Evaluation of Grief Support Services for Bereaved Youth: An Overview and Update on the UCSB Project LOSS National Collaborative

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Evaluation of Grief Support Services for Bereaved
YouthAn Overview and Update on the UCSB Project
LOSS National Collaborative

• Shane Jimerson, Ph.D. Amber Kaufman, M.A.
• University of California, Santa Barbara
• Counseling, Clinical, and School Psychology
• Child and Adolescent Development

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A bit about us...

• AMK - Doctoral Student at UCSB, Counseling,
  Clinical, and School Psychology. Involved with
  Project LOSS for over 2 years.
• SRJ - Professor of CCSP and CAD at UCSB
  worked with bereaved children and
  families for years gathered data from
  participants for over five years. Used data to
  inform development of curriculum and solicit
  resources for center. In the past two years have
  begun to establish the Project LOSS National
  Collaborative...
• The UCSB Project LOSS research team includes
• Kelly Graydon, Elana Hamovitch, Danielle
  Drewisch, Jenny Minnich, and Jaclyn Bauer.

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Mourning Child Grief Support Group Curriculum
Lehmann, Jimerson, Gaasch, 2001
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Evaluation of Grief Support Services for Bereaved
YouthAn Overview and Update on the UCSB Project
LOSS National Collaborative OBJECTIVES

• I. Brief review of published research
• II. Important considerations engaging in this
  research
• III. Overview of relevant measures and
  methodology of grief support services
• IV. Overview and update of UCSB Project LOSS
  National Collaborative

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I. REVIEW OF PUBLISHED RESEARCH

• Opie, N.D., Goodwin, T., Finke, L.M., Beattey,
  J.M., Lee, B., van Epps, J. (1992). The effect
  of a bereavement group experience on bereaved
  childrens and adolescents affective and somatic
  distress. Journal of Child and Adolescent
  Psychiatric Mental Health Nursing, 5, 20-26.
• Schilling, R., Koh, N., Abramovitz, R.,
  Gilbert, L. (1992). Bereavement groups for
  inner-city children. Research on Social Work
  Practice, 2, 405-419.
• Tonkins, S. M., Lambert, M. (1996). A
  treatment outcome study of bereavement groups for
  children. Child and Adolescent Social Work
  Journal, 13, 3-21.
• Graham, M. Janzen, Sontag, Bleyl, Prero, and
  Lyman (2000). An Examination of the Effectiveness
  of Two Types of Childrens Grief Groups.
  Submitted for publication currently under review.
  Available from author at  the Council on Social
  Work Education, in Washington, DC. 
• Sandler, I. and colleagues (2001). The Family
  Bereavement Program Efficacy Evaluation of a
  Theory-Based Prevention Program for
  Parentally-Bereaved Children and Adolescents.
  Submitted for publication currently under review.
  Available from author at Arizona State
  University.   

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OPIE AND COLLEAGUES (1992)

• Examined affective disorders, somatic complaints
  and the frequency of loss in elementary and
  junior high schools found 61 of elementary
  school students and 56 of junior high students
  reported they had lost a significant loved one in
  the past two years
• Explored the contribution of grief support groups
  on bereavement experiences of children and
  adolescents - Of 16 elementary and junior high
  support participants, 7 decreased affective
  distress 6 increased affective distress. All
  but 1 decreased somatic complaints.

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SCHILLING AND COLLEAGUES (1992)

• 38 children between 8-12 years of age
• Examination of grief support group with pre-test
  and post-test design (no control group)
• Measured depression and attitudes/ concepts of
  death
• Most of the children remained depressed
  throughout the study
• Children appeared to develop more mature concepts
  of death

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TONKINS AND LAMBERT (1996)

• 16 children (7-11 years of age)
• (10 intervention, 6 wait-list)
• Examination of children who attended one of three
  time-limited therapy groups
• Examined two hypotheses
• 1) Group participants would have a decrease in
  grief symptoms as compared to the control
  subjects
• 2) Group participants would demonstrate a
  decreased grief symptomology compared to their
  pretreatment level of grief

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• RESULTS (TONKINS AND LAMBERT, 1996)
• 1)Parents Bereavement Questionnaire
• - decrease in overall emotions for intervention
  group
• (e.g., sadness, anger, withdrawal,
  guilt,anxiety, loneliness)
• 2)Childrens Depression Inventory
• - decrease for intervention group relative to
  control group and also pre versus post
• 3) Child Behavior Checklist (parent report)
• - decrease in report of grief symptoms of
  intervention relative to control
• 4) Child Behavior Checklist (teacher report)
• - decrease in report of grief symptoms of
  intervention relative to control

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GRAHAM AND COLLEAGUES (2000)

• 57 children (age 6-12 years)
• (38 open, 14 closed, 5 wait-list)
• Assessment of the effects of grief and
  self-concept over time
• Examine the type of group model (open or
  close-ended)
• Results indicated
• 1) decrease in grief scores for both types of
  groups
• 2) increase in self-concept scores for both types
  of groups
• Note the wait list groups demonstrated similar
  trends, although these were not statistically
  significant

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SANDLER AND COLLEAGUES (in press)

• 244 children and adolescents
  (135 intervention, 109 control)
• The Family Bereavement Program Efficacy
  Evaluation of a Theory-Based Prevention Program
  for Parentally Bereaved Children and Adolescents
• Procedure pre-test, post-test, 11-month
  follow-up
• Pre-Post analysis showed improved multiple
  mediators (family and child resources and
  adversities)
• Follow-Up analysis showed reduced mental health
  problems

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Limitations in previous research

• Sample sizes are small, this limits
  generalization
• Selected instruments often do not measure the
  process or design of groups themselves
• No commonly used instruments across these studies

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IMPORTANT CONSIDERATIONS ENGAGING IN THIS RESEARCH

• Systematic Data Collection
• Documenting Services Provided
• Comparison Group

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OVERVIEW OF RELEVANT MEASURES AND METHODOLOGY

• Appropriate Measures of Grief Reactions and
  Outcomes
• Measures of general behaviors and adjustment
• Pre-, Post-, and Follow-up Designs

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APPROPRIATE MEASURES OF GRIEF REACTIONS AND
OUTCOMES

• Bereavement Rumination Scale (BRS)
• Hogan Sibling Inventory of Bereavement (HSIB)
• Hogan Grief Reaction Checklist (HGRC)
• Hogan Inventory of Bereavement (HIB)
• Texas Revised Inventory of Grief - child report
  (C-TRIG)
• Jimerson Youth Common Grief Reactions Checklist -
  caregiver report (JYCGC-CR) self report
  (JYCGRC-SR)
• Jimerson Loss Outcomes Checklist
• The Grief Interview Dr. Fristad

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MEASURES OF GENERAL BEHAVIORS AND ADJUSTMENT

• Child Behavior Checklist (CBCL)
• Behavior Assessment Scale for Children (BASC)
• Jimerson Facilitator Rating of Childs Adjustment
  (FRA)
• Jimerson Caregiver Rating of Childs Adjustment
  (CRA)
• Harter Self Perception Profile for Children
• The Behavior and Emotion Rating Scale (BERS)
• Childhood Depression Inventory (CDI)
• Jimerson General Intake Survey

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UCSB PROJECT LOSS, NATIONAL COLLABORATIVE

• Overview of the basic design of the collaborative
• Update on the progress of the collaborative
• Discussion about other programs joining the
  collaborative

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Basic Design

• Establish a multi-site national collaborative
  with centers that provide services to bereaved
  children to evaluate the processes and efficacy
  of grief support groups
• Implications for understanding grief reactions of
  children

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Update on Progress

• Centers already involved
• Center for Grief, Minnesota
• Bos Place, Texas
• Our House, California
• Camp Begin Again, Florida
• Fairview Ridges, Minnesota
• Center for Grieving Children, Maine

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• Common Measures
• (used currently across all sites)
• Caregiver
• Grief Support Groups General Information Sheet
• Jimerson Caregiver Rating of Childs Adjustment
• Jimerson Youth Common Grief Reactions Checklist -
  Caregiver Report
• Child
• Jimerson Youth Common Grief Reactions Checklist -
  Self Report
• Child Depression Inventory
• Hogan Inventory of Bereavement
• Jimerson Loss Outcomes Checklist
• Facilitator
• Jimerson Facilitator Rating of Childs Adjustment

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Multiple Levels of Analysis

• 1) FORMATIVE
• Refers to the design of the intervention
  (i.e., the process of the support group)
• 2) SUMMATIVE
• Refers to the degree to which it influences
  outcomes the participants
• (i.e., the effectiveness of the support group)

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Some preliminary results

• The Loss Outcomes checklist reveals many teens
  indicated experiencing more positive outcomes
  from loss than negative outcomes, for example,
  out of 24 teens
• 83 indicated a deeper appreciation for life
• 79 indicated greater caring for loved ones
• 75 indicated developing emotional strength
• 66 indicated putting priorities in different
  order
• Only 8 indicated they isolated themselves
  socially and emotionally

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Some preliminary results, cont

• Jimerson Youth Common Grief Reactions Checklist -
  Caregiver Report reveals that based on 25
  caregivers reporting on their youth at intake
• 30 of teens were seen as experiencing depressive
  symptoms often and/or it is currently a problem
• 19 of teens were seen as being aggressive often
  and/or it is currently a problem
• 19 of teens were seen as having school problems
  often and/or it is currently a problem
• 5 of teens were seen as having somatic problems
  often and/or it is currently a problem

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Some preliminary results, cont

• Jimerson Youth Common Grief Reactions Checklist -
  Self Report
• Results are based on 25 youth self-reporting on
  duration and intensity of 4 problem areas
• Results reported as percentage of teens

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• Questions ???
• Comments !!!
• Discussion ...

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Evaluation of Grief Support Services for Bereaved
YouthAn Overview and Update on the UCSB Project
LOSS National CollaborativeQuestions???
Comments!!! Discussion...

• Shane Jimerson, Ph.D. Amber Kaufman, M.A.
• University of California, Santa Barbara
• Counseling, Clinical, and School Psychology
• Child and Adolescent Development