific, evolving tasks of shared life cycle development. This approach redefines bereavement “symptoms” as problematic when they interfere with negotiation of next steps in interdependent development within realistic ecologies and available resources in cultural contexts. The article uses clinical examples of interventions after a loved one's death from a chronic illness to illustrate how interventions can help identify critical developmental systems and leverage points supporting positive development and giving priority to the bereaved's own goals for grief and growth. This intervention model emphasizes patient-centered perspectives, conducts an ethical inquiry about consequences of adaptive strategies for all family members, and constructs collaborations between care providers and families.

Coping with the intensity of child bereavement work

ABSTRACT This study explored how six volunteers working at a residential weekend intervention for bereaved children cope with the demands of their role. Data was collected through individual semi-structured interviews and analysed using Interpretative Phenomenological Analysis. The analyses confirmed that supporting bereaved people, especially children, can be intense and emotionally draining so it is essential that there are solid support networks and good self-care mechanisms available to volunteers. The study identified the need for organisations to take these findings into account during recruitment and training of volunteers and to better support them in their role to ensure longevity.

Using Orff-based techniques in children's bereavement groups: A cognitive-behavioral music therapy approach

Children affected by the death of a loved one can face multiple challenges including difficulties identifying and dealing with emotions, impaired social interactions, distorted thoughts, and behavioral problems. The inclusive and engaging nature of music-based therapeutic experiences provides children with a developmentally appropriate way to address a variety of needs. This article describes the use of Orff-based music therapy interventions in a cognitive-behavioral framework to assist children through the grieving process. The Orff-based music therapy program provides opportunities for emotional healing, building positive social relationships, cognitive reframing, and decreasing behavioral problems. The philosophy of cognitive-behavioral music therapy is articulated, and session goals and objectives are stated. Sample Orff-based music therapy sessions are provided with a rationale for their use.

HIV disclosure and discussions about grief with Shona children: A comparison between health care workers and community members in Eastern Zimbabwe

Research in HIV-related counseling for African children has concentrated on urban tertiary hospitals, but most children have their first health care encounter at a rural primary health care center. This study investigated perceptions about the acceptability of disclosing the parents’ or child's HIV status to a child and talking about grief with children, as well as the preferred time, type and setting for HIV disclosure. An anonymous survey was taken from 64 primary health care workers and 131 community members from rural Eastern Zimbabwe. The results expressed a high need and desire for such communications and should be interpreted against a background of high perceived confidence to talk about grief with adults and a high degree of familiarity with child bereavement and foster care. The participants preferred that partial disclosure occurs from the age of 10.8 (±4.2) years and full disclosure from the age of 14.4 (±4.5) years. Compared to community members, health care workers were significantly more open to full disclosure and disclosure at a younger age but were slightly less open to discussing grief. The different preferred combinations of persons to initiate such communications included a health care worker in up to 56% of the responses and a family member in up to 52%. The most commonly preferred family members were father's sister (up to 37%) and grandmother (up to 40%) rather than the partner (up to 15%). Southern African family dynamics may hinder a mother initiating HIV disclosure and discussions about grief, even though she is traditionally present during HIV diagnosis, counseling and health education. A more culturally adapted approach than the standard Western ‘couple approach’ may thus be required. Consequently, counseling training models may need to be adapted. Further research into empowering mothers to involve significant members from the extended family may be highly beneficial.

Live and Let Die: Improving care and support for young people

The Child Bereavement Trust Conference will be taking place in September this year, overstretched mental health workers are feeling an emotional strain, the government promises £4 billion towards providing a Sure Start chlldren’s centre for every community and The Food for the Brain Foundation discovers that diet significantly affects a child’s behaviour and academic performance.

Are we getting it right? Parents' perceptions of hospice child bereavement support services

Objective : To determine parents' experiences and perceptions of a support service for families with bereaved children, provided by a UK charity for cancer patients in seven hospices in the UK. Method : Individual interviews with 25 purposively selected parents. Results : Parents used the service for: advice and reassurance; support for their children while they grieved; and advice on ameliorating behavioural difficulties at home and school. Non-service users did not think formalised support was necessary or had other sufficient support. Nevertheless, important to parents in both groups was that the service existed so their children's needs were being or could be addressed. Children and their parents benefited from talking to a non-family member, and being involved in social events that reduced feelings of isolation. Conclusion : The hospice child bereavement service was offered as an integral part of palliative cancer care support. Future research could explore collaborative work between counsellors and other professionals. Pallative Medicine 2007; 21: 401—407